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Bioethics and Moral Issues in Nursing

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Bioethics and moral issues in nursing

Ethics •

Greek “ethos”   meaning charact character, er, customs, habitual usage, conduct  A science that deals w with ith principles of right or wrong, good or bad and governs our relationships with others and that is based on personal beliefs and values  A systematic attempt to make sense of our individual and social moral experience (DeGeorge) Practical and normative science based on reason, which studies human acts and provides norms for their goodness or badness ikewise known as moral philosophy , insofar as it deals with morality, moral rectitude or the rightness and wrongness of human acts (!imbre"a, (!im bre"a, #$$%, p& ') alue problems  **e bvery ig ryda etday hicys+udg *eve udgme ment nt ca call lls+ s+ -ommon approaches.solutions  Phil Philos osop ophi hica cal. l.re reli ligi gious ous bel belie iefs fs  /e /eiighin ghing gp pot oten enti tial al outc outcom omes es  -u -urr rrent ent prac practi tice ce.p .pas astt ex exper perie ienc nce e 0thical dilemmaa situation when one must choose between two e1ually unfavorable alternatives !o acknowledge that individual can come to different opinions with regards to value issues is not to say that all opinions have the same worth, or that a particular answer is better than the other& !here is a fine distinction or overlap between law

!he right of individuals to take actions for themselves  !o respect autonomy is to respect others  People engaged in autonomous and self determining actions must have the belief and capability of selfgovernance, and a stable and internali"ed set of principles NOT prevail  7ndividual autonomy DOES NOT prevail when it interferes with the rights, health or wellbeing of another   Principle of autonomy marks the significance of individual autonomy which mandates a strong sense of personal responsibility for one8s own life (!imbre"a, #$$%, p& 59) #& 3en 3enefi eficen cence ce and :on :onmal malefi eficen cence ce  !he duty to help others by doing what is best for them without inflicting evil or harm beneficence nurse manager act acts s with   A beneficence empathy for the patients and staff without resentment or malice  -onflict4 sometimes treatment decisions are viewed as harmful from the patient8s perspective '& Di Dist stri ribut butiv ive e ;ust ;ustic ice e  7t is giving a person that which he.she deserved  7t implies the benefits and burdens ought to be distributed e1ually and fairly, regardless of  race, gender, religion, or socioeconomic status so that no one person bears a disproportionate share of benefits or burdens a& Alloca Allocatio tionh nhow ow much much will will be devo devoted ted tto oa particular effort b& <at <ation ioning ingw who ho wi will ll get the the re resou source rces s and who will not =ther relevant principles4 <ightsprivileges, <ightsprivi leges, concessions, claims, freedoms 2idelitythe 2idelityth e obligation to be faithful to responsibilities.commitments responsibilities. commitments to oneself and others eracitytelling er acitytelling the truth or not intentionally deceiving or misleading others >tandard of best interest vs paternalism (decide for others) •

and ethics& !hey may be congruent or conflicting& 2or example, what is ethical may not be legal and what is legal may not be ethical 3etter decisions come from4 5& alues alues clar clarific ificatio ationexa nexaminin mining g what we believe is good, bad, beautiful, worthy, meaningful6our personal values #& 3ui 3uildi lding ng a fr frame amewo work rk tto o examin examine e our decision -ode of ethics  7nforms the nurse and the public of the values and standards of conduct  Provides the professional expectations in ethical matters  Provides a decisionmaking framework for solving ethical problems



-lassifications of ethics4 -lassifications 5& <ule ethics ethics app appeals eals tto o a set of criter criteria, ia, norms norms,, or rules to settle what is the right and ust and ethical decision to make #& Act ethi ethics cs determi determines nes rright ightness ness and w wrongne rongness ss by weighing the conse1uences of the act itself 


!el eleolog eological ical theor theories( ies(-onse -onse1uenc 1uenceori eoriented ented)) teleos *end+ or *purpose+  Greek telos, teleos *end+  >tresses the endresult, goal or conse1uence of an act as the determining factor of its rightness and wrongness



