What is Ethics? The branch of philosophy concerned with systematizing, defending, and - PowerPoint Presentation

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2. What is Ethics?The branch of philosophy concerned with systematizing, defending, and proposing concepts of right and wrong conduct. The term ethics derives from the Ancient Greek word ethikos, which derives from the word ethos (habit, or custom).

3. In other words, ethics…Investigates various moral questions, such as “What is the best way for people to live?” or “What actions are right or wrong” or “What’s the proper course of action in particular circumstances?”Ethicists are philosophers who specialize in ethics.

4. 3 major areas of study within ethics are Meta-ethics: (Descriptive)Moral Ontology: Nature and origin.Moral Epistemology: Knowledge.Moral Semantics: Meaning of terms.2. Normative ethics: (Prescriptive) - Norms/Ethical Systems3. Applied ethics: (Practical) How do we take moral knowledge and put it into practice?

5. 1. META-ETHICS

6. Meta-Ethics asks about the nature, how we understand, know about, and what we mean when we talk about right and wrong. A question such as, "Should I get an abortion?" or “Is it ever right to kill?” are not meta-ethical questions. A meta-ethical question is more general and more abstract: "Is it possible to acquire knowledge of right and wrong?" or “Are certain actions objectively right or wrong” “If certain actions are objectively wrong or right, what makes them so?”

7. Various Theories of Meta-ethicsCognitivism vs. non-cognitivism:Cognitivism: ethical sentences express actual propositions that can be true or false, which non-cognitivists deny. Cognitivism embodies many views: e.g. moral realism: ethical sentences express propositions about mind-independent facts. moral subjectivism: ethical sentences express propositions about peoples' attitudes or opinions. error theory: ethical sentences express propositions, but they are all false.

8. Non-cognitivism: non-cognitivists claim that moral statements are not in the business of describing properties or making statements that could be true or false in any sense. Moral statements have no substantial truth conditions. When people utter moral sentences they are not expressing states of mind that are beliefs or that are cognitive in the way that beliefs are. Rather they are expressing non-cognitive attitudes more similar to desires, approval or disapproval, like “Hey!”

9. Moral ontology is about the kind of things we refer to by ethical propositions. Non-cognitivists (also Non-descriptivists) say morality does not need a specific ontology, since ethical propositions do not refer to anything. This is known as an anti-realism. Realists on the other hand claim morality to have a paradigm.

10. Moral Nihilism: meta-ethical view that nothing is intrinsically moral or immoral. killing someone, for whatever reason, is neither inherently right nor inherently wrong. Moral nihilists consider morality to be human construction.Moral nihilism is distinct from moral relativism, which does allow for actions to be right or wrong relative to a particular culture or individual. Moral nihilism implies moral skepticism.Moral nihilism = "nothing is morally wrong.”

11. Expressivism: when someone says something is immoral he is not saying it is right or wrong. He expresses his feelings, emotions. Torture, is disgusting, not morally wrong.Expressivism: a form of non-cognitivism: the view that moral statements lack truth-value.  Non-cognitivism implies that moral knowledge is impossible.

12. universal prescriptivism is a non-cognitivist form of moral universalism: judgments about morality may be correct or not in a consistent, universal way, but do not attempt to describe features of reality.

13. Error theory:There are no moral features in the world; nothing is right or wrong.No moral judgments are true; however,Our sincere moral judgments try, but always fail, to describe the moral features of things.Thus, we always lapse into error when thinking in moral terms. We are trying to state the truth when we make moral judgments. But since there is no moral truth, all of our moral claims are mistaken—hence the error.

14. 2. NORMATIVE ETHICS

15. Normative Ethics is the study of ethical action. It is the area of ethics concerned with the set of questions that arise when considering how one ought to act, morally speaking. Normative ethics is distinct from meta-ethics because it examines standards for the rightness and wrongness of actions, while meta-ethics studies the meaning of moral language and the metaphysics of moral facts.  Normative ethics because deals with norms or moral systems, which we’ll consider later on.

