COURSE NOTES – HG1681

UNIT 2 DECISION MAKING IN VALUE ISSUES AND THE WORKPLACE

Nihilism
• Believing that nothing is truly right or wrong
• The rejection of all religious and moral principles, often in the belief that life is
meaningless

Hedonism
• The pursuit of pleasure and the avoidance of pain
• Synonyms: self-indulgence, pleasure-seeking, self-gratification
• The ethical theory that pleasure (in the sense of satisfaction of desires) is the
highest good and proper aim of human life

Altruism
• Acting in the best interests of others rather than our own self-interest
• Although we often act selfishly, we also seem to be wired to cooperate with others

Standpoint Theory
• Considers those who have the most to lose when making a decision
• Remember the saying: “Walk a mile in my shoes”

Fair Opportunity Rule

• No person shall receive goods and services on the basis of undeserved advantage or
be denied goods based on undeserved disadvantage
• What does that mean?

Theories of How to Decide What is Ethical

How do we decide what we “ought” to do?

Examining Value Issues

• Three main theoretical constructs/frameworks we will use:
o Teleological (Consequence-Oriented) Theories
 What will happen if I do this?
o Deontological (Duty-Oriented) Theories
 What is my duty in this situation?
o Virtue Ethics
 What is right or wrong in this situation?
• In healthcare, this means we focus on relief from pain/suffering, getting rid of
disabling conditions, prolonging life, prevention and control of disease

Consequence-Oriented Theories (Teleological)

 • Based on predicted outcomes (what we think will happen)
• Utilitarianism (the most common form)
• Means that the right answer, the thing we should do, is the one that will maximize
the good
• Utilitarianism
• Jeremy Bentham and John Stuart Mill
• The good that exists in the promotion of happiness, or the greatest opportunity to
increase pleasure over pain (Hedonism)
• Mill expanded by instead of just focusing on physical pleasures but also on higher
order pleasures like intellectual and social enjoyments

Utilitarianism
• Jeremy Bentham used math to decide
• He gave every impact either a +  or a - 
• Morality of a decision is based on the greater number of  vs  consequences
• An immoral decision has a greater number of  and less  consequences

Utilitarianism – Two Different Styles

• Act Utilitarianism
• Rule Utilitarianism

Act Utilitarianism
• Each decision must have the consequences interpreted individually to decide
whether or not it is morally justified
• Skips any reference to principle and rules
• Morally right action is the one that brings the greatest happiness to the greatest
number of people
• Also called Hedonic calculus

An Example - Act Utilitarianism

• A medical student desperately needs 50,000QR to pay his tuition and become a
doctor
• He shoots a rich man, steals the money from his wallet, pays the tuition and
becomes a doctor
• As a doctor he saves many lives and benefits many people, only the rich man was
harmed
• The consequences benefit more people, so that the act of the shooting and stealing
is morally justified

New Rules Needed

• Because of this example, new rules were needed
 • Equal consideration of interest – one individual is not allowed to increase their share
of happiness at the expense of another
• Each person’s happiness is equally important

Criticisms of Act Utilitarianism

• Trying to predict every possible outcome to calculate the number of good or bad
results is difficult
• People may be used in order to achieve a good result

Rule Utilitarianism
• Follow a rule that leads to the greater good
• How correct a rule is depends on how much good is created by that rule
• Rules that lead to the greatest good have better results than allowing any
exceptions to that rule (changing it based on different needs)
• Tries to avoid Hedonic calculus

An Example - Rule Utilitarianism

• A medical student desperately needs 50,000QR to pay his tuition and become a
doctor
• He shoots a rich man, steals the money from his wallet, pays the tuition and
becomes a doctor
• As a doctor he saves many lives and benefits many people, only the rich man was
harmed
• However, the difference is that the rule is a doctor must do no harm – killing or
harming the rich man does not match the greater goal of helping people
• This makes the act of shooting and stealing immoral

Consequence-Oriented Reasoning
• 1. Describe the problem
• 2. List solutions
• 3. Compare solutions with their consequences. How does this work out?

Case study – Mr. Jimmy

• A 78 year old man with emphysema who has smoked two packs of cigarettes a day
for 40 years
• His doctor is demanding that he quit smoking
• He becomes very irritable and unhappy when he tries to quit
• His family hate it when he tries to quit because he is so difficult to live with

Criticisms of Utilitarianism
• Does not pay attention to whether the act is carried out with good or bad intentions
• It is impossible to calculate all possible consequences
• May be used to permit unfairness
 o Benefiting a large group’s happiness may cause sadness or harm to smaller
groups or individuals
• Lack of respect for persons
o It could be moral to use a person to achieve good (as a means to an end)
• Your own morals could disagree with the conclusion you reach
• Does not consider special duties, i.e. may permit doctors to harm patients

Duty-Oriented Reasoning
Created by Immanuel Kant - (Kantian Ethics)
• Talked about something called moral imperatives
• This simply means that you ask yourself “If everyone did what I plan to do, would it
be good?”
• Would this be the right thing to do regardless of the situation?
• No exceptions – no grey areas – very black and white thinking
• An action is either right or wrong; it can’t be both
• If it’s good, then it is good regardless of the context

Duty-Oriented Theories (Deontological)