;eremy 3entham (5?%@[email protected]'#) and ;ohn >tuart ill ([email protected]$B[email protected]?')  An ethical theory theory that promotes making making decisions based on what will provide the greatest good for the greatest number  -laims that there is one and only one moral principle6that is, the principle of utility , formulated by Mill Mill44 *actions are good insofar as they tend to promote happiness, bad as they tend to produce unhappiness Principle allows the ends to ustify the means Utility  or  or usefulness of an action is determined by the extent to which it promotes happiness rather than its reverse (pain) 3entham and ill, bent on getting rid of any strain of individualism and subectivism, gave an alternative formulation of the utilitarian utility principle, known as the principle the principle of greatest greatest happiness: an happiness:  an action is good (right) insofar as it produces the greatest happiness for the greatest number of peopleC bad (wrong) insofar as it produces more harm than benefit for the greatest number of individuals&

7:!<7:>7- G==D> (/illiam 2rankena) 7:!<7:>7ife, consciousness, activity ealth and strength Pleasure and satisfaction of all or certain kinds appiness, contentment !ruth Enowledge and true opinion, wisdom 3eauty and harmony harmony,, proportion  Aesthetic experience experience orally good, disposition or virtues utual affection, love, friendship and cooperation 2reedom >elfexpression ;ust distribution of goods and evils Power and experiences of achievement PeaceC security  Adventure and novelty novelty Good reputation, honor, selfesteem 3entham ? -ategories and Attendant 1uestions4 5& 7ntens 7ntensity ityho how w intens intense e was the the pleasur pleasureF eF #& Dur Durati ation onhow how long long does does th the e pleasur pleasure e las lastF tF '& -er -ertai tainty ntyhow how certai certain n are y you ou th that at th the e pleasure will occurF %& Pro Proxim ximity ityhow how s soon oon will will tthe he pleas pleasure ure be experiencedF 9& 2ec 2ecund undity ityhow how many many more more pleas pleasure ures s will will happen as a result of this one B& Pur Purity ityhow how free free fro from m pain pain is th the e pleasu pleasureF reF

?& 0xt 0xtent entho how w many many will will exper experien ience ce th the e pleasure subtract the pains,   Add the pleasures, subtract strike the balance, and make the decision ill argues that there are no means for  determining which is the more intense between two pleasurable sensationsC it is :=! one8s own happiness but for the happiness of all should be considered in making moral decision  Act utilitarianismthe utilitarianismthe principle principle of greatest happiness is applied to acts in particular  situations/circumstances; is also situationalistic <ule utilitarianism the principle of greatest happiness has been tested on rules and rules  and therefore the rules can be utili"ed to decide on right or o r wrongC is also absolutistic

Critics o! tilitarianism" (lacks the principle of  ustice) 5& !he ca calcu lculat lation ion of all all possib possible le con conse1 se1uen uences ces of our actions, or worse yet our inactions appears impossible #& ti tilit litari ariani anism sm ma may y be us used ed to s sanc anctio tion n unfairness and the violation of rights '& relativity til tilitari itarianism anism is not sensi sensitive tive to the agent agent of duty %& ti tilit litari ariani anism sm doe does s not seem seem to gi give ve enough enough respect to persons 9& nder util utilitari itarianism anism it iis s ustifi ustifiable able to prevent prevent others from doing what we believe to be harmful acts to themselves B& til tilitari itarianism anism alone alone does does not not pr provide ovide a basis basis for our own moral attitudes and presuppositions tilitarian tilitari an <esponses to criticisms4 tilitarians tilitari ans could deny that the critic8s scenario would play out as claimed tilitarians tilitari ans might argue that the supposedly •

counter intuitiverather result than should issue inin a or revision of our intuitions a change reection of the theory tilitarians tilitari ans might move to rule utilitarianism

