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Moral decision making
- 1. Moral Decision-Making Marna S.Barrett, Ph.D. Department of Psychiatry University of Pennsylvania School of Medicine
- 2. Moral Decision-Making • Whatis decision-making? • How is moral decision-making different? • Why do we need a model specific to ethics and mental health?
- 3. Moral Decision-Making • Whatis decision-making? – identifying and choosing alternatives based on values and preferences. – process of sufficiently reducing uncertainty and doubt about alternatives to allow a reasonable choice to be made.
- 4. Moral Decision-Making • Howis moral decision-making different? – process for dealing with moral uncertainties – introduces a degree of rationality and rigor into our moral deliberations
- 5. Moral Decision-Making • Whydo we need a model specific to ethics and mental health? – ethical problems require examination through filters (organizational, social, personal, legal) – mental health has unique issues (authority over others, determine social policy, legal influence)
- 6. Organizing Principles ofEthics Autonomy: right to noninterference, self-determination Beneficence: mercy, kindness, charity to others Empathy: experience the experience of others Fidelity: faithfulness to duties or obligations Justice: benefits, risks, costs distributed fairly Nonmaleficience: avoid harm or risk of harm Universalizability: all moral principles/judgments have universal applicability Moral Decision-Making
- 7. Moral Decision-Making Ethics Principlesinform decisions ♦ Ends -based ♦ Rule-based or Kantian principle ♦ Justice or fairness-based (Aristotle) ♦ Care-based principle (i.e., Golden Rule) ♦ Virtue-based
- 8. Moral decision-making 1. Mostdilemmas are not right vs. wrong but right vs. right dilemmas. - It is right to protect forests, it is right to provide jobs for loggers - It is right to uphold confidentiality, it is right to protect the welfare of others How Good People Make Tough Choices Rushworth M. Kidder, 1995 Moral Decision-Making
- 9. Moral decision-making 2. Dilemmasoften represent competing moral paradigms - Truth vs. Loyalty - Individual vs. Community - Short-term vs. Long-term goals - Justice vs. Mercy Moral Decision-Making
- 10. I. Standards-based model Basedon the assumption that rules, laws, & policies provide the best basis for determining action. ♦ Determine primary dilemma ♦ Spell out ethical standards for response ♦ Determine if there is a reason to deviate ♦ Decide on course of action Moral Decision-Making
- 11. II. Principles-based model Clarify ♦Determine dilemma ♦ Formulate alternatives ♦ What key ethical principles and values involved Evaluate ♦ Is any ethical principle violated? ♦ Distinguish facts from beliefs, theories, opinions ♦ Consider credibility of sources ♦ Weigh the benefits, burdens and risks Moral Decision-Making
- 12. II. Principles-based model(cont’d) Decide ♦ Evaluate alternatives & determine consequences ♦ Prioritize ethical principles/values ♦ Consider the worst case scenario ♦ Apply principles Implement ♦ to maximize benefits & minimize costs & risks Monitor and modify ♦ as new information emerges Moral Decision-Making
- 13. III. Virtues-based model Considersthat dispositions and habits enable us to act according to the highest potential of our character and on behalf of our values. ♦ Virtue ethics asks of any action: --What kind of person will I become if I do this? --Is this action consistent with my acting at my best? ♦ Use virtues in considering options ♦ Make decision accordingly Moral Decision-Making
- 14. IV. Moral reasoning-basedmodel ♦ Recognize the moral issue ♦ Make a judgment ♦ Establish intent * individual and situational variables * factors of opportunity and significant others Moral Decision-Making
- 15. IV. Moral reasoning-basedmodel (cont’d) ♦ Moral intensity (effect of decision on others): * concentration of effect (individual or group) * probability of effect (likelihood of harm) * proximity (closeness to the issue) * social consensus (agreement with society) * temporal immediacy (closeness in time) * magnitude of consequence (impact) ♦ Act Moral Decision-Making
- 16. V. Practice-based model ♦Recognize problem, get facts ♦ Assess values, benefits, burdens ♦ Determine legal, social influences ♦ Generate solutions, outcomes ♦ Consult ♦ Act, review, reflect Moral Decision-Making
- 17. Moral Decision-Making Application ofa practice-based model Steps 1. Recognize there is a moral issue 2. Determine the actor(s) 3. Gather the relevant facts 4. Test for right-versus-wrong issues 5. Test for right-versus-right paradigms
- 18. Moral Decision-Making Steps 6. Determineresolution principles involved • Ends-based • Rule-based or Kantian principle • Justice or fairness-based • Care-based principle • Virtue-based 7. Investigate possibilities for action: “trilemma”
- 19. Moral Decision-Making Steps 8. Consult 9.Weigh benefits & burdens 10. Consider other dilemmas that arise 11. Make the decision
- 20. Moral Decision-Making Steps 12. Formulatea justification for the decision ♦ List reasons & arguments ♦ Recognize shortcomings ♦ Anticipate objections ♦ Recognize limitations in perspective 13. Document 14. Review and reflect on decision
Editor's Notes
- #7 Ends-Based: act utilitarian: actions justify the means, rule utilitarian: Justice or Fairness-based model: While respecting and valuing the freedom of individuals to pursue their own goals, the common-good approach challenges us also to recognize and further those goals we share in common. Virtue-base model: In dealing with an ethical problem using the virtue approach, we might ask, What kind of person should I be? What will promote the development of character within myself and my community?
- #10 - Truth vs. Loyalty (duty to courts --- duty to patients) - Individual vs. Community (self needs --- patient needs) - Short-term vs. Long-term goals (work demands --- family demands) - Justice vs. Mercy (respect for automony --- respect for others)
- #15 Virtues: Autonomy: right to noninterference, self-determination Beneficence: mercy, kindness, charity to others Empathy: experience the experience of others Fidelity: faithfulness to duties or obligations (competence) Justice: benefits, risks, costs distributed fairly Nonmaleficience: avoid harm or risk of harm Universalizability: all moral principles/judgments have universal applicability
- #16 Virtues: Autonomy: right to noninterference, self-determination Beneficence: mercy, kindness, charity to others Empathy: experience the experience of others Fidelity: faithfulness to duties or obligations (competence) Justice: benefits, risks, costs distributed fairly Nonmaleficience: avoid harm or risk of harm Universalizability: all moral principles/judgments have universal applicability
- #18 3. Facts: who, what, where, when. Do I even need to be involved? 4. Right vs wrong: stench test, front-page test, Mom test 5. Right vs right: (1) truth vs. loyalty, (2) self vs. community, (3) short-term vs. long-term, (4) justice vs. mercy What values are influencing the problem?
- #19 Resolution principles: ends justify means, would I want rule established based on my behavior, what is fair & just do to others how I would want to be treated what are the values I hold important