Ethics and morality

1. HISTORY OF MEDICAL BIOETHICS
PIR BUX JOKHIO
Assistant Professor
02-02-2018

2. Objectives
• Define Ethics, morals
• Define Bioethics
• Define Medical Ethics

3. • “Unexamined life is not worth living”
(Aristotle)
• Ethics is to know the difference between what
you have the right to do and what is right to
do. (Potter Stewart)

4. Knowledge
• Francis Bacon (16th century) :knowledge is
power, since great changes are born of
knowledge.
• It is not due to a lack of ethical and political
will: they are also due to a lack of knowledge
and the organization of such knowledge.

5. • Knowledge societies, which are both thinking
societies and societies shaped by thought, make
this effort to reflect on their own practices:
• The frenzied speed of society makes it necessary
to keep abreast of the times and to foresee, and
not merely reactively resolve the problem
outlined above;
• Jonas points out, the technology and power of
intervention today are far riskier than those of
earlier societies and technologies. This, taken
together with the irreversibility of some
consequences, is sufficient cause for caution, in
order to avoid acting rashly in the name of
acritiscal techno-scientific progress

6. Ethics
• Ethics is moral philosophy, a critical-rational reflection
on morals.
• More than being descriptive of a given society’s moral
codes, whether morals are legitimate,
• Whether they have some underlying justification;
establishing whether rules and values are in force,
ethics reflects on their validity.
• To ascertain the conditions of its validity and helps
render the different historical morals respectable.
Morals are cultural products, relative to historical
contexts. Ethics cannot deny the reality of moral
pluralism: it holds that many moral options are valid
but that not all are valid or even equally valid

7. • Ethics is an understanding of the nature of
conflicts arising from moral imperatives and
how best we may deal with them.

8. Morals
• The moral question (from the Latin, mos-
moris, habits, customs) is, what should I do?,
and the reply consists of proposing an action
(or an omission). Ethics (from the Greek,
ethos, character) asks, why should I do it?
• The reply consists of an argument
(Secondary)
• the question of the distinction between ethics
and morals : “morals are lived and ethics are
thought” (Aranguren )

9. • Ethics deals with the study and justification of moral
beliefs.
• A branch of philosophy which examines what is right
and what is wrong.
• Ethics and More are regarded as identical concepts, but
actually they are not.
• The term ethics is derived from the Greek word ήθος
(ethos) meaning moral character.
• The term morality comes from the Latin word mos
meaning custom or manner. Morals, from which the
term morality is derived, are social rules or inhibitions
from the society.
• Ethics is the science, and morals refer to one’s conduct
or character

10. What then does ethics contribute?
• universality,
• It seeks to provide a basis for and justify moral
decisions and actions, by going beyond the mere first
person singular, the “I”.
• Ethics maintains that every moral good is the object of
desire of an autonomous will,
• As if it is something that someone desires for himself,
because he consider it a valuable good,
• He must at the same time desire it for everyone else.
• The criteria of universalisation and of personal
autonomy and commitment are key criteria of
normative ethics, which seeks to guide moral actions
by being constantly prepared to scrutinize them

11. • Critically examines his own morals must
distance himself from them;,
• He must doubt them, questioning whether
such customs are the best, something that
entails an awareness that reflects and
overcomes unconscious attachment to morals
received through acculturation. (Socratically)
• A critical capacity vis-à-vis the status quo, the
“establishment”

12. • Accordingly, ethics, in the form of critical-rational
reflection, requires a developed moral conscience
of a post-conventional level on the Kohlberg scale
(Lawrence Kohlberg’s stages of moral
development constitute an adaptation of one of
Jean Piaget’s psychological theories. The theory
holds that moral reasoning, the basis for ethical
behavior, has six identifiable developmental
stages, each more adequate at responding to
moral dilemmas than its predecessor. Kohlberg’s
scale is about how people justify behaviors and
the general hypothesis is that moral behavior is
more responsible, consistent and predictable
from people at higher levels).

13. • At this level, one is capable of taking up a stance
against conventions and fears neither autonomy
nor being rejected by the group.
• Conventions are criticized for the inadequacy of
the criterion that equates the socially current
with the ethically valid.
• The pre-conventional is also criticized, with the
warning that just because something is liked, does
not mean that it is correct. Thus, only on this
post-conventional level is one able to assume the
criterion of universalizability, where the key
question is whether one can desire something
both for oneself and for everybody else.

14. • If there are more truths, one way to find what
makes them true is to use a value system,
• If there is a value that can be discovered.
• Socrates and Plato would reply yes (they both
believed that goodness exists absolutely), they
did not have the same view about what is good.
• Humes said that moral expressions are
expressions of emotion or sentiment feeling.
• Ethics: Fundamental Elements a society is created
by great individuals (writers, poets, artists,
leaders, etc.) or derived from some list of moral
absolutes, e.g. religious moral code, whether
explicit or not.

15. NORMATIVE ETHICS
• Normative ethics studies the issue of how we ought to live
and act.
• The good life investigates the requirements for a human to
live well.
• Right action attempts to find what it is for an action to be
morally acceptable.
• Attempts to provide a system of principles, rules and
procedures for determining what (morally speaking) a
person should do and should not do.
• It is distinguished from meta-ethics because it investigates
standards for the rightness and wrongness of actions,
whereas meta-ethics examines the meaning of moral
language and the metaphysics of moral facts. Normative
ethics is also different from “descriptive ethics” which is an
empirical investigation of people’s moral beliefs.

