Principles and Values in

Biomedical Ethics

William Sweet

© William Sweet, 2014-2016

TABLE OF CONTENTS

Chapter 1 - What is ethics?

Chapter 2 - Theories about ethics

1. Relativism, Subjectivism, and Conventionalism

2. Egoism

3. Legalism

4. Amoralism

5. Discussion questions for Chapter 2

6. Bibliography

Chapter 3 - Ethical theories

1. Religious Theories of Ethics

2. Rights-Based Ethical Theories

3. Consequentialism (Utilitarianism)

4. Deontological Ethics

5. Virtue Ethics

6. Ethics of Care

7. Natural Law

8. Concluding Remarks

9. Discussion Questions for Chapter 3

10. Bibliography

Chapter 4 - Ethical values in professional life

1. Ethical values

2. Doing good (beneficence)

3. Recognizing dignity

4. Being just

5. Recognizing autonomy

6. Respecting privacy and confidentiality

7. Acting with integrity

8. Living one's values vs. Imposing values

9. Ethical failure

10. Concluding REmarks

11. Discussion questions for Chapter 4

12. Bibliography

CHAPTER 1

WHAT IS ETHICS?

Outline

Aim: to explain what ethics is, and to situate its relevance to health and

medicine

1. Ethics is a subfield of philosophy

a. Philosophy as a rational, critical and speculative science

2. Ethics is focussed on human conduct

a. Some definitions and their common features

b. Kinds of ethics: normative ethics and meta-ethics

c. The distinction between ethics and morality

d. Personal and professional ethics

e. Codes of ethics

f. Conflicts between personal and professional ethics

3. Making ethical decisions

a. What are we focusing on or evaluating in making ethical

judgements and decisions?

b. Templates of ethical-decision making

4. The relation of practice to ethical principles and ethical theories

5. The value of education in ethics for professional practice

a. The purpose of the study of ethics

b. Understanding and responding to others

6. The characteristics of an ethical theory

7. Concluding Remarks

Reading Questions

1. What is ethics? What is it concerned with? What is its aim?

2. What ’tools’ do we have to carry out such a study and investigation?

3. What is the difference between normative and meta-ethics? Between

ethics and morality?

4. What are some of the characteristics found in examples of good

reasoning?

5. How is ethics part of both personal and professional life?

6. What is the connection between ethical practice and ethical theory?

7. What are the reasons for having codes of ethics? What are the

limitations of such codes?

8. What are the main characteristics of an ethical theory? What reason do

we have for saying this?

9. Explain the difference between an ethical theory and a theory about

ethics.

2 Chapter 1

WHAT IS ETHICS?

1. Ethics is a subfield of philosophy

i) that emphasizes ‘public’ (or ‘natural’) reason

Philosophy – literally, ‘the love of wisdom’ – is the study and

rational investigation of the nature of reality, of how reality is known, and

of the place of human beings in the world. For example, philosophy

traditionally raises such questions as: Are there any limits to human

knowledge? Is reality purely physical and material? How ought people to

lead their lives?, and so on.

To carry out such a study and investigation, philosophy emphasizes

‘public’ (or ‘natural’) reason. By this, philosophers mean that people must

have “the power… to think, understand, and form judgements logically”

(Oxford Dictionary) – that is, the ability to comprehend, infer, or think in an

orderly way. Moreover, philosophers emphasise that, for people to answer

these and similar questions, they must have evidence – that is, information

that all human beings can, in principle, have access to – or be able to show

that the answer follows logically from such evidence.

Philosophy, therefore, does not assume or presuppose the truth of

any religion, ideology, set of values, or source of information that is not

accessible to any informed and intellectually mature person.

The primary tools that philosophers (and that all people who wish

to reason well) use, then, are reason and evidence. Providing evidence and

using reason in a careful way is called, in philosophy, “giving an argument.”

ii) that is critical and speculative

Philosophy is a critical investigation. It is concerned not only with

what people think or believe, but also – and more importantly – with

understanding what exactly people mean by their beliefs, what reasons they

have for holding them, and what they are assuming.

