Professional Ethics

for Biomedical
Engineers

By Dr. Syed M. Wasim Raza

drsmwasim@neduet.edu.pk
 Ethical Theories
❑ Ethical Theories
➢ An ethical theory is a systematic exposition of a particular view about what is
the nature and basis of good or right
➢ The theory provides reasons or norms for judging acts to be right or wrong
and attempts to give a justification for these norms
➢ The theory provides ethical principles or guidelines that embody certain values
➢ These can be used to decide in particular cases what action should be chosen
and carried out
➢ Ethical theories provide part of the decision-making foundation for Decision
Making
➢ Each theory emphasizes different points – a different decision-making style or
a decision rule—such as predicting the outcome and following one’s duties to
others in order to reach what the individual considers an ethically correct
decision
 Ethical Theories
❑ Ethical Theories
➢ Ethical theories have two main aims.
❖ The first is enumerative: identify those acts that we ought (or ought not) to
perform
❖ The second is explanatory: provide an account as to why we ought (or ought
not) to perform the acts identified

❑ Enumerative aim
➢ An ethical theory tries to articulate a general principle that tells us the
status of the various actions we could possibly face
➢ There are four main assessments this principle might deliver:
impermissible, permissible, optional, and required
➢ These assessments are called deontic verdicts, because they tell us our
various duties
 Ethical Theories
❑ Ethical Theories
❑ Now to visualize what a theory says about each of these actions, we could further
imagine that some doors are marked with an X. This X indicates that proceeding
through the door—performing this action—is, according to the theory,
impermissible. With this picture, we can now represent the verdicts a theory might
issue as follows:
❖ An action is impermissible if and only if refraining from the action is required
o This is a door with an X on it, telling you not to proceed
o The door represents a course of action that you could take, but ethically you
shouldn’t.

X
 Ethical Theories
❑ Ethical Theories
❖ An action is permissible if and only if it is an action that is not impermissible
o This is a door without an O on it, telling you it is Okay to proceed

0
 Ethical Theories
❑ Ethical Theories
❖ An action is optional if and only if it is permissible to perform or not perform
the action.
❖ Suppose, for simplicity, that you only have three actions available to you. One
of these acts is impermissible; the other two are permissible. So the choice
set you face looks like this:
Act 1: Impermissible Act 2: Permissible Act 3: Permissible

X 0 0

➢ Since you can permissibly perform Act 2 or Act 3, both of these act are optional
➢ You need to make sure you refrain from performing Act 1, but ethically the rest
is up to you
 Ethical Theories
❑ Ethical Theories
❖ An action is required if and only if it is the uniquely permissible action
available—a permissible action that is not optional
❖ Suppose again that you only have three actions available to you. But this time
two of these acts are impermissible; the remaining act is permissible. So this
new choice set looks like this:
Act 1: Impermissible Act 2: Impermissible Act 1: Impermissible

X X 0

➢ Since you can only permissibly perform Act 3, this act is required
➢ All of the other acts open to you are ethically blocked
 Ethical Theories
❑ Ethical Theories
➢ Explanatory aim of an ethical theory
❖ Why do acts have the deontic statuses that they do?
❖ The answer to this question tells us which facts are genuinely reason-
providing
❖ If, for example, you think you ought not have performed the regrettable
action because it caused harm, then you take harm facts to be one of the
factors that determine the statuses of actions
❖ It is, at least in part, because of the harm it would cause that you are required
to refrain from acting in this regrettable way
 Ethical Theories
❑ Ethical Theories
❑ At the top, at the level of theory, we can start by
clarifying for ourselves what we think are basic ethical
values move downward to the level of principles
generated from the theory. The next step is to apply
these principles to concrete cases

