Principles to apply to OCR Ethical Issues

You have studied two types of ethical systems.  Relativist systems, which can also be called teleological, and absolutist systems, also called deontological. Virtue ethics is not like either of these.  Virtue Ethics is a way of maximising human happiness by defining the qualities (virtues) you need in order to BE happy, and by suggesting ways to achieve those virtues.

Relativist ethical systems do not attempt to consider whether acts are intrinsically right or wrong.  Instead they attempt to predict the outcome of a particular course of action in a particular set of circumstances.  If that outcome is a 'good' as measured by the ethical system, then the action is a morally right one.  Such systems of ethics can also be called teleological.  Examples of relativist ethical systems include Act and Rule Utilitarianism and Situation Ethics.  

Absolutist, deontological systems of ethics which attempt to identify whether actions are intrinsically right or wrong regardless of their outcome or the circumstances in which the acts were carried out.  They use both religious and non-religious criteria in order to do this.  Examples you have studied are Natural Law and the Categorical Imperative.

Christian (Religious) Principles

You may comment upon any of the 3 approaches we have covered when asked by the question to consider a religious approach to medical ethics.  

1. Roman Catholic  This is absolutist and deontological    The principle of the Sanctity of Human life and the primary duty of humans to follow God's instructions underpin the Roman Catholic approach to any ethical issues.  A Catholic would ask "What does the Church teach about this action?"  The Church claims for itself ultimate authority in moral matters, based upon the Scriptures, the traditions of the Church and the Guidance of the Holy Spirit.  The Roman Catholic approach to medical issues largely depends on Natural Law (see below).
2. Liberal Protestant approach  This is teleological and relativist.  As a rule, it follows Augustine's (and Joseph Fletcher's Situation Ethics) approach - a right action is one that achieves the most loving outcome for all concerned.  A situation Ethicist would ask the questions "What action would result in the greatest expression of self-giving love for all concerned in this situation?"  No action is ruled out automatically.  Fletcher specifically rejects a set of a priori rules to govern behaviour.  He does, however, say that actions must be in keeping with Jesus' command to 'Love your neighbour as yourself'.  For example, he felt that some sexual relationships outside marriage were morally correct because they expressed self-giving love for the partner.  He contrasted this with some marriages where there was no love between the partners, and therefore sex could not be the instrument for conveying love between them.
3. Evangelical Protestant Approach  This is absolutist and deontological.  An Evangelical would asks "Does God permit or forbid this action?  What does the Bible say on the matter?"   Sanctity of Human Life, ensoulment and personhood at conception and intrinsic dignity of human life characterises this approach.  Obedience to God is the highest duty, and they would also argue that following God's commands will bring its own reward, and that following God's commands will ultimately bring the greatest benefit to those who are prepared to follow them.  

   They would also want to emphasise the need to  support people who find themselves at the 'sharp end' of medical ethics issues, and so organisations such as SPUC, CARE etc would offer support to, say, women facing unwanted pregnancies.

Utilitarian Principles

Utilitarianism is a teleological and relativist system of ethics.  It is secular in principle but Christians do employ it.  Here, we must distinguish between Act Utility and Rule Utility.

1. Act Utility invites people to use the Hedonic Calculus to work out how the greatest pleasure and least pain can be achieved in any given situation. The act which achieves this is morally right.   An Act Utilitarian would ask "Which action is going to result in the greatest happiness and least pain for the most people?"  You should demonstrate how the Hedonic Calculus could be used, say, by a couple deciding whether to embark upon fertility treatment, or a family deciding whether to switch a life support system off.  The existence of God is irrelevant to this system.  Peter Singer argues for Preference Utility in such situations.  Preference Utility says that as much choice as possible should be given to people within the law.  "Good consists in the satisfaction of people's preferences and the rightness of an action depends upon depends directly or indirectly on its being productive of such satisfaction." The Penguin Dictionary of Philosophy
2. Rule Utility invites society to put in place rules which, if followed, should bring the greatest happiness and least pain to society and the individuals who make up society.  A Rule Utilitarian would ask "What rules would bring the greatest happiness and least pain to people if they were followed by everyone?"   Laws are often formulated using this principle.  Such laws can be changed if new information calls into question the pain/pleasure balance utilitarianism requires.  For example, until recently it was against the law to experiment or do research upon human foetuses.  However, within the past 2 years, law makers have decided that the happiness and welfare of society will be forwarded by permitting limited research on embryos up to 15 days' of gestation. The law has been changed.  Similarly, the legal limit for abortion for social reasons has recently been lowered from 28 weeks' gestation as in the 1967 Act to 24 weeks.

