MODULE 9 - Reason and Impartiality As Requirements For Ethics

 

ETH 101- ETHICS

LECTURE/ HANDOUT 9- REASON AND IMPARTIALITY IMPARTIALITY AS REQUIREMENTS REQUIREMENTS FOR ETHICS

OBJECTIVES:  At the end end of lecture lecture handout handout 9, the the student student will be able to:       

awaken awareness that genuine moral or value judgments ought to be backed by pertinent reasons. instill the desire to possess the value of impartiality demonstrating personal feelings or inclinations that should be suppressed if necessary. understand the philosophy of reason as the basis or motive for an action, decision, or conviction, and be able to apply it in real life with a stable knowledge of what it is. analyze how the 7-Step Moral Reasoning Model can help in the use of reason and impartiality in deciding moral matters. identify principles that have a bearing on the case. determine the ethical issues. assess the consequences, both negative and positive of each decision.

INTRODUCTION/OVERVIEW  Humans have not only feelings but also reason, and reason plays an important role in Ethics as it is a moral truth.  Reason spells the difference of moral judgments from mere expressions of personal preference.  Moral deliberation is a matter of weighing reasons and being guided by them.  Being defined by good reasons, moral truths are objective in the sense that they are true no matter what we might want or think.    

The idea that each individual’s interest and point of view are equally important is impartiality. Impartiality requires that we give equal and/or adequate consideration to the interests of all concerned parties. The principle of impartiality assumes that every person us equally important and no one is seen as intrinsically more significant than anyone else. The 7-step Moral Reasoning Model is good in the sense that it has room in it to accommodate a whole host of different moral and ethical perspectives, considering the ethnic and religious diversity of our society.

One of the reasons Ethical Subjectivism and Emotivism are not viable theories in ethics is that they miss to make distinction between moral judgments and mere expressions of personal preference. preference. Genuine moral or value judgments ought to

 

be backed up by pertinent reasons. Moreover, they must possess the quality of impartiality, which means, among other things that personal feelings or inclinations should be suppressed if necessary.

Reason and Impartiality Defined

Humans have not only feelings but also reason, and reason and  reason plays a vital role in Ethics. In Ethics.  In fact, moral truths are truths of reason; that is, a moral judgment is true if it is espoused by better reasons than the alternatives. Reason is the basis the basis or motive for an action, decision, or conviction . As a quality, quality, it refers to the capacity the capacity for logical, rational, and analytic thought; for consciously making sense of things, establishing and verifying facts, applying common sense and logic, and  justifying,  justifyin g, and if necessary, necessary, changing changing practices, practices, institution institutions, s, and beliefs beliefs based based on existing or new existing information.

 A relevant relevant definition definition of reason to our topic is “the power of the mind to think, understand, and form judgments by a process of logic.  However, one of the most influential philosophers in the history of Western philosophy, philosophy , Immanuel Kant, argued that reason that  reason alone is the basis for morality, and once the person understood this basic requirement for morality, he or she would see that acting morally is the same as acting rationally. In rationally.  In Kant’s view, the definition of morality alone shows that a person must decide what to do. You, as person, are able to think and reflect on different actions and then choose what action to take. That a  moral decision  means mere desires did not force you to act in a particular manner. You acted by the power of your will.  As a student, student, you are constantly constantly in turmoil on on whether whether to study study or not to study. study. You know the importance of studying and the consequence of not studying. However, you also know the importance of taking a break from the daily grind. So, when exams are coming and you feel so stressed from fulfilling all school requirements and you feel the need to take a break- in Kant’s argument that morality is based on reason, what is the moral choice? Impartiality on the other hand involves the idea that each that  each individual’s interests and point of view are equally important. Also important. Also called called evenhandedness or fairmindedness, impartiality is a principle of justice holding that decisions ought to be based on objective criteria, rather on the basis of bias, prejudice, or preferring the benefit of one person over another for improper reasons. Impartiality, in morality requires that we give equal and/or adequate consideration to the interests of all concerned parties. The principle of impartiality assumes that every person, generally speaking is equally important; that is, no one is seen as intrinsically more significant than anyone else.