But philosophy also seeks and offers answers; in this respect, it is a

speculative activity. It aims at answering the kinds of questions raised above

(e.g., about the limits of knowledge or the nature of reality), and it claims

that answers to these questions can be arrived at.

iii) that adopts a rigorous approach

Doing philosophy (and any kind of critical or speculative or

scientific reasoning) well requires the development of good judgement. It

also requires having some knowledge of the principles of good reasoning

and argument; these are studied by the philosophical subfield called logic.

There is no complete and exhaustive list of rules or procedures to guide

What is Ethics? 3

people in carrying out these critical and speculative activities. Still, in

examples of good reasoning, the following characteristics are often found:

• thinking about our (and others’) assumptions,

• patiently examining the facts, taking care not to over interpret them

• asking (sometimes, simple) questions about existing views or opinions,

• giving reasons for one’s view,

• ensuring that the reasons given are relevant and provide sufficient

evidence for one’s conclusions,

• carefully considering relevant values,

• weighing evidence for and against

Such an approach enables us to have a clear, justifiable views, and

to make stronger, effective, evidence-based decisions

iv) whose aim is to know what is true or, at least, what we

should reasonably believe.

The study of philosophy and its subfields is not a matter of asking

questions for their own sake, or for which there are no answers. While many

of the questions that philosophers ask are questions that continue to be

asked today, most philosophers would also agree that there are answers –

though, because of the difficulty of these questions, these answers may be

difficult to reach. Moreover, even where we cannot be certain of what the

answer is, we have a responsibility to hold only those views that are

reasonable. The aim of philosophy, then, is not to give a personal opinion,

but to arrive at objective truth, which should be held by all those who think

logically and rationally about the matter.

2. The focus of ethics is human conduct

Defining the word ‘ethics’ is challenging. Here are some definitions from

some popular dictionaries.

i) Ethics can be defined as

a. “the rules of conduct recognized in a particular profession or area of

human life." – New Shorter Oxford Dictionary.

b. “that study or discipline which concerns itself with judgments of

approval and disapproval, judgments as to the rightness or wrongness,

goodness or badness, virtue or vice, desirability or wisdom of actions,

dispositions, ends, objects, or states of affairs” – D.D. Runes (ed), A

Dictionary of Philosophy (New York: Philosophical Library, 1942) /

http://www.ditext.com/ runes/e.html

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c. “an investigation into the fundamental principles and basic concepts

that are or ought to be found... in those systems that are intended to

guide the lives of human beings as human beings" – A. Flew (ed), A

Dictionary of Philosophy (New York: St. Martin's Press, 1979), p. 105.

d. "the practical normative study of the rightness or wrongness of human

conduct as known by natural reason" – A. Fagothey, Right and Reason:

Ethics in Theory and Practice (3d. ed, St Louis, MO: C.V. Mosby,

1963)

e. “a practical and normative science that discovers, explains, and

demonstrates the principles and rules of right conduct.” – A. Fagothey

and M. Gonsalves, Fagothey’s Right and Reason (9th ed, Columbus,

OH: Merrill, 1989)

f. “the study of the meaning and means of living a truly human life”

(Of course, the primary function of dictionaries is to report how

people use a word, not dictate meaning; by themselves, dictionaries are not

the final authority about what something is.)

We can see immediately that the preceding definitions are not

identical, and that they do not all focus on the same concerns. Some deal

with (i) an investigation into concepts; others, with (ii) a study of

judgements that people have made, and are concerned with how to arrive

correctly at such judgements and with whether they have been applied

correctly or legitimately; and others see ethics as (iii) a study (or science) of

rules or prescriptions for conduct – for what one ought to do – and their

applications (judgements).

These definitions, however, do not contradict. Ethics involves all of

these concerns, and all the preceding definitions have a single focus; they all

deal with human conduct.

