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Author: Ross S. Feldberg
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We will examine the controversial topic of Physician-Assisted Suicide (PAS) as a model to explore the general area of ethics and critical thinking. In previous years I have used an introductory ethics text The Elements of Moral Philosophy by James Rachels ( Rachels J. The Elements of Moral Philosophy. 5th ed. Boston: McGraw-Hill; 2007).I highly recommend this brief and well-written introduction to ethical thinking. Sadly, Dr. Rachels died in September 2003, but this book is still in print and I highly recommend it. Since we only use a small part of it this year, I am not using the full text; I offer the following as a very (very) brief introduction to some ethical ideas. (My apologies to those of you who have studied this topic in more depth.) We won’t have time to discuss these readings per se, but will refer back to them as we discuss physician-assisted suicide.

1. Consequentialist Ethics (Utilitarianism):

In summary, consequentialist ethics judges an action based on its outcome. Outcomes, not intentions are what matter. This idea was advanced by the British philosophers Jeremy Bentham and John Stewart Mill in the mid 19th century and was a revolutionary concept, since it removed the question of what constituted right action from the domain of religion (God’s punishment or reward as key motivator) and placed it directly in human hands. In utilitarianism , the ethical course of action is that one which results in the greatest happiness (benefit) for the greatest number of people (optimal utility).

This sounds reasonable, but there are some problems with this approach: (1) we often are unable to accurately calculate the full benefits and costs of any course of action, and (2) how can we justify a course of action that, even though it benefits a number of people, results in harm to an innocent person? Because of these and other problems, a number of modifications to utilitarianism have been suggested (e.g., act utilitarianism examines the consequences of specific acts, while rule utilitarianism seeks to determine the fundamental rules by which we should live our lives and then examines the consequences of following those rules in a specific situation). Most of us at least somewhat adhere to a utilitarian approach to ethical decision making in our everyday lives.

Other Sources of Information on Utilitarianism:

2. Kantian Ethics (Deontology or Rule Ethics)

First advanced by the German philosopher Immanuel Kant , deontological ethics is based on the idea that we should live our lives following certain categorical ( universal ) rules without worrying about the precise consequence of following those rules. How do we recognize a universal rule? Kant’s solution to this problem was that any behavior that we would want to see followed by all people at all times is likely to be a categorical rule (e.g., do not lie since even though a specific lie may avoid hurting someone, a society in which people lie is fundamentally an unstable society). Fundamental rules in deontology might be: “do not harm others,” “do not lie,” and “do not treat persons as a means to an end” (Kantian rules are often framed as prohibitions). The problem here is that there may be situations in which the rules come into conflict (typical example: someone who wants to do harm to a neighbor asks you where he lives. Kant would insist you tell the truth since you have no way of predicting whether harm will actually come to your neighbor but you do know that you should not lie). While deontology seems overly rigid, we often adhere to specific principles in our everyday ethical decisions.

Other Sites on deontological ethics:

3. Some Other Approaches to Ethics

Modern thinkers have developed a variety of other ethical theories to help guide our actions. We won’t have time to talk about these, but here are just a few:

  • Casuistical Ethics
    In this branch of ethics one reaches decisions about a course of action in a specific case by comparing the case to similar cases that are less problematic and thus easier to resolve. This is similar to our legal system, which resolves conflicting claims by reference to prior paradigmatic cases.

  • Virtue Ethics
    This is an ethical approach that focuses on the character or moral quality of the individuals in a situation rather than on what is actually done.

  • Ethics Based on Reason