Ethical Theories
Different ethical theories exist and theories can be applied to different situations to inform our thinking and support decision making. This section provides an overview of key theories applicable to healthcare.
Consequentialism
Consequentialist ethics holds the view that the correct moral response is related to the outcome, or consequence, of the act. The central aim is the premise of 'maximising the greatest good for the greatest number'. The 'good' referred to can be expressed in a variety of ways and may refer to values or 'utility' such as happiness, being pain or symptom free or another life enhancing outcome.
As an ethical theory consequentialism is attractive as there is always an outcome and the correct moral response is the one which will produce the greatest good for the greatest number. However, it does have limitations as it can endorse acts which would be contrary to the rights of individuals if the end result is one which would improve care for many others.
Deontology
Deontology is based on duties and rights and respects individuals as ends in themselves. It places value on the intentions of the individual (rather than the outcomes of any action) and focuses on rules, obligations and duties. Deontology requires absolute adherence to these obligations and acting from duty is viewed as acting ethically. One of the key criticisms in healthcare is that applying a strictly deontological approach to healthcare can lead to conflicts of interest between equally entitled individuals which can be difficult or even seemingly impossible to resolve.
Virtue Ethics
The key difference between consequentialism, deontology and virtue ethics is that the latter emphasises the moral character, or virtues of the individual. Virtue ethics has emerged due to the perceived deficits in ethical theories such as consequentialism and deontology for healthcare. The virtues are embedded character traits which are held to be societally valuable such as truth-telling, trustworthiness, honesty and kindness. Practical wisdom relates to how the virtues are applied or enacted. Virtue ethics is about an individual of good character doing the right thing.
Examples in healthcare are seen in codes of conduct and guidance developed by professional regulators which ultimately rely on the registrant incorporating their moral character into their practice e.g. The Nursing and Midwifery Council (NMC) guidance on good health and good character (NMC, 2010)
Principlism (Beauchamp and Childress, 2008)
Principlism is a commonly used ethical approach in healthcare. It emphasises four key ethical principles (autonomy, beneficence, non-malificence, and justice) which most ethical theories share and blends these with virtues and practical wisdom. This is an attempt to bring together the best elements of ethical theories which are compatible with most societal, individual or religious belief systems. By incorporating virtue ethics it enables healthcare professionals, patients and significant others, to place value or added weight on a particular principle to find a balance and rationale for decision-making.
Principlism is not without its critics or criticisms. However, because it provides a means of integrating multiple factors and reaching situation specific decisions it continues to be the most popular and cited ethical framework for healthcare.
The following link provides a further introduction to ethical theories. Introduction to moral theories and principles that inform ethical decision making in healthcare.
A Practical Guide for Clinical Ethics Support, Section C, Ethical Frameworks (2004) (Extract)
View the interactive resource for an overview of common ethical
theories and principles. CETL: Moral Theories
NB: The resource refers to bioethics but the ethical
principles are applicable to all healthcare ethics.
