1
Chapter 3
The Moral Status of Gametes and
Embryos: Storage and Surrogacy
3
Technology Changes Things
• It changes options for reproductive choices.
• It can separate roles of genetic mother and
gestational mother.
• The social mother may be different from
either of the above.
• Babies might have 5-6 parents (see Table 3-1)!
4
Technology Changes Things
• Decision points have also multiplied.
• Many steps can be completed in the lab which
allows different decision points about having a
baby.
• We are not prepared to deal with all of the
changes conceptually, emotionally or ethically.
• Yet, we must be prepared to make decisions.
5
There is a need to Examine the Moral
Community
• There is a need to decide the boundaries of
the moral community.
• Who counts in the moral community?
• One must take the members of this
community into account as we make
decisions.
• The issue goes beyond deontology or
utilitarianism.
6
Thinking about Moral Standing
• Moral standing goes beyond cruelty.
• It addresses moral dignity and respect.
• Are children full members of the moral
community?
• What is the actual moral standing of children?
• Uncertainly exists about the moral standing of
embryos.
7
Technology and Attitudes
• Technology changes our attitude about the
embryo.
• It may also change levels of commitment,
emotional attachment, and parenting.
• Is there a difference between attitudes toward
genetic and adopted children in light of
technology?
8
Questions about Attitudes towards
Embryos and Babies
• What is the status of a frozen pre-embryo?
• Should a pre-embryo be given the same status
as a human being?
• When does a baby become a member of the
moral community?
9
Table 3-2 Moral Reference Groups
What About Surrogate Contracts?
• Should surrogate contracts be held in the
same level of trust as any contract?
• What if a surrogate’s life is endangered by the
pregnancy?
• What about those surrogates who want
contact with the child?
• Courts are struggling with these difficult
issues.
11
The Need to Stretch Our Thinking
• It is too heavy handed to stop technology
progress because we do not have defined
ethics.
• But it is not enough to leave it to the status
quo.
• Therefore, we must explore the issues and try
to come to consensus.
12
In Summary…
13
Slide Number 1Chapter 3Slide Number 3Technology Changes ThingsTechnology Changes ThingsThere is a need to Examine the Moral CommunityThinking about Moral StandingTechnology and Attitudes Questions about Attitudes towards Embryos and BabiesTable 3-2 Moral Reference GroupsWhat About Surrogate Contracts?The Need to Stretch Our ThinkingIn Summary…
WGS 3123
Social Justice and Social Change
Film Response 3
Watch the documentary Before the Flood (Fisher Stevens 2012). It can be access online through
the library. Log into your account. Searc ...
1 Chapter 3 The Moral Status of Gametes and Em.docx
1. 1
Chapter 3
The Moral Status of Gametes and
Embryos: Storage and Surrogacy
3
Technology Changes Things
• It changes options for reproductive choices.
• It can separate roles of genetic mother and
gestational mother.
• The social mother may be different from
either of the above.
• Babies might have 5-6 parents (see Table 3-1)!
4
Technology Changes Things
2. • Decision points have also multiplied.
• Many steps can be completed in the lab which
allows different decision points about having a
baby.
• We are not prepared to deal with all of the
changes conceptually, emotionally or ethically.
• Yet, we must be prepared to make decisions.
5
There is a need to Examine the Moral
Community
• There is a need to decide the boundaries of
the moral community.
• Who counts in the moral community?
• One must take the members of this
community into account as we make
decisions.
• The issue goes beyond deontology or
utilitarianism.
6
Thinking about Moral Standing
3. • Moral standing goes beyond cruelty.
• It addresses moral dignity and respect.
• Are children full members of the moral
community?
• What is the actual moral standing of children?
• Uncertainly exists about the moral standing of
embryos.
7
Technology and Attitudes
• Technology changes our attitude about the
embryo.
• It may also change levels of commitment,
emotional attachment, and parenting.
• Is there a difference between attitudes toward
genetic and adopted children in light of
technology?
8
Questions about Attitudes towards
Embryos and Babies
• What is the status of a frozen pre-embryo?
4. • Should a pre-embryo be given the same status
as a human being?
• When does a baby become a member of the
moral community?
9
Table 3-2 Moral Reference Groups
What About Surrogate Contracts?