❑ At the bottom of the ladder, facing a particular ethical

choice or dilemma. We can work our way back up the
ladder, thinking through the principles and theories
that implicitly guide our concrete decisions
 Ethical Theories
❑ Ethical Theories
➢ Take a situation in which YOU lie to a person, X
❖ That was good because you intended to make X happy by telling him a
white lie—or it was bad because you meant to deceive him and do him
harm.
Motive
❖ That was good because it is good to make people happy—or it was bad
because it is always wrong to tell a lie.
Act
❖ That was good because it helped X develop his self-esteem—or it was
bad because it caused X to believe things about himself that were not
true
Consequences
 Ethical Theories
❑ Ethical Theories
➢ Those theories that base moral judgments on consequences are called
consequentialist or sometimes teleological moral theories (from the Greek
root telos, meaning “goal” or “end”)
➢ Those theories that hold that actions can be right or wrong regardless of their
consequences are called non consequentialist or deontological theories (from
the Greek root deon, meaning “duty”)
 Ethical Theories
❑ Teleology Theories
❑ Utilitarianism (Jeremy Bentham (1748-1832) and John Stuart Mill (1806- 1873))
➢ It primarily refers to moral views or theories which base their evaluations of
acts solely on consequences
➢ Consequentialism sees the rightness or the wrongness of an action in terms of
the consequences brought by that action or according to the balance of their
good and bad consequences
➢ The most common, but not the only, form of consequentialism is utilitarianism
or social consequentialism holds that one should act as to do the greatest good
for the greatest number
➢ Utilitarianism is the moral/ethical theory that states that right actions ought to
produce the greatest happiness for the greatest number of people
 Ethical Theories
❑ Teleology Theories
❑ Utilitarianism
➢ Bentham and Mill are hedonistic utilitarian’s because they conceive utility
entirely in terms of happiness or pleasure, two broad terms that they treat as
synonymous
➢ J. S. Mill defined good as the presence of pleasure and the absence of pain
➢ Utilitarianism concentrate on value of well being, which may be analysed in
terms of pleasure, happiness, welfare, preference satisfaction or the like, they
accept only one basic principle of ethics: the principle of utility
 Ethical Theories
❑ Teleology Theories
❑ Utilitarianism
➢ The principle of utility
➢ This principle asserts that we ought always to produce the maximal balance of
positive value over disvalue (or the least possible disvalue, if only undesirable
results can be achieved
➢ This principle is the main aspect of the consequentlist theory which has been
put forward by Bentham and Mill as a universal moral truth, and it is the
ultimate standard of right and wrong for all the utilitarian’s
➢ Actions are right in proportion as they tend to promote happiness, wrong as
they tend to produce the reverse of happiness so it is the demand to produce
the greatest balance of good over evil
➢ From the utilitarian’s perspective the principle of utility is the sole and absolute
principle of ethics
 Ethical Theories
❑ Teleology Theories
❑ Utilitarianism
➢ An action or practice is right (when compared to any alternative action or
practice) if it leads to the greatest possible balance of good consequences or
to the least possible balance of bad consequences in the world as a whole.
➢ This principle asserts that we ought always to produce the maximal balance of
good consequences over bad consequences
➢ The principle of utility as the Greatest Happiness Principle: "Actions are right in
proportion as they tend to promote happiness, wrong as they tend to produce
the reverse of happiness, i.e., pleasure or absence of pain"
 Ethical Theories
❑ Utilitarianism
➢ The Act utilitarianism
❖ What good and bad consequences will probably result from this action in
this circumstances
➢ The Rule utilitarianism consider
❖ In the spirit of rule utilitarianism, a moral code is first established by
reference to the principles Utility. That is a set of valid moral rules is
established by determining which rules as opposed to conceivable
alternatives, if generally followed would produce the greatest balance of
good over evil
❖ In rule-utilitarianism, individual actions are morally right if they are in
accord with those rules
 Ethical Theories
❑ Utilitarianism
➢ One attraction of utilitarianism is its simplicity
➢ As a single principle to guide our actions, it can potentially answer any moral
question
➢ It also seems to get to the heart of what we feel morality should be about—
promoting human flourishing (meaning living well) and avoiding suffering
 Ethical Theories
❑ Utilitarianism
➢ This theory has been criticized for the fact that one cannot predict the outcome
of actions in advance, thus it is impossible to set the standers of one’s moral
action on the basis of the act itself
➢ Problems arise for utilitarian’s who are concerned about the maximization of
individual preferences when some of these individuals have considered what
judgments tell us are morally unacceptable preferences also an additional
problem concerned with immoral actions
➢ Suppose the only way to achieve the maximal utilitarian outcome is to perform
an immoral act such as killing one person to distribute his organs to several
others who will die without them
➢ Utilitarianism seems to say not only that such killing is permissible, but that it is
morally obligatory
 Ethical Theories
❑ Deontology (Immanuel Kant (1724-1804)
➢ Deontological theory underlines the importance of one’s duties and
obligations.
➢ Deon is a Greek word meaning ‘obligation’, ‘necessity’, ‘that which is binding’
➢ The deontological approach to ethics argues that duties are the base of ethics
rather than the consequences.
➢ The deontological class of ethical theories states that people should adhere to
