MORALITY ETHICS AND

BIOETHICS
Bioethics 2

1
 1. Morality, Ethics, and Values
• Morality and Morals tend to be used
interchangeably.
• They refer to the moral rules that members of
society live by, or are expected to live by, and
they express the values they have.
– “You should not kill” is a moral rule.
• Saving and promoting life is a value.
– “Students should not cheat in an exam” is a
moral rule.
• Honesty and fair play is a value.
2
 2. Ethics
• It is not enough to have moral rules, these
should be justified with ethical arguments.
• People need to ask themselves why they feel
this or that way about certain issues.
• Ethics refers to principles and theories about
moral rules
– They question and justify the rules.
– If ethics cannot find no rational justification for those
rules, people are better off abandoning them.
• Morality is the stuff our social and personal life is
made of,
• Ethics is the questioning of what we believe.
• The terms ‘Ethical theories and moral theories’
tend to be used interchangeably.
3
 3. Values
• Values are abstract ideas about what is good
and what is bad, shared by people in society.
• Something we value is something that we
believe is set against the other things that we
don’t value, or value less.
• Norms are the way that people in a society have
of expressing their values.
– If negative sanctions are given to someone who
cheated, you conclude that honesty is a value in that
society.

4
• The abstractness of the values creates
conflicts.
• The values themselves might not be in
conflict, but the real world implications
might be:
– People might accept the same values, but find
that they cannot agree on how to put those
values in practice
• Your best friend asks to copy your assignment
paper: Does your loyalty to your friend win over
your commitment to honesty?
5
 4. Bioethics
• Bioethics is multidimensional and cross-disciplinary in
orientation and conduct.
• It is an interdisciplinary field of inquiry and action
concerned with the moral, social and religious issues
connected with biotechnology and medicine.
• Concerned with the questions that arise in relationships
among life sciences, biotechnology, medicine, law
philosophy and theology.
• Arose in the 1960s in response to the radical
transformation of the older and traditional domains of
health care ethics (medical ethics, nursing ethics).
– Introduction of dialysis was an important land mark.

6
 Sources of morality
• Religion – The divine command theory
– Many people look to religion for moral
guidance; they are what God commands.
• Questions:
– (a) is something moral because God
approves of it, or does God approve of
something because it is moral?
– (b) slavery, colonialism, apartheid were
approved by religion, now they are not:
• Has God changed His commands?
7
• For those who subscribe to the Divine Command
Theory
– Something is moral because God approves of
it;
– Morality is what God commands or wills;
– No other justification is necessary for an
action to be right other than God's command.
• Rabin, and Sadat were killed by individuals
who believed they were commanded by
God to do so.
• It is immaterial to argue that God would not
have commanded any one to commit such
terrible acts. 8
– If you accept the divine command theory the
only way to resolve a moral issue – such
deciding if you should kill someone, is to wait
for God to speak to you.
• Among some Born Again Christians in
Tanzania women and men approach
prospective spouses and tell them that God
has revealed to them that they are the
chosen partners for them.
• The answer of the reluctant prospective
spouse is to say that they will pray about
the matter and wait for God’s answer.
9
• But some people do not think that all answers
are to be found in religious traditions.
• Agnostics and Atheists view religion itself as an
unknown or a nonexistent factor.
– Agnostics claim that they do not know if there is a
God, or that it is impossible to know.
– Atheists claim that there is no God.
• Both agnostics and atheists find that religion
may suggest solutions to their problems, but
such solutions are accepted not because they
come from God but because they somehow
make sense. 10
 Natural Law theory
• This disagrees with the divine command theory
• Posits that morality exists independently of
religion.
– Morality is universally binding on any one, no matter
what their religion or lack of it.
– Morality is grounded in rational human nature.
– Human or civil law or tradition is moral to the extent
that it is in accord with natural or moral law – if it is
not, i.e. it is degrading to humans, one has an
obligation to disobey it:
• Hence the opposition to slavery and torture
• Members of animal liberation groups break into laboratories
to set animals free
• Anti – nuclear activists block roads leading to nuclear power
plants
11
• What is moral and what is legal may
diverge.
• We may be morally obliged to do
something that the law proscribes or does
not require.
– The law is not the final word.
– Legislators do not determine what is moral.
– We cannot justify doing what is immoral by
saying “The law permits it”
12
• Some laws are not morally right:
– Hence Martin Luther King protested state and
federal laws which supported segregation.
• Though we must take into account what
the law says about a situation into account
in deciding what to do, what the law says
should not necessarily determine what we
ought to do.

