Biomedical Ethics - Unit 2 - Reasoning

Kant's Deontological Ethics

- Moral status of actions cannot be fully understood in terms of the consequences of actions - Kant insists that the morality of human actions requires us to examine the underlying principles upon which a human being chooses to act. - Deontological ethical theory evaluates the moral rightness or wrongness of actions in terms of whether or not a given act is performed for the sake of moral duty. Thus, a deontological ethical theory can be contrasted from a consequentialist ethical theory insofar as the morality of actions does not look exclusively at the consequences of actions in order to determine whether or not a given act is morally right or wrong. A deontological ethical theory, such as Kant's, claims that there are certain actions that it is always our moral duty to either perform or refrain from performing, regardless of the consequences. On a deontological account actions can therefore be divided into three basic categories: (i) actions that are required by duty, (ii) actions that are forbidden by duty, and (iii) actions that are consistent with duty and therefore permissible. Actions that are required by duty are those actions that it is our duty to actively promote, while actions that are forbidden by duty are those actions that it is our duty to refrain from and avoid. Permissible actions, meanwhile, are those actions that are neither morally required nor forbidden (e.g., tying one's shoes). Permissible actions are ultimately amoral acts because they are neither moral nor immoral. So what kinds of actions are required, forbidden, and permissible according to Kantian deontology? Kant's ethics is notoriously complex and scholars today still debate the proper interpretation of his ethical theory.[1] Nevertheless, some general observations can be made that can help to explain the nature of dutiful action in Kant's ethics. In Kant's most often-read book on moral philosophy, his Groundwork for the Metaphysics of Morals, he presents his readers with two leading formulations of dutiful actions. Both formulations offer us a way in which to better understand what Kant takes to be morally forbidden, required, and permitted by duty. The first formulation is: Act only according to that maxim by which you can at the same time will that it should become a universal law. This first formulation is the more abstract and complicated of Kant's formulas. By the term "maxim" Kant means, loosely speaking, the underlying principle that a moral agent acts upon. Thus, Kant's first formulation prescribes that one ought never to act upon a principle that cannot become a universal law for all rational beings to follow. Many contemporary Kant scholars claim that this first formulation provides us with a formula for best understanding what is morally forbidden. Actions are morally forbidden if they cannot pass this test of "universalizability." That is to say, if the underlying principle ("maxim") of one's action cannot become a universal law of nature, then that action is immoral / forbidden. On page xxvii of our course textbook the authors have provided a lengthy passage from Kant in which he explains why making a false promise cannot be universalized and why it is therefore morally forbidden. When reading this section it is worth noticing that what Kant considers to be morally problematic about a false promise is not based upon consequentialist considerations. Instead, Kant objects to false-promise making because false-promise making cannot be consistently willed as a universal law for all rational beings to follow. Many Kant readers (especially first-time Kant readers) find Kant's first formulation to be rather complex, and they typically prefer Kant's second formulation instead. The second formulation is: Act so that you treat humanity, whether in your own person or in that of another, always as an end and never only as a means. This second formulation is preferred by Kant readers for a number of reasons. First of all, it is easier to understand than the first formula. Secondly, this second formulation provides us with a much clearer account of what kinds of actions are morally forbidden and what kinds of actions are morally required. Kant's second formula states that one should never treat human beings solely as a means to one's end. In other words, one should not treat any human being as a mere tool / thing / instrument / slave for one's own use and / or enjoyment. Although one must often "use' human beings for the sake of a chosen end (e.g., a taxi driver is "used" insofar as he drives us to our requested destination), Kant's second formulation states that we should not treat a human being solely as a means to an end. We ought also, Kant argues, to treat human beings as an end in themselves. In other words, we ought to treat human beings with dignity and respect. In one's various social interactions, then, Kant prescribes that one ought to be courteous, grateful, benevolent, honest, etc., in whatever way that is appropriate to that given situation. In keeping with our taxi cab example, Kant would say that instead of treating the taxi driver solely as a means to an end, one ought to treat the person who is driving us to our destination with dignity and respect. Why? Well, once again, Kant does not appeal to consequentialist forms of reasoning in order to justify the morality of such actions. Instead, Kant argues that one must treat human beings with dignity and respect because human beings have a unique and distinctive capacity for rational self-government. As the authors of our textbook put it, referring to Kant's closely-tied third formulation: "The capacity to rise above the compelling forces of desire, self-interest and physical necessity, to act freely on the basis of reasons, is what gives rational beings their dignity and worth. To treat a person as an end in herself, then, is to respect her autonomy and freedom" (Gedge and Waluchow, xxviii). We should be able to see how Kant's second formulation provides us with a rather clear account of what kinds of actions are morally forbidden and required by Kantian deontology. Treating a human being solely as a means would be an act that is forbidden by duty. Meanwhile, duty requires us to positively treat human beings with dignity and respect. Summary of Kant's deontological ethics: As noted above, Kant's ethics is notoriously complex but certain prominent points can nevertheless provide us with a helpful framework for assessing the morality of certain actions. Kant's deontology forbids the following kinds of actions. Actions which maxim cannot become universal law, and / or actions that treat human beings solely as a means. Kant's deontology requires the following kind of action. Treat human beings with dignity and respect. Permissible actions are therefore those actions that, even though they do not treat human beings with dignity and respect, they can be universalized and they do not treat human beings solely as a means. For example, listening to the radio, tying one's shoes, raking leaves, etc., would be considered permissible actions according to Kant. Such actions are therefore termed amoral because they are neither moral (required) nor immoral (forbidden).