B. SITA SITATIO TION N ETHIC ETHICS S  #advocated by ;oseph 2letcher  

' Approaches to morality4 5& Legalistic approach (normative) approach (normative) describes certain general moral prescriptions, laws, or norms by which to  udge, determine, and settle the rightness rightness or wrongness of human udgments or decisions !oo restrictive and circumscribed 7nade1uate and insensitive to the complexity Antimonian approachfrees approachfrees the -hristian from the obligations of the  



moral law in which case there are no absolute precepts or moral principles  !o liberal and unconventional '& Situationism Situationismthe the preferred approachC moral norm depends upon a given situation, but whatever this situation may be, one must always act in the name of -hristian love *Situation refers to a human condition *Situation or any state of moral affairs and issues that demands a moral udgment or action states that the moral norm depends upon a

given situation, but whatever this situation may be, one must act in the name of -<7>!7A: =0  ' types of ove 5& 0r 0ros oss sex exua uall love love #& Phi Phili liab abind inds sp pare arents nts to child child '& Aga Agape peone one8s 8s c care are,, concer concern, n, and k kind indnes ness s towards others best exemplified by -hristian love His Propositions:  =nly one thing is intrinsically good, namely love, nothing else  e&g& a doctor who helps a rape or incest victim to abort the fetus conceived as a result of sexual

 

assault would be acting out of concern and kindness towards the pregnant woman !he ultimate norm of -hristian decisions is love, nothing else  e&g& a physician who extends medical assistance to an inured :PA rebel acts out of -hristian love Love and justice are the same, same , for ustice is love distributed Love wills the neighbor’s good , whether we like him or not emotion or   Agape:=! primarily an emotion an affection but primarily a good will, an active determination of the will

=nly the 0:D ustifies the means  >tealing a neighbor8s licensed revolver to keep him from shooting somebody is moral morally ly legitimate6 legitimate6 untruth is is morally acceptable under the situation  Decisions ought to be made situationally not prescriptively  Puts a high premium on freedom and responsibility  !he moral oughtness in carrying out one8s obligation to decide depends upon the given circumstancesC there is no absolute prescriptions for all decisions >ituation ethics, in meical conte!t combines conte!t combines love and ustice in treating ill patients 7t seems that what makes an act good is whether it is expedient, edifying, constructive, and humaneC

whether it builds up rather than destroys, condemns, or kills ;oseph 2letcher8s Guidelines for making 0thical -hoices4 -ompassion for people as human being -onsideration of conse1uences Proportionate good Priority of actual nees over nees over ideal or potential needs  A desire to enlarge c choice hoice and reduce chance  A courageous acceptance of tthe he need to make decisions and the e1ually courageous acceptance of the conse1uences Difficulties4  -ontextualism may encourage ethical relativism  :onprescriptive ethics may be used  !he prudence of a situationist does not always guarantee obective and impartial  udgment&

C. Ethical Ethical relati relati$ism% $ism%mora morall relati$ relati$ism ism  -laims that there is := universal or absolute

moral principle >tandards of right and wrong are always

relative to a particular culture or society !he moral opinion of one individual is good as  any other for there is := obective basis for saying that a particular action is right or wrong apart from a specific social group  0xamples of culturally accepted practices with surrounding ethical issues& 5& Allow Allowing ing old people people to d die ie to star starvat vation ion and exposure to cold, allowing wife to sleep with guest overnight60ski overnight60skimo mo culture #& A m man an is obli obligat gated ed to mar marry ry hi his s brothe brother8s r8s widowH 7sraelite.uslim culture '& Eill Eilling ing of ttwins winsCC offeri offering ng v virgi irgins ns in volc volcano ano worshipC female castration6African castration6African culture %& Olog .!rial .!rial marriageAmerican culture -riticisms of 0thical relativism4 5&0thical actions are universally acknowledged to be so (contradicts common beliefs and ordinary experiences in several ways) #&!he sense of *oughtness+ or moral obligation transcends any sociocultural consideration or upbringing '&7t is selfcontradictory and inconsistent  


ore of a theory of knowledge, truth and meaning than of morality -harles Pierce ([email protected]'I5I55) and /illiam ;ames ([email protected]#5I5$)