16. 3. APPLIED ETHICS

17. Applied Ethics is the examination of particular moral issues in private and public life. Use of philosophical methods to identify the morally correct course of action in various fields of human life. Bioethics.Environmental ethicsBusiness ethics. Spots ethics.

18. PERSONAL AUTONOMY AND MORAL AGENCY

19. People make many different moral choices without knowing that they are. We take it for granted that we are autonomous. But what does it mean? Autonomous: to make free choices as a self-determining individual. Are we all autonomous?To be fully autonomous, one must satisfy 3 conditions: 1. Independent condition. 2. Competency condition. 3. Authenticity condition.

20. Infants, comatose people, senile, and so on lack autonomy because lack (1) independence. Also, to be autonomous one must make free choices without the control of anyone or the control of something from within the subject. If you are under threat, under age, you lack autonomy. If you have OCD, suffer from kleptomania, addictions, etc. you are not autonomous. 

21. (2) Competency: One must also be rational and rationally capable of deliberating his or her moral choices: Know what our choices are.Able to understand consequences for those choices.Able to evaluate the best choices for us.Must make decisions that are true most of the time.And need to be able to reason correctly.

22. (3) Authenticity: One may be independent, competent, but not individualistic. Think about how many “fully functional” adults make decisions based upon their upbringing, faith, peer pressure. EG: refuse medical treatment based on one’s interpretation of religious doctrines.

23. Individuals who lack autonomy are morally incompetent. When one is morally incompetent and the state overrules his choices and actions for his own good, this is called paternalism.Whether or not one is able to make independent, competent, or authentic choices, he or she is referred to as a moral agent.

24. Moral AgencyWho/What is a moral agent?Philosophers argue over the criteria to determine moral agency: RationalityAbility to deliberate moral judgmentHumanityCognitive capacitiesSentienceRelationship

25. …A ChallengeWho are We to Judge?

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27. MORAL RELATIVISM: the concept that morality is relative. This can be relativism or subjectivism.Objectivism says that all people are under the same moral principles. Moral principles are objective.  Subjectivism: each individual has his/her own moral principles.Relativism says that societies decide what is moral. Who are we to judge?  

28. Who Are We to Judge?The Callatians, an Indian people, ate their dead people, while ancient Greeks cremated theirs. They viewed each other’s practice as immoral. So moral relativism concludes that morality is a matter of what peoples take it to be.

29. However, not always clear that people’s moral principles differ. People’s beliefs differ. Callatians believed that their dead would continue living if ingested. Greeks believed flesh could be corrupted and so cremated the dead. Also Greeks believed fire to purify the body. Often, two peoples’ differences are not moral but cultural.  Abortion? People are divided over abortion. Why? All agree that murder is wrong. We disagree over whether a fetus is a person. 

30. Implications of Relativism

31. If you are a relativist, the implication is that you must admit there was nothing wrong about Nazi morality and slavery!

32. Think About it…M.L.K, Jr. and William Garrison fought against segregation and slavery. They were moral reformers. If you are a moral relativist, you cannot praise King or Garrison. In fact, you should condemn them.

33. …Also, moral progress is impossible if relativism is true. If one tries to better the living conditions and moral principles of a society he is making progress. Moral progress implies moving toward an ideal, objective, moral standard. But this is what relativism denies!

34. Also, relativism says that moral standard of a particular society is determined by what that society practices and deems moral. But a society cannot make moral progress because progress requires changing the practices that give that society their moral standards!

35. Also, relativism says that the social group you belong to determines morality, right? But ask yourself, to which social group do I belong? Answer: you belong to many groups.

36. Finally, some might say that relativism is valid because we should have tolerance and respect other people’s practices and beliefs. But, if we apply the principle of tolerance as a universal principle, then tolerance is ruled out by relativism! In other words, if you use the argument from tolerance, you are not a relativist but an objectivist.

37. Assessing Ethical Theories

38.  Important in ethics is to determine what makes things right or wrong. Which theory is best?A theory’s principles must provide a compelling explanation of why certain things are good or right while others are bad or wrong. Adequate ethical theory needs to satisfy certain criteria. The more fully the theory satisfies all these criteria the better the theory.

