This document summarizes key concepts from the ethics of Kant, Ross, Rawls, Aquinas, and other philosophers. It discusses Kant's categorical imperative, Ross' prima facie duties, Rawls' principles of justice, and Aquinas' natural law theory. It also examines how these ethical frameworks relate to medical ethics, highlighting duties, rights, resource allocation, and other issues. The document notes both insights and difficulties with each philosophical approach.

1. JOFRED M. MARTINEZ, RN
CHAPTER 3

2. Kant’s Ethics (Immanuel Kant)
 sometimes called deontologism for its emphasis
on duty or obligation
 others regard it as a form of intuitionism
precisely because of its claim that morality is
exclusively within the human personality; what
is morally right or wrong is solely a matter of
intent, motive and will

3. Immanuel Kant

4. ACT DONE IN ACCORD WITH DUTY AND ACT
DONE FROM A SENSE OF DUTY
a. Act done in accord with duty
b. Act done from a sense of duty

5. Categorical Imperative
• Kant’s categorical imperative mandates an action
without any conditions whatsoever, and without
regard to the consequences that such an action
may yield
• It is a command or maxim that enjoins a person to
do such and such an act without qualification; it thus
lays down a universal rule which will ensure that the
person is acting from a sense of duty

6. Formulations of Categorical Imperative
1. Act only on that maxim which you can at the same
time will to become a universal law (Paton 1948).
2. Always act so as to treat humanity, either yourself
or others, as an end and never as only a means,
All cases in which one acts inhumanly against
another man are ways in which others are treated
as only a means are morally wrong

7. Types of Duties
1. Perfect
One which we must always observe, irrespective of
time and place.
2. Imperfect
One which we must observe only on some
occassions.

8. Autonomous Self-Regulating Will
• Autonomy means governing, regulating, restraining
oneself, including one’s own choices or courses of
action, in accord with moral principles which are
one’s own and which are binding on everyone

9. Medical Context
• First, it is always wrong to lie, no matter what the
consequences may be.
• Second, we must always treat people as ends and
not only as means
• Third, an action is right and legitimate insofar as it
satisfies the categorical imperative

10. Medical Context
4. Fourthly, Kant’s distinction between perfect and
imperfect duties suggests that some rights should
be recognized ----- in a doctor-patient relationship,
for example, the physician has an imperfect duty to
accept one as a patient - that is, how he
discharges his duty is his own decision, his own
prerogative, his own right

11. Difficulties
1. Kant’s principles have no clear way of resolving
issues of conflicting duties
2. The categorical imperative fails to establish duties
in cases involving maxims that cannot be willed to
become a universal law of subjective reasons

12. Difficulties
3. Kant’s ethics presents problem in connection with
the notion that we have a duty to treat others as
rational beings or persons – this problem is a
serious one with regard to the moral issue of
abortion
a. Is a fetus that is developing in its mother’s womb– be it
deformed or not, considered a person?
b. Is an infant born with serious physical deformities a
rational being?

13. William David Ross
• Though influenced by rule utilitarianism, Ross has
rejected precept that an action is validated as right
by its consequences
• The outcomes of an act -- however beneficial and
pleasant they may be for many individuals -- may
not determine its rightness

14. William David Ross

15. Rules and Moral Principles
Absolute rules are often insensitive to the
consequences of an act; at times, not only are they
in conflict with one another but they are also
inflexible that they become irrelevant to ever-
changing situations.

16. Rightness and Goodness
Neither can be explained or replaced by other
properties, when it is said that an act is right,
rightness is the moral property of that act – but it is
not identical with the act per se, a right act can
originate from a morally bad motive.

17. Actual Duty and Prima Facie Duty
• Actual duty – is one’s real duty in a given situation --
- it is the action one ought to choose from among
any other actions
• Prima facie duty – is one that directs or commands
what ought to perform when other relevant factors
are not taken into account

18. What to do in such a situation according to Ross are
the following:
1. Learn and discern the facts in the case
2. Consider the possible consequences of our
actions
3. Reflect on our prima facie duties
4. Decide on the best course of action under the
circumstances

19. Seven Types Of Prima Facie Duties
1. Duty of fidelity
2. Duty of reparation
3. Duty of gratitude
4. Duty of justice
5. Duty of beneficence
6. Duty of self-improvement
7. Duty of nonmaleficence

20. Duty of Fidelity
We should be faithful to our duties, obligations,
vows, or pledges; this likewise refers to one’s
loyalty to a worthy cause, telling the truth as the
situation demands it, keeping actual and implicit
promises, and not representing fiction as truth.

