Ethical Theories and Basic Moral Principles

Drs. Uki Dwiputranto, Grad.Dip.Sc., M.Sc

ETHICAL THEORIES (teori Etika)

Bioethics (bioetika)

Ethical Theories (teori

etika) deals with moral issues that

come up in particular cases.

deals with standards and

principles of moral reasoning.

Ethical theory is the starting point, and we apply the theory to the case at hand in order to reach a conclusion

about what should we done.

Kamu salahAku yang paling tua pasti paling benar LOGIKA-nya..!

Dalam memperdebatkan masalah-masalah lingkup ethics/ bioethics, harus diikuti dengan sikap terbuka bahwa setiap hal yang dipercayai sebagai ‘kebenaran’ (truth) adakalanya suatu saat harus direvisi ( no beliefs is immune to revision ).

Dengan kata lain suatu kebenaran baru dapat diyakini setelah dilakukan penyesuaian disana-sini.

Jadi aku pasti salah

dong..!

Setiap kita menetapkan kebenaran moral yang

kita yakini, sering terlebih dahulu diuji

dengan pandangan yang nyata di masyarakat

atau di dunia.

Dalil urutan logika TIDAK selamanya

dapat diterapkan secara utuh dalam

menilai moralitas (Quine, 1970)

1. Menyebabkan kematian (membunuh) sesama manusia = tidak sesuai dengan nilai moral.

2. Setiap embrio manusia = manusia juga.

3. Wanita yang menggugurkan kandungannya = membunuh embrio.

4. Jadi, wanita tersebut = membunuh manusia.

5. Kesimpulan: wanita tersebut melakukan perbuatan yang tidak sesuai dengan nilai-nilai moral. Fact..... !

Fact..... !Adakalanya kita berhadapan dengan kesimpulan atau kenyataan

yang menurut urutan logika tidak dapat diterima.

Why..... ?Selalu ada perkecualian-perkecualian (exception) yang dapat

diterima (acceptable) karena masalah yang dihadapi dalam

kehidupan selalu berkait dengan masalah lain yang juga punya

nilai-nilai moral yang diakui.

Example........................?

Example..... ?• Tindakan aborsi untuk menyelamatkan si-ibu dibolehkan karena

tindakan menyelamatkan si-ibu pun bermoral (tinggi).

Perlu menyusun logika baru yang berbeda

Misal:

Benarkah embrio sudah dapat

dikatakan sebagai manusia....?

Karena tidak semua embrio yang

terbentuk (via teknologi in vitro) dapat

dikembalikan ke rahim ibunya.

Tidak Mudah

so…

1. Deontology = non-consequencialist.

Penilaian benar/ tidaknya, baik/ tidaknya suatu perbuatan tidak perlu dilihat akibat/ hasil akhirnya. Yang dinilai adalah perbuatannya itu sendiri, bukan hasilnya.

Contoh: ketaatan kepada perintah Tuhan

(Imanuel Kant, 1724-1804): kewajiban seseorang untuk berbuat baik dapat dijelaskan secara rasional dan tidak harus selalu bersifat dogmatis.

2. Teleology = consequencialist.

• Ethical egoism: kewajiban berbuat baik karena demi kepentingannya sendiri.

• Utilitarianism*): kewajiban berbuat baik adalah demi kepentingan semua fihak dan masyarakat (in any

situation we should do what will have the best overall consequences for everyone concerned.)

Baik/ buruknya, benar/ salahnya seseorang dinilai dari tujuan yang hendak dicapai. Menurut aliran ini setiap manusia wajib berbuat sesuatu untuk tujuan yang baik.

DOING GOOD dan DO NO HARM/ PRIMUM NON NOCERE

TujuaTujuann

Menunjukkan bagaimana teori etik mampu menjelaskan Menunjukkan bagaimana teori etik mampu menjelaskan masalah-masalah masalah-masalah health carehealth care dan membantu mengatasi dan membantu mengatasi terbatasnya formula dari masa lalu mengenai terbatasnya formula dari masa lalu mengenai tanggungjawab etis.tanggungjawab etis.

Unreasonable to expect any theory to overcome all limitations of time & place, and reach a

universally acceptable perspective.

