Real-Life Ethical Dilemmas
Examine the case of Baby Boy Doe (Darr, 2011, p. 16.) The objective of this assignment is to get you to think critically about real-life ethical dilemmas and the moral principals involved. There is no right or wrong answer, just try to look at this case subjectively. Most of the time, resolving ethical dilemmas is not so “black and white.” Discuss arguments for and against the issues below
1. Discuss what makes this an ethical dilemma (read pp. 3 and 4).
2. Discuss the implications of this study in terms of the moral principles described in chapter 1.
Here are some questions that may guide your thinking:
Respect for persons: Did the hospital/ physicians allow the parents to be autonomous in their decision-making? Do you see any elements of paternalism on behalf of the physicians?
Beneficence: Did the hospital/ physicians act beneficently?
Nonmaleficence: Did the hospital/ physicians consider nonmaleficence?
Justice: Did the hospital act in a just way?
3. Finally, do you think that the hospital did all that it could in this situation? Did it act appropriately? Explain.
Assignments are to be a minimum of 2 full pages of text and 3 reputable references in proper APA format.
Reference: Darr, K. (2011). Ethics in Health Services Management. (5th Edition). Baltimore, MD: Health Professions Press, Inc
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CHAPTER 1
CONSIDERING MORAL PHILOSOPHIES AND PRINCIPLES
hat sources guide us in ethical decision making? How do they help us identify and act on the morally correct choice? Philosophers, theologians, and others grapple with such
questions. The clearest tradition of ethics in Western medicine dates from the ancient Greeks. Throughout the 20th century and into the 21st century, managers and nurses have formally sought to clarify, establish, and, sometimes, enforce ethical standards. Their codes and activities incorporate philosophies about the ethical relationships of providers to one another, to patients, and to society. For managers, the appropriate relationship with the organizations that employ them is an added dimension of their codes.
A natural starting point for discussing ethics and understanding how to resolve ethical problems is to review the moral philosophies that have had a major influence on Western European thought and values. Among the most prominent of these philosophies are utilitarian teleology; Kantian deontology; natural law as formulated by St. Thomas Aquinas; and the work of the 20th-century American philosopher John Rawls. The latter part of the 20th century saw renewed interest in casuistry and virtue ethics. Its emphasis on the individual makes virtue ethics especially helpful in guiding action for managers. In addition, the ethics of care is considered briefly.
Principles derived from these moral philosophies provide the framework or moral (ethical) underpinnings for delivery of health services by organizations. These principles will assist managers (and health services caregivers) in honing a personal ethic. The derivative operative principles are respect for persons, beneficence, nonmaleficence, and justice. Virtue ethics stands on its own as a moral philosophy; also, it helps supplement the principles when they lack rigor in analyzing or solving ethical problems.
The following case about Baby Boy Doe is true. State and federal law would prevent it today. Its simplicity and starkness make it a useful paradigm against which to apply the moral philosophies and derivative principles discussed in this chapter.
Baby Boy Doe In 1970, a male infant born at a major East Coast medical center was diagnosed with mental retardation and duodenal atresia (the absence of a connection between the stomach and intestine). Surgeons determined that although the baby was very small, the atresia was operable, with a high probability of success. The surgery would not alter the baby’s mental retardation, but would permit him to take nourishment by mouth.
The baby’s parents decided to forego the surgery—something they had the legal right to do—and over the course of the following 2 weeks, the infant was left to die from dehydration and starvation. No basic determination of the extent of mental impairment had been made, nor could it have been, at the time the infant died. Neither hospital personnel nor state family and social services sought to aid him.
Darr, K. (2011). Ethics in health services management, fifth edition. Retrieved from http://ebookcentral.proquest.com Created from apus on 2020-05-04 08:57:50.
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This case sends a shudder through most people. Feelings or emotions, however, are insufficient. If managers are to be effective in addressing and solving—or, preferably, preventing—such problems, they must identify and understand the issues involved, know the roles of staff and organization, and apply guidelines for ethical decision making. Following a discussion of moral philosophies and ethical principles, the case of Baby Boy Doe is analyzed.
