Lesson 8: FEELINGS

Emotions – that is to say feelings and intuitions – play a major part in most of the ethical
decisions people make. Nearly everyone does not realize how much their emotions direct their moral
choices. But experts believe it is impossible to make any vital moral judgments lacking emotions. Inner-
directed pessimistic emotions like remorse, humiliation, and shame often prompt people to act ethically.
However, outer-directed negative emotions intend to restraint or chastise. Positive emotions like
appreciation and respect, which people may feel when they see someone acting with compassion or
gentleness, can prompt people to lend a hand to other people. So, while we may believe that our moral
decisions are inclined most by our philosophy or religious principles, in truth our emotions play an
important role in our ethical decision-making.

LEARNING OUTCOMES

After studying this chapter, the students should be able to:

1. Explain the importance of using feelings and reason in the decision making process;
2. Compare reasonable and emotional responses; and
3. Critique an ethical dilemma.

LECTURE NOTES

1. Defining the Emotions: What are the Desiderata?

Two broad desiderata have governed the project of defining emotions in both philosophy and
affective science: (a) Achieving compatibility with ordinary linguistic usage, and (b) Achieving theoretical
fruitfulness. A definition that aims exclusively at (a) is a descriptive definition. A definition that aims at
(b) at the cost of possibly violating some ordinary intuitions is prescriptive. To secure ordinary language
compatibility, traditional philosophers have relied on introspection, thought experiments, casual
observation, gleaning of insights from literary texts and other artistic sources, and more recently,
experimental tests of ordinary intuitions and of the psychological processes underlying them performed
within “experimental philosophy”.
Most people believe that even basic emotions are capable of
clouding our judgment, thus affecting our ability to make rational
decisions. However, the reality is more complicated than this, and
neuroscience may hold the key to understanding why.
Before the 1990s, the study of the human brain focused essentially
on rational thinking, at the expense of emotional experiences. It was
understood that rational thinking was the main function of the brain, and
emotions blocked this function. But thanks to the work of scientists such
as Antonio Damasio and the development of new neuro-imaging
techniques, it has been demonstrated that emotions are crucial at the time
of making “correct” decisions. This shatters the long-held view that that
emotion and reason are dichotomous, (with reason being seen as the
superior factor).
Photo: Antonio Damasio

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 Over many years, Antonio Damasio investigated patients who had sustained injuries to the
frontal lobe that did not affect memory, language, attention or any other fundamental rational process,
but who had suffered changes to other behavioral aspects connected to emotions, such as motivation.
What is interesting about his studies is that these types of patients were not capable of acting as they
had done previously: they were not capable of maintaining their employment, did not follow schedules,
were easily distracted, spent too much time on irrelevant tasks and were unable to focus. But, above all,
were incapable of making simple decisions.

Although a lack of emotional control can lead to inconvenient behavior, these studies
demonstrated that the absence of emotions equally led to a situation of irrational behavior during
decision making. In other words, emotions have a fundamental role in decision making and behavior,
acting as the catalyst when selecting the most suitable way of acting. Emotion and reason navigate in
parallel and are mutually dependent in ensuring one´s ability to function correctly, adapt to
surroundings, and respond to the demands of different environments.

Photo source: psychologicalscience.org

Difference between feelings and emotions

To explain how emotions influence our decision making, it is important to understand the In
1872, Charles Darwin published his study on the expression of emotions in animals and humans, where
he argued that emotions motivate people to respond quickly to a stimulus from their environment,
which in turn increases the probability of survival. At that moment, he made the case that emotions lead
us to react physically. For example, if we encounter a bear, we experience fear and this fear makes us
run. However, in 1884 the psychologist William James proposed revolutionary, albeit controversial ideas
on emotions and feelings.

Photo source: bitbrain.com

James understood that, as a response to a stimulus or experience, a physiological reaction is

caused (a change in physical state- perspiration, breathing, higher pulse rate, etc.) and this reaction
generated an emotion or emotional state (cognitive, social, contextual and environmental evaluations).
In other words, if we encounter a bear, first we run and then we feel fear. At that time, James’ ideas
were not successful. However, Damasio was able to reassess them at a later date and his findings still
inform modern neuroscience. Emotions are neuro-physiological reactions unleashed by an external or

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internal stimulus (emotions are physical). Feelings are a self-perception of specific emotions, being a
subjective expression of emotions (feelings are mental).

According to Damasio, what he calls primary emotions are automatic and innate physiological
reactions that, as proposed by James, are produced by a stimulus (an emotional response). These
emotions, which are also present in animals, are basic to our survival because they allow us to achieve
useful objectives, such as hiding from a predator or fighting against a competitor. However, the process
continues after the body reacts. This defines primary emotion. The next step is to feel the emotion
connected to the original stimulus (conscious thought). Through these mental associations and
reactions, we obtain more flexible emotions, based on our previous personal experience beliefs
(subjective experience).

Conclusion
Both our feelings and our reason reflect our participation in a moral community, or more likely
several moral communities. As children, our moral community is our family, which soon broadens to
include our friends and then is defined by the rules of our school. As adults, our moral community
extends from our family to our friends (at work, in our neighborhood or a support group, and perhaps in
our religious community), to our city, our country, the people of the world whose moral and legal rights
are defined by international law, and perhaps also to a moral community that includes non-human
organisms and ecosystems.

Photo source: health.harvard.edu

LEARNING ACTIVITY

Critique the behavior and the responses of the agent(s) in the ethical case provided. Write your
thoughts in a separate sheet of paper.