• Should surrogate contracts be held in the
same level of trust as any contract?
• What if a surrogate’s life is endangered by the
pregnancy?
• What about those surrogates who want
contact with the child?
• Courts are struggling with these difficult
issues.
11
The Need to Stretch Our Thinking
• It is too heavy handed to stop technology
5. progress because we do not have defined
ethics.
• But it is not enough to leave it to the status
quo.
• Therefore, we must explore the issues and try
to come to consensus.
12
In Summary…
13
Slide Number 1Chapter 3Slide Number 3Technology Changes
ThingsTechnology Changes ThingsThere is a need to Examine
the Moral CommunityThinking about Moral
StandingTechnology and Attitudes Questions about Attitudes
towards Embryos and BabiesTable 3-2 Moral Reference
GroupsWhat About Surrogate Contracts?The Need to Stretch
Our ThinkingIn Summary…
WGS 3123
Social Justice and Social Change
Film Response 3
Watch the documentary Before the Flood (Fisher Stevens 2012).
6. It can be access online through
the library. Log into your account. Search for the film by
inputting “Before the Flood DiCaprio”
and select “Full text available at: Alexander Street Press.”
1. Describe reaction of the media to the announcement of
Leonardo DiCaprio as the United
Nations Messenger of Peace on Climate Change? (max. 200
words)
2. What are fossil fuels and what is the most devastating form
of producing them? Why?
(max. 200 words)
3. What will happen when the sea ice in the Arctic Oceans
melts? (max. 200 words)
4. Why is there such opposition to the science (of climate
change) and who finances much
of the climate science denialism? What do they have to gain?
(max. 200 words)
5. Why does the average American household consume more
than France, China, and
Indian, among others? (max. 200 words)
6. How are oceans and rainforests stabilizing forces in climate?
7. (max. 200 words)
7. Why is beef production one of the most inefficient uses of
resources? What percentage of
emissions in the US comes from the consumption of beef? (max.
200 words)
8. What is the advantage of solar power and batteries? What is a
carbon tax and how might
it encourage more sustainable practices? (max. 200 words)
9. According to Johan Rockstrom, what might the world look
like if we do not take action
now? (max. 200 words)
10. According to Piers Sellers, what is the biggest impact of
climate change and why? How
does this result in civil uprisings in places with sustained
drought? (max. 200 words)
Note: film titles must always be presented in italics
---------------------------------------------------------------------------
------------------------------------------
Formatting
8. bles are allowed
Style
form (i.e. no point form!)
hey are listed
Submission
ill be granted for this assignment
1
Chapter 5
9. Abortion: The Unexplored
Middle Ground
3
The Current Position on Abortion
• Despite health care reform, there is still a
constant debate between the rights of the
unborn and the right of privacy.
• Each side makes uncompromised arguments.
• The arguments between morality and public
policy continue to be a battle.
4
What About a Middle Ground?
• There is a need to:
• Establish a format for public conversation on
the abortion.
• Avoid labels and move to true discourse.
• Design a peaceable public policy.
5
10. Twenty Elements of the Common Ground
• The intentional taking of human life is
presumed to be immoral.
• Abortion is a killing act.
• Abortion to save the life of the mother is a
morally acceptable action.
6
Twenty Elements of the Common Ground
• Judgment about the morality of abortion
cannot be based just on a woman’s right to
choose.
• Abortion for convenience is morally wrong.
• Conditions that lead to abortion should be
abolished as much as possible.
7
Twenty Elements of the Common Ground
• Abortion is a tragic experience and should be
avoided if possible.
11. • There should be alternatives to abortion.
• Abortion is not just a private affair.
8
Twenty Elements of the Common Ground
• Roe v. Wade is offensive to many people.
• If a law cannot be enforced, it is a bad law.
• An “absolutely prohibitive” law on abortion is
not enforceable.
9
Twenty Elements of the Common Ground
• There should be some public restrictions on
abortion.
• The best education about abortion is witness.
• Abortion is frequently a subtlety coerced
decision.
10
Twenty Elements of the Common Ground
• The availability of contraceptives does not
12. reduce the number of abortions.
• Permissive laws forfeit the sanctity of life for
the unborn.
• Hospitals that perform abortions should have
to follow policy.
