WEEK 6: LEARNING MATERIAL Date: March 15-19, 2021

COURSE: GEC 7: General Ethics

Lesson 10: Reason and Impartiality as Minimum Requirements for Morality

TOPIC LEARNING OUTCOMES: Upon completion of this topic, the student must be able to:
1. Explain reason and impartiality as minimum requirements for morality; and
2. Evaluate a moral dilemma using the 7 step moral reasoning model.

Introduction:

The Greek philosopher Aristotle regarded that human beings have a rational soul that makes us
different with that of animals and plants. Rationality (n.d.) is the capability for logical thought with the
ability to reason towards sound conclusions based on facts and evidence, draw inferences from
situations and circumstances, and make sound well-reasoned judgments based on factual information.
Plants and animals are incapable of complex reasoning and introspection, much more so in
distinguishing good from bad and right from wrong. A person is called “rational or reasonable”
(Korsgaard, n.d.) when his beliefs and actions conform to the dictates of those principles, or when he is
subjectively guided by them. Reason is also identified with the capacity that enables us to identify
“reasons,” the particular considerations that count in favor of belief or action. Since human beings are
rational, they have “freewill to strive for perfection” (n.d.). By achieving this fulfillment and well-
rounded development, they would somehow attain happiness. It follows that in order to be ethical, an
individual should decide on actions that properly express his rationality.

Moral judgments must be backed by the best arguments or reasons out there, not only good reasons or
better judgments. Our decisions must be guided as much as possible by reason. The morally right thing
to do is always the thing best supported by the arguments. Morality requires impartiality with regard
to those moral agents affected by a violation of a moral rule. Morality requires the impartial
consideration of each individual's interests. For example, being partial toward friends is not morally
allowed. Impartiality (fair-mindedness) is a principle of justice holding that decisions should be based
on objective criteria, rather than on the basis of bias, self-interest, prejudice, or preferring the benefit
to one person over another for improper reasons. Other elements of impartiality are accuracy, fairness,
balance, context, and no conflicts or prejudgments. The respect for truth at all costs is necessary
(Khatami, 2009; Rachels, 2018).

The minimum conception of morality is: Morality is the effort to guide one’s conduct by reason – that
is, to do what there are the best reasons for doing – while giving equal weight to the interest of each
individual affected by one’s decision (Rachels, 2018).

Models in Ethical Decision Making

There are several models of ethical decision making and action. Powers and Vogel (1980) have
identified six aspects that affect and are included into moral reasoning and decision making: (1) moral

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imagination; (2) moral identification; (3) 52 moral evaluation; (4) tolerating moral disagreement and
ambiguity; (5) integration of moral competence with other competencies; (6) a sense of moral
obligation and moral motivation. Rest (1994) proposes that moral decision-making involves four
psychological processes: moral sensitivity, moral judgment, moral motivation/intention, and moral
character/action.

Before anything else, one must recognize that there is an ethical issue. Could a decision or situation be
damaging to someone or to some group? Is this issue more about that what is legal or what is most
efficient? If so, how? The decision making process could be usefully demonstrated in a Seven Step-wise
Model of Scott Rae (2009) presented below.

Situation – "Please Don't Tell!"

A twenty-year-old Hispanic male was brought to a hospital emergency room, having suffered abdominal
injuries due to gunshot wounds obtained in gang violence. He had no medical insurance, and his stay in
the hospital was somewhat shorter than expected due to his good recovery. Physicians attending to him
felt that he could complete his recovery at home just as easily as in the hospital and he was released
after only a few days in the hospital.

During his stay in the hospital, the patient admitted to his primary physician that he was HIV positive,
having contracted the virus that causes AIDS. This was confirmed by a blood test administered while he
was hospitalized. When he was discharged from the hospital, the physician recommended that a
professional nurse visit him regularly at home in order to change the bandages on his still substantial
wounds and to insure that an infection did not develop.

Since he had no health insurance he was dependent on Medicaid, a government program that pays for
necessary medical care for those who cannot afford it. However, Medicaid refused to pay for home
nursing care since there was someone already in the home who was capable of providing the necessary
care. That person was the patient's twenty-two-year-old sister, who was willing to take care of her
brother until he was fully recovered. Their mother had died years ago and the sister was accustomed to
providing care for her younger siblings.

The patient had no objection to his sister providing this care, but he insisted that she not be told that he
had tested HIV positive. Though he had always had a good relationship with his sister, she did not know
that he was an active homosexual. His even greater fear was that his father would hear of his
homosexual orientation and lifestyle. Homosexuality is generally looked upon with extreme disfavor
among Hispanics.

