Biomedical Ethics

Biomedical Ethics is deliberation on moral issues that arise in the context

medical practice
bio-medical research . . . like Dr. Moreau's

Ethical deliberation (moral reasoning) involves the application of principles: Practical Syllogism

You should do unto others as you would have them do unto you. {Moral Principle: an ought: The Golden Rule}
I wouldn't want my brother to take my toys if he were bigger than me. {Fact: an is: Application of the Principle}
So, I shouldn't take my brother's toys.

An set of such principles or oughts -- is a moral theory; hopefully an organized set.

The Nature of Biomedical Ethics

Descriptive vs. Normative Ethics

Descriptive ethics:

how we do act and choose and argue about " good" & "right" & what to do.

a sociological or anthropological question

Normative ethics

how we should act and choose and argue about these things
a philosophical question

Metaethics: Conceptual Issues (more distinctively philosophical)

Analysis of conceptual & interconnectedness issues

Do the ends justify the means? Always? Never? When?
Does all moral reasoning involve application of principles? (as the practical syllogism suggests)
Is everything there is made by God for some particular purpose?

Quasi-descriptive: not normativity neutral: answers we give to metaethical questions have normative repercusssions

If we answer yes to 3.
Then we will lend strong support to a (theistic) Natural Law Theory

it's good to use things as God intended
it's bad to use things as God didn't intend

Ethical Theories

An set of such normative principles or oughts is a moral theory;

hopefully an organized set to provide
"a framework within which a person can correctly determine, on any given occasion, what [they] morally ought to do" (5)

The Critical Assessment of Competing Ethical Theories

General Criteria (roughly of organization): apply to ethical theories as theoretic

consistency: doesn't contradict itself
clarity: applicable in practice:

from Don't use people just as means
to "Obtain the subjects informed consent prior to any experimentation on human subjects."
ATTN: Dr. Moreau

completeness: extent of its coverage or range of cases to which it applies
simplicity

more important than just a subsidiary tie-breaker
the more complicated the framework the harder it will be to use

to determine what to do
on given occasions
especially when it's necessary to think fast

Specifically ethical criteria

the implications fit our experience of the moral life & are answerable to our moral intutions
provide effective guidance where most needed:

"where substantive moral considerations can be advanced on both sides" (5)
especially to cases of conflict between prima facie values or duties or moral dilemmas

patriotism vs. filial duty (Sartre's case)
lying vs. loyalty to a friend
preserve her chastity vs. save the life of her brother

Proviso: our moral intuitions aren't sacroscanct

a principle of equal treatment regardless of race or creed was inconsistent with the moral feelings of our forebears

felt nothing wrong with slavery
or more recent forebears, with racial discrimination

they were wrong
sometimes it's necessary to modify our intuitions in the light of strongly justified principles

Teleological vs. Deontological Theories

The basic distinction my version [what Mappes & Degrazia say, alas]

teleological theories hold the moral value of an act to depend wholly on its consequences: on results.
deontological theories hold the moral value of an act depends wholly on it's internal characteristcs: on style.

[Mappes: maintain that m.v. is "not exclusively" a matter of consequences]

mixed theories hold the moral value of an act depends on both style & outcome.

Ethical Egoism: A teleological theory

Basic Principle: A person ought to act so as to promote his or her own self-interest.
Criticisms

has implications that are drastically contrary to (most of our) normative moral intuitions, I trust

if I enjoy killing people & eatuing them -- like Jeff Dahmer
then that's what I morally ought to do
nothing at all would have been wrong

if only he'd been more careful
maybe even as things turned out his course was morally warranted

maybe the profits -- he enjoyed it so much while it lasted
outweigh the cost -- loss of freedom & his life shortly thereafter

can't consistently be publically advocated

assuming that I'm better off if you're sparing some thought for my interests
it's not in my best interests to tell you to only look after your own

has implications that are drastically contrary to our (our common) metaethical understanding about the relationship between morality and self-interested prudence (enlighted pursuit of your long-run best interests)

we think morality and prudence sometimes can conflict: there is a tension between self-interest and morality

that morality functions (compare the help with hard problems criterion above)

to restrict our pursuit of our own interests
to reconcile different individual's often competing interests.

this is arguably one place where guidance is most needed
and Ethical egoism fails to provide it

Utilitarianism: A person ought to act in a way that promotes the interests of all concerned.