39. 1. Completeness: theory should be able to address completely moral concepts. If the theory leaves something out that must be included, then that theory is faulty. Hedonistic theories, don’t account for justice.2. Explanatory Power: The theory must give us insight into what makes something moral or immoral. It must help us understand the difference between right and wrong.

40. 3. Practicability: how useful is a theory? - Clear and precise moral claims. If the theory’s principles are vague, then it isn’t a practical theory: “don’t hurt people unless they deserve it.” Vague. - Moral guidance to ordinary people. - Principles should not create conflict. Imagine a friend lives in the US illegally. Should you turn him in? A practicable theory must be able to resolve your dilemma.

41. 4. Moral confirmation: a theory must give correct answers to moral questions. Does it work? A theory is morally confirmed if we have good reasons to consider it true. This criterion resembles the scientific method. In science we begin testing a theory’s hypotheses by experiment and observation.

42. SOME WAYS NOT TO ANSWER MORAL QUESTIONS, AND THE IDEAL MORAL JUDGMENT

43.  Moral judgments and personal preferences Some people like classical music; others do not. This is disagreement in preferences. Moral disagreements, disagreements over right or wrong, are not the same. If I say abortion is always wrong and you say abortion is never wrong, then you are denying what I affirm. The point: right or wrong require reasons. Cannot be determined just by finding out about the personal preferences of people.

44. Moral judgments and feelingsSome philosophers think words like right and wrong are empty. This position suggests it doesn’t matter one way or the other. But morality matters. So, one must not use personal feelings to determine what’s right and wrong. 

45. Thinking it is so does not make it so This should be obvious: upon reflection you might be surprised. You might think same-sex marriage is immoral, but when you reason logically, you might arrive at the opposite conclusion.

46. Irrelevance of statisticsSome people think that the more people believe something, the truer something is. Religious people may say that God exists because the majority of the world’s population believes in a god. Clearly this is not true. If the majority holds that capital punishment is wrong, that doesn’t make it wrong.

47. The appeal to a moral authority: Many people think that there is a moral authority, and that is God. However, appealing to such an authority creates problems because the existence of God is controversial.

48. THE IDEAL MORAL JUDGMENTThere are different concepts that an ideal moral judgment must satisfy 

49. Conceptual clarity: if someone tells us that euthanasia is always wrong we could not determine whether that statement is true before we understand what euthanasia is. Concepts need clarity. In the case of abortion, for example, is a fetus is a person?

50. Information: We answer moral questions by having knowledge of the world. For example, in order to know why eating meet is morally wrong, we must know the facts, that is, animals feel pain and like us do not want to feel pain. They are killed, Chopped up, packaged, and sold. Many people ignore, or want to ignore, these facts.

51. Rationality: must be able to recognize the connection between different ideas. The only way is to use logic. Sally thinks all abortions are morally wrong, but she recently has had an abortion. Sally is not being rational or logical.

52. Impartiality: correct answer to moral questions must be impartial. Impartiality is related to justice: the principle that justice is the similar, and injustice the dissimilar, treatment of similar individuals. If causing suffering to humans is wrong, but it is not wrong in the case of animals, this is not impartial. - we should consider irrelevant characteristics such as the color of the skin, the color of hair, nationality, height, age, species, and so on.

53. Coolness: the idea is that the more emotionally charged we are, the more likely we are to reach a mistaken moral conclusion come while the cooler or calm or we are, greater the chances that we will avoid mistakes.

54. VALID MORAL PRINCIPLESbesides information, impartiality, conceptual clarity, etc., ideal moral judgment must be based on valid or correct moral principles. Ideally, one wants not only to make the correct moral judgment but also to make it for the correct reasons.

