ETHICAL THEORIES

Geraldine S. Canete, MAN, RN

A human person act based on reason and will. With will, he chooses to do something that is determined
by his reason that is ought to be done. With reason, he makes use of his mind and embark on seeking for
knowledge. For nurses, we study the broad base of knowledge and use this knowledge as basis of our
nursing actions. We try to aim for objective facts, tested and tried to be sound and effective to ensure
correctness and safety of our nursing care plan. We justify and rationalize our judgments, decisions and
actions based on this objective notion of what is good. By objective, we mean it is not based on feelings
or personal motivations and instead a product of careful reflections and rigorous scientific evidence-based
study.

In ethics, there are ethical theories that guide us also in ethical decision-making. However, some of these
theories oppose one another i.e. ethical egoism and virtue ethics etc, leaving the person unable to decide
on which theory he can make use as anchor of any ethical decisions.

As a teacher in ethics for several years and upon observing of the world and reality around me, I have
come to the conclusion that some people choose a framework based on what suits his or her needs. Which
in itself it truly subjective.

However, Ethics must be objective, otherwise it fails to set a standard that will guide human character.
Nevertheless, for purposes of scholarly study, we discuss the different ethical theories to have a wider
perspective of the several ethical theories. A separate discussion will be dedicated to attempt a discussion
on how to do ethical decision-making and how to determine the goodness and badness of a human act
in simple terms.

Summary of Ethical Theories

1. Teleological Ethical Theories – rightness and wrongness solely depend on the consequence
2. Deontological Ethical Theories – actions are morally right independent of their consequences
3. Virtue Ethical Theories – ethical value is determined by his character which refers to virtues,
inclinations and intentions that dispose of a person to be ready to act ethically. Character builds
a substantive moral foundation for one’s actions. A person with the strong character has imbibed
emotional, intellectual, moral and social virtues to achieve the self-discipline to do what is right
and good. Whereas a person with weak character finds himself doing the wrong things and doing
what is harmful to him and makes excuses for all his actions.
4. System Development Ethical Theories – the extent to which organization system is sensitive to the
need to develop a work culture supportive of ethical conduct determine the ethical values of
actions. If the organization do not implement morally supportive systems then the organization is
exposed to future ethical risks.

Types of Teleological Ethical Theories.

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 1. Ethical Egoism – It posits that an action is good is it produces or is likely to produce results that
maximize the person’s self-interest which the person himself defines. Even at the expense of
others. It is based on the notion that it is always right to promote one’s own good.
2. Utilitarianism – posits that an action is good if it results in maximum satisfaction for a large number
of people who are likely to get affected by the action.
3. Eudaimonism – It posits that an action is good if it results in the fulfillment of goals along with the
welfare of the human beings. The actions are said to be fruitful if it promotes or tends to promote
the fulfillment of goals that constitute human nature and its happiness.

Types of Deontological Ethical theories:

1. Negative and Positive Rights Theories – asserts that an action is right if it protects the individual
from harm or unwarranted interference from other people or the government while exercising his
right. The Example: selling your property without the interference of others. The positive right
theory posits that an action is right if it provides an individual with anything that he needs to exist.
Example, right to adequate health care.
2. Social Contract Theories – posits that people contract with each other to abide by the moral and
political obligations towards the society in which they live. This theory is based on the notion that
if there is no order and law in the society, then people will have unlimited freedoms like killing
another because of too much hatred, stealing money and property because one needs it etc. What
chaotic world it would be, thus, people enter into an agreement with each other to give up some
of their freedoms and accept the obligation to respect and safeguard the rights of others. The
individual then gains a civil rights that constitute the social benefits that he is entitled to the extent
he fulfills his due obligations towards society.
3. Social Justice Theories – it asserts that the action is right if it confirms the fairness in the distributive,
retributive dimensions of cost and rewards. The distributive dimension means the perceived
fairness in the distribution of social benefits and burden among the group members. The
retributive dimension considers the punishment proportionate to the extent of the crime while the
compensatory dimension is the way people are compensated in relation to the injuries inflicted
upon them.