Act-Utilitarianianism

General characterization: advocates weighing the consequences for all concerned on a case by case basis

Basic principle: A person ought to act so as to produce the greatest balance of good over evil, everyone considered.
utility = the net balance of GOODS for all concerned: do what has the most utility or "act so as to maximize utility"
contrast with egoism: concerned with the costs and benefits for all concerned

radical impartiality of utilitarianism: "each counts one none more than one"
radical partiality of egoism: only my costs and benefits count

Question of intrinsic value: what are the costs (or ills) and benefits (or goods) to be counted

intrinsic vs instrumental goods

intrinsic goods -- candidates: love, pleasure, knowledge -- are good in themselves
instrumental goods are -- examples: money, medications -- are useful for some purpose

Hedonistic utilitarianism of Bentham: in

pleasure is the only intrinsic good
pain is the only intrinsic ill

John Stuart Mill's alteration

calls the intrinsic good "happiness"
the intrinsic bad "unhappiness"
Greatest happiness principle: Act so as to achieve the greatest happiness for the greatest number.

Interest-statisfaction utilitarianism: democratic & diplomatic (delegates the tough question)

each counts one
and each gets to decide what what counts (as costs & benefits) for themselves

How to calculate utility: spreadsheet comparisons

a column for each possible course of action
a row for the costs & benefits for each individual affected
add up the costs & benefits for each column, i.e., each available course of action
choose the act that results in

the greatest profit
or the least loss

common misunderstanding: utilitarianism doesn't say you ought to do whatever has more benefits than costs

in win-win situations: the greater of the goods is what you ought to choose

some action might have more benefits than costs and still not be the right course
e.g., I have a $1000 to give to some lucky individual

I give it some needy person
I give it to Bill Gates

in lose-lose situations: choose the lesser of the "evils" is what you ought to choose

some action might have more costs than benefits and still be the least costly alternative
e.g., flee the burning house and leave your precious personal possessions behind or stay and risk death

Situational character

act utilitarianism in considering what to do on a case by case basis might be termed "situation ethics"
whether it's wrong to lie, e.g., depends on the circumstances . . . since the consequences of lying may differ in different circumstances

if I lie to a prospective sexual partner about being HIV negative or single: that's wrong
if I lie to the Gestapo about the whereabouts of the Jewish family down the street: that's right

attitude toward moral rules

moral rules like "never tell a lie," "thou shalt not steal," etc. are rulesof thumb
especially useful when time constraints prevent a fuller utilitarian calculation

Criticism & Reply

Criticism: the undoability of the calculation

requires forseeing remote consequences that can't accurately be predicted
requires comparing apples & oranges:

the pleasure of eating a cheeseburger
the joy of watching a ballet

Reply: appeal to commonsense

morality ain't easy: act utilitarianism only asking us to
weigh the consequences . . . which we have to do anyway
predicting what will result is unavoidably part of deciding what to do

2nd Reply: Restriction to Social decision making where there's more time for deliberation & more voices to make their interests known

Examples of Act-Utilitarian Reasoning in a Biomedical Context

Whether to force feed an 86 year old man in a nursing home lost the capacity for enjoying all that was most important to him in life and who refuses to eat (my father in law, Horace Abbott)

more or less direct benefits: relatively certain

relieved of his suffering & spared him the indignity of forced feeding (which he would have resisted)
burdens of sadness & worry lifted from his children

indirect benefits: more uncertain (so need to discount depending on probability)

medical resources conserved for the use of others
gain in social conern for death with dignity as a quality of life issue

indirect costs: more uncertain (so need to discount depending on probability)

loss of respect for the sanctity of life
possible deleterious social consequences of such loss of respect: slippery slope to cruelty & callous disregard for human life

decision: don't force feed

Book cases

A severely impaired newborn, believed to have no realistic chance of surviving more than a few weeks has contracted pneumonia.

benefits (cut costs): suffering of the infant and parents
costs: breakdown in protective attitudes toward innocents?
similar to Horace's case

A researcher deciding whether or not to inform would be experimental subjects of nausea they stand a good chance of experiencing.

benefits: gain in scientific knowledge & potential medical benefits
costs: loss of trust in science & scientists
similar to Moreau's plan to mate Miss Thornton with that Manimal

Who to allocate a dialysis services to

a derelict: benefits . . . his miserable existence is prolonged
a 40 year old civic minded mother of three children: benefits to society, her husband, & herself + the life being prolonged has far better prospects of quality & longevity

