Basics of Behavioral Sciences

GMP Students, 1st year, 2019 – 2020 Fall semester

General Ethics Introduction – The Philosophical and

Ethical Foundations of Modern Bioethics

Lecturer: Bodnár János Kristóf (PhD) bodnar.janos@sph.unideb.hu 1

BIOETHICS IN THE MEDICAL
CURRICULUM
4th year, 2nd semester

Compulsory subject in the Behavioral Science final exam

5 double hour lectures + 5 double hour seminars

Lecturers: Bodnár János Kristóf (PhD), Péter Szabina (PhD)

Course Reader: Robert M. Veatch – The Basics of Bioethics (3rd

Edition). New York: Routledge, 2011.

Grading: Written examination (test + essay questions)

WHAT IS ETHICS?
Etymology: greek term ethos (meaning: character, virtue)

Definitions:
 Aristotle: (Ethics is after the question) „Good persons
exist – how it is possible?”
 George E. Moore: „General inquiry of good”
 Ludwig Wittgenstein: „The facts contribute only to
the setting of the problem, not to its solution”

Historically it was part of philosophical and religious

enquiry, later the natural sciences (e.g. cognitive
neuroscience) and other human sciences (psychology,
sociology, anthropology) also started examining ethical
questions.
SUBFIELDS OF ETHICS
1. Descriptive ethics
 Sociology of morality (examines what systems of values pertain in
a given society/subculture/profession)
 Moral psychology (investigates questions of moral development of
individuals – e.g. how to change certain moral behaviors, how
those evolve over age –, ethical issues related to certain mental
disorders)

2. Normative/prescriptive ethics

 General (tries to answer what norms/values should be followed,
and what are the virtues to be valued)
 Applied (sets norms for a given profession, science)

3. Meta-ethics
 Deals with the foundational questions of ethics (e.g. the nature of
value, its sources, its justification)
THE PROBLEM OF VALUE
Inside or Outside?

 Is it (only) the intent that is valuable, or (only/also) the

consequences?

Lying to save a life? (Kant) vs. Lying in therapy

Saving a life and motivations in philosophy (Kierkegaard vs.

Mill) and in psychology (Skinner)

Intents and outcomes: The principle of double effect in

religion (Thomas Aquinas) vs. In medicine (EOLD)
THE PROBLEM OF VALUE
Inside or Outside?

 The difference between legality (sheer conformism) and

morality (self-determination)

 Enlightenment, moral childhood, autonomy (Kant)

 Abraham’s story: Kant vs. Kierkegaard

 Natural law vs. Positive law (Antigone’s tragedy)

 Nuremberg laws vs. the Declaration of Geneva:

„the laws of humanity”
THE PROBLEM OF VALUE
Inside or Outside?

 Is it a feeling? Or is it followed by a feeling? The relationship

of happiness and morality

 Socrates, Kant, Mill: Virtue and happiness

 In medicine: Patient autonomy vs. Do no harm!

 Questions of conscience and responsibility (Harris, Locke)

 Good vs. Normal, Evil vs. Sick

 Psychopaths, psychoses, criminal insanity

 Understanding, Preventing and Treating them

THE PROBLEM OF VALUE
Inside or Outside?
 Are we born with certain values, or with a capability to learn
them? (Rationalists vs. Empiricists, Rousseau vs. Parsons)

 Could virtue be taught? (Socrates)

 The role of the freedom of the will in the paradigm of

modern sciences? (Harris, Sartre) – patient autonomy

 To what extent I am responsible for my own values? (Issues

of factual / genetic / socio-cultural / financial determination)

 Trolley-problem – scarce resource allocation

 Social determinants of health – addictions, access to
healthy nutrition
 Issues of justice – access to medicine
THE PROBLEM OF VALUE
 The Values – are they True or simply Right?

Factual statements (empirical propositions) vs. Value Judgments

(normative propositions) (Objectivists vs. Pragmatists, Rorty)
Do they have truth-value (moral realism, noncognitivism)
How to ground, justify them? (Wittgenstein, Nietzsche)

 The Naturalistic Fallacy (Moore)

 The Is – Ought problem (Hume)
 Hedonism, Religious Fundamentalism – Pro Life movements
Can Science give Ethics to itself?
Healthism (Harris)
 Drapetomania
THE PROBLEM OF VALUE
The ‚Ungrounded Ground’ (Schopenhauer, Popper, Wittgenstein)

Transcendent
 E.g. religious commandments
 Problem: Religious Diversity, many of these values could be
accepted without reference to religious dogmas
 Religion and medicine: circumcision, stem-cells, JWs

 Immanent
 E.g. laws, social norms, professional codes of conduct
 Problem: Legality and morality – Nuremberg Laws

 Formal Rules – ‚Golden Rules’

 Categorical Imperative, Nietzschean Affirmation
 Problem (?): The more formal ,the less substantive…
THE PROBLEM OF VALUE
Universalism vs. Relativism
 Are there universal values? Global bioethics vs. Local values
 Universal values as a descriptive vs. normative issue

Classical liberalism
 Value pluralism, autonomy vs. Voluntary request for FGM
 Neutrality vs. euthanasia, abortion
 Night-watch state vs. Coerced treatments
 Paradox of Tolerance: Freedom of speech vs. Anti-vaccination

Humans and other Sentient Beings

 Can animals be moral?
 If so/not, do we have duties towards them?

Humans and Machines

 Can machines be moral?
 AI and morality
NORMATIVE ETHICS
 1. Deontological ethics (duty-based ethics – Immanuel Kant, John
Rawls)
 An action is valuable if it is according to a pre-established
set of duties / prescriptions. For example
 Religious commandments (‚Thou shalt not kill!’), Tolstoy,
Quakers
 Human rights (right for life, property, religious freedom)

 In Bioethics:

 Patients rights
 Confidentiality: generally vs. 3rd party’s interest
 Fidelity: generally vs. mental disorders
 Self-determination: generally vs. public health emergencies
NORMATIVE ETHICS
 2. Consequentialist ethics (consequence based ethics –Bentham,
Mill)
 An action is valuable if it results in valuable consequences
 Utilitarianism – Liberalism
 Risk/benefit assessment, triage, RCT

 In Bioethics:

 Confidentiality – Hippocratic model

 Fidelity – Hippocratic model
 Self-determination, fidelity – placebo-controlled RCT’s
 Do no harm – triage

 3. Virtue ethics
THE PURPOSE OF BIOETHICS
Ethical Sensitivity: a person’s capacity to „feel” those situations and
decisions, when there is a difficult moral choice, when ethical
deliberation is needed.

 Best interest of the patient, beneficence: pain alleviation, EOLDs,

JW
 Facts and values, legality and morality, codes of conducts vs.
Personal values
Ethical Deliberation: „imaginative rehearsal in the mind” of
alternative courses of action when confronted with a difficult moral
choice.
Ethical Justification: when we choose one course of action, and give
reasons
•Laws, declarations, codes, principalism, normative theories, casuistry
SCIENCE AND ETHICS
 Is science capable of providing norms/ethics for itself?

– means and aims – the invention of radioactivity

– the difference of use and abuse –could science only

determine this line? (e.g. opiates in clinical practice and in
recreational use, medical marijuana)

– could / should medicine be ‚value-free’ (issues of death-

criteria, abortion, transplantation)