11
Twenty Elements of the Common Ground
• The “consistent ethic of life” should be taken
seriously.
• Whenever a discussion about abortion
becomes heated, it should stop.
12
Discussions Should Continue
• To find middle ground, one should understand
the 20 elements surrounding abortion.
• The issue of religious and ethics beliefs should
be considered dispassionately.
• Issues will continue to be both political and
ethical as PPACA is implemented.
13
13. In Summary…
14
Slide Number 1Chapter 5Slide Number 3The Current Position
on AbortionWhat About a Middle Ground?Twenty Elements of
the Common Ground Twenty Elements of the Common Ground
Twenty Elements of the Common Ground Twenty Elements of
the Common Ground Twenty Elements of the Common Ground
Twenty Elements of the Common Ground Twenty Elements of
the Common Ground Discussions Should ContinueIn
Summary…
1
Chapter 4
The Ethical Challenge of the
New Reproductive
Technology
3
Ethically Evaluating Reproductive
14. Technologies
• There is a need for moral consensus at
infertility technologies increase.
• There are also legal and regulatory confusions
about the “baby business”.
• Society is has conflicts over the morality of sex
and reproduction.
• How can we ethically assess reproductive
technologies?
4
Inadequate Evaluation Approaches
• Act utility is not adequate because:
• You should not separate lovemaking and baby
making.
• Alternative technologies do not protect the
embryo.
• Many current technologies could be seen as
immoral.
5
Private Rights Argument
15. • Reproductive rights are private and part of
autonomy.
• Competent adults must be free to exercise
their reproductive rights including the use of
technology.
• People who disagree must demonstrate that
harm occurs.
• However, long-term affects remain unknown
with developing technologies.
6
Are these Arguments too Limited?
• Problems posed by the new technologies are
more complex.
• Adults acts affect more than themselves.
• Decisions have social consequences.
• The technological imperative must not govern
reproductive practices and policy.
7
Technology Cannot be Unrestricted
• Ecological and ethical disasters have occurred
16. when technology is unrestricted.
• Side effects may outweigh advantages.
• Technology is never neutral or value free.
• It must be ethically assessed.
8
The Basis for an Ethical Position
• It needs to be grounded in what benefits the
children, their parents and families, and
society.
• When there is a conflict, priority should be
given to the child or potential child.
• Human communities have moral imperative to
protect children.
9
Need to Consider the Past
• There is a need to consider safeguard and
norms from the past.
• The burden of proof should be on the
innovator.
• The child cannot give informed consent,
17. therefore society must be vigilant.
• Adults’ desires is not moral justification, but
the concept of do no harm is moral
justification.
10
Adoption Practices as an Argument
• Children have been adopted and raised
successfully.
• In adoption, the child already exists and needs
care.
• But to create, make to order, or purchase a
child for the parent’s desires is different
ethically.
11
Alternative Reproductive Technology
• Technology is ethical when:
• It allows a socially adequate heterosexual
infertile couple to have a child.
• It restores a normally expected function.
• Technology must also not do harm to the
18. child, couple, or society.
12
Distributive Justice
• Health care professionals have a moral duty to
the community.
• Distributive justice issues exist about who gets
expensive procedures.
• Other ethics issues are centered around profit
versus benefits.
• Justice and the interest of the child should
come first.
13
Surrogates
• Surrogates are not ethically acceptable
options.
• There are problems and risks for the
surrogate, the families, and the child.
• How you got here does make a difference.
• The child may have many issues concerning
his or her origins.
19. 14
The Family View
• Pair bonding produces greater resources for
parenting.
• Commitment between heterosexual married
couple who choose to have children can be
strong.
• Extended families can support the parent
couple.
• Genetic ties do matter.
15
Parents and Spouses
• There are ethical and even legal issues when
the genetic parents differ from the donor
parents.
• Surrogacy can also result in many ethical and
emotional problems.
• With genetic parents, the child is a sharing of
their genes, but also unique.
16
20. Parents and Spouses
• When technological assistance is used for
reproduction by married couples, it can
strengthen the marriage bonds.
• Each parent will be equally invested in the
resulting child.
• Parents have to be prepared for
disappointment and be open to adoption or
childlessness as options.
17
Parents and Spouses
• Children who are not related to one of their
parents have the potential for many problems.