Rule Utilitarianism (RU)

- To understand this RU, consider what would be said if someone's "free riding" came to light - Some might argue that what that person is doing harms no one, or at least harms them in only minor ways - But imagine what would happen if everyone did what you are doing - Individual actions are judged to be right or wrong according to the consequences of a universally adopted general rule describing the action to be carried out. If the observance of a set of general rules would tend toward utility maximization, then any action to be undertaken must be condoned by those rules. - Act is morally right if it conforms to a rule whose general observance tends to maximize utility and minimize disutility

Utilitarianism - 2 Strands

1. Classical utilitarianism (aka act utilitarianism) (AU) 2. Rule utilitarianism (RU). - Actions are right if they tend to promote happiness, wrong if they tend to produce the reverse - Utility = Happiness - Principle of utility focuses on the consequences of an action, rather than on any features of the actions themselves - Each person is to count for one, and no one is to count for more than one - Procedure for determining the right action ---} examine likely consequences of an action, compare them with the likely consequences of an alternative action, and the action with the best (or least bad) consequences is the one that should be performed.

Objectives

1. Explain how ethical reasoning differs from other types of reasoning. 2. Describe how ethical principles and factual statements come together in moral reasoning. 3. Summarize various ethical theories (utilitarian, Kantian, Aristotelian, and feminist) on how to reach moral decisions. 4. Give examples of the application of each of these theories in a health care context.

Theories

1. Utilitarianism (both act and rule utilitarianism). 2. Kant's deontological ethics. 3. Aristotle's virtue ethics. 4. Feminist ethics.

Objections to Rule Utilitarianism

1. We would follow the rules when it is best to do so and depart from them when that seems best " (Gedge and Waluchow, xxv). This means we are just maximizing the utility of our individual actions. If instead the rule utilitarian insists that we never deviate from the rules even for the sake of utility, then the critic says RU has no business calling itself utilitarianism—it's just old-fashioned rule-following come-what-may. 2. RU functions on the basis of the notion of the "general observance" of the set of rules—the rules would maximize utility only if pretty well everyone follows them. If not everyone follows them, it is a theory about an ideal world, not the actual world. Perhaps, then, we should not be held accountable for following rules that few other people follow, even if following them would lead to general happiness.

2 questions of ethical inquiry

1. What should I do? 2. What sort of person should I be? - The first question involves particular acts - The second involves the character of the agent, the person who performs the action. What you do is relevant to who you are, but because people sometimes act "out of character," what a person does is not always indicative of his or her character.

3 levels of moral response

1st Level - Expressive Level - Person just emotes, states an opinion, says how they feel - No reflection or moral justification - Talk shows tend to take place at this level 2nd Level - Pre-reflective Level - One justifies one's response by reference to moral concepts (rules, principles, values, norms). - These are accepted uncritically, sometimes poorly understood, and often applied inappropriately - Defining feature of response - uncritical acceptance of norms - Characterized by the use of ethical words that contribute nothing to ethical debate and deliberation (choice, autonomy, and natural or unnatural) 3rd Level - Reflective Level - Moral judgments are not based entirely on conventional norms blindly accepted, but on principles, rules, and values to which we ourselves consciously subscribe

Act Utilitarianism (AU)

Act is right if there is no other action that would have: a) Produced a greater balance of utility over disutility b) Produced a smaller balance of disutility over utility

Reading Assignment

Introduction: Ethical Resources for Decision-Making - xi-xlv - skip "Ethical Pluralism: W. D. Ross," xxviii-xxxi - Optional: "Naturalized Feminist Bioethics" and "The Language of Rights," xxxviii-xliii).

Ethical Theory

Systematic, critical study of the basic underlying principles, values, and concepts utilized in thinking about moral life

Objections to Act Utilitarianism (AU)

Utilitarian theory calls for us to take all people affected by an action into consideration equally. This means that we are to be impartial in ethical contexts. That may be the correct approach in professional contexts, but we do not lead most of our lives as though being impartial is a good thing. According to AU, the torture of innocent people is acceptable if there are circumstances in which it maximizes happiness. But aren't some actions just wrong even though they would maximize happiness?