Intentions & Results
In ethical reasoning we value acting with a good intention and achieving the best outcome. When these arguments clash, we become creative.
For instance, we generally believe doctors should tell a patient the truth. But a doctor may lie to encourage a patient, because the doctor believes having hope may contribute to the patient’s recovery.
If our intention is good and no one seems to be harmed, we often think a lie is right as well as best.
Empathy & Reason
Neuroscience has confirmed that we have evolved the capacity for empathy and have mirror neurons that enable us to feel the emotions we see in others.
We also have evolved the mental ability to use reason to weigh the possible consequences of taking an action, which enables us to make the choice that seems to offer the best possible outcome.
Acting, Being & Predicting
Having good intentions involves being concerned with taking the right action or being a good person, or both.
Being responsible for the practical outcome of our actions involves weighing the likely consequences of the possible choices we have, and then acting in the way that we predict will have the best possible outcome.
Philosophers and theologians have developed these arguments into ethical traditions.
Deontological ethics concerns doing what is right, whereas teleological ethics is about our intention to be good persons in a good society.
Consequential ethics considers what practical choice will lead to the best possible results.
The four words above the horizontal line represent intrinsic ethical values.
We should do our duty and respect the rights of others, because we affirm these actions are intrinsically right.
We ought to cultivate moral virtues that reflect character, and also be caring in our relationships, because we believe these intentions are intrinsically good.
The word “consequences” represents the ethical argument that we should act to realize the best possible future.
Deontology vs Consequences
Disagreement about moral issues may reflect a clash between deontological and consequential reasoning.
A patient’s right to give informed consent means a doctor has a duty to be honest in advising a patient.
Yet there is evidence that patients do better when encouraged and may even respond positively to a placebo.
Principles vs Predictions
Ethical arguments for taking the right action are rooted in our religious and cultural traditions.
Neuroscience confirms that we have evolved to make moral decisions based on empathy as well as our ability to predict the likely outcome of our actions.
Consequential arguments for doing what we think will yield the best possible outcome reflect the ethical and practical traditions of political philosophy and economics.
Teleology vs Consequences
In addressing ethical issues arguments for compassion and forgiveness may seem to clash with our responsibility to achieve the best possible outcome.
For instance, a parent or a physician may demand life-sustaining care for an infant with a poor long-term prognosis.
Or, it may seem that allowing the impaired infant to die would likely be better for the child and/or the family.
Proactive vs Predicting
Traditional ethics ascribes intrinsic value only to human beings. This makes the use of natural resources merely a practical matter of what has the best consequences for us.
Yet, human health depends on the health of the earth’s biosphere, so proactive health care should include caring for the earth’s ecosystems.
What might embracing an ecological way of life mean for health care?
We consider arguments for intrinsic values in order to construct an ethical presumption as to what we should do.
We test our reasoning by predicting the likely consequences of acting on this ethical presumption.
If our predictions confirm the ethical presumption, then our moral choice is clear. But if the likely consequences seem more adverse than beneficial, then we should reassess our options.
Arguments in health ethics concern duty and rights, character and relationships, and consequences.
Kant's focus is duty. Rawls is more concerned with rights.
Catholic teaching relies on the natural law tradition that affirms we should fulfill our human purpose by being good persons and doing what is right.
Arguments based on consequences rely on utilitarian reasoning.
ANA* Ethics Code - Deontological Arguments
The nurse’s primary commitment is to the patient, whether an individual, family, group or community.
The nurse is responsible and accountable for individual nursing practice. The nurse’s obligation is to provide optimum patient care.
The nurse promotes, advocates for and strives to protect the rights of patients.
The nurse owes the same duties to self as to others.
*American Nurses Association
ANA Ethics Code - Teleological Arguments
The nurse practices with compassion and respect for the inherent dignity, worth and uniqueness of every person, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
The profession of nursing is responsible for articulating nursing values and for maintaining the integrity of the nursing profession and its practices.
ANA Ethics Code - Consequential Arguments
The nurse participates in establishing, maintaining and improving health care environments and conditions of employment conducive to the provision of quality health care.
The nurse participates in the advancement of the profession.
The nurse collaborates with other health professionals and the public in promoting efforts to meet health care needs.
ANA Code: Summary
The duty to provide optimal care reflects the goal in the ancient Hippocratic Oath to do no harm and to act with a good intention.
Hospitals have been named for the Good Samaritan to emphasize the importance of care and compassion in providing medical services.
Good intentions and compassionate professionals are necessary but not sufficient. The outcome must be quality health care.