MORAL PHILOSOPHIES
Utilitarianism
Utilitarians are consequentialists: They evaluate an action in terms of its effect rather than the action’s intrinsic attributes. Synonymous with utilitarians are teleologists (from the Greek telos, meaning end or goal). Utilitarianism has historical connections to hedonism (Epicureanism), which measured morality by the amount of pleasure obtained from an act or a rule as to how to act—greater pleasure was equated with greater morality. This theory was refined by two 19th-century English philosophers, Jeremy Bentham and John Stuart Mill. Mill’s elaboration of utilitarianism was the most complete. Unlike Bentham, Mill sought to distinguish pleasures (the good) on qualitative grounds. Questions about the superiority of certain pleasures, such as listening to a piano concerto, were to be answered by consulting a person of sensitivity and broad experience, even though requiring such judgments diminished the objectivity of utilitarianism. Mill stressed individual freedom. In On Liberty, he noted that freedom is requisite to producing happiness and that this makes it unacceptable for the rights of any group or individual to be infringed in significant ways.
In determining the morally correct choice, utilitarians ignore the means of achieving an end and judge the results of an action by comparing the good produced by a particular action to the good produced by alternatives or the amount of evil avoided. Modified utility theory is the basis for the cost–benefit analysis commonly used by economists and managers. “The greatest good for the greatest number” and “the end justifies the means” are statements attributable to utilitarians. However, these statements are only crude gauges of utilitarianism, inappropriately applied without qualification.
Utilitarianism is divided into act utility and rule utility. Both measure consequences, and the action that brings into being the most good (understood in a nonmoral sense) is deemed the morally correct choice.
Act utilitarians judge each action independently, without reference to preestablished guidelines (rules). They measure the amount of good, or (nonmoral) value brought into being, and the amount of evil, or (non-moral) disvalue avoided by acting on a particular choice. Each person affected is counted equally, which seems to assign a strong sense of objectivity to this moral philosophy. Because it is episodic and capricious, act utilitarianism is incompatible with developing and deriving the ethical principles needed for a personal ethic, organizations’ philosophies, and codes of ethics. Therefore, it receives no further attention.
Rule utilitarians are also concerned only with consequences, but they have prospectively considered various actions and the amount of good or evil brought into being by each. These assessments are used to develop rules (guidelines) for action, because it has been determined that, overall, certain rules produce the most good and result in the least evil or “un-good.”
Darr, K. (2011). Ethics in health services management, fifth edition. Retrieved from http://ebookcentral.proquest.com Created from apus on 2020-05-04 08:57:50.
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Therefore, these rules determine the morally correct choice. The rules are followed for all similar situations, even if they sometimes do not produce the best results. The rule directs selection of the morally correct choice. Rule utilitarianism assists in developing moral principles for health services management. Following Mill, however, it must be stressed that the underlying context and requirement is that liberty be maximized for all.
Deontology
Deontologists adhere to a formalist moral philosophy (in Greek, deon means duty). The foremost proponent of deontology was Immanuel Kant, an 18th-century German philosopher. Kant’s basic precept was that relations with others must be based on duty. An action is moral if it arises solely from “good will,” not from other motives. According to Kant, good will is that which is good without qualification. Unlike utilitarians, deontologists view the end as unimportant, because, in Kant’s view, persons have duties to one another as moral agents, duties that take precedence over the consequences of actions. Kantians hold that certain absolute duties are always in force. Among the most important is respect, or the Golden Rule (“Do unto others as you would have them do unto you”). Kant argued that all persons have this duty; respect toward others must always be paid.
Actions that are to be taken under the auspices of this duty must first be tested in a special way, a test Kant termed the categorical imperative. The categorical imperative requires that actions under consideration be universalized. In other words, if a principle of action is thought…
