ETHICAL TERMINOLOGIES

1. Considerations of ethics and brief
terminology
Amita K.C. (BPH, MPH)
amita2013hope@gmail.com

2. Ethics and brief terminology
• Defining the Good, Virtue Ethics, Situation
Ethics, Care Ethics
• Moral worth, types of moral worth
• Paternalism, Plagiarism, Patent right,
Autonomy, Competence and Decisional
Capacity, Truth-Telling , Pluralism and
Healthcare Professionals

3. Virtue Ethics
• Virtue: excellence of intellect or character,
good quality, good value, good worth
• Character: certain inborn moral virtue
• What sort of person must I be to achieve my
life purposes ?
• What makes one a good or excellent person?
• Rather than “what is right or good to be based
on my duty or to achieve good consequences

4. Virtue Ethics
• Virtues are intellectual or character traits or
habits that are developed throughout one’s life
through Personal effort, training, and practice
• eg: Wisdom, courage, hope justice, faith, love,
charity,
• Temperance : also known as restraint, the
practice of self-control, abstention and
moderation tempering the appetition ; especially
sexually
• Honesty, compassion, caring, responsibility,
integrity, trustworthiness, carefulness.

5. Virtue Ethics
• Moral virtue is a character trait that is morally
valued
• A person with moral virtue has both
consistent moral action and morally
appropriate desire
• Practice of virtuous behavior
• Rather than virtuous acts being the end result
of good character

6. Virtue Ethics
• Virtues are tendencies to act, feel, and judge that
are developed from nature capacity by proper
training and exercise
• Practice creates habit of acting in a virtuous way
• Virtue can be learned and improved
• Excellence of character depends on motivation,
care, clear judgment, self control and practice
• Fruit of intelligent search
• Possession of the simple person, not the gift of
innocent intent (Aristotle)

7. Virtue Ethics
• Virtuous acts must be chosen for their own
sake
• Virtuous character is created repeatedly acting
in a virtuous manner
• Virtuous acts must be chosen for their own
sake
• Choice must proceed from a solid and
unchangeable character
• Virtue is disposition to choose the mean
• Human wellbeing is the highest aim of
morality

8. • Golden mean of virtuous behavior
• Golden Virtue: Practicing moderation
• Avoiding both excess and deficiency
• No list of moral principles
• Basic Moral question is not “What should one do?”
but “What should one be?”
• Virtue lies not only engaging in virtuous acts, but also
in Will ( Phillipa Foot)
• Will is defined as “which is wished for as well as what
is sought.”
• Positive will is sometimes the necessary ingredient in
success

9. Examples
• Sometimes one man succeeds where another
fails not because there is some specific
difference in their previous conduct but rather
because his heart lies in different place; and
disposition of heart is part of virtue.
• A man’s virtue is judged by his inner most
desires as well as by his intentions. This fits
with idea that a virtue such as generosity lies
as much as someone’s attitudes as in his
actions.
-( Phillipa foot, 1997)

10. According to foot
• Virtue is not a skill or an art
• Can’t be merely a practiced or perfected act
• It must engage in will
• An act can’t be considered virtuous, if the
intention is not good
• Virtue is one of hope (every one has capacity
to learn virtuous acts but
• Road to virtuous character is less easily
traveled

11. • Deep sympathy and discomfort at the other
person’s suffering.
• Sympathetic / empathetic and caring
presence outweigh need for technical care
• Discernment: wisdom, sensitive insights, acute
judgment, understanding, appropriate action
in given situations
• It results in influencial actions
• Requires sensitivity and attention

12. • Helps in developing relationships
• Integrity: soundness, reliability, wholeness,
and a coherent integration
• Continue over time, reasonable stable,
justified in action and judgment,
• A person of integrity has a consistency of
conventions, actions, emotions, and is
trustworthy
• Deficiency may include hypocrisy, insincerity,
and bad faith

13. Situation Ethics

14. Situation ethics (contextualism)
• In situation ethics, right and wrong depend
upon the situation.
• There are no universal moral rules or rights -
each case is unique and deserves a unique
solution.
• Situational Ethics was pioneered by Joseph
Fletcher (1905-1991).

15. Situational Ethics: Fletcher's Model
• Situational Ethics, according to Fletcher's model, states
that decision-making should be based upon the
circumstances of a particular situation, and not upon
fixed Law.
• The only absolute is Love. Love should be the motive
behind every decision. As long as Love is your
intention, the end justifies the means. Justice is not in
the letter of the Law, it is in the distribution of Love.
• Fletcher founded his model upon a statement found in
the New Testament of the Bible that reads, "God is
Love”

16. Situation ethics (contextualism)
• In situation ethics, within each context, it is
not a universal law that is to be followed, but
the law of love.
• A Greek word used to describe love in
the Bible is "agape".
• Agape love is conceived as having no strings
attached to it and seeking nothing in return; it
is a totally unconditional love.