 

Other ethicists however, suggest that some clarification is required. From the impartial standpoint, to say that no one is seen as intrinsically more significant than anyone else, is not to say that there is no reason whatsoever for which an individual might demand more moral attention or better treatment than others. Many ethicists suppose that from the impartial point of view, properly conceived, some persons count as more significant, at least in certain ways. A virtuous and respectable religious leader may be supposed be more significant than a mere maid; so infirst. an emergency building on fire) thetodecent religious leader ought to be rescued The reason,(say a nonetheless, is not that the religious leader is intrinsically more significant; rather, it is that he makes greater contribution to society. How is impartiality a requirement for morality? For example, during an exam you saw your friend (who is sitting next to you) secretly open he notebook to look for an answer on one of the test questions. Your teacher noticed that your classmate was doing something suspicious. He called your classmate and asked if she was cheating. She surreptitiously closed her notebook and answered, “No”. Your teacher did not trust your classmate’s answer so he asked you. What will you say? According to philosopher and professor Dr. James Rachels, for your decision to be moral, you should think how your answer will affect your friend, your teacher, the rest of your classmates, and how it will affect you as a person. An person.  An impartial choice involves basing your decision on how all the person in the situation will be affected, and not to the advantage of a particular party that you favor. Thus for the question, “ Are reason and impartiality a requirement for morality?” Let’s go back to what Dr. Rachels said: morality “ at the very least is the effort to guide one’s action based on the most logical choice (reason) while giving equal importance to the interests of each person affected by your decisions (impartiality). The Seven Step Moral Reasoning Model Contemporary author Scott B. Rae, Ph.D. proposes a model for making ethical decisions. To say the least, his suggested 7-step model introduces the use of reason and impartiality in deciding on moral matters.

Dr. Rae starts presenting his model by telling the case of a twenty year old Hispanic male who was brought to a hospital emergency room, having suffered abdominal injuries due to a gunshot wounds obtained in gang violence: “He had no medical insurance, and his stay in the hospital was somewhat shorter  than expected due to his good recovery. Physicians attending to him felt that he could complete his recovery at home just as easily as in the hospital and he was released after only a few days in the hospital. During his stay in the hospital, the patient admitted to his primary physician that he was HIV positive, having contracted the virus that causes AIDS. This was confirmed by a blood test administered while he was hospitalized.

 

“When he was discharged from the hospital, the physician recommended that a professional nurse visit him regularly at home in order to change the bandages on his still substantial wounds and to ensure that an infection did not develop.’ “Since he had no health insurance, he was dependent on Medical, a government program that pays for necessary medical care for those who cannot afford it. However, Medicard refused to pay for home nursing care since there was someone already in the home who was capable of providing the necessary care.’ “That person was the patient’s twenty- one- year old sister, who was willing to take care of the brother until he was fully recovered. Their mother had died years ago and the sister was accustomed to providing care for her younger siblings. The patient had no objection to his sister providing this care, but he insisted that she not be told that he had tested HIV positive. Though he had always good relationship with his sister, she did not know that he was an active homosexual. His even greater fear was that his father would hear of his homosexual orientation and lifestyle. lifestyle . Homosexuality is generally looked upon with extreme disfavor among Hispanics.’ Now, here lies the moral dilemma. The patient’s doctor is bound by his code of ethics that puts a very high priority on keeping confidentiality. This code mandates that information about one’s medical condition that he or she does not want known cannot be revealed by the physician. Some would even argue that the that  the obligation of confidentiality is even greater with HIV/AIDS since revelation of somebody’s homosexual orientation usually carries devastating personal costs for the person who is forced “out of the closet.” On the other hand, the patient’s sister, without knowing the truth, is putting herself at risk by providing nursing care for him. Some would categorically argue that she has a right to know the risks to which she is subjecting herself, especially since she willingly volunteered to take care of her brother. So, if you were the physician, what would you do in this case? Would you break the rule of confidentiality to safeguard the patient’s sister, or would you keep confidentiality to protect the patient from harm that would come to him from his other family members, especially his father. For Rae, as good a question as “what would you do” in this situation is probably the question, “how would you decide what to do” in this situation? He believes that the process of making a moral decision can be as significant as the decision itself, and many ethical decisions that people encounter” are so complex that it is easy to exhaust oneself talking around the problem without actually making any progress toward resolving it. The response to many moral dilemmas is “where do I start?’ and the person who is faced with these decisions often needs direction that will enable him or her to move constructively toward resolution and see the forest for the trees.”

 

To sufficiently address the ethical dilemmas that people encounter regularly, Rae offers model which can be used to insure that all the needed bases are covered. He admits that the model is not a formula that will automatically generate the “right’ answer to an ethical problem but a guideline in ascertaining that all the right questions are being asked in the process of ethical deliberation.

The following are the steps or elements of a model for making moral decisions:

a. Gather the Facts. Gathering the facts is the indispensable first step prior to any ethical analysis and reflection on the case. In examining a case, we want to know the available facts at hand, as well as any facts present not known but that need to be determined. We thus have to ask not only “what do we know?” but also “what do we need to know?” in order to generate an intelligent ethical decision. In the case of the Hispanic male in the story of Rae the following are the relevant facts: The patient is a young man, infected with HIV and an active homosexual. 

