Moral philosophy has moved from addressing Plato's question of what makes the good person, to Kant's query as to the right thing to do, to Buber's concern with relationship. Whether referring to business ethics' interest in relationships between corporations and consumers; legal ethics' focus on relationships among the legal system, clients, and society; or nursing ethics' consideration of the relationship between patient and nurse; ethics and morality are conceptualized and actualized on the playing field of relationship.
The nature of nursing as a moral endeavor is an assumption embedded in any philosophical or theoretical consideration of the discipline and practice of nursing. An the goal of nursing is a moral one, namely, the good of those for whom nurses care, no aspect of practice exists that does not invite consideration of the ethical dimensions of nursing actions. This moral obligation for nurses to consider their behavior from an ethical perspective has not gone unnoticed by the discipline, and as many as fourteen philosophical theories or perspectives of morality have been applied to moral deliberation in nursing (Bandman & Bandman, 1995). This essay is aimed at defining and comparing the most commonly used ethical theories in Nursing. The author has focused on Utilitarian and Deontology Theory; Care and Justice Ethics and Rights Theory by defining, discussing and comparing them.
Significance of Moral in Nursing
A recent review of the literature in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) uncovered over 4000 citations published in English during the 1990s under the key words "nursing ethics." Confidentiality, consent, whistle-blowing, advocacy, and end of life decisions were only a few of the topics of moral concerns gleaned from citations seeking answer the question of the right thing to do, the question that ethical study universally addresses (Fry, 1992).
Deontology vs. Utilitarianism
The two major ethics theories in Nursing, which identify and rationalize moral rules and principles, are Deontology and Utilitarianism. This paper will elaborate and critically reflect on the definitions of both and provide examples along with why the term/concept is important to the nursing profession.
The origin of the word 'deontology' is two Greek words deon (duty) and science (or study) of (logos). It is also considered as the binding duties (cited in an Excerpt, Moreland, and J.P.). Deontology is though to be one of the moral theories that guide us in our choices comparing other theories and in our decisions in contrast to other theories. Deontology also guides us about ourselves.
The scholars have stated three main characteristics of Deontological ethics. First; the obligation must be considered and done without any excuse. Also, an essential moral characteristic of any act is either it is right or wrong. For instance the immoral acts such as telling lies, breaking promises or murdering someone are inherently wrong and it is the duty of all of us to avoid these types of acts, no matter what the situation is. Furthermore, the consequences of an act cannot be ignored, for example, nurses are trained and they know which act will harm the patient and which will benefit h/her while providing care. Though outcomes of an act not the only motive behind making decision to act rightly but effects or consequences guide us to explore our duty, and are not liable for deciding the duty.
Secondly, humans must be considered as objects of inherent ethical value. Lastly, this theory suggests that the act or the rule must be applicable for all who are in the same moral situation. This rule does not imply that in such and such conditions you should do this, but these are the commands that should be followed in a same way no matter whatever circumstances are. For example telling truth or keeping promises should be acted upon in all situations.
Overall, it can be concluded that in the Deontology, the choice of right does not completely depends on its effect but on its conformity with a moral norm. For deontologists, the Right has priority over the Good, therefore, if an act is not in accord with the right or is not within moral norm; it will not be done. Deontological theory can be accounted for strong, cross-cultural moral intuitions. Finally, Deontological theories provide us with the reason as why a specific person is in a position to complain about anything and can ask any one to explain why they breach their moral duties.
Despite these advantages of Deontological theory, there are a few weaknesses too, which should also be considered while comparing this theory with other ethical theories. It is necessary for deontologists to explore and resolve the conflicts that are present among certain duties, and certain rights. Kant's daring declaration that "a conflict of duties is inconceivable" (Kant 1780, 25) is the proof of weakness of the theory. Although there are many distinctions that surely lessen possible conflicts such as intention/foresee, to do/allow to do cause/aid etc.; but whether they hold potential to remove such conflicts is a question that needs to be resolved.
Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873) first defined Utilitarianism. Bentham believes that each human being, throughout his existence is governed by two masters, the pain and pleasure. Therefore, he offered the rule of utility; that the virtue is the only thing that brings the furthermost happiness. John Stuart Mill adopted Bentham's ethical theory and adding to his concept of happiness he explained that pleasures that are obtained from culture, education/knowledge and from our soul or religion are of more importance then the material pleasures. Thus, Mill's utilitarianism also revolves around pleasure or happiness.
Both the philosophers define happiness as something that comes when we learn to keep balance between our sorrows and pleasures. They also believe that the feelings of pain and pleasure have their own value. Utilitarian are of the view that the natural consequences of two optional actions can be compared and it can be estimated which action will have a better effect. Therefore, this theory is also called consequentialism moral theory which describes the direct outcome of an action.
Hence, the main rule of Utilitarianism is that that actions are right or wrong proportionately; right if they are able to promote happiness and wrong if they are capable to generate the repeal of happiness. By happiness it means the presence of pleasure and the absence of pain; by unhappiness it means existence of pain and the deprivation of pleasure. Utilitarianism has its own external and internal sanctions; these include hope of kindness and the fear of unhappiness. The hope and fear is related to our fellow man or our creator who is the sovereign of the Universe, together with what we hold for them like compassion or love, or it is about the love and fear of Him that restricts us to abide his will in competition of self-centered consequences.
As discussed above, it is evident that the utilitarian approaches of morality entail that any act itself is not right or wrong but its righteousness or wrongness depends on its consequence. If the outcome of an act is negative the act is wrong and if an act has a positive consequence the act is right. Thus Utilitarian are of the view that outcome of any act can be measured and that ethical decisions are those which have consequences that lead to the happiness for the majority of the members of a society.
Thus utilitarian is the ethical theory having belief that every act that leads to the happiness of or maximizes the happiness of society will be considered ethical (Nuffield, 2009). Utilitarianism deems that outcomes of an act are predictable.
One main deficit of this theory is that it judges actions on the basis of their consequences no matter the act itself right or wrong. For an instance, we can use utilitarianism to validate punishment for a blameless person by enslaving him if our act helps to maximize or aid to the happiness of society overall. But in this case our actions are obviously not ethical regardless of how productive they are for the majority.
Utilitarianism is also blamed that it looks only the outcomes of actions and neglect the wishes or intents behind them. Intentions or motives are important to some extent: it is not good to call an action good if intention behind it is to harm someone but that unintentionally causes good "overall good." Karl Popper (1945) recommended that the utilitarian formula "Maximize happiness" should be substituted by the formula "Minimize suffering"; this concept has been named as "negative utilitarianism." He believes in the notion that from the moral point-of-view, suffering is much more important to be treated then the promotion of happiness.
Although, this moral theory depends on the results of the acts but major drawback of this theory…