Moreover, all of these definitions recognise that ethics is a study or

a science. The study of ethics is not a ‘how to’ course. A person can study

ethics without being or becoming ethical, just as a person can study religion

without being or becoming religious. Still, a person who is interested in

developing his or her ethical character should benefit from the study of

ethics.

Ethics is sometimes called moral philosophy, and ‘being ethical’

and ‘being moral’ are generally synonymous. It is true that the term ‘ethics’

often appears when one’s focus is on social norms and procedures, whereas

the term ‘morality’ tends to be used when one’s focus is on the behaviours

of the individual. Nevertheless, in this book, we will take ‘ethics’ and

‘morality’ as synonymous.

ii) Ethics is divided into ‘normative ethics’ and ‘meta-ethics’

One of the things that we notice in looking at the preceding

definitions of ethics is that the study of ethics covers a wide range of topics.

What is Ethics? 5

There are, then, different aspects or subdivisions of ethics. Some of the

topics are “normative”; others are more conceptual or “meta-ethical.”

Normativity is concerned with standards or norms involved in

determining appropriate conduct or action.

‘Normative ethics,’ therefore, deals with the standards of behavior

that people should adopt. In a broad sense, it deals with what ethical

standard people should follow – for example, whether we should use, as

our ethical standard, whatever produces the greatest amount of happiness, or

whatever is our duty, or what God or the gods command, or “the golden

rule” (“Do unto others as you would have them do unto you”), and so on.

But normative ethics also deals with what specifically people

should do: Should people be vegetarians? Should they support abortion? or

capital punishment?, and so on. Such questions are sometimes called

matters of “applied ethics.”

There are, however, some questions about ethics that are more

abstract. They underlie or even go beyond the subject matter of ethics.

These are meta-ethical questions. In general, meta-ethics is the analysis of

the nature, scope, and meaning of ethical terms (as well as of concepts,

properties, and statements), of the foundations of moral principles and

attitudes, and of the distinction between what is moral and what is not.

Here, someone might ask “What does the word ‘good’ mean?” “Is there any

reason why anyone should lead an ethical life?”, and so on.

Though ethics raises questions that are normative, not all normative

questions are ethical questions. Consider, for example, cases where we use

the word ‘good’. We can ask whether a film is good, whether the coffee that

a person is drinking is good, whether a piece of art is good, and also

whether a person – say, Mother Teresa of Calcutta – is good. All of these

are normative questions, but only the latter is an ethical question.

iii) Ethics is present in both personal and professional life

Ethics has a place in our personal and in our professional lives. It is

part of our personal lives so far as most people believe that leading an

ethical life is important for their own, as well as for general, happiness and

fulfillment. But ethics is also part of our professional lives (e.g., in health

care, but also as students, professors, lawyers, engineers, and employers and

employees in general).

Ethics has a place in the lives of every one of us. For example, we

make normative/ethical judgements about ourselves and others (e.g., ‘She

was wrong to do that’; “He got what he deserved”; ‘She is a good person’;

‘You were unfair to me’). We also sometimes discuss ethical issues

(possibly, with the hope or aim of changing someone’s view or, even,

influencing public opinion or policy). We often hear people saying things

like ‘People should be more ecologically minded,’ or ‘The land claims of

native people should be respected,’ or ‘We should spend money on poverty

relief, not war.’

6 Chapter 1

Of course, there is more to ethical life than making judgments.

People generally aspire to be better than they are –they want to do the right

thing, develop the right habits, be thought of as good people, develop a

good character, be more caring, honest, compassionate, loyal, and so on.

