Essential Medical Law Basic ethical theories

Fundamental medical law

Basic ethical theories

There are two main ethical theories: deontological- which is based on what is the right thing to do in any particular circumstances; and utilitarianism – which aims broadly to maximize happiness and evaluates an action on the consequences of that action:

1.      Deontological theory: ‘deon’ means duty and this approach determines whether an action is right by asking if there is a duty to do it or not, for example, a duty not to kill. These duties may arise also from the other person’s right, such as a ‘right to be informed’ or from the idea of ‘respect for persons’.

a) Concerned with actions not consequences

b )Moral value is decided by the goodness of an action

c) If something is wrong then it is always wrong
Kant's theory is based on duty

d) To act morally is to do your duty - your duty is to obey the moral law

e) We should not be distracted by feeling / inclination (not act out of love / compassion)

f) It is not our duty to do things we can't do
The fact that we ought to do something implies we should do it (I ought to = I can do...)

g) Kant's theory says moral statements are prescriptive (prescribe an action)
Humans seek an ultimate end - supreme good; summum bonum (where virtue and happiness are united) but immortality of the soul was essential to achieve this.

2.      Utilitarian theory

This judges an action by what its consequences are, with the aim of maximizing happiness( Bentham and Mill)

Right conduct was that which maximizes happiness or utility. Action could be evaluated ethically for the amount of benefit and detriment which it produced.

It does not take a stand on principle but simply looks at the consequences. For example, it would not consider abortion wrong in itself because it offends the principle of the ’sanctity of life’ , but would judge it on its overall effect on society.

A utilitarian approach will breach duties and violate rights if this maximizes the good.

Aggregate over individual

Act utilitarianism vs. Rule utilitarianism

1.     Act utilitarianism is the belief that an action becomes morally right when it produces the greatest good for the greatest number of people, while Rule utilitarianism is the belief that the moral correctness of an action depends on the correctness of the rules that allows it to achieve the greatest good.

2.     Act utilitarianism is the belief that it is alright to break a rule as long as it brings a greater good, while Rule utilitarianism is a belief that even if a rule cannot bring a greater good, breaking it will not either.

Basic ethical principles

1.      Principle of Autonomy (self-rule) and its wider meaning is to think and act freely. In a medical context, the doctor would be under a duty to respect the patient’s autonomy(Respect patients' decisions) as opposed to paternalism.

2.      Principle of beneficience (to do good) Medicine should be for the benefit of patients. Need not be curative, could be palliative. Consider the problems raised research, e.g. the experiments of the 'Nazi doctors'.

3.      Principle of non-maleficience(to do no harm) Correlative of beneficence. Note that its importance may depend on the state of medical knowledge, upon the usefulness of medical procedures.

4.      Principle of justice (to treat people fairly) Doctors distribute resources. How is this to be done fairly? Allocation according to merit, or age, or wealth, or race, or sex?

The traditional approach in medicine was based on the principle of beneficience, in that doctors saw their role as helping patients. All too often, this became ‘doctor knows best’ and many doctors took a paternalistic approach to their patients. Over the last 30 years, patient’s rights have grown more important and the principle of autonomy has come to the fore.

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