Medical Ethics ARTH02039, 1 CP

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Medical Ethics ARTH02039, 1 CP

• Responsible teachers
• Professor Raul-Allan Kiivet
• Assistant Professor Kersti Pärna
• Department of Public Health
• http//biomedicum.ut.ee/arth/oppetoo/

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I Lecture What is ethics?II Lecture
Historical milestones of ethical thoughtIII
Lecture Introduction to medical ethics

• Andres Soosaar
• http//biomedicum.ut.ee/andress

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Introduction to ethics meaning, main concepts
and their realization in human being and society
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• Common sense says that ethics and morals are
  connected somehow to good behavior (both real one
  or plans in mind). Here we see immediately
  certain polarity between moral and immoral and a
  need to explain behaviour.
• Classical approach in ethics concerns personal
  and interpersonal behaviour, nowadays ethical
  aspects are increasingly important to understand
  human behavior in environmental context. For
  example need to preserve nature and animal rights
  are becoming more and more influential in our
  life.

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Problem setting of the lecture

• What is behaviour and how to explain it?
• How moral or ethical explanation of behaviour is
  different from other explanations?
• Functions of moral and their realization in
  society.

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It is necessary to recall some trivial things
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Behaviour as an output of organism

• Every outside oriented activity of organism is
  behaviour. Some people are thinking that mental
  activities which are related to planning,
  performing, understanding, and analyzing of those
  activities are also part of behaviour.
• The unit of behaviour is an act or a case or
  event. It is possible to imagine human life as a
  series of acts or cases. When you guess that next
  behavioural event is caused by previous, you will
  get chain of events.

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Necessity of sociality

• The world seems to be organized in a way that
  none can exist absolutely alone in sense of
  living and nonliving environment. We are
  necessarily members of an environment which has
  huge influence on us.
• This world order has produced in a moment human
  beings and possibility to communicate is the
  critical prerequisite for any development of
  them.

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Free will and behaviour

• Common sense assigns free will to human being
  which gives to him possibility to choose among
  options and follow the chosen option.
• When free well would miss, there wouldnt no
  chance to speak about personal morals. Free will
  is an important constituent of human autonomy.
• Free will is connected to mind and consciousness
  and their cognitive performance. This performance
  is limited, therefore a person is able to catch
  only partial set of all possible options.
• There is no absolute or unlimited free will, only
  certain part of its behaviour is understandable
  and controllable by it, other events are not
  controllable by free will, and the third set of
  events may run so or so.

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Understanding and analysis of behaviour 1

• There are several different criteria to
  understand behaviour goal, adaptation,
  efficiency, value, means, influence to others etc
• Analysis of behaviour is possible by subject
  itself or by others

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Understanding and analysis of behaviour 2

• As behaviour is so complex, then its holistic
  understanding is often complicated or impossible
  and usually only some aspects are taken into
  account.
• In case of human behaviour biological,
  psychological, and social aspects are usually
  taken in a quite isolated way.

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Paul makes a fire

• To warm himself
• No connection to moral
• To destroy certain things
• This may have connection to moral or not
• To signal certain location to enemies
• This has very strong moral component

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Biological aspects of behaviour

• Ethology and biological anthropolgy have their
  own conceptual apparatus and theories which have
  roots in biology. For example genetic aspects of
  behaviour.
• Homeostatic behavioural motives, e.g. nutrition,
  thirst, thermoregulatory responses.
• The difference of self and non-self, e.g.
  programmed defence and sexual reactions.

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Psychological aspects of behaviour

• Explanation of behaviour through mental
  phenomena.
• Consciousness versus unconsciousness
• Sharp difference between self and non-self
• Motivations, motives, learning, planning are
  important determinants of behaviour

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Social aspects of behaviour

• Human being is necessarily a member of numerous
  social groups.
• Non-self seems to be more important
• Culture and religion are important fields which
  influence moral sphere of a society.
• There are sociological (public opinion, group
  consciousness, etc), political, economical ,
  legal tools to understand behaviour.