Types of Virtue Ethical Theories:

1. Individual Character Ethics – it holds that the identification and development of noble human traits
help in determining both the instrumental an intrinsic value of ethical interactions. These noble
traits are courage, self-discipline, prudence, gratitude, wisdom sincerity, understanding,
benevolence etc.
2. Work Character Ethics – The identification and development of reflective practitioner noble traits
at work such as creativity, honesty, loyalty, honor, trustworthiness, civility, dependability, shared
work pride, empathy, etc. which determine the intrinsic and instrumental ethical quality of work
life.
3. Professional Character Ethics – holds that self-regulation, loyalty, impartial judgments, altruism,
truthfulness, public service determine the intrinsic and instrumental ethical quality of an individual
associated with communities.

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Types of System Development Ethical Theories:

1. Personal Improvement Ethics – the action is good if it is intended to promote the individual’s
personal responsibility for the continuous learning, improvement, holistic development and moral
excellence. Example: continuing education program
2. Organizational Ethics – action is right if it confirms the development of the formal and informal
organizational processes which in turn enhances the procedural outcomes, respectful caring,
innovation in ethical work culture and systematic justice.
3. Extraorganizational Ethics – the action is right if it promotes collaborative partnerships and respect
the global and domestic constituencies representing the diverse political, economic, legal, social,
ecological and philanthropic concerns that affect the organization.

Other ethical theories

Subjective Relativism:

o Relativism:
§ No Universal norms of right and wrong.
§ One can be wrong or right based on relative views.
o Subjective Relativism:
§ Right and wrong for each person are decided by themselves.
§ What’s wrong for someone may be right for someone else.
o Case for subjective relativism:
§ There can be disagreements on moral issues. (example: abortion)
§ Ethical debates are disagreeable and pointless.
o Case against subjective relativism:
§ Blurs line between doing what one thinks is right and what they want to do.
§ Makes no moral distinction between actions of people.
§ Decisions may not be based on reason.
§ Subjective relativism and tolerance are two different things.

Cultural Relativism:

o In A Nutshell:
§ “Right” and “wrong” depends on a society’s moral guidelines.
§ Guidelines vary from a place to place and from time to time.
§ An action can be right in a certain society at one time and wrong in another society
or at another time.
o Case for cultural relativism:
§ Different social contexts demand different moral guidelines.
§ It is arrogant for one society to judge another.
o Case against cultural relativism:
§ Two societies having different moral views doesn’t mean they’re ought to have
different views.
§ Doesn’t explain how moral guidelines are determined.
§ Doesn’t account for evolution of moral guidelines.
§ Provides no way out for cultures in conflict

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 § Existence of many acceptable practices doesn’t mean all practices are acceptable.
§ What if there are no cultural norms?
§ Societies share certain core values.
§ Only indirectly based on reason.

Divine Command Theory:

o Overview:
§ Good actions: aligned with God’s will.
§ Bad actions: contrary to God’s will.
§ Holy books reveal God’s will. We should use them as moral decision-making
guides.
o Case for:
§ We owe obedience to our creator.
§ God is all-good and all-knowing.
§ God is the ultimate authority.
o Case against:
§ Different holy books disagree on certain teachings.
§ Society is multicultural. Secular.
§ Some modern moral problems not directly addressed in scripture.
§ “The good” != “God”.
§ Based on obedience, not reason.

Kantianism:

o Critical importance of good will:

§ Good will: The desire to do the right thing.
§ Immanuel Kant: Only thing in the world that is good without qualification is good
will.
§ Reason should cultivate desire to do the right thing.
• “What we want” vs “What we ought to do”
o Categorical imperative:
§ Stuff:
• Moral value of an action depends on the underlying moral rule.
• Our actions should be grounded by an appropriate moral rule.
• What makes a moral rule appropriate?
• Kant proposed the Categorical Imperative.
§ Categorical Imperative (1st formulation):
• Act only from moral rules that you can at the same time will to become
universal moral laws.
o i.e. For it not to have contradictions.
o Example: Making a promise with the intention of breaking it later.
Which is flawed.
§ Categorical Imperative (2nd formulation):
• Act so that you treat both yourself and other people as ends in themselves
and never only as a means to an end.

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 § Perfect and imperfect duties:
• Perfect duty: Duty obliged to fulfill without exception. (Example: Telling
the truth)
• Imperfect duty: Duty obliged to fulfill in general but not in every instance.
(Example: Helping others)
§ Case for:
• Rational.
• Aligns with common moral concern.
o What if everyone acted that way?
• Produces universal moral guidelines.
• Treats all persons as moral equals.
§ Case against:
• Sometimes no rule can adequately characterize an action.
• Sometimes there is no way to resolve conflict between rules.
o In a conflict between a perfect and imperfect duty, perfect duty
prevails.
o In a conflict between 2 perfect duties. No solution.
• Kantianism allows no exceptions to perfect duties.

