Chad Garton

This paper aims to explore, define, and compare four ethical principles: Deontology,

Utilitarianism, Virtue Ethics, and Ethics of Care. Using examples will aid in understanding the

practical applicability of each principle. Let's begin with brief definitions. Deontology is a rule-

driven principle that emphasizes duties defined by roles, focusing on alignment with obligations

rather than outcomes or relationships. According to Kant,1(p10) moral decisions are correct when

aligned with categorical imperatives—absolute moral principles universally applicable and

independent of personal desires or situations.1 In summary, Deontology involves acting in good

will by prioritizing the relationship between duty and the categorical imperative.

Utilitarianism known as the "happy theory," Utilitarianism guides actions based on

promoting overall happiness or pleasure, not necessarily in a physical and sensual aspect but

from a mental and intellectual standpoint—termed "Higher pleasures" by John Stuart Mill.2 It

comprises four components:2(p6) Consequentialism, Hedonism, Maximalism, and Universalism.

Unlike Deontology, Utilitarianism is characterized or viewed as feeling and outcome driven.

Virtue Ethics, closer to Utilitarianism but distinct, involves developing practical wisdom

through virtuous principles for sound judgments. Aristotle's virtue categories aim at pristine

character development, facilitating individuals in attaining a happy life. Practicing virtue ethics

entails making decisions using wisdom, justifying actions with your own held virtues, and

maintaining a balanced approach without leaning towards extremes.3

Ethics of Care prioritizes empathy, healthy relationships, and understanding others in

decision-making, rooted in maintaining relationships to uphold moral ties. Morally significant

actions are guided by a sense of care and concern for individuals' well-being. It serves as a

critique of traditional ethical theories like utilitarianism and deontology for their perceived
 Chad Garton

abstraction and neglect of relational aspects of morality. To apply Care Ethics, one must be

attentive, understand all parties sympathetically, and reflect on responses through observation. 4

In the subsequent exploration, I will use a personal real-world example from clinical practice to

illustrate the practical utility of each principle in addressing ethical concerns.

During my time as a physical therapy technician, a challenging ethical situation emerged

with a workman's compensation patient undergoing knee surgery. This patient had exhausted all

authorized visits before surgery, and post-operatively, they sought additional treatment. Faced

with the dilemma of whether to proceed with treatment while waiting for more authorized visits,

my supervisor and I encountered a complex decision-making process. From a Deontological

standpoint, adherence to duties and the categorical imperative would suggest waiting for

approval from the case manager before scheduling further treatment. Acting with goodwill and

aligning actions within the scope of our duties would be prioritized.

An alternative perspective involves the Ethics of Care approach, where considerations

extend beyond rules to contemplate the impact on relationships. We had to weigh the potential

effects on our relationship with the patient, our company, and the risk management team

overseeing the case. This approach underscores the importance of assessing the moral

implications within the context of existing relationships. Utilitarianism introduces the idea of

maximalism and universalism. Maximalism, aiming for maximum good, could justify continuing

treatment for the patient's care needs, company productivity, and internal satisfaction. However,

universalism might argue for waiting, considering the equal consideration of everyone's

happiness, including the company's adherence to rules and potential risk management

disapproval.
 Chad Garton

In this specific case, my supervisor's decision to proceed with treatment was guided by

Virtue Ethics. Using practical wisdom, he reflected on past occurrences, risk management trends,

and the company's trust, deciding that prioritizing the patient's well-being over strict adherence

to rules was a virtuous choice. The doctrine of the mean, advocating for balanced and

courageous decisions, played a crucial role in the final choice, ensuring the patient received care

with a sense of responsibility for the outcomes. Had I been in the therapist's shoes, a combination

of Virtue Ethics and Ethics of Care would have been pivotal in navigating this ethical dilemma,

emphasizing thoughtful reflection, courage, and a commitment to patient well-being.

In evaluating ethical theories for clinical decision-making, my ranking from least to most

appealing is as follows: Deontology, Utilitarianism, Ethics of Care, and Virtue Ethics.

Deontology holds a valuable position but ranks lowest on my list due to its strict adherence to

duties and categorical imperatives. While it provides a solid framework, the rigidity might limit

flexibility in certain clinical scenarios. Utilitarianism comes next, driven by the pursuit of overall

happiness or pleasure. However, its emphasis on outcomes and the potential for sacrificing

individual needs for the greater good raises concerns about the fair treatment of individuals.

Ethics of Care earns a higher place for its commendable aspects, including consideration for all

relationships and contextual understanding. However, the linear approach to moral development

staging is a limiting factor, as not everyone necessarily requires social approval before

developing moral principles. Topping my list is Virtue Ethics, which I find most appealing for

clinical decision-making. Its emphasis on fostering a happy life through wisdom and finding a

middle ground within virtuous categories resonates strongly with me. This theory grants a sense

of freedom from rigid rules associated with one's role and places a high value on self-respect,

providing a well-rounded approach to rationalizing ethical decisions. These rankings reflect my

 Chad Garton

inclination towards ethical theories that prioritize individual virtues, wisdom, and a balanced life

while considering the unique nuances of clinical practice.

 Chad Garton

References

1. Silkwood-Sheer D. Deontology. PowerPoint presented at: Central Michigan university

PTH695 Ethics in Physical Therapy; January 30, 2024; Mount Pleasant, Mi.

2. Silkwood-Sheer D. Utilitarianism. PowerPoint presented at: Central Michigan university

PTH695 Ethics in Physical Therapy; February 6, 2024; Mount Pleasant, Mi.

3. Silkwood-Sheer D. Virtue Ethics. PowerPoint presented at: Central Michigan university

PTH695 Ethics in Physical Therapy; February 13, 2024; Mount Pleasant, Mi.

4. Silkwood-Sheer D. Ethics of Care. PowerPoint presented at: Central Michigan university

PTH695 Ethics in Physical Therapy; February 20, 2024; Mount Pleasant, Mi.