Chapter 9

Theories and Methods in Ethics

Introduction

• The first purpose of this chapter is to analyze the theoretical nature of ethics—i.e., to ask whether ethical theories really exist.

• To answer this question, the nature of philosophy, ethics, science, and theory is explored.

• The second purpose is to introduce several major theories of ethics with which nurses should be familiar.

Philosophical Inquiry (1 of 2)

• Philosophy is an effort to understand abstract questions about the nature of knowledge, being, and truth.

• There are three main of philosophical inquiry:– Epistemology: The study of knowledge– Ontology/metaphysics: The study of the nature of being– Axiology: The study of values

• Axiological inquiry is at the heart of ethics.

Philosophical Inquiry (2 of 2)

• Ethics is defined as a systematic approach to understanding, analyzing, and distinguishing matters of right and wrong, as well as how these matters relate to human well-being.

• Ethics is an active process, not a static condition.• Ethics can be contrasted with morals, or specific

beliefs, behaviors, and ways of being that are derived from ethics.

Science: The Daughter of Philosophy (1 of 2)

• During the Age of Enlightenment, the ancient discipline of philosophy gave rise to modern scientific approaches and practices.

• Some scholars consider philosophy an intermediate between theology and science:– Like theology, philosophy is speculative and provides no

definitive answers– Life science, philosophy is based on reason rather than

dogma or tradition

Science: The Daughter of Philosophy (2 of 2)

• Despite their shared rationality, science and philosophy differ in several important ways:– Experiments work in science but not philosophy– Philosophy addresses issues outside the realm of science

(e.g., questions of good and evil)– Science should be conducted impartially, whereas

philosophy is value laden– Science breaks the whole into parts, whereas

philosophy reassembles the parts into a whole that is better than the original

Methods and Outcomes of Inquiry (1 of 2)

• Scientists generally use the scientific method to conduct scientific inquiry.

• Such inquiry is characterized by objectivity, generalizability, reproducibility, and the ability to achieve outcomes of practical importance.

• Philosophical inquiry, however, is concerned with acquiring knowledge for its own sake rather than for its practical benefits.

Methods and Outcomes of Inquiry (2 of 2)

• Scholars use three methods of ethical inquiry:– Normative ethics: An attempt to decide or prescribe values and

ways of being that are right or wrong, good or bad, etc.– Meta-ethics: An attempt to understand morality by analyzing the

meaning of ethically related concepts and theories.– Descriptive ethics: An attempt to describe what people think about

morality or how they actually behave.

• In conducting ethical inquiry, one should be aware of the “fact/value” distinction to avoid the pitfall in moral reasoning called the “is/ought” gap.

Perspectives on Theory (1 of 5)

• Scholars describe “theory” in different ways.• For example, Reynolds proposed that three

primary forms of theories exist:– Set-of-laws form: Includes theories that can be classified

as scientific laws.– Axiomatic form: Includes sets of definitions, existence

statements, and relational statements.– Causal process form: Includes sets of definitions,

existence statements, and causal statements.

Perspectives on Theory (2 of 5)

• Other scholars describe nursing theories as being based in specific nursing philosophies:– Fawcett: A theory consists of specific concepts

derived from a conceptual model, along with the propositions that describe those concepts and the relations among them.

– Meleis: A theory is a coherent set of statements related to significant questions in a discipline, and it is used to describe, explain, or predict events, situations, or relationships.

Perspectives on Theory (3 of 5)

– Dickoff and James: A theory should be “situation producing,” meaning it has a purpose, includes specific goals, is prescriptive, and lists aspects of related activity.

– Wiedenbach: A theory is an abstract phenomenon that arises from observation and involves a set of related ideas that guide nursing practice—including what needs to be accomplished, how it will be accomplished, and in what context it will be done.

Perspectives on Theory (4 of 5)

– Beckstrand: Nurses don’t need a practice theory; rather, they require access to scientific theories that explain natural phenomena and ethical theories that describe what actions will result in morality and goodness.

– Vaughn: Ethical theories must be both explanatory (i.e., they explain what makes an action good) and prescriptive (i.e., they include details about how they can be applied in real life).

Perspectives on Theory (5 of 5)

– Beaumont and Childress: A good ethical theory involves abstract reflection, systematic presentation, integrated principles, and systematic justification, and it also includes a hypothesis that offers a moral framework.

Theoretical Approaches to Ethics

• Most ethical theories are normative, meaning they serve as guides for moral behavior.

• Such theories can be subcategorized as:– Rule-based theories– Consequentialist theories– Communitarian theories

Rule-Based Theories (1 of 3)

• Scholars recognize three such theories: natural law theory, rights theory, and deontology.

• Natural law theory originated in the work of St. Thomas Aquinas:– States that the rightness of actions is self-evident because

morality is determined by inherent human nature, not by customs or preferences

– Associated with rule-based Judeo-Christian ethics, including prohibitions against “unnatural acts”

Rule-Based Theories (2 of 3)

• Rights theory originated with Thomas Hobbes:– Here, rights are viewed as justified claims that

individuals and groups can make on others– Decisions about allowing or disallowing rights come

from a society’s normative framework– Moral rights can be hard to define, and they may or

may not be absolute– To exercise his or her rights ethically, a person should

not violate the rights of other people

Rule-Based Theories (3 of 3)

• Deontology originated with Immanuel Kant:– People are seen as rational, autonomous beings with

the ability to know objective laws and to decide to act morally—or according to their duty

– Only dutiful actions have moral worth, and they are superior to actions motivated by love

– Individuals are seen as ends in themselves– Duties are classified as either hypothetical (optional)

or categorical (absolute) imperatives

Consequentialist Theories (1 of 2)

• Unlike deontology, these theories consider consequences to be an important indicator of the moral value of one’s actions.

• Utilitarianism, developed by Bentham and Mill, is the best-known of these theories:– Actions are judged by their utility—or the

usefulness of their consequences– Emphasis is placed on collective groups rather

than individual people

Consequentialist Theories (1 of 2)

– Ethical behavior is defined as that which promotes the greatest good while inflicting the least harm possible in a situation

– Distinction is made between higher pleasures (which only humans can experience) and lower pleasures (which all animals can experience)

– Because this approach focuses on overall populations, it is common in public heath practice

Communitarian Theories

• These theories are based on the idea that everything fundamental in ethics derives from communal values, goals, and practices.

• Personal moral goals are seen as significant, but greater importance is placed on identifying a community’s moral goals.

• Such theories recognize that people naturally favor those with whom they live and frequently interact.

Conclusion

• “Doing ethics” is a critical part of nursing practice.

• Accordingly, advanced practice nurses must understand the distinction between philosophy and ethics, and they must seek to apply specific moral principles in their daily work.