ON VIRTUE ETHICS
Virtue
Refers to excellence in character. Virtues are thought of as purposive dispositions and character traits that
are developed throughout life. These are praiseworthy traits of human character. Schools, social institutions, and
families help to shape a person’s moral character.

Virtue Ethics
Deals with questions such as, “What sort of person must I be?” and “What makes an individual a good or
virtuous person?” rather, than “What is right or good to do?” When people practice virtue ethics, they do not use
universal rules or principles to guide their actions. Rather than focusing on what is right or wrong, virtue
ethics is based on the excellence of one’s character and the consideration of what a person wants to become.

Historic Influences and Tradition

The origin of virtue ethics is associated with the ancient Greeks, most notably Plato and Aristotle. In Eastern
philosophy specifically in Buddhism, virtue ethics is valued. Likewise, in nursing, virtue ethics is valued as
manifested in the works of Florence Nightingale.

Virtues in Bioethics
Virtues are the character of the health care provider, which are morally praiseworthy traits. These characters
are immeasurable, when these virtues are cultivated into a nurse. Personality; it is believed that that he/she
can grow into a compassionate, humble, courageous health care professional with integrity.

Professional Virtues
Purity and holiness have religious overtones but these are embodied in The Hippocratic Oath. In nursing,
to maintain purity and manifest a holy disposition is also important. The following Codes of Ethics for
Nurses have implied statements:

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The nurse at all times maintains standards of personal conduct which reflects well on the profession and
enhance public confidence” (International Code of Ethics for Nurses)

The nurse owes the same duties to self as to others including the responsibility to preserve integrity and
safety…” (American Nurses Associations Code of Ethics, approved June 30, 2001)

“[Nurses must] perform their professional duties inconformity with existing laws, rules, regulations, measures,
and generally acceptable principles of moral conduct and proper decorum.” (Code of Ethics for Filipino Registered
Nurses) The above statements imply that virtues in nursing are important in order to act based on social
values and needs, as they are applied to realities of health and nursing care in a changing society.

Secular Virtues
According to Plato, the four classical Greek virtues which are found to be praiseworthy are: justice,
temperance, courage, and wisdom. These virtues enable the nurse to be firm in facing adversity, intactness of character, to be
kind and optimistic, and to experience great joy in serving.

Religious Virtues
Roman Catholics tend to affirm both Greeks and Christian virtues, thus having a full list of seven virtues
(namely prudence, justice, temperance, fortitude, faith, hope and love); while Protestants, being more prone to
see tension between the Greeks and Christians, often limit their list to the three Pauline virtues such as faith, hope,
and love (agape or charity). In addition to the Biblical Christian virtues, other major religions also put
forward virtue lists such as contentedness, gratitude, generosity, and magnanimity from among the Muslims. The
ancient Hindu Caraka Samhita lists care, attention, humility, and constant reflection. The famous Confucian
virtues are humaneness, compassion, and filial piety. Filial piety is important in ancient Chinese medical ethics.
It has been seen as implying that Chinese physicians are ideally like family member treating patients as
brothers rather than the more distant “professional” relation that is the norm in Western culture.

Virtue- Based Nursing Model

The Moral Ground Model has its foundation in Aristotle’s approach to ‟virtue ethics with a proposed path to
moral ground adapted from the Eightfold Path of Buddhism. Both the ethics of Aristotle and Buddhism are teleological
philosophies, meaning that they both focus human morality on moving toward a final purpose or goal. The model implies that
as nurses go about in their day-to-day activities, they are aware that this routine may give them dissatisfaction
from their profession. But nurses are also aware that they have to focus less on their dissatisfaction instead,
they need to carry on with their work. The following activities and attitudes will develop the nurses
‟intellectual and moral virtues which could facilitate growth in her character as a person and as a nurse in the
profession:

Insight (sophia)
Sophia
is translated as wisdom. This is the ability to think well about the nature of the world, and it involves careful
deliberation of universal truths. The nurse’s sensitivity to the situations ‟of people around her can make her learn
from their experiences. Remaining open to learning can educate nurses about intellectual virtues that provide
insight into the nature of reality, which could shape them to become practically wise.

