Bioethics goes beyond the traditional doctor-patient relationships and instead critically examines and reflects on ethical issues. Bio-ethics is not the development of a code but a better understanding of the issues. It asks deep philosophical questions regarding the nature of ethics and embraces public policy and the direction of science. Therefore bioethics focuses on dealing with the moral issues that come up in particular cases. Ethical theories on the other hand deal with the standards and principles of moral reasoning and these in turn are applied as a rule to particular cases.
The relationship between bioethics and ethical theory? I have differentiated the distinction between bioethics and ethical theory but now I will discuss how they relate to each other when trying to solve practical problems. There have been three models put forward that illustrate the ways, which they can both relate to each other. These are “the straightforward application model”, “the physics /car mechanic model” and the “biology/ medicine model”. I will look at each of these approaches referring them to utilitarianism where possible.
The “straightforward application model” takes the ethical theory to be the starting point and applies the theory to the case in hand in order to reach the conclusion of action to be taken. However this model has been rejected on the basis that we should not just be asking what a particular theory says but asking what really is best. Utilitarianism can often lead to revolting, ridiculous and immoral situations when applied practically with the agent having to continually calculate what decision to make. This leads to the most serious difficulty, which is the inability to know what will come of are deeds, we can only know what might happen with reference to probability and this itself is littered with insufficient availability of information, human error and self-deception.
Some say ethical theories tend to be too abstract and bioethics is too complicated to be codified into a set of rules and answered by simply applying an ethical theory. This model seems to take the relationship between bioethics and ethical theory as a one-way affair. As Anne Maclean said in her book2 “Philosophy does not deliver a verdict upon moral questions”
“The physics/ car mechanics model” uses the analogy of the relation between physics and automobile repair to illustrate the relationship. It states you don’t need to know physics to be a good mechanic or apply physics to fix cars. In the same way it suggests you don’t need to know or use an ethical theory or refer to an ethical theory to resolve bioethical problems. Therefore this is a different conception of the relationship between bioethics and ethical theory. This approach instead focuses on case studies, which investigate actual events to see how they can practically resolve particular circumstances. These studies can then be used as a guide in order to make mid level principles to be used in future cases and therefore they do not need to rely or refer to abstract theories of morality.
However the problem here is that theoretical issues always crop up in which we need reference to ethical theories in order to understand and attempt to resolve the issues at hand. For example if we talk about abortion it is essential to discuss the nature of personhood. (Maybe a utilitarian example here instead) Therefore in ethical issues we can’t escape reference to ethical theories when making decisions. There is also the problem of conflicts between med-level principles, this is a problem in deciding which one to use and which one is right. Therefore the moral conclusions found in books and article written by bioethicists are the opinions they hold, upon the matters they discuss. As bioethicists James Rachel’s said, “do we trust arguments, and follow them wherever they lead, or do we trust our intuitions and reject argument when it does not lead in the ‘right’ direction”
The biology/ medicine model seems to be the most satisfactory model in understanding the relationship between ethical theory and bioethics. The analogy states that a physician, who knows both medicine and biology, is more capable of treating the patient in hand rather than a physician who treats patients with just the toolbox of the knowledge of medicine.
This model is illustrating that bioethics do not operate independently of ethical theory but neither can an ethical theory just be applied to particular cases. There seems to be a marriage in the relationship between the two, they contribute to each other and flow from each other Rawls described this as a “reflective equilibrium” between observation and theory, that is both theory and observation respond cohesively to each other. In other words normative ethics are tested out practically in situations and then the ethical theory can be tuned, improved or changed. (Practical example of utilitarianism)
Finding the right action? To People who are capable of expressing and acting by and to moral decisions, there is more that is involved in that decision than simply focusing and hoping for good consequences or understanding how ethical theories fit in practically, my point is we all want to do the right decision but finding what the right decision could be is a different matter? We all like good consequences at the end of are action and behavior; this is the fruit of what we will see and the satisfaction if the result is pleasing.
However as W.D. Ross pointed out there would seem to be different combinations of behaviors3 which determines different degrees to what a right action could be. People, who have a tendency to do certain actions4 where the motive is good, will more often produce acts5 where the consequence of the results are ‘right acts’ for that specific situation. In order to achieve correct motives we therefore need good individual virtue, Aristotle claimed these were achieved through a disposition to observe some mean relative to us.
