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Abstract literatureWeek 1
Chapter 1 ~ Moral norms – Beauchamp & Childress
Normative and nonnormative ethics
Ethics is a generic term covering several different ways of understanding and examining the moral of
life.
Normative ethics
General normative ethics addresses the question, “Which general moral norms for the guidance and
evaluation of conduct should we accept and why?” Ethical theories attempt to identify and justify
these norms, which are often referred to as principles. Practical ethics employs the general concepts
and norms to address particular problems. General norms are usually only starting points for the
development of norms of conduct suitable for specific contexts.
Nonnormative ethics
There are two types of nonnormative ethics:
- Descriptive ethics The factual investigation of moral beliefs and conduct
o Uses scientific techniques to study how people reason and act
- Metaethics The analysis of the language, concepts, and methods of reasoning in
normative ethics
o It is also concerned with moral epistemology (the theory of moral knowledge), the
logic and patterns of moral reasoning and justification, and the possibility and nature
of moral truth
These two types are nonnormative because their objective is to establish what factually or
conceptually is the case, not what ethically ought to be the case or what is ethically valuable.
The common mortality as universal morality
Morality Refers to norms about right and wrong human conduct that are so widely shared that
they form a stable social compact. This could include moral principles, rules, ideas, rights and virtues.
The nature of the common morality
There are some morals that are common sense to most people and are not relative to cultures,
groups or individuals. Violation of these norms is unethical. Universal morality is the common
morality.
The common morality The set of universal norms shared by all persons committed to morality.
Contains moral norms that are abstract, universal, and content-thin.
There are also common moral character traits, or virtues. Negative traits that are the opposite of
these virtues are vices.
Ways of examining the common morality
If the appeals are normative, the claim is that the common morality has normative force. This means
that is establishes moral standards for everyone and violating these standards is unethical. If the
references are nonnormative, the claim is that we can empirically study whether the common
morality is present in all cultures.
Particular moralities as nonuniversal
This part is about particular moralities, which contain moral norms that are not shared by all cultures,
groups, and individuals.
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,The nature of particular moralities
Particular moralities present concrete, nonuniversal, and content-rich norms. This is distinguished by
the specificity of their norms, but these norms are not morally justified if they violate norms in the
common morality. The specific moralities include the responsibilities, aspirations, ideals, sentiments,
attitudes and sensitives found in diverse cultural traditions, religious traditions, professional practice
standards, and institutional guides. These sometimes require special knowledge
Professional moralities Are one form of particular morality and include moral codes and standards
of practice.
Moral ideals Provide a second instructive of what may be parts of particular moralities. These are
not required by any person. Persons who fail to fulfill their ideals cannot be blamed or criticized by
others.
Persons who accept a particular morality sometimes presume that they can use this morality to
speak with an authoritative moral voice for all persons. They have a false belief that this falls under
the authority of common morality, but their particular beliefs do not bind other persons or
communities.
Professional and public moralities
Most professions have a professional morality with standards of conduct that are generally
acknowledged and encouraged by those in the profession who are serious about their moral
responsibilities. Members of professions often informally adhere to moral guidelines.
Profession A cluster of occupational roles, that is, roles in which the incumbents perform certain
functions valued in the society in general, and, by these activities, typically earn a living at a full-time
job.
Professionals are usually distinguished by their special knowledge and training as well as by their
commitment to provide important services or information to patients, clients, students or
consumers.
Health care professions specify and enforce obligations for their members. These obligations
comprise the ‘ethics’ of the profession, although there may be role-specific rules or ideals that are
not obligatory.
Because the traditional standards of professional morality are often vague, some professions codify
their standards in detailed statements aimed at reducing the vagueness. These codes must be
coherent, defensible and comprehensive within their domain. Some codes are just oversimplifying
moral requirements.
The regulation and oversight of professional conduct
Additional moral direction comes through the public policy process.
Public policy Refers to a set of normative, enforceable guidelines accepted by an official public
body, such as an agency of government or a legislature.
There is a close connection between law and public policy; all law constitute public policies, but not
all public policies are laws. In contrast to laws, public policies need to be explicitly formulated or
codified.
Policies that have to do with funding in health care incorporate moral considerations. Moral analysis
is part of good policy formation. Public policy is often formulated in contexts that are marked by
profound social disagreements, uncertainties and differing interpretations of history. Moral
principles and rules provide a normative structure for policy formation and evaluation, but policies
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,are also shaped by empirical data and by information available in fields such as medicine, nursing,
etc.
When using moral norms to formulate or criticize public policies, we cannot move with assurance
from a judgement that an act is morally right (or wrong) to a judgement that a corresponding law or
policy is morally right (or wrong). The judgement that an act is morally wrong does not necessarily
lead to the judgement that the government should prohibit it or refuse to allocate funds to support
it.