• Issues of parenting and bonding arise in
blended families and divorce can be one
result.
• Donors and surrogates do not disappear from
family memory.
18
21. Parents and Spouses
• There is a psychological tendency to want to
know your birth origins.
• Openness of information responds to the
child’s right to know and to seeking
information.
• Secrecy and deception can cause issues for
the child and for the family.
19
The Child
• A child created by some reproductive
technologies is part of a biosocial experiment
without his/her consent.
• There is a psychological difference to the child
between adoption and being created by
technology.
• The created child may be seen more as a
commodity.
• Parental fantasies make a difference.
20
22. The Child
• Gourmet children may have to live up to
higher expectations.
• Rejection of gourmet children who do not
measure up is entirely possible.
• A child desired for the wrong reasons may
face rejection if not perfect.
21
The Child
• The child may also have real issues with his or
her identity.
• Questions about self-identity arise and the
need to know about other kin can become an
issue.
• Now grown sperm-donor babies are using the
Internet to support each other.
22
Donors and the Cultural Ethos
• The baby business will continue to grow as a
23. profitable entity.
• The ethics of the donor’s action has not been
analyzed.
• Donors are actually selling their genetic
heritage.
• Donors abdicate responsibility for their
reproductive acts.
23
Donors and the Cultural Ethos
• Should human eggs and sperm become
commodities?
• Does this practice have the potential to exploit
the poor?
• Does this practice change the nature of
motherhood and families?
• Does this practice reduce people to means to
an end?
24
In Summary…
25
24. Slide Number 1Chapter 4Slide Number 3Ethically Evaluating
Reproductive TechnologiesInadequate Evaluation
ApproachesPrivate Rights ArgumentAre these Arguments too
Limited?Technology Cannot be UnrestrictedThe Basis for an
Ethical PositionNeed to Consider the PastAdoption Practices as
an ArgumentAlternative Reproductive TechnologyDistributive
JusticeSurrogatesThe Family ViewParents and SpousesParents
and SpousesParents and SpousesParents and SpousesThe
ChildThe ChildThe ChildDonors and the Cultural EthosDonors
and the Cultural EthosIn Summary…
1
Chapter 2
Principles of Health Care
Ethics
3
Principles of Ethics
• Extends your foundation of ethics.
• Gives you ways to apply ethics to practical
situations.
• The four most often used in health care are
25. nonmaleficience, beneficence, autonomy, and
justice.
4
Nonmaleficience
• Sometimes this is translated as “first do no
harm”.
• Ethical theories define harm in different ways.
• Consequentialist says harm is that which
prevents good.
• Natural law says harm is something that limits
our potential.
5
Nonmaleficence
• Deontologists say harm is something that
prevents you from doing your moral duty.
• Virtue ethicists say harm is something that
leads you away from practicing high moral
character.
• Ethical egoists say that harm is something that
goes against your self interest.
26. 6
Harm in the Clinical Setting
• Harm is something that negatively affects
patients.
• Clinically, we think of physical harm but other
harm is possible.
• Harm is also caused by negligence.
• Harm can be caused by violating autonomy.
7
Beneficience
• Beneficence comes from the Latin word for
good- “bene”- and means to benefit.
• Requires a decision to engage in beneficent
acts or to be altruistic.
• It is a fundamental principle of health care
practice.
• What theories support beneficence?
8
27. Health care and Beneficience
• The standard of altruism is higher for health
care professionals.
• Altruism is expected.
• Beneficence sometimes is extended to
paternalism when the health care professional
makes decisions for the good of the patient.
• What is this called?
9
Autonomy
• Autonomy means that you can rule yourself.
• It implies a respect for others.
• In health care, we have a duty to treat, but not
to judge.
• What are the conditions necessary for
autonomy in health care?
10
Specific Competence
• Is defined as the ability to do some things but
28. not others. So, you can be competent in a
limited way.
• In issues where a person is not competent, the
concept of substitute judgment can be used.
This is also involves the idea of reasonable
person’s decision.
11
Specific Competence
• Coercion can also affect a person’s ability to
exercise autonomy.
• Issues of competence and autonomy also are
part of informed consent and other health
care issues which are discussed in later
chapters.
12
Justice
• The term can be used to mean fairness.
