Moral Principles in Health Care
The Five Principles Approach to Medical Ethics:
Moral Theories – are put forward as a complete description and explanation of right and
wrong, mean to hold always, and can never be overridden.
Moral Principles – are less comprehensive than moral theories; they are relevant
considerations in a broad range of situations but might be overridden by some other
principle or value
Moral Rules – even narrower than principles, e.g. “tell the truth”, “keep your promises”
Ross and the Five Principles Approach:
Note the similarity between the five principles approach to ethics in health care and
Both approaches reject the idea that there is a single, underlying characteristic or property
that all right acts share (that makes them right) and a single property that all wrong acts
share (that makes them wrong)
This position is referred to as “pluralism” in ethics
Concerns the extent to which a person has control over his or her life and actions
Why is autonomy good, or valuable, or important?
What exactly is autonomy?
What’s so great about autonomy?
Instrumental value – the utilitarian perspective
Each person better able to know, and control, her own happiness
People derive satisfaction from controlling their lives
Individuality leads to new ideas, knowledge, etc, which benefits humanity
Intrinsic value – the Kantian perspective
the ability to act autonomously is good in itself, autonomy is “what makes us
Those character traits we regard as virtues presuppose autonomy, example,
courage, generosity, loyalty, morality itself A third view
Human Rights. Regardless of the value or importance of autonomy, each person
has the right to control his or her own life.
What is it to be autonomous?
The Negative Concept of Freedom:
Some philosophers define freedom as the “absence of external constraints”
Roughly, external constraints intervene between our desires and our actions so as to
prevent us from doing what we want.
Meaning, if there are no external constraints on you, you are perfectly free
The case of the drug addict:
He wants to be free of drugs b/c they are ruining his life, but his physical
addiction is so powerful that he is unable to stop taking them
Is the drug addict autonomous? The negative concept of freedom seems to imply
that he is
The idea of internal constraints?
The negative concept overlooks free will:
We have a decisionmaking faculty – the will
External constraints do not affect the freedom of a person’s will. They just prevent
us from doing what we freely decide to do
But sometimes a person’s decisionmaking faculty is not under his/her control –
here internal constraints undermine or destroy the freedom of her will
The Double Decker (Hierarchical) Theory:
“Autonomy is a secondorder capacity to reflect critically upon one’s firstorder
preferences and desires, and the ability to either identify with these or to change
them in light of higherorder preferences and values. By exercising such a
capacity we define our nature, give meaning and coherence to our lives, and take
responsibility for the kind of person we are.”
Gerald Dworkin, “Autonomy and Informed Consent”
1 order desires – ordinary desires for things in the world
2 order desires – are desires that are in some way about other desires
So, autonomy requires:
1) Having higher order desires/preferences
2) Having the ability to evaluate your firstorder desires, and resist t