What is Health Ethics?


This webpage is designed to provide a brief overview of some of the concepts and principles used frequently when discussing an issue in the field of health ethics. We encourage you to seek further information on the terms listed here, as well as the many that have not been included.


What is Ethics?

Ethics is basically about the way human beings treat each other and the natural environment; it is the systematic examination of the attitudes and behaviours of people. For our purposes, ethics can be broken down into two parts: it is about carefully studying the values that actually do guide our attitudes and behaviours in given contexts; and it is about exploring what values ought to guide our
attitudes and behaviours.

One could argue that all of us, no matter what our social, cultural, economic or professional backgrounds, are in the business of practicing ethics on a daily basis. We have certain values (things we think are important for their own sake) and beliefs (views about the nature of existence and the way we understand the world to be). For example, many of us think individuals should not be penalized for wrongs that are not of their doing. This suggests that justice or fairness is important to us. Many of us also feel that we should reach out and help those less fortunate in our society. This may suggest that we believe that human beings
are somehow interconnected and that we cherish values such as charity and generosity.


What is Health Ethics?

Health ethics is the branch of ethics that deals with ethical issues in health, health care, medicine and biology. It involves discussions about treatment choices and care options that individuals, families, and health care providers must face. It requires a critical reflection upon the relationships between health care professionals and those they serve, as well as the programmes, systems, and structures developed to improve the health of a population. Bioethics involves deliberating about the allocation of resources, and reflecting on the complex moral choices arising from on-going health care restructuring and advancing technology. It also entails a critical, political, and ethical analysis of the definition
and the determinants of health.

A few specific examples of health ethics situations
include:
  • Making decisions about end-of-life care
  • Determining whether to fund the treatment of disease or the promotion of health
  • Critically examining the discrepancies in health status between populations and our ethical obligations to ensure ethical access to health and health services
  • Ensuring ethical conduct in health research
  • Deliberating upon the ethical implications of genetic cloning technology

Types of Ethics

Descriptive Ethics

The aim of descriptive ethics is to depict and clarify moral opinions and practices, and to explicitly articulate the concepts and assumptions implicit in these. For example, “What does group X think about the morality of abortion?” is a question of descriptive ethics.

Normative Ethics

Normative ethics concerns making moral judgments about what is right and wrong, good and bad etc. It also involves developing action guides to direct ethical behaviour. For example, “Is aborting a fetus ethically justifiable?” is a normative question.

Meta-Ethics

The discussion here is not about what particular people think ethics is or what ought or ought not to be considered ethical (morally praiseworthy or blameworthy). Rather, meta-ethics involves analyses of the language, concepts, and methods of reasoning in health care. For example, “What does ‘ethically justifiable’ mean?” is a meta-ethical question.


Three Theoretical Concepts in Ethics(1)

Consequentialism (or Teleology)

According to consequentialism, the right course of action is determined by examining the consequences or outcome of an action and selecting the one that produces the greatest good. Thus, no action is in itself right or wrong; it is the action’s consequences that determine this. One consequentialist theory is utilitarianism, which defines the greatest good as happiness. Using a utilitarian approach to an ethical dilemma, one would choose the course of action that will produce the greatest happiness for the greatest number of people. Critics of utilitarianism assert the difficulty of measuring happiness and accurately predicting the consequences of one’s actions. Additionally, one may criticize this ethical theory for potentially sacrificing the happiness of the minority for the happiness of the majority.

Deontology

According to the deontological perspective, the right course of action is that which is consistent with one’s moral duties. According to Immanuel Kant, the theory’s most well known proponent, one of these duties is to never use another person as a means to one’s own ends. Additionally, before making a decision, one should think about the proposed action, and ask oneself whether it would be reasonable for everyone to act in such a way. If it is indeed reasonable to “universalize” a course of action, then one can deem that act to be ethical. According to deontology then, an action itself has features that are distinct from the action’s consequences, and that make the action the right. One critique of Kant’s deontology is its rigidity in abiding by these rules despite the potential consequences of one’s actions.

Virtue Ethics

Unlike consequentialism and deontology, virtue ethics does not focus on rules or principles to determine ethical behaviour. Instead, the emphasis is on one’s character and what kind of person one ought to be, both of which are defined by our traditions and communities. Critics of virtue ethics question the emphasis on tradition and community, given that our world consists of a mosaic of cultures and ethnicities. That is, it is problematic to achieve a common morality derived from this plethora of traditions and communities. Additionally, critics sometimes argue that virtue ethics does not provide sufficient guidance on how
to act in difficult situations.


Principles of Secular Bioethics

Much of contemporary Western bioethics is founded upon or makes reference to four principles
outlined by Tom Beauchamp and James Childress in Principles of Biomedical Ethics(2). These principles are rooted in a combination of consequentialism and deontology, and assume that we have some basic moral beliefs that have developed over time and can provide a good starting point for ethical guidance. From these basic beliefs, Beauchamp and Childress have outlined four principles to guide behaviour:

Respect for Autonomy

Respect for Autonomy is based on self-determination and the right of individuals to make independent and informed decisions concerning their life, well-being and best interest. Within the context of autonomy arise issues such as privacy, confidentiality and informed consent.

Beneficence

Beneficence, or doing good, involves promoting another’s welfare, acting in an individual’s best interest and in a manner which benefits others.

Non-maleficence

Non-maleficence requires one to do no harm and to protect others from harm. This also includes the duty to maintain professional competence and to be aware of the isolation and powerlessness of others.

Distributive Justice

The principle of justice entails that all persons in society are of equal moral worth, thus should be treated with fairness or equally under similar circumstances.


(1) This section is adapted from Yeo, M. & Moorhouse, A. (1996). Concepts and cases in nursing ethics (2nd ed.). Peterborough: Broadview.

(2) Beauchamp, T.L. & Childress, J.F. (2001). Principles of biomedical ethics. New York: Oxford University.