But ethics is also part of a person’s professional life. Some

professions exhibit this by having professional codes which are binding on

members of the profession (e.g., Rules of Professional Conduct for lawyers,

Code of Ethics & Standards of Professional Conduct for Chartered

Financial Analysts, The Canadian Medical Association Code of Ethics for

physicians, etc.). In many professions, there is no formal code, but there are

expectations of how one should or ought to behave as a professional. More

broadly, there are also general expectations of what is needed to have an

ethical workplace – that employees and employers should be honest and fair

in their dealings with one another, with colleagues, and with clients; that

people should be conscientious in their work; that they should not engage in

disruptive behavior, lie, or gossip, and the like – even if these are not

formally mandated. Some of these expectations go further – e.g., avoiding

real or apparent conflicts of interest, using resources responsibly,

responding to the genuine needs of clients, reporting inappropriate behavior,

and so on.

iv) Ethics is sometimes expressed in codes of ethics

Codes of ethics are lists of values, principles, and responsibilities,

issued by professional bodies (e.g., ‘colleges,’ professional associations, or

‘societies’), especially ones that are in some way self-regulating. In these

lists or codes we also find, implicitly or explicitly, ethical theories.

There are a number of reasons and purposes why codes of ethics

have been issued. Codes of ethics

• provide general guidelines for practitioners, and are reminders to

practitioners of the expectations of their profession

• are a sign to all (especially the public) of the key values, principles and

the commitments of the profession (and how it reflects a public good or

interest)

• provide the public with knowledge of what they can (minimally) expect

of members of the profession

• guide the profession as a whole in self-regulation

Codes of ethics are not, however, required for ethical conduct and, in any

event, even when they are followed, they may not ensure good ethical

behaviour and decisions.

(As noted above) Formal codes of ethics are not essential for all

professions. There are professions that do not have an explicit code, but

whose practice is governed by a series of conventions or practices that

express basic ethical principles. Moreover, even where codes of ethics exist,

What is Ethics? 7

they are not sufficient to guarantee ethical behaviour. Codes do not, for

example, prescribe specific actions. How to move from what is in a code of

ethics to a particular decision is not always obvious or easy, and

determining what to do involves a process of ethical reasoning.

Moreover, sometimes a person may be ethically obligated to act in

a way that appears to, or does, violate a code, for example, when one’s

professional commitments and one’s broader ethical commitments conflict.

One illustration of this is the phenomenon of whistle-blowing – where a

person’s professional commitment (e.g., to confidentiality) is overridden by

another ethical value (e.g., the wellbeing of the community). Another

illustration is where a person’s professional commitment (e.g., to providing

a service) is in conflict with one’s moral conscience.

It is in situations such as this that ethical reasoning is particularly

important.

Yet even where personal and professional ethics commitments may

seem to conflict, the ethical professional should take care. Sometimes the

conflict is only apparent. And, depending on the situation and the level of a

person’s knowledge, the conflict may be readily resolvable. For example, if

there is a conflict between carrying out a minor promise and fulfilling a

professional responsibility, the professional responsibility will often take

priority. A soldier who, in time of war, has some (but not conclusive)

doubts about the legitimacy of an order, but also limited information about

the matter, may be simply expected to follow the order. But of course there

are cases where a soldier knows or ought to know that an order is unethical,

and so legitimately can – and, arguably, must – refuse to follow it.

This last point reminds us that ethics is more than following the law

or ‘following orders.’ It also involves recognizing the importance of one’s

moral personality and character, such as one’s wellbeing, dignity, and

integrity.

Ethical people, then, live their values consistently and

courageously. Living by your values, however, does not mean that you are

imposing your values on others.

v) Ethics requires analysis, reasoning, and argument

Reasoning ethically requires a knowledge of facts and values, good

reasoning skills, insight, experience, education and training, and the

development of judgement. It is also a skill that should be constantly open

to improvement. For example, it is only over time and through practice that

professionals develop skills such as

• Identifying ethical situations or dilemmas, and the relevant moral facts

• Knowing, understanding, and properly interpreting values, principles,

and codes

• Applying or making decisions based on codes / values / principles

8 Chapter 1

• Developing habits of good reasoning, ‘personal’ judgement, and

character

• Being able, when necessary, to see beyond ‘codes’; challenging codes;

rethinking practices

vi) Ethics involves argument and proof

As ethical agents, we are not only required to explain or justify our

own moral action, but to assess the views and reasons of others. The aim of

ethical reasoning is to know what one ought to do – that is, to arrive at a

reasonable answer. Ethics is not simply a mere ‘matter of opinion.’

