Philosophy 2803 – Lecture II

1. Philosophy 2803 – Lecture II Introduction to Ethical Theory

2. Why Survey Ethical Theory At All? • Different Aims in Different Courses • In a course on ethical theory • In order to investigate what the correct theory is • In a course like this • In order to acquire some tools to work with • The survey identifies a number of perspectives that should be taken into account when considering ethically difficult cases

3. Relativism vs. Objectivism Again • Last week, we primarily considered moral relativism • Remember relativism is not just a descriptivetheory. It’s a normative theory. • It claims not just that people’s moral beliefs differ, but that all there is to the moral facts is the beliefs held in a particular culture. • What’s right = what a culture believes is right • This week we’ll focus on objectivism

4. Moral Objectivism • 'Moral facts' are like 'physical facts'. • What the facts are is independent of what anyone thinks • They have to be discovered like the laws of physics • Discovery may be difficult (again, compare to physics) • Note: Believing in objectivism doesn’t mean you know what the moral facts are

5. Why Focus on Objectivism? • A glib answer: • Our culture places importance on justifying our moral beliefs. • It says we should, morally speaking, defend those beliefs. • As such, even if relativism is true, it seems we’re morally obligated to defend our beliefs as though there were objective facts to uncover

6. What Are the Objective Facts? • Suppose for the moments that objectivism is true. What are the objective facts of morality? • Three Candidates: • Consequentialism • Deontological Theories • Principilism • See text for other examples

7. Case #1 • X, an emergency room physician, happens upon a roadside accident. A car has crashed leaving 4 people seriously hurt • After calling 911, X begins examining the injuries of the 4 people • All are in danger of dying if they don’t receive immediate attention. • A quick examination reveals that one person, K, will require so much attention the other three may well die before he finishes treating K • If K is left until last, his life is in serious danger, but X will likely be able to save the other three

8. Consequentialism • Consequentialists maintain that whether an action is morally right or wrong depends on the action's consequences.  • In any situation, the morally right thing to do is whatever will have the best consequences. • E.g., save 3 people, rather than 1 • Consequentialist theories are sometimes called teleological theories.

9. What Kind of Consequences? • Consequentialism isn't very informative unless it's combined with a theory about what the best consequences are. • E.g., Creedism = consequentialism + the theory that consequences should be assessed in terms of how they reflect on the career of Creed Good for Creed = good consequences

10. Utilitarianism • Utilitarianism is the most influential variety of consequentialism • The 'Founders' of Utilitarianism • Jeremy Bentham (1748-1832) • John Stuart Mill (1806-1873) • The Basis of Utilitarianism:  ask what has intrinsic value and assess the consequences of an action in terms of intrinsically valuable things.

11. Jeremy Bentham

12. Intrinsic vs. Instrumental Value • Instrumental Value - a thing has only instrumental value if it is only valuable for what it may get you • e.g., money • Intrinsic Value - a thing has intrinsic value if you value it for itself • i.e., you’d value it even if it brought you nothing else • It may, however, also possess instrumental value • What, if anything, has intrinsic value?

13. What Has Intrinsic Value? • What Utilitarians Think Is Intrinsically Valuable:  happiness • Actually, not all utilitarians agree that happiness is quite the right way of putting this.  • Other suggestions include satisfaction, well-being, pleasure. (See text) • Each variation yields a slightly different theory • For now, the general approach is what matters

14. The ‘Greatest Happiness Principle’ • "actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.“ (John Stuart Mill) • In other words, judge an action by the total amount of happiness and unhappiness it creates • Note: this means the total happiness (and unhappiness) of everyone affected

15. Act vs. Rule Utilitarianism • Notice that the GHP is a little vague.  • it's not clear whether Mill means • (i) an action is right if this sort of action tends to promote happiness or • (ii) an action is right if this particular action will promote happiness. • If you believe in version i, you're a Rule Utilitarian. • If you believe in version ii, you're an Act Utilitarian.