• Aristotle thought we should treat similar cases
in a similar way unless there was some
relevant or material difference.
• We need to examine types of justice:
procedural and distributive.
29. 13
Procedural Justice
• This is sometimes called due process.
• It means that you get your turn; you are
treated like everyone else.
• Procedural injustice can occur with employee
situations.
• Due process is also involved with policy
making in procedural justice.
14
Distributive Justice
• This form of justice involves balancing benefits
and burdens.
• Health care resource allocation is one example
of an distributive injustice?
• Health care is a scarce resource, so
• Resource allocation issues are common in
health care; what are some examples of these
issues?
30. 15
Material Reasons to Discriminate
• Basic argument is that the person deserves it
or needs it
• In the U.S., if you work hard, you deserve to
be rewarded.
• In contrast, if you disobey the law, you
deserve to be punished.
16
Discrimination based on Need
• Need can be based on misfortune or disability.
• Need can be based on special talents or
abilities and on opportunities.
• Need can be based on past discrimination.
• Need can also be based on structural social
problems.
17
31. In the larger society…
• There is a need to discriminate based on
material need.
• You are rewarded based on how much you
contribute.
• You are also rewarded based on how much
effort you put forth.
• This thinking also applies to patient care. Can
you give some examples?
18
Need based on Misfortune
• Misfortune can lead to discriminate based on
or against need for care.
• For example, life threatening situations are
treated before minor emergencies.
• Special talents or the potential loss of
opportunity can be arguments for special
treatment.
• What other groups fall into the need based
category?
19
32. Need based on past Discrimination
• Redress of past injustices may be a reason for
different treatment.
• The health care system has responded to the
needs of some special groups.
• Structural problems have also been
considered in needs based discrimination;
what are some examples?
20
Distributive Justice and Rights
• We are still debating if health care is a right or
a commodity.
• Need to think about whether something is a
legal right or a moral right.
• There are many types of right and many
overlap each other (See figure in text).
21
Legal or Positive Rights
• Legal right means that someone has a legal
33. obligation to fulfill your right.
• Positive right means that you are entitled to
something.
• Sometimes legal rights become that which you
can enforce.
22
Substantive Rights
• Can be legal rights or not.
• They are right to a particular thing such as
education, health care, minimum wage, etc.
• Different nations have differing opinions
about substantive rights for their citizens.
23
Negative Rights
• You have the right to be left alone.
• The Bill of Rights lists many negative rights.
• The negative right of one person may be in
conflict with the negative right of another (i.e.
smokers).
• Other negative rights include freedom from
34. sexual harassment, and medical record
privacy.
24
Process, Natural, and Ideal Rights
• You have the right of due process.
• Natural rights means that you respect the
attributes that people have in nature.
• These rights allow humans to reach their full
potential.
• Natural rights express our common morality
and ideal rights inspire.
25
Reflective Equilibrium Model
• Making ethical decisions requires considered
judgments.
• These judgments require rational moral
reasoning.
• Ethical theories and principles are used to
explain moral reasoning.
• Reflective equilibrium model provides a
35. process for considering and reconsidering
decisions.
26
Reflective Equilibrium Model
Common
morality
Considered
judgments
Ethical
principles
Ethical
theories
Health care issue
at hand
Reflective equilibrium at work
27
How can you Use the Model in Practice?
• Describe a situation where making an ethics
choice might be difficult.
• Now, use Reflective Equilibrium Model to
36. assist you in deciding the most ethical decision
to make.
• Why is this model not in common practice in
health care?
28
In Summary…
29
Slide Number 1Chapter 2Slide Number 3Principles of
EthicsNonmaleficienceNonmaleficenceHarm in the Clinical
SettingBeneficience Health care and BeneficienceAutonomy
Specific CompetenceSpecific CompetenceJusticeProcedural
JusticeDistributive Justice Material Reasons to Discriminate
Discrimination based on NeedIn the larger society…Need based
on MisfortuneNeed based on past DiscriminationDistributive
Justice and RightsLegal or Positive RightsSubstantive
RightsNegative Rights Process, Natural, and Ideal Rights
Reflective Equilibrium ModelReflective Equilibrium Model
How can you Use the Model in Practice?In Summary…
1
Chapter 1
Theory of Health Care
37. Ethics
3
Why Study Ethics?