Moral dilemmas
A familiar feature of decision making in morality, law and public policy is reasoning through difficult
cases and sometimes dilemmas. Moral dilemmas are situations in which moral obligations demand or
appear to demand that a person adopt each of two (or more) alternative, but incompatible actions,
such that the person cannot perform all the required actions. These dilemmas occur in at least two
forms:
1. Some evidence or argument indicates that an act is morally permissible and some evidence
or argument indicates that it is morally wrong, but the evidence or strength of argument on
both sides is inconclusive
2. An agent believes that, on moral grounds, he or she is obligated to perform two or more
mutually exclusive actions. In a morel dilemma of this form, one or more moral norms
obligate an agent to do x and one or more moral norms obligate the agent to do y, but the
agent cannot do both in the circumstance. The reason behind this alternatives x and y are
weighty and neither set of reasons is overriding. If one acts on either set of reasons, one’s
actions will be morally acceptable in some respects and morally unacceptable in others.
When there is a competition between moral reasons and nonmoral reasons (such as self-interest),
this is a practical dilemma.
Almost every moral dilemma is solvable, but just a few become only more difficult and remain
unresolved even after the most careful reflection.
A framework of moral norms
The moral norms that are central for biomedical ethics derive from the common morality.
Principles
There are four clusters of moral principles:
1. Respect for autonomy A norm of respecting and supporting autonomous decisions
2. Nonmaleficence A norm of avoiding the causation of harm
3. Beneficence A group of norms pertaining to relieving, lessening, or preventing harm and
providing benefits and balancing benefits against risks and costs
4. Justice A group of norms for fairly distributing benefits, risks and costs
Rules
The larger framework in the book encompasses several types of norms: principles, rules, rights and
virtues. Principles are more general and comprehensive than rules. Both are norms of obligation, but
rules are more specific in content and more restricted in scope. Principles do not function as precise
guides in each circumstance in the way that more detailed rules and judgements do. There are
several types of rules, and these are the most important:
- Substantive rules rules of truth telling, confidentiality, privacy, forgoing treatment,
informed consent, and rationing health care provide more specific guides to action than do
abstract principles
- Authority rules there are also rules for decisional authority – that is, rules regarding who
may and should make decisions and perform actions. Authority rules do not delineate
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, substantive standards or criteria for making decisions. However, authority rules and
substantive rules can interact.
o For example, rules of surrogate authority, rules of professional authority, rules of
distribution authority
- Procedural rules There are also rules that establish procedures to be followed. The resort
for procedural rules is when we run out of substantive rules and when authority rules are
incomplete or inconclusive.
o For example, for determining eligibility for organ transplantation and procedures for
reporting grievances to higher authorities
Conflicting moral norms
Prima facie obligations and rights
Principles, rules, obligations and rights are not rigid or absolute standards that allow no compromise.
All general norms are justifiably overridden by other norms in some circumstances.
Actions that harm individuals, case basic needs to go unmet, or limit liberties are often said to be
wrong prima facie (i.e. wrongness is upheld unless the act is justifiable because of norms that are
more stringent in the circumstances) or wrong pro tanto (i.e. wrong to a certain extent or wrong
unless there is a compelling justification) – which is to say that the action is wrong in the absence of
other moral considerations that supply a compelling justification.
There is a distinction that is accepted between prima facie and actual obligations. A prima facie
obligation must be fulfilled unless it conflicts with an equal or stronger obligation. Likewise, a prima
facie right, we maintain, must prevail unless it conflicts with an equal or stronger right. Agents can
determine their actual obligations by examining the respective weights of competing prima facie
obligations.
These matters can be very complicated and it can help to develop a structured moral system or set of
guidelines in which:
- Some rights in a certain class of rights have a fixed priority over others in another class
- It is extremely difficult for morally compelling social objectives to outweigh basic rights
Almost daily we confront situations that force us to choose among conflicting values in our personal
lives.
Moral regret and residual obligation
An agent who determines that an act is the best act to perform under circumstances of a conflict of
obligations may still not be able to discharge all aspects of moral obligation by performing that act.
Even the morally best action in the circumstances may still be regrettable and may leave a moral
residue (moral trace). Moral residue results because an overridden prima facie obligation does not
simply go away when overridden. There is also a realization that you have a duty to bring closure to
the situation.
Specifying principles and rules
The four clusters of principles must be specified in order to achieve more concrete guidance. We can
narrow the scope by spelling out where, when, why, how, by what means, to whom, or by whom the
action is to be done or avoided. Specification adds content.
Progressive specification can continue indefinitely, but to qualify all along the way as a specification
some transparent connection must be maintained to the initial general norm that gives moral
authority to the resulting string of specifications. Many already specified rules will need further
specification to handle new circumstances of conflict.
Some specified norms are virtually absolute and need no further specification.
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