“How long should health care workers have to be with patients who may not survive?”

What are key features of consequentialist theories?
August 1, 2019
Theories about the nature of moral judgments.
August 1, 2019

“How long should health care workers have to be with patients who may not survive?”

Module 3. Consequentialism Otherwise known as Utilitarianism Ethics unwrapped videos Stanford, Encycloiedia of Philosophy Consequentialism It is common for us to determine our moral responsibility by weighing the consequences of our actions. This seems on the surface, easiest and fairest. Is it? According to consequentialism, correct moral conduct is determined solely by a cost-benefit analysis of an action’s consequences: Consequentialism: An action is morally right if the consequences of that action are more favorable than unfavorable. Consequentialist normative principles require that 1) we first tally both the good and bad consequences of an action. 2) we then determine whether the total good outweigh the total bad consequences. Consequentialist theories are sometimes called teleological theories, from the Greek word telos, or end, since the end result of the action is the sole determining factor of its morality. Every ethical evaluation is a process of analyzing three different aspects of a scene, situation or decision Agent Consequences Action For practice, think of some examples in daily life: 1 2 3 4 5 6 7 8 ● Consequentialist theories became popular in the 18th century by philosophers who wanted a quick way to morally assess an action by appealing to experience (John Locke), rather than by appealing to gut intuitions or long lists of questionable duties (Kant). ● the most attractive feature of consequentialism is that it appeals to publicly observable consequences of actions. Most versions of consequentialism are more precisely formulated than the general principle above. Importantly, this kind of thinking represented a break from the “God / King / Church told me” Ethics (Deontological Ethics) ● Three common consequentialist theories of ethics ● Ethical Egoism: an action is morally right if the consequences of that action are more favorable than unfavorable only to the agent performing the action. ● Ethical Altruism: an action is morally right if the consequences of that action are more favorable than unfavorable to everyone except the agent. ● Utilitarianism: an action is morally right if the consequences of that action are more favorable than unfavorable to everyone — which, actually, no decision can completely guarantee Consider the following example. A woman was traveling through a developing country when she witnessed a car in front of her run off the road and roll over several times. She asked the hired driver to pull over to assist, but, to her surprise, the driver accelerated nervously past the scene. A few miles down the road the driver explained that in his country if someone assists an accident victim, then the police often hold the assisting person responsible for the accident itself. If the victim dies, then the assisting person could be held responsible for the death. The driver continued explaining that road accident victims are therefore usually left unattended and often die from exposure to the country’s harsh desert conditions. ● On the principle of ethical egoism, the woman in this illustration would only be concerned with the consequences of her attempted assistance as she would be affected. Clearly, the decision to drive on would be the morally proper choice. ● On the principle of ethical altruism, she would be concerned only with the consequences of her action as others are affected, particularly the accident victim. Tallying only those consequences reveals that assisting the victim would be the morally correct choice, irrespective of the negative consequences that result for her. ● On the principle of utilitarianism, she must consider the consequences for both herself and the victim. The outcome here is less clear, and the woman would need to precisely calculate the overall benefit versus disbenefit of her action. ● But suppose it became evident that TWO persons were in the car i. Two Types of Utilitarianism Act-utilitarianism: Certain acts in themselves are moral Rule-utilitarianism: A group of persons decides See Jeremy Bentham, next slide Jeremy Bentham 1747 -1832 Jeremy Bentham presented one of the earliest fully developed systems of utilitarianism. Two features of his theory are noteworthy. ● First, Bentham proposed that we tally the consequences of each action we perform and thereby determine on a case by case basis whether an action is morally right or wrong. This aspect of Bentham’s theory is known as act-utilitarianism. ● Second, Bentham also proposed that we tally the pleasure and pain which results from our actions. For Bentham, pleasure and pain are the only consequences that matter in determining whether our conduct is moral. This aspect of Bentham’s theory is known as hedonistic utilitarianism. Critics point out limitations in both of these aspects. Act Utilitarianism ● First, according to act-utilitarianism, it would be morally wrong to waste time on leisure activities such as watching television, since