Practical wisdom (phronesis)

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Phronesis
is sometimes translated as prudence. It is the capability to consider the mode of action in order to deliver
change, especially to enhance the quality of life. It involves using one’s insight into reality in deliberatively
reasoning and applying ‟the intellectual virtue of practical wisdom in directing ones ‟actions. It
includes knowing how a person of virtue chooses to act. Nurses are expected to be prudent at all times. He/she could
exercise prudence by careful analysis of the actions and the decisions that he/she makes especially in
rendering care to clients. Inability to be prudent could lead to situations involving negligence or malpractice.

Choice (prohairesis)
Morality is achieved through choice (prohairesis), facilitated by insight, practical wisdom, and evenness of
emotional states. Moral virtues and the excellence of the nurses ‟disposition, or character, are cultivated through
habitual practice such as effective communication and compassionate caring.

Goal or telos
It embodies personal and professional excellence in nursing which is characterized as active happiness and
well-being that is consistent with an enlightening awareness of the causes of moral suffering as well as the awareness
of the sacredness of the day to day moral nature of n u r s e ’ s w o r k .

Virtues of the Health Care Provider

Fidelity
Refers to the obligation of a person to be faithful to agreements, responsibilities, and commitments that
he has made to himself and to others. It is the main principle that supports the concept of accountability
of nurses and other professionals.
Honesty
Being fair and just in character and behaviour, not cheating or stealing, free of deceit. This is synonymous with sincerity, integrity,
truthful, uprightness, and just. Honesty to self and in the performance of duty is expected from the nurse.
Humility
This is defined as being modest in dealings, unpretentious, with simplicity, and submissive. Nurses are known for this
virtue as they perform their role as a member of the health care team.
Respect
This is showing a deferential esteem felt or shown toward a person. Nurses do not only show this virtue to
the patients but to the other members of the health team, community, and society, or in any setting that she is involved.
Compassion
This is a virtue that is important for the nurse because this enables her to serve others selflessly.
Prudence
This is described as acting with cautiousness, with foresight, and with discretion. A nurse is expected to be
prudent in all that she does, especially in the performance of her duty.
Courage
This is the ability to disregard fear in acting out one’s convictions and belief. There are also times in a nurse’s
career when he/she ‟becomes physically and emotionally exhausted and yet, somehow, finds the strength to go on.
Nurses have to muster up strength and persevere to be able to perform their duties and responsibilities.

Habits of the Health Care Provider

The Good Habits

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Be Proactive -The proactive habit can be applied in multiple ways to foster healthcare interoperability. This is acting in a
flexible manner in order to perform better and achieve more. This could be done in the communication of
patient data through the use of information technology. Being proactive in healthcare results to:1.

Adaptability –being flexible to adapt to the various data requirements2.

Independence –removing total reliance to others to achieve your objectives3.

Satisfaction –delivering responsive clients service ‟With a proactive mindset and approach, there is
interdependence among health care providers in health care delivery.

Begin with the End in Mind

Knowing what you want to achieve for your practice is important in deciding what integration approach
should be taken. With better service as the vision, the health care delivery goals are better achieved. As a
health care provider, the nurse’s involvement could ‟increase the efficiency of service. These could be
through collaboration with the other members of the health care team, and the integration of technology in the different
departments and levels of care.

Put First Things First

The patient is first. Delivering high quality patient care in a timely and accurate manner is fundamental.
What helps facilitate putting patients first? There are many answers to this question. Having the right
physicians, nurses, and other personnel is an essential part of the formula. Having the right facilities and
equipment is a vital part of the formula. Having the right systems, applications, and ways to connect them
is an integral part of the formula. While the quality of care is largely determined by human hands, an expert
mind and a caring spirit also.

Seek First to Understand, Then to Be Understood

Many times, we jump to what we need, rather than listening to what our patients are requesting. A simple question to ask is, to
gain greater understanding should be “What are you going to do with the information that I gave you?” Understanding what
our patients need, rather than assuming, is imperative.

Synergize
What does synergize actually mean? Another term for synergy is alliance. In the healthcare environment,
instead of treating each party as a department, it may be better to treat them as alliances. For alliances to work,
everyone involved needs to work together. That is the point of synergy, and it is necessary to make
connected, healthcare initiatives to work and be effective.

