Ethical theories

Learning Objectives:

At the end of the lesson, the students will be able to:

1. Discuss the importance of ethical theories in nursing practice
2. Describe each type of ethical theories.
3. Explain the similarities and differences of these ethical theories.
4. Articulate the core values of a professional nurse.
5. Answer the case samples by applying the concepts of deontology,
teleology, utilitarianism, and virtue ethics.
Topics:

 Concept of ethical theory

 Types of Ethical Theories
 Deontology
 Teleology
 Utilitarianism
 Virtue Ethics
Ethical Theory?

 Ethical Theories are attempts to provide a clear, unified

account of what our ethical obligations are.
 Ethical theories are thus formal statements about what we ought to do,
when faced with an ethical dilemma.
 An ethical theory is an answer to the question “what makes a thing good
or bad”?
 In trying to answer such questions, it becomes clear that one of the central
issues in ethics is whether we should focus on the consequences or the
nature of actions.
When encountering an ethical problem during the
course of their work, nurses are confronted by at least
three basic questions:

1. What should I do in this situation?

2. What is the ‘right’ thing to do?
3. How can I be sure (and be reassured) that my
decisions and actions in the situation at hand are
‘morally right’, all things considered? In short, how
can I be sure that I am behaving ethically and doing
the ‘right thing’
Types of ethical theories

 Deontology
 Teleology
 Utilitarianism
 Virtue Ethics
1. Deontology
 Types of Ethical Theories:
DEONTOLOGY

 The word deontological is derived from the Greek word deon, meaning
'duty’.
 It is a category of normative ethics because what is acceptable behavior
follows the norm of society which is adherence to certain rules and duties.
 Deontological theories holds that actions that are morally right are those in
accordance with adherence to certain rules, duties, rights, or maxims.
 Actions that align with the rules and duties are ethical, while actions that
don’t aren’t.
 This is agent-centered theory because it focusses on the duties of the
person acting rather than the rights of a person acted upon.
 Examples of DEONTOLOGICAL THEORIES

 Divine Command Theory

 The “Golden Rule”
 Natural Law and Natural Rights Theories
 Non-aggression Principle
 Categorical Imperative (Kantian Ethics)
Divine Command Theory:

 The theory asserts that what is moral is determined

by God's commands and that for a person to be moral
he is to follow God's commands.
 The theory asserts that what is moral is determined
by God's commands and that for a person to be moral
he is to follow God's commands.
 Christianity can be an example of deontology, where
someone’s morality is measured by whether or not
they follow The Ten Commandments.
The Golden Rule

 Also known as the ethics of reciprocity, this famous cross cultural

maxim states that “do to others as you want them do to you”
 It is our duty to act in such a manner that we would want
everyone else to act in a similar manner in similar circumstances
towards all other people.
 Natural Law and Natural Rights Theories

 Natural law is a theory in ethics and philosophy that says that human
beings possess intrinsic values that govern their reasoning and
behavior.
 Natural law maintains that these rules of right and wrong are inherent in
people and are not created by society or court judges.
 Example of natural law includes the idea that it is universally accepted and
understood that killing a human being is wrong.
Natural Law and Natural Rights Theories

 Natural rights theory holds that individuals have certain rights–

such as the rights to life, liberty, and property–in virtue of their
human nature rather than on account of prevailing laws or
conventions.
 Example of natural right: It is also universally accepted that punishing
someone for killing that person is right.
 Non-aggression Principle

 The Non-Aggression Principle (NAP) is the idea that

individuals have the right to make their own choices in life so
long as those choices do not involve the initiation of force or
fraud against others.
 Applying the Non-Aggression Principle leads libertarians to
argue that actions or policies such as murder, enslavement,
kidnapping, theft, and fraud are illegitimate whether practiced by
individuals, or by institutions such as government.
Categorical Imperative (Kantian Ethics)

Who is Immanuel Kant?

 Immanuel Kant (Prussia, 1724-1804) was one of the most
influential intellectuals in the field of political philosophy.
 According to Kant, the morality of an act (whether good or
bad; right or wrong) is acting in accordance with categorical
imperative, otherwise it is non-moral or immoral.
 Kant believes that the categorical imperative is the supreme
principle of morality.
What is the categorical imperative?

 Imperative means a command, because a human being may be

inclined to not adhere to a moral code of conduct, as it is only
human to seek pleasure and reduce pain.
Example: Do not cheat; you have to fulfill your promise
 There are two types of command/imperative:
1. Hypothetical – expresses a conditional command (example: if
you want to become a nurse study hard)
2. Categorical – expresses an absolute command (do not cheat)
Kantian Ethics

 To know more of the nature and dynamics of categorical imperative, we need

let us familiarize ourselves with the Core Concepts of Kantian Ethics:
A. The idea of the Good Will
B. The Duty and the moral worth of an act
C. The Formulations of the Categorical Imperative
A. Good Will: GOOD will facilitates human act.
 But what makes a good will good? According to Kant a good will is good not
because it produces good results or greatest happiness to the greatest number
of people as in the case of Utilitarian Ethics but it is good by virtue of its
intrinsic value. It is good without qualification, it is good without a condition.
Kantian Ethics: How is the good will
manifested?

