Deontological Ethics and DNR Decisions in Oncology Care
This paper examines deontological ethics as a normative moral theory grounded in duty rather than consequences or character, tracing its foundations through Kantian philosophy. It contrasts deontology with consequentialism and virtue ethics, then applies deontological principles — including Kant's categorical imperative, the Formula of Ends, and the Kingdom of Ends — to Do Not Resuscitate (DNR) decisions in hematology and oncology care settings. The paper also addresses critiques of Kantian ethics, including the naturalistic fallacy and the exclusion of sympathy from moral reasoning, before concluding with practical recommendations for improving ethical competence among healthcare professionals navigating end-of-life care dilemmas.
- Introduction to Deontological Ethics: Defines deontology and its ethical foundations
- Deontology Versus Consequentialism: Contrasts deontology with consequentialist moral theory
- Kantian Ethical Framework: Explains Kant's categorical imperative and related formulas
- Applying Kantian Ethics to DNR Decisions: Maps Kantian principles onto DNR clinical scenarios
- Critiques of Kantian Deontology: Evaluates key weaknesses in Kantian moral theory
- Ethical Competence in Healthcare: Recommends improving ethical competence among clinicians
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What makes this paper effective
- It builds understanding progressively, moving from abstract philosophical foundations to concrete clinical applications in oncology and hematology settings.
- It situates deontology within a comparative framework, contrasting it clearly with consequentialism and virtue ethics before developing its own argument.
- It presents both the strengths and limitations of Kantian ethics honestly, demonstrating balanced scholarly engagement rather than advocacy.
Key academic technique demonstrated
The paper demonstrates applied ethical analysis — taking an abstract philosophical framework (Kantian deontology) and systematically mapping its core formulations (universalizability, Formula of Ends, Kingdom of Ends) onto a specific real-world dilemma (DNR decisions). This technique shows how philosophical theory functions as a practical decision-making tool in professional contexts.
Structure breakdown
The paper opens with definitional groundwork for deontology, then contrasts it with competing theories. It introduces Kantian ethics in depth before applying those principles to DNR scenarios in clinical care. A critique section evaluates weaknesses in the Kantian approach, and the conclusion translates theoretical insights into actionable recommendations for healthcare professionals. The structure moves coherently from theory to application to evaluation.
Introduction to Deontological Ethics
The term deontology has its roots in the Greek language — deon being the Greek word for "duty" and logos meaning "study" or "science of." Within the context of modern ethical philosophy, the normative theory of deontology involves prohibited, allowed, or ethically incumbent choices. That is, deontology is categorized among those ethical theories which drive and evaluate one's choice of what one should do (i.e., deontic theories), as opposed to virtue or aretaic theories, which drive and evaluate the type of individual one is or ought to be. In the context of ethical theories involving choice assessment, deontologists and consequentialists maintain opposing positions (Stanford Encyclopedia of Philosophy, 2016).
Deontological ethics, or deontology, represents an ethical approach which concentrates on how right or wrong an action is, as opposed to how right or wrong its effects or consequences are (consequentialism) or the agent's behavior and traits (virtue ethics). Therefore, for deontologists, the determination of whether any given situation is good or bad is governed by whether its underlying action is right or wrong. In simpler terms, a choice is considered "right" if it conforms to an ethical norm: right must be prioritized over good. If, for instance, an individual puts forward the idea that all life forms presently inhabiting the world but not supporting agriculture ought to be eliminated to end starvation, deontologists would oppose this idea, claiming that a world from which starvation has been eliminated is not a good situation owing to how that outcome came about in the first place (Alexander & Moore, 2007).
Deontological theories come under the "normative theories" category. They do not presuppose any distinct stance on moral epistemology or moral ontology. Deontologists may be presumed to be ethical realists of the non-natural variety — in which moral attributes are not natural attributes in themselves, despite being non-reductively linked to natural ones — or of the natural variety, in which natural and moral attributes are identical. Alternatively, deontologists may be constructivists, conventionalists, divine command theoreticians, expressivists, or transcendentalists regarding the nature of ethicality. Similarly, deontologists may claim to know, intuitively, the contents of deontological ethicality, or to know them via Kantian reflections on a particular normative condition, or by arriving at a reflective balance between ethical judgments and the theories developed to explain them (Stanford Encyclopedia of Philosophy, 2016).
Deontology Versus Consequentialism
Deontological theories of ethics are best understood in contrast to those put forward by consequentialists. A brief examination of consequentialism, along with the associated issues that motivate deontologists, provides a useful foundation for analyzing deontological models. According to consequentialists, preferences, purposes, and actions must be evaluated from an ethical standpoint based solely on the consequences or situations they produce. Hence, a consequentialist must first identify the situations or conditions that are of intrinsic value — typically collectively labeled "the Good." They can then claim that choices which increase or lead to more good are ethically correct and ought to be made and implemented (Alexander & Moore, 2007).
At times, deontology may align with moral absolutism — the view that certain actions must be considered ethically wrong regardless of their consequences — but this alignment is not necessary. Consider, for example, Immanuel Kant's famous argument that lying is always unethical, even when one is faced with a killer seeking the hiding place of a soon-to-be victim. However, according to others, the outcome of lying or a similar seemingly unethical act might, on occasion, make it right to lie — a position associated with moral relativism, or "obligations/duty-based" ethics, since deontologists hold that ethical principles bind individuals to their duties (Karnik & Kanekar, 2016).
Kantian Ethical Framework
DNR, or "Do Not Resuscitate," decisions are often reached within hematology and oncology care settings, with nursing professionals and physicians experiencing associated moral quandaries. Ethics has been regarded as a fundamental healthcare competency; within the healthcare setting, it has been described as the capability of dealing ethically and satisfactorily with tasks that pose moral predicaments. One ethical competence model for healthcare workers involves three key components: doing, knowing, and being — indicating that moral competence requires abilities of action, knowledge, and character. Moral competence may be acquired through education, experience, and communication, and a supportive climate is necessary to maintain a superior level of ethical competence (Pettersson, Hedström & Höglund, 2018).
In cases of conflict between patients or surrogates and the healthcare practitioner regarding end-of-life care decisions, appropriate steps may be taken by instituting a moral committee to address the legal or moral problem and documenting its proceedings. The management of healthcare organizations may also compile policies for introducing, promoting, and discussing the application of advanced directives as part of the admittance procedure (Pettersson, Hedström & Höglund, 2018).
Kant asserts that what is "good" is what one should do, while what is "intrinsically right" and "inherently good" is how one should behave for everyone's benefit, regardless of outcome. Kant's ethical system is built around the categorical imperative, the universalizability principle, the Formula of Ends, and the Formula of a Kingdom of Ends — each providing a distinct lens for evaluating moral action.
References
Alexander, L., & Moore, M. (2007, November 21). Deontological ethics. Retrieved September 12, 2018, from https://plato.stanford.edu/entries/ethics-deontological/
Dolgoff, R., Harrington, D., & Loewenberg, F. M. (2012). Brooks/Cole empowerment series: Ethical decisions for social work practice. Cengage Learning.
Karnik, S., & Kanekar, A. (2016, May). Ethical issues surrounding end-of-life care: A narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.
Pettersson, M., Hedström, M., & Höglund, A. T. (2018). Ethical competence in DNR decisions — a qualitative study of Swedish physicians and nurses working in hematology and oncology care. BMC Medical Ethics, 19(1), 63.
Stanford Encyclopedia of Philosophy. (2016, October). Kantian ethics. Retrieved September 12, 2018.
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