Ethics and Ethical Decision-Making

(note that these slides are intended to accompany the lecture/podcast on ethical theories and principles)

Dr Malcolm Smith
mk.smith@qut.edu.au

CRICOS No.00213J
The Tuskegee Study
Autonomy
The right to choose what is in your best interests; the right
to self-determination.
Every human being of adult years and sound mind
has a right to determine what should be done with his own
body
Schloendorff v Society of New York Hospital (1914) 211 NY 125 at 126.

Autonomy is said to comprise of two key elements:

Capacity for intentional action
An absence of restraint or controlling forces
Tom L Beauchamp and James F Childress, Principles of Biomedical Ethics (5th ed, OUP 2001).
Beneficence
The duty to benefit and assist others, to care for their
welfare and to always act in the best interests of the
patient

Carried too far beneficence can become paternalism

(something well come back to!)

This principle might be given greater priority in

circumstances where the autonomy of the individual
cannot be established (e.g. adults who lack capacity, or
children)
Non-maleficence
This principle creates an ethical duty to do no harm and
to protect others from harm

A health professional must not needlessly harm or injure

a patient

There is an ethical duty (reinforced by law) to provide a

proper standard of care that avoids or minimises the risk
of harm (e.g. negligence)

This principle affirms the need for professional

competence
Justice
Distributive justice the fair distribution
and allocation of health services

Rights based justice respect

patient rights

Legal justice respect morally just laws and

be accountable for acts or failures to act (omissions)
Ethical principles
Beauchamp and Childress devised four ethical principles to
guide ethical reflection within health care

These principles can be used as a starting point to organise

ethical reflection within this unit

The principles and/or sub-principles may be in conflict with

each other and will often need to be balanced

T. Beauchamp and J. Childress, Principles of Biomedical Ethics, 6 th ed. (Oxford: Oxford University
Press, 2009).
T. Beauchamp and J. Childress, Principles of Biomedical Ethics, 6th ed. (Oxford: Oxford University
Press, 2009).
Ethical theories: Consequentialist

Teleological (from the Greek telos: consequences)

theories judge conduct in accordance with its
consequences

Utilitarianism is the most famous of these theories

Jeremy Bentham and John Stuart Mill: hedonists

their approach to ethics founded upon pursuit of
(greatest overall) pleasure
Utilitarianism
How do we measure consequences?
Pleasure/pain? (Bentham)
Happiness? (J S Mill)
Ideals? (G E Moore)

Whose interests and which consequences are relevant?

Just mine? (egoism)
A groups interests? (group utilitarianism)
Everyones? (utilitarianism)

How do we rank the outcomes?

Dependant upon a ranking of values?
Ethical theories: Deontological theory
Deontological theory (from the Greek deontos: duty) is concerned with the
intrinsic rightness or wrongness of an action, not the consequences
Concerned with duty
Ultimate basis: pure reason

Immanuel Kant
The only thing in the world which is good without qualification is a good
will
Kant set out his theory in the categorical imperative
Applies unconditionally (such as keep your promises)

Two formulations of the categorical imperative relevant:

Universal moral law
Treat people as ends
Paternalism: Beneficence taken too far?

Image from New York Times: http://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html?_r=0

What is ethics?

Compared with law?

Some similarities
Both normative
Human creations
Emphasise reasoning and justification
Law and ethics share a respect for autonomy and
independent moral judgement