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Week 5: Kantian Ethics & Provider Responsibilities

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Consequences of Utilitarianism

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Consequences of Utilitarianism

  1. Diverting trolley cars to kill an innocent person

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Consequences of Utilitarianism

  • Diverting trolley cars to kill an innocent person
  • Pushing large men to their death off of footbridges in order to stop runaway trolley cars;

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Consequences of Utilitarianism

  • Diverting trolley cars to kill an innocent person
  • Pushing large men to their death off of footbridges in order to stop runaway trolley cars;
  • Cannibalizing sick cabin boys;

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Consequences of Utilitarianism

  • Diverting trolley cars to kill an innocent person
  • Pushing large men to their death off of footbridges in order to stop runaway trolley cars;
  • Cannibalizing sick cabin boys;
  • Executing a political activist in South America;

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Consequences of Utilitarianism

  • Diverting trolley cars to kill an innocent person
  • Pushing large men to their death off of footbridges in order to stop runaway trolley cars;
  • Cannibalizing sick cabin boys;
  • Executing a political activist in South America;
  • Taking jobs to produce chemical weapons;

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Consequences of Utilitarianism

  • Diverting trolley cars to kill an innocent person
  • Pushing large men to their death off of footbridges in order to stop runaway trolley cars;
  • Cannibalizing sick cabin boys;
  • Executing a political activist in South America;
  • Taking jobs to produce chemical weapons;
  • Torturing small children in broom closets in order to preserve the happiness of a town

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Consequences of Utilitarianism

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Consequences of Utilitarianism

  • Reason alone cannot motivate the will; (Hume)

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Consequences of Utilitarianism

  • Reason alone cannot motivate the will; (Hume)
  • Reason is a “slave to the passions” (Hume); reason serves pleasure

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Consequences of Utilitarianism

  • Reason alone cannot motivate the will; (Hume)
  • Reason is a “slave to the passions” (Hume); reason serves pleasure
  • Moral distinctions are derived from a natural tendency toward doing what is pleasing to us

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“[If] reason is not competent to guide the will with certainty in regard to its objects and the satisfaction of all our wants...this being an end to which an implanted instinct would have led with much greater certainty; and since, nevertheless, reason is imparted to us as a practical faculty...admitting that nature generally in the distribution of her capacities has adapted the means to the end, its true destination must be to produce a will, not merely good as a means to something else, but good in itself, for which reason was absolutely necessary.”

Kant on Reason

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“[If] reason is not competent to guide the will with certainty in regard to its objects and the satisfaction of all our wants...this being an end to which an implanted instinct would have led with much greater certainty; and since, nevertheless, reason is imparted to us as a practical faculty...admitting that nature generally in the distribution of her capacities has adapted the means to the end, its true destination must be to produce a will, not merely good as a means to something else, but good in itself, for which reason was absolutely necessary.”

Kant on Reason

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Immanuel Kant (1785)

“Reason recognizes the establishment of a good will as its highest practical destination, and in attaining this purpose is capable only of a satisfaction of its own proper kind, namely that from the attainment of an end, which end again is determined by reason only, notwithstanding that this may involve many a disappointment to the ends of inclination.”

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Kant - The Good Will

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Kant - The Good Will

  • What sort of things are good without qualification?

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Kant - The Good Will

  • What sort of things are good without qualification? Money? Power?

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Kant - The Good Will

  • What sort of things are good without qualification? Money? Power?
  • The only thing that is “good without qualification” or “good in itself” = a good will

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Kant - The Good Will

  • What sort of things are good without qualification? Money? Power?
  • The only thing that is “good without qualification” or “good in itself” = a good will

  • A good will acts from duty not from inclination

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Kant - The Good Will

  • What sort of things are good without qualification? Money? Power?
  • The only thing that is “good without qualification” or “good in itself” = a good will

  • A good will acts from duty not from inclination
  • How ought a “good will” decide what its duties are?

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The good will follows the dictates or commands of reason:

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The good will follows the dictates or commands of reason:

  • Hypothetical imperative = “If I want/desire X, then I will do Y.” (conditional; nonmoral)

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The good will follows the dictates or commands of reason:

  • Hypothetical imperative = “If I want/desire X, then I will do Y.” (conditional; nonmoral)
  • Categorical Imperative = “Do X.” (unconditional; moral)

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The Categorical Imperative

Act only in accordance with that maxim through which you can at the same time will that it become a universal law.

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What is a maxim?

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What is a maxim?

  • A reason for acting

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What is a maxim?

  • A reason for acting

How do we use Kant’s Categorical Imperative to tell us what we ought to do?

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What is a maxim?

  • A reason for acting

How do we use Kant’s Categorical Imperative to tell us what we ought to do?