3elieves that the true and valid form of knowledge is one which is practical, workable, beneficial and useful !he truth of an idea is determined by its conse"uences,, if an idea is devoid of conse"uences results it is meaningless Truth is Truth  is a part of experience that can provide workable guides to practical behavior  Pragmatism is called e!perimentalism e!perimentalism   since it promotes the process of verifying and validating tthe he verity of of truth ;ohn Dewey ([email protected]5I9#) believes that ieas are ieas  are also instruments of action and tools for solving problem instrumentation(if instrumentation (if ideas are prove to be effective instrumentstrue) 7deas are also instrument in reconstructing experiences reconstructivism 7deas are true if and when they help an individual progress grow and develop intellectually,, as well as morally through intellectually his own experience and selfactivity6 selfactivity6  progressivism

-ritics for Pragmatism4 materialistic (the cash value of an  ery materialistic idea), very individualistic, very subective


 A man man shoots a neighbor8s dog in in secret since he thought it was harmful in the neighborhood, chased passers by and places motor at risk for accidents6situation accidents6situati on ethics

Deo Deonto ntolog logica icall !heori !heories es (D (Duty utyor orien iented ted))  !his theroty emphasi"es that an act is good only if it springs springs from good will& will& !he act is  udged to be good ifif the fundamental principles of the act redeemed to be good regardless of the conse1uences of the act  !his theory holds that because unforeseen

A. *ANT+ S ETHICS  #7mmanuel Eant (5?#%[email protected]$%) ’

A))lications o! the ethical theories" •

 A suicide suicide bomber agrees to to blow the bomb attached to him to kill the senator and stop his corrupt activities in the country (0thical relativism) !he nurse removes the tubes of a #year comatose patient at he family8s re1uest owing to decreasing financial resources to sustain the patient8s life (pragmatism, situation ethics) >aving a life of of a patient (blo (blood od transfusion) to a patient who refuses (;ehovah8s witness)6 0thical relativism Divorce is ustified by parents, who for the love of their children, do not want them to be affected by their constant 1uarrels >ituation ethics, pragmatism  A decision decision in the busi business ness transaction is good good when it augments the income of the company (pragmatism)  An A2P A2P nurse s sees ees an :PA :PA rebel wounded in battle& istory told that the nurses8 father who was a soldier was once tortured by :PA8s in the mountains and eventually was beheaded& !he nurse rescue the rebel and s provided medical assistance6situation assistance6situati on ethic  A nurse8s nurse8s husband is in in the ward of a hospital and listed at number # in the reservation list& A patient reserved in number 5 is given priority over the husband6situati h usband6situation on ethics

circumstances cannot always be controlled, people should not be held responsible for the conse1uences of their actions because the act was performed with good intentions and the outcome was not due to negligence 3elieves that morality is derived from rationality, not from experience, and that obligation is grounded not in the natur'e of man or in world circumstances but in pure reason

Eant maintains that one acts morally if and only if one does whatever one is obliged to do from a sense of duty or obligation  A categorical imperat imperative ive or unconditional command must be applied similarly in all situations without exception (niversability) (niversability) Decisions are based on the unchanging principles derived from universal values and considered separately from conse1uences  Always act so so as to treat huma humanity nity either yourself or others, as an end never only as a means =!70refers =!70r efers to the duty to perform, determine morality regardless of conse1uences Dut#,, is that which an individual ought to Dut# do, do, despite the inclination to do soC doing what one is obliged to do6duty also known as o$ligation  Act done %N A&&O'D with duty  done out of the desire to so or fear of accusations  :onmoralC has no moral significance  Act done ('OM A SENSE of SENSE of duty  <ecogni"e that there is special obligation because of the relationships  <ightness or wrongness of an action is determined by the =!70refers =!70r efers to duty that one 

ought perform 0ntailstoan oughtness that must be performed irrespective of the results, at all times and in all places


