Applying Normative Theories to a Moral Situation

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1-Use Case 1.1 for this assignment , please refer to the discussion regarding Case 2.1 in Unit 2, under the heading “Applying Normative Theