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Sign up. Virtue ethics is directly applicable to health care ethics in that, traditionally, health care professionals have been expected to exhibit at least some of the moral virtues, not the least of which are compassion and honesty. The preeminent proponent of utilitarianism as an ethical theory in the 19 th century was John Stuart Mill. As a normative ethical theorist, Mill articulated and defended a theory of morality that was designed to prescribe moral behavior for all of humankind. Conversely, human actions, which are committed in moral decision-making situations, are determined to be morally incorrect to the extent to which they, on balance, produce more unhappiness rather than happiness for those who are affected by such actions.

However, unlike virtually all of his utilitarian predecessors, Mill offered a version of utilitarian ethics that was designed to accommodate many, if not most, of the same ethical concerns that Aristotle had expressed in his version of virtue ethics. In other words, even after it is determined that the utilitarian calculation of the ratio of happiness to unhappiness, in a particular moral decision-making situation, might result in an option that is deemed to be morally correct, an additional calculation might be in order to determine the ratio of happiness to unhappiness in the event that such an option, in future like cases, would consistently be deemed the appropriate one such that if this latter calculation would likely result in a ratio of unhappiness over happiness, then the option in the original case might be rejected despite its having been recommended by the utilitarian calculation for the original moral decision-making situation.

For example, in a moral decision-making situation in which an employed blue-collar worker witnesses a homeless person dropping a twenty-dollar bill on the sidewalk, the utilitarian calculation would recommend, as the morally correct option, to return the twenty-dollar bill to the homeless person rather than to keep it for oneself. However, given the same exact moral decision-making situation except that rather than a homeless person dropping a twenty-dollar bill on the sidewalk, the twenty-dollar bill is dropped by a universally known and easily recognizable multi-billionaire.

Another possible reason to reject an otherwise recommended option, based on the utilitarian calculation, would be if the same option were to be repeatedly chosen routinely by others in society, as influenced by the action in the original case in question.

To the extent that the action in question, if repeated routinely by others in society, would result in unfavorable consequences for the society as a whole, that is, it would run counter to the maintenance of social utility, then the agent in the original moral decision-making situation in which this action was an option should choose to refrain from committing this action. For example, if a prominent citizen of a small town, upon learning that the local community bank was having financial problems due to an unusually bad economy decided to withdraw all of the money that he had deposited in his accounts with this bank, the utilitarian calculation would, presumably, sanction such an action.

However, precisely because this man is a well-known citizen of this small town, it can be predicted, reasonably, that word of his bank withdrawal would spread throughout the town and would likely cause many, if not most, of his fellow citizens to follow suit. The problem is that if the vast majority of the townspeople did follow suit, then the bank would fail, and everyone in this town would be worse off than before.

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In other words, this would serve to undermine social utility, and so, the original action would not be recommended by the utilitarian calculation. As applicable to health care ethics, utilitarian considerations have become fairly standard procedure for large percentages of health care professionals over the past several generations. It is not at all uncommon for decisions to be made, by health care professionals at all levels of health care, on the basis of what is in the best interest of a particular collectivity of patients.

For example, officials at the U. Centers for Disease Control CDC learn of an outbreak of a serious, potentially fatal communicable disease. These officials decide to quarantine hundreds of people in the geographic area in which the outbreak occurred and to mandate that health care professionals across the country who diagnose patients with this same communicable disease must not only take similar measures but also must report the names and other personal information of the affected patients to the CDC.

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These decisions are, themselves, decisions of moral if not also legal decision-making, and these decisions raise additional moral issues. At any rate, the fundamental reason for taking such measures, under the specified circumstances, is for the protection of the health of the citizens in those areas where the outbreaks occurred, but, ultimately, such measures are taken for the protection of the health of American citizens in general, that is, to promote social utility Mill, A deontological normative ethical theory is one according to which human actions are evaluated in accordance with principles of obligation, or duty.

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If this attempt to universalize the maxim were to result in a contradiction, such a contradiction would dictate that the maxim in question cannot be universalized; and if the maxim cannot be universalized, then one ought not to commit the action. Kant asks his reader to consider the case of a man who stands in need of a loan of money but who also knows well that he will not be able to repay such a loan in the appropriate amount of time. The maxim of his action would be: Whenever I find myself in need of a loan of money but know that I am unable to repay it, I shall deceitfully promise to repay the loan in order to obtain the money.

To attempt to universalize this maxim, this man would need to entertain a future course of events in which all rational beings would also routinely attempt to act on this same maxim whenever they might find themselves in relevantly similar circumstances. However, as a rational being, this man would come to realize that this maxim could not be universalized because to attempt to do so would result in a contradiction.

