Ethical Theories in

Biomedical Context
EMMA SOJOR-MATE,[Link], RN,LPT
College of Nursing, Pharmacy and Allied
Health Sciences (CNPHAS)
Negros Oriental State University
Teleological Theories
Ethical Egoism
“A person ought to act so as to promote his or
her own self interest.”
The morality of an action is the function of the
goodness and badness of the consequences (for
the agent or the doer)
It is a person’s moral obligation to perform an
action that is flagrantly antisocial in nature.
Example:
Mr. A loves to set buildings on fire; nothing
makes him happier than watching a building
burn. He recognizes. He recognizes arson
destroys property and subjects human life to
serious risk, but he happens to be a thoroughly
unsympathetic person. If Mr. A is clever enough
and is certain that he will not be caught, then,
Arson is the morally right thing for him to do.
Principle of Utility
Human actions are to be morally assessed in
terms of their production of maximal non-moral
value.
Non- moral values such as
friendship,knowledge, or health.
The question would then be, “ how are we to
determine what value could be produced in any
given circumstance?
Utilitarians agree that ultimately we ought to
look to the production of what is INTRINSICALLY
valuable rather than EXTRINSICALLY valuable.
Principle of utility cont'd
That is, (Intrinsic value) would be what is good
in itself and not as (extrinsic value) what is good
as means of something else ought to be
produced.
An intrinsic value, then, is a value in life we wish
to possess and enjoy just for its own sake.
UTILITARIAN THEORIES OF INTRINSIC VALUE:
Two major distinction is drawn,
• Hedonistic Utilitarians
• Pluralistic Utilitarians
Principle of Utility cont'd
Jeremy Bentham and J.S. Mill are reffered to as
hedonistic utilitarians because they conceived
utility entirely in terms of happiness and
pleasure
Bentham viewed utility as that aspect of any
object or event whereby it tends to produce
different pleasures in the form of benefit,
advantage, good and the prevention of pain.
J.S. Mill viewed utility as that aspect where in an
action produces happiness.
Cont'd
Pluralistic utilitarians (ex. G.E. Moore) argued
that other values besides happiness possess
intrinsic worth; among these values are
friendship, knowledge, courage, health,and
beauty.
Act Utilitarianism
A person ought to act so as to produce the
greatest balance over evil, everyone considered.
Act Utilitarian Calculation
1. Delineate alternative paths of actions.
[Link] or foresee the consequences of each
alternative actions.
3. Evaluate the consequences and weigh the
good against the bad, considering the impact of
the action on everyone whom it is likely to
affect.
Cont'd
3. The act that would produce the greatest
balance of good over evil is the morally right
act.
Ex. A severely impaired newborn believed to
have no realistic chance of surviving more than
few weeks, has contracted pneumonia. A
physician, in conjunction with the parents of the
infant must decide whether to fight of the
pneumonia with antibiotics, thereby prolonging
the life of the infant. The other alternative is
simply to allow the infant to die.
Cont'd
Surely the infant has nothing to gain, and
something to lose, by a slight extension of a
pain filled life. The parents, whose suffering
cannot be eradicated whatever action is taken,
nevertheless will find some relief knowing that
their child’s suffering has ended. However, there
may be decisive consequences of allowing
death to occur. Perhaps allowing the infant to
die will contribute to the breakdown of
protective attitudes towards infants in general.
Consequences seems minimal.
Conclusion
Withholding antibiotics, thereby allowing the
infant to die is the right thing to do.
Example:
Suppose that you are mountain climbing with
your closest friend, a person whom you admire
and respect, and from whom you have received
many favors. Now suppose you lose your grip on
a rope while he is descending a sheer cliff. He
falls. By the time your reach him he’s dying. In
these dying moments he asks that you make a
secret promise to him, and you agree. He
reveals a great financial secret he has harboring.
Through the years of hard work and careful
investments he has hoarded a million dollars.
Cont'd
He asks you to deliver this money to an uncle
who has helped him in the past. But you know
that this uncle is very rich gambler and will
eventually squander the money. No one else
knows about either the promise or the secret
cash.
You could put the money to much better use by
giving it to charitable institutions. You would not
disappoint the man whom you made the
promise because he’s DEAD. Nor would you
weaken the faith in the socially useful
institutions of promise making and breaking.
Conclusion
On Act utilitarian principles, it would appear
that you should not carry out your promise to
your dying friend.
Critical assessment of Act-
Utilitarianism
Act-Utilitarianism confronts individuals with an
overly demanding moral standards.
• decisions is a matter of “mere prudence” and
“what is best for me”
Act-Utilitarianism does not accord with our
experience of particular, morally significant
relationships.
• we are related to particular individuals in a host
of morally significant ways.
Cont'd
Act-Utilitarianism does not accord to our
conviction that individuals have rights.
• the action that is identified as moral may entail
a violation of one person’s right.
Rule-Utilitarianism
A person is ought to act in accordance with the
rule that, if generally followed, would produce
the greatest balance of good over evil, everyone
considered.
Determining the morally correct action involves
an indirect appeal to the principle of utility.
Moral codes are established by reference to the
principle of utility.
Individual actions are morally right if they are in
accord with those rules.
Rule-Utilitarian reasoning
schematically representad:
Cont'd
First step for Rule Utilitarian is the articulation
of a set of moral rules or the development of a
moral code, justified on the basis of utilitarian
considerations.
Then the question would be which rules, if
generally followed, would produce the greatest
balance of good over evil, everyone considered.
That is, which rules if adopted or recognized
from our moral code, would maximize utility.
Cont'd
In order to be plausible, the rules that
constitute the moral code must be understood
as incorporating certain exceptions.
The need to recognize a justified exceptions is
perhaps most apparent when we remember
that moral rules, if stated unconditionally, can
easily come into conflict with each other.
Ex. “Do not lie”
Vs. “Do not lie except when necessary to
prevent an innocent person from being
seriously harmed.”
Example:
“Tarasoff case”
A woman was killed by a man who had
previously disclosed to a psychiatrist his
intention to kill her. The psychiatrist did attempt
to have the man committed but, on the grounds
of patient/physician confidentiality, did not
communicate the threat to the woman when
the commitment attempt failed. The judge
appealed to the public the importance of
observing rules.
Cont'd
But on utilitarian grounds holds that rules of
confidentiality are less important than rules
protecting persons from violent assult.
Critical Assessment of Rule-
Utilitarianism
Some critics would say the R-U cannot provide
an adequate theoretical foundation for
individual rights
R-U is incompatible with the blatant injustice of
enslaving one segment of society’s population.
Deontological Theories
DEONTOLOGICAL ETHICS
Derived from the Greek word “deon” meaning
“duty”
Deontology is a category of normative ethical
theories that encompasses any theory which is
primarily concerned with adherence to certain
rules or duties.
Consequences do NOT matter!
Intention is relevant. I am acting a certain way
only if I act for the right reason.
Kantian Deontology
Developed by German Philosopher Immanuel
Kant (1724-1804)
Kant sees utilitarianism as embodying a radically
wrong approach in ethical theory.
He emphasizes the need to avoid the “ serpent
winding” of utilitarian thinking and refers to the
principle of utility as “ a wavering and uncertain
standard.”
The supreme principle of morality, the principle
of which all of our various duties derive is, as
Kant calls it, the “ Categorical Imperative”
Cont'd
First formulation:
“Act only on that maxim through which you can
at the same time will that it should become a
universal law.”
Second Formulation:
“Act in such a way that you always treat
humanity, whether in your own person or in the
person of any other , never simply as means,
but always at the same time as an end.”
Cont'd
2 Major reasons for choosing to exhibit the
structure of Kant’s ethical system in reference
with the second formulation of the categorical
imperative:
The second formulation embodies a central
notion-respect for persons-that is some what
easier to grasp.
When argumentation in biomedical ethics
reflects a Kantian viewpoint, it is almost always
couched in terms of the 2nd formulation rather
than the 1st.
Cont'd
Every person has an inherent dignity.