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He suffered fairly severe abdominal wounds but is recovering well. Homosexuality is looked down upon in Hispanic communities. The patient has insisted that his physician maintain confidentiality about his HIV status. The patient is afraid of rejection by his father if his homosexuality is discovered, an understandable fear given the way homosexuality is viewed in the Hispanic community. He was wounded by gunfire in gang violence. It is not clear but is a reasonable assumption that he is a gang member. As a result, he likely fears rejection and perhaps retribution from his fellow gang members, especially if they discover that he is HIV positive. He is uninsured and cannot afford home nursing care by a professional. Medical refuses to pay for professional home nursing care. The patient’s sister is wiling and able to provide the necessary nursing care for her brother. She is accustomed to providing maternal-like care for her brothers and sisters. The patient has specifically requested that his sister not be told of his HIV status. She does not know that his brother is an active homosexual. The patient’s sister would be changing fairly sizable wound dressings for her brother and the chance are high that she would come into contact with his HIV and infected blood. The probability of her becoming infected with the virus from this contact is difficult to predict.

 

b. Determine the Ethical Issue (s) . In the case, the competing interests are those of the sister who will provide the care and the patient who will receive it. Both of them have interests in being protected from harm. The patient fears being harmed in a psycho- social way if his homosexuality and HIV status were discovered. In effect, he has put the physician in a difficult situation by demanding that his right to confidentiality be kept. Though she does not know it, his sisterwith fears harm due to the risk of contracting the HIV virus from contact hermedical brother’s blood. The case be stated as a conflict between confidentiality for the patient vs. the right to know the patient’s condition for his sister due to the risk she would be taking in giving him nursing care. By way of summary, the conflict is the need for patient confidentiality vs. the duty to warn the sister of risk of harm. Identify fy the Principl Principles es that have a Bearin Bearing g on the Case. c. Identi

So, what principles have bearing in the case? Two ethical principles that speak to the case come out of the way in which the moral issue is stated. The case is about a conflict of rights, a conflict of duties that the physician has toward his patient and toward the sister. He is morally obligated to exercise compassion toward both, but what compassion ( or the duty to “do no harm”) requires depends on which individual in the case is in view. Two principles are thus dominant. First is the widely acknowledged principle that patients that patients have a right to have their medical information kept confidential, especially the information that could be used to harm them if it were revealed. But revealed.  But a second principle relevant to the case is the duty the  duty of the physician to warn interested parties other than the patient if they are at risk of looming and considerable harm.  A difficult difficult aspect of any ethical ethical decision decision is deciding deciding what weight weight to give give the principles relevant to the case. No doubt, the principle of confidentiality is deemed virtually sacred in the medical profession and most physicians will argue that it is necessary to keep confidentiality if patients are to trust their physicians and continue coming for treatment. However, confidentiality is often measured as subordinate to the duty to warn someone who will likely be harmed if that information is not revealed. For example, if a psychologist believes that his patient will kill his wife, or beat her severely, he has a moral obligation to inform the wife that she is in danger from her husband. The duty to warn someone from imminent severe harm is usually considered a more heavily weighted principle than confidentiality in case like these. In the case, the crucial question is weighing the two conflicting principles is the degree of risk that patient’s sister is taking by providing nursing care for her  bother. If the risk is not considerable, then that weighs confidentiality a bit more

 

