ETHICAL THEORIES

Introduction
Health care ethics is an applied ethical study dealing with moral problems that demand deliberate decisions.
Moral decisions made are justified accordingly by moral rules, which, in turn, are grounded in ethical principles and
ultimately in ethical theories. Moreover, in dealing with moral issues, it is better to have certain moral principles by
which to act and make moral decisions, than to do so without them.
By acting on a particular precept, rather than on a mere impulse or an inclination, we make our moral
decisions more defensible and justifiable. We are in a better position to provide justifications and explanations for
our actions.
There is a need, therefore, to study several ethical theories.
Ethical doctrines attempt to determine whether an act is good or bad, whether we are acting rightly or
wrongly. It help answer the question: what is the norm of morality by which to settle whether one’s decisions are
licit or not, legitimate or not legitimate, proper or not proper, suitable or not suitable?
Attempts to resolve these queries have led to the construction of the diverse ethical formulations of general
and universal concepts and principles, which serve as the basis of good and evil, right and wrong. They are now
known as the different ethical schools of thought formulated by great thinkers the world over. These ethical theories
are usually classified as general ethics.

Duty Ethics By Kant

1. Immanuel Kant - German philosopher of 18th century.

In his classic work “Ground work of the metaphysics of morals” – he attempted to define a person as a rational
human being with freedom and moral worth. He emphasized that people should regard everyone with dignity and
respect and when they do not, individuals feel used and demoralized.

A person is morally good and admirable if actions are done from a sense of duty. Doing one’s duty is doing what
one is obliged to do. Duty is an obligation Sometimes Kant’s ethical view is called deontologism for its emphasis on
duty or obligation (deontos in Greek)

DUTY ETHICS
Duty ethics stresses duty as the norm of moral actions. The duty ethicist is interested in these questions:
What makes an act moral as distinguished from a nonmoral one? What is the difference between a person who acts
morally and one who does not?
Kant teaches that one acts morally (or performs a moral act) if and only if one does whatever one is obliged
to do. But what is that act which an individual is obliged to do? It is one that is performed or done form a sense of
duty or obligation. Thus, what makes an act moral is its being done out of duty, as distinguished from other acts
done for other reasons.
Duty in this context is that which an individual ought to do, despite the inclination to do otherwise.
Doing one’s duty then is doing what one is obliged to do. This leads to the distinction between an act done in
accord with duty and an act done from a sense of duty. To illustrate: A health care professional, for instance, who
performs his medical functions out of the desire to do so, or out of fear of being accused of negligence, is acting in
accord with duty; hence, his act has no moral significance, or nonmoral.
Anyone, therefore, who does something merely because one feels like doing it (say, out of personal
inclination) is not acting morally, is not a moral person, nor is he performing a moral act.
Now, health care professionals act from a sense of duty if they recognize that there is a special obligation to their
patients because of their relationships with them.
Health care professionals who understand the nature of such an obligation and act upon it accordingly are
indeed moral persons; otherwise, they are not. It is thus clear that the essence of morality, for the duty ethicist, is to
be found in the motive from which an act is done. The rightness or wrongness of an action is determined by the
motive from which it is being carried out; regardless of the consequences which doing or not doing so will
produce.
The motive here refers to the duty that one ought to perform; it is what makes the act morally good. A
person who does such an act is a person of good will. A good person is a moral one who acts from a respect for
duty, and one who acts from a sense of duty is a person of good will and ethical individual.
 But how can one know one’s duty in a given situation, so that one may act accordingly? Is there a way or
test by which to determine what one’s duty will be under a particular set of circumstances? According to Kant, to be
able to determine one’s duty in a particular situation, one must test the act’s universalizability, by applying the
categorical imperative.
The categorical imperative is an ethics principle which states: “Act only on that maxim which you can at
the same will to become a universal code of behavior.” To illustrate, let’s take the example of stealing, applying the
categorical imperative, to steal or not to steal. Let the maxim or precept be: “Everybody should steal.” That is, my
wife, mother, brother, sister, cousin, and all others should steal. The maxim must be binding on everyone at all
times and in all paces; it must become a universal code of behavior mandating everybody else to steal.
Of course, since you cannot will the said maxim (i.e., “Everybody else should steal”) to become a universal
principle, then you should not teal. You now recognize that it is your sense of duty to steal. Hence, the moral dictate
of the categorical imperative forbids stealing, lying, killing breaking of promises, among many others, under any
and all circumstances.
By simply invoking the said formulation of the categorical imperative, one can readily determine the
rightness and wrongness of one’s actions or decisions. Wrong acts involve contradictory, repugnant, or inconsistent
results, as when for example, we apply the maximum to others but not to ourselves, or when we lay down a set of
conditions or qualifications to justify exceptions to a moral rule.

Two types of ethics principles

a. Hypothetical imperative- duties or rules that people ought to observe if certain ends are to be achieved.
b. Categorical imperative- moral actions must be based on reason.
No action can ever be judged as right if the action cannot have potential to become a binding law for all people.
Questions ask “if I perform this action, should it become universal law?
Kant stated that people ought to follow a universal framework of moral maxims / rules to guide actions and duties
because it is only through dutiful actions that people have moral worth.

Two Types of Duty

Kant makes a distinction between perfect and imperfect duty.
A perfect duty is one which we must always observe, irrespective of time and place. That I should not harm or inflict
injury upon others is a perfect duty. An attendant nurse has a perfect duty to take care of her patient. An imperfect
duty is one which we must observe only on some occasions. That I should show love and compassion occasionally
to others, based on my own choice, is an imperfect duty.