16. • Norms are sentences (rules) that aim to affect an action,
• Include commands, permissions and prohibitions
• Conceptual abstractions which describe, explain, and
express.
• Abstract concepts include sincerity, justification, and
honesty.
• Normative rules interpret “ought-to” kind of statements
and assertions, as contrasted from sentences that give “is”
type statements and assertions.
• To describe “norms” as reasons to believe, and to feel.
Finally, a theory of social justice is an attempt to find how a
society must be structured, and how the social goods of
freedom and power should be distributed in a society

17. Applied ethics
• The branch of ethics which investigates the
application of ethical theories in actual life. To
this end, applied ethics attempts to illuminate
the possibility of disagreement about the way
theories and principles should be applied
• Specific areas of applied ethics are: • Medical
ethics • Bioethics • Public sector ethics •
Welfare ethics • Business ethics • Decision
making ethics • Legal ethics (justice)

18. • Medical ethics and humanities teaching have become
essential to teaching professionalism in medicine
because the concept of professionalism is intrinsically
scientific, clinical, ethical, and social.
• Regarding character and ethical behavior
• The acquisition of humanistic skills
• Education in “medical ethics, human values, and
communication skills”.

19. META ETHICS
• Meta ethics examines the nature of morality in
general, and what justifies moral judgments.
Three questions investigated by meta ethics are:
• Are ethical demands true-apt (i.e., capable of
being true or not true) or are they, for example,
emotional claims?
• • If ,true-apt, are they ever true, and if so what is
the nature of the facts they represent?
• • If there are moral truths what makes them true,
and they are absolutely true or always relative to
some individual or society or culture?

20. • 'Bioethics' is a relatively new term originating
from Greek words; 'bios’ meaning life and
‘ethos’ meaning behavior. It dates back to
1926 when the German Protestant priest Fritz
Jahr coined it in his article 'bioethical
imperative' about the scientific use of animals
and plants.
• He anticipated potential arguments and
discussions in biological research involving
animals and plants.

21. • In 1970, the American biochemist Van
Rensselaer Potter synergistically extended it
with a broader sense, i.e. global ethics, a
discipline representing a link between biology,
ecology, medicine and human values for the
survival of both human beings and other
animal species.

22. Biomedical ethics
• Bio-ethics is the study of moral values and judgments
applied to medicine.
• A shared reflective examination of the issues in
health-care (service), health science (academics and
research) and health policy as right and wrong, with
indication of what to do and what not to
• Involved in a wide range of human inquiries, such
as; debates over the boundaries of life (e.g.
abortion, euthanasia), surrogacy, allocation of
scarce health-care resources (e.g. organ donation,
health-care rationing), right to refuse medical care
for religious or cultural reasons etc

23. • Some bioethicists would narrow ethical evaluation to the morality
of medical treatments or technological innovations, and the timing
of medical treatment of humans.
• Others would broaden the scope to include the morality of all
actions that might help or harm organisms.
• Medical ethics is understood narrowly as an applied professional
ethics,
• Medical ethics shares many principles with other branches of
health-care ethics, e.g. nursing ethics.
• Bioethics appears to have worked more extensively, touching upon
the philosophy of science and issues of biotechnology.
• A bioethicist aids the health-care and research community in
investigating moral issues involved in dilemmas of life and death,
and ethical dilemmas in medicine and science.
• Bio-ethics is a discussion which might take place in any area of
human life and society, i.e. in media, academy, classrooms, and
labs, offices, hospital wards etc.

24. • The intricacy and complexity of bio-ethical issues
are increasing with advancing biotechnology;
like: cloning, gene therapy, life extension, human
genetic engineering, astro-ethics and life in space,
and with manipulation of biology; e.g. altered
DNA, RNA and proteins. These developments are
leading us to a situation where we will require
new perspectives on life, such as: biotic ethics
that values life itself at its basic biological
processes and structures, and seeks their
propagation. Hence, Bio-ethics is in constant need
of rethinking and revision.

25. • Technology opens up a broad scope of intervention: on
being masters of our own destiny, thanks to such
technology, we assume a power for which we have to
be accountable. Technocratic euphoria still prevails,
that is, what is scientific is good per se, inasmuch as it
is axiologically neutral and disinterested; and
everything new is better, from a concept of progress
• As it goes unquestioned- clumsy.
• From an ethical point of view, progress means
emancipation -ridding oneself of superstitions,
ignorance or physical and social impediments- as well
as an increase in degrees of autonomy (of
opportunities and capacities).
• however, that more is not always better, and hence
iatrogenesis, brought about by medicine itself.

26. Profession
• Three essential characteristics : expert
knowledge, self-regulation, and a fiduciary
responsibility to place the needs of the client
ahead of the self-interest of the practitioner
• The dominant conception of profession is
sociological.
• Professionalism is the basis of medicine’s contract
with society.
• Contract = Public trust in physicians, which
depends on the integrity of both the individual
physician and the whole profession

27. In this View
• Ethics = Predictor for a profession
• Etymology of the word profession, which means “a declaration,
promise, or commitment publicly announced”
• Moral confusion and doubts , Temptations of self-interest, power,
prestige, pride, profit, and privilege
• Sources of potential evil=
• (1) Commodification of health care as a product like any other
• (2)Moral skepticism that denies the validity of any stable moral
truth and even the capacity of reason to apprehend such truth even
if it exists
• (3)The respect for patient’s autonomy has been sometimes
regarded as a cause for a lower implication of the physician in the
relationship.
• (4) Technological progress

28. References
• Shakya, D.R. Bioethics for the Welfare of the
Health Service Provider and Consumer.
• Royo-Bordonada, M,A; Roman-maestre,B.
Towards public health Ethics. Public Health
Reviews. 2005,36(3):1-15
• Tzafestas,S, G. Ethics: Fundamental Issues .
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