55. Criteria for evaluating moral principles: Consistency: whatever principle let Sally to believe that all abortions are morally wrong and yet have an abortion is morally right, must be an inconsistent principle. Adequacy of scope: A successful principle is one that provides guidance to different circumstances. So, the wider the principle’s scope, the greater its potential uses, the narrower its scope, the narrower its range of applications.Precision: What we want from an ethical principle is not to be vague. For example if we are told we should love our neighbors and we should do no harm we must also be told in a clear way what love, harm, and a neighbor are supposed to mean.

56. Moral Theories

57. ConsequentialismConsequentialistic Ethics: EgoismEverything we do has consequences. Consequentialism defines morally right actions based on what produces desirable consequences. Consequentialism: an approach to ethics arguing that only consequences are what makes something morally good or bad.Utility: Desirable consequences.Disutility: Undesirable consequences.

58. Hedonism and ConsequentialismConsequentialistic theories commit to a definition of utility.Hedonistic theories regard Pleasure/Happiness as utility and pain as disutility.Hedonism views pleasure as the only good.Not all pleasures are good.Pleasure and happiness are not the same.Most consequentialists understand utility as happiness.

59. Only intrinsic good is pleasure. It is good in itself. No God or moral authority or moral paradigm.Humans are not divine or special, and as individuals have no intrinsic value. The happiness of the majority is what counts.Why consequentialism? Something is right based on consequences. I should not make a decision based on principles or duty. I must consider the consequences of my actions. Right action is one that produces consequences that maximize happiness for the greatest number of beings.

60. - To be practicable, consequentialism must give us accurate assessment of how much utility something might produce.Utility must be predictable and measurable.Pleasures can be predicted, but what about happiness?Mill (1806 – 1873): consider pleasures conducive to happiness.Different kinds of pleasures:Pleasure of creating art, thinking of morality, vs. getting drunk, sex, food, etc.Intellectual pleasure are higher than physical.Higher pleasures more conducive to happiness.“it is better to be Socrates dissatisfied than a pig satisfied.”Many people do not know higher pleasures due to lack of education.This makes it an elitist theory.

61. Act UtilitarianismRight actions maximize happiness/pleasure.everything we do is motivated by a desire to maximize pleasure and minimize pain. – the greatest amount of good for the greatest number of beings.Why pleasure/happiness? Because that’s the only thing that matter.What beings? All sentient beings.Act utilitarianism tells us what counts as the right act—what we ought to do.

62. Which act ought we carry out?We assess an act by following these aspects:

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64. How we Proceed…First we identify the choices. Next we determine utility and subtract disutility by considering 1,2,3,4.The outcome that leads to the greatest overall utility is for act utilitarians the morally right thing to do.

65. MillJohn Stuart Mill, argues that it is a mistake to confuse the standards for right action with a consideration of our motives to perform a right action: "He who saves a fellow creature from drowning does what is morally right, whether his motive be duty, or the hope of being paid for his trouble; he who betrays the friend that trusts him, is guilty of a crime, even if his object be to serve another friend to whom he is under greater obligations." According to Mill, scrutiny of motives or intentions will show that almost all good behavior proceeds from questionable intentions. Therefore, Mill argues, our moral analysis should ignore matters of intention.

66. CriticismsIs happiness all that matters?Paradox of Hedonism: if happiness is all that matters, we must pursue it. But we can’t. Try making yourself happy. Happiness is like a NYC bus—you never know when it’s coming.

67. Rule UtilitarianismCertain practices/core values such as promising can generate consequences conducive to maximization of utility.Rule utilitarianism defines a morally right rule or practice as one that promotes overall utility.Principle of rules: a morally right rule is one that is widely followed would promote greater utility than if it did not exist.Principle of acts: a morally right act is one that follows morally right rules. We have a moral duty to obey those rules unless they come into conflict.

68. Act utilitarianism: must decide by calculating consequences case by case.Rule utilitarianism: based on experiences of consequences, apply certain rules that maximize utility.Hedonistic utilitarianism: maximize pleasure/minimize suffering.Preference utilitarianism: maximize utility based on people’s preferences. Each individual preference is unique. But in the end the aggregative satisfaction is the goal.True preferences vs. corrupt preferences.

