ethics 1, 2, 12

Neuroethics

Encompasses the myriad ways in which developments in basic and clinical neuroscience intersect with social and ethical issues Concept of neuroethics is consistent with James Rest's contention that moral action requires Moral sensitivity (recognizing the issue) - Emotional response Moral motivation (willingness to engage in problem solving) Moral courage (willingness to take a stand) Moral reasoning (complex cognitive process of deliberation and option formulation) Moral reasoning without moral courage will probably not result in moral action Can you learn to control your emotions?

Categorical imperative

"Act only according to that maxim (motivating principle) by which you can at the same time will that it should become a universal law" Keep in mind that using this as a guide would require making assumptions about what all rational humans desire Flaw in Kant's theory - all moral principles are absolute resolving ethical dilemmas requires making exceptions to the rules [Categorical - without exception]

Doctrine of the mean (Aristotle)

- Good judgement locates the mean between two extremes Virtue -> range of behavior Temperance: Hurtful self-denial -> over indulgence Courage: Cowardice -> foolhardiness Generosity: Stinginess -> wastefulness Truthfulness: Lacking candor -> revealing too much as to cause harm Some virtue ethicists concede this is only rough guidance, but that it is all that is appropriate due to the nature of morality [How you know how to be in the middle is based on wisdom and experience]

Week 3

.

Cardinal Virtues of Plato and Aristotle

1. Wisdom 2. Courage 3. Temperance 4. Justice Alasdair and MacIntyre add 1. Honesty 2. Integrity Virtue ethics has influenced thinking about morality in 4 ways 1. Focuses attention on moral motivation and moral psychology 2. Values personal relationships 3. Highlights ideals of moral aspirations 4. Focuses attention to communities Bring in involvement of others and relationships - value of good relationships

Act and Rule Utilitarianism

Act utilitarianism - focus on individual actions Moral decision making requires identification of all feasible options and assessment of one with the best consequences. What if the benefits of stealing are greater than the harm to the victims? Robin Hood? Rule utilitarianism - focus on consequences of general rules People should follow a set of rules that were adopted and determined to maximize overall good (or sets of rules for specific settings and circumstances) [Act - good consequences from the act themselves; make individual decisions based on case rule= - what if this decision because a general rule for everyone in similar situations; lots of laws could seemingly be based in this; especially welfare laws which could include drinking age? Be educated until 18, gun permit.. Driving down the middle because there is a pothole vs. driving down the middle of the road every time you drive]

Additional goals (reasons for studying ethics)

Argue in morally reasonable ways toward beliefs that are justified Manifest attitudes of care and respect for other persons and oneself Appreciate diversity as manifested in moral tolerance Acting as a morally responsible professional Maintaining moral integrity by integrating personal with professional values

Duty Ethics

Basic theory - We have moral duty to respect persons Duties correlate with rights E.g. duty to respect life <-> right not to be killed Ethical dilemmas are resolved by assigning priorities [Assign priorities to duties - not all equally of value]

Utilitarianism

Both rights and duty ethical theories maintain that what is right and wrong does not depend on any consequences that may result from any action Both are considered deontological ethical theories where morality is based on the action itself Basic principle of utilitarianism is to maximize good consequences. -> Produce the most good for the most people considering everyone as an equal Moral decisions should be made by 1. Examining facts 2. Exercising best judgement about alternatives 3. Making choice that maximizes good consequences [Producing the most good for the most people Relies on you treating everyone equally Most good might be choosing that one baby dies for other 3 but considering everyone as an equal contradicts that option]

Is there a conflict between duty and individuals right not to assist?

Conflict between imposing positive duties and autonomy and individual rights Slippery slope leading to the imposition of many "desirable" behaviors Seat belt and helmet laws John Stuart Mill ("the greatest of the utilitarian's") said: "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others."

