Biomedical Engineering Reference
In-Depth Information
elaborate and nonhedonistic theories of intrinsic value. Utilitarianism is classified
into two categories:
1.
Act utilitarianism
looks at the consequences of each individual act and cal-
culates utility each time the act is performed.
2.
Rule utilitarianism
looks at the consequences of having everyone follow
a particular rule and calculates the overall utility of accepting or rejecting
the rule.
Act-utilitarian reasoning would be used in a biomedical context, for example,
when considering whether to allocate dialysis services to a derelict, thus prolonging
his miserable existence or to allocate these services to a 35-year-old mother, whose
life is of benefit to her family and to society, and who has better prospects for a
good quality of life. Act-utilitarianism ignores special relationships, such as parent
and child, physician and patient. For a physician to damage the interests of an in-
dividual patient in an effort to maximize utility seems wrong. Critics of hedonism
believe that some pleasures do not have intrinsic value (e.g., malicious pleasures) or
things other than pleasure have intrinsic value (e.g., knowledge and justice).
Deontologists (
deon
means duty in Greek) consider that doing one's duties is
self-evident for correctness and morality (i.e., they rely not on the consequences of
an action but on whether an action is right or wrong for it's own sake). German
philosopher Immanuel Kant believed that statements about the moral law were a
priori and could be reached through logic alone, independent of experience. Kant
explored rational steps that direct him to his conclusions. Kant distinguishes two
types of imperatives: hypothetical and categorical. A hypothetical imperative is
entirely dependent on the consequences. Do A to ensure that B and, in turn, C
happen. According to Kant, any fully rational agent would follow categorical im-
peratives not based on any consequences but performed for the sake of duty only;
they are ends in themselves not simply a means to an end. For example, a physician
may never justifiably lie to a patient and experimental subjects must never be used
without their voluntary informed consent.
All single-principle ethical theories such as act-utilitarianism and Kant's cat-
egorical imperative do not appreciate the complexity of bioethical decision mak-
ing or the tensions that arise from different ethical obligations pulling people in
different directions. For example, what is extraordinary care and who decides it?
Who should decide when such care should be withdrawn? Should it be the father
whose action caused the irreversible coma, the mother, the hospital, or the society
that is forced to pay for the care? Should a baby with a defective heart be given the
heart of a pig or none at all? There are mixed theories in regards to the moral value
of an act, which can depend on both style and outcome. Bioethical committees
comprised of individuals from different backgrounds are usually used in decision
making. Hospitals generally have an ethics committee to handle decision making in
individual cases, and general policies for the hospital. Universities and institutions
(see Section 11.3.2) have committees that generate and insure compliance with
ethical standards governing the use of animal and human subjects in experimenta-
tion. Every doctor, nurse, or bioengineer must have some training in ethics, ranging
from a module of a course to one or two courses.
