Friday, April 08, 2005

Should we be talking about ethics?

Is there such thing as right and wrong? This question is at the heart of philosophy and ethics. Ethics is just one of many branches of philosophy. The main branches of philosophy include: Metaphysics (the study of existence and reality), Epistemology (the study of knowledge and knowing), Ethics (the study of proper action), Politics (the study of proper force), Esthetics (the study of art), and Logic (the study of reasoning and argumentation). All branches of philosophy deal with the issue of right and wrong in different ways. Ethics is the formal study of moral standards and conduct. Ethics asks the questions: what is good? What is evil? How should I behave and why? How should I balance my needs against the needs of others? Ethics, like all branches of philosophy, assumes that right and wrong exits. However, it is the defining of right and wrong, good and bad which ethical philosophy focuses.

Is there such thing as right and wrong? This question is at the heart of philosophy and ethics. Ethics is just one of many branches of philosophy. The main branches of philosophy include: Metaphysics (the study of existence and reality), Epistemology (the study of knowledge and knowing), Ethics (the study of proper action), Politics (the study of proper force), Esthetics (the study of art), and Logic (the study of reasoning and argumentation). All branches of philosophy deal with the issue of right and wrong in different ways. Ethics is the formal study of moral standards and conduct. Ethics asks the questions: what is good? What is evil? How should I behave and why? How should I balance my needs against the needs of others? Ethics, like all branches of philosophy, assumes that right and wrong exits. However, it is the defining of right and wrong, good and bad which ethical philosophy focuses.

Ethics can be divided into metaethics and normative ethics. Metaethics is the investigation of the nature of ethical statements. It questions what does "good" and "right" mean, and how we know what is right. Normative ethics, on the other hand, attempts to arrive at practical moral standards that tell us right from wrong, and how to live moral lives. Normative ethics can be divided into the theory of conduct, which addresses standards of morality, or moral codes or rules and theory of value, which addressed how things are deemed to be valuable.

Most ethical arguments fall into several categories. Deontological arguments are based on generalizable statements, rules, or codes; such as, “thou shalt not kill.” A famous deontologic argument asks, “what if everyone did it?” Conversely, utilitarian arguments are outcome-based. This argument asks, “will the outcome of the decision produce the greatest good for the greatest number?” Utilitarian arguments are also referred to as being consequentialist. Other ethical theories include: communitarianism, which focuses on the interests and values of the community, and principle-based theories, which are not absolute or hierarchical. Principle-based theories are based on a set of guidelines where individual guidelines may assume a greater or lesser priority depending on the situation.

A famous example of a principle-based theory is the “Georgetown mantra” by Tom Beauchamp and James Childress (Principles of Biomedical Ethics), which establishes that the following principles of beneficence, non-maleficence, autonomy, and justice should be considered in all ethical decisions. Autonomy requires respect for people’s decisions and values. Beneficence addresses the need to help people. Non-maleficence recognizes the maxim to “first do no harm.” Justice requires that all like cases be treated alike; and benefits and burdens be distributed fairly.

So, why do we need to talk about ethics in medicine? The reason is because ethically difficult decisions arise in medicine everyday where it is not clear what is the best, or right thing to do. Inevitably, there will be differences of opinion, which can result in conflict. Sometimes that conflict cannot be resolved by those involves and requires mediation by a 3rd-party. Some highly publicized cases go to the state or federal courts to be decided. However, state or federal judges are not the best persons to make medical ethics determinations. The United States constitution expects that individuals and institutions regulate themselves. Therefore, hospitals have formed ethics committees to resolve issues as they arise. This way, those involved resolve the conflict and outside courts are not needed. “Self-government” is an ethical principle in which this country was established.

The teaching and discussion of ethics and ethical theories gives doctors tools they can use to recognize and analyze ethical issues as they arise. This approach also provides tools for physicians to use in their practice and prevent conflict over ethical issues. Therefore, we should continue to teach, discuss, and learn about ethical theory because from a deontological viewpoint, “it’s the right thing to do” while from a utilitarian argument, “it’s working.”

1 comment:

BRoz said...

Is there such thing as right and wrong? This question is at the heart of philosophy and ethics. Ethics is just one of many branches of philosophy. The main branches of philosophy include: Metaphysics (the study of existence and reality), Epistemology (the study of knowledge and knowing), Ethics (the study of proper action), Politics (the study of proper force), Esthetics (the study of art), and Logic (the study of reasoning and argumentation). All branches of philosophy deal with the issue of right and wrong in different ways. Ethics is the formal study of moral standards and conduct. Ethics asks the questions: what is good? What is evil? How should I behave and why? How should I balance my needs against the needs of others? Ethics, like all branches of philosophy, assumes that right and wrong exits. However, it is the defining of right and wrong, good and bad which ethical philosophy focuses.

Ethics can be divided into metaethics and normative ethics. Metaethics is the investigation of the nature of ethical statements. It questions what does "good" and "right" mean, and how we know what is right. Normative ethics, on the other hand, attempts to arrive at practical moral standards that tell us right from wrong, and how to live moral lives. Normative ethics can be divided into the theory of conduct, which addresses standards of morality, or moral codes or rules and theory of value, which addressed how things are deemed to be valuable.

Most ethical arguments fall into several categories. Deontological arguments are based on generalizable statements, rules, or codes; such as, “thou shalt not kill.” A famous deontologic argument asks, “what if everyone did it?” Conversely, utilitarian arguments are outcome-based. This argument asks, “will the outcome of the decision produce the greatest good for the greatest number?” Utilitarian arguments are also referred to as being consequentialist. Other ethical theories include: communitarianism, which focuses on the interests and values of the community, and principle-based theories, which are not absolute or hierarchical. Principle-based theories are based on a set of guidelines where individual guidelines may assume a greater or lesser priority depending on the situation.

A famous example of a principle-based theory is the “Georgetown mantra” by Tom Beauchamp and James Childress (Principles of Biomedical Ethics), which establishes that the following principles of beneficence, non-maleficence, autonomy, and justice should be considered in all ethical decisions. Autonomy requires respect for people’s decisions and values. Beneficence addresses the need to help people. Non-maleficence recognizes the maxim to “first do no harm.” Justice requires that all like cases be treated alike; and benefits and burdens be distributed fairly.

So, why do we need to talk about ethics in medicine? The reason is because ethically difficult decisions arise in medicine everyday where it is not clear what is the best, or right thing to do. Inevitably, there will be differences of opinion, which can result in conflict. Sometimes that conflict cannot be resolved by those involves and requires mediation by a 3rd-party. Some highly publicized cases go to the state or federal courts to be decided. However, state or federal judges are not the best persons to make medical ethics determinations. The United States constitution expects that individuals and institutions regulate themselves. Therefore, hospitals have formed ethics committees to resolve issues as they arise. This way, those involved resolve the conflict and outside courts are not needed. “Self-government” is an ethical principle in which this country was established.

The teaching and discussion of ethics and ethical theories gives doctors tools they can use to recognize and analyze ethical issues as they arise. This approach also provides tools for physicians to use in their practice and prevent conflict over ethical issues. Therefore, we should continue to teach, discuss, and learn about ethical theory because from a deontological viewpoint, “it’s the right thing to do” while from a utilitarian argument, “it’s working.”