Medical Ethics Religious and Secular Ethics

Essentially this is the theory that is based upon what God deems as right is right and what God deems as wrong is wrong. What God expects of us derives from his immutable moral nature.

Thus since God’s nature is unchanging our moral obligations are fixed, unchanging, and absolute.

Scriptural Basis

Augustine believed that the divine command theory could be deduced from the scripture. That if we were to follow the Bible we would be following God’s command.

Augustine felt that the Bible was the chief source of Christian Ethics.

Natural Law Theory

Aquinas’ theory is based upon the idea that the world was created by a supremely rational being (God) and that all things created were given a specific role or purpose. And thus since good is seen as a natural end, humans are naturally inclined towards it.

Aquinas reasoned that, because God created the world and everything in it with an order and a purpose reflective of his will, by examining the nature of things we should be able to discover what God expected of us. (36)

In other words, the mental powers given by God for discerning his existence has also enabled us to discern moral law.

Aquinas argues that things that we are naturally inclined towards are good. The examples he gives us are:

1. preservation of self

2. education of offspring, reproduction of species and so forth

3. natural inclination to according to the nature of his reasoning, leading to know the truth about God, live in societies and thus follow the natural law.

The Doctrine of Double Effect

The principle of double effect recognizes that sometimes it is permissible to bring about, as a merely foreseen side effect, a harmful event that it would be impermissible to bring about intentionally.(37)

The Doctrine of Double Effect (cont.)

Specifically , under the doctrine of double effect, a harmful effect is permissible if and only if:

1. the act itself is morally good or neutral;

2.only the good effect of the act is intended directly;

3. the bad effect of the act is not the means for achieving the good effect;

4. the good effect outweighs the bad effect.

Ordinary vs. Extraordinary measures

Ordinary refers to all reasonable and beneficial medicines and treatments that can be obtained and used without excess burden on the patient.

Extraordinary refers to all medicines and treatments that can be obtained or used only with excessive burden to the patient or ones that wouldn’t offer the patient reasonable hope of benefit.

According to the ordinary/extraordinary distinction, a patient is not morally obligated to use any means, natural or artificial, that does not offer a reasonable hope of curing the patient’s condition. (37)

Self-evidence of Natural Law

Aquinas’ said that “a thing is said to be self-evident in two ways: first, in itself; secondly, in relation to us. Any proposition is said to be self-evident in itself, if its predicate is contained in the notion of the subject…”

For example: Man is a rational being. This idea is self-evident in the fact that men can reason and thus are rational by nature.

The second way takes the practical reasoning of man to be self-evident. In other words without the ability and knowledge of the subject nothing is self-evident about it. But since we have these abilities they become self-evident, such as the ideas of good and evil.

Secular Natural Law

John Locke’s formulation of natural law theory is based on our observations of nature itself.

Locke derived certain inalienable rights which flowed from nature’s laws, those being life and liberty.

He said that it was precisely and only to protect these natural rights and ensure equal treatment against the threats to them posed by conflicting and unrestrained self-interests that people formed societies. (38)

Legal and Moral Rights

Legal rights are those that we retain under a government. The right to vote for example.

Moral rights (human rights) refer to those that we hold on the basis of our humanhood.

Whereas a legal right is derived from law or a legal system, a moral right is derived merely from being a human being. (38)

Social Contract Theory

Idea put forth by Thomas Hobbes – It is the claim that it is the people who bring the state or government into being to secure and promote their basic rights and well-being. Empowering civil authority to spell out legal rights based on natural or moral rights, presumably to ensure the requisite mutual trust for the social cooperation needed to protect those rights. (39)

Essentially, we all agree to live together to maintain our personal rights and in order to do this we give up control of certain rights to ensure the preservation of the others.

Kantian Ethics

Believed that there all duties could be derived from the categorical imperative. We may only act and are bound to act in such a way that it doesn’t violate either premise of the theory.

Kant claims that there is only one thing that is good without qualification: good will.

“a good will is not good because of what it effects or accomplishes –because of its fitness for attaining some proposed end: it is good through its willing alone – that is, good in itself.”

Moral Choice

According to Kant, by telling us what to do…reason enabled us to go beyond natural instinct and narrow self-interest. Reason told us what principles of action had the force of an unconditional moral duty, …one that is universal and absolute; one that always applied, unexceptionally to all rational creatures. (42)

He termed this universal basis of moral obligation the categorical imperative.

The Categorical Imperative

Two formulations of the theory:

Principle of Reciprocity – “act only on that maxim through which you can at the same time will that it should be universal law”

Principle of Humanity – “act in such a way that you will always treat humanity never simply as a means, but at the same time as an end.”

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