The patient's physician is bound by his code of ethics that places a very high priority on keeping
confidentiality. That is, information about someone's medical condition that he or she does not want
known cannot be divulged by the physician. Some would argue that the responsibility of confidentiality
is even greater with HIV/AIDS since disclosure of someone's homosexuality normally carries
devastating personal consequences for the individual who is forced "out of the closet."

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On the other hand, the patient's sister is putting herself at risk by providing nursing care for him.
Doesn't she have a right to know the risks to which she is subjecting herself, especially since she
willingly volunteered to take care of her brother?

If you were the physician, what would you do in this case? Would you breach the norm of confidentiality
to protect the patient's sister, or would you keep confidentiality in order to protect the patient from
harm that would come to him from his other family members, especially his father?

Perhaps as good a question as "what would you do" in this situation is the question, "how would you
decide what to do" in this situation? The process of making a moral decision can be as important as the
decision itself, and many ethical decisions that people encounter are so complex that it is easy to exhaust
oneself talking around the problem without actually making any progress toward resolving it. The
response to many moral dilemmas is "where do I start?' and the person who is faced with these
decisions often needs direction that will enable him or her to move constructively toward resolution
and "see the forest for the trees."

In order to adequately address the ethical dilemmas that people encounter regularly, the following is a
model that can be used to insure that all the necessary bases are covered. This is not a formula that will
automatically generate the "right" answer to an ethical problem. Rather it is a guideline that is designed
to make sure that all the right questions are being asked in the process of ethical deliberation.

Given the ethnic and religious diversity of our society, it is important that the model used for making
ethical decisions have "room" in it to accommodate a whole host of different moral and ethical
perspectives. This model is not tied to any one particular perspective, but can be used comfortably with
a variety of cultural, ethnic and religious backgrounds. This is not a distinctively Christian model,
though it is consistent with the Scripture and any Christian can use Biblical principles in utilizing this
model. Take note though that what makes many moral dilemmas so difficult is that the Scripture does
not speak to the issue as clearly as one would prefer because Scripture has not directly addressed the
issue. More general principles can be brought to bear on the issue at hand. However, in these instances,
there is often disagreement about which Biblical principles are applicable to the specific issue under
discussion. For example, in Case 1 (Please Don't Tell) the physician could invoke the Biblical principle
of compassion toward his patient in refusing to disclose information that would harm him. But at the
same time, he could invoke the same principle of compassion toward the sister in protecting her from
the risk of medical harm. It is not clear that appeal to principles alone will conclusively resolve this case.
Thus, to insist that all ethical dilemmas are resolved simply by appeal to Biblical principles seems to
oversimplify the case. Certainly many moral questions are resolved conclusively by appeal to Scripture.
But there are other cases in which that does not happen. That is not to say that Scripture is not sufficient
for the believer’s spiritual life, but that the special revelation of Scripture is often supplemented by the
general revelation of God outside Scripture. This model makes room for both general and special
revelation, and gives each a place in helping to resolve the difficult moral dilemmas facing people today.

1. Gather the Facts -Frequently ethical dilemmas can be resolved simply by clarifying the facts of
the case in question. In those cases, that prove to be more difficult, gathering the facts is the
essential first step prior to any ethical analysis and reflection on the case. In analyzing a case, we

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 want to know the available facts at hand as well as any facts currently not known but that need to
be ascertained. Thus one is asking not only "what do we know?" but also "what do we need to
know?" in order to make an intelligent ethical decision.

2. Determine the Ethical Issues-The ethical issue(s) are stated in terms of competing interests. It's
these conflicting interests that actually make for an ethical dilemma. The issues should be
presented in a __________ vs. __________ format in order to reflect the interests that are colliding in a
particular ethical dilemma. For example, many ethical decisions, especially at the end of a patient's
life can be stated in terms of patient autonomy (or the right of the individual to make his or her
own decisions about medical care) vs. the sanctity of life (or the duty to preserve life). In Case #1
above, the interests of the patient in having the physician keep confidentiality conflict with the
interests of his sister in being protected from the risk of contracting the HIV virus.

3. What Principles have a bearing on the Case?- In any ethical dilemma, there are certain moral
values or principles that are central to the competing positions being taken. It is critical to identify
these principles, and in some cases, to determine whether some principles are to be weighted more
heavily than others. Clearly Biblical principles will be weighted the most heavily. There may be
other principles that speak to the case that may come from other sources. There may be
Constitutional principles or principles drawn from natural law that supplement the Biblical
principles that come into play here.