13
• Morality and ethics are not just following
the law
– A good law does incorporate many ethical
principles, but a law can deviate from what is
ethical.
• Ethics is not following culturally accepted
norms.
– Some cultures are quite ethical, but others are
blind to certain ethical concerns.
14
• It is also problematic for professionals
simply to follow what the ethical code of
the profession sanctions.
• Standard practices may be sanctioned and
legitimized: Yet they may be mistaken.
– Standard practice does not guarantee an
ethical practice.
– A professional is obliged to question those
norms, and to act otherwise if they are wrong.
15
• Professions have Codes of Ethics,
– But codes of ethics have a history – they have
changed as the profession has changed.
• Codes of ethics often fail to provide
solutions to all dilemmas, because they
are not specific enough.

16
 Doing what is ethical
• When faced with an ethical problem, we
ought to proceed in a systematic way to
understand what the problem is.
– Get the facts;
– Discount your own bias;
– Give reasons to justify the action you intend to
take;
– Check with ethical principles and ethical
theories.
17
• Ethical principles and ethical theories are
the foundations of ethical analysis.
• They are the viewpoints from which
guidance can be obtained for what to do
when faced with an ethical problem.

18
 The principles of Health Care
Ethics
• Beneficence
– Doing good, and avoiding evil.
– Helping others to advance their interests as they
perceive them (as opposed to paternalism).

• Nonmaleficence
– First, do no harm/ Above all do no harm.
• Requires that the professional “keeps up to date”, refers pts
when appropriate, does not delegate tasks to those who are
not competent.
• Does not abandon pts when therapy fails, but will at least
provide pain relief.
19
• Autonomy: that the patient has the right to make
decisions about what can be done on her / his body,
needs to be asked for permission, and has to be given
adequate information to enable him / her make the
decision, i.e. to give Informed Consent.
• Paternalism: is the interference with a person’s liberty of
action justified by reason referring exclusively to the
welfare or interests of the person being coerced.
– Can only be justified when the individual’s autonomy is
diminished.
• Justice: that resources, including the health worker’s
time and attention will be made available to all pts. in
accordance with their medical need.
• Fairness: that all pts. in similar circumstances of
medical need will be treated in the same way.

20
• Veracity: that the health worker will be
truthful when communicating with the pt.
or guardian about the nature of the illness
and its management.
• Confidentiality: that what the pt. tells the
health worker, or what the health worker
finds out about the pt. and her / his
condition is treated as privileged
information and is kept in strict confidence.
 Universal moral theories
• Most moral philosophers believe that there
are moral principles that are universal and
objective:
1. Respect for autonomy;
2. Non-maleficence;
3. Beneficence;
4. Justice .

22
• The theories posit that moral principles are
discovered rather than created by people.
• There are many theories:
– Utilitarianism
– Deontology
– Rights ethics
– Virtue ethics, etc
• There is a great deal of overlap between
them,
– each emphasizes a particular aspect or
morality.
• Each theory has limitations, hence the need
to adopt a multidimensional approach that
draws from the strengths of each theory.
• All theories have the same ultimate goal: to
provide a rational basis for making better
decisions

24
• Moral theory offers guidance but does not
offer specific solutions.

• An understanding of the relevant facts,

cultural traditions, practical wisdom, and a
sound moral reasoning are all necessary
adjuncts to theory

– Requests for abortion are denied.

– Request s for assisted suicide denied.
25
 Some perspectives of morality
• Humans have an interest in establishing
and following moral rules:
– Applying rules for decent behaviour makes
sense, and rationality is the prerequisite for
making moral behaviour.
– Morality is a built-in, fail-safe biological trait:
humans cannot help being moral, otherwise
the human species would perish.
– Morality is playing safe when you can’t get
away with doing what you want:
• It derives from fear of being caught.
• If one can get away with something, one does it.
26
 Cultural relativism and the moral
community
• Moral rules are aspects of the cultural norms of society.
• Cultural norms vary from society to society.
• This variation has its roots in how cultures define their
moral communities, not in differences in basic moral
standards.
• Cultural relativism defines the moral community in
ethnocentric, rather than universalistic terms:
– There are no universal or natural human rights.
– Someone or something has moral value only because society
grants this status.
– There is no source of moral value other than culture.

27
• There is commonality in the concept of
moral community among cultures.
• Some cultures are more inclusive and less
hierarchical than others in their definition
of moral community.
• A moral community refers to all beings
who have moral worth in themselves, and
as such, deserve the respect of the
community.