How might one assess an ethical argument? What would constitute

a proof in ethics? What would constitute a good argument or reason? There

is no specific mechanism or procedure for doing this. In principle, however,

we can identify some key features of good arguments. The meaning of one’s

statements should be clear, and the statements true and relevant to the issue.

They should also provide sufficient evidence for one’s views. (This might

include pointing out the implications – e.g., undesirable consequences – of

one’s opponent’s views.) If an argument is not conclusive – if it does not

provide good or sufficient evidence – we should be very reluctant to accept

it because there is no sufficient reason for believing the conclusion of the

argument to be true.

When we examine theories about ethics, ethical theories, and the

applications of these theories, we should keep these conditions for a good

argument in mind.

3. Making ethical decisions

There can, of course, be disagreement over what facts and values are

relevant, and about the priority that a person gives to some facts or values

over others. One of the purposes of the present book is to show some of the

different elements that may be involved in making an ethical decision. This

point will be developed later but, for the moment, notice that people focus

on different things in arriving at their ethical judgements.

i) One issue to consider is that, in making an ethical judgement

about an event, what exactly are we looking for or at in the event? What do

we need to know?

If we want to determine the ethical character of an action, we might

look at the person doing it or we might look at the act itself. If we focus on

the act, again, we might look at different things: the consequences of the

action, or something about the act itself, or at the intention (or motive) of

the agent.

What is Ethics? 9

From the above example it seems that, to find out if what someone

did was good, we might look at the act itself (e.g., acting to save a life), or

the consequences of the act (e.g., whether that person actually saved a life),

or her motive or principle (e.g., the reason why she acted). Thus, in certain

circumstances, a person’s act might be a good one, but that that person was

a bad person.

It is clear from this example, then, we need to know all the relevant

facts, but we also need to decide what, in the circumstances, is ethically

most important.

ii) One might also ask how professional ethicists and ethics committees

approach ethical decision-making and whether there are any general

procedures that they might use. Many professional ethics committees have

templates of decision-making. Here is one that is sometimes used:

Recognise the moral dimension of the task or problem

Enumerate the guiding and evaluative principles

Consider the following case:

Jane Jenkins is walking over a bridge that spans a river. As she does

so, she sees her philosophy professor splashing about in the water. She

shouts ‘Don’t worry,’ and she jumps in.

At this point, can we say whether what Jane did was good? (For

example, some people would say that what she did was good – that she

had, for example, a good motive – to save someone’s life. )

Now, suppose that

• the professor was just playing around in the water.

• Jane doesn’t know how to swim.

• she tries to rescue him, but gets too close and is pulled down

by him, and drowns.

• she is not a great swimmer, but is walking alongside someone

who has worked as a lifeguard.

• she hopes to get a reward and some kind of award or medal

for doing this.

Do any of these circumstances – and, if so, which – affect the

judgement that what Jane did was good?

10 Chapter 1

Specify the facts, including stakeholders and their guiding

principles

Plot various action alternatives

Evaluate alternatives in light of principles and stakeholders

Consult and involve stakeholders as appropriate

Tell stakeholders the reasons for the decision1

There are, of course, other ‘templates.’2 Note, however, the

commitment to careful reasoning and the importance of giving reasons.

iii) Ethical reasoning, then, is not just rule following, doing what

you have customarily believed, or even doing what your intuitions tell you

to do. It involves having reasons, and understanding why the reasons you

give are good reasons – i.e., reasons that should be plausible to other

reasonably well-informed, intellectually mature persons. It is also fair to say

that expertise in ethical decision-making is a ‘habit’ developed through

practice over time. Having reasons and knowing the underlying

principles, then, shows that there is a similarity between ethical

reasoning and other kinds of reasoning, such as scientific reasoning.

iv) Viewed in this context, we can see why a reaction to an ethical

judgement – such as ‘Who’s to say?’ – has little relevance in ethics.