Critical Assessment of Act-Utilitarianism

Basic complaint: does violence to normative & conceptual intuitions that

some things -- what to major in -- seem to be questions I can decide solely on the basis of personal considerations -- what's in it for me

according to AU however a person is under continuous obligation to maximize utility
reverse complaint from EE: EE "collapsed" morality into prudence; AU "expands" morality to usurp prudence
collapses distinction between

duty
what's above & beyond

we have special obligations to family & friends & those we've made promises to (the "highly personal character of duty")

each counts one and none count more then
no one would have any firm obligations & commitments
to anyone

that people have rights rights that it would be unjust to disrespect

case of framing an innocent man to prevent a race riot: would allow unjust treatment of the scapegoat
case of photographing people in the locker room shower without their consent and posting the photos on the internet: seems here that act utilitarianisms would approve of violation of individual's rights

if no one can identity you: your head's cropped, say
so you never find out
wouldn't act utilitarianism approve of this violation of rights

then the benefits = the jollies folks got from looking at the pictures
the costs = nothing . . . nobody's hurt

Possible responses

biting the bullet: call for reform of these intuitions
damage control:

emphasize the unreality of the examples
in reality the MSU wrestling team did find out they'd been photographed in the showers & suffered embarrassment

revise the theory to accomodate the problems: rule utilitarianism

Rule-Utilitarianism

Basic Principle: A person ought to act in accordance with the rule that, if generally followed, would produce the greatest balance of good over evil, everyone considered.
Analysis: the principle of utility is "kicked upstairs" to be a rule for making moral rules

evaluate the rules
apply the rules to evaluate actions (just as in any other rule based system)\

Virtues of the theory

utility does provides a plausible basis for many traditional & commonsense moral principles

do not lie
do not steal
do not kill
come to the aid of people in distress

salves the chaffing intuitions

general rule of violating privacy would make everyone insecure in their privacy
general rule of sacrificing scapegoats would make everyone insecure in their safety

Worry about the theory: loss of flexability: makes us too rulebound?

lying to save life . . . have to consider exceptions to rule
make lemonade: evisage progress of modified rules: do not lie unless to save a life an even better rule

Examples of Rule-Utilitarian Reasoning in a Biomedical Context

Concerning physician disclosure:

which rule should be adopted?

A physician should never lie to a patient about their terminal condition.
A physician should never lie to a patient about their condition unless in the physicians estimate it would be better for the patient not to know.

cost-benefit analysis

never lie

benefits: maintains patient confidence in their physicians, give patient and their family opportunity to prepare for death;
costs: immediate grief & pain for patient and family on finding out

lie at your professional discretion

benefits: spares the family the immediate grief & its subequent ill effects the physician may forsee (patient loses hope)
costs: loss of chance to prepare; general loss of patient confidence in their physicians.

Allowing active euthanasia

benefits: relief of pain and other suffering of patient and family; freeing up medical resources
costs: possible abuses; possible loss of respect for life; resulting climate of fear and dread for the elderly and the disabled

medical confidentiality

proposed rule: physicians should break confidentiality when that is necessary to ensure the protection of a third party
cost benefit analysis

benefits (or cut costs): third parties spared harm
costs (lost benefits): patient trust in their physicians would be undermined

Critical Assessment of Rule-Utilitarianism

Squares better with moral intuitions than act utilitarianism -- even reasonably well

allows scope for prudence: rules have holes . . . they don't cover everything & what they don't is left to our individual discretion
allows scope for special duties: rules of special obligation -- e.g., of physician confidentiality -- can be warranted on utilitarian grounds

in order for Drs to effectively treat their patients
their patients must confide in them
hence it's beneficial on balance, for all, to have such a rule of confidentiality

controversial how well it answers the rights & justice based intuitions

Does reasonably well in providing guidance where we need it

where would be rules conflict
gives us a procedure of sorts to follow -- a rule for making rules -- to decide where to make the exceptions

Kantian Deontology

Proposes an alternative rule for making rules: the Categorical Imperative based on the Golden Rule
Two formulations: following the text (we will emphasize the second)

"Act only on that maxim through which you can at the same time will that it should become a universal law."
"Act in such a way that you always treat humaning, whether in your own person or that of any other, never simply as a means, but always at the same time as an end."

