The field of ethics is broad encompassing a large discourse of conversation within the scope of philosophy. Modern day health care providers routinely deal with objective measures and evidence-based medicine. The challenge to these providers is that ethics is less objective, less black and white, and fraught with issues of morals and morality. Thus, any discussion of ethics must begin with a strong definition and a brief historical perspective.
Broadly defined, ethics is the explicit, philosophical reflection on moral beliefs and practices. Ethics is a conscious stepping back and reflecting on morality. Ethics, a field of study in philosophy, has historical roots back to Plato in 329 BC. Though philosophers through the centuries have debated ethical issues and moral philosophies, to this day we continue to have debates of right and wrong; moral and immoral; ethical and not ethical. Thus, this course will seek to provide a basis for clinicians to evaluate moral problem solving and ethical dilemmas within the rehabilitation practice.
Modern philosophers generally divide ethical theories into three general subject areas. They are:
Metaethics investigates where ethical principles come from and what they mean. It attempts to answer the questions of whether ethical issues are merely social inventions or an expression of individual emotions. Metaethics focuses on issues of universal truths, the role of reason in ethical judgments and the meaning of ethical terms. Normative ethics is more practical and easier to comprehend. It looks to the development of moral standards that regulated right and wrong. Applied ethics involves examining controversial issues through the use of conceptual tools of metaethics and normative ethics. Discussions in applied ethics attempt to resolve controversial issues. Thus, distinct lines between each of the three may blur and overlap. Nonetheless, this home study will outline each of the three with a focus on applied ethics as moral issues in physical therapy tend to be within controversial issues of modern day medicine.
Metaethics investigates the origin and meaning of ethical concepts. Due to its breadth and depth, it is the least precise of the three types of ethical theories. The term “meta” means after or beyond. Thus, the notion of metaethics involves a view of ethics from a 20,000 foot level. Within metaethics are two prominent issues:
A. Metaphysical issues – dealing with whether morality exists independent of human beings;
B. Psychological issues – concerned with the underlying metal basis of moral judgments and conduct.
Metaphysical issues discuss whether moral values are eternal truths that exist in a spirit-like realm, or simply human conventions. Metaphysics is often referred to as an “eternal law” where god, an all powerful spirit is in control of everything in the world. Metaphysics basic belief in an external force that wills human life into existence has been a controversial topic since the time of ancient Greek philosophers beginning with Plato. Thus, this is a topic that physical therapists should be aware has been a founding block of ethics and one that has yet to be resolved to any culture’s satisfaction.
The second, more worldly approach to metaphysical status of morality follows a more skeptical philosophical tradition that traces its roots back to another less well-known Greek philosopher, Sextus Empiricus. This view holds that moral values are not objective and do not come from spirit-like objects or divine commands. Rather, philosophers that hold this viewpoint argue that strictly human inventions create morality.
This metaphysical viewpoint is termed moral relativism. There are two distinct types of moral relativism. The first is individual relativism meaning individual people create their own moral standards. The second is cultural relativism that states that morality is grounded in one’s culture or society. This viewpoint is popular as it allows for discussion of values that differ dramatically from one culture to another. Examples of this are attitudes toward polygamy, homosexuality, and end-of-life decisions.
The second generally recognized ethical subject area is normative ethics. Normative ethics is considered more practical than metaethics. This area looks at how one arrives at moral standards that regulate right and wrong. Articulating habits that one should acquire, duties to follow, or consequences of behavior are all covered in normative ethics.
The Golden Rule (Do onto others as one would have others do onto you) is a classic example of a normative principle. The Golden Rule establishes a single principle against which society judges all actions. Other normative theories focus on a set of foundational principles or a set of good character traits. To create such principles, normative ethics may be described through a set of three strategies. These strategies are known as:
Virtue theories place an emphasis on developing good habits of character. Less precise than defined rules of conduct such as “don’t kill,” or “don’t steal,” virtue theories emphasize moral education. Historically, virtue theory is one of the oldest normative traditions in Western philosophy tracing roots back to ancient Greek civilization. Plato defined four virtues in his work that have become known as the cardinal virtues. The four are wisdom, courage, temperance, and justice. After Plato the virtues of fortitude, generosity, self-respect, good temper, and sincerity were added. In addition to advocating development of good characteristics, virtue theories also include the avoidance of bad character traits, termed vices. Vices are defined as cowardice, insensibility, injustice, and vanity.
Duty theories are based on principles of obligation. For example, we are obligated to care for the ill or the young. Tracing roots back to the Greek too, duty theories are considered foundational theories. The 17th century German philosopher Samuel Pufendorf is credited with the first real development of duty theories. His work classified duty theories into duties to God; duties to oneself; and duties to others. Another 17th century philosopher, Britain’s John Locke, added to this area of ethics by adding his “rights theory.” Thomas Jefferson built upon Locke’s rights theories by defining three foundation rights in America. These rights stand today as the right of life, liberty, and the pursuit of happiness. These rights have four features. They are natural, universal, equal, and inalienable. Thus, much of the United States’ Declaration of Independence is based in duty theory.
It is common to determine moral responsibility by weighing the consequences of one’s actions. For example, is drunk driving without hurting someone more moral than a drunk driver who kills an innocent bystander? In both examples, a person was driving while under the influence of alcohol. However, situations differed in that another person became involved. In consequentialist theory, the driver who hurt another would be considered a less favorable outcome and therefore judged more severely.
The consequentialist theory requires that one consider both the good and bad consequences in an action. Second, one must then determine whether the total of good outweighs the bad. If the good are greater, then the action is morally proper. If the bad are greater, than the action is morally improper. Since the end result of the action is the dole determining factor of morality, consequentialist theories have fallen in disfavor in the 20th and 21st centuries. These theories were widely popular in the 18th century with philosophers who wanted a quick way to morally assess an action by appealing to experience, rather than appealing to gut intuitions, or long lists of questionable duties.
The third concept area is applied ethics. Applied ethics examines controversial issues such as abortion, infanticide, animal rights, environmental concerns, homosexuality, capital punishment, or nuclear war. By using conceptual tools derived from metaethics and normative ethics, applied ethics attempts to resolve controversies or at least find a common ground for intelligent discussions. In more recent years, applied ethics has been subdivided into more convenient groups such as medical ethics, business ethics, environmental ethics, and sexual ethics. The rest of this course will concentrate on medical or health care ethics. However, briefly, applied ethics generally has two distinct features. First, the ethics issue needs to be controversial and second the issue must be distinctly a moral issue.
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