Case Study, House MD, Season 1 Ep. 4

Discussion points Identify conflicting moral reasons for this ethical dilemma E. g. Conflicting responsibilities, rights, consequences, care relationships, ideals and virtues Moral reasons include honesty, fairness, integrity, respect, compassion, loyalty etc. Identify factual information pertinent to the dilemma Identify realistic courses of action (possible decisions) Be creative, but realistic Think of this as a pretest Moral reasons include honesty, fairness, integrity, respect, compassion, loyalty etc. 4 sick babies - sacrifice 1 to save the rest? Lack of complete honesty to parents - lack of respect of autonomy for the parents Fair to hide from parents? Need to be both upfront but also truthful about the impact after Each decision has ramifications Baby has right to live, diminished autonomy, right to the best care

Virtue Ethics (a.k.a. Character ethics)

Do what it takes to be a good person. Defines virtues (to be strived for) and vices (to be avoided) Virtues - desirable patterns of intentions, emotions, attitudes and reasoning Vices - undesirable patterns of the same Challenge - connecting conduct to virtues and vices [Anybody know some one who they consider to be virtuous? Why? Challenge of choosing what to do to follow these virtues]

Virtue Ethics (a.k.a. Character ethics) repeat

Do what it takes to be a good person. Defines virtues (to be strived for) and vices (to be avoided) Virtues - desirable patterns of intentions, emotions, attitudes and reasoning Vices - undesirable patterns of the same Morally primary and foundational Virtues, rules, and principles are important and interwoven Challenge - connecting conduct to virtues and vices Example: An honest person (Virtue) will pay head to rules such as "tell the truth" and "do not steal" [Anybody know some one who they consider to be virtuous? Why?]

Not hear to preach

Don't assume anyone has 'right' answers All on equal footing Aim is to obtain tools to strengthen capacities to deal responsibly with moral vagueness, ambiguity, conflicting reasons and disagreements Also, research shows high levels of moral reasoning and ability to understand other position predict clinical competence - success in general? -> best providers are caring ethical providers

Contrast between Kohlberg and Gilligan's concepts of moral development

Heinz dilemma Heinz's wife is dying of cancer Expensive drug may save her life Heinz cannot afford the drug nor get funds from friends or get a loan Pharmacist won't give him a discount So he steals the drug Was he justified? Some say 'no', and reason that he should have tried to convince the pharmacist to reduce the price In Kohlberg's scheme this would be viewed as indecisive and represent a lower level of moral reasoning (not rules based) In Gilligan's scheme, this represents the highest level of development because it shows contextual awareness and balancing of legitimate needs of oneself and others Caring and justice in conflict? Seek balance? [Gilligan said Kohlberg presupposed an ethics of justice, so can you have beneficence and justice? Balance?]

What is morality and good moral conduct?

Good vs. Bad; Right vs. Wrong; Ought and Ought not Different ways to approach this might include: Obeying the law Pursuing what is good for ourselves Pursuing what is good for most people Respecting human rights Promoting human well-being

Beneficence toward strangers (not clients)

Helping others is good, but how much is required, how much is expected, how much is needed to achieve superhero status? Beauchamp and Childress spectrum of moral action (beneficence continuum): Obligatory (strict and weak) Supererogatory (beyond obligatory, saintly and heroic ideals) -They are optional -They exceed what is obligatory -They are intentionally taken to helpful others -Morally good and praiseworthy

Moral Development

How individuals develop moral understanding Focus is on caring about and for others Lawrence Kohlberg - Justice perspective moral development progresses from ways of thinking about rules in terms of avoiding punishment (child-like) to rules in terms of meeting expectation, to universal applicability (consistent rules ranked in order of importance, e.g. human rights) Carol Gilligan - Care perspective Moral development progresses from self-centered viewpoint (satisfying one's own needed and wants), to self sacrificing (meeting other's needs), to an ability to reason a balance between own and other's needs Gilligan suggested females employ ethics of care that emphasizes care based relationships, males employ ethics of justice (more rules oriented) Not confirmed through subsequent research but an important contribution [Gilligan suggested females employ ethics of care, males employ ethics of justice - no confirmation through subsequent research http://www.goodtherapy.org/famous-psychologists/carol-gilligan.html]

Why doesn't the law compel people to help other people?