4. List the Alternatives -Part of the creative thinking involved in resolving an ethical dilemma
involves coming up with various alternative courses of action. Though there will be some
alternatives which you will rule out without much thought, in general, the more alternatives that
are listed, the better the chance that your list will include some high quality ones. In addition, you
may come up with some very creative alternatives that you had not considered before.

5. Compare the Alternatives with the Principles -At this point, the task is one of eliminating
alternatives according to the moral principles that have a bearing on the case. In many instances,
the case will be resolved at this point, since the principles will eliminate all alternatives except one.
In fact, the purpose of this comparison is to see if there is a clear decision that can be made without
further deliberation. If a clear decision is not forthcoming, then the next part in the model must be
considered. At the least, some of the alternatives may be eliminated by this step of comparison.

6. Weigh the Consequences -If the principles do not yield a clear decision, then a consideration of
the consequences of the remaining available alternatives is in order. Both positive and negative
consequences are to be considered. They should be informally weighted, since some positive
consequences are more beneficial than others and some negative consequences are more
detrimental than others.

7. Make a Decision -Deliberation cannot go on forever. At some point, a decision must be made.
Realize that one common element to ethical dilemmas is that there are no easy and painless
solutions to them. Frequently, the decision that is made is one that involves the least number of
problems or negative consequences, not one that is devoid of them.

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Back to the situation – Please Don't Tell!

Using the model, let's return to the case at hand. This will illustrate how the model is used and clarify
exactly what is meant by each of the elements in the model.

1. Gather the Facts: The relevant facts in this case are as follows:
 The patient is a young man, infected with HIV and an active homosexual.
 He suffered fairly severe abdominal wounds but is recovering well.
 Homosexuality is looked down upon in Hispanic communities.
 The patient has insisted that his physician maintain confidentiality about his HIV status.
 The patient is afraid of rejection by his father if his homosexuality is discovered, an
understandable fear given the way homosexuality is viewed in the Hispanic community.
 He was wounded by gunfire in gang violence. It is not clear but is a reasonable assumption that
he is a gang member. As a result, he likely fears rejection and perhaps retribution from his
fellow gang members, especially if they discover that he is HIV positive.
 He is uninsured and cannot afford home nursing care by a professional.
 Medicaid refuses to pay for professional home nursing care.
 The patient's sister is willing and able to provide the necessary nursing care for her brother.
She is accustomed to providing maternal-like care for her brothers and sisters.
 The patient has specifically requested that his sister not be told of his HIV status. She does not
know that he is an active homosexual.
 The patient's sister would be changing fairly sizable wound dressings for her brother and the
chances are high that she would come into contact with his HIV infected blood. The probability
of her becoming infected with the virus from this contact is difficult to predict.

2. Determine the Ethical issue(s) The competing interests in this case are those of the sister who
will provide the care and the patient who will receive it. Both have interests in being protected
from harm. The patient fears being harmed in a psycho-social way if his homosexuality and HIV
status were discovered. Thus he has put the physician in a difficult situation by demanding that his
right to confidentiality be kept. Though she does not know it, his sister fears medical harm due to
the risk of contracting the HIV virus from contact with her brother's blood. This could be stated as
a conflict between confidentiality for the 56 patient vs. the right to know the patient's condition
for his sister due to the risk she would be taking in giving him nursing care. The conflict could be
summarized by the need for patient confidentiality vs. the duty to warn the sister of risk of harm.

3. What Principles have a bearing on the Case? Two moral principles that speak to this case come
out of the way in which the ethical issue is stated. This case revolves around a conflict of rights, a
conflict of duties that the physician has toward his patient and toward the sister. He is called to
exercise compassion toward both, but what compassion (or the duty to "do no harm") demands
depends on which individual in the case is in view. Thus two principles are paramount. First is the
widely recognized principle that patients have a right to have their medical information kept
confidential, particularly the information that could be used to harm them if it were disclosed. But
a second principle that comes into play is the duty of the physician to warn interested parties other
than the patient if they are at risk of imminent and substantial harm. One of the difficult aspects of
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 any ethical decision is knowing what weight to give the principles that are relevant to the case.
Here, the principle of confidentiality is considered virtually sacred in the medical profession and
most physicians will argue that it is necessary to keep confidentiality if patients are to trust their
physicians and continue coming for treatment. But confidentiality is often considered subordinate
to the duty to warn someone who will likely be harmed if that information is not disclosed. For
example, if a psychologist believes that his patient will kill his wife, or beat her severely, he has a
moral obligation to inform the wife that she is in danger from her husband. The duty to warn
someone from imminent and severe harm is usually considered a more heavily weighted principle
than confidentiality in cases like these.

