Week 2 Ethics in Health Care

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Chapter One

Human Value Development

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Human Behavior

• Human behavior is not random

• We are attempting to achieve

something

• Beyond reflexes and instincts, we

seem to be attending to:

– Needs

– Values

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Hierarchy of Needs

• Abraham Maslow – motivation based

on needs:

– Physiological

– Safety

– Social

– Esteem

– Self-actualization

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Motivation by Values

• The difference between “is” and

“ought”:

– Inner voice telling us what we ought to

do, even in the face of pressing needs

– Consider the males on the Titanic –

what was their need? What did they feel

they “ought” to do?

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Value System

• Values:

– Inner set of subjective feelings, attitudes,

beliefs, and opinions that guide our

understanding of what ought to be

• Rank the following in importance to you:

– Freedom from constraint

– Privacy

– Group identification

– Freedom from disability

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Human Values

• The case of Neanderthal Man

• What tells you he was a creature of

values?

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Value Theorists

• Jean Piaget

• Lawrence Kohlberg

• Carol Gilligan

• Morris Massey

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Kohlberg Model

• Level One – Preconventional

Morality

– Stage 1. Reward and Punishment

– Stage 2. Individualism and Exchange

• Level Two – Conventional Morality

– Stage 3. Good Boy/Good Girl

– Stage 4. Law and Order Orientation

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Kohlberg Model (continued)

• Level Three

– Postconventional

Morality

– Stage 5. Social Contract

– Stage 6. Universal Principles

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Gilligan Challenge

• Boys and girls may follow different

developmental paths in gaining value

systems – two separate paths that

lead to different highest

values

• Highest Value:

– Legalistic equality for males

– Personal responsibility for females

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Gilligan Challenge (continued)

• If different paths, should this lead to

differing value models?

– Males – a model based on equality and

justice

– Females – a model based on caring

• Can one truly function without the

other?

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Massey’s

Value Cohorts

• “You are what you are because of

where you were when.”

– Significant emotional events happen to

the society as a whole

– People within a historical time frame are

shaped by the same significant events

– Time frame cohorts share similar values

based on shared experiences

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Massey’s Value Cohorts
(continued)

• Traditionalists

– Great Depression – World War II

• In-betweeners

– Post World War II America – Cold War

• Challengers

– Civil Rights movement – Vietnam

• Synthesizers

– Fall of Communism – Globalization

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Value Cohorts

• How might significant emotional

events shape society values?

– World War II

– Vietnam War

– Cold War

– Assassination of President Kennedy

– Fall of Berlin Wall

– Twin Towers attack

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Personal Values

• What significant emotional events

shaped your personal value system?

• Starting with “I feel a person should,”

complete value statements for:

– Privacy

– Loyalty and trust

– Abortion

– Authority and social order

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Key Concepts

• Values-based motivation is more

subjective than that based on needs

• Humans have an innate capacity to

acquire ethical beliefs taught by our

culture

• Jean Piaget, Lawrence Kohlberg, and

Carol Gilligan are important value

development theorists

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Key Concepts (continued)

• The Kohlberg model provides for

three general levels of value

development:

– Preconventional

– Conventional

– Postconventional

• Each of these general levels is

divided into two stages

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Key Concepts (continued)

• Kohlberg’s highest level for value

development is when the individual

makes a personal commitment to:

– Universal principles of equal rights

– Social justice

– Respect for the basic dignity of all

people as individuals

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Key Concepts (continued)

• Carol Gilligan:

– Feminist value development

perspective, arguing that the Kohlberg

model is biased toward young men

– Young women follow a different

developmental path, placing personal

responsibility and caring as highest

values

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Key Concepts (continued)

• Morris Massey – shaping of

generational values based on

historical events that shaped the

group as a whole:

– Traditionalists

– In-betweeners

– Challengers

– Synthesizers

ChapterTwo

Decision Making

in Value Issues

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“Am I Sure It Is My Job

to Handle This?”

• Review the case – does the new person

have an obligation?

• Decision making formats require you to

ask yourself:

– What are the facts?

– What values are at stake?

– What options are available to me?

• Evaluate options and select the best one

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Examining Value Issues

• Consequence-oriented:

– The right answer would maximize some good

– Utilitarianism

• Duty-oriented:

– Consequences are essentially irrelevant;

rightness or wrongness are inherent in the act

itself

– Kantian ethics

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Examining Value Issues
(continued)

• Virtue ethics

– Emphasis is not consequences nor

reasoning to a universal truth, but rather

the character of the actor or the duty

associated with the role

– Aretaic ethics

• Divine command ethics

– Right answer in a finite set of rules set

forth by a divine or exemplary being

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Consequence-Oriented

Theories

•

Utilitarianism

– Jeremy Bentham, John Stuart Mill

– No appeal to an absolute authority or

principle; the only test of rival solutions

lies in the

consequences

– The good resides in the promotion of

happiness, or the greatest net increase

of pleasure over pain

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Utilitarianism

• Act utilitarianism:

– “Pig philosophy” problem

• Equal consideration of interest

– “Hedonic calculus” problem

• Rule utilitarianism:

– Right action conforms to a rule that has

been validated by the principle of utility

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Consequence-Oriented

Reasoning

1. Describe the problem

2. List solutions

3. Compare solutions with UTILITY

• Work the problem of Mr. Jimenez:

case study: Act Utilitarianism

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Criticisms of Utilitarianism

