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Medical Ethics Lecture 6:

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Hayley Webster

on 2 July 2017

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Transcript of Medical Ethics Lecture 6:

Medical Ethics:
Religion, Utilitarianism, Kantian Ethics.

Religious moral theory
The theory that morality depends on, or comes from, religion.
Most common religious moral theory =
divine command theory.
Right actions = commanded by God.
Wrong actions = forbidden by God.
God decides what is moral and immoral.
The Euthyphro Dilemma
Horn 1: Actions are right or wrong because God
says so. God creates
the moral law.
(Divine command
Horn 2: God commands certain actions
they are right.
In this case, morality is independent of God. He doesn't decide what it is, and is subject to it.
Horn 1: God decides what is good or bad (DCT is true)
Problem: moral law is entirely arbitrary.
Case 1: God decides that stealing is wrong. Stealing thus becomes wrong because God has said so.
Case 2: God decides that murder is morally permissible. Murder thus becomes permissible because God says so.
Critics say that God would never decide that murder was permissible because God is all good.
But according to DCT there is no independent notion of 'good' outside what God commands. Good just = whatever God decides. So to say 'God is good' just translates to 'God commands whatever he commands!'
Horn 2: Goodness and badness are independent of God.
DCT is false, and we don't actually need God for morality.
The moral law is independent of both God and humans, and both God and humans are subject to it. God, just like us, is capable of doing wrong.
God is good = God never does wrong. He follows the law perfectly.
Right action moral theories
The morality of an action depends entirely on the consequences.
Intentions are irrelevant
Murder is wrong because it leads to bad consequences
Morality of an action depends on intentions and on the nature of the action itself.
Consequences are irrelevant.
Murder is wrong because it is an inherently wrong action.

Rule utilitarianism
Kantian ethics
Right actions are those that produce the most
for the greatest number. Wrong actions are those that produce the most unhappiness for the greatest number.
If we max happiness we are doing the right thing. If we fail to max happiness we have done the wrong thing.
Impartial - everyone is treated equally. No one's happiness is worth more than anyone else.
Actions are only instrumentally wrong, not intrinsically wrong.
Intentions are never wrong - intentions are only 'bad' in the sense that they lead to bad outcomes.
We should always try to maximise happiness.
History of utilitarianism
Jeremy Bentham: 1748-1832
Good = pleasure/happiness.
Bad = pain, unhappiness.

Hedonic utilitarianism.

History of utilitarianism
John Stewart Mill: 1806-1873
Criticised Bentham in two important ways:
1: Bentham saw no distinction between pleasures. Mill saw a distinction between high and low pleasures.
2: Bentham saw no distinction between animal and human pleasure/pain. Mill thought human pleasure/pain was more important.
Act utilitarianism
Rightness of actions depends on amount of good produced by
individual actions.
An action is good if it produces more happiness than unhappiness.

Rule utilitarianism
A right action is one that conforms to a rule that, if followed consistently by everyone, would create a balance of good over bad. Note - an individual act may be required by a rule, but may produce bad effects in a particular situation.
Q: Think of a case/example from medical ethics. What would an act utilitarian say about the case? What would a rule utilitarian say about the case?
Problem 1: Measurement problem
Just how do we add up happiness? What is the calculation? And how are we supposed to do this for each moral dilemma we face?!
Problem 2: Prediction problem
How can we predict in advance which actions will produce the most good? What if an action we think will produce the most good turns out to be disastrous?
Problem 3: Very demanding
Utilitarianism seems to make impossible demands of us (why?)
Response - morality requires sacrifice!
Problem 4: Impartiality immoral?
Bernard Williams - the 'one thought too many' objection.It
seems really
bad to save a stranger before your loved ones
Problem 5: No intrinsic goodness/badness
Torture, child murder, etc, is not intrinsically wrong. They are only wrong because they have bad consequences. If they had good consequences then they would be permissible.
Problem 6: Justice problem
Example of the mob versus homeless man. If you could jail one homeless guy to stop a rampaging mob...it seems you should to it according to utilitarianism. But this is totally unjust.
Kantian Ethics
Deontological theory. "For Kant, the core of morality consists in following a rational and universally applicable moral rule and doing so purely out of a sense of duty. An action is right only if it conforms to such a rule and is praiseworthy only if we perform it for duty's sake alone."
Something that applies without exception. You MUST do it.
A command, an order.
Categorical Imperative
A command that applies without exception. You have a duty to do it - you must do it.
Moral theories: recap
A moral theory explains what it is about an action that makes it right/wrong.
Relevance of moral theories
1) Every moral argument must contain at least one moral premise. This premise needs to be backed up by a moral theory.
2) Moral principles that we appeal to all the time may derive from or be supported by a particular moral theory.
Moral theory and med ethics
Moral theories are general theories. They are meant to apply in all situations. Med ethics deals with particular cases. Very often we need to supplement our theory with particular details about a case, and see just how the theory operates in these specific contexts.
THE categorical imperative
Kant thinks that all of morality rests on what he calls THE categorical imperative - a command that must be followed no matter what. It is expressed in two different ways, which Kant thinks are equivalent (although some debate about this.)
THE categorical imperative
Act in such a way that your action could be willed to be a universal law.
Always treat people as ends in themselves, not
as means.
Could lying be a universal law? In other words, could everone in the world lie? If we can imagine a world where everyone lied, that is still consistent, then lying is permissible.
But if everyone lied society would break down. Lying is thus impermissible.
Murder? Suicide? Stealing?
Kant believed that humans have intrinsic humanity which deserves automatic respect. We have innate moral worth because we are free and rational beings.
According to Kant, we treat people as means (tools) when we restrict their freedom and undermine their rationality. Can you think of an example from medical ethics in which people's freedom is restricted? Which undermines their rationality?
Problem 1: hard case - hiding from the Nazis
You are hiding a Jewish family from the Nazis. The Nazis come to your door and ask you if you are hiding Jews. What would you say?
What would Kant say?
Problem 2: hard case - painful death
An old man with a terminal illness is suffering a very painful death. He want to take a drug so he can die painlessly. If he doesn't take the drug he will live a miserable existence for a few more weeks. Is it wrong for him to take the drug?
What would Kant say?
Problem 3: reason doesn't necessarily motivate us.
For Kant, if you rationally realise what is right then you will be spurred to do that action no matter what. Just the rational realisation of the right thing to do is enough to make you do it.
But Hume argued that this seems odd. Hume says you could imagine a case where someone rationally knows the right think to do but still chooses not to do it - one could be apathetic. In this case, Kant is wrong. Reason does not force us to do the right thing. We could recognise what is right but choose to do wrong.
Problem 4: The clashing duties
Kant thinks that anything which can be universalised according to the categorical imperative is an absolute moral duty - we have to do it no matter what.
The problem is we can think of cases where we have two equally compelling duties and they clash - example?
Kant thinks that both duties are absolute - so we should do both! But we can't. He gives us no way to choose between them.
Problem 5: only applies to rational agents
Utilitarianism applies to any creature capable of feeling happiness or pain.
Kantian ethics only applies to creatures who are rational. Who does this exclude from morality?
Animals, babies, patients in vegetative state, people in comas, demented people, disabled people, mentally ill people - Kant even thought women were irrational!
Problem 6: Good motives, bad outcomes
Imagine a really unlucky guy who has really good motives but who messes up everytime. Everytime he tries to do good the worst possible thing happens. One day he tries to donate to charity but ends up starting WW3.
What would a utilitarian say about his actions?
What would Kant say about this guy and his actions?
You can still see Bentham's
preserved body at University College London! Here I am looking weirdly happy to be next to him.
Full transcript