our time could be spent in ways that produced a greater social benefit, such as charity work. But prohibiting leisure activities doesn’t seem reasonable. ● More significantly, according to act-utilitarianism, specific acts of torture or slavery would be morally permissible if the social benefit of these actions outweighed the disbenefit. A revised version of utilitarianism called rule-utilitarianism addresses these problems. ● According to rule-utilitarianism, a behavioral code or rule is morally right if the consequences of adopting that rule are more favorable than unfavorable to as many as possible. Unlike act utilitarianism, which weighs the consequences of each particular action, rule-utilitarianism offers a litmus test only for the morality of moral rules, such as “stealing is wrong.” Adopting a rule against theft clearly has more favorable consequences than unfavorable consequences for everyone. The same is true for moral rules against lying or murdering. ● Rule-utilitarianism, then, offers a two-tiered method for judging conduct. 1. A particular action, such as stealing my neighbor’s car, is judged wrong since it violates a moral rule against theft. 2. In turn, the rule against theft is morally binding because adopting this rule produces favorable consequences for everyone. John Stuart Mill’s version of utilitarianism is rule-oriented. John Stuart Mill John Stuart Mill’s Utilitarianism endeavours to raise the Utilitarian ideal to a higher plane than that of the undisguised selfishness upon which Bentham rested it. As the foundation of his structure Mill asserts that every person necessarily acts in order to obtain his own happiness; but finding this ground logically insufficient to furnish a basis for an adequate criterion of conduct, and prompted by his own large sympathies, he quickly endeavours to substitute “the happiness of all concerned” for “the agent’s own happiness”. The argument over which he endeavours to pass from the first to the second position, may serve as an example. The argument, in brief, is that, as each one desires and pursues his own happiness, and the sum total of these individual ends makes up the general happiness, it follows that the general happiness is the one thing desirable by all and provides the Utilitarian standard of what is right in conduct. Utilitarianism isn’t as fair as it first seems? A utilitarian calculation is satisfied if there is greater overall gain of utility. Someone always loses. Therefore, if the vast majority of people are happy, even at the expense of a small minority, the conditions are satisfied and it is classified as an ethically sound situation. This means that certain minority groups whose interests clash continually with the majority will always be at a disadvantage in a utilitarian calculation. This is unfair to people who are outcasts or who don’t agree with society’s norms but haven’t done anything to justify not being counted as people. A Review: Utilitarian theories The end results or purpose determine whether a given course of action is right or wrong. An act is moral if it brings more good consequences than bad. The greatest good for the greatest number determines whether an action is right or wrong. Two forms of utilitarianism: 1. The only thing intrinsically good is pleasure; the only thing intrinsically bad is pain. 2. Morality requires the maximization of net good. Deontological Theories (in Module 3) Moral standards exist independent of the end results. Ethics come from a binding obligation or duty (deon) to do right. Ethics: an increase in Clear thinking The ability to weigh the evidence and the sets of competing needs and feelings as objectively as possible — to sort out wishes and desires from the facts. II. Social Contract Theory ● Thomas Hobbes ( 1588 – 1679) was an advocate of psychological egoism—the view that all of our actions are selfishly motivated. Upon that foundation, Hobbes developed a normative theory known as social contract theory, which is a type of rule-utilitarianisn. ● According to Hobbes, for purely selfish reasons, the agent is better off living in a world with moral rules than one without moral rules. For without moral rules, we are subject to the whims of other people’s selfish interests. Our property, our families, and even our lives are at continual risk. Selfishness alone will therefore motivate each agent to adopt a basic set of rules which will allow for a civilized community. ● Not surprisingly, these rules would include prohibitions against lying, stealing and killing. However, these rules will ensure safety for each agent only if the rules are enforced. As selfish creatures, each of us would plunder our neighbors’ property once their guards were down. Each agent would then be at risk from his neighbor. Therefore, for selfish reasons alone, we devise a means of enforcing these rules: we create a policing agency which punishes us if we violate rules. This we call the State — a form of Civil Social Contract III. Road-trip: What about other people’s ethics? Cultural relativism ● ● Moralities follow cultural lines. Each person’s culture supplies the standards that determine what that person should do, and these differ fundamentally across cultures. So, to sort out a standard, we need to answer the following questions: ● Do different cultures have different moral codes? ● Are differences in apparent moral codes simply different applications of a similar moral code applied in different circumstances? ● If something is true, it does not mean everyone knows it. Problems with being a “relativist” 1. If cultural relativism is true, we could not say that customs of other cultures are morally inferior (e.g. Nazi practices). All practices would be immune from criticism. 