Kantian deontology and respect for persons

humans are autonomous rational agents with

ends of their own
which they decide for themselves

when we impede their ability to choose and pursue their own ends we offend against their dignity as free agents

we don't have a price -- humans aren't just valuable for their utility, like any old object
human beings are sources of value, through their valuations, which gives them a value beyond all price: dignity

Duties to self and others deriving from this principle of respect for persons

perfect duties: allow for no exceptions & are binding under all circumstances

duties not to treat others merely as means

imperfect duties: require us to promote certain goals, e.g., the welfare of others

are trumped by perfect duties
roughly duties to actively facilitate others pursuits of their ends

Notable perfect duties

not to kill an innocent person
not to lie
to keep promises
to self

avoid drunkenness: use yourself as a means to pleasure
not to commit suicide (kills an innocent person -- yourself

Notable imperfect duties

to aid their capacities for development as rational beings
to self: personal development, or use of one's talents
acts based on imperfect duties to others are acts of benificence

The Kantian Framework in a Biomedical Context

a physician may never justifiably lie to a patient
experimental subjects must never be used without their voluntary informed consent

Critical Assessment of Kantian Deontology

Virtues

the categorical imperative or duty of respect for persons supplies a plausible grounds for commonplace & traditional moral principles

do not lie
do not kill
keep you promises
do not steal

provides a secure foundation for individual rights as correlates of perfect duties

my right to life is the correlate of others' perfect duties not to kill
my right not be be lied to the correlate of others' perfect duties not to lie
an innocent persons right not to be punished the correlate of the perfect duty not to steal his livelihood, or his freedom

insistence that individual rights can't be overridden by utilitarian consideration echoes the saying -- expressing some kind of intuitive conviction -- that "the end doesn't justify the means"

Vices: inflexiblity

conflict with intuitions:

benificence slighted & perfect duties overstated

you should not tell a lie to same someones life: e.g., if a hit man came looking for you

perfect duty not to lie
outweighs imperfect duty to assist

you should not steal a loaf a bread to save your child's life

dubious duties to self, e.g., not to commit suicide

duty to others (suicide is often wrenching to the family)
duty to God (he gave you this life & only he has the authority to take it)
but a duty to self?

guidance in problematic cases

does provide guidance: whether to lie to save someone's life
but provides the wrong guidance!
another example: patient confidentiality

suppose Tim McVeigh had confided his plans to his psychiatrist & the psychiatrist thought he was serious.
shouldn't the psychiatrist break his promise of confidentiality to save hundreds of innocent lives?\
my moral intuition is that he should

another example: I borrow your gun and promise to return it when you ask

you find out your wife is cheating on you & you come to me in a crazy jealous rage screaming "I kill her!" and demand your gun back
am I morally obliged to I return your gun?
Kant says yes. Most people's moral intuitions -- I think -- say no.

W. D. Ross's Theory of Prima Facie Duties

prima facie duties are duties you have other things being equal or conditional obligations

prima facie duties are duties you have unless some other duty or value conflicts
not absolute -- unlike Kantian perfect duties

fails Mappes & DeGrazia's second test of providing guidance in moral dilemmas

Relevant Concepts and Principles

Autonomy

General characterization: autonomy is "self-governance or self determination"

involves making your own decisions
is violated when others decide for you when you are capable of deciding yourself

complications that emerge "when questions are asked about justified infringements or limitations of individual autonomy" motivate elaborations of the underlying notion along three lines

Autonomy as Liberty of Action

automony is defined as the absence of coercian
coercian: the use of force or the threat of force to make someone do what they would otherwise be unwilling to do

occurent coercian: involves the actual use of physical force: I knock you on the head and take your wallet
dispositional coercian: involves the threat of physical force: I hold a gun on you and take your wallet

direct: the threat is person-to-person
indirect: the threat is legal (the harm is threatened by law)

Autonomy as Freedom of Choice

automomy is defined as the presence of options
sometimes -- even in the absence of coercian -- you may lack autonomy as freedom of choice

no one's stopping you -- by force or threats -- from viewing pornography on the internet
but they've installed net nanny software on the network you use to access the internet

Autonomy as Effective Deliberation

Compared with the preceding conceptions:

AFD focus on internal psychological factors
ALA and AFC focus on external factors

of coercian (ALA)
of opportunity (AFC)

Two factors making for autonomy of decisions

rationality of deliberations leading to the choice
unconstrained (and informed) nature of the deliberations

internal constraints: inflamation of guilt, habits of deference, etc.
lack or information internal analog of lack of opportunity:

lack the means to deliberate rationally
e.g., if the Dr. has withheld information about side-effects, available options, etc.