Human nature suggests some minimum obligatory general beneficence We know this because we feel shock and revulsion in hearing about cases where people failed to act to help and protect human rights Despite this, laws only compel us to help is special circumstances (e.g to protect your children and family, people on our property, where there is an contractual obligation) In general, U.S. state laws grant us "freedom not to act" People are not expected to act if doing so puts them in harms way Not to be confused with "leaving the seen of an accident"

Rights ethics

Human rights are most important and take priority over other rights For example, right to life takes priority over right not to be lied to https://www.youtube.com/watch?v=ETroXvRFoKY https://www.youtube.com/watch?v=cS-tshQ9sys 2:20 for explanation of rights Human rights are intuitively obvious (self evident) Rights ethics establishes individuals as moral equals [Declaration of Independence Life, liberty, pursuit of happiness First sentence - laws of nature and nature's God Self evident truths - all men created equal, endowed with certain unalienable rights (life, lib, pursuit..), ; don't interfere with other's abilities to pursuit their own happiness Happiness is not hedonism - technically in this time right to property or to use time, talent, and resources that bring most satisfaction and would impacts family etc the most Purpose of government - reason for government's existence is to secure these rights Is equality missing? Could be included in liberty, controversial despite saying all men created equal in document]

Human vs. Legal rights

Human rights cannot be taken away Human rights can be violated Human rights can be voluntarily waived or assigned to others to exercise (e.g. health proxy) Legal rights refer to specific system (may violate human rights) [Healthcare, insurance, driver's license Can be violated - slavery Waive - power of attorney; babies/children/elderly Different societies may have different rights - be systematically denied through governments/ constant source of conflict in world Libertarian party - government should serve one purpose - to protect liberty]

Human vs. Animal characteristics

Humans have the capacity for moral judgment and moral reasoning Other species exhibit 'building blocks' empathy, reciprocity, concept of fairness But in these other species (mostly) altruistic behavior is only functional, i.e. without appreciation of how the behavior might result in a personal benefit (return of the favor) Concept of neuroethics is that human brains are hardwired to have emotional responses to witnessing of immoral behavior. The response is then modulated by higher level reasoning

Beauchamp & Childress

In bioethics, Beauchamp & Childress established the four basic principles as: 1. Respect for autonomy 2. Nonmaleficence (do no harm) 3. Beneficence (promote good) 4. Justice These form the (duty-ethics) basis for most healthcare practitioner codes of conduct

Religious ethics

In general, religious ethics links moral virtues, ideals, and principles to religious beliefs and ideas w.r.t ethics, religions generally provide: Moral motivation E.g. some religions provide a view of the universe where good moral conduct is rewarded and bad moral conduct is discouraged or some teach that good deeds lead to good fortune and bad deeds lead to bad fortune Religions tend to encourage virtues (e.g. Christianity - Love; Buddhism - Compassion; Islam - Piety and pursuit of excellence; Judaism - righteousness and justice) Moral guidance Guidance is provided through teachings on how to conduct oneself Moral justification E.g some religions make claims about moral justification by appeal to commandments of a god [Religion is a source of moral values Moral motivation - afterlife? Behave certain way? Have certain values? Guidance - lessons, wisdom Justification - commandments/ guidelines]

What is good?

Intrinsic good - things worth seeking for their own sake (e.g. pleasure) Intrinsic bad - things to be avoided given their nature (e.g. pain) Jeremy Bentham Hedonism - seeking only pleasure and avoiding pain John Stuart Mill Quality of pleasure as well as quantity must be considered Alternate definitions of good 1. preference satisfaction 2. pluralistic theory (varied list of goods - pleasures, love, friendship, happiness, virtues, etc.) [Intrinsic bad - disease, ignorance Preference satisfaction - good for autonomy Should not limit what others think of as good - virtues, love]

What are the basic human rights?

John Locke Life, liberty, property Jefferson Life, liberty, pursuit of happiness Melden (more recent) Right to pursue ones interests (liberty) Argues other rights stem from liberty [Liberty - the state of being free within society from oppressive restrictions imposed by authority on one's way of life, behavior, or political views.]

Good Samaritan laws

Laws to protect individuals and medical professionals from civil and criminal charges if they try to help but end up doing harm (reasonable assistance)

Other Countries

Legislation of positive duties Europe: Person is expected to act if doing so does not put him or herself in danger (duty to rescue laws) E.g. Princess Dianna -Photographers prosecuted under French Good Samaritan law for taking pictures of dying victims of auto accident instead of attempting to save their lives