21. Duty of Reparation
A duty to make amends for injury that we have
inflicted on others.
An act of making amends, righting the wrongs
we have done to others.
Also known as the duty of compensation.

22. Duty of Gratitude
A duty to appreciate and recognize the services
others have done for us, which may be either a
favor, kindness, good fortune, a great help, or
saving one’s life

23. Duty of Justice
Stresses the proper distribution of social
benefits and burdens. Not only should we enjoy
social benefits with others, but we should also
equally share with them the burdens of social living.

24. Duty of Beneficence
Enjoins us not only to bring about what is good
for others but also to help them better their
conditions with respect to virtue, intelligence, or
comfort
Requires the provision of benefits and balancing
of benefits and harm for all people concerned in a
given circumstance

25. Duty of Self-Improvement
A duty to improve and develop oneself with
respect to virtue, intelligence, and happiness
It should go hand-in-hand with other duties, for
unless one performs or carries out one’s duty to
oneself, the fulfillment of one’s other duties would
be less effective.

26. Duty of Nonmaleficence
Duty to avoid inflicting evil, injury or harm upon
others as we would avoid doing so to ouselves ---
we ought to prevent evil or harm, which
encompasses pain, suffering, disability and death.

27. Medical Context
It encourages us to show discernment and
sensitivity with regard to the unique aspects of varying
situations before making a decision.
It urges us to be judicious, prudent, and flexible in
the light of the facts at hand then explore the
possibilities of our decisions --- our moral guide
should be not what is useful, but what is right.

28. Medical Context
The list of prima facie duties may serve as
moral guidelines for health care professionals,
including researchers--- such a list prompts health
personnel responsible for patient care to reflect on
these duties and to choose the one that best applies
to a particular situation

29. Difficulties
Contrary to what Ross seems to suggest, it is
practically impossible for all individuals to be able to
discern the same moral principles and prima facie
duties
One’s perception of what is right and wrong, as
well as of one’s duties, is the by-product of one’s
education, training and experience

30. Three Aspects of the Theory of Justice
a. Every individual is inviolable---the larger sum of
advantages which is supposedly to be enjoyed by
the many should not outweigh the sacrifices or
inconveniences to be imposed on a few.

31. John Rawls

32. Three Aspects of the Theory of Justice
b. An erroneous theory is tolerable in the absence of
a good one
As much as possible, when given two
erroneous laws, one should choose the better and
the less erroneous one.
An act of injustice, for instance, can be tolerated
if and only if it is necessary to avoid an even
greater act of injustice.

33. Three Aspects of the Theory of Justice
c. Individual liberties should be restricted in order to
maintain equality of opportunity.
Liberties of equal citizenship are of paramount
importance in a just society
Individual rights are not subject to political
bargaining or compromise

34. Three Aspects of the Theory of Justice
c. Individual liberties should be restricted in order to
maintain equality of opportunity.
Liberties of equal citizenship are of paramount
importance in a just society
Individual rights are not subject to political
bargaining or compromise

35. Principles of Justice
a. Equal access to the basic human rights and
principles --- this principle defines and secures
equal liberties of citizenship
Our basic rights and liberties include the right to
vote and to be eligible for public office, freedom of
speech and peaceable assembly.

36. Principles of Justice
b. Fair equality of opportunity and the equal
distribution of socio-economic inequalities
As much as the availability of resources will
allow, everyone should be given an opportunity for
self-development or to receive medical treatment.

37. Justice in Human Relations
a. fairness in our dealings with others
b. fidelity
c. respect for persons
d. beneficence
e. natural duties – the duty of justice, the duty of
helping others in need or in jeopardy, the duty
not to harm or injure others, and the duty to
keep our promises

38. Medical Context
Rawls recommends the legitimacy of paternalism
which others should act or decide in our behalf
whenever we are unable to make decision by and for
ourselves --- for instance, should we become mentally
incompetent.

39. Medical Context
Rawls justifies the allocation of social resources for
the training of medical personnel by the benefits that it
will yield to society in general --- likewise, he
sanctions the voluntary consent of an individual to
become a research subject, by virtue of his basic right
to decide on what risks he is willing to take with his
own life

40. Medical Context
Rawls also introduced the concept of an order of
priority, with regard to equal access to health care,
within the context of the principles of equal opportunity
and equal distribution of socio-medical resources.