The key question here in weighting the principles of confidentiality and the duty to warn (both
fulfilling the Biblical notion of compassion toward those in need of it) is the degree of risk that the
patient's sister is taking by providing nursing care for her brother. If the risk is not substantial,
then that weights confidentiality a bit more heavily. But if the risk is significant, then the duty to
warn is the more heavily weighted principle. This is particularly so given the fact that the sister
has volunteered to perform a very self-sacrificing service for her brother. Some would argue that
her altruism is an additional factor that weights the duty to warn principle more heavily. Others
would suggest that his contracting HIV is an example of "reaping what one sows," and that
minimizes consideration of the patient's desire for confidentiality. An additional factor that should
be figured into the deliberation is that the risk to the patient, though it may have a higher
probability of happening, is not as severe as the risk to the sister. After all, if the worst case scenario
happened to the patient, his father would disown him and the gang would throw him out (though
their action could be more severe than that). He would recover from all of that. But if his sister
contracted HIV, she would not recover from that. Though the probability of the worst case scenario
is higher for the patient, the results of the worst case are clearly higher for the sister.

4. List the Alternatives

In this case, there are a number of viable alternatives that involve compromise on either the
patient's part or his sister's. However, there are two alternatives that do not involve compromise
and they each reflect a weighting of the principles.

One alternative would be to tell the sister that her brother is HIV positive. This alternative comes
out of taking the duty to warn principle as higher priority. On the other hand, a second alternative
is to refuse to tell her that information, upholding the patient's request for confidentiality and
taking the confidentiality principle as the one that carries the most weight. However, there are
other alternatives. For example, the physician could warn the patient's sister in general terms
about taking appropriate precautions for caring for these types of wounds. She is to wear gloves
and even a mask at all times when handling the bandages. Should she get any blood on her clothes
or body, she is to wash immediately with a disinfectant soap. In other words, she is to take
universal precautions that any medical professional routinely takes in caring for patients. A further
alternative is to request that the patient inform his sister of his condition. He could then request
that she not tell any other family member or any or his friends. If he refused, then the next step
might be to say to him in effect, "If you don't tell her, I will."

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5. Compare Alternatives with Principles

In many cases, the principles resolve the case. Depending on how one assesses the relative weight
of the principles, which may be the case here. In fact, it may be that the alternative of encouraging
universal precautions for the sister but not telling her why, comes very close to satisfying all the
relevant principles. But certainly there are questions about the adequacy of those precautions. Will
she follow them, or treat them casually? However, assume for the moment that appeal to principles
does not resolve the dilemma.

6. Assess the Consequences

Here the task is to take the viable alternatives that attempt to predict what the likely consequences
(both positive and negative) of each would be. In addition, one should try to estimate roughly how
beneficial are the positive consequences and how severe the negative ones are, since some
consequences are clearly more substantial than others.

In many cases, when two opposing alternatives are presented, the consequences of one are the
mirror image of the other. This is the case here with the alternatives of telling that sister, or
refusing to tell her of her brother's HIV status.

In the first alternative, that of telling the sister (or insisting that the patient tells his sister), the
likely consequences include the following:

The sister would be properly warned about the risks of taking care of her brother, minimizing the
risk of her contracting HIV, and saving her from the risk of developing a fatal illness. The brother's
HIV status would be out in the open, leaving family and gang friends to draw their own conclusions
about his homosexuality. Should they draw the right conclusion, which is likely, he suffers
significant psycho-social harm from his gang members, and possibly (though not certainly) from
his family.

Trust with the physician and the patient suffers and he may refuse to see that physician, or any
other one again until a dire medical emergency. This would be unfortunate since due to his HIV
status, he will need on going medical care. But if the physician refuses to disclose the information,
the following may be expected as the likely consequences:

The sister would not know about the risks she is taking, making her vulnerable to contracting an
infection for which there is no cure. The degree of risk that she is taking is open to debate, but some
would argue that if the degree of risk is any more than minimal, that justifies warning her since the
virus produces a fatal disease.

The patient's HIV status is a well-kept secret, as his homosexuality. But it is not likely that either
his HIV status or his homosexuality can be kept a secret forever, since as HIV develops into full-
blown AIDS, both are likely to come out at some point in the future.

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 Trust between the physician and patient is maintained. If the alternative of telling the sister to take
general precautions is taken, the following are the likely consequences: She may exercise
appropriate caution in taking care of her brother, but she may not. She may treat the precautions
casually and unknowingly put herself at risk. If the physician tells her about the precautions in very
strong terms to insure her compliance with them, that may start her asking questions about why
the doctor was so insistent on her following his precautions. In fact, one of the motives of the
physician might be to nudge her toward asking some of those questions, of her brother, to further
minimize the risk of contracting HIV.