69. Deontology – Kant

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71. The only unconditionally good this is the will.1. Only actions that proceed from duty have moral worth.I can act in accordance or in conformity to duty: I promise that I will give you a lift, but I do it because I want to avoid the ill consequences from not doing so. I then am not doing what is right for the right reason. My action does not proceed from duty. My will cannot be good.

72. If I pay my debt because I want you to lend me more or because I am afraid to pay penalties, my will is not good because my action dos not proceed from the recognition that I have a duty. Or, I can charge difference prices to different customers. But say that I want to maintain a good reputation for my business, then I will conform with the duty that I should not charge different customers differently. But am I doing it for the right reason? No because my action does not proceed from duty.

73. An action that proceeds from duty has its moral worth not from the purpose to be attained but from the maxim by which it is determined. A maxim is a subjective principle of volition. My maxim is the principle that motivates me to do something. So an action is never morally good because of what I do but rather because of why I do it.

74. My will might be motivated by material incentive = Not good. If I pay you back not because of reputation or because I want you to like me, or what not, but because I recognize that I have a duty, a principle, categorical that commands me to pay you back. This is good.Duty is the necessity of acting from respect for the moral law.

75. Categorical imperative“Act only according to that maxim whereby you can at the same time will that it should become a universal law without contradiction.” Ask yourself “Would I want all people in all places, at all times to do what I am about to do?”

76. The first formulationRequires that the maxims be chosen as though they should hold as universal laws of nature. This is a test to determine whether a maxim can be universalized:Take a moral statement, for example the declaration “I will cheat for personal benefit.” Imagine a possible world in which everyone followed that maxim. Decide whether any contradictions or irrationalities arise in such a world as a result of following the maxim.If a contradiction or irrationality arises, acting on that maxim is not allowed in the real world.If there is no contradiction, that maxim is morally sound; but if there is, well, then it is not morally sound!

77. The second formulation holds that the rational being is “the basis of all maxims of action” and must be treated never as a mere means but as an end. What this means is that all rational beings should never be exploited for personal gain.What makes a being rational? Freedom!

78. The third formulationAll maxims must harmonize with a possible Kingdom of Ends. This means that we should act in such a way that we may think of ourselves as “a member in the universal realm of ends”.

79. Virtue Ethics

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81. Virtue EthicsA virtue is a dispositional trait that is socially valuable. An excellent and reliable trait of one’s character.A moral virtue is a dispositional trait that is morally valuable.emphasizes the role of one's character and the virtues that one's character embodies for determining or evaluating ethical behavior.Character requires practice.Role models.No rule can tell me to do the right thing. I must use my virtues to determine correct action.To do wrong is lack of knowledge.Goal of virtue ethics is well being/happiness/human flourishing.

82. VirtuesPrudenceCompassionGenerosityBenevolence Wisdom JusticeCourageTemperance

83. Aristotle argued that moral virtues are means between two corresponding vices, one of excess and one of deficiency. For example: courage is a virtue found between the vices of cowardliness and rashness. Rashness Courage Cowardliness[___________________I___________________]

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85. 5 Central Virtues in Healthcare1. Compassion:Since healthcare, then compassion is a prelude to caring. Attitude of altruistic care—Sympathy for others’ suffering. Connected with mercy/merciful.Expressed through beneficence to alleviate others’ suffering.Compassion is directed to others.

86. 2. Discernement:Sensitive insight, astute judgment, understanding how to act.Ability to make competent judgments and reach judgment without being unduly influenced.Practical wisdom? For Aristotle a practically wise person understands how to act with right intensity of feeling, the right way, right time, balancing reason and desire.A Discerning physician will see when a patient needs comfort rather than privacy. He will measure level of consolation.Discernment is understanding how to balance respect for autonomy and beneficence—like a parent cares for his children.

87. 3. Trustworthiness:Patients are vulnerable, thus trust is essential in health care. Reliance and trust in the moral character of another person.To merit confidence in one’s character and conduct.Trustworthiness of a health care provider goes beyond legal relationship.How much do we trust health care providers today?

