“Decision Making In Value Issues And Private Law”

Chapter 3

Submitted to

SITTIE ASNIYAH AMATONDING , RN.

Professor

Mindanao Institute of Healthcare Professional, Inc.

Marawi City

In Partial Fulfillment

of the Requirements for the Course

Ethics of Health Care:

A Guide for Clinical Practice Lecture

Submitted by

Group 1_BSN2-B

October 2024
CHAPTER 3: DECISION MAKING IN VALUE ISSUES AND PRIVATE LAW

Value Confrontations
Teological (Consequences-Oriented) Theories
Deontological (Duty-Oriented) Theories
Virtue Ethics
Divine Command Ethics
Private Law

Group 1 Members:

Abdina, Sittie Salia

Abdullah, Saima
Alawi, Fairuz
Amerol, Ashliya R.
Cabsaran, Sonaya
Deri, Ferdaussi
Maguindanao, Amilyn
Mimbantas, Normaleah
Rachman, Fatima
Sultan, Mohaima
VALUE CONFRONTATION

It is our values that tell us what is right and wrong, good and evil, and imply a
preference in regard to correct human behavior. As professionals, it is necessary, even in our
opposition, to attempt to be constructive, not destructive, in the methods we use when we
come to disagreements over issues involving personal values.

Ethical Dilemmas - a situation where people are forced to make a choice between two
options available to them.

Essential Mental Attributes for Ethical Reasoning

1.Ethical Humility - awareness of the limits of one’s own ethical insights.

2.Ethical Courage - willingness to assess fairly ideas, beliefs, and viewpoints differing from
our own.

3.Ethical Empathy - a willingness to attempt to understand the opinions of others and try to
see the issue from their position.

4.Ethical Fair-mindedness - to hold one’s own beliefs and opinions to the same standard of
proof and evidence that we require for the opinions of others.

To acknowledge that individuals can come to different opinions in regard to value issues is
not to say that all opinions have the same worth or credibility, or that one particular answer is
better than another. Often, we will find ourselves with no right answers or several right
answers that seem to fit the situation.

TEOLOGICAL (CONSEQUENCES-ORIENTED) THEORIES

Teleological theories- are ethical frameworks that determine the morality of an action
based on its outcomes or consequences. The term "teleology" derives from the Greek word
"telos," meaning "end" or "goal." Here are some key points about teleological theories.

The things that good to do

Life, consciousness, and activity

 Health and strength

 Pleasure and satisfaction of all or certain kinds

Happiness, beatitude, contentment

Truth

Knowledge and true opinion of various kinds, wisdom

 Beauty, harmony, proportion in objects contemplated

Aesthetic experience

Morally good dispositions or virtues

Mutual affection, love, friendship, cooperation

Just distribution of goods and evils

Harmony and proportion in one's own life

Power and experiences of achievement

 Self-expression

Freedom

 Peace, security

 Adventure and novelty

Good reputation, honor, esteem

utilitarianism- is a consequentialist ethical theory that evaluates actions based on their

overall outcomes, aiming to maximize happiness or well-being. In the context of bioethics, it
plays a significant role in decision-making processes regarding healthcare, medical research,
and public health policies.

Act utilitarianism- is a specific form of utilitarian ethics focused on the consequences of

individual actions. Here are its key features.

equal consideration of interest- is an ethical principle that insists on giving equal weight to
the interests of all beings affected by an action, fostering fairness and impartiality in moral
evaluations

DECISION MAKENG IN VALUE ISSUES AND PRIVATE LAW

-Deemed to be right if it conforms to a rule that has been validate by the principle of
utility the principle of utility requires the rule bring about positive results when generalized to
a wide variety of situations.
CONSEQUENCE

-oriented viewpoint are often very persuasive in that they give comfort to modern
cynicism in regard to the absence of absolute truth. He holds that human need determines
what is or not ethical.

DEONTOLOGICAL THEORY (Immanuel Kant 1724- 1804)

- Duty oriented ethicist feels the basic rightness or wrongness of an act depends on its
intrinsic nature rather than on the situation or sequence.

- This position is often described as a deontological theory taken from the greek word of
duty.

- This particular worldview is codified. in several major ethical system and religion. in the
classic work groundwork of the metaphysics of moral. Immanuel Kant held that the
consequences of an action were essentially irrelevant.