• Because health care is changing, you need
tools for making necessary and difficult
decisions.
• It will help you better understand patients,
fellow professionals, and the system in
general.
• It will assist you in building and maintaining
your career.
4
Types of Ethics
• Normative ethics
– Is the study of what is right and wrong.
• Metaethics
– Is the study of ethical concepts and theories.
5
38. Types of Normative Ethical Theories
• Authority-based
• Egoistic
• Natural law
• Deontological
• Teleological
• Virtue
6
Ethical Relativism
• Ethical relativism purports that there is no
absolute theory for ethics.
• However, this lack of a complete theory does
not mean everything is relative.
• People need to make rational decisions about
ethics-based issues.
• Therefore, ethics theories are useful.
7
Egoism as Ethics Theory
• Egoism is based on the idea that one’s self
interest is the basis his or her ethics decisions.
39. • Theory is not helpful in health care ethics
because professionals are taught to set aside
self-interest.
• The interests of the patient should come first.
8
Authority-based Ethics Theory
• Decisions about ethics (right or wrong) are
based on central authority such as in a
theology or an ideology.
• For health care ethics, there may difficulty
deciding which authority is the correct one.
• However, knowing this view of ethics helps
with understanding patients and health policy
decisions.
9
Virtue Ethics Theory
• Is founded in the writings of Aristotle.
• Everything moves from potentiality to
actuality.
• Character development allows you to
actualize your highest good.
40. • Eudaimonia should be sought as the highest
good.
10
Virtue Ethics Theory
• Eudaimonia means that you seek to build your
character and increase virtue.
• Professional education seeks to develop
people of high character.
• People who work toward eudaimonia become
persons of practical wisdom.
11
Virtue Ethics Theory
• Principles of ethics can help to define your
character and assist with your actions. See
Chapter Two for more information.
• Virtue ethics is criticized as being elitist.
• Virtue ethics requires the balancing of
conflicting obligations.
• People with practical wisdom can make
41. appropriate ethical decisions.
12
Natural Law Theory
• It is founded in the writings of St. Thomas
Aquinas
• It assumes that nature is rational and orderly.
• Humans are part of the natural world and are
given the ability to be rational.
• Our natural reason allows us to distinguish
right from wrong.
13
Natural Law Theory
• Reason is also action in that humans can
choose to do good or evil.
• The Principle of Double Effect helps us
decided which action is good.
• Good is also defined as that which helps to
maximize potential, such as preserving life,
gaining wisdom, and knowing God.
42. 14
Natural Law Theory
• In natural law, there are some acts that are
not ethical because they violate the ability to
reach one’s potential.
• People who support social responsibility can
use natural law as a foundation for actions.
• Understanding natural law also assists with
patient relations.
15
Deontology Theory
• Comes from the Greek word “deon” meaning
“duty.”
• It is sometimes called duty-based ethics.
• One of the main theorists is Immanuel Kant.
• The world exists in the form of things we can
experience directly (phenomenal world) and
things that exist independently of the intellect
(noumenal world).
43. 16
Deontology Theory
• Free will makes ethics possible and without it
we would not need ethics.
• Areas of character can be used for good or
evil.
• Therefore, the only true good is good will.
• The ability to choose to do good is what
makes us human.
17
Deontology Theory
• Actions are judged by their intention and not
just their outcomes.
• Kant attempted to define a rational principle
for making moral judgments.
• The principle is the categorical imperative.
• People can never be used as a means to an
end; they must be respected.
18
44. Deontology Theory
• The Golden Rule is not a synonym for the
categorical imperative.
• Kant believed that we must act based on duty
to moral law and not on the consequences of
our actions.
• Practicing this is its pure form is difficult in
modern society.
19
Kant and Virtue Ethics
• Pure Kantian ethics is absolute in its definition
of duty but virtue ethics allows for grey areas.
• Kant does not assist with deciding among
lesser evils and greater goods
• Virtue ethics allows the use of tools to make
these decisions
20
Deontology and Policy
45. • Health care professionals recognize a duty to
the patient
• Health care managers also have a duty to the
patient, but they have duties to the
organization and community as well.
• Conflicting duties must be considered in policy
making.
21
Non-Kantian Deontology
• Recent proponents of the deontology
tradition include John Rawls and Robert
Nozick.
