Ethical Schools Resources

Ethics are ways of thinking which uses moral principles or values to help in making a decision. Ethics can be distinguished from and at times can be confused with morality, which is a personal sense of right or wrong. Ethics is rather about how decisions are made, as well as the outcome of those decisions. Depending on your own ethical standpoint you may see the decision-making process as more important in reaching a decision or you may see the outcome as more important.

Bioethics is a branch of ethics where the decisions being made concern living beings, both human and animal. These decisions can relate to an individual, for example whether a particular treatment should be given, or can concern society broadly, for example should animals or human embryos be used in research.

On this page you will find (listed alphabetically) brief descriptions of some key concepts in healthcare ethics and of some of the most influential schools of ethics in healthcare. You will also find  some comment on how these ways of think can be relevant in healthcare, plus information about some of the main proponents from each school of though and links to further reading. This page is very much work in progress so more resources and comment will be added overtime.  As always, do let us know, using the ‘Contact Us’ tab above, if there are additions or changes we should consider making to this page.

Autonomy

Autonomy is a core principle of medical ethics in the UK and the Western world. In essence autonomy is the principle that an individual has control over his or her own body and can decide what happens to that body. The concept of autonomy can be traced back to ancient Greece, when it was used more in relation to the right of the city state to control itself, rather than in relation to individuals. Autonomy was central to the writings of the influential German philosopher Immanuel Kant (1724-1804) who made the link to free will. However, it was not until the 1970s that autonomy began to become central to healthcare, with the emergence of medical ethics as an influential discipline. Autonomy is one of Beauchamp and Childress’ ‘Principles of Medical Ethics’, (see below) which have dominated much of medical school ethical teaching.

Autonomy is now embodied in English law to such an the extent that a patient deemed to be competent has the autonomy to refuse treatment recommended by his or her medical team, even if this will inevitably result in the patient’s avoidable death. Treating a competent patient against his or her wishes is a criminal assault in English law.  The key legal principle of informed consent, as established by the UK Supreme Court in Montgomery v Lanarkshire 2015 illustrates how the ethical concept of autonomy is now at the core of English and Scottish law.

Additional reading:

Campbell L, (2017) Kant, autonomy and bioethics, Ethics Medicine and Public Health, 3, 381-392 (behind pay wall).

Schneewind J

B, The Invention of Autonomy: A History of Modern Moral Philosophy, Cambridge University Press, (2010)

Taylor, J.S. Introduction: Autonomy in Healthcare. HEC Forum 30, 187–189 (2018). https://doi.org/10.1007/s10730-018-9360-9

Beauchamp and Childress Principles of Medical Ethics

Tom Beauchamp an American philosopher and academic and James Childress, an American philosopher, theologian and academic first published their four Principles of Medical Ethics in 1979. They were not the first to use principlism, using principles to approach ethical dilemmas, but they have certainly been the most influential.

Beauchamp and Childress advocated that medical decisions should be based on four principles:

• Autonomy – The individual’s right to make his or her own choice.
• Beneficence – The principle of acting in the best interests of others
• Non-maleficence – The principle of first do no harm adopted from the Hippocratic Oath
• Justice – A principle emphasising fairness and equality

A problem is how each principle should be weighed against another, particularly where they may conflict either when deciding for an individual or when balancing up competing needs. An attempt has been made to produce a tool to measure the principles and balance them when making a decision. 

Additional reading:

Beauchamp and Childress, Principles of Biomedical Ethics, Eighth edition, Oxford University Press, (2019)

Shea M, Forty Years of the Four Principles: Enduring Themes from Beauchamp and Childress, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 45, Issue 4-5, August 2020, Pages 387–395, https://doi.org/10.1093/jmp/jhaa020

Beneficence

This is the ethical principle that actions should always be in an individual’s best interests. As with autonomy discussed above, this ethical principle is now the foundation of English healthcare law, when an individual is not competent to exercise their autonomy.  It is embodied in English law statutes such as the Mental Capacity Act (MCA). You can link to the MCA and associated guidance, plus the Scottish equivalent from our Disability Resources page. 

Beneficence is also very firmly imbedded, as the concept of best interests in international and domestic law (see out Children and Young People Resources page for more).

Additional Reading:

Picton-Howell Z, ‘What Is wrong with the best interests test in clinical decision making’?, Researchgate, (2016)

Consequential Ethics

Consequential ethics are based on the viewpoint that it is the outcome or consequences of an action which determines whether or not it is ethical. A criticism of this viewpoint is that it presumes the outcome or consequences can be predicted, alternatively it is not possible to judge whether an action is ethical until after it has happened. Utilitarianism (see below) is perhaps the best known sub-set of consequential ethics, as it hold that actions are ethical to the extent to which they promote happiness. A modern day proponent of consequential ethics is Peter Singer, Professor of Bioethics at Princeton University.