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On human nature

• Big notions have sometimes been created to
  merge different perspectives. The concept of
  human nature is a good example of that. At the
  same time big notion with limited content will
  limit the understanding of the issue.
• The human nature is a popular, multiple meaning,
  and confusing concept, e.g. Aristotles social
  animal (zoon politikon) concepts or Plautus homo
  homini lupus est
• Human being has biological (natural),
  psychological, and social aspects in his
  nature.They may have overlapping areas, but there
  is no chance to reduce one aspect totally to
  another.

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What are moral and ethics?
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Ethics(Merriam-Webster Online)

• Main Entry ethic Pronunciation
  'e-thikFunction nounEtymology Middle English
  ethik, from Middle French ethique, from Latin
  ethice, from Greek EthikE, from Ethikos1 plural
  but singular or plural in construction the
  discipline dealing with what is good and bad and
  with moral duty and obligation2 a a set of
  moral principles or values b a theory or system
  of moral values ltthe present-day materialistic
  ethicgt c plural but singular or plural in
  construction the principles of conduct
  governing an individual or a group ltprofessional
  ethicsgt d a guiding philosophy

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Moral(Merriam-Webster Online)

• Main Entry moral Pronunciation 'mor-l,
  'mär-Function adjectiveEtymology Middle
  English, from Middle French, from Latin moralis,
  from mor-, mos custom1 a of or relating to
  principles of right and wrong in behavior
  ETHICAL ltmoral judgmentsgt b expressing or
  teaching a conception of right behavior lta moral
  poemgt c conforming to a standard of right
  behavior d sanctioned by or operative on one's
  conscience or ethical judgment lta moral
  obligationgt e capable of right and wrong action
  lta moral agentgt2 probable though not proved
  VIRTUAL lta moral certaintygt3 having the
  effects of such on the mind, confidence, or will
  lta moral victorygt ltmoral supportgt- morally
  /--lE/ adverbsynonyms MORAL, ETHICAL, VIRTUOUS,
  RIGHTEOUS, NOBLE

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Moral(Merriam-Webster Online)

• Main Entry moral Pronunciation 'mor-l,
  'mär- 3 is m-'ralFunction noun1 a the
  moral significance or practical lesson (as of a
  story) b a passage pointing out usually in
  conclusion the lesson to be drawn from a story2
  plural a moral practices or teachings modes
  of conduct b ETHICS3 MORALE

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Popular understandings

• Many of us use moral and ethical, moral and
  ethics synonymously.
• Some people think that moral is connected to
  morality and moral norms of conduct or behaviour
  and ethics is more involved how to study, explain
  and justify moral. Moral norms are more flexible
  and develop with society, ethics is more
  conservative, neutral, and explanatory one.
• The etiquette is a special fixed form of conduct.
  
• Metaethics is a field which is focused on
  language and principles of theory making in
  ethics.

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Ethics as a part of philosophy

• Ethics with onthology, gnoseology, and aesthetics
  are principal fields of philosophy.
• Modern special fields of ethics, e.g. bioethics,
  are rather interdisciplinary fields.

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What makes ethics autonomous?

• A long tradition since ancient times. Here has
  importance the idea of uniqueness of human being.
  Many thinkers hold that moral issues are the core
  of personality and human being.
• Understanding of behaviour and life in special
  qualitative terms of value, e.g. good-bad,
  fair-unfair, honest-dishonest, etc.
• There is no way to reduce moral totally to any of
  3 big whales biology, psychology, sociology.

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The object of morals

• Main objects of morals are act, case, and whole
  life. The question about meaning life is a large
  scale problem of ethics.
• Act and case seem in some sense to be eternal. It
  means the possibilities in an anterograde or a
  retrograde way.
• Ethical assessment or opinion is generally
  relative, i.e. it may depending on person, time,
  social circustances etc.
• An act or case may often be morally controversial
  and contain both positive and negative moral
  aspects. To express total opinion some weighing
  of different sides is needed.

