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An Introduction to Health Ethics

What is Ethics?

Ethics is the study of how human beings treat each other and the natural environment; it is
the systematic examination of the attitudes and behaviours of people. Ethics is about
carefully studying the values that actually do guide our attitudes and behaviours in given
contexts, and it is about exploring what values ought to guide our attitudes and behaviours.
No matter what our social, cultural, economic or professional backgrounds are, we are all in
the business of practicing ethics on a daily basis. We have certain values (things we think are
important for their own sake) and beliefs (views about the nature of existence and the way
we understand the world to be). For example, many of us think individuals should not be
penalized for wrongs that are not of their doing. This suggests that justice or fairness is
important to us. Many of us also feel that we should help those less fortunate in our society.
This may suggest a belief that human beings are interconnected and that we hold values such
as charity and generosity.

What is Health Ethics?

Health ethics is the branch of ethics that deals with ethical issues in health, health care,
medicine and science. It involves discussions about treatment choices and care options that
individuals, families, and health care providers must face. It requires a critical reflection upon
the relationships between health care professionals and those they serve, as well as the
programmes, systems, and structures developed to improve the health of a population.
Health ethics involves deliberating about the allocation of resources, and reflecting on the
complex moral choices arising from ongoing health care restructuring and advancing
technology. It also entails a critical, political, and ethical analysis of the definition and the
determinants of health.

A few specific examples of health ethics issues include:

– Making decisions about end-of-life care
– Determining whether to allocate funds to the treatment of disease or the promotion of
health
– Critically examining the discrepancies in health status between populations and our
ethical obligations to ensure equitable access to health services
– Ensuring ethical conduct in health research
– Deliberating upon the ethical implications of genetic cloning technology

Types of Ethics

Descriptive Ethics

The aim of descriptive ethics is to depict and clarify moral opinions and practices, and to
explicitly articulate the concepts and assumptions implicit in these. For example, “What does
group X think about the morality of abortion?” is a question of descriptive ethics.

Normative Ethics

Normative ethics concerns making moral judgments about what is right and wrong, good
and bad etc. It also involves developing action guides to direct ethical behaviour. For
example, “Is aborting a fetus ethically justifiable?” is a normative question.

Meta-Ethics

The discussion here is not about what particular people think ethics is or what ought or
ought not to be considered ethical. Rather, meta-ethics involves analyses of the language,
concepts, and methods of reasoning in health care. For example, “What does ‘ethically
justifiable’ mean?” is a meta-ethical question.

Some Theoretical Concepts in Ethics

Consequentialism

According to consequentialism, the right course of action is determined by examining the
consequences or outcome of an action and selecting the one that produces the greatest good.
Thus, no action is in itself right or wrong – it is the action’s consequences that determine
whether it is right or wrong. One consequentialist theory is utilitarianism, which defines the
greatest good as happiness. Using a utilitarian approach to an ethical dilemma, one would
choose the course of action that will produce the greatest happiness for the greatest number
of people. Critics of utilitarianism highlight the difficulty of measuring happiness and
accurately predicting the consequences of one’s actions. They also point out that one could
potentially sacrifice the happiness of the minority for the happiness of the majority.

Deontology

According deontology, or duty-based ethics, the right course of action is that which is
consistent with one’s moral duties. According to Immanuel Kant, the theory’s most well
known proponent, one of these duties is to never use another person as a means to one’s
own ends. Additionally, before making a decision, one should think about whether it would
be reasonable for everyone to act in the proposed way. If it is indeed reasonable to
“universalize” a course of action, then one can deem that act to be ethical. According to
deontology then, an action itself has features that are distinct from the action’s
consequences, and that make the action right. One critique of Kant’s deontology is its
rigidity in abiding by these rules despite the potential consequences of one’s actions.

Virtue Ethics

Unlike consequentialism and deontology, virtue ethics does not focus on rules, consequences
or principles to determine ethical behaviour. Instead, the emphasis is on one’s character and
what kind of person one ought to be, which are defined by our traditions and communities.
Critics of virtue ethics question the emphasis on tradition and community, given that our
world consists of a mosaic of cultures and ethnicities. That is, it is problematic to achieve a
common morality derived from so many traditions and communities. Additionally, critics
sometimes argue that virtue ethics does not provide sufficient guidance on how to act in
difficult situations.

Relational Ethics

Relational ethics understands the individual not as autonomous and independent, but as a
relational, interdependent being, and emphasizes relationships as integral to human existence
and consciousness. Nel Noddings’ defines “ethical caring” not in terms of one person
naturally caring for another, but one person caring for another because they believe it is the
right thing to do. Noddings “care ethics” rejects the need for universal principles for
behaviour, arguing that a care decision must be made in the context of the particular
relationship. Although relational ethics is recognized as a feminist ethics, some have
criticized it for reinforcing traditional stereotypes of women as caregivers. Others have
argued that relational ethics is too ambiguous and contextual and doesn’t offer concrete
guidance for ethical action.

Principlism

Much of contemporary Western bioethics is founded upon or makes reference to four
principles outlined by Tom Beauchamp and James Childress in Principles of Biomedical Ethics2.
These principles are rooted in a combination of consequentialism and deontology, and
assume that humans have some basic moral beliefs that can provide a good starting point for
ethical guidance. From these basic beliefs, Beauchamp and Childress have outlined four
principles to guide behaviour:

Respect for Autonomy

Respect for Autonomy is based on self-determination and the right of individuals to make
independent and informed decisions concerning their life, well-being and best interest.
Within the context of autonomy arise issues such as privacy, confidentiality and informed
consent.

Beneficence

Beneficence, or doing good, involves promoting another’s welfare, acting in an
individual’s best interest and in a manner which benefits others.

Non-maleficence

Non-maleficence requires one to do no harm and to protect others from harm. This also
includes the duty to maintain professional competence and to be aware of the isolation
and powerlessness of others.

Distributive Justice

The principle of justice entails that all persons in society are of equal moral worth, thus
should be treated with fairness or equally under similar circumstances.