Sometimes, when confronted with a situation about which there is

much ethical debate, or with a judgement or view that one radically

disagrees with, a person may say ’Who’s to say’? The question is, however,

ambiguous. If it means something like ‘Who, specifically, should we turn to

in order to get more insight into the issue or to answer the question?’, the

answer is likely to be ‘The experts’ – as it would when raising questions in

any field – and while it may be challenging to determine who are the

experts in ethics, it is not obviously an impossible task. (Or, perhaps, the

‘question’ is simply to express a caution to us not to proceed too quickly –

that we may be supposing things that are not true or for which we have no

reason to believe.) But if the question really means that one doubts that

anyone can provide a rational answer to the question, then this is simply

ethical scepticism. Ethical scepticism may be a possible theory about ethics,

1 This is taken from Michael Yeo, “Ethics and Regional Health

Boards,” in The Ethics of the New Economy: Restructuring and Beyond, Leo

Groarke (ed.) (Waterloo, ON: Wilfrid Laurier University Press, 1998): 125-141.

2 See, for example, that offered in Appendix I:

http://people.stfx.ca/wsweet/Framework-for-Ethical-Decisionmaking.pdf

What is Ethics? 11

but it stops ethical discussion altogether; it eliminates the possibility of a

person coming to any answer at all. For that reason, scepticism has little

place in a study of principles and values in biomedical ethics.

4. The relation of practice to ethical principles and ethical theories

Normally, when people make an ethical decision, they base it on the

insights, experience, training, and the like that they have. Values are also

involved – for example, personal values, institutional values, and

professional values. Yet something else may also be involved, and that is

their view of what it means to do good or be good – their ethical principles.

It may be that a person believes that there are basic moral rules (e.g., that

people should never lie, or deliberately kill another human being), so that

the principle or rule tells a person what she or he ought to do in particular

cases. Or it may be that there is a basic principle (e.g., to love, or to do good

to others, or to promote social well-being), which may mean that sometimes

a person can (or must!) lie or harm another. Or it may be that morality is

somehow determined by the context. Or, again, that there are rules which

apply in most, but not all, situations, that may lead us, for example, to treat

our friends and family differently than we would treat strangers.

What this shows us is that, for many of us, ethics is not just a

matter of facts and values, but also prioritizing values – and this shows that

basic principles or theories are involved as well.

The focus of this book is the principles and values of biomedical

ethics. Principles are universal norms, rules, or laws that are foundational to

a field or discipline (as in the principles of logic). (For other examples here,

consider David Hume’s An Enquiry Concerning the Principles of Morals or

Bertrand Russell’s The Principles of Mathematics.) Values, however, are

different. They are “standards or qualities that are esteemed, desired, [and]

considered important or have worth or merit.” Values can, therefore, be

subjective, and many values may be neither basic nor foundational. While

values and ethical principles have sometimes been taken to mean the same

thing – “core values” have sometimes been called “principles”– values are

better understood as “sets of beliefs about good and bad, right and wrong”

that “serve as a guiding force in life and provide a sense of direction to an

individual in a society,” but that may not have a universal character.

By ‘values’, people have in mind things such as: dignity, non-

maleficence (or “do no harm”), beneficence, autonomy, justice, and fidelity

or accountability. By principles, people have in mind rules such as ‘never

treat anyone merely as an instrument to your goals, but always as a being of

inherent worth’, ‘promote the greatest happiness of the greatest number’,

‘thou shalt not kill,’ and so on.