Kohlberg's and Gilligan's Schemes of Moral DEvelopment

Levels of Moral Development 1. Precoventional Kohlberg's Justice Perspective: self-centered, with concern for 1 - avoiding punishment and 2- satisfying one's own needs Gilligan's care perspective: viewing one's own needs as all that matters 2. Conventional Kohlberg's Justice Perspective: expectation-meeting, with concern for 3- pleasing others, 4 - meeting society's expectations Gilligan's care perspective: self-sacrificing: viewing others' needs as more important 3. Postconventional Kohlberg's justice perspective: autonomous recognition to 5- social agreements and 6- universal rules Gilligan's care perspective: mature care ethic: able to reason toward a balance of one's own and others' needs [Preconventional - young kid Conventional is going through life doing what youre supposed to do; not very advanced but meeting the need and society's expectations; noticing other's needs Postconventional - realizing more but how do you navigate the world; more mature balancing own and others]

Liberty rights vs. Welfare rights

Liberty rights Rights not to be interfered with (e.g. not killed, not kidnapped, not have property stolen) Welfare rights Right to have basic needs satisfied (e.g. receive food, receive healthcare, receive unemployment compensation and social security) The libertarian view is that only liberty rights are included in the set of human rights Most rights ethicists believe human rights include both liberty and human rights (that is, a minimum set of welfare rights are implied by liberty rights) [Healthcare providers obviously deal with many welfare rights e.g of implied welfare rights is provision of basic needs to child with a disability so that they have ability to pursue happiness Welfare rights - given out by government ; common belief that they qualify as human rights but not universally accepted Healthcare is not a human right Right to an education? ]

What about liberty?

Mill argues that each individual is best able to chart a path to happiness therefore promoting happiness requires maximizing personal freedom Mill contends that the only purpose for which power can be exercised over another in a civilized community against (his/her) will is to prevent harm to others - Harm Principle Promotes autonomy [All decisions based on happiness/greater good -so where does liberty get considered? Broad harm principle - if I think you driving a fossil fuel car is going to kill us all, can I actually stop you from driving it?]

Which pleasures are most important (higher quality)?

Mill suggested this should be decided by a popular vote. (i.e. the one that most would agree is a better pleasure) E. g. Pleasure of love is better than pleasure from violence But my mother told me that just because everyone is doing it does not make it right?? Can't the majority be wrong? [Just because everyone is doing it - does that make it right? Ie Nazis]

Complex motivation

Mixed motives theory Human action is motivated by a mixture of motives including self-interest (egoism) and altruism (selfless concern for the well-being of others) For professionals, we can categorize motives as 1. Craft (desire to meet standards of professional excellence) 2. Compensation (desire to earn a living and successfully attain recognition) 3. Moral concern (maintain moral integrity, have the virtue of caring)

David Ross

Modified Kant's ethics to make them more realistic and useful with the introduction of the concept of Prima Facie duties Genuine duties that sometimes have exceptions when they conflict with other duties having greater importance in given situations How do you know which have greater importance? You just know. (according to Ross) Good moral judgement consists of identifying the full range of duties relevant to a situation and reflecting carefully on how to balance those duties in light of the relevant facts of the situation [Understand there are exceptions to duties in certain circumstances Not all duties are absolute such as when you prioritize (can't all be the same value then) Self-evident - sound familiar?]

Particular moralities

Moral norms for specific groups (cultural traditions, religious traditions, professional practice standards) https://www.youtube.com/watch?v=SwONnm4TKHw (hockey fights)

Special moral rights

Moral rights arising from contracts, promises, legislation, citizenship, etc. E.g. healthcare provider and client relationship Right to liberty encompasses other rights associated with healthcare provider and client relationship. E.g. lying. How? Professional codes of conduct define such relationships - leads to definition of duties [Lying undermines clients right to pursue their health needs Can these overpower normal human rights? Healthcare provider lies to you but for overall welfare/good "this isn't going to hurt" obviously less serious Abusive husband lied to saying wife wasn't at that ER - allow time for security etc, higher precedence over welfare of patient Can also divert attention - ask different questions/facts - not lying but omitting facts ]

Non-normative ethics

Non-normative ethics 1. Descriptive ethics Facts about what a group of people believe in moral matters and how people act (regardless of whether their beliefs and actions are justified) Descriptive ethics = Description of conduct of groups of people (e.g. prosthetists) 2. Metaethics Involves analysis of the language, concepts and methods of reasoning in normative ethics E.g. what is meant by 'right', 'obligation', 'virtue', 'morality', 'justification' [Is this all we need? Easy. Why study ethics? Just tell me what is 'right' and I'll do it Descriptive - focus on group of people; how do you put what you believe into practice Metaethics - focus on language]

Define "ethics"

Normative ethics - Moral value types (standards of good and evil that govern behavior and choices) --Obligatory (right) --Permissible (all right) --Good --Morally valuable Apply to -Personal decisions -Public policy -Organizational procedures Normative ethics is the study of what is morally justified Normative ethics define morally justified conduct, beliefs and character [Moral values are the standards of good and evil, which govern an individual's behavior and choices.]