Treating others as Ends.

One important moral principle of duty ethics, which is very relevant not only in the medical context but in any
human relationship as well, is stated thus: “Always act so as to treat humanity, either yourself or others, as an
end and never as only a means.” To treat others as an end means to respect their rights and regard them as fellow
human beings (and that makes it morally good and just); to treat others as a means is to use them for one’s own
personal interest, to degrade and violate their rights and to take advantage of their innocence or helplessness (which
makes it morally bad and unjust).

And so whenever a health care professional performs his duty as such to his patient, he is treating the latter as an
end, that is, as a fellow human person with dignity and freedom. On the contrary, whenever a nurse is remiss in her
duty or cheats on her patient through negligence and dishonesty, the patient is being treated as only a means.

Autonomous and Self-Regulating Will. Kant’s concept of the will as autonomous and self-regulating has
contributed a great deal to our understanding of autonomy as freedom of action. When we say an individual has
autonomous and self-regulating will, we refer to his or her independence, self-reliance, and self-contained
capacity to make moral decisions by and for herself/himself.

This means that the reasons and justifications for one’s decisions are one’s own. To respect an autonomous agent,
therefore, is to recognize one’s own considered value judgment, even if the latter is believed to be mistaken or
incorrect. To respect one’s reason in this way is to acknowledge one’s right to one’s own decision or view, as
may be the case.

Basis of Human Dignity.

Kant’s notion of autonomy is bound to his concept that every person is a rational being possessing worth and
dignity. As such, individual persons are ends in themselves and are capable of making their own moral decisions.
They are not to be treated merely as means.

To treat an individual merely as a means is an infraction of Kant’s concept of autonomy, because one is treated in a
way one does not want to be.
Not to respect an autonomous agent is either to reject that person’s own judgment or to deny him the
freedom to choose and act on that judgment. For Kant, mutual respect for autonomy between persons in moral
relation is the basis of justice; its violation would be a form of injustice.

In the Medical Context In dealing with issues in medical practice and research, Kant’s ethical principles are of far-
reaching importance. First, for Kant it is always wrong to lie, no matter what the consequences may be. Medical
investigators/researches should not lie to their patients. Lying for him is intrinsically wrong.
Second, we must always treat people (including ourselves) as ends and not only as means. In medical
experimentation, for instance, a patient must be informed of the procedure to be undertaken and must give voluntary
consent to become a subject. Deceiving a would-be experimental patient is a surreptitious way of depriving him of
autonomy; hence he is treated only as a means. Deception for lying, as far as Kant is concerned, dehumanizes the
patient in such circumstances.
Third, we also have a duty to treat ourselves as ends to preserve our dignity and worth as human beings (of
course, our good health included). For a patient to refuse a badly-needed surgical treatment, although he has been
informed that it is necessary to preserve his life, would be morally unjustifiable. In no case, however, does a
Kantian ethic legitimize a physician’s decision to force a patient to fulfill his duty to himself.
Fourth, it would be against Kant’s ethical principle for us to volunteer to undergo a risky experiment that
threatens our lives without first knowing the nature, safety, or legitimacy of the experiment. And, of course, suicide
is a mortal violation of Kant’s precept.
Fifth, Kant’s distinction between perfect and imperfect duty suggests that some rights should be
recognized. In a doctor-patient relationship, for example, the physician has an imperfect duty to accept me as a
patient; that is how he discharges his duty is his own decision, his own prerogative, his own right.
Once I am accepted, however, as his patient then I can make legitimate claims. For example, I can demand
not to be harmed, not to be lied to or to be deceived; hence his perfect duty now is not to inflict injury upon me; and
it becomes his perfect duty to acknowledge it.

Difficulties. Despite it’s being a fruitful source of principles and ideas for working out moral dilemmas of medical
experimentation and practice, duty ethics meets some difficulties in certain areas of moral decision-making. First,
Kant’s principles have no clear way of resolving cases of keep a secret, but someone else asks me about the thing I
am supposed to keep secret. There are now two conflicting duties: my duty to keep the secret and my duty not to
lie, or my duty to tell the truth.
Either I keep the secret or tell the truth. If I keep the secret, I will be lying or not telling the truth. If I tell
the truth (or reveal the secret), then I will break my promise to keep it. According to Kant’s position I should do
both. But in such a situation, how can I keep and divulge the secret at the same time?
Another example may be cited: Here is a maniac, armed with a handgun looking for a relative of his in
order to kill him. His relative happens to be in our hours. Should I tell him the truth? If I do, his relative will be
killed. If I do not, I will be telling a lie. According to Kant, I must not lie to the maniac.
Second, Kant’s ethics presents another difficulty in connection with the notion that we have a duty to treat
others as rational beings or persons. This is replete with so many serious moral problems: Is a fetus that is
developing in its mother’s womb (be it deformed or not) considered a person? Is an infant born with serious
physical deformities a rational being?
Third, Kant’s concept of a rational person is the basis of what he calls an autonomous and self-regulating
will. Does a newborn baby or a mentally retarded individuals, have such a will? What about an insane person?
Without such a will, then the individual cannot legitimately consent to being the subject of medical research and
experimentation. Nor can he give permission for necessary medical treatment to be taken up on him.