88. 4. Integrity:In morality, Integrity means reliability, soundness, and integration of moral character.Impartiality, objectivity, respecting moral norms.2 aspects of integrity:Coherent Integration of emotions, knowledge, aspirations.Being faithful to moral values, defending them if necessary. People love dogs and eat cows due to lack of moral conviction.

89. 5. conscientiousness:A conscientious person is motivated to do what’s right because it’s right, has determined through due diligence what’s right, intends to do what’s right, and makes appropriate efforts to do what’s right.One issue in health care is conscientious refusal.A nurse, for example, may claim conscientious exemption from participation in abortions or sterilizations, even to the extent to refuse to fill out admission forms!

90. Feminist Ethics/CareWomen see morality differently from men.Motherly care. Kohlberg stages.Medicine dilemma. Would it be right to steal a medicine that you cannot afford but will safe your life?Men tend to respond in legal/obligation terms. Women prefer compassion.

91. MEDICAL ETHICS

92. Medical ethics Difference between Bioethics and Medical Ethics:Medical ethics is a professional, practical ethic used to resolve moral issues in the practice of medicine. As a scholarly discipline, medical ethics is the study of its practical application in clinical settings as well as its history, philosophy, and sociology. In virtue of practicing medicine, there are certain obligations to follow. Bioethics is a critical challenge to professional ethics.

93. Historically, Western medical ethics originates with guidelines on the duty of physicians in antiquity, such as the Hippocratic Oath. The first code of medical ethics, Formula Comitis Archiatrorum, was published in the 5th century, during the reign of the Ostrogothic king Theodoric the Great. In the medieval and early modern period, Islamic scholarship made great contributions to the field: Avicenna's Canon of Medicine, Muhammad Rhazes, Jewish thinkers such as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas, and the case-oriented analysis (casuistry) of Catholic moral theology.

94. By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. In England, Thomas Percival, a physician and author, crafted the first modern code of medical ethics. He drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, in which he coined the expressions "medical ethics" and "medical jurisprudence". In 1815, the Apothecaries Act was passed by the Parliament of the United Kingdom. It introduced compulsory apprenticeship and formal qualifications for the apothecaries of the day under the license of the Society of Apothecaries. This was the beginning of regulation of the medical profession in the UK. In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival's work.

95. ValuesA common framework used in the analysis of medical ethics is the "four principles" approach proposed by Tom Beauchamp and James Childress. It recognizes four basic moral principles, which are to be judged and weighed against each other. The four principles are as follows:Respect for autonomy - the patient has the right to refuse or choose his treatment.

96. Beneficence - a practitioner should act in the best interest of the patient. Non-maleficence - "first, do no harm." Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.Other values that are sometimes discussed include:Respect for persons - the patient (and the person treating the patient) have the right to be treated with dignity.Truthfulness and honesty - the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee syphilis experiment.

97. Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts.When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and, on occasion, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life saving; and truth telling was not emphasized to a large extent before the HIV era.

98. AutonomyThe principle of autonomy recognizes the rights of individuals to self-determination. This is rooted in society's respect for individuals' ability to make informed decisions about personal matters. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient rather than medical professionals. The increasing importance of autonomy can be seen as a social reaction to a "paternalistic" tradition within healthcare. Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism to the detriment of outcomes for some patients. Respect for autonomy is the basis for informed consent and advance directives.

99. Paternalism is behavior by state to limit some person or group's liberty or autonomy for what is presumed to be that person's or group's own good.  Some, such as John Stuart Mill, think paternalism to be appropriate towards children: "It is, perhaps, hardly necessary to say that this doctrine is meant to apply only to human beings in the maturity of their faculties. We are not speaking of children, or of young persons below the age which the law may fix as that of manhood or womanhood." Paternalism towards adults is sometimes thought to treat them as if they were children.