their obligations and duties when engaged in decision making when ethics are
in play
➢ This means that a person will follow his or her obligations to another
individual or society because upholding one’s duty is what is considered
ethically correct
 Ethical Theories
❑ Deontology
➢ Right actions, according to Emmanuel Kant (1964) are prescribed by duties –
keep promises, be truthful, be fair, avoid inflicting suffering on others and
reciprocate the kindness of others
➢ Kantian ethics is thus about doing the right thing regardless of whether it
makes one happy, quite the opposite of Mill’s view
 Ethical Theories
❑ Deontology
➢ Kant’s supreme, supreme principle of morality, the principle from which all of
our various duties derive, is called by Kant the “Categorical Imperative” and is
expressed in several ways in his writings
➢ His first formulation: I ought never to act except in such a way that I can also
will that my maxim become a universal law. Kant says that this principle
justifies all particular imperatives of obligation (all “ought” statements that
morally obligate
➢ “This imperative tells us what must be done irrespective of our desires and the
maxim must be capable of being conceived and willed without contradiction”
 Ethical Theories
❑ Deontology Immanuel Kant
➢ The second formulation is “Act in such way that you always treat humanity
whether in your own person or in the person of any other, never simply as a
means, but always at the same time as an end”
➢ The first formulation has often been compared with the golden rule (do unto
others as you would have them do unto you)
➢ Unlike utilitarian’s, deontologists hold that lying is wrong even if a lie would
accomplish great good for individuals and society
➢ In Kant’s categorical imperative doctrine, truth telling is a duty (imperative)
which binds unconditionally (categorical)
➢ A lie is always evil for Kant because it harms human discourse and the dignity of
every human person
➢ Truth telling is always a duty, whether the other has the right to know or
whether innocent persons will be severely harmed
 Ethical Theories
❑ Deontology
➢ Deontological systems have an advantage over utilitarianism in that they
usually imply many scenarios that seem intuitively wrong are immoral (such as
sacrificing one person to obtain their organs for the benefit of many)
➢ This may be because their rules are originally derived from our common moral
intuitions
➢ Of course, this can turn to disadvantage in catastrophic situations, such as
where torturing one person is required to save one million people
 Ethical Theories
❑ Virtue
➢ One of the earliest philosophical approaches to correct behavior was that of
virtue ethics
➢ According to this approach, if a person has a “good” character, that person will
behave ethically as a matter of course
➢ Virtue ethics is based on the writings of the Greek philosopher Aristotle (384–
382 BC)
➢ Aristotle believed that there was general agreement that everyone has a “life
goal” and that ultimate life goal was “happiness”
➢ Although each person has a different definition of happiness, Aristotle believed
that happiness is achieved by what he called “excellence in performing rational
activities” (thinking), which includes “excellence in choosing”
 Ethical Theories
❑ Virtue
➢ Aristotle argued that the best choices lie between the two extremes, preferably
somewhere in the middle, which he called the golden mean
➢ The person who selects and acts on these middle-ground choices is virtuous
➢ A person who does so with a pattern of consistency born of practice is thought
to have good character
➢ Aristotle believed that becoming a virtuous person was a matter of habit and
could be learned over time
➢ The more one acts virtuously, the stronger the character trait becomes. In the
throes of a crisis, character traits come to the fore and are more likely than
relying on sudden decision making to result in good outcomes
 Ethical Theories
❑ Virtue
➢ From this standpoint, part of becoming a “good” biomedical engineer would
require that students should practice a life of moderate choices based on those
choices they believe an ethically ideal role model would make
➢ Continuing to practice in this vein is believed to foster good habits that have
the best likelihood of leading to right actions in professional practice
➢ That is, the virtuous biomedical engineer would simply be disposed to do the
ethically right thing, rather than having to reason to an ethical solution by
some procedure
 Ethical Theories
❑ Virtue
➢ Beauchamp and Childress (1994) have identified four virtues that they consider
primary to the ethics of health and health care related professionals:
➢ Compassion
❖ A notion related to caring, includes a concern for others and an awareness
of their pain or suffering
❖ The compassionate person is disposed to respond with appropriate feelings
of sympathy and mercy, as well as a desire to help decrease pain and other
suffering
 Ethical Theories
❑ Virtue
➢ Discernment
❖ While compassion has a strong emotional component, discernment is an
intellectual trait
❖ The discerning person is able to take decisive action based on insight
resulting from a history of clear judgment and understanding
❖ He or she is able to make ethical judgments without being unduly
influenced by other personal or political factors
❖ The person sees to the heart of the matter without the bias of personal
involvement or personal feelings, without the common ethical flaw known
as “conflict of interest.”
❖ The discerning person is able to see what needs to be done, when, and in
what way in situations involving ethical considerations
 Ethical Theories
❑ Virtue
➢ Trustworthiness
❖ Is a character trait that gives other people confidence that an individual will
consistently do the right thing for the right (ethical) reasons
❖ Beauchamp and Childress believe that the presence or lack of
trustworthiness may be the most influential factor in whether a
relationship continues between a patient and a caregiver