1. According to Kant, it is manifested when it is done for the sake of DUTY,

hence, in order for a good will to be good, it is done for the sake of duty.
Example: Helping some one in need:
a. If helping is done because she expects something in return, then the will is
not Good without qualification.
b. If helping is done because she believes it is her DUTY to do so, then for
Kant, the will is good without qualification
2. Autonomy of the will which means self-legislating and not influenced by
any outside factors or not forced to do it.
Kantian Ethics

B. The Duty and the moral worth of an act

 According to Kant, duty should be the motive of any moral act.
INCLINATION OR SELF INTEREST CAN NEVER BE A MOTIVE OF ANY MORAL
ACT.
 For example, a physician treating a patient, he is moved to treat the
patient because it is his duty as a health care provider and not the interest
of profiting from the patient.
 For Kant, an act is done for the sake of duty has moral worth, if the act is
done out of self-inclination, then it has no moral worth.
Kantian Ethics

B. The Duty and the moral worth of an act

 For Kant, duty are of two kinds: Actions that accord with duty and Actions
for the sake of duty.
 Actions in accord with duty has no moral worth.
 Actions for the sake of duty has moral worth.

C. Formulation of the Categorical Imperative:

First Formulation: Principle of Universality: Act only on the maxim/saying
whereby you can, at the time will, that it should become a
universal law.
Kantian Ethics: Formulation of
Categorical Imperative

First Formulation: Principle of Universality

This means that if an act done is capable of being done by others similarly
situated because it is the right thing to do, then that act has moral worth.
Act done is not capable of being done by others similarly situated because to
many others it is unacceptable, then that act is immoral and has no moral
worth.
Example: Stealing the properties of others and giving them to the poor.
Example: Helping others in need
Kantian Ethics: Formulation of
Categorical Imperative

Second Formulation or Formula of the End: Principle of Humanity: So

act as to treat humanity whether in your person or in that
of another never as means but always as an end.
 Respect for Persons because every person has an inherent worth which
is every one of us is free and rational – to do, to say, to act
 Avoid thwarting others by force, lying, threatening, discriminating are
examples of disrespect of persons
 Ex. Hiring people to kill somebody are treated as mere instruments
Kantian Ethics: Formulation of
Categorical Imperative

Second Formulation or Formula of the End: Principle of Humanity:

 Any act that treats humanity as a means is not morally right.
Example: borrowing money with a false promise to pay later
Example: cheating someone during examination
 DEONTOLOGY: Categorical
Imperative/Universalism
Examples:

 Do Not Kill. We all see killing or murdering as the wrongest human deed
because we are taught since our childhood that killing anybody including
an animal in a wrong act. ...
 Do Not Steal. ...
 Religious Belief. ...
 Keeping Promises. ...
 Cheating. ...
 Do Not Lie. ...
 Respect The Elders.
 Categorical Imperative (Kantian Ethics)

 Duty-based Theory: Thus, believed that for as

long as we perform all moral duties being
categorical imperative, then the consequences
whether it is good or bad is not important, it is
justified or permissible.
 Categorical Imperative (Kantian Ethics)

 According to Kant “The rightness or goodness of

the action does not depend on their
consequences but on whether or not we have
fulfilled our duty.”
 No one is accountable for the wrong outcome
or bad consequences.
Exercises: Read and
resolve the following case
samples
Case No. 1

A staff nurse working in a private hospital is told by the Medical Director who is a
gynecologist to assist him in the tubal ligation of a post D.R. case for purposes of
preventing further conception as per request of the patient on the ground of
having many children already. The said nurse knows it is immoral. Yet, she assists
out of fear of losing her job if ever refusal is made.
1. Is the nurse morally accountable for her act of assisting out of fear?
2. Explain within the context of the principle of Deontology.
 Divine Command Theory
 The “Golden Rule”
 Natural Law and Natural Rights Theories
 Non-aggression Principle
 Categorical Imperative (Kantian Ethics)
Case No. 2