Categorical Imperative (CI) Test:

  1. Formulate your maxim.
  2. Universalize your maxim.
  3. Does your maxim contradict itself? (perfect duty)
  4. Can you sincerely will your maxim? (imperfect duty)

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Categorical Imperative (CI) Test:

  1. Maxim formulation: (a) I didn’t study for my math test, so I’m going to cheat on the test.

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I didn’t study for my math test, so I’m going to cheat on the test.
  • Universalization: (b) Everyone who doesn’t study for a test is going to cheat on the test.

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I didn’t study for the math test, so I’m going to cheat on the test.
  • Universalization: (b) Everyone who doesn’t study for a test is going to cheat on the test.
  • Does this result in a (practical/external or logical/internal) contradiction?

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I didn’t study for the math test, so I’m going to cheat on the test.
  • Universalization: (b) Everyone who doesn’t study for a test is going to cheat on the test.
  • Does this result in a (practical/external or logical/internal) contradiction?
    1. Can you really universalize the action of lying and cheating on tests?

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I didn’t study for the math test, so I’m going to cheat on the test.
  • Universalization: (b) Everyone who doesn’t study for a test is going to cheat on the test.
  • Does this result in a (practical/external or logical/internal) contradiction?
    • Can you really universalize the action of lying and cheating on tests?
    • No, it’s a logical*/internal contradiction. You negate the action via your maxim. (You have a perfect duty not to lie or cheat.)

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I never received help when I was in need, so I won’t help anyone else when they are in need!

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I never received help when I was in need, so I won’t help anyone else when they are in need!
  • Universalization: (b) No one will ever help anyone when they are in need of help.

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I never received help when I was in need, so I won’t help anyone else when they are in need!
  • Universalization: (b) No one will ever help anyone when they are in need of help.
  • Does this result in a (practical or logical) contradiction?
    • No, probably not. (Not a perfect duty)

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I never received help when I was in need, so I won’t help anyone else when they are in need!
  • Universalization: (b) No one will ever help anyone when they are in need of help.
  • Does this result in a (practical or logical) contradiction?
    • No, probably not. (Not a perfect duty)
  • Can you sincerely will/want to live in a world where X happens as a matter of course?

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Categorical Imperative (CI) Test:

  • Maxim formulation: (a) I never received help when I was in need, so I won’t help anyone else when they are in need!
  • Universalization: (b) No one will ever help anyone when they are in need of help.
  • Does this result in a (practical or logical) contradiction?
    • No, probably not. (Not a perfect duty)
  • Can you sincerely will/want to live in a world where X happens as a matter of course?
    • Probably not, this world would be terrible! (You have an imperfect duty to perform this action.)

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The Categorical Imperative - Humanity Formulation

“Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means.”

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In ethics teams, give both a utilitarian and a Kantian analysis of the following case study.

Be prepared to share your response with the class!

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Using our ethical frameworks so far, how ought we determine the moral obligations of healthcare providers?

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Next, consider the following case study from the AMA Journal of Ethics:

  • What would you decide if you had to adjudicate between Dr. Ward's response and Theresa's needs as a patient? Whose position ought to take priority? Which ethical theory best supports your decision? (E.g., Cultural Relativism, Utilitarianism, or Kantian Ethics)
  • What would someone who is skeptical of your decision say in response to you and what reasons they might use to come to a different conclusion?

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Case Study: Reproductive Rights

Dr. Richard Ward is the only family practitioner in a small rural town where he has been practicing for 30 years. One morning 16-year-old Theresa Scholtz comes to Dr. Richard Ward's office alone. She does not have an appointment and tells the receptionist she will wait until Dr. Ward has time to see her. Dr. Ward has quite a few scheduled appointments that morning, so Theresa has to wait more than an hour before she can be seen.

The nurse finally takes Theresa back to an examination room, weighs her, takes her temperature and blood pressure and then asks the reason for her visit. Theresa looks nervous and ill at ease; she doesn't immediately answer.

Theresa doesn't look at the nurse but says quietly, "I am afraid I might be pregnant."

"So you are here to get a pregnancy test?" the nurse asks.

Theresa shakes her head, "No, I want Dr. Ward to give me the morning-after pill so I don't have to get a pregnancy test or have an abortion."

The nurse gets ready to leave, saying, "Dr. Ward will be in shortly."

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When Dr. Ward comes into the exam room Theresa explains to him that she was out at a party, had a few too many drinks, and ended up having unprotected sex with her boyfriend. She says she is worried about the possibility of being pregnant and wants the Plan B® pill.

"I don't want to have a baby right now. I'm too young. I have to finish school," she says. "And I don't want to have to make a decision about an abortion. I want to just take this pill and move on."

Dr. Ward listens to Theresa's concerns and then says, "I understand why you are here. I have always had a policy of not performing abortions, and I won't start now by prescribing the morning-after pill. You can make an appointment with me in a couple of weeks for a pregnancy test to find out if you are pregnant. If you really want the morning-after pill I can give you the card of a physician I know in Gardendale who will see you."

"Gardendale?" Theresa says. "But Gardendale is 115 miles away. How will I get there without telling my parents why I am going? And how will I get there soon enough for the pill to work?"