Two senses of "rationality"

means-end rationality (deliberative)

reasoning logically
on the basis of good evidence
about the most effective means
to achieve some end

end-setting rationality (rational wishing)

reasoning -- or wishing -- logically
on the basis of good evidence and sound assumptions
about the most satisfying goals
in the long run, and all else considered

Combined sense:

rational acts must be based on decisions concerning the best means to mazimize appropriately chosen ends
rational agents -- agents capable of acting rationally -- must be

able to formulate appropriate (long-range and circumspect) goals
able to prioritize among these goals
able to determine the best means to achieve these goals
able to act effectively to realize these goals
able to abandon or modify goals if

the consequences of using available means are undesirable
or inadequate

would-be rationality impeding factors

lack of mental abilities or facility at excercising these abilities
interfering factors (which may prevent someone with the abilities and even facility from exercising them on a particular occasion)

emotions: fear
laziness
effects of drugs, e.g., pain killers

may be better to speak of degrees of rationality

lack of information

doesn't queer the rationality of the thought processes (e.g. my car is runs fine)
but may queer the outcome due to insufficient or bad data (it's out of gas; or the gas is bad)

insufficient information: if my Dr. Investor withholds information about certain options or side-effects

Dr. Investor has an interest in a nursing home in Saginaw
and doesn't tell you of an equally good one here in Alma

misinformation: if Dr. (or whoever) inadvertently tells me something false

"There is no adequate long-term facility in Alma" he says.
He doesn't know of one, but in fact there is.

disinformation -- aka lies

Knowing perfectly well there is, Dr. Investor
"There is no adequate long-term faclility"

Summary: A infringes on the autonomy of B if

A imposes constraints on B's

liberty of action or
deliberative processes

A narrows B's range of choices

The Value of Autonomy

Kantian view

human rational and self-directed agency -- the exercise of free will -- is the souce of the incalculable value (or dignity) of human existence

we are not just things whose value consists in being means to ends
we are end-setters with value in and of our own precisely as such

so respect for their autonomy is due to all human beings as a fundamental right as the 2nd formulation of the categorical imperative states
Kantian description of autonomy current in biomedical ethics includes

self-control: capacity for adopting means based on effective deliberation
self-direction: in pursuit of rationally chosen ends
self-governance: not driven by emotion or coerced by others

Utilitarian view

Mill: liberty of action and thought are needed for happiness since such liberty develops requisite

intellectual traits
character traits

Autonomy not a fundamental value or first principle (as for Kant) but is an indispensible means to the end of happiness
Autonomy involves

choose their own plans for life
make their own decisions without manipulation by others
exercise firmness and self control in acting on their decisions.

Liberty-Limiting Principles

Autonomy such a key value "a moral justification must be given for any infringement on or limitation or usurpation of autonomy.
Six arguably liberty limiting principle: more you allow and the more easiliy you allow them the less justification you require for infringement

harm principle: A person's liberty is justifiably restricted to prevent that person from harming others.
offense principle: A person's liberty is justifiably restricted to prevent that person from offending others.
paternalism principle: A person's liberty is justifiably restricted to prevent that person from harming himself.
strong paternalism principle: A person's liberty is justifiably restricted to benefit that person.
legal moralism principle: A person's liberty is justifiably restricted to prevent that person from acting immorally.
social welfare principle: A person's liberty is justifiably restricted to benefit others.

discussion of these perhaps most prominently discussed when questions are raised about the the justification of coercive laws against "victimless crimes"

laws against hallucinogenic drugs (the book example), prostitution, etc.
"victimless crimes" are those with no complainant, e.g. use of even sale of drugs

harm principle almost universally acknowledged

what justifies coercive laws against murder, rape, theft, assault, etc.
a bystander who prevents an assault it praised -- not blamed -- for their actions

which other principles justify what sort of restrictions is very controversial

Discussion: Liberty Limiting Principles and Bioethics

Harm principle

only one Mill accepts
in biomedical contexts

restraining a patient who posed a danger to other patients
laws against practicing medicine without a license?

Offense principle

offensive behavior causes shame, embarrassment, or discomfort in onlookers
biomedical context: commitment of individuals to mental institutions due to nondangerous but offensive behavior

Legal moralism: whose acceptance makes for "the tyrrany of the majority" (Mill)

liberty may be limited to "enforce morals"
in a biomedical context: objections to suicide are moralistic.

if the suicide is rationally decided upon
otherwise, paternalism would be the limiting principle.