100. Examples of paternalism: laws requiring the use of motorcycle helmets, laws, seatbelts, punishing citizens for not obtaining their driving license in time, and a psychiatrist confiscating sharp objects from someone who is suicidal.Soft and hard paternalism:The terms soft and hard are used in two quite different senses in this context. Philosophers usually use "soft paternalism" for paternalism toward a person whose action or choice is insufficiently voluntary to be genuinely his or hers. Hard paternalism in this usage means paternalism toward a person whose action or choice is sufficiently voluntary to be genuinely his or hers.

101. Autonomy v. Paternalism: Autonomy is difficult because as one gets sick, he loses it. Also, some do not have if due to cognitive issues. So paternalism creeps in.

102. Beneficencetaking actions that serve the best interests of patients. However, not easy to determine which practices do in fact help patients.James Childress and Tom Beauchamp identify beneficence as one of the core values of healthcare ethics. Some scholars, such as Edmund Pellegrino, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery and euthanasia fall beyond its purview.

103. Non-maleficence"first, do no harm." Many consider that should be the main or primary consideration that it is more important not to harm your patient than to do them good. Enthusiastic practitioners use treatments they believe will do good, without really knowing whether they do no harm: "The treatment was a success, but the patient died." It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not prescribing medications they know to be harmful — he or she should not prescribe medications unless she knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks.

104. Principle of double effectDouble effect refers to two types of consequences that may be produced by a single action, and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence.A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient while simultaneously having the maleficent effect of shortening the life of the patient through suppression of the respiratory system.

105. Respect for human rightsThe human rights era started with the formation of the United Nations in 1945, which was charged with the promotion of human rights. The Universal Declaration of Human Rights (1948) was the first major document to define human rights. Medical doctors have an ethical duty to protect the human rights and human dignity of the patient so the advent of a document that defines human rights has had its effect on medical ethics. Most codes of medical ethics now require respect for the human rights of the patient.

106. Conflicts between autonomy and beneficence/non-maleficenceAutonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in the patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. In general, Western medicine defers to the wishes of a mentally competent patient to make their own decisions, even in cases where the medical team believes that they are not acting in their own best interests. However, many other societies prioritize beneficence over autonomy.

107. Examples include when a patient does not want a treatment because of, for example, religious or cultural views. In the case of euthanasia, the patient, or relatives of a patient, may want to end the life of the patient. Also, the patient may want an unnecessary treatment, as can be the case in hypochondria or with cosmetic surgery; here, the practitioner may be required to balance the desires of the patient for medically unnecessary potential risks against the patient's informed autonomy in the issue. A doctor may want to prefer autonomy because refusal to please the patient's self-determination would harm the doctor-patient relationship.

108. Individuals' capacity for informed decision-making might come into question during resolution of conflicts between autonomy and beneficence. The role of surrogate medical decision makers is an extension of the principle of autonomy. On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a breach of patients' autonomy may cause decreased confidence for medical services in the population and subsequently less willingness to seek help, which in turn may cause inability to perform beneficence. The principles of autonomy and beneficence/non-maleficence may also be expanded to include effects on the relatives of patients or even the medical practitioners, the overall population and economic issues when making medical decisions.

109. EuthanasiaThere is disagreement among American physicians as to whether the non-maleficence principle excludes the practice of euthanasia. An example of a doctor who did not believe euthanasia should be excluded was Dr. Jack Kevorkian, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show 60 Minutes.

110. In some countries such as the Netherlands, euthanasia is an accepted medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the “First do not Harm” is based on the belief that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient.

111. JusticeThe idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved.  The health care provider must consider four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation.  Reproductive technologies create ethical dilemmas because treatment is not equally available to all people.

112. Justice in health care is a form of fairness, or as Aristotle once said, “giving to each that which is his due.” This implies the fair distribution of goods in society. The question of distributive justice also seems to hinge on the fact that some goods and services are in short supply, there is not enough to go around, (medicine, organs, etc.) thus some fair means of allocating scarce resources must be determined.