In general, the patient's HIV status and homosexual orientation are kept secret, and confidentiality
is honored, but the question of how long it will remain a secret is unknown and it is likely that it
will become known eventually. Trust with the physician and patient is maintained. However, if the
sister is nudged to ask her brother some pressing questions about why these precautions are so
important, he may conclude that the physician has prompted his sister to ask these questions,
leaving him feeling betrayed.

7. Make a Decision
What would you decide in this case? Which principles are the weightiest? Are there others that you
would include? Which alternatives are the most viable? Are there others that you would suggest?
Which consequences seem to you the most severe? Are there others that you think will occur? It is
important to realize that at some point you must stop deliberating and make a decision, as
uncomfortable as that may be.

Learning Activity :

Analyze the situation of Rebecca using the 7 step ethical decision model. Place your output in a word
document and submit online. You are a resident assistant in a co-ed residence hall. One evening, a first
year female resident named Rebecca comes to your apartment. She tells you that she had been grabbed
on campus by an unidentified male who released her when she screamed. Rebecca explains that she
tells you only because her best friend convinced her to approach you. She did not want to report the
incident to the campus police, and, in fact, states she wants the information to stop at your level. 59
After speaking with Rebecca for about an hour, you convince her to inform the police. She reluctantly
details the same story to the police. Over the next several days, you see Rebecca a number of times. The
police investigation has intensified and the information has been released to the student newspaper as
a public safety announcement. Rebecca becomes more distraught and withdrawn. You convince her to
visit a counsellor. She agrees, only if you accompany her. One day during an emotional and vague
conversation, you and Rebecca are discussing the assault. You feel there is more to the story then you
are being told. You assure Rebecca that anything she reveals to you will remain confidential. She offers
nothing more. Over the next few days, Rebecca begins to respond to your continued prodding and
becomes more comfortable with you. A week later, Rebecca comes to you with the "whole story." She
had been drugged, detained and raped by another student (also a resident of your building) at a campus
party. Rebecca is clearly traumatized by sharing her story with you. She repeatedly emphasizes her
desire for confidentiality. You convince Rebecca to tell campus police the whole story, but she refuses
to reveal to them the assailant. The police finally had the details of the assault, but they had no clues to

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aid in their investigation. Rebecca is the only person who knows the identity of the rapist, and only you
know that the individual resides in your building. What do you do?

Assessment Task:

Exercise
Name: _____________________________________________________________________ Course & Year: _______________________

Direction: Answer the following questions in a paragraph or two

1. “Alam natin na tayo ay tao pero kadalasan ay hindi natin alam paano magpakatao.” Make a reaction
on this statement reflecting the idea on reason and impartiality as minimum requirements for
morality.
2. Is gender equality justifiable under the concepts of reason and impartiality? Justify your answer.

Learning Resources

De Guzman, Jens Micah, et al. (2018). Ethics: Principles of ethical behavior in modern society. Philippines: MUTYA
Publishing.

Khatami, M. (2009). Morality, rationality and impartiality. Falsafeh Vol. 37, No. 1, Spring 2009, pp. 91-110.
http://about.abc.net.au/wpcontent/uploads/2012/06/ElementsOfImpartialitySep2007.pdf

Kohlberg, Lawrence. (1981). Essays on moral development. San Francisco, CA: Harper & Row.

Korsgaard, C. M. (n.d.) “Rationality” https://www.people.fas.harvard.edu

Powers, C. W., & Vogel, D. (1980). Ethics in the education of business managers. Hasting-on-Hudson, NY: Institute of
Society, Ethics and the Life Sciences.

Rachel, James and Stuart Rachels. (2018). Elements of moral philosophy, 9th ed. New York: McGraw-Hill.

Rae, Scott B., and Kenman L. Wong. (1996). “A Model for Moral Decision Making.” Chap. 16 in Beyond Integrity: A
Judeo-Christian Approach to Business Ethics. Grand Rapids, MI: Zondervan.

Rest, J. (1994). Background: Theory and research. In: J. Rest & D. Narvaez (Eds.), Moral development in the professions:
Psychology and applied ethics (pp. 1–26). New Jersey: Lawrence Erlbaum Associates, Inc.

Rationality & Rational (Nov. 22, 2003) https://www.enotes.com

Prepared by:
MR. ALLAN JOSEPH L. LIPE
Course Facilitator

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