2. We could justify actions simply because they are the norm of the culture. 3. We could not criticize our own culture or progress ethically or culturally. So then, the difference among cultures is belief system, not our values. Values are only one thing that helps dictate what is practiced culturally. Values are universal (e.g. value infants, truth-telling & not murdering). Thus: 1. We must be careful to not assume all our preferences are based on some absolute rational standard; 2. We must realize that our feelings are not necessarily perceptions of truth. So, for a cultural relativist, how do we know what is the right thing to do? We could invoke Ethical Absolutism: There is a single Truth. My position embodies that truth. Ethical absolutism gets some things right and We need to make judgments (at least sometimes) But it gets some things wrong, including: Our truth is the truth We can’t learn from others Or we could adopt Ethical Relativism: No single moral framework can be used to settle disputes within nations and across the world. No set of moral standards is universally binding. Ethical relativism has several important insights: The need for tolerance and understanding. The fact of moral diversity: We should not pass judgment on practices in other cultures when we don’t understand them. Sometimes reasonable people may differ on what’s morally acceptable. Some Cases: Lying to be nice: You be the judge Mark is an upperclass male college student at a large university. He is a double major in Psychology and Political Science, is involved with on-campus Associated Student Government, and works two jobs in order to pay for college and essentials like food. Mark is very focused on his education and career growth at this stage in his life and in the rare free moments he has, he enjoys spending time with his housemates who are his best friends. He isn’t against dating, but he knows that relationships take time and money and is not sure he has the availability or funds for a girlfriend. That being said, he has told his roommates several times that if he finds the right girl, he will make time for her and will budget his earnings accordingly. Joe, Mark’s roommate, has been trying to set up his friend with a girl for a long time. Joe is under the impression that Mark needs someone to help him enjoy the moment and not just focus on the future. Joe sets Mark up with his girlfriend’s best friend, Laura. He tells Mark to just go to coffee with the girl and see if they mesh. Mark agrees to go to coffee with Laura. At coffee, Mark struggles to find anything in common with Laura. He thinks she is a nice girl, but he also doesn’t feel that she is someone he wants to date. Her interests and hobbies are very different from Mark, and it even seems like her values are different at times during his talk. Mark enjoys the conversation with her, but he decides he doesn’t want to pursue anything after the coffee. When leaving the coffee shop, Laura tells Mark she had a good time and would like to get to know him even better. She gives Mark her phone number and asks him if he will call her later. Mark knows he isn’t going to call Laura. He has no interest pursuing her for a relationship and is already so strapped for time. However, he tells her he will call her because he thinks it is better to be nice than to tell her the truth. Did Mark do the right thing? Was lying to Laura that he’d call her the nice thing to do? Is it just to withhold the truth from someone, even if you think it’s for his or her betterment? This week’s Case: NYT: “The Deadly Choices at Memorial” “nearly a year after Katrina, Louisiana Department of Justice agents arrested the doctor and the nurses in connection with the deaths of four patients. The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view. In her advocacy, Dr. Pou argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina. NYT: “The Deadly Choices at Memorial” In her advocacy, Dr. Pou argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina. Case Study, contd: “The Deadly Choices at Memorial” At a recent national conference for hospital disaster planners, Pou asked a question: “How long should health care workers have to be with patients who may not survive?” The story of Memorial Medical Center raises other questions: Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them? See the story here: http://www.nytimes.com/2009/08/30/magazine/30doctors.html?pagewanted=all&m cubz=0 Utilitarianism / Consequentialism: intro and video *Utube Video, Crash course on Utilitarianism (10) https://www.youtube.com/watch?v=-a739VjqdSI Julie Markham, Utilitarianism pt 1 https://www.youtube.com/watch?