113. It is generally held that persons who are equals should qualify for equal treatment. An example is the application of Medicare, which is available to all persons over the age of 65. This category of persons is equal with respect to their age, but the criteria chosen says nothing about need or other factors about the persons in this category. In fact, our society uses a variety of factors as criteria for distributive justice, including the following:

114. To each person an equal shareTo each person according to needTo each person according to effortTo each person according to contributionTo each person according to meritTo each person according to free-market exchanges(Beauchamp & Childress, 1994, p. 330)

115. John Rawls (1999) claims many of the inequalities we experience are a result of a “natural lottery” or a “social lottery.” Individuals are not to blame, therefore, society should providing resources to help overcome the disadvantaged situation. One of the most controversial issues in modern health care is the question pertaining to “who has the right to health care?” Or, stated another way, perhaps as a society we want to be beneficent and fair and provide some decent minimum level of health care for all citizens, regardless of ability to pay.

116. Medicaid is a program to help those at the poverty level. Yet, in times of recession, thousands of families below the poverty level have been denied Medicaid as a cost saving maneuver. The principle of justice is a strong motivation toward the reform of our health care system so that the needs of the entire population are taken into account. The demands of the principle of justice must apply systemically in the laws and policies of society that govern the access of a population to health care. Much work remains to be done in this arena.

117. Informed consentInformed consent in ethics usually refers to the idea that a person must be fully informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, or the specific legal requirements, which vary from place to place, for capacity to consent.

118. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next of kin make decisions for them. The value of informed consent is closely related to the values of autonomy and truth telling.

119. Confidentialityis commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.

120. Confidentiality is mandated in America by laws. However, numerous exceptions to the rules have been carved out over the years. For example, many states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles.

121. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. Many states in the U.S. have laws governing parental notification in underage abortion.

122. Criticism of orthodoxyIt has been argued that mainstream medical ethics is biased by the assumption of a framework in which individuals are not free to contract with one another to provide whatever medical treatment is demanded, subject to the ability to pay. Because the welfare state typically provides a high proportion of medical care, and because there are legal restrictions on what treatment may be provided and by whom, an automatic divergence may exist between patient wishes and the preferences of medical practitioners and other parties. Some have questioned the idea that beneficence might in some cases have priority over autonomy. Violations of autonomy more often reflect the interests of the state or of the supplier group than those of the patient.

123. Guidelines And Ethics committeesThere are various ethical guidelines. For example, the Declaration of Helsinki is regarded as authoritative in human research ethics.Often, simple communication is not enough to resolve a conflict, and a hospital ethics committee must convene to decide a complex matter.These bodies are composed primarily of healthcare professionals, but may also include philosophers, lay people, and clergy - indeed, in many parts of the world their presence is considered mandatory in order to provide balance.

124. Truth-tellingSome cultures do not place a great emphasis on informing the patient of the diagnosis, especially when cancer is the diagnosis. American culture rarely used truth-telling especially in medical cases, up until the 1970s. In American medicine, the principle of informed consent now takes precedence over other ethical values, and patients are usually at least asked whether they want to know the diagnosis.

125. Conflicts of interestPhysicians should not allow a conflict of interest to influence medical judgment. In some cases, conflicts are hard to avoid, and doctors have a responsibility to avoid entering such situations. Research has shown that conflicts of interests are very common among both academic physicians and physicians in practice.

126. FutilityThe concept of medical futility has been an important topic in discussions of medical ethics. What should be done if there is no chance that a patient will survive but the family members insist on advanced care? Advance directives include living wills and durable powers of attorney for health care. In many cases, the "expressed wishes" of the patient are documented in these directives, and this provides a framework to guide family members and health care professionals in the decision-making process when the patient is incapacitated. Undocumented expressed wishes can also help guide decisions in the absence of advance directives, as in the Quinlan case.

127. Courts have supported definitions of futility to include simple biological survival, as in the Baby K case (in which the courts ordered a child born with only a brain stem instead of a complete brain to be kept on a ventilator based on the religious belief that all life must be preserved).In some hospitals, medical futility is referred to as “non-beneficial care.” Baby Doe Law establishes state protection for a disabled child's right to life, ensuring that this right is protected even over the wishes of parents or guardians in cases where they want to withhold treatment.