&ategorical imperati)e imperati)e the kernel of Eant8s ethical theory6one must test the act8s uni)ersalia$ilit# imperati)e+mandates an  &ategorical imperati)e+mandates action without any condition whatsoever and without regard to the conse1uences that such action may yield   An obligation that that must be applie applied d irrespective of results, at all times and in all phases  orally legitimate and ust  H#pothetical imperati)e  andates an action in reference to a corresponding condition or limitation performed from a sense of prudence  0xercise sound udgments in practical matters  (ormulation o, categorical imperati)e: 5& Act on only ly on tthat hat maxim maxim w which hich yo you u can at the same time will to become a universal law #& Alw Always ays act so as to to treat h humani umanity ty,, either yourself or others, as an end and never as only means+6Eant8s principle of ustice  <ationality, in Eant8s view, confers upon every person an intrinsic worth and human dignity  0very human being, therefore because she.he is rational creature, has an inherent value and dignity which is not determined by one8s profession, upbringing or financial capability  - t#pes o, uties: 5& Perfe Perfect ct duty w which hich one m must ust always always observe irrespective of time, place, or circumstances (categorical imperative) #& 7mper 7mperfect fect du duty ty whi which ch is onl only y observed observed on some occasions based on choice (ypothethical imperative) Principles:  Autonomy se lfregulating ng  !he autonomousC selfregulati will  A per perso son8 n8s s in inde depe pend nden ence ce,, self self reliance, selfcontained capacity to make an oral decision by and for himself   'especting autonomy 'especting  autonomy is done with the notion that every person are ends in themselves and are capable of making their own moral decisions  !o tr trea eatt an in indi divi vidu dual al mere merely ly as a means means is  is an infarction of

Eant8s concept of autonomy Meical conte!t (5) (5)  yi ying ng is A/AJ /AJ> wro wrong ng,, no no matter what the conse1uences are

(#) (#) D Dut uty y tto o ttre reat at ou ours rsel elve ves s as as ends and to preserve dignity and worth as human beings6 refusal of surgical treatment to preserve life is morall# un.usti,ia$le (')A (')Act ctio ion n iis s ri righ ghtt an and d lleg egit itim imat ate e insofar as it satisfies the categorical imperative (%) (%) Eant Eant8s 8s di dist stin inct ctio ion n be betw twee een n perfect and imperfect duties suggests that some rights

should be recogni"ed -ritics of Eant4 !he exceptions less character (categorical imperative) of Eant8s philosophy makes it too rigid for real life orality cannot be derived from pure reason !he disregard of the conse1uences of our actions can lead to disastrous results 0ven though nonhuman animals feel pain and pleasure for Eant they do not have any independent moral standing since they are not rational beings 7t is possible to be b e faced with conflict between two duties e1ually supported by our imperative Problem with man8s rationality and nonautonomy •

Eant8s <esponses to -riticisms !o believe that one needs e exceptions xceptions is to regard experience as control to humanity which is metaphysically incorrect !hat morality is indeed the basis of morality becomes clear if we imagine someone who has her pain receptors impaired so she does not feel pain Disregarding conse1uences does sometimes lead to unhappiness but the world is full of unhappiness and even death the complaint is not really against Eant8s morality but against the suffering in the world •

Eant against animals, buthas the rules source of our the dutymistreatment to animals isofindirect Eant responds in two ways& 2irst, there is often a way out of an apparent dilemmasC second, life may very well be tragic in that we are sometimes obliged to violate the law&

,. Ross oss eth ethic ics s    

 