Thus, the loaning of money would, at least temporarily, come to a halt. As Kant points out to his reader, because of the contradiction involved in attempting to universalize this maxim, neither the promise deceitful as it is itself nor the end to be achieved by the promise that is, the loan of money would be realizable. So, the fact that a contradiction results from the attempt to universalize the maxim reveals the impossibility of the maxim being able to be universalized, and because the maxim cannot be universalized, then the man ought not to commit the action. In application to any specific moral decision-making situation, the agent is being asked to respect rational beings as valuable in, and for, themselves, or as ends in themselves, and, thereby, to commit to the principle to never treat a person either oneself or any other as merely a means to some other end.

To apply this formulation of the categorical imperative to the same example as before is to realize that, once again, one ought not to make a deceitful promise. For, to make a deceitful promise to repay a loan of money in an effort to obtain such a loan is to treat the person to whom such a promise is made as a means only to the end of obtaining the money. To be faithful to this formulation of the categorical imperative is to never commit any action that treats any person as a means only to some other end Kant, For example, if a patient who had been prescribed an opioid for only a short period of time, post-surgery, were to contemplate whether to feign the continued experience of pain during the follow-up visit with the surgeon in an effort to obtain a new prescription for the same opioid in order to abet the opioid addiction of a friend, then the patient would be attempting to treat the surgeon as a means only to another end.

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Central to their approach are the following four ethical principles: 1 respect for autonomy, 2 nonmaleficence, 3 beneficence, and 4 justice. However, given the abstract nature of these ethical principles, it is necessary to instantiate them with sufficient content so as to be able to be practically applicable to particular cases of moral decision-making.

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  • This is what is referred to as an application of the method of specification, which is designed to restrict the range and the scope of the ethical principle in question. In addition, each ethical principle, again, in order to be practically applicable, needs to be subjected to another methodological procedure, namely that of balancing according to which the principle, as a moral norm that is competing with others, and in order to be eligible for application to a particular case of moral decision-making, needs to be deemed to be of sufficient weight or strength, as compared to its competitors Beauchamp and Childress, None of the four ethical principles has been designated as enjoying superiority over the others; in fact, it is explicitly acknowledged that any of the four principles can, and would, reasonably be expected to conflict with any other.

    Because of this, it has been pointed out that this method of moral decision-making is subject to the problem of having no means by which to adjudicate such conflicts. Moreover, to the extent that, in practice, the application of principlism can be reduced to a mere checklist of ethical considerations, it is not sufficiently nuanced to be, ultimately, effective Gert and Clouser, In other words, like the method of decision-making that is used by judges who must render decisions in the law, casuists insist that the best way in which to make decisions on specific cases as they arise in the field of health care, and which raise significant moral issues, is to use prior cases that have come to be viewed as paradigmatic, if not precedent setting, in order to serve as benchmarks for analogical reasoning concerning the new case in question.

    For example, if a new case were to come about in the field of health care that raised the moral issue of how the health care professionals of a hospice organization should treat a woman who is five months into her pregnancy but who also has been diagnosed with stage four pancreatic cancer and has a life expectancy between two and three months, the casuist would advise that the moral decisions concerning the treatment of this woman should be made by seeking out as large a number as possible of cases that had occurred prior to this one and that exhibited as many as possible relevantly similar salient characteristics in addition to as many as possible of the same moral issues.

    To render moral assessments concerning how these previous cases were handled some more morally acceptable and others not, or even more instructive would be at least one that stands out as reflective of either decisions determined to have been obviously morally correct or decisions determined to have been blatantly morally objectionable is to have established guideposts for moral decision-making in the present case under consideration Jonsen and Toulmin, According to the proponents of casuistry, normative ethical theories and ethical principles can take moral decision-making only so far because, first, the abstract nature of such theories and principles is such that they fail to adequately accommodate the particular details of the cases to which they are applied, and second, there will always be some cases that serve to confound them, either by failure of the theory or principle to be practically applicable or by suggesting an action that is found to be morally unsatisfying in some way. However, casuistry, as a method of moral decision-making, seems to make use of various sorts of moral norms or rules, if only in a subconscious or nonconscious way. Furthermore, this moral norm or rule, itself, will almost certainly turn out to have been reflective of either popular societal or cultural bias because of the conscious methodology to refrain from the use of normative ethical theories and ethical principles, both of which carry with them standards of objectivity Beauchamp and Childress, For example, even though, theoretically and even legally, women, by a particular point in time during the first half of the 20 th century, were eligible for admission to medical schools should they have chosen to exercise their autonomous rights to apply for such admission, in practice and in fact, both the social conditioning of women and the gender bias of the men who administered medical schools, and who made decisions on which applicants would satisfy the requirements for admission, ensured that medical schools would graduate, almost exclusively, men with only single digit exceptions in America.