➢ Integrity
❖ Integrity may be disturbed when the individual must compromise some
beliefs and values
❖ This compromising often results in a tension known as moral distress
❖ People are said to have integrity when they are known not to compromise
their ethical principles.
❖ We are more likely to trust people who we believe have integrity
 Ethical Theories
❑ Relativism
➢ Ethical values are relative to a particular environment or location
➢ There are no moral principles that are completely right, relevant and applicable to
companies and people of all different countries and societies and they may have
different ethical codes
➢ There is no standard or principle that can be used to evaluate one societal code
better than the other
➢ The ethical code of specific society has no special rank, which means it is simply one
among many
➢ There is no universal truth in moral/ethical principles that can be held for all peoples
at all times
➢ The moral code of a specific country or society identifies what is right within that
society; if the moral code of that country or society says that a certain action is right,
then that action is right at least within that society
 Ethical Theories
❑ Casuistry
➢ It focuses on decision making using particular cases, where the judgments
reached rely on judgments reached in prior cases.
➢ Casuists concentrate our attention on practical decision making in particular
cases and on the implications of those cases for other cases. Here we proceed
by identifying the specific features of, and problems present in, the case.
➢ We may attempt to identify the relevant precedents and prior experiences we
have had with related cases, attempting to determine how similar and how
different the present case is from other cases
 Ethical Theories
❑ Egoism
➢ It is a theory about what we ought to do, how we ought to act
➢ Individual ethical egoism
➢ According to this version, I ought to look out only for my own interests.
➢ I ought to be concerned about others only to the extent that this concern
also contributes to my own interests.
➢ Universal ethical egoism
➢ Maintains that people ought to look out for and seek only their own best
interests
➢ People ought to help others only when and to the extent that it is in
their own best interests to do so.
➢ The general idea of egoism theory is that one must always perform in his/her
own interest
➢ An action is considered to be morally right when it promotes a person’s self-
interests more than the interests of others.
 Ethical Theories
❑ Principlism
❑ Is a widely applied ethical approach based on four fundamental moral principles
sometimes referred to as “the big four” developed in the 1970s by the Americans
Tom Beauchamp and James Childress
❑ Identify four primary principles as the followings:
❖ Respect for autonomy,
❖ Non-Malfeasance,
❖ Beneficence (including utility) and
❖ Justice and several derivative rules: veracity, fidelity, privacy and
confidentiality along with various other rules such as informed
consent.
 Ethical Theories
❑ Principlism
➢ Danner Clouser and Bernnard Gert (1990) coined the label principlism
➢ Others have called this frame work the four principles approach (the principlism
approach argue that the four principles that are included in Principlism express
‘‘the general values underlying rules in the common morality’’), where the
common morality is ‘‘the set of norms that all morally serious persons share’’ and
to be applied to solve the contemporary ethical dilemmas
 Ethical Theories
❑ Principlism
➢ Beauchamp and childress had said that principlism has proved a popular framework
for thinking about biomedical ethics, and often forms part of the education for
those coming into medicine
➢ It is not intended to be a general moral theory, but rather aims to provide a
framework to help those working in medicine both to identify moral problems and
to make decisions about what to do.
➢ Similarly, some ethicist has claimed that the four principles can explain and justify
all the substantive and universalisable moral claims in medical ethics
➢ Although this approach is sometimes criticized for its lack of foundational theory
and its Western-dominated methodology, principlism is widely used as a starting
point for practical ethical decision-making in the clinical, technological and
epidemiological professions
Ethical Theories
 Ethical Theories
❑ What role can ethical theories and principles play in addressing ethical issues?
❑ Ethical theories and principles are helpful in addressing ethical issues in two key
ways:
➢ They explain why the issue at hand is an ethical issue
➢ They justify why one course of action ought to be preferred over another
❑ Ethical theories provide a coherent system of thought about what constitutes
ethical action and tend to be abstract; ethical principles are more narrowly focused
and provide the basis for specific rules or norms that can be more readily applied in
practice
❑ Some ethical theories focus on the consequences of decisions to determine what
the right course of action should be
➢ For example, utilitarianism is a consequentialist theory, which holds that
resources should be allocated to achieve the best overall outcomes, e.g.
improved population health
 Ethical Theories
❑ What role can ethical theories and principles play in addressing ethical issues?
❑ Other ethical theories hold that certain types of action are categorically wrong,
regardless of their consequences
➢ For example, some people maintain that it is inherently unethical for
physicians to actively hasten a patient’s death, regardless of the patient’s
wishes or how much the patient may be suffering
❑ Some theories are primarily concerned with how decisions are made (are decisions
made rightly?), rather than what decisions are made (what is the right decision?)
❑ Some ethical theories aim to achieve greater social justice by considering the social
and institutional conditions that shape the health of individuals and populations.