Peter is a father and his son is very sick. Peter took his son to the doctor and found out that his son needs a very expensive surgery. Peter, not knowing what to do to save his son, decides to lie. Peter goes to a bank and asks for a personal loan intended to be for investing in a new business that would generate a lot of revenue.
According to Bentham, Peter did the right thing because, at the end, he saved a life. According to you, what have you done if lying would have been your only choice to save a life?
As we can see with this example, ethical dilemmas are not easy to solve. Ethics depend on a moral framework. We make decisions based on what we believe is right and what is best for us, but not necessarily for everyone else.
In some situations, we decide with our hearts, in other situations with our brains. Being human is part of the dilemma. When addressing this situation from an utilitarian approach to ethics, it is clear that this course of action would lead to a positive outcome.
Kant would suggest Peter lied because the theory states, we are morally obligated to act in accordance with a certain set of principles and rules regardless of outcome. In the final Peter acted in the best moral interest of his son but who is to say that is was not in accordance with set ethical values and not mere duty principle.
If there are two or more options to choose from, the one with the better or best outcome is the morally right choice to make. This lends utilitarianism an intrinsic sense of moral equality that was very controversial in the 18 th and 19th centuries when Jeremy Bentham and John Stuart Mill, both social reformers, popularized it.
Not all forms of consequentialism have this property; for instance, prioritarianism recommends placing more weight on the less advantaged in society so they receive more policy attention than utilitarianism would give them. One problem that many people find with utilitarianism — and consequentialism in general — is that it can recommend actions that seem to violate commonsense morality. At the same time, though, we tend to think that lying and cheating, regardless of the outcomes they might generate in specific cases, are simply wrong.
This is the kind of judgment that a deontologist would make. Deontology finds moral value in an act itself rather than the outcome it leads to. Deontology is usually expressed in rules, principles, or duties that proclaim certain acts to be moral or not. For example, most deontologists would regard lying and cheating to be wrong as a matter of principle, regardless of whether they led to better outcomes in select cases.
A version of utilitarianism known as rule utilitarianism also makes general judgments about actions, but based on their usual outcomes rather than the moral nature of the actions themselves. As with consequentialism, there are numerous varieties of deontology, but by far the most commonly cited is that of Immanuel Kant, who grounded his duty-based system of ethics in the autonomy and dignity of the person and the respect they demand from all persons as well as the government.
They are based on four fundamental principles, i. Much of the modern medical ethics deals with the moral dilemmas arising in the context of patient's autonomy and the fundamental principles of informed consent and confidentiality.
Ethical practice is a systematic approach toward the institution of these principles to approach an appropriate decision-making. While these definitions are clear to express, exceptions arise in each of these principles during clinical practice.
For example, when a doctor owes a duty to both patient and society, situations of breech in confidentiality may arise. Similarly, the practice of fundamental principles of autonomy and informed consent may be breeched in the care of newborn, mentally handicapped or patients in the permanent vegetative state. In practical ethics, two arms of thoughts exist in decision-making: Utilitarian and deontological.
In the utilitarian approach, decisions are chose based on the greatest amount of benefit obtained for the greatest number of individuals. This is also known as the consequentialist approach since the outcomes determine the morality of the intervention. This approach could lead to harm to some individuals while the net outcome is maximum benefit. This approach is usually guided by the calculated benefits or harms for an action or intervention based on evidence.
A few examples of utilitarian approach in medical care include setting a target by hospitals for resuscitation of premature newborns gestational age or treatment of burns patients degree of injury based on the availability of time and resources. There are two variants of utilitarianism: Act utilitarianism and rule utilitarianism.
Act utilitarianism deals with decisions undertaken for each individual case analyzing the benefits and harms promoting overall better consequences. This method would lead to enormous wastage of time and energy in decision-making and are prone to bias. In rule utilitarianism, no prediction or calculation of benefits or harms is performed. These decisions are guided by preformed rules based on evidence and hence provide better guidance than act utilitarianism in decision-making.
These ethical issues can be accommodated when dealing with patients who are competent to play a role in decision-making, while posing moral dilemmas in patients who are incompetent, e. In the above scenario, dilemmas can be dealt ethically and legally if the patients had made advance decision directives about their life similar to decisions on wealth.
In contrast to the utilitarian concept, deontology is ethics of duty where the morality of an action depends on the nature of the action, i.
This concept was introduced by a philosopher, Immanuel Kant and hence widely referred as Kantian deontology. The decisions of deontology may be appropriate for an individual but does not necessarily produce a good outcome for the society. The doctor-patient interaction or relationship is by nature, deontological since medical teaching practices inculcate this tradition, and when this deontological practice is breached, the context of medical negligence arises.
This tradition drives clinicians to do good to patients, strengthening the doctor-patient bond.
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