   Rule Utility does not contemplate any duty to God, although Mill believed that Rule Utility embodied within itself the Golden Rule of Jesus "Love your neighbour as yourself."

Natural Law

1. This is absolutist and deontological system underpinning Roman Catholic teaching on Medical Ethics issues.  The key principles from this system which apply to medical issues are protection of the innocent, and the preservation of human life. Someone applying Natural Law to a situation would ask "Does this action uphold or go against the Primary precepts?  Are there any secondary precepts which apply to this action?"  If the action upholds the Primary precepts then it is morally right.  If it does not, then it must be morally wrong.

The Roman Catholic Church applies these principles to human life from the moment of conception. This means that any act which results in the deliberate and intended destruction of human life is intrinsically sinful. A word here about the principle of double effect.

Double effect is the expression used when an intrinsically good action causes another intrinsically bad action as an unwanted effect.  This applies especially to termination of a pregnancy.  The Roman Catholic Church forbids the termination of a pregnancy as a precaution to secure the health of a mother.  For example, a woman has had a stroke.  She has been advised by doctors that a pregnancy would endanger her life.  She becomes pregnant by accident.  The Roman Catholic Church would not agree that a termination was acceptable in those circumstances.  An innocent life cannot be destroyed to protect the mother's life.  Instead, every medical care should be taken to protect both the child and the mother's life.  

However suppose it was discovered that a pregnant woman has cancer of the uterus which requires immediate treatment if her life is to be preserved, and life-saving treatment would kill the unborn baby.  In this case, the duty of the woman to have treatment which would save her life necessarily means that the pregnancy will be terminated.  The foetus cannot survive the chemotherapy or the possible removal of the cancerous uterus.  The woman has a duty to preserve her life, as refusing treatment is tantamount to suicide - also a sin.  Therefore the intrinsically good act of attempting to preserve the mother's life by the only methods possible have an unwanted effect - the termination of the pregnancy.  In this, and only in this case is the termination of the pregnancy acceptable for it is an unwanted double effect of the treatment.

Bear in mind that Aquinas did not believe that the ensoulment of a foetus happened at conception.  That is later Catholic teaching, 1869 I think.  Aquinas believed that ensoulment happened at 40 days' gestation in the case of a male foetus and 90 days in the case of a female foetus.  This is not to say that he would have approved of abortion, embryo research etc.  However, at least one commentator that I have read on the subject recently has argued that accepting Aquinas' teaching would permit research on embryos ..

Furthermore, teleological principles are applied in the case of contraception and homosexuality.  As using contraception actively prevents pregnancy, and homosexual sex cannot, by its nature, result in conception, then the natural purpose (telos) of sex, ie conception, cannot take place. Therefore the Catholic Church says that such acts are intrinsically sinful.

Virtue Ethics - how can they be applied to ethical issues?

Virtue Ethics is about becoming a virtuous person - a person with the moral qualities required to do good things and make good decisions.  Virtue Ethics does not attempt to prescribe a series of rules or even principles to apply to ethical dilemmas.  At first this might appear to mean that Virtue Ethics could give no help to someone faced with a crisis or even a difficult decision to make.  And indeed, when deciding whether to jump into a raging flood in order to save a small child or to run and get help, it would be hard to decide whether prudence or courage would be the most important virtue to pursue when deciding what to do.  Turning to Virtue Ethics in a crisis might not help your decision.  However, this would be to miss some important points.

Firstly, practising virtue should PREPARE a person to make wise decisions.  As Virtue Ethics encourages people to look at any situation within a wider context in order to assess the virtues inherent within it.  Which virtues would be relevant?  Courage? fortitude? Prudence?

Secondly decisions must be made in the light of the way in which they will develop/demonstrate the virtues to which people aspire.  In theory, this should mean that decisions should avoid the extremes of excess and deficiency, eg, selfishness, cowardice.  This should mean that the decisions are at least justifiable morally in terms of developing virtues and doing good things.

Finally, decisions cannot be taken in isolation from the wider effects that they may have.  A virtuous person would need to consider the effects that their various options would have on their own life and those of others.

Tip from the Webmistress

Comments upon the recent deaths of Terri Schiavo and Pope John Paul II characterise many of the approached to medical and bio-medical ethics demanded by this course.  Zip round the internet looking for websites and articles discussing the issues raised by the manner in which these two people died, and see which principles you can identify.

Return to Ethics Base Page