Sharpen the Saw

If there is only one thing that we can do in our life or in our organizations, it should be to look continuously
for ways to improve. Whether it is in our client relationships, the way we solve our problems, or the way that we
approach solutions, keeping our eyes open to new ways on how do things is a must. This process of renewal will keep progress
moving forward. To achieve healthcare interoperability in our communities, continuous improvement is a
must, because (if for no other reason) there are so many changes to which we need to adapt. There
is a simple choice—adapt and improve or maintain the status quo and keep the paper flowing. The improvements can be
realized through many different resources. From workshops and trade shows to case studies, white papers, and blogs, there

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are many different avenues to continue to grow and adapt. Also, there is simple interaction—talking with
people from similar or different organizations to gain their perspectives can open the thought process.
Setting aside the time to learn and improve is the first step.

Vices of the Health Care Provider

Vices are defects of one’s character or behaviour. Most, but not ‟all virtues are considered a mean between
two kinds of vices, involving either an excess or a deficiency. For example, Aristotle named courage as a virtue, the
excess of courage is rashness, and the deficiency of courage is cowardice. Another example is truthfulness;
the excess is imposture, and the deficiency as self-deprecation.

Fraud
This is a criminal deception using false representations to gain an unjust advantage. This could be
synonymous with cheating, deceit, swindling, counterfeit, forgery, falsification, double-dealing. Nurses
could fall into such situations when he becomes an accomplice to such circumstances or practices such
actions.

Pride
A high or overbearing opinion of ones worth or importance.
‟Nurses could at times exhibit such attitude over their achievements, or feeling of elation or satisfaction
of achievements, qualities, or possessions, over individuals or other professionals. Example: Senior health care
providers should act as mentors to the younger ones, but sometimes they are not as accommodating as expected.

Greed
This is described as the excessive desire especially for food or wealth. Nurses could be put to trap in situations
such as greed for power, position and material wealth.

In conclusion, literatures reveal numerous ethical theories that help us determine the goodness and
badness of human actions especially in the face of an ethical dilemma. Some theories offered clarity while
some offered more confusions. It is good to understand each ethical theory which philosophers contended
based on their understanding of the things of this world. We also carefully reflect on the weakness of each
theory. In the end, what we really need to develop is a set of objective and sound ethical criteria that will
enable us to achieve clarity in terms of ethical judgment and sound ethical decision making while
developing the necessary virtues to help up choose and act firmly on such ethical decisions.

Formative Assessmnet for TAL students:

Choose 2 scenarios below and apply a particular ethical theory that can help you determine the good
things to do. 10 points each

1. A young woman asking for abortion because she is not ready for a baby and has no job. – you
believe in the inviolability of life yet you also understand the young woman’s predicament on
raising the child and respects her autonomy.
2. A woman with congestive heart disease pregnant, being asked to terminate pregnancy but wants
to deliver the baby to full term despite the risk on her part. – you respect the patient’s autonomy

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 and also believes in the inviolability of life yet you also recognize the risk and harm the patient is
facing due to her pregnancy,
3. A cancer patient in pain asking for more morphine despite being given already the prescribed
dosage. – you understand the suffering of the patient but you also recognize that harm that
morphine can do and can’t do on terminal pain.
4. An old couple wanting for a designer baby – you believe in the natural law yet you also recognize
the longing of the old couple to have a child of their own liking.
5. A middle age couple, childless, wanting for surrogate mother to carry their child. – you believe in
the natural law yet you also understand the longings of the middle age couple to have a child.
6. A young man selling his kidney so he can support his ailing child. – you believe in the principle of
totality yet you also understand the young man’s needs to support his family.
7. A young man choosing sex reassignment surgery because he doesn’t want to live any longer as a
man. – you believe in the natural law yet you also believe in respecting the autonomy/freedom of
choice of the young man.
8. You want to pass the summative exam to maintain your scholarship, but you did not study, then
here comes your classmate offering help by sharing her answers. – you believe in the principle of
veracity that supports truth regarding your capacity yet you also do not want to fail the summative
exam and lose the scholarship.

RFERENCES:

Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine Edition:
Cengage Learning Asia Pte. Ltd.,.

Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical
Problems. Revised Edition. Manila: Sinagtala Publishers

Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc.

Rice, C. (1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,

Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 1988

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