/illiam David <oss ([email protected]??) -onsiders Eant8s absolute principles to be too rigid <oss has reected the utilitarian precept oral rules serve as moral guidelines in such a way that they must be adusted or modified, if not set aside in some situations, depending upon our situation of what is right and what is good <ightness belongs to acts, independent of motives oral goodness belongs to motives


 is that which is done  while an !"#O$  an !"#O$     !"  is is the doing of an act   ctual duty   <ea <eall dut duty y in a given given s situ ituati ationC onC itit is the the action action one ought to choose from among many other actions  !he act action ion one oug ought ht to choo choose se a amon mong g many other actions  %rima facie duty &at first view'  Direc Directs ts or or co comma mmands nds what what one oug ought ht tto o perform when other relevant factors are not taken into account !wo o principles to resolve cases of conflicting duties  !w 5& Act iin n acco accorda rdance nce with with th the e str strong onger er,, more more stringent or more severe prima facie duty #& Act in accorda accordance nce with with the p prima rima facie duty duty,, which has a greater balance of rightness over wrongness compared to other prima facie duties  !he ultimate guide in particular cases of conflict on rightness and wrongness of an action is determined based on moral intuition6 intuitionism  0 Prima ,acie ut# 1 Du Dut# t# o, ,i ,ie eli lit# t#22 one8s loyalty to a worthy cause - Du Dut# t# o, re repa para rati tion on22duty to make amends for inury inflicted to others 3 Du Dut# t# o o,, gra grati titu tue e22 duty to appreciate and recogni"e the services others done for us 4 Du Dut# t# o, .u .ust stic ice2 e2proper proper distribution of social benefits and burdens 5 Du Dut# t# o, $e $ene ne,i ,ice cenc nce2 e2enoins enoins not only to bring about what is good for others but also to help them better their conditions with respect to virtue, intelligence, or comfort 6 Du Dut# t# o, sel sel,2i ,2impr mpro) o)eme ement nt22duty to improve and develop ourselves with respect to virtue, intelligence, and happiness 0 Du Dut# t# o o,, no nonm nmal ale, e,ic icen ence2 ce2*not *not inuring others+ Difficulties Difficul ties with <oss 0thics 7ndividual8s differ from each other8s moral perceptions, so, <oss8s duty principle varies from one person to person as a result of following one8s own moral perception of a *duty+ <oss did not give impression as to how to solve conflicting two prima facie duties as to which of the two has the greatest balance of rightness over wrongness

would not have any specific information (sex, race, natural abilities, social status, or economic conditions) regarding those involved thus choosing the alternative for the most disadvantaged persons Theor# o, 7ustice A 0very individual is inviolablenot even the general welfare of society can override and a nd supersede this inviolability 8  An erroneous theory is is tolerable in tthe he absence of a good oneC and as much as possible, one should choose the better (less erroneous) law when given two (erroneous) laws & 7ndividual liberties should be restricted in order to maintain e1uality of opportunities  <awl8s twofold principle of ustice 5& 2i 2irst rst,, e1ual e1ual a acce ccess ss tto o the basic basic hu human man right and liberties #& >ec >econd ond,, fai fairr e1u e1uali ality ty of oppor opportun tunity ity and and the e1ual distribution of socioeconomic ine1ualities  ;ustice in uman <elations4

2our types4 5& 2ai 2airne rness ss in in our dea dealin lings gs w with ith othe others rs #& 2 idspec eliect ty t ffor '& <e <esp or pers person ons s %& 3eneficenc nce e 

:atural duties 5& !he !he dut duty yo off us usti tice ce #& !he duty duty of help helping ing others others in ne need ed or in in  eopardy '& !he duty duty not not to har harm m or in inure ure others others %& !h !he e duty duty tto o ke keep ep our our p pro romi mise ses s Di,,iculties: 7ts account of hypothetical community under the *veil of ignorance+ seems to contradict his notion of ustice as fairness Despite his obection to utilitarianis utilitarianism, m, his •

concept of ustice likely parallels to the utility principle (principle of greatest number)


c. Ra-l8s theor o! social e/uit and 0ustice   

;ohn <awls e has built on Eant8s and <oss8s fundamental notion of the ultimate dignity of human beings ses social morality as the basis of social

<ational people would choose a strategy   ustice

whose worst possible result would be better than the other alterations *eil of ignorance+ concept or the *original position+6whereby position+6w hereby persons making choices