Evolution - Survival of the fittest

Not just survival of the strongest (power and force) but survival of "those who are cooperative and mutually supportive" Evidence suggests communal living has benefits beyond protection and procuring food Therefore those with the skills to prosper living in a communities survive

Caring, Character and Principles

Outline: Relationship-centered care Character and the virtue of caring Kohlberg and Gilligan's care ethics Evolution of caring Biomedical ethics principles Beneficence toward strangers Motivations for being moral Ethical egoism - not covered Psychological egoism - not covered Complex motivation

Relationship centered model for care

Personal relationship between you and your client (both ways): providing healthcare is a complex task a legal relationship governed by contracts a moral relationship guided by moral values (Pew-Fetzer task force: concern for clients, sensitivity to their needs, empathy for their suffering, respect for their rights and value for their general well being) Dimensions of care in relationship-centered model 1. Providing healthcare (care giving) 2. Exercising due care (meeting standards) 3. Providing services with attitude and value of concern 4. Manifesting the virtue of caring Patients trust and participation in healing process are important factors in the 'healing' process

Types of ethical theories (moral philosophies)

Rights ethics Duty ethics Utilitarianism Virtue ethics Religious ethics Pragmatism

How did famous virtue ethicists handle this problem?

Plato Virtues provide an inner harmony (mental health and well being) Aristotle Suggested that proper conduct consists of exercising practical wisdom instilled through years of proper training in reasoning, perception and emotion. (i.e. proper conduct is exercising practical wisdom) [Because im older than you than I probably know better? Good people only make good decisions? Not super practical ]

Confusing Pleasure with Happiness

Pleasure is short term Happiness is long term Recreational drug use -> pleasure -> drug abuse -> unhappiness Interpret Mill as intrinsic good is happy life [From a utilitarian view - what is going to bring the most happiness in life]

Should qualified professionals be required to do more than laypersons?

Professional should prioritize beneficence in professional activities over autonomy. Ideals that would be ordinarily beyond obligatory would shift toward being an obligation for a trained professional who is "on duty" Table 2-3 Professionals and the Beneficence Continuum Obligation (strict obligation, weak obligation) Professional Obligation (ideals beyond the obligatory) Supererogation (saintly and heroic ideals) [Would be obligations if on duty]

What's Rational?

Rationality is having the capacity to act based on universally valid principles of action and on rational desires What do rational persons desire? 1. To continue to live 2. To develop their talents and aptitudes 3. Not to have others make insincere promises to them 4. To receive necessary help when needed According to Kant, motives and intentions are important considerations concerning morality. Moral dignity depends on one's capacity to exercise moral good will. - Do duty because it is a duty not because you will benefit [Similar to human rights - live, pursuit of happiness Not only what you choose to do but why you choose to do it Aka moral dignity or moral good will You do the act because it is a duty not because of the benefits of the duty (look good, monetary gain)]

Types of ethical theories (moral philosophies) repeat

Rights ethics - because one is a human being that person is entitled to certain rights Duty ethics - we have moral duty to respect persons Utilitarianism - the greater good; to maximize good consequences Virtue ethics - do what it takes to be a good person. Religious ethics - links moral virtues, ideals, and principles to religious beliefs and ideas Pragmatism - responsible moral judgement can be exercised without resorting to a strict theory

What are our basic moral duties?

Ross organized most basic duties into categories: 1. Duties deriving from one's actions in making commitments or in causing harm (fidelity and reparation) 2. Duties deriving from other people's actions toward you (gratitude and reciprocity) 3. Duties to maintain fair distribution of benefits and burdens (justice) 4. Duties based on opportunity to help others (beneficence) 5. Duties linked to opportunities to develop one's talents (self-improvement) 6. Duties of not injuring others (nonmaleficence)

Common morality*

Set of universal norms shared by all persons committed to morality Obligations Do not kill Do not cause pain and suffering Prevent harm Tell the truth Keep your promises Do not steal Do not punish the innocent Obey just laws Etc. Virtues (moral charater traits) Honesty Integrity Conscientiousness Trustworthiness Fidelity Kindness Etc. [Common morality holds for everyone, not just people in special groups such as healthcare industry workers, public officials, members of specific religious groups, etc.]