A person may change his or her prioritization of values, the values

themselves, and even underlying principles, depending on how they carry

out into practice. Developing one’s ethical judgement and abilities, then,

12 Chapter 1

may involve a dialectical process – with our practice modifying our theories

and our theories modifying our practices.

5. The value of education in ethics for professional practice

The aim of the study of ethics, then, is primarily:

• To know and understand ethical principles and values, the reasons for

them, and their limitations (if any);

• To assist in making reasoned, ethical decisions and judgements;

• To meet the ethical demands of our lives, including our professions, by

acting on these values and principles.

A number of institutions have ‘statements of values.’

One example is that of the Ottawa Hospital, in Ottawa, Ontario. (The

hospital is made up of the former Grace Hospital, Riverside Hospital,

Ottawa General Hospital and Ottawa Civic Hospital.)

“Core Values

Compassion

A Commitment to Quality

Working Together

Respect for the Individual”

Another example is that of St. Martha’s Regional Hospital, Antigonish,

Nova Scotia:

• Respecting life in all its stages

• Welcoming the diversity of people

• Caring for all without discrimination

• Excellence in the delivery of health care

• Collaborating with our community partners

• Assuming responsibility for the weak and vulnerable

• Healing and wellness of the whole person – body, mind and

spirit

• Being responsible stewards of our human and financial

resources

Such statements of values may not be complete; there may be other

fundamental or core values relevant in these contexts and in these

institutions as well (e.g., fundamental respect for life, commitment to the

common good, etc.).

What is Ethics? 13

There are additional benefits as well.

To begin with, the study of ethics offers us a chance to see what our

own moral beliefs, standards, and theories are:

• to see whether they are consistent or inconsistent

• to see what sorts of objections one might make to them

• to see whether we ought to change or modify our own ethical beliefs,

values, or principles.

Moreover, as in our own case, understanding the ethical views of

others, and being able to communicate and discuss with, and explain to

them, requires being able to understand the values, principles, and theories

behind their views.

6. Characteristics of an ethical theory

The next two chapters of this book present and discuss matters of theory and

principle – theories about ethics and ethical theories.

We should not confuse people’s ethical views with other

preferences or beliefs they may have; as noted earlier, there are other

normative claims and statements of preference (e.g., what a person might

like to do) that, strictly speaking, have little to do with what a person ought

to do. An ethical theory will normally have the following characteristics.3

1. It enables us to make judgements and prescriptions about

human behavior/conduct/acts/or the results of those acts (e.g., You were

wrong to lie to your mother; You ought to help Smith with his work).

2. These judgements are based on certain rules or principles –

although a person may not be able to articulate those rules completely, or

provide a general moral theory (e.g., explain exactly why lying is wrong –

which might be because it makes people unhappy, or violates their rights or

their dignity, or is forbidden by God, and so on).

3. These rules or principles are universalizable, and express more

than a personal policy or preference. An ethical theory generally proposes to

set rules or principles that will apply to all rational beings, and not just to

one person or a select group of persons.

4. These rules or principles are "supremely authoritative or

overriding as a guide to action" and override nonmoral rules and principles

– e.g., what a country’s law states. (For example, the ethical rule that

“people ought to be treated equally” would override a country’s law that

enforces apartheid.)

3 This is a modified account of Tom Beauchamp, Philosophical Ethics:

An Introduction to Moral Philosophy (New York: McGraw-Hill, 1982), pp.

15ff.

14 Chapter 1

5. Thus, ethical theories are distinct from principles of prudence,

self-interest, social etiquette and the like.

6. There are penalties or sanctions following on violations of these

rules or principles.

7. Ethical theories generally seek to reduce or eliminate conflict.

These characteristics are not, however, necessary and sufficient

conditions; we might see them as allowing us to say that a theory is an

ethical one to the extent that it possesses these characteristics.

7. Concluding remarks

This chapter provides a general explanation of what ethics is, and how it is

relevant to health and medicine. It identifies some features of ethics that are

essential to it serving as a rational guide to human conduct, and it suggests

how one might analyse and prove ethical claims.