    The point is that the concept of autonomy, in its theoretical sense, is too abstract to have had any practical application to women, in this case, whose eligibility for acceptance to medical schools was denied on the basis of gender.

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    Thus, in addition to this concept of relational autonomy, concepts of responsibility and compassion as well as those of freedom and equality are essential to the majority of the proponents of feminist ethics Holmes and Purdy, and Sherwin, While among those who consider themselves to be proponents of feminist ethics there exists a range of perspectives concerning not only some of the most important ethical issues within the framework of this school of thought but also concerning the very nature of this school of thought, agreement can be found in the need to reflect on both the oppression and the suppression of women that has been inherent in most every culture throughout human history.

    Yet another method of moral decision-making, which is sometimes thought of as a sub-field of feminist ethics but in the early 21 st century has come to be seen in its own right as a methodology and was given birth by feminist ethics, is usually referred to as the ethics of care. Like the proponents of feminist ethics, the proponents of the ethics of care have decided that any methodology of moral decision-making that is based on abstract theories or principles, rights or duties, or even objective decision-making turns out to be unsatisfying in terms of interacting with others in moral decision-making situations.

    Nursing, as a profession, has been, traditionally, a profession of the nurturing of, as well as the caring for, the patient. Until the latter part of the 20 th century, nursing was also, historically, a profession for women. In no way is this to suggest that this ethics of care would, either intentionally or in practice, preclude men from identifying with it also.

    It should go without saying that many are the health care professionals who would choose to nurture, and to care for, their own patients in this same way, with or without the existence of any such accrediting agencies Kuhse, In addition to the application of a variety of methods of moral decision-making to the practice of health care, ethical principles are also so applicable, but not procedurally in the same way as in the method of moral decision-making identified above as principlism. In other words, ethical principles operate on a different level of moral decision-making than do normative ethical theories or other methods of moral decision-making; nonetheless, ethical principles, like normative ethical theories and these other methods of moral decision-making, are prescriptive, that is, they offer recommendations for moral action.

    In theory, ethical principles can be used as one measure of how effective normative ethical theories are in their application to moral decision-making situations. For, any proposed normative ethical theory that is incapable of accommodating the requirements of the most fundamental ethical principles can be called into question on that very basis. In practice, autonomy, on the part of the patient, and paternalism, on the part of the health care professional represent mutually exclusive events, that is, to the extent that one of these two is present, in decision-making and their attendant actions within the clinical relationship of the patient and the health care professional, to that same extent is the other one absent.

    Some health care professionals continue to profess their own personal beliefs that patient autonomy is over-rated because, in their own clinical experience, patients continue to make poor decisions concerning what is in the best interest of their own health care. Certainly, this is a realistic concern, and it probably always will be. That is, not every adult patient has the ability to comprehend medical explanations even if such explanations are cast in the language of the native tongue of the patient and even if the ability of comprehension that is necessary for a proper understanding is at the level of, say, an average high school graduate.

    Reasons for these so-called exceptional cases vary from cultural or religious differences between the health care professional, on the one hand, and the patient, on the other, to the patient in question being a close relative, or friend, of the health care professional even in a clinical situation in which the health care professional has no part in the practice of health care for this close relative or friend.

    In either of these types of cases and many like ones , these so-called exceptional cases are not exceptional cases at all. At its most fundamental level, a true respect for autonomous decision-making on the part of the patient demands that it be honored, objectively, even in the tough cases. To the extent to which health care professionals serve their patients by helping them to maintain or improve their health status, health care professionals can be said, to the same extent, to be acting beneficently toward the patients they serve.

    In theory, every action performed by a health care professional, in a professional relationship with a patient, can be expected to be guided by the ethical principle of beneficence. Moreover, the respect for patient autonomy and the practice of beneficent medical care can be considered to be mutually complementary. However, despite the complementary nature of the ethical principle of autonomy and that of beneficence, it is not uncommon for these two ethical principles to conflict one with the other.

    For example, a young adult patient who has only recently suffered a ruptured appendix such that it is still early in the progression of pain might refuse to undergo an appendectomy for the reasons that the patient has never undergone surgery before and claims to be deathly afraid of hospitals. Such cases of conflict between these two ethical principles would normally be adjudicated according to which right that is, that of autonomy or that of beneficence can reasonably, and objectively, be determined to supersede the other in importance.

    In the former example, the patient, after recovering from the life-saving appendectomy, might be appreciative of the fact that the principle of beneficence was allowed to prevail over the principle of autonomy.