The moral duties of the doctorThe moral duties of the doctor

• The duty to help, cureThe duty to help, cure• The duty to promote and protect the The duty to promote and protect the

patient’s healthpatient’s health• The duty to informThe duty to inform• The duty to confidentialityThe duty to confidentiality• The duty to protect the patient’s lifeThe duty to protect the patient’s life• The duty to respect the patient’s autonomyThe duty to respect the patient’s autonomy• The duty to protect privacyThe duty to protect privacy• The duty to respect the patient’s dignity The duty to respect the patient’s dignity

The moral rights of the patientThe moral rights of the patient

• The right to high quality medical serviceThe right to high quality medical service• The right to autonomous choiceThe right to autonomous choice• The right to decideThe right to decide• The right to be informedThe right to be informed• The right to privacyThe right to privacy• The right to health educationThe right to health education• The right to dignityThe right to dignity

1.1. AutonomyAutonomy (respect (respect forfor autonomy)autonomy) respecting the decision making capacitiesrespecting the decision making capacities

2.2. JusticeJustice distributing benefits, risks, & costs fairlydistributing benefits, risks, & costs fairly

3.3. BeneficenceBeneficence providing & balancing benefits against risks & providing & balancing benefits against risks & costscosts

4.4. NonmaleficenceNonmaleficence avoiding the causation of harmavoiding the causation of harm

4-BASIC MORAL PRINCIPLES

1. Autonomy1. Autonomy “ “self-rule” (Greek) self-rule” (Greek) rightright of of

individuals to make choicesindividuals to make choices See that people are differentSee that people are different

Personal choicesPersonal choices

Respecting people as equal persons Respecting people as equal persons with their own set of valueswith their own set of values a duty to let people make their own a duty to let people make their own choiceschoices corresponding responsibilities of corresponding responsibilities of individuals towards societyindividuals towards society

Autonomous actionAutonomous action

We analyze autonomous action in terms of persons We analyze autonomous action in terms of persons who actwho act

• IntentionallyIntentionally• With understanding With understanding • Without controlling influences that determine their Without controlling influences that determine their

actionaction

To respect an autonomous agentTo respect an autonomous agent

is to acknowledge that person’s rightis to acknowledge that person’s right to hold views, to to hold views, to make choices, and to take actions based on personal make choices, and to take actions based on personal values and beliefs.values and beliefs. Such respect involves Such respect involves respectful actionrespectful action, , NOTNOT merely a respectful merely a respectful attitudeattitude. Respect involves . Respect involves treating persons to enable them to act autonomously, treating persons to enable them to act autonomously, whereas disrespect for autonomy involves attitudes and whereas disrespect for autonomy involves attitudes and actions that ignore, insult, or demean others’ autonomy actions that ignore, insult, or demean others’ autonomy and thus deny a minimal equity to persons.and thus deny a minimal equity to persons.

Simple meanings

• Self governance• Liberty right• Privacy• Individual choice• Freedom of the will

• If you visit a doctor do you make treatment decisions on your own or in discussion with other family member, and the doctor

• What factors could we use to make such decisions in our daily lives ?

• When we make decisions for ourselves do we also have responsibility for what happens ?

2. Justice2. Justice Autonomy is limited by balancing desires with Autonomy is limited by balancing desires with

respect for the autonomy of other individualsrespect for the autonomy of other individuals Justice = fairness = equityJustice = fairness = equity

equality in access to health careequality in access to health care Problems:Problems:

- Scarce resources/treatments for patients- Scarce resources/treatments for patients- Socioeconomic situation of patient & families- Socioeconomic situation of patient & families- Healthcare system & healthcare budget- Healthcare system & healthcare budget

The concept of justiceThe concept of justice

The terms fairness, desert (what is deserved), and The terms fairness, desert (what is deserved), and entitlement (that to which one is entitled) have been entitlement (that to which one is entitled) have been used by various philosophers in attempts to explicate used by various philosophers in attempts to explicate justice. These accounts all interpret justice as fair, justice. These accounts all interpret justice as fair, equitable, and appropriate treatment in light of what is equitable, and appropriate treatment in light of what is due or owed to person. due or owed to person.