Social welfare

liberty may be limited to benefit society
biomedical example: psychological research

often key to the experiment that the subjects not be informed about the purpose of the experiment
a prima facie infringement of their autonomy
justified -- if at all -- by social benefits to be gained through the scientific knowledge gained by the research

Paternalism: most prominent of the principles in biomedical contexts

Paternalism

"Paternalism is the interference with, limtation of, or usurpation of individual autonomy justified by reasons referring exclusively to the welfare of or needs of the person whose autonomy is being usurped." (31)
Biomedical examples: book cases

Dr. who believes I will commit suicide if he gives me his disagnosis -- it's Alzheimers -- & so witholds it in my own interest.
Dr. who believes surgery is my best treatment for her cancer patient & so does not disclose significant information about alternative treatments.
Dr. who refuses to perform abortion believing she will eventually regret the decision and become seriously depressed.

Discussion

Kantian perspective (Charles Fried): paternalism is never justified for competent adult patients

patients cannot be denied relevant information or otherwise have their autonomy infringed
under any circumstances
autonomy is an absolute right which all have a perfect duty to respect

Utilitarian perspective (Mill)

unwarranted because individuals are usually the own best judges of their own utilities

make them happy (Mill)
or satisfy their preferences (P-S view) especially

may still be appropriate in cases of "diminished autonomy"

children
mentally handicapped adults
the distraught or suffering
the un(der)educated
women (formerly)

Danger of self-fulfilling diagnoses of "diminished autonomy"

if you don't choose what I (the all-knowing Dr.) think I know is best for you
it must be you're autonomy is diminished in some way

Mappes & DeGrazia's opinion
paternalism is justified if

the person's reasoning ability is significantly constrained by intellectual lacks

reasoning disablity
ignorance of relevant facts

especially restraint is necessary to prevent serious irrevocable harm
examples

stopping someone on LSD from leaping out the 20th story window "to get home more quickly"
stopping a severely retarded person from playing in traffic
decisions to commit suicide made under the influence of

alcohol or drugs
reversible depression

weak paternalism: restraint of liberty is justified

when the intervention is responsive to the welfare of an individual whose automomy is significantly diminished
to keep a person from bringing about presumably irrational self-harming outcomes

temporarily and provisionally
until it can be determined that the individual is acting autonomously

strong paternalism going beyond these two cases holds that paternalistic interference in the choices of persons whose autonomy is not significantly diminished are sometimes fully warranted.

strong paternalism (since it's still only prevention of self-harm that warrants interference) not the same as extreme paternalism
extreme paternalism would warrant interference for your benefit (not just to prevent harm)

Much current mistrust of paternalism

perhaps more of a reaction abuses of paternalism

to serve class-agendas & based on prejudicial stereotypes
to maintain the perogatives (or cover the ass) of the medical establishment

rather than to paternalism per se

The Principles of Biomedical Ethics (Beauchamp and Childress)

Medical Ethical issues should be decided by appeal to the following
Four conditional principles: which prevails in conflict cases "depends on the context"

respect for autonomy requires health care professionals not to interfere with their patients effective exercise of their autonomy
nonmaleficience: requires that health-care professionals do no harm to their patients
beneficence: requires that health-care professionals act in ways that promote patient welfare
justice: demands that social benefits (e.g., health-care) and costs (e.g., taxes) should be justly distributed

Biomedical Ethics

The Nature of Biomedical Ethics

Ethical Theories

The Critical Assessment of Competing Ethical Theories

Teleological vs. Deontological Theories

Act-Utilitarianianism

Examples of Act-Utilitarian Reasoning in a Biomedical Context

Critical Assessment of Act-Utilitarianism

Rule-Utilitarianism

Examples of Rule-Utilitarian Reasoning in a Biomedical Context

Critical Assessment of Rule-Utilitarianism

Kantian Deontology

The Kantian Framework in a Biomedical Context

Critical Assessment of Kantian Deontology

W. D. Ross's Theory of Prima Facie Duties

Relevant Concepts and Principles

Autonomy

The Value of Autonomy

Liberty-Limiting Principles

Paternalism

The Principles of Biomedical Ethics (Beauchamp and Childress)

Alternative Directions and Methods

Virtue Ethics

The Ethics of Care and Feminist Ethics

Causuistry: Care-Based Reasoning in Historical Context

Reflective Equilibrium and Appeals to Coherence