• These theorists deal with the idea of justice
through our actions.
• Their thinking influences health care reform,
public health, and other health areas.
22
John Rawls
• John Rawls worked to define the
characteristics of a just society.
• He examined justice as fairness and applied it
46. to societies that respect the rule of law.
• His work is based on the idea of a social
contract between members of a society.
23
Self Interest and Justice
• Rawls used a hypothetical or mind experiment
called the original position to explain why
rational people would protect everyone’s self
interests.
• In this mind experiment, he also included the
concept of the veil of ignorance to help us
understand why we would care about self
interests.
24
Self Interest and Justice
• If we were in the original position, we would
all be equal.
• Therefore, we could all be treated in the same
way in a society.
• Therefore, it would be in our self interest to
make sure that everyone is given an equal
share of benefits and burdens.
47. 25
Basic Principles of Justice
• The first principle of justice for Rawls is liberty.
• This principle is also a priority over all other
principles of justice.
• People should have equal right to basic
liberties (see the Bill of Rights).
26
Basic Principles of Justice
• The second principle for Rawls is justification
of inequalities.
• He uses the difference principle to justify
when social and economic inequities are
appropriate.
• Physicians are a classic example of the
difference principle.
27
48. Rawls’ Opponent
• Robert Nozick is also considered to be a
deontologist.
• He represents the conservative tradition and
has great influence in the debate over health
care reform.
• Nozick emphasizes the autonomy and the
rights of the individual.
28
Nozick and Social Goods
• For Nozick, there is no social good that
requires sacrifice.
• We are only “other people”.
• We should influence people to take steps to
improve their own situations.
• Theories like Rawls supports defeat voluntary
agreements.
29
Nozick and Distributive Justice
• For Nozick, there is no principle of distributive
49. justice.
• He finds justice in acquisition and owned
resources.
• Historical injustices are not addressed in his
theory except to suggest that society could be
organized to maximize the position of the
least well off.
30
Consequentialism Theory
• Through Mill’s work, this theory is also known
as utilitarianism.
• For this theory, your intentions are irrelevant;
all that counts is the outcome.
• Greatest Good for the Greatest Number is
often used as a summary of the theory.
31
Consequentialism Theory
• Has two main types
• Classical or act utilitarianism.
– Each act considered on its own
• Rule utilitarianism.
50. – Develop rules that net the greatest benefit
32
Consequentialism Theory
• Rule utilitarianism is used to make health care
policy.
• Exceptions can be made under special
circumstances.
• Rule utilitarianism also allows for negative
consequentialism or preventing the greatest
harm for the greatest number.
33
Consequentialism Theory
• Preference utilitarianism argues that good is
honoring preferences and bad is frustrating
preferences
• Preferences must be known or a substituted
judgment can be used
34
51. Consequentialism Theory
• Criticisms of utilitarianism include
– The minority is not protected when the
greatest good for the greatest number is
the goal.
– Some say this theory means that the ends
justifies the means.
• These criticisms are not valid because respect
for autonomy and liberty is essential to the
theory.
35
Use of Ethical Theories
• There is no pure ethical theory; each has
strengths and weaknesses.
• However, health care professionals must make
complicated ethics decisions
• The ability to understand theory enhances
your decision making tool kit.
36
In Summary…
52. 37
Slide Number 1Chapter 1Slide Number 3Why Study
Ethics?Types of Ethics Types of Normative Ethical Theories
Ethical RelativismEgoism as Ethics TheoryAuthority-based
Ethics TheoryVirtue Ethics TheoryVirtue Ethics Theory Virtue
Ethics TheoryNatural Law TheoryNatural Law TheoryNatural
Law TheoryDeontology TheoryDeontology TheoryDeontology
TheoryDeontology TheoryKant and Virtue EthicsDeontology
and Policy Non-Kantian DeontologyJohn RawlsSelf Interest and
JusticeSelf Interest and Justice Basic Principles of JusticeBasic
Principles of JusticeRawls’ OpponentNozick and Social
GoodsNozick and Distributive JusticeConsequentialism
TheoryConsequentialism TheoryConsequentialism
TheoryConsequentialism TheoryConsequentialism TheoryUse of
Ethical TheoriesIn Summary…