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Morals as a factor in planning of behaviour

• Moral issues have strong cognitive aspect and
  assess the world through moral prism.
  Furthermore, the knowledge pretend to be
  objective, but inspite of that the knowledge
  itself, gathering and application of it contain
  moral aspects.
• Hopefully moral things are important factors in
  human decision making and behaviour.

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Morality and the subject of moral

• According to John Skorupski (REP Morality and
  ethics) morality is a distinct sphere within the
  domain of normative thinking about action and
  feeling the whole domain, however, is the subject
  of ethics.
• How should the moral sphere be characterized? The
  three most influential suggestions are that
  morality should be characterized by its function,
  by the supremacy of the moral, or by the
  distinctive moral sentiments.

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Normativity of morals

• Morals will be usually realized via certain norms
  (rules) or sets of norms, e.g. Decalogue in the
  Bible or Hippocratic oath.
• The most rational way to ground those norms is to
  refer on certain values but others groundings are
  also possible.
• The realization of norms is scheduled by other
  people, social institutions, and by person
  itself.

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The duty-freedom scale

• There is no absolute freedom, not in real life
  nor in abstract form.
• Person has with liberties also duties. Duties are
  estimated by its social location and they direct
  human attitudes and real doings. Some locations,
  e.g. some professions require certain fulfilment
  of certain needs and conditions.
• Liberties are often limited by social interests.

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The scale of the goal and usefulness of act or
event

• Intentions, actions, and cases are understandable
  in terms of their goals, consequences, and
  utility.
• The result may be useful to the person or to
  society.
• Utilitarianism stresses very much social utility
  of human action.

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Morals and Law 1

• Law and morals are not identical but overlapping
  areas. A popular understanding says that a legal
  system expresses certain moral minimum of
  society.
• They both have their own ways and tools to
  realize themselves.

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Morals and Law 2

• Legal regulation is described by unity on the
  territory of legal entity, realization by force,
  and public democratic way to change it.
• Moral regulation is described by big variety in
  forms and styles.

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Morals and ideology

• Morals and ideology are tightly interconnected,
  ideology is an established doctrine which
  contains influential moral component.
• Ideologies have used to justify itself certain
  philosophical concepts and theories, e.g
  Nietzsches concepts were used to establish Nazi
  ideology.
• After establishment the ideology has not need to
  ground and justify itself, creators usually try
  to give to it eternal position. The basis of
  modern global ideology tends to be the Universal
  Declaration of Human Rights, http//www.unhchr.ch/
  udhr/index.htm

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Estonian situation

• Last 10 years the leading idea has been the need
  of constitutional state. It has shifted the
  balance between law and ehtics very much in
  direction of law.
• Unclear situation with morals in the society may
  produce moral vacuum in the society and there
  several options which may fill the moral space in
  the society.
• When moral social regulations are weak, it may
  easily happen that all things which are not
  prohibited by law are allowed.

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Carriers of moral thoughts and reflections

• All the people and their everyday life experience
  are important players in the big game of morals.
  Art and humanities as intellectual fields also
  serve as an important source of moral
  reflections.
• Some social institutions have duty and goals to
  perform study and analyses of ethical problems,
  e.g. Professional societies, certain academic
  units, ethical committees.
• Huge and rapidly increasing amount of literature
  on differents aspects of ethics, e.g. numerous
  codes and declarations in medical ethics.

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Estonian situation

• Public moral discussion has been quite sporadic
  and mostly by journalists acoording to the
  principles of mass media.
• Some people complain on an moral crisis in the
  society. In fact situation is not so hopeless, we
  are probably in transition from one moral world
  to another or the third (the unified Europe).
• Tartu University has the Centre for Ethics, take
  a look http//www.ut.ee/eetikakeskus/