Catergorical Imperative - An action could be known to be right when it was in accordance

with rule the satisfied a principle.

Imperative- were formulated by finding a maxim that would be understand as universal law.
- It is command derived from principle.

Three elements of imperative

*Universal application
*Unconditionality
* Demanding an action

Criticisms of Kant

1. The exceptionless character of Kant’s moral philosophy makes it too rigid for real
life Real-life situations are so varied that it is impossible to create rules that can
guide us in all circumstances
2. Morality cannot be derived from pure reason. The fact we can feel pain and
pleasure is central to morality. It is unlikely we would care about morality if we
did not feel pain or pleasure.
3. The disregard of the consequences of our actions can lead to disastrous results We
all have been hurt by well-meaning people who were’overly concerned to “obey
the law
4. Even though nonhuman animals feel pain and pleasure, for Kant they do not have
any independent moral standing since they are. Not: ratianal beings.
5. It is possible to be faced with a conflict between two duties equally supported by
an imperative.

Duty-oriented theorists obviously wish to promote a good result; however, they feel that
merely serving the good is not an adequate foundation for ethics. Forinstance, if life sacred,
ST then murder is wrong, regardless of the circumstances leading to the act.
One influential formulation of duty-oriented reasoning is the contract theory of John Rawls.
In tnis theory Rawls proposes that if a reasoning individual were placed in a social situa- tion
requiring a value choice without knowing what role he was playing in the situation (Rawls
calls this the original position), the individual would choose the alternative that best
supported or favbred the most disadvantaged person.

Each person possesses an inviolability founded on justice that even the welfare of the society
as a whole cannot override. This is a decidedly duty-oriented position in thatit establishes the
duty of moral equality, which could not be bargained away regardless of social interest or the
wel- fare of the society as a whole.

Neither theoretical position, consequence or duty oriented, has produced a theory that can be
accepted under all circumstances.

The first principle of the social contract is to secure basic liberties for all individuals within
the covenant:
Following this line of reasoning, the concern of an ethical society would be toward the care
and support of its most disadvantaged citizenry, as they are the ones who are least able to
speak for themselves

The individual whose intuitive moral sense leads him or her to believe abortion is wrong
under all circumstances, and the priest who maintains the confidentiality of the confessional
even in the case of unreported incest, are both following the dictates of a duty-oriented or ab-
solutist system.

Neither theoretical position, consequence or duty oriented, has produced a theory that can be
accepted under all circumstances. Both duty and consequence ethics pose grave problems in
modern decision making.

VIRTUE ETHICS

"Your beliefs become your thoughts,

Your thoughts become your words,
Your words become your actions,
Your actions become your habits,
Your habits become your values,
Your values become your destiny."
-Mahatma Gandhi

• Overview of ethics beyond duty-based and consequence-based systems, focusing on

character attributes

Critique of Action-Oriented Ethics

• Morally challenged technologist vs. a virtuous technologist

- the former technologist decided against unethical actions out of fear vs. another who
inherently avoids them

• Discussion on the moral equivalence of actions versus the character behind the actions

• Consequence-oriented systems evaluate actions rather than the moral character behind
them, leading to moral equivalence in some cases.

Aristotle’s Perspective

• Nicomachean Ethics
- Emphasis on the moral agent's character rather than just actions
- He argues that a good person enjoys performing noble actions, highlighting the importance
of virtues.

• Aretaic Ethics
- from Greek word "arete", which means "excellence" or "virtue"
- prioritizes the character and virtues (like courage and justice) over specific actions.
- The central question is about how to live well, rather than merely what actions to take.

Central Tenets of Virtue Ethics

✓ Importance of developing good character traits (e.g., courage, justice)

✓ Virtue ethics emphasizes personal character and moral habit development

Philosophical Support for Virtue Ethics

* Alasdair MacIntyre's argument for a return to virtue-based ethics.

- advocate for virtue-based ethics, arguing that action-based systems lack the motivation for
moral behavior.

Role of Habit in Virtue Development

✓ Aristotle’s assertion that virtues are formed through habits rather than being innate.

✓ Aristotle believed that the essence of humanity is to practice virtues, which creates a good
character through consistent virtuous actions.