• Rightness and wrongness depends on whether the act is the right thing to do
• The consequences do not matter
• Laws, rules would be followed even if they hurt someone
• Concerned with what people do, not with the consequences of their actions
• Do the right thing BECAUSE it is the right thing to do
• Don’t do wrong things – avoid them because they are wrong
• Example: wrong to kill innocent people, wrong to steal, wrong to tell lies, RIGHT to
keep promises
• Someone who follows duty-oriented reasoning should do the right thing, even if
that produces more harm (less good) than doing the wrong thing
• People have a duty to do the right thing, even if it produces bad results
• Example: it would be wrong to tell a lie to save a friend from a murderer

Kantian Ethics – Duty Oriented

• There are three categorical imperatives
o Universal application – this means it is everyone’s responsibility
o Unconditional
o Demands an action

Positives of Deontology
• The emphasis is on every human being
• Forms a basis for human rights
• It provides certainty for us
If the action is right you should do it – if it is wrong you should not do it
• Deals with our intentions and our motives
If the intention was good, and there is an “accident” (something goes wrong), then the
person has not done anything wrong

Criticisms of Deontology
• It sets absolute rules – no room for relativism
o Doesn’t do well with the cases where duties are in conflict
o It’s too rigid for real life – rules can’t guide us in all circumstances
• Allows acts that make the world ”less good”
• Goodness does not result from the reason alone
• Ignores consequences

Let’s Compare – Check in

• Rule utilitarianism
o Does not allow exceptions
o Based on consequences that we have found through past experiences
• Consequentialists begin by considering what things are good and identify “right”
actions as the ones that produce the most good

• Deontology
o Does not allow exceptions
o Based on duty
• Deontologists do it the other way around; they first consider what actions are
“right” and proceed from there

Virtue Ethics (Aretaic Reasoning)

• Emphasis is not what rules should be followed, but instead on helping people
develop good traits, such as kindness and generosity
• These good traits will allow a person to make correct decisions later in life
• In healthcare, each profession as a set of virtues that practitioners can adopt in
practice

Reasoning with Virtue Ethics

• Describe the problem
• List solutions
• Compare solutions with professional traditions
• Correct answer

Criticisms of Virtue Ethics

• Does not provide specific direction for problems
• New problems may require new solutions not covered by traditional practice
• Relying on tradition may not allow respect for individual choice or use of reason
• Lack of personal autonomy
• Humans may attempt to respond to several different role demands at the same time
 • Results may not maximize happiness

Key Concepts Review

• Several theoretical positions for solving ethical dilemmas
o Consequence / Utilitarian / Teleological
o Duty / Deontological / Kantian Ethics
o Virtue / Aretaic

• Act Utilitarianism
o Purest form of utilitarian reasoning, each act is evaluated for pleasure
achieved and pain avoided
• Rule Utilitarianism
o Develops rules for action based on previously supported principle of utility
(consequence)
• There is an equal consideration of interest: an important concept to keep
utilitarianism from becoming a purely self-serving form of reasoning

• Kant proposed a duty-oriented system in which morality is based on rationality, not

experience
• Consequences are essentially irrelevant
• Universal truths create obligations for actions, required for all people, for all times,
in all situations

• The primary focus for virtue ethics is doing good

• Virtues can be formed as habits, which in times of decision making, become our
choice of action

Define
• Utilitarianism
• Deontology
• Virtue Ethics
• Standpoint Theory
• Hedonic Calculus
• Nihilism
• Altruism
• Fair Opportunity Rule

The workplace
• Employers are becoming increasingly concerned about a lack of character and
positive personal values in the workplace.
 • Employees are responsible for a variety of dishonest, illegal and unethical behavior
(ALSO in Health Care)

What are Character? And Personal Values?

• Character: A person’s moral behavior and qualities
• Personal values: Things of great worth and importance to a person.
• Example: A professional that attempts to maintain honestly with patients and
coworkers has HONESTY as a Personal value

Examples of lack of character in the Workplace

• Disrespectful
• Unreliable
• Manipulative
• Dishonest (lying)
• Employees having arguments and fights
• Absenteeism (Not showing up for work)
• Negligence (Failure to perform or give care in a reasonable careful and cautions
manner)

Can you think of some example of dishonest behavior in the workplace?

• Stealing - computers, office supplies, syringes, medication & patients personal
belongings
• Falsifying information - Misrepresenting your education credentials or work
experience
• Fraudulent medical insurance claims - Billing an insurance company for a patient
procedure that never accrued
• Changing results of a research study
• Turning in a time card that is inaccurate
• Low Productivity
 Talking/ texting friends
 Social media
 Online shopping

Examples of Positive values in the workplace

• Integrity (honest and sound moral principles)
• Trustworthy
• Appreciative
• Courteous
• Dependable
• Diligent
• Generous
• Loyal
• Self-disciplined/ Truthful
Character, Personal values and Priorities

• Personal values are the beliefs and attitudes held by an individual that provide a
foundation for behavior and the way the individual experiences life.
 • Example: A imaging professional may personally value timelines and
organization, her values influence the way she makes decisions and
judgement
• Our character, Personal values and priorities influence and guide us in our
daily life at home and at work

Steps to making ethical decision

• Step 1 – Identify the characteristics of the problem

o Who are the concerned parties? Who should make the decision?

• Step 2 – Gather the facts of the case

o What is fact? What is opinion? Legal implications? Has the issue been
decided by courts before?

• Step 3 – Examine the options

o What are the option? The more option the more likely to find a
solution you support

• Step 4 – Weigh the potential options

o What happens to the individual in each option? Has everyone been

considered equally? Which principles are favored or sacrificed? What
ethical system will you use?

• Step 5 – Make your decision and act on it

• Step 6 – Access and evaluate the results