17. Situation ethics (Contextualism)
• Situation ethics rejects 'prefabricated
decisions and prescriptive rules'.
• It teaches that ethical decisions should follow
flexible guidelines rather than absolute rules,
and be taken on a case by case basis.
• Situation ethics was originally devised in a
Christian context, but it can easily be applied
in a non-religious way.

18. Elements of situation ethics
• The elements of situation ethics were
described by Joseph Fletcher, its leading
modern proponent, like this:
• Moral judgments are decisions, not
conclusions
• Decisions ought to be made situationally, not
prescriptively
• We should seek the well-being of people,
rather than love principles.

19. • Love "wills the neighbour's good" [desires the
best for our neighbour] whether we like them
or not The ultimate norm of Christian
decisions is love: nothing else
• The radical obligation of the Christian ethic to
love even the enemy implies unmistakably
that every neighbour is not a friend and that
some are just the opposite.

20. • Love and justice are the same, for justice is love
distributedLove and justice both require acts of
will
• Love and justice are not properties of actions,
they are things that people either do or don't do
• Love and justice are essentially the same
• Justice is Christian love using its head--calculating
its duties. The Christian love ethic, searching
seriously for a social policy, forms a coalition with
the utilitarian principle of the 'greatest good of
the greatest number.'

21. Ethics of care
• The ethics of care (alternatively care
ethics or EoC) is a theory about what makes
actions morally right or wrong.
• It is one of a cluster of normative ethical
theories that were developed by feminists in
the second half of the twentieth century.

22. Ethics of Care as a feminist ethic
• Care-focused feminism is a branch of feminist
thought, informed primarily by ethics of care as
developed by Carol Gilligan and Nel Noddings in
mid 1980s.
• This body of theory is critical of how caring is
socially engendered to women and consequently
devalued.
• “Care-focused feminists regard women’s capacity
for care as a human strength”
• which can and should be taught to and expected
of men as well as women.

23. Ethics of care
• The moral theory known as “ the ethics of
care” implies that there is moral significance
in the fundamental elements of relationships
and dependencies in human life.
• Normatively, care ethics seeks to maintain
relationships by contextualizing and
promoting the well-being of care-givers and
care-receivers in a network of social relations.

24. Ethics of Care as a feminist ethic
• Ethics of care is also a basis for care-focused
feminist theorizing on maternal ethics.
• It builds on the motivation to care for those
who are dependent and vulnerable, and it is
inspired by both memories of being cared for
and the idealizations of self.

25. Ethics of care
• Although care ethics is not synonymous with
feminist ethics, much has been written about
care ethics as a feminine and feminist ethic, in
relation to motherhood, international
relations, and political theory.
• Care ethics is widely applied to a number of
moral issues and ethical fields, including
caring for animals and the environment,
bioethics, and more recently public policy.

26. Moral
• Morals are the rules that govern which actions
are right and which are wrong.
• A morals can be for all of society or an
individual’s beliefs.
• Sometimes a moral can be from a story or
experience.

27. Examples of Morals in Society
• Do not gossip
• Tell the truth
• Have courage
• Do not have sex before marriage
• Keep your promises
• Do not cheat
• Be trustworthy
• Respect others
• Keep your self control
• Have humility
• Serve mankind

28. Moral worth
• Moral worth can be defined as a particular
way in which an action or an agent are
valuable, or deserve credit (or deserve
discredit).
• A central thought about moral worth is that it
involves the agent's motives for acting

29. Moral worth
• The moral worth of an action then should not be
identified with its value in producing good
consequences or preventing bad ones (including
the very performance of the act).
• A central task for moral philosophy is to establish
what counts as the right moral reasons for
performing an action, and particularly whether
these include the thought that 'the action is
right', even when that is true.

30. • An act has moral worth (i.e., is morally good)
if and only if it
• 1. is in accordance with the moral law (right-
morally permissible or obligatory);
• 2. it is not performed merely from inclination,
regardless of whether or not the inclination be
selfish or caring and;
• 3. is performed from respect for the moral
law.

31. Truth-Telling
• Truth-telling in medicine is a broad area and
often encompasses several ethical issues.
• These issues include the right of patients or
their families to receive information about
their diagnosis and illness.
• The physician, on the other hand, must
balance his or her obligation to tell the truth
against the imperative of “do no harm”.

32. Truth-Telling
• Questions often arise concerning how much
truth to tell.
• When, if ever, is a physician justified in
withholding information?
• Can too much information be harmful?

33. Paternalism
• Paternalism involves acting without
consent or even overriding a person’s
wishes, wants, or actions in order to
benefit the patient or at least to prevent
harm to the patient.