Aristotle's Key Traits of Virtuous Character (V-C-M)

• Virtuous acts should be chosen for their own sake

• Choices must stem from a stable character

• The mean in ethical decision-making

virtuous person - it has disposition of moderation toward the mean between two extremes. we
have all experience times when we needed to swing hard against the directions in which our
passion where leading us.

beyond character of moral virtue, Aristotle also believed in intellectual virtues such as

practical wisdom - this he define as the power of deleliberation about things good for oneself.

Intellectual virtues- could be directly thaugh

moral virtues or character virtues- must be lived in order to be learned

Shakespeare's advice in Hamlet was correct:

if one were to have virtue, one must first assume it.

goodness is a matter of character and character is developed by actions over time.

the ethics of care- impasize the important of response.

Important vertue that form the basis for the development of and the expression of Caring in
health care practice are: compassion, Discernment, thrust worthiness, integrity and
conscientious.

This virtue provides a moral compass for decision making in the ethics of care.

DIVINE COMMAND ETHICS

Divine command ethics- is a fourth type of theory of often used in ethical debates so it
merits inclusion in this survey of standard ethical theories.

Criticisms of Divine Mandate Theory

1.) Command theories assume belief in either divine being or exemplary individuals.
2.) Command theories cannot cover all possiblecases of moral decision.
3.) Command theories generally have a “no exceptions” clause either explicit or
implicit
4.) Command theories has what may be called the “Euthyphro Problem” from the
platonic dialogue from which it originated.

PRIVATE LAW
 It is the concerned with the recognition of the rights and enforcement of the rights and
duties of private citizens and organization.

THESE ARE THE TWO TYPES OF BASICALLY PRIVATE LAW

TORTS LAW → is the private or civil wrong or inury, other than a breach of contract.
CONTRACT LAW

COMMON NEGLIGENT ACTS OF COMMISSION & OMISSION

(EXAMPLE OF COMMISSION ARE:)

 Administrating wrong medication

 Administrating wrong dosage
 Performing the wrong surgical procedure
 Performing a surgical procedure without patient consent
 Performing a procedure on the wrong patient

(EXAMPLE OF OMISSION ARE:)

 Failing to conduct a thorough history or examination

 Failing to assess and reassess a patient’s nutritional needs
 Failing to administer medication as prescribed
 Failing to follow up a critical laboratory test

NEGLIGENCE

→is the unintentional of commission and omission of an act that a reasonably prudent
person would or would not do under the same or similar circumstances.
→ negligence or carelessness of a professional health provider (physical therapist,
pharmacist, nurse, physician) is generally described as malpractice.
→ negligence takes many forms, the most common are:

MALFEASANCE → the execution of an unlawful or improper act.

MISFEASANCE → the improper performance of an act that leads of injury.
NON-FEASANCE→ the failure to perform an act, when there is duty to act.
CRIMINAL NEGLIGENCE → the reckless disregard for the safety of another.

To sustain a claim of negligence, evidence of the following must be in place. These are often
called the four Ds of a negligence case.

• Duty - a provider-patient relationship must be established. A duty to care must exist.

• Dereliction of Duty - a breach of duty, when the provider fails to act as an ordinary
competent provider would have acted in a similar situation.

• Direct Cause - the breach of duty was the direct and proximate cause of the injury,
damage, or loss.
 • Damage - an injury or loss actually took place.

The key difference between intentional torts and negligence is intent: intentional torts
involve a deliberate act, while negligence involves a failure to act reasonably. Some common
forms of intentional torts that have implications within the health care setting are:

• Assault and Battery - Any lawful touching of another that is without justification
or excuse is both a tort and a crime. Assault is committed without physical contact,
such as someone verbally cursing and threatening, whereas battery requires physical
contact of some sort (bodily injury or offensive touching).
• Defamation of Character - it occurs when one person communicates to a second
person about a third in such a manner that the reputation of the person about whom
the discussion was held is harmed. Written communication is termed libel, whereas
spoken defamation is slander.

• False Imprisonment - The illegal confinement of an individual against his or her

will by another individual in a manner that violates the confined individual's right to
be free from restraint of movement.

• Invasion of Privacy - refers to the right to live without unwanted public exposure of
personal information.