heavily. But if the risk is substantial, then the duty to warn is the more heavily weighted principle. Considering that the sister has volunteered to perform a very selsacrificing service for her brother, it can be argued that her self-sacrifice is an additional factor that weighs the duty to warn principle more heavily. Some would even claim that the patient’s HIV is an example of “reaping what one sows”, and that all the more minimizes consideration of the patient’s desire for confidentiality.  Another element that that should should be considered considered in the deliberation deliberation is that the the risk to the patient, though it may have a higher probability of happening, is not as severe as the risk to the sister. After all, if the worst scenario happened to the patient, his father will disown him and the gang would throw him out. He would recover from all of that. But if his sister contracted HIV, she would not recover from that. Though the probability of the worst- case scenario is higher for the patient, the results of the worst case are clearly higher for the sister. d. Lis Listt the the Al Alte terna rnativ tives es This step involves coming up with various alternative course of action of as part of the creative thinking included in resolving a moral dilemma. Though there will be some alternatives which you will rule out without much thought, in general, the more alternatives that are listed, the better the chance that your list will include some quality ones. In addition, you may come up with some creative alternatives that you had not considered before. In the case, one option is to tell the sister that her brother is HIV positive. This alternative comes out of considering the duty to warn principle as higher priority. A second option is to refuse to tell her that information, considering the confidentiality principle is carrying the most weight, thereby upholding the patient’s request for confidentiality. However, there are other alternatives that do not involve compromise and they each reflect a weighing of the two principles. One alternative is for the physician to warn the patient’s sister in general terms about taking suitable precautions for caring for these types of wounds. At all times, she is to wear gloves and a mask when handling the bandages. If she gets any blood on her clothes or body, she has to wash instantly with a disinfectant soap. Meaning, she has to take universal precautions that any medical professional normally takes in caring for patients.  Another alternative alternative is to request request that that the patient patient inform inform his sister sister of his his condition. The patient could then request that she not tell any other family member or any of his friends. If the patient declined, then the next step might be to say to him in effect, “If you don’t tell her, I will. e. Compar Compare e Alternat Alternative ives s with Princ Principl iples es

 

This step involves eliminating alternatives according to the moral principles that have a bearing on the case. In many cases, the case will be resolved at this point, since the principles will remove all alternatives except one.  As a matter matter of fact, fact, the purpose purpose of this comparison comparison is to determine determine whether whether there is a clear decision that can be made without further deliberation.

f. As Asse sess ss the the co cons nseq eque uenc nce e If the principles do not produce a clear decision, then ‘a consideration of the consequence of the remaining available alternatives is in order. Both positive and negative consequences are to be considered. They should be informally weighted, since some positive consequences are more beneficial than others and some negative consequences are more detrimental than others. The undertaking here is to take the viable alternatives that attempt to predict what the likely consequences ( both positive and negative) of each would be. Furthermore, it should be tried to estimate approximately how beneficial are the positive consequences and how severe the negative ones are, since some consequences are evidently more substantial than others.

Usually when two opposing alternatives are offered, the consequences of one are the mirror image of the other. This is exemplified by our case’s alternatives of telling the sister, or refusing to tell her of her brother’s HIV status. The option of telling the sister (or insisting that the patient tells his sister) has the following likely consequences: The sister would be properly warned about the risks of taking care of her brother minimizing the risk of her contracting contracting HIV, and saving her from the risk of developing a fatal illness. The brother’s HIV status would be out in the open, leaving family and gang friends to draw their own conclusions about the homosexuality. Should they draw the right conclusion, which is likely, he suffers significant psycho-social harm from his gang members, and possibly (though not certainly) from his family. Trust with the physician and the patient suffers and he may refuse to see that physician, or any other one again until a dire medical emergency. This would be unfortunate since due to his HIV status, he will need ongoing medical care. 

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In the alternative of the physician refusing to disclose the information, the following may be estimated as the likely consequences: 

The sister would not know about the risks she is taking, making her vulnerable to contracting an infection for which there is no cure. The degree of risk that she is taking is open to debate, but some would argue that if the the degree risk is any more than minimal, that justifies warning her since virusofproduces fatal disease.

 

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The patient’s HIV status is a well-kept secret,as his homosexuality can be kept a secret forever, since as HIV develops into full-blown AIDS, both are likely to come out at some point in the future. Trust between the physician and patient is maintained.

g. Makes a decision . Rae leaves us the following further questions in making decision: What would you decide in this case? Which principles are the most weighty? Are there others that you would include? Which alternatives are the most viable? Are there others that you would suggest? Which consequences seem to you the most severe? Are there others that you think will occur? For one thing, Rae’s model is good in the sense that it has room in it to accommodate a whole host of different moral and ethical perspectives, considering the ethnic and religious diversity of our society. Finally, it promotes the primal consideration of reason and impartiality in ethics without necessarily eradicating the role of feelings in ethical deliberation.

REFERENCE: Bulaong, Oscar G.et al 2018 Ethics Foundations of Moral Valuation. Rex Bookstore Inc. Nicanor Reyes St. Recto Ave. Manila, Philippines De Guzman, J.M. et al 2017 Principles of Ethical Behavior in Modern Society. Mutya Publishing House Inc. Potrero, Malabon Manebog, J.DG. Ethics: A primer Appendix A Plato on Justice http://classics.mit.edu/Plato/republic Gallinero, Winston B. et al 2018 Ethics. Mutya Publishing House Inc. Pateros Malabon City Pasco, Marc Oliver D. et al 2018. Ethics. C&E Publishing Inc. Quezon City, Philippines

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