34. 34
Paternalism cont..
There are 2 elements in this definition:
1. the absence of consent
2. the beneficent motive (the welfare of the
patient)

35. 35
Paternalism cont…
• Paternalism exists when the health care
worker intervenes to prevent patients from
harming themselves in some serious way
• e.g they can intervene in the case of those
who are attempting suicide

36. 36
Paternalism cont…
• From an ethical point of view, writers generally reject
the right of health care providers to use strong
paternalism
• The courts have sometimes allowed treatment
without informed consent to relieve serious pain or
suffering
• This treatment may remove doubts about
competency of the person and allow informed
consent
• Here the treatment is directly in the service of
autonomy

37. Plagiarism
• is the use or close imitation of the language
and thoughts of another author and the
representation of them as one's own original
work
• Within academia, plagiarism by students,
professors, or researchers is considered
academic dishonesty or academic fraud

38. Patent right
• A patent is an exclusive right given by law to
inventors to make use of, and exploit, their
inventions for a limited period of time.
• By granting the inventor a temporary
monopoly in exchange for a full description of
how to perform the invention, patents play a
key role in developing industry around the
world.

39. Patent right
• Once the owner of an invention has been
granted a patent in any particular country,
they then have the legal authority to exclude
others from making, using, or selling the
claimed invention in that country without
their consent, for a fixed period of time.
• Patent s are time bound monopoly right.

40. TRIPS
• Trade Related Aspects of Intellectual Property
(TRIPS) on the right to health, particularly the
debate regarding the impact of global patent
rules on the prices of essential medicines.
• It also addresses the arguments for and
against patent regimes in the drug field.
• TRIPS helps to ensure that patents are not
undermined by the sale of competing pirated
copies.

41. Arguments in Favour of Patents right
• The rationale for granting patents is the need
to reward an inventor
• Patents reward people for their inventions,
thus encouraging creativity and innovation
• the money raised from patent protection is
said to be necessary to fund the considerable
costs of research and development (R&D).

42. impact of patent rights on the price of
medicines
• TRIPS requires Member States of the WTO to
provide protection for patent rights for 20 years
• impact of patent rights on the price of medicines.
Prices will be artificially too high for the
prescribed 20-year period as patent-holders seek
to maximize returns on their investment.
• For example, the costs of patented drugs which
combat the HIV virus are enormous.

43. impact of patent rights on the price of
medicines
• Such prices are only affordable in
industrialized countries due to government
benefits, which are not available in the
developing world.
• Clearly, it is impossible for most people in the
developing world, where most HIV cases arise,
to pay such prices.

44. impact of patent rights on human
health
• Similar problems, which have received far less
attention than issues regarding access to AIDS
drugs, arise with regard to access to drugs and
vaccines for other treatable killer diseases.
• For example, most women in the developing
world cannot afford the new vaccine for
cervical cancer, which is widely available to
women in the North America, Latin America
and Europe .

45. Autonomy
• 1. Respect for autonomy/ Respect for person
• Respect for persons recognizes the capacity and
rights of all individuals to make their own choices
and decisions.
• There is a need to provide special protection to
vulnerable persons.
• Examples of vulnerable groups
• Children, prisoners, mentally ill
• people with limited education, living in poverty, limited
access to health care services
• Women (in some cultures)

46. 46
Respect for autonomy
cont…
• Respect for persons is embodied in the informed
consent process.
• Informed consent is designed to empower the
individual to make a voluntary informed decision.
• Potential research participants must fully
comprehend all elements of the informed consent
process.

47. Respect for autonomy
cont…
• A person of diminished autonomy is in some
respect controlled by others or incapable of
deliberating or acting on the basis of his/her
desires and plans
• E.g prisoners and mentally retarded
individuals
• Mental incapacitation limits the autonomy of
the retarded person
47

48. Competence and Decisional Capacity
• We often use the terms "competence" and
"capacity" (short for "decision-making capacity")
interchangeably.
• However, they are not exactly the same.
• Competence is a legal term.
• Competence is presumed unless a court has
determined that an individual is incompetent. A
judicial declaration of incompetence may be
global, or it may be limited (e.g., to financial
matters, personal care, or medical decisions).

49. Competence and Decisional Capacity
• Decision-making capacity, on the other hand,
is a clinical term that is task-specific.
• A physician may determine that a patient does
not have the capacity to make a decision for
or against surgery for a hip fracture, but she
may have the capacity to decide if she wants a
sleeping pill or a laxative.

50. Pluralism and Healthcare Professionals
• The existence of multiple healing systems and
options within a society.
• Pluralism has always existed in health care
systems;
• there have always been multiple practitioners to
choose from and multiple ways of understanding
health and healing.
• While the ideal pluralism suggests multiple
healing options competing on a level playing
field, in modern societies this is often not the
case.