• Im

possible

to calculate all possible

consequences

• Used to sanction unfairness

• Lack of sensitivity to special duties

• Lack of respect for persons

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Criticisms of Utilitarianism
(continued)

• May allow unacceptable intervention

in private lives of individuals

• If followed, may recommend solutions

that conflict with personal belief

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Kantian Ethics

• Immanuel Kant (1724–1804)

– Humans are rational beings

– Morality is derived from rationality; our

obligations are grounded not in our

nature or in circumstances but in pure

reason

– Reason provides the guide to universal

principles that can be applied to all

people, at all

times, in all situations

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Kantian Ethics

(continued)

• Categorical imperatives:

– Universal application

– Unconditionality

– Demanding an action

• An action is either right or wrong; it cannot

be both

• Example maxim for health care providers:

“We must always treat others as ends and

not as means only”

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Duty-Oriented Reasoning

Describe problem List Solutions
Compare Solutions with

Principles

Possible findings

One Compliant

Alternative

Several Compliant

Alternatives

Compliant/Conflicting

Principles

Correct Answer
Select Among

Choices
Rank Principles

Select Choice Work case study: Duty-Oriented Reasoning

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Criticisms of

Duty-Oriented Reasoning
• Exceptionless nature – too rigid for

real life

• Morality not derived from reason

alone

• Disregard of consequences

• Question of concern for nonhumans

• Multiple solutions of equal merit

possible

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Virtue Ethics

• Aretaic ethics:

– Taken from Greek arete, which means

excellence or virtue

• Big question:

– “Is it the action or the character of the

agent acting that is the heart of the

matter?”

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Virtue Ethics (continued)

• Virtue ethics:

– Emphasis placed on heart of the moral

agent, not the particular action

• If an individual lives a life of good

moral character and develops ethical

habits – ethical response to a

problem expected

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Virtue Ethics (continued)

• The question is not “what shall I do?”

in a particular situation, but rather,

“how shall I live?”

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Virtue Ethics (continued)

• Modern formulation of virtue ethics:

– Each profession has set of virtues that

practitioners can adopt in

practice

– When personal habits, they come

forward when questions arise

• The question: “What would a good

(fill in specialty) do in this situation?”

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Reasoning with Virtue Ethics

1. Describe problem

2. List solutions

3. Compare solutions with

professional traditions

4. Correct answer

• Review case study:

Virtue Ethics: Saints and Sinners

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Criticisms of Virtue Ethics

• Does not provide specific direction for

problems

• New problems may require new

solutions not covered by traditional

practice

• Relying on tradition may not allow

respect for individual choice or use of

reason

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Criticisms of Virtue Ethics

(continued)

• Humans may attempt to respond to

several different role demands at

same time

• Results may not maximize happiness

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Divine

Command Ethics

• Big Idea:

– Divine or exemplary being has set down

a finite set of rules by which one can

gain guidance when making ethical

decisions

• Specific reference to divine scripture

such as the Ten Commandments

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Divine Command Ethics
(continued)

• General evaluation of actions based

on a model of perfection

• WWJD – if you are Christian, what

would Jesus do?

• In a similar fashion Muslims and

Buddhists turn to the life and example

of Muhammad and Siddhartha

Gautama

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Reasoning by

Divine Command

1. Describe problem
2. List solutions

3. Find appropriate scriptural

reference

4. Follow scriptural admonition

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Criticisms of Divine

Command Ethics

• Belief in divine or exemplary beings

can be questioned by non-believers

• Scriptures do not cover all possible

cases that require moral decisions

• Seeming exceptionless nature

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Criticisms of Divine

Command Ethics (continued)

• Euthyphro problem

• Recently several beheadings were

justified in the name of God; they

believed God told them to do this

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Key Concepts

• Several theoretical positions for
solving ethical dilemmas:

– Consequence

– Duty

– Virtue

– Divine command

• Review the illustrations for each
position in the chapter and solve a
problem using the system

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Key Concepts (continued)

• Act utilitarianism:

– Purest form of utilitarian reasoning,

each act evaluated for pleasure

attained, pain avoided

• Rule utilitarianism:

– Develops rules for action based on

previous validation by principle of utility

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Key Concepts (continued)
• Equal consideration of interest

important concept to keep

utilitarianism from becoming a purely

self-serving form of reasoning

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Key Concepts (continued)

• Kant proposed duty-oriented system:

morality based on rationality, not

experience

• Consequences essentially irrelevant

• Universal truths create obligations for

actions, binding for all people, for all

times, in all situations

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Key Concepts (continued)

• The primary focus for virtue ethics is

the heart of the moral agent

• Virtues can be formed as habits,

which in times of question become

our choice of action

• Even in virtue, the ancient Greeks

counseled moderation and the golden

mean

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Key Concepts (continued)
• Divine command ethics

– Source of divine guidance or exemplary

being:

• Ten Commandments (Christians and Jews)

• Eight-Fold Path (Buddhists)

– Problem of nonbelievers

– Euthyphro problem

Week 2 Ethics in Health Care

Please read power 

points

 presentations. 

Based on that content, please research additional information in the internet. You may also use any other textbook, newspapers, magazines, articles, etc for this assignment.

Write a 250 words summary essay. Please include a Title Page, Conclusion, and References.