Therefore utilitarianism could be viewed as shallow because it does not take into account the action, which is affected by the virtue of that person and instead just focuses on the act or consequence. In all ethical decisions there is an agent, which does an action with certain motive behind it and which results in a consequence. However in defense of utilitarianism recent versions of rule utilitarianism have held that a certain virtuous character guides right action because that character is needed to assess the correct rules that should be established, the correct moral rules are shown by their consequences as opposed to individual acts themselves. People have objected here because it would seem utilitarianism slipping into deontological framework and moving away from consequences.
However all Ethical decisions are made with thoughts and considerations to the consequences of the agent’s action, when people make decisions they are always thinking how their decision will work out and affect the people involved. However with utilitarianism there need not be reference to the character or the motive of the individual when making a decision. The outcome of this is when individually people act within the ethical moral framework of utilitarianism, despite seemingly good consequences for the majority, the individual health care worker has acted immorally. I will highlight practical problems of Utilitarianists theory within healthcare.
Practical problems. John Harris’s ‘survival lottery’ emphasizes the impracticality of utilitarianism used solely as an ethical principle when he discusses the possibility of introducing a random organ donation lottery. This is where individuals would be selected to donate their organs because those organs could be used in order to save two or more people and therefore it is giving the greatest happiness to the greatest number.
The question with the ‘survival lottery’ is should this resource be available for a supply of life. Doctors are they’re to prevent death and promote health by using the adequate resources available, but if the resource for treatment or antidote is not available there is nothing that can be done.
A utilitarianism would have to agree that the survival lottery would produce more happiness overall – on condition they prove the lives saved would create more happiness than stress given to society for effectively being on death row. It does however create seemly immoral conduct for doctors, forcing them to be life’s judges as they select innocent people for sacrifice. Harris pointed out that the survival lottery would not be available for those who had brought misfortune on themselves, however the downfall of this point is that it is impossible to differentiate what counts as a deserving case and document people’s lives effectively enough for this purpose.
However the question is would the case be different if someone was willing to give the life of himself or herself or someone else in order to help save others? This was the problem of the case of Theresa Ann Campo Pearson in 1992, born without a brain and the parents aware that she would not live long and never have a conscious life decided to donate her organs to children who could benefit. Florida law however forbid this and so baby Theresa died 9 days later as well as the other children who could have benefited from her organs. A Utilitarianism would argue that baby Theresa organs should be given to provide other people life, Bioethicists however at the time argued that it would have been unethical to kill in order to save and that it is wrong to use people for other people’s ends. However in war people are fighting for our behalf and for maybe our lives, often giving themselves up for our end.
No doubt the survival lottery can easily be broken down on our intuition that it is wrong to force people to give their lives in order to save. However if the parties involved are willing like in babies Theresa’s case and some good can be born out of a hard situation it would seem like a good idea. However if this practice became common to kill in order to preserve, people might start demanding that consent be given to help people who they say could benefit more by staying alive than others. In baby Theresa’s case it is easy to see both sides of the coin, it seems unethical but it would save lives, these are the problems facing health care workers.
A major problem for health care workers seeking to uphold utilitarianism is the issue of trying to find a criterion of what can count as the happiness for the greatest number. We know the premise of utility is simple and this is its attraction but meta ethical questions are important. We need to define what it means and what it would take to be happy and what counts as degrees of happiness. This raises many questions, for example who has the right to health care? Does someone’s age come into the enjoyment that can be produced? Are we to spread the limited resources around and benefit more people or concentrate resources to an individuals needs as we recognize everyone’s right to health?
Quality adjusted life years (QALY) is a concept which is used to see how societies resources can be used to benefit patients lives, one year of good quality life is a QALY. Therefore this system identifies the physical, social and psychological aspects of the quality of a person’s life and then the cost per QALY can be ranked and used for resource allocation. As with utilitarianism one unit of QALY is of equal benefit no matter who enjoys it.
A utilitarian would want to produce as many QALY’s as possible while using up as little resources as possible, which means the people with the most needs will be left without health care as the ones who can be cheaply cured take precedent. The problem with the idea of a right to health care is such a right is a bottomless pit because there is not an unlimited resource available so we need to be selective. Does this mean we have to select who would benefit the most at the cheapest cost; a Utilitarianist would have to say yes and agree that not everyone has the right to health care.
Therefore it seems when individuals uphold an ethical theory such as utilitarianism religiously the consequences become immoral. Ethical decisions are therefore made by the individual’s own experience and related to their own compassion. This is the uniqueness of the human race that we have a consciousness that can not be explained through theorizing and instead we can recognize when something isn’t right.