Why study ethics?

Strengthen capacities for dealing with moral dilemmas, vagueness and disagreements Skills needed to: Identify and clarify moral issues and moral reasons Weighing conflicting moral reasons Forming consistent and well-developed moral perspectives Being aware of alternative view points Using moral reasons and arguments with precision (consistency) [Moral reasons include honesty, fairness, integrity, respect, compassion, loyalty etc.]

Pragmatism

The anti-ethical theory theory Explores how responsible moral judgement can be exercised without resorting to a strict theory Does not dismiss the various theories but allows for application of parts of different theories as specific situations require, in a pragmatic sense. [Taking the best of multiple theories In this situation what is the best to do based on different theories ]

Principles of Bioethics (getting down to rules)

Virtues and ideals too vague to provide practical guidance In healthcare, the general moral principles of Beauchamp and Childress are widely accepted: Respect for Autonomy - (Respect-self determination, self-governance)The right for an individual to make his or her own choice. Beneficence -(Promote good of others) The principle of acting with the best interest of the other in mind. Non-maleficence - (Do not harm clients) The principle that "above all, do no harm," as stated in the Hippocratic Oath. Justice - (Treat clients fairly) A concept that emphasizes fairness and equality among individuals. These broad norms imply more specific rules, e.g. Respect for autonomy implies" Obtain informed consent Maintain confidentiality Tell the truth Beneficence - (cornerstone of professional healthcare): Be sensitive to patients needs ad fears Alleviate suffering Provide HC is accord with high standards of excellence [Explain how rules are implied from norm, "respect for autonomy"]

Evolution of caring

What are the social influences or biological evolution Are we hard-wired to be caring? (Nurture vs. Nature) Did people evolve to be caring? Does caring (moral judgement) differentiate humans from other creatures? [Can people change to be come better people 3 triplets separated at birth and adopted by 3 different families who were each told child was in developmental study Lots of IRB issues etc that would've happened today but they purposefully separated and followed the children to have a study on triplets ]

Ethical Dilemmas

What are they? Situations in which moral reasons come into conflict How to resolve? 1. Identify moral reasons (duties, rights, consequences, virtues, ...) 2. Identify relevant factual information 3. Identify realistic options to resolve dilemma and potential outcomes of those options 4. Make a decision that balances and integrates moral reasons 5. Take action 6. Review [Someone's duty interferes with someone's rights Review aka what can/did you learn from this]

Virtue of Caring

What's a virtue? - habit of acting in a morally valuable way Morally valuable way? - a way beneficial to one's self and to others Many virtue are relevant to healthcare but the virtue of caring has special importance What's the virtue of caring? It is an umbrella virtue Promote the health of clients according to standards with the client's well-being in mind. Sensitivity (understand morally relevant features and contexts) Empathy (understand feeling of others) vs. sympathy [i feel your pain vs. i'm sorry that you're in pain] Compassion (response to suffering) Kindness (sensitive helpfulness) Conscientiousness (in meeting responsibilities) [What's health? Better artificial limb = better health? They won't remember what you did but will remember how you made them feel. Good clinician is a caring clinician. Be caring or show that you are caring? Consider relationship therefore must show caring.]

List of virtues

co-operation self-discipline excellence consideration honesty respect creativity independence, courtesy, trust, kindness, courage, perseverance, enthusiasm, detachment, unity, humility, commitment, patience, flexibility, responsibility, truthfulness, determination

Immanuel Kant (1724 - 1804)

https://www.youtube.com/watch?v=eQcC1qYP08s "Act so that you treat humanity, whether in your own person or in that of another, as an end and never as a means." Always respect persons as having legitimate purposes of their own which places limits on your own purposes, and respect your own rational purposes as limiting how to act toward yourself Summed up as respect for autonomy [Categorical imperative - "includes all categories" rule that would apply at all times across all categories Do what is rationally (logically) right for human beings Only human beings are capable of rationality (have volition, can make choices) As rational, only human beings are autonomous 2 ethical imperatives/Core values: 1 - what is best for everyone equally? 2- what preserves the needs of each individual equally?]