41. Difficulties
In Rawls account of a hypothetical community
under the veil of ignorance, he does not permit the
people in the original position to know their goals,
plans, interests, and purposes, but only their self-
respect, wealth and rationality

42. Difficulties
Despite his objection against utilitarianism, Rawls’s
concept of justice (“liberties of individuals should be
restricted, provided that such restrictions are for the
benefit of everyone”) refers to the utility principle or
principle of the greatest number.

43. St. Thomas Aquinas
So called precisely because there exists a natural
moral law which is manifested by the natural light of
human reason, demanding the preservation of the
natural order and forbidding its violation
In Aquinas’s view, the source of the moral law is
reason itself. Reason directs us towards the good as
the goal of our action, and that good is discoverable
within our nature

44. St. Thomas Aquinas

45. Voice of Right Reason or Voice of Conscience
The moral law is the dictate of the voice of reason
– “the good must be done, and evil, avoided”.
How are we to determine whether we are acting
rightly or wrongly?
If we follow the voice of reason we are acting
rightly, we are acting wrongly if we act against it

46. “Thus, whenever I am faced with a particular act,
the voice of reason serves as my natural guide in
making moral decision. Similarly, I know I am doing
the right thing if and when I follow the voice of my
conscience; otherwise , I feel a sense of guilt, self-
reproach, or remorse. This explains why some
Thomists say we cannot run away from our
conscience, as Judas Iscariot allegedly tried when he
betrayed Jesus”

47. Man’s Threefold Natural Inclination
1. Self-preservation – urges us to care for our health,
not to kill ouselves or put ourselves in danger
2. Just dealings with others – reason by nature leads
us to treat others with the same dignity and
respect that we accord ourselves
3. Propagation of our species – we are naturally
inclined to perpetuate our species which is viewed
as a natural good

48. Determinants of Moral Action
1. The Object
What the will intends directly and primarily is the
object of the moral act; it may be either a thing (for
example, money), or an action (such as surgical
operation).

49. Determinants of Moral Action
2. The Circumstances
There are conditions which, when superadded
to the nature of the moral act, will affect its
morality, they are called the circumstances.
“Will affect its morality” means that a given
circumstance or a set of circumstances will either
mitigate or aggravate the goodness or badness of
a particular act.

50. Determinants of Moral Action
Seven Circumstances
1. Who?
This circumstance has something to do with the
special quality, prestige, rank or excellence of the
person involved in the moral act.

51. Determinants of Moral Action
Seven Circumstances
2. What?
This circumstance refers to the quantity or
quality of the moral object.

52. Determinants of Moral Action
Seven Circumstances
3. Where?
This circumstance denotes the place where the
act occurs

53. Determinants of Moral Action
Seven Circumstances
4. By what means?
This refers to the means used in carrying out
the act.

54. Determinants of Moral Action
Seven Circumstances
5. Why?
The end or purpose is considered as a
circumstance affecting the goodness or badness of
the action
If the act itself is bad and is still carried out with
a bad purpose, the said act becomes much worse

55. Determinants of Moral Action
Seven Circumstances
6. How?
This circumstance indicates the manner in
which the action is done.

56. Determinants of Moral Action
Seven Circumstances
7. When?
This circumstance refers to the time element
involved in the performance of the action, not only
with regard to quantity but to quality as well.

57. Determinants of Moral Action
3. The End or Purpose
The end or purpose may be taken either as a
circumstance or as the end of the agent, for it is an
integral part of every moral act in either sense.
A good act with a moral motive makes the moral
action bad,likewise, we may not employ an evil
means in order to attain a good end.

58. The principle applies to a situation in which a good
effect and an evil effect will result from a good cause
We may have a good action which will yield two
effects, a good one and an evil one, how are we to
solve this question?

59. An individual has the right to cut off, mutilate or
remove any defective or worn out non-functioning part
of his body; to dispose of his organs or to destroy their
capacity to function “only insofar as the general well-
being of the whole body requires it.

60. Principle of Stewardship
Declares that human life comes from God, and no
individual is the master of his/her own body.
Humans are only mere stewards or caretakers ,
with the responsibility of protecting and cultivating
spiritual and bodily functions.

61. Principle of Inviolability of Life
States that life is God’s and has been loaned to us,
hence it is inviolable and sacred.
It is only God who has complete control and
dominion over life, our duty is to take care of it until
God takes it back from us.

62. Principle of Sexuality and Procreation
Twofold Purpose of Sexual Union
a. the procreation and nurturing of children
b. the expression of loving union and companionship