A student nurse suspects that her clinical instructor inadvertently gives her a wrong instruction
as to the specific doctor’s order that is to be carried out to a certain patient. However, she
does not bother to validate it with her C.I. and to refer to the patient’s chart as she is afraid of
being scolded and branded for being wiser than the C.I. She just consoles herself: “Anyway,
she’s my C.I. She has to know more than I do, for all I care!” She does what her C.I. tells her
without knowing the truth of the doctor’s order. Consequently, the patient receives wrong
medication and suffers anaphylactic shock from it.
1. What makes the fear of the student an extrinsic fear?
2. What makes the good thing good?
3. What makes a good thing bad or evil?
4. What are the circumstances that can never justify the performance of an evil act good?
5. In the context of deontology, is the wrong medication that resulted to anaphylactic
shock necessarily makes the C.I. and the student nurse accountable? Why?
6. To whom should accountability be the most?
Case No. 3

A certain patient is rushed to the ER as a victim of “hit and run” accident. He

has no relatives to provide any identification and sign consent forms for he is
just taken by empathetic bystanders. Emergency treatment is given without
much ado as the patient already gets unconscious.
1. Unconscious, does the patient still have voluntary nature of the act of
submitting for immediate treatment? Why?
2. Are bystanders morally obliged to rush the unconscious patient to the ER?
3. Explain what is a duty-based ethics?
2. Teleology
What is Teleology?

 It is derived from the Greek word telos which means end, or

goal or purpose.
 St. Thomas Aquinas: Everything we do has an aim, an end,
a goal, or a purpose. Actions are done for the sake of being
done is actually aiming on something.
 According to Aristotle, every action and purpose may be said
to aim at some good.
 You will not do anything that will interfere with the purpose,
or end, or goal.
Example

• Purpose in eating?
• End in eating?
• When is eating good? Bad? Is it a moral issue?
Example: Sex
What is Teleology?

 It is a theory of morality that derives duty or moral obligation from

what is good or desirable as an end to be achieved.
 Acts are not good or bad in themselves, but only through the results
they produce.
 This theory focuses on the results or outcome of the act, which means
that whether such act is right or wrong depends upon end, purpose,
aim, or goal of the action.
 If the end is good or desirable then the act is good or desirable, and if
the end is bad then the act is bad.
How do we decide what a good purpose
is?

 To make sure that our purpose itself is good, it has to be

intrinsically good – things like justice, security, health and
happiness, rather than things that are a means to an end, like
profit or personal gain.
 Something is 'intrinsically good' if it is good in itself (as an end
itself), not with respect to its instrumental goodness--not
what it is good for (not as a means to an end).
TELEOLOGY

 The key difference between teleological and

deontological ethics is that the teleological
ethics determines the goodness or badness of
an action by examining its purpose, end, aim,
goal whereas deontological ethics determines
the goodness or badness of the action by
examining the action itself.
Exercises: Read and
resolve the following case
samples
Case No. 1

A nurse whose faith differs from that of the Catholic Church refuses to assist in
a certain medical mission on family planning in a densely populated urban
poor community as her conscience certainly tells her that it is morally wrong.
The Chief of Mission also a Catholic and armed with sound moral principles
and precepts explains that the mission is much needed because statistics
show that overpopulation implies poor health and its consequences impacts
economy and development.
1. Is the nurse duty bound to follow her conscience or that binding force as
explained by the Chief of Mission? Why?
2. Is this within the concept of Teleological Ethics? Why
Case No. 2

Based on his thorough study, a medical doctor discovers a certain medicine

that gives him a well-founded reason to believe that it is probably the most
effective cure whose effect is even fastest among others for a certain
sickness. Other than his discovery, there is a medicine available at the
pharmacy which is sure and definite cure for the said sickness.
1. Is the doctor morally allowed to use the medicine that gives him the solidly
probable reason to be the most effective cure for the sickness? Why?
2. Is the concept of teleology applicable here in this case?
3. UTILITARIANISM
 UTILITARIANISM

 English philosophers and proponents of Utilitarianism

 Jeremy Bentham
 John Stuart Mill
 Utilitarianism is an ethical theory that determines right from
wrong by focusing on outcomes.
 ‘ends justify the means’
UTILITARIANISM

Three Generally accepted axioms of Utilitarianism

 Pleasure or happiness is the only thing that has
intrinsic value
 Actions are right if they promote happiness and
wrong if they promote unhappiness
 Everyone’s happiness counts equally
UTILITARIANISM

 Jeremy Bentham
 “Ethics at large may be defined as the art of directing men’s
actions to the production of the greatest possible quantity of
happiness.”
HAPPINESS – PAIN = NET HAPINESS
= NET PAIN
 NET HAPPINESS – MORALLY RIGHT
 NET PAIN – MORALLY WRONG
 EXAMple: studying hard

HAPPINESS PAIN NET

PASS THE SUBJECT TIRED 5 IN FAVOR TO
GET HIGH GRADES LACK OF SLEEP HAPPINESS
WILL GRADUATE
WILL GET A GOOD JOB
WILL GET HIGHER SALARY
FINANCIALLY STABLE
SUCCESSFUL
VIRTUE
ETHICS
 Virtue ethics

 A philosophy developed by Aristotle and other Ancient Greeks.