28
• Buddhism supports a universalistic rather than a
relativistic moral community:
– All living things are encompassed within their
moral community.
– Many native American cultures include other
humans and nonhuman animals in the moral
community:
• it may be necessary to kill living beings for one’s
own survival, but this is done with respect, and
only when necessary, because other animals are
not mere resources for humans, but co-dwellers.

29
 The mandala
• The moral community can be represented by
using a mandala – the ancient Sanskrit word for
a circle that symbolizes the cosmic order.
• The mandala includes within its borders all that
has intrinsic moral value.
• Beings who have the greater status in a culture
are placed toward the centre of the mandala.
• As one moves further towards the edges of the
mandala, one’s moral value diminishes.
• Beings that are outside the moral community are
placed out side the circle
30
• The mandala of the US moral community in the
1800’s placed white male landowners in the
centre; white male non landowners were further
removed from the centre, while white women
were at the edge of the circle.
– Non-white humans, as well as animals were outside
the circle.
• Think of the current US moral community with Barack
Obama as President, but not Andrew Young.
• In Nazi Germany the Jews were outside the
moral community.

31
The Mandala

32
– What does the mandala of the
Masai include and exclude?
• Masai folks and cattle versus non-
Masais.
– What does the mandala of your
own racial or ethnic group include
and exclude?
• Discrimination
• Intermarriage
33
• People who are outside the moral community,
and those who are at the fringes constitute the
marginalized
– Homosexuals, drug addicts, & prostitutes etc, are
examples of these, and often have problems getting
the protection from those at the centre of the moral
community.
– Hence the resistance to Harm reduction strategies for
protecting them against HIV infection.
• Such distinctions with reference to membership
of the moral community legitimizes the
oppression and even extermination of certain
groups of people.
34
• The cultural definition of the moral community
changes over time
– In US African Americans are now inside the circle, but
at the margins.
– Some explain the resistance to Obama’s agenda to
the fact that he is a black person.
– Animal companions and endangered species enjoy
the protection of the moral community, but farm
animals, insects and most wild animals are outside,
and may be killed, experimented on or kept in cruel
conditions without fear of censure from those at the
centre of the moral community.
35
• Biomedical scientific and technological
developments have contributed to the
preeminence of ethical issues in research and
health care.
• This is part and parcel of the broader concern in
society for the quality, dignity and
meaningfulness of life, about distributive justice,
equity and universalism.
– The moral community is tending towards more
inclusiveness; hence not only concern for human
rights for all human beings, animal rights, and
environmental protection.

36
• Medical ethics, as indeed are other constituent
components of health care ethics, continues to
be important hence the concern for the Good
Clinical Practice.
• But it is now a component of virtually all decision
making in health care:
– How should such decisions be made?
– Who should participate in making them?
– How are dilemmas posed by biomedical advances be
dealt with? (beginning of life and end of life decisions)
37
 5. Issues in Bioethics
• Individualism is the primary value-complex on
which the intellectual and moral edifice of
bioethics rests.
• Individualism starts with the belief in the
importance, uniqueness, dignity, and
sovereignty of the individual, and on the sanctity
of each individual life.
• From this flows the assumption that every
person is entitled to certain individual rights.
• Autonomy of self, self-determination, and privacy
are regarded as fundamental among these
rights. 38
• Each individual needs to have the
opportunity to develop their potential, to
realize their self interests to the fullest, to
achieve and to enjoy the good life.
• In effect ‘individuals are entitled to be and
to do as they see fit, so long as they do
not violate the comparable rights of
others.”

39
• Down-plays the role of the collective and social
relationships
• Beneficence may be seen as paternalism
• Informed consent is never symmetrical.
• Veracity and truth telling. But this tends towards looking at
denial by the patient as an undesirable defense because it
complicates truth telling and truth receiving:
– The affirmation that patients have the right to know the truth veers
toward insistence that they ought to face the truth and deal with it
rationally.
• The concept and language of rights prevails over those of
responsibility and obligation.
– The strongest appeals to responsibility are concentrated on
requirements for the protection and promotion of individual rights.
40
• Your practice of Bioethics has to be
grounded in the reality of society in which
you operate – not blind adoption of tenets!
– The role of relatives of patients beyond giving
consent by proxy for the comatose patient?
• This is a rich area for bioethics research in
our context!
– NB The African Charter of Human Rights
differs from the Universal Charter by
espousing collective rights.
41
 Rule of thumb in bioethics

• Just because something is scientifically or

technologically possible, and is not
proscribed by the law, it may not be ethical
to do it.

42