Principles of distributive Principles of distributive justicejustice

• To each person an equal share (formal To each person an equal share (formal equity)equity)

• To each person according to needTo each person according to need

• To each person according to To each person according to efforteffort

• To each person according to contributionTo each person according to contribution

• To each person according to meritTo each person according to merit

• To each person according to free-market To each person according to free-market exchangesexchanges

3. Beneficence 3. Beneficence

Beneficence Beneficence attempt to do good attempt to do good

Balance doing good >< risk of Balance doing good >< risk of

doing harmdoing harm

Tools: - risk assessmentTools: - risk assessment

- cost-benefit analysis- cost-benefit analysis

Cases where beneficence >< Cases where beneficence ><

autonomy? autonomy?

Moralitas TIDAK HANYA kita menjamin autonomy dan menahan diri dari menimbulkan bahaya/ kerugian (harm), tapi juga harus memberi kontribusi bagi kesejahteraannya (welfare).

• Pikirkan/ diskusikan tentang sebuah kasus dimana kita memerlukan keseimbangan antara benefit (kebaikan/ keuntungan) dari suatu tindakan yang membatasi autonomy seseorang untuk menentukan pilihan bebasnya.

• Pikirkan/ diskusikan tentang kemungkinan penggunaan sebuah teknologi kedokteran baru, dan identifikasikan “benefits” dan “risks”-nya.

4. Nonmaleficence 4. Nonmaleficence • Precise outcome not always Precise outcome not always

certain!certain!• Uncertainty Uncertainty risk of failure? risk of failure?

chance of chance of success?success?

• Try to minimize or avoid doing Try to minimize or avoid doing harmharm

• Failure to attempt to do goodFailure to attempt to do good

Form of doing harmForm of doing harm

Examples of risky technology?Examples of risky technology?

Nonmaleficence and Nonmaleficence and beneficencebeneficence

The principle ofThe principle of nonmaleficence nonmaleficence asserts an obligation asserts an obligation not to inflict harm intentionally. Principles ofnot to inflict harm intentionally. Principles of beneficencebeneficence potentially demand more than the principle potentially demand more than the principle of nonmaleficence, because agents must take of nonmaleficence, because agents must take positive positive stepssteps to help others, not merely refrain from harmful to help others, not merely refrain from harmful acts.acts.

Prinsip nonmaleficence: wajib mencegah “harm” secara sengaja.

( Primum non nocere : above all (or at first) DO NO HARM)

Nonmaleficence Beneficence

• One ought NOT to inflict evil or harm

• One ought to prevent evil or harm

• One ought to remove evil or harm

• One ought to do or promote good

Nonmaleficence

1. Do not kill

2. Do not cause pain

3. Do not incapacitate others

4. Do not cause offense to others

5. Do not deprive others of the goods of life

Dapatkah Anda pikirkan tentang sebuah teknologi yang diduga terlalu berisiko untuk digunakan sekarang ? Bila dapat, pikirkan pula teknologi mutakhir yang telah kita gunakan untuk hal yang sama. Ingat lagi ke belakang apakah teknologi mutakhir ini juga menimbulkan “harm” ?

ReferencesReferences

1.1. Beauchamp, T.L., Childress J.F. Principles of Beauchamp, T.L., Childress J.F. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994.Press, 1994.

2.2. Lo, B. Resolving Ethical Dilemmas. Baltimore: Williams Lo, B. Resolving Ethical Dilemmas. Baltimore: Williams & Wilkins, 1995.& Wilkins, 1995.

3.3. Jonsen A.R., Siegler, M., Winslade, W.J. Clinical Jonsen A.R., Siegler, M., Winslade, W.J. Clinical Ethics, 5th ed. New York: McGraw-Hill, 2002.Ethics, 5th ed. New York: McGraw-Hill, 2002.

4.4. WHO Regional Office for South-East Asia. Health WHO Regional Office for South-East Asia. Health Ethics Teaching Guidelines for the SEAR Countries. Ethics Teaching Guidelines for the SEAR Countries. New Delhi, 2002.New Delhi, 2002.

5.5. Steinbock, B. The Oxford Handbook of Bioethics. Steinbock, B. The Oxford Handbook of Bioethics. Oxford University Press. 2007.Oxford University Press. 2007.