Dental Ethics: A Brief Review __________________________________________________________________
Categorical Imperative Another deontologic ethical principle is Immanuel Kant’s Categorical Imperative. Kant believed that rather than divine inspiration, individuals possessed a special sense that would reveal ethical truth to them. Ethical truth is thought to be inborn and causes humans to act in the proper manner. Some of the ethical principles to come from Kant will become more familiar as the principles associated with bioethics are discussed. These include individual rights, self-determination, keeping promises, privacy, personal responsibility, dignity, and sanctity of life. TELEOLOGIC ETHICAL THEORIES The teleologic ethical theories or consequential ethics are outcome-based theories. It is not the motive or intention that causes one to act ethically, but the consequences of the act [19]. If the action causes a good effect, it is said to be ethical. So here, the end justifies the means. Utilitarianism Utilitarianism is the most well-known teleologic ethical theory. This is the principle that follows the outcome-based belief of actions that provide the greatest good for the greatest number of people. Rather than speaking for the individual, this prin- ciple speaks for the group or society. Social laws in the United States are based upon this principle. The individual interests are secondary to the interest of the group. There are two types of utilitarianism: act utilitarianism and rule utilitarianism. In act utilitarianism, the person’s situation determines whether an act is right or wrong. In rule utilitarianism, the person’s past experiences influence one to the greatest good. There are no rules to the game, as each situation presents a different set of circumstances. This is also referred to as situational ethics. Situational ethics would say that if the act or decision results in happiness or goodness for the person or persons affected, it would be ethically right. Individuals may choose the utilitarian system of ethics because they find it fulfills their own need for happiness, in which they have a personal interest. It avoids the wall of rules and regulations that may cause a person to feel a lack of control. In Western society, the rule of utility is whatever leads to an end of happiness fits the situation. The downside of utilitarianism is its application to healthcare decision making. In making national healthcare policy based upon utilitarianism, several questions arise. Who decides what is good or best for the greatest number? Is it society, the govern- ment, or the individual? For the rest, are they to receive some of the benefits, or is it an all or nothing concept? How does the concept of “good” become quantified in health care in such concepts as good, harm, benefits, and greatest? Where does this leave the individual trying to make healthcare decisions?
ETHICAL THEORETICAL SYSTEMS Six fundamental theories that directly concern dental profes- sionals will be described in this course. They are the deonto- logic, teleologic, motivist, natural law, transcultural, and rela- tive/multicultural ethical theoretical systems. These systems are each made up of principles, precepts, and rules that form a specific theoretical framework that provides the follower with general strategies for defining the ethical actions to be taken in any given situation. DEONTOLOGIC ETHICAL THEORIES Under the deontologic umbrella, an action is deemed right or wrong according to whether it follows pre-established criteria known as imperatives. An imperative in our language is viewed as a “must do,” a rule, an absolute, a black and white issue. This is an ethic based upon duty linked to absolute truths set down by specific philosophical schools of thought. If the principles dictated by these imperatives are met with dutiful compliance, one is said to be acting ethically. One of the most significant features of deontologic ethics is found in John Rawls’ Theory of Justice , which states that every person of equal ability has a right to equal use and application of liberty. However, certain liberties may be at competition with one another. There are also some principles within the same ethical theoretical system that can conflict with one another. An example of this conflict might involve a decision over allocation of scarce resources. Under the principle of justice, all people should receive equal resources (benefits), but allocation can become an ethical dilemma when those resources are scarce. The precepts in the deontologic system of ethical decision making stand on moral rules and unwavering principles. No matter what situation presents itself, the purest deontologic decision maker would stand fast by a hierarchy of maxims. They are as follows [18]: • People should always be treated as ends and never as means. • Human life has value. • One is always to tell the truth. • Above all in healthcare, do no harm. • All people are of equal value. Theologic Ethics A well-known deontologic ethical theory is based upon reli- gious beliefs and is known as the theologic ethical theory. The principles of this theory promote a summum bonum , or highest good, derived from divine inspiration. A familiar principle is to do unto others as you would have them do unto you. One would be viewed as ethically sound to follow this principle within this system of beliefs.
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