Nevertheless, ethics, as a rigorous study of how human beings

ought to act and what human beings ought to do, has been challenged. There

are theories about ethics that would eliminate or greatly reduce the

possibility of making ethically legitimate and binding judgements.

In the next chapter we look at some theories about ethics – at

whether it is possible to have a general, systematic, ethical theory that

applies to all, and whether it is possible to make ethical judgements that are

rational, objective, and should be adopted by all people. Or are ethical

claims simply personal preferences, or limited to the culture we live in, or

just nonsense?

How you decide this issue indicates your underlying moral standard.

A case to discern ethical principle

Suppose that you are an atheist married to a Christian, and you

have three small children. Your spouse is dying and you are alone with

her one evening when she asks you to promise to raise the children in the

Christian faith – even though you do not believe in that faith.

Your spouse says she would accept death more easily if you

made such a pledge, but would rather die unhappy than have you make a

false promise.

You make the promise and, seconds later, she passes away.

Should you keep your promise, even though it involves

considerable effort and sacrifice, and even though you don't believe in

Christianity? Or should you forget the promise once your spouse has

died?

What is Ethics? 15

BIBLIOGRAPHY

Beauchamp, Tom L., Philosophical Ethics (3rd ed., McGraw Hill, 2001).

Childress, James F. and Tom L. Beauchamp, Principles of Biomedical

Ethics (7th ed., Oxford University Press, 2012)

Cooper, Neil, "Morality and Importance," in The Definition of Morality, ed.

G. Wallace and A. D. M. Walker (London: Methuen, 1970). [on

overriding non-moral rules]

Dworkin, Ronald, "Lord Devlin and the Enforcement of Morals," (originally

published as "Liberty and Morality" in Yale Law Journal) in Taking

Rights Seriously (Cambridge, MA: The Belknap Press of Harvard

University Press, 1977), ch. 10.

Fagothey, Austin and Milton Gonsalves, Fagothey’s Right and Reason (9th

ed, Columbus, OH: Merrill, 1989).

Sweet, William (ed), The Bases of Ethics (Marquette University Press,

2001).

Honderich, Ted (ed), The Oxford Companion to Philosophy (2nd ed., Oxford

University Press, 2005).

Encyclopedia of Philosophy, 1st ed., 8 vols. 1967, 2nd ed., 10 Vols. (ed.

Donald M. Borchert (Gale/Thomson Learning, 2006)

Routledge Encyclopedia of Philosophy (Routledge, 1998)

A Dictionary of Philosophy, ed. D.D. Runes (reprinted 1962;

http://www.ditext.com/runes/ )

A Dictionary of Philosophy, ed. Antony G Flew (rev. 2nd ed., New York: St

Martin’s Press, 2001)

The Oxford Handbook of Practical Ethics, ed. Hugh LaFollette (New York:

Oxford University Press, 2003).

Web-based resources

Canadian Bioethics Society – http://www.bioethics.ca/index-ang.html

Canadian Catholic Bioethics Institute – http://www.ccbi-utoronto.ca/

Centre for Applied Ethics “Starting Points in Health Care Ethics /

Bioethics” http://www.ethics.ubc.ca/start/biomed.html

Canadian Medical Association Journal - Bioethics for Clinicians

http://www.cmaj.ca/misc/bioethics_e.dtl

Canadian Medical Association Code of Ethics

http://policybase.cma.ca/PolicyPDF/PD04-06.pdf

Code of Ethics for Registered Nurses (Canada)

https://cna-aiic.ca/~/media/cna/files/en/codeofethics.pdf

Ethicsweb.ca – http://www.ethicsweb.ca – a gateway for resources.

International Council of Nurses Code of Ethics

http://www.icn.ch/images/stories/documents/about/icncode_english

.pdf

Stanford Encyclopedia of Philosophy, http:// plato.stanford.edu

16 Chapter 1