 Itis a moral theory that focuses on the development of moral
character.
 It is a quest to understand and live a life of moral character.
 Virtuesare engrained dispositions to act by standards of
excellence.
 Virtue ethics

 It is a character-based approach of determining right or wrong action or good

or bad results or consequences of a particular action.
 An action is only RIGHT if it is an action that a virtuous person would carry
out in the same circumstances.
 Virtue ethics is an approach that focuses on character with the assumption
that a person of good character will tend to behave in ways that are
consistent with their character.
Virtue ethics

 CHARACTER is the key to the moral life, for it is in the

VIRTUOUS CHARACTER that moral conduct and values
naturally arise.
A virtuous person is a righteous person.
A person practicing good habits such as honesty, justice,
generosity, bravery, and so on, develops an honorable
and moral character of a virtuous person.
What is virtue ethics example?

 "Virtues" are attitudes, dispositions, or character traits

that enable us to be and to act in ways that develop
this potential.
 They enable us to pursue the ideals we have adopted.
 Honesty, courage, compassion, generosity, fidelity,
integrity, fairness, self-control, and prudence are all
examples of virtues.
For Aristotle, EUDAIMONIA is the highest
human good, the only human good
that is desirable for its own sake (as an
end in itself) rather than for the sake of
something else (as a means toward
some other end).
 What is the purpose of eudaimonia?

 In
Greek philosophy, Eudaimonia means achieving the
best conditions possible for a human being, in every
sense–not only happiness, but also virtue, morality, and
a meaningful life. It was the ultimate goal of
philosophy: to become better people—to fulfill our
unique potential as human beings.
 Example: Eudaimonia

 Ifyou’re a parent, you should excel at raising your

children; if you’re a doctor, you should excel at
healing people; and if you’re a philosopher, you
should excel at gaining knowledge and wisdom, and
teaching. Of course, each person plays many roles life,
and it’s by excelling in all of them that one achieves
Eudaimonia.
Eudaimonia vs. Happiness

Happiness Eudaimonia

Emotion State of being

Temporary Ongoing
Measured by pleasure Measured by excellence
Can be achieved by immoral Can only be achieved by living
means a moral life
Connected with luck Connected with effort
How does virtue lead to a good life?

 By having virtues or positive character traits, he or

she is committed to doing the right thing no
matter what the personal cost, and does not bend
to impulses, urges or desires, but acts according to
values and principles.
 These virtues or positive character traits will lead
humans to happiness and a good life.
 By practicing the virtues every day without FAIL will become a habit
 Habits lead to EXCELLENCE
 Excellence produce VIRTUE
Will Batman Kill Deontologist Teleologist Utilitarianism Virtue Ethics
Joker?

Answer No Yes Yes No

Reason for Do not kill is a End, aim, The act is said to
be morally right if
Batman is a
the action Commandm purpose, goal its consequence or super hero
of the act outcome brings
ent of God
determines greater happiness Killing Joker is
than pain.
the goodness not his option.
Action must or evil of the
be duty- action itself The act of killing Superheroes
Joker will provide
based A great number of happiness to the are virtuous
people will benefit people living in the persons.
the good city and relieve
them of the
consequence as
unnecessary pain, The act of a
they will be safe
and secured of stress and anxiety virtuous
their lives. Joker brings if person is
allowed to live.
always
morally right.
Will Batman Kill Deontologist Teleologist Utilitarianism Virtue Ethics
Joker?

Answer No Yes Yes No

Ethical/Moral Let Joker The means The means Let the
Intervention be used to used to wheels of
captured eliminate by eliminate by justice
and have killing Joker killing Joker determine
him is ethically is regarded the
brought to good and as morally appropriate
trial for his justified useful and punishment
wrongdoin because if permissible of Joker
gs. he is because it without
eliminated, brings necessarily
then lives of happiness killing him.
many will to many.
be
Virtue Ethics in Nursing

 A virtue ethics for nursing is therefore concerned with the

character of individual nurses and seeks ways to enable
nurses to develop character traits appropriate for actions
that enhance wellbeing.
 Virtuousness is about the doing virtue, doing what is right.
 Virtue in nursing practice is about doing right for patients,
their loved ones, our practice and ourselves as well as
the broader society.
Core Values of a Professional Nurse

 Nursing values are fundamental to the practice of nursing.

They guide standards for action, provide a framework for
evaluating behavior and influence practice decisions.
 Caring is best demonstrated by a nurse's ability to embody
the five core values of professional nursing such as human
dignity, integrity, autonomy, altruism, and social justice.