An example of consequential ethics at play healthcare might be seen in the hypothetical allocation of resources where a decision is made to use of budget of £X,000 to treat five patients with minor conditions rather than to treat a single patient with a more complex condition.

Additional reading:

Spall B, A Brief Introduction to Consequential Ethics

Singer P, Practical Ethics, Cambridge University Press (2017)

Deontological Ethics

Deontological ethics can be contrasted with consequential ethics, in that rather than outcomes, duties form the basis of ethical conduct. Immanuel Kant, mentioned above, placed weight on the concept of duty in his writing.

For a deontological ethicist an act is seen as being intrinsically either right or wrong and the decision maker must act in the right way.  The obvious problem here is who decides what is right or wrong? Ethical dilemmas and disagreements in healthcare often arise because different individuals, based on their personal and professional experiences and backgrounds will have different understandings of what is the ‘right’ thing in a particular situation.

By way of an example, a paediatric disability specialist who has known a disabled child for many years and knows something about about the child’s day-to-day life, may take a different ethical viewpoint on whether that disabled children should receive intensive care treatment if or when he or she becomes critically ill, from paediatric respiratory consultant who has only seen the child when he or she is unwell. Both doctors may also hold different views as to the value of a disabled child’s life generally based both on their personal values and their professional expertise and experience.  The Oxford ethicist and neonatologist Dominic Wilkinson argues that it is the patient’s preferences (or where the patient is unable to hold or express a preference,  for example a baby, their family’s preferences) which should dictate the ‘right’ way to act, rather than the doctor’s personal preferences.

Additional reading:

Standford Encyclopaedia of Ethics: Deontological Ethics

Chalbi M, Understanding Kant’s Ethics, Cambridge University Press (2016)

Hill TE, The Blackwell Guide to Kant’s Ethics, Wiley-Blackwell (2009)

Ethics of Care

Ethic of Care is a feminist school of ethical thought. Ethical behaviour is based on inter-dependent relationships. Whilst Beauchamp and Childress Principles approach is most commonly taught in medical schools, Ethics of Care is often taught to nursing students. Within this school of ethics, consideration of the impact of the decision on those around the central actor must be though about for a decision to be ethical and particular thought must be given to those who are most vulnerable. Compassion, kindness and consideration are key.

Nel Noddings is a leading proponent of the Ethics of Care, especially in the context of education, Carol Gilligan who states ‘The ethics of care starts from the premise that as humans we are inherently relational, responsive beings and the human condition is one of connectedness or interdependence’, is another.

The 6Cs set of values for health and social care staff can be seen as being strongly influenced by the Ethics of Care approach.

Additional reading:

Gilligan C, In a Different Voice: Psychological Theory and Women’s Development, Harvard University Press (2016)

Tronto J, Moral Boundaries: A Political Argument for an Ethics of Care, Routledge (1994)

Noddings N, Starting at Home: Caring and Social Policy, University of California Press, (2002)

Utilitarianism

Utilitarianism is, as was seen above, a sub-set of the Consequential ethics school of thought.  Jeremy Bentham  (1784-1832) and John Stuart Mill (1806-1873) are its most famous proponents. They advocated utility, or the greatest happiness for the greatest number as the basis for ethical decision making. Bentham labelled it the Great Happiness principle.  For Bentham and Mill the right ethical choice was the one that created the greatest happiness.  See above, under Consequentialism, for a brief consideration of how this might play out in healthcare.

Additional reading:

Bentham & Mill, Utilitarianism and other Essays (Classics) by Mill & Bentham, Pearson (2000)

de Lazari-Radek K & Singer P, Utilitarianism, A Very Short Introduction, Oxford University Press, 2017

Virtue Ethics

Virtue Ethicists judge the rightness of action on what a ‘right thinking’ or virtuous person would do in the same circumstances. The focus here is on the character of the moral agent rather than the rightness or wrongness of their actions.

Virtue Ethics can be traced back to the writings of the Greek philosopher Aristotle, who argued that virtue is developed through a process of reasoning and thinking which enables the individual to develop practical wisdom.

In healthcare very experienced practitioners often talk (at least when discussing their work with healthcare academics) of developing practical wisdom, not just through experience, but through deep analysis and reflection. Virtue ethics is seen as being a particularly helpful ethical approach when essentially ‘good’ individuals are put into ethically challenging situations. Their Virtue and Practical Wisdom, enables them to cope with the stresses of the challenges they face and act ethically in all circumstances.

Additional Reading:

Aristotle and Barnes J, Ethics, Writings from the Complete Works (2014)

Hursthouse R, On Virtue Ethics, Oxford University Press (2002)

Taylor R, Virtue Ethics, An Introduction, Prometheus Books, (2002)

Townsend E, What are virtues? Aristotle’s Virtue Ethics for Kids, The Eidetic Publishing Group (2020)

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