Fourfold classification of duties:

1. Perfect duties to self
2. Perfect duties to others
3. Imperfect duty to self
4. Imperfect duty to others
Cont'd
PERFECT DUTIES-duties requiring strict
abstention from those actions that involve using
person merely as mean.
Perfect duties to others
A transgression in this category occurs
whenever on person treats another person
merely as means.
• Respect for persons entails that each of us
recognizes the rightful authority of other
persons to conduct their individual lives as they
see fit.
Cont'd
Perfect duties to self
• CI demands that no person (including oneself)
be treated merely as means.
Ex. Duty not to commit suicide.
IMPERFECT DUTIES- require the promotion of
certain goals. However, action in the name of
these goals must never be at the expense of a
perfect duty. In broad terms, there are two such
goals:
1. An agent’s Personal Perfection (i.e.
Development
2. Happiness or welfare of others
Cont'd
Imperfect duties to self
commitment to the development of one’s
capacities as rational being.
Imperfect duties to others
Duty of Beneficence/Happiness or welfare of
others.
• If one acts in such a way as to further the
happiness or welfare of others. (Concept of
Beneficence)
• Nonmaleficence- noninfliction of harm on
others.
Critical Assessment of Kant's
Deontology
It does not only overstate the significance of
certain “perfect” duties but also understate the
significance of the Duty of Beneficence.
W.D. Ross's Prima Facie Duties
W.D. Ross-English Philosopher that proposed a
deontological theory that has received
considerable attention among ethical theorist
Latin phrase prima facie, literally means “ at first
glance”. Conditional is what expresses most the
sense of the phrase.
Proposed that our various duties has no unitary
basis but rather emerge out from our “morally
significant relations”
Cont'd
Each of these relations is the foundation of a
“prima facie duty” w/c is more or less
incumbent on me according to the circumstance
of the case.
In a particular circumstance, we are bound to
only one prima facie duty, this particular prima
facie duty is our actual duty.
In conflict-of-duty situations, where two ore
more prima facie duties compete for priority,
only one of these duties, the more stringent one
in the circumstances, can be our actual duty.
Cont'd
W.D. Ross proposes the following divisions of
our prima facie duties.
1. Duties to fidelity
Includes keeping promises, honoring
agreements and contracts and telling the truth.
2. Duties to reparation
Duty to rectify the wrong thing that has been
perpetrated
3. Duties of gratitude
Rest upon previous acts to others, namely
beneficial services provided by them.
Cont'd
4. Duties of beneficence
Rest on the fact that there are other beings in
the world whose condition we can make better.
5. Duties of Nonmaleficence
“duty not to injure others”. Recognized by Ross
as especially stringent.
6. Duties of Justice
Duty to justly distribute benefits in accordance
to personal merit.
Cont'd
7. Duty of self-improvement
“Rest on the fact that we can improve our own
condition.”
Critical Assessment of Ross's Theory
Although Ross’s theory provides us with a
helpful framework in conceptualizing our moral
dilemmas, it provides us with virtually no
substantive guidance in resolving them.
There are no principles we can appeal to in an
effort to make an appropriate decision.
Principles of Biomedical Ethics
Principle of respect of autonomy
Principle of nonmaleficence
Principle of Beneficence
Principle of Justice
 THE END 
Reference:
Thomas A. Mappes and David Degrazia,
BIOMEDICAL ETHICS, 5th Edition, 2001
Beauchamp & Childress, Principles of
Biomedical Ethics, 2nd Edition, 1983