An ethical dilemma found in a case study

By Toni Cesta, PhD, RN, FAAN

Senior Vice President
Lutheran Medical Center
Brooklyn, NY

I will never forget my biggest ethical dilemma. It happened when I was a director of case management
at a large medical center in New York City. It was the day after Thanksgiving. I was at work, but a lot of
people in administration were off that day. I received a page from the director of critical care medicine.
He was covering the ICU that day and wanted to transfer a patient to our hospital from another state.I
knew the patient he was referring to, because the patient recently had been in our hospital for a six-
month length of stay, and the patient's discharge plan had been difficult and complex. The doctor
explained to me that the patient had been readmitted to a hospital in another state, but that his wife
wanted him to return to our hospital because she knew the nursing and medical staff and felt more

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comfortable there. The doctor wanted the patient in our hospital too, because he felt it was "the right
thing to do for the patient" and would improve continuity of care.

Since I knew the patient and his wife, and I also knew that the admission would be out-of-network and
probably not reimbursable, I found myself faced with a classic organizational, or case management,
ethical dilemma. I explained to the doctor that the transfer would not be approved by the patient's
managed care insurer, as the care the patient required could be provided at an in-network hospital. I
was concerned that the patient would have another long stay, entirely without payment to the hospital.
The doctor understood my concerns, but he wanted to put the needs of the patient and his wife above
those of the hospital. In this classic conflict, he was exhibiting beneficence. Beneficence is defined as an
ethical principle that directs the healthcare professional to take action to promote the well-being of his
or her patients.

I, on the other hand, was advocating for a decision that addressed the financial needs of my employer,
the hospital. However, since my decision had a direct impact on the patient, the patient's wife, and the
potential quality of care of the patient, I found myself faced with a difficult decision. Without anyone to
share the decision-making burden with me, I considered the wishes of the patient's wife against the
financial needs of the hospital. In my initial response to the physician, I denied the admission and cited
the financial risk at hand and the potential non-reimbursement to the hospital.

Needless to say, the physician was not happy with my decision and provided me with a list of reasons
why I had made the wrong decision. His beneficence was front and center! I considered his argument, as
well as what I had told my case managers and case management students many times: "when in doubt,
err on the side of the patient. If you do this, no one can fault you for your decision."I finally agreed to
the transfer. The outcome was not pretty. The patient came to our hospital that day. He stayed in acute
care for several months and ultimately was transferred to our acute rehab unit. The entire stay was nine
months. And we got paid for none of it. So, ask yourself. What would you have done in this situation?
Perhaps, if I'd had an organizational ethics committee and could have taken my dilemma to them, the
outcome might have been different. Even if it hadn't been different, at least I would have had the power
of the committee behind me to support my decision.

Assesment Rubric

Criterion Poor (1pt.) Fair (2pts.) Good (3pts.) Excellent (5pts.)

Content & No clear position Position not Clear position Takes a strong,
Development taken; reasons clearly stated; taken and well defined
undeveloped; no development is defined; some position; uses at
supporting facts brief; unrelated, reasons and least three
used unsupported some details appropriate
general present, but not reasons with at
statements, fully developed. least two
reasons, and Counter supporting
details; minimal arguments details for each
facts used. addressed. reason. Counter
Counter arguments
arguments not effectively
acknowledged. addressed, w/o
undercutting
position.

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Organization & Organization and Structure of the Structure is Structure of
Structure structure detract paper is not easy mostly clear and
paper is clear
from the to follow. easy to follow.and easy to
message of the Paragraph Paragraph follow.
writer. transitions need transitions areParagraph
Paragraphs are improvement. present. transitions are
disjointed and Conclusion is Conclusion is logical and
lack transition of missing, or if logical. maintain the
thoughts. provided, does flow of thought
not flow from throughout the
the body of the paper.
paper. Conclusion is
logical and flows
from the body of
the paper
Grammar, Paper contains Paper contains Rules of Rules of
Punct. & Spelling grammatical, few grammatical, grammar, usage, grammar, usage,
punctuation, and punctuation and and punctuation and punctuation
spelling errors. spelling errors. are followed are followed;
Language uses Language lacks with minor spelling is
jargon or clarity or errors. Few or no correct.
conversational includes the use spelling errors. Language is clear
tone. of some jargon and precise;
or conversational sentences
tone. display
consistently
strong, varied
structure.

REFERENCES

Bechara, A., Damásio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences
following damage to human prefrontal cortex, Cognition, 50, 7-15.
Carey, “Study Finds Brain Injury Changes Moral Judgment,” The New York Times (Mar. 21, 2007) online
at http://www.nytimes.com/2007/03/21/health/21cnd-brain.html.
Case Management Insider. Retrieved fromhttps://www.reliasmedia.com/articles/131262-case
management-insider-an-ethical-dilemma-found-in-a-case-study
Fehr, Beverley and James A. Russell, 1984, “Concept of Emotion Viewed from a Prototype
Perspective”, Journal of Experimental Psychology: General, 113(3), 464–486. doi:10.1037/0096
3445.113.3.464
Thompson, Mind in Life: Biology, Phenomenology, and the Sciences of Mind, (Cambridge, MA: The
Belknap Press of Harvard University Press, 2007), 386.
Shiv, B., Loewenstein, G., Bechara, A., Damásio, H., & Damasio, A. R. (2005). Investment behavior and
the negative side of emotion. Psychological Science, 16, 435-439.
The concept of Emotion. Retrieved from https://plato.stanford.edu/entries/emotion/

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