 

=bectivism  Also called !homistic !homistic ethics ethics after >t& !homas A1uinas (5##95#?%) or >cholastic ethics -laims that there exists a natural law which is manifested by the natural light of human reason, demanding the preservation of the natural order and forbidding its violation !he divine law expressed in human nature 0&g& life, reproduction6*do not disrupt the natural ways. order of the world+   >tems fro the divine law 7n this view, the source of moral law reason itself (reason recogni"es the basic principle)


 *Do good, avoid evil+ethics is grounded

his body only as the general wellbeing of the whole body re1uires it  /e have a natural obligation not only to preserve our lives but also to preserve the integrity of our bodies

in our concern for human good+  >ynderesisinherent capacity of an individual to distinguish the good from bad through reason and reflection 

Other Moral Principles 9ner Natural La Ethics 5& >tew >tewardshi ardship p declar declares es that life life comes from from God and humans are mere stewards.caretakers and not the master of his body

oice of right reason or voice of oice conscience  <egar <egard d righ rightt reason.vo reason.voice ice of rreason eason as the moral norm, insofar as an individual8s capacity to determine what is right from what is wrong is no

#& 7nviolability of life6states life6states that that life is God8s God8s and has been loaned to us, hence it is inviolable and sacred '& >exu >exuality ality and procr procreatio eation6(5 n6(5)) procreat procreation ion and nurturing of children, (#) expression e xpression of loving union and companionship

less than the manifestation of moral law  =the =therr view it as a voice of conscienc conscience e referring to the immediate udgment of  practical reason applying the general principle of morality to individual concrete actions or decisions morally right whey they are in   Actions are morally accord with our nature and end as human beings  an8s 'fold natural inclinations4 5& >el >elfp fpres reserv ervati ation on #& ;ust deali dealing ng w with ith o others thers '& Propa Propagati gation on of our speci species es  ' Determinants of moral action (ust all be good) 5& !he ob obect6o ect6obect bect of tthe he moral ac act4 t4 thing or action #& !he circ circumsta umstances nces con conditio ditions ns which, which, when superadded to the nature of moral act, will affect its morality  -o -ond ndit itio ions ns th that at affe affect ct (aggravate or mitigate) the morality of an act  /ho /hoFw Fwha hatF tFwh wher ereF eF 3y what what meansF /hyFowF/henF '& !he e end nd of the age agent nt  Purp Purpos ose eo off tthe he do doer er or ag agent ent  Af Affec fects ts goodne goodness. ss.bad badnes ness s of an action  Dou$le E,,ect Principle

nder certain conditions, some evil effect may be permitted to occur so long as it meets these % conditions4 5& !he act action ion dir directl ectly y intended intended must must be good in itself, or at least morally indifferent #& !he goo good d effec effectt mus mustt follo follow w from tthe he action at least as immediately as the evil effect '& !he for foreseen eseen ev evilil effect effect may not not be intended or approved but merely permitted to occur  %& !her !here e must be be proporti proportionate onate and and sufficient reason for allowing thethe evil effect to occur while performing action  Principle o, Totalit# cutoff,   An individual has the right to cutoff, mutilate or remove defective parts of

=n :atural aw 0thics, it is morally wrong to4 1  Allow babies with with serious birth deformities.defects deformities.defec ts to die - asten death of a persona as direct and primary intention 3 Perform acts that terminate lives of the incurable, either by taking steps to bring about their deaths or by failing to take steps to prolong their lives through ordinary treatment Di,,iculties:  :aturalists ground on the Aristotelian assumption of an organi"ed universe the goal or purpose contradicts the contemporary evolutional theory  -onscience is not a reliable norm of reality because it differs from individual to individual 3irtue Ethics  3y philosopher AristotleC he suggested a different solution than the actioncentered ethical systems of duty reasoning oriented and conse1uenceoriented by focusing not on the particular action but rather on the 0A<! of the moral agent  e follows aretaic ethics (Greek cuete, excellence or virtue)  irtue ethics focuses on the heart of the moral agent making the decision rather than the reasoning to a right action  2ocuses on the sorts of characteristics, traits, virtues that a good person should have -riticisms4 irtue ethics generally does not provide specific directions in regard to decisionmaking •

