Ethical theories are systematic rules or principles governing the right conduct. All practitioners upon entering a profession are invested with the responsibility to adhere to the ethical practices and conduct set by the profession. The ethical judgments may be made based upon experience or based upon the nature or principles of reason. Ethical theories provide part of the decision-making foundation for decision making when principles of biomedical ethics are in play because these theories represent the viewpoints from which individuals seek guidance as they make decisions. Each theory emphasizes different points, a different decision-making style or a decision rule such as predicting the outcome and following one’s duties to others in order to reach what the individual considers an ethically correct decision. In order to understand ethical decision making, it is important for health professionals to realize that not everyone makes decisions in the same way, using the same information, employing the same decision rules. For individuals, the ethical theory they employ for decision making guidance emphasizes aspects of an ethical dilemma important to them and leads them to the most ethically correct resolution according to the guidelines within the ethical theory itself. Four broad categories of ethical theory include deontology, utilitarianism, rights, and virtues.(Boring et al, 1948)
Firstly, the deontological class of ethical theories states that people should adhere to their obligations and duties when engaged in decision making when ethics are in play. This means that a person will follow his or her obligations to another individual or society because upholding one’s duty is what is considered ethically correct. Deontological theory uses rules rather than consequences to justify an action or policy. The best-known deontological theory is that of Immanuel Kant in the 18th century. ‘Kantianism’ is a modern term, referring to a Kant-like emphasis on duties and rules. Kant defended rules such as ‘do not lie’, ‘keep promises’, ‘do not kill’ on what he claimed were rational grounds. Rules should comply with the categorical imperative. For instance, a deontologist will always keep his promises to a friend and will follow the law. A person who adheres to deontological theory will produce very consistent decisions since they will be based on the individual’s set duties. Deontology contains many positive attributes, but it also contains flaws. One flaw is that there is no rationale or logical basis for deciding an individual’s duties. For instance, a doctor may decide that it is his or her duty to always be on time to meetings. Although this appears to be something good, we do not know why the person chose to make this his duty. (Carlson et al, 2005)
Another ethical theory is utilitarian which is based on one’s ability to predict the consequences of an action. To a utilitarian, the choice that yields the greatest benefit to the most people is the one that is ethically correct. There are two types of utilitarianism, act utilitarianism and rule utilitarianism. Act utilitarianism subscribes precisely to the definition of utilitarianism as a person who performs the acts that benefit the most people, regardless of personal feelings or the societal constraints such as laws. Rule utilitarianism takes into account the law and is concerned with fairness. A rule utilitarian seeks to benefit the most people but through the fairest and most just means available. Therefore, added benefits of rule utilitarianism are that it values justice and includes beneficence at the same time. Both act and rule utilitarianism has disadvantages. Although people can use their life experiences to attempt to predict outcomes, no one can be certain that his or her predictions will be accurate. Uncertainty can lead to unexpected results making the utilitarian decision maker appear unethical as time passes, as the choice made did not benefit the most people as predicted. Another assumption that a utilitarian decision maker must make concerns his/her ability to compare the various types of consequences against each other on a similar scale. But, comparing material gains, such as money, against intangible gains, such as happiness, is very difficult since their qualities differ to such a large extent. An act utilitarian decision maker is concerned with achieving the maximum good. Thus, one individual’s rights may be infringed upon in order to benefit a greater number of people. In other words, act utilitarianism is not always concerned with justice, beneficence or autonomy for an individual if oppressing the individual leads to the solution that benefits a majority of people.(Neuman and Dickinson,2001)
In ethical theories based on rights, the rights established by a society are protected and given the highest priority. Rights are considered to be ethically correct and valid since a large population endorses them. Individuals may also bestow rights upon others if they have the ability and resources to do so. For example, a person may say that her friend may borrow her laptop for the afternoon. The friend who was given the ability to borrow the laptop now has a right to the laptop in the afternoon. A major complication of this theory on a larger scale is that one must decipher what the characteristics of a right are in a society. The society has to determine what rights it wants to uphold and give to its citizens. In order for a society to determine what rights it wants to enact, it must decide what the society’s goals and ethical priorities are. Therefore, in order for the rights theory to be useful, it must be used in conjunction with another ethical theory that will consistently explain the goals of the society. For example in America people have the right to choose their religion because this right is upheld in the Constitution. (Slowther et at, 2004)
Lastly, there is virtue ethical theory which judges a person by his or her character rather than by an action that may deviate from his or her normal behaviour. It takes the person’s morals, reputation, and motivation into account when rating an unusual and irregular behaviour that is considered unethical. Virtue ethics can be seen in the way we feel is the ‘right’ way to behave towards patients and to colleagues. For example, a virtuous doctor or nurse would take time to explain treatment options to a patient and find out what he or she wants. One weakness of virtue ethical theory is that it does not take into consideration a person’s change in moral character. Virtue ethics is the name given to a modern revival and revision of Aristotle’s ethical thinking. Aristotle’s ethics, while not generally thought of as consequentialist, is certainly teleological. For him, the purpose, of a human life is to live according to reason. This leads to ‘happiness’ in the sense of human flourishing. This flourishing is achieved by the habitual practice of moral and intellectual excellences, or ‘virtues’. For Aristotle, the excellences are of two types. A moral virtue is an excellence of character, a ‘mean’ between two vices. One of Aristotle’s virtues is courage, a mean between recklessness and cowardice, which are vices. Modern virtue ethics sets itself the task of discerning the virtues for our time. In a healthcare setting what virtues would we like doctors, nurses, etc. to possess – self-control, truthfulness, generosity, compassion, discernment, integrity? Aristotle also identified a second type of excellences, intellectual virtues, which constitute a preference for truth over falsehood and for clarity over muddle, both in pure reason and in practical affairs. (Chanku, 2012)

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