16. Case #2 • X has inoperable lung cancer that is unresponsive to chemotherapy & radiation therapy • X will most likely die within one year • X’s physician believes X could not handle this news • X’s physician decides to lie about the diagnosis for a while in order to ‘buy X a little more time’

17. Deontology • 'Duty Based' Ethics • Deontologists deny that what ultimately matters is an action's consequences.  • What matters is the kind of action it is. • What matters is doing our duty. • Identify principle(s) from which our duties arise

18. Kinds of Deontological Theory • There are many kinds of deontological theory • e.g., ‘The Golden Rule' - "Do unto others as you'd have them do unto you." • Deontological theories may be identifed as monist or pluralist depending on the number of fundamental principles of duty the theory identifies • Monist = 1 • Pluralist = more than 1 • See text for examples of pluralism

19. Kant • Immanuel Kant (1724-1804) is the most influential deontologist. • Rejecting Consequentialism "A good will is good not because of what it effects or accomplishes." Even if by bad luck a good person never accomplishes anything much, the good will would "like a jewel, still shine by its own light as something which has its full value in itself."

20. The Categorical Imperative • Kant claims that all our actions should be judged according to a rule he calls the Categorical Imperative.  • First Version:  "Act only according to that maxim [i.e., rule] whereby you can at the same time will that it become a universal law." • E.g., telling a lie whenever you need to borrow money is morally wrong because this sort of act is not ‘universalizable’.  • If everyone acted this way, the whole practice of promising to repay a loan would collapse.

21. The Second Version of the C.I. • Second Version (The “practical imperative”): “Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means.” • Note: Kant is a monist since he thinks both versions of the C.I. ultimately say the same thing • This means there are certain ways we must not treat people (no matter how much utility might be produced by treating them in those ways) • E.g., don’t lie to a patient

22. The Second Principle & Medical Ethics • The second principle has been very influential in medical ethics • A ‘medical’ reading of this principle • it is necessary to treat people as autonomous agents capable of making their own decision

23. Autonomy • A central element in many deontological theories is the idea of autonomy • Autonomy = self + rule • Autonomous decisions are ones which you make for yourself for your own reasons (ideally, your own well-informed reasons) • By respecting your autonomous decisions, we respect you as an ‘end in itself’

24. Group Work 1. List the strengths of deontology 2. List the weaknesses of deontology 3. List the strengths of consequentialism 4. List the weaknesses of consequentialism

25. Strengths of Consequentialism • Practical, Results-oriented View • Relatively clear how to make ethical judgments • simply reflect on consequences

26. Weaknesses of Consequentialism • How can we know all the consequences of an action? • How can we compare utility from person to person? • Do we include all generations?  All species? • Will utilitarianism lead us to ‘repugnant conclusions’? • In theory, any kind of action could be justified if the consequences of the situation work out just right.

27. Strengths of Deontology • Sets clear moral boundaries • Some things just can’t be done • Possibility of multiple principles allows for flexibility • Only on pluralist versions of deontology

28. Weaknesses of Deontology • If we don’t rely on consequences for moral justification, then can we find a convincing case for identifying basic moral principles? • Deontology’s basic approach is not as simple as consequentialism’s • Deontology can seem overly ‘legalistic’ • i.e., too focused on rules • too inflexible

29. The Point • Considerations raised by both theories are worth taking seriously • We’ll close by considering a theory that tries to encompass both: principilism

30. Principilism • Principilism attempts to have it both ways • Popularized by Beauchamp and Childress • Principles of Biomedical Ethics (1979) • The ‘Georgetown Mantra’ • Now the dominant theory in medical ethics

31. Four Principles • 1. Autonomy • 2. Beneficence • 3. Non-maleficence • 4. Justice • The text might call this a pluralist deontological theory since it endorses a number of fundamental principles • I disagree. Conditions 2 & 3 identify this as a hybrid of consequentialism and deontology

32. The Principles • 1. Autonomy • The autonomy of patients (families, co-workers, etc.) must be respected • 2. Beneficence • Help others (i.e., benefit them)

33. The Principles • 3. Non-maleficence • ‘Do no harm’ • 4. Justice • “fair, equitable, and appropriate treatment in light of what is due or owed” (Beauchamp & Childress, 2001, 226) • Treating like cases alike

34. Assessing Principilism • Note: while this is the orthodox theory in medicine these days, it’s not the be all and end all of medical ethics • Principilism’s virtue: takes consequences and principles seriously • Principilism’s vice: how do we balance consequences and principles when push comes to shove? • This is a question we’ll confront numerous times in this class

35. The Point (Again) • As noted, we will not attempt to settle the question of which ethical theory is correct • Think of the theories discussed tonight as identifying viewpoints that must be considered when taking a stand on issues in medical ethics • We must be prepared to consider challenges to our views and arguments from these viewpoints