7n that virtue ethics relies on traditional practices, it does not 1uickly respond to changes in the practice that re1uire new sorts of moral responses


!he derivation of duty from one8s social role is likely to lead to perpetuate pe rpetuate classic sexism and paternalism !he traditional emphasis makes morality depend on past experience rather than reason& !his environment provides little respect or personal autonomy or the use of reason in moral  udgments Practitioners often find themselves attempting to address more than one set of ideali"ed roles, which may come into conflict irtue ethics often yields results that do not maximi"e happiness

<esponses to criticisms4 /hile it is true that virtue ethics does not give specific directions, it does not have to , for virtue ethics is concerne ith character , not action irtue ethics takes it as a good thing that it does not change 1uickly in response to whims of the masses /hile virtue ethics does not emphasi"e the rationality of the individual decision maker, it does not rely on higher reason4 the wisdom of ages •

2ramework for 0thical Decision Hmaking 5& 7de 7denti ntify fy the ch chara aracte cteris risti tics cs of the pr probl oblem em #& Ga Gath ther er the the fac facts ts o off th the e ca case se '& %& 9& B&

0xam 0xamine ine the opti options ons with with init initial ial credibili credibility ty /ei /eigh gh and and evalu evaluate ate p pote otenti ntial al optio options ns ak ake e your your decisi decision on and act on it Ass Assess ess and eva evalua luate te the res result ults s Ethics and human acts •

4 Di Di)i )ine ne & &om omma man n ethi ethics cs  !here is a divine being who has set down a finite series of rules that adherents claim can provide guidance to most, if not all, moral decisions  0xample, 5$ commandments which provide rules against stealing, adulteryK  -riticisms4 -ommand theory assumes belief in either divine beings or exemplary individuals& !o the extent that these can be 1uestioned, so can the theory -ommand theory can not cover all possible cases of moral decisions •

-ommand theory generally have *no exceptions+ clause, either explicit or implicit -ommand theory has what maybe called *0uthypro problem+ from the Platonic dialogue from which it originated <esponses4 /hile there is no convincing response to the first criticism when dealing with unbelievers, the supposition of a divine being or exemplary being is unproblematic when dealing with unbelievers !he response is simply to argue that the 1uestions of interpretations are not insurmountable& 7t is believed that the very need for exceptions to revealed truth is a sign of  a decadent time and perhaps a greater  •

adherence to the rules will lead to a more morally sound society  A command command theorists coul could d argue that there are reasons behind a religious moral inunctions but that we are unable to completely fathom the  ustification due to our personal limitations&

uman actsacts which are done with knowledge and full consent of the will  Acts of manacts performed /7!= /7!=! ! knowledge and full consent of the will incible 7gnoranceignorance 7gnoranceignorance that can be overcome by exerting some effort 7nvincible ignorance ignorance that can hardly be removed even if one overcoming it 0rroneous conscience a situation where one8s conscience errs or is mistaken  Actions can be done in good or bad faith faith

Bioethics2ethics o! li!e Bioethics2ethics 0thics of medical care 3ranch of applied ethics which investigates practices and developments in the life sciences and.or biomedical fields Deals with predicaments concerning life, health and death that have resulted from modern biological technology particularly the way they have affected human lives • •

E$olution o! ,ioethics orality growing out of human relationships edical ethics and the ippocratic oath <esearch ethics and the :uremburg code (attempted to humani"e the cruel and barbaric nature of human experimentation) • • •

3That i! ou con!ess -ith our mouth4 35esus 35esus is Lord64 and ,elie$e in our heart that 'od raised Him !rom the dead4 ou -ill ,e sa$ed.6



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