Choose two of the four ethical viewpoints we have considered – utilitarianism, r

Question

Choose two of the four ethical viewpoints we have considered – utilitarianism, respect for persons, care or the ethics of virtue – Show how each of your chosen viewpoints highlights slightly different aspects of each situation as being morally significant. Finally, what conclusions do each of your chosen viewpoints lead you to in this situation… and why? 3~4 pages please!

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After the car he is driving collides at high speed with a telephone pole, Mr. D.* is brought in to the hospital emergency room in serious condition. The physicians who examine him recommend surgery to repair a serious internal hemorrhage. But the 66 year old man refuses, saying that he “wants to be left alone to die.” The physicians also learn that three weeks earlier Mr. D. was diagnosed as having carcinoma of the tongue. He has refused surgery for this cancerous lesion and has asked his own physician not to tell his wife that he has a fatal disease.

The hospital physicians believe that Mr. D. will die without surgery for the hemorrhage, and they call in a psychiatric resident to evaluate the patient. Dr. Moore interviews Mr. D. and finds him coherent, rational and alert. Mr. D. describes himself as a man who values his independence. He feels that he has had a satisfactory professional life as an engineer, and a good personal life with his wife and two children (who are now grown). He expresses some sadness at his situation, but says “I have had a good and full life, but now it’s over.”

Dr. Moore suggest, and Mr. D. does not deny, that the automobile accident was I n fact a deliberate attempt at suicide. What should Dr. Moore recommend? That the patient’s refusal of treatment for immediate surgery should be accepted as the act of a rational person? Or that the refusal of treatment should not be honored, and a court order should be sought on the grounds that a presumed suicide attempt is prima facie evidence of mental illness (and impaired decision making)?

*Since this is an actual medical case, the identity of the patient is masked to preserve confidentiality.”

Explanation / Answer

Utilitarianism

Utilitarianism is an ethical theory which states that the best action is the one that maximizes utility. "Utility" is defined in various ways, usually in terms of the well-being of sentient entities. Jeremy Bentham, the founder of utilitarianism, described utility as the sum of all pleasure that results from an action, minus the suffering of anyone involved in the action. Utilitarianism is a version of consequentialism, which states that the consequences of any action are the only standard of right and wrong. Unlike other forms of consequentialism, such as egoism, utilitarianism considers the interests of all beings equally.

Proponents of utilitarianism have disagreed on a number of points, such as whether actions should be chosen based on their likely results (act utilitarianism) or whether agents should conform to rules that maximize utility (rule utilitarianism). There is also disagreement as to whether total (total utilitarianism) or average (average utilitarianism) utility should be maximized.

Though the seeds of the theory can be found in the hedonists Aristippus and Epicurus, who viewed happiness as the only good, the tradition of utilitarianism properly began with Bentham, and has included John Stuart Mill, Henry Sidgwick, R. M. Hare, David Braybrooke, and Peter Singer. It has been applied to social welfare economics, the crisis of global poverty, the ethics of raising animals for food and the importance of avoiding existential risks to humanity.

Respect for persons

Respect for persons is the concept that all people deserve the right to fully exercise their autonomy. Showing respect for persons is a system for interaction in which one entity ensures that another has agency to be able to make a choice.

This concept is usually discussed in the context of research ethics. It is one of the three basic principles of research ethics stated in the Belmont Report issued by the Office of Human Subject Research; it comprises two essential moral requirements: to recognize the right for autonomy and to protect individuals who are disadvantaged to the extent that they cannot practice this right.

An autonomous person is defined as an individual who is capable of self-legislation and is able to make judgments and actions based on his/her particular set of values, preferences, and beliefs. Respecting a person’s autonomy thus involves considering his/her choices and decisions without deliberate obstruction. It also requires that subjects be treated in a non-degrading manner out of respect for their dignity. In practice, respect for persons is operationalized by obtaining Informed Consent from all individuals who are going to be research subjects.

Vulnerable populations

The standard case for applying respect for persons is when the person receiving the health intervention is of sound mind, fit to make personal decisions, and empowered to choose from various options. Other cases involve showing respect to people who for whatever reason are not free to choose among the typical range of options when making a decision.

In medical research ethics, the term Vulnerable Populations generally refers to individuals whose situations do not allow them to protect their own interests. The categories of individuals that constitute Vulnerable Populations are outlined under The Common Rule (45 CFR 46, Subparts A-D). These include individuals who are minors, prisoners, pregnant, physically handicapped, mentally disabled, old, economically disadvantaged, educationally disadvantaged, or subordinates in hierarchical groups (e.g. a soldier).

These individuals are entitled to protection, and additional ethical justification is needed to involve such populations in human subject studies. In such cases, a balance should be established between protecting subjects from exploitation and depriving these subjects of access to the potential benefits of research.

Reasons justifying the participation of these subjects would include that some studies could not be carried out without a vulnerable population. Another justification would be that the aim of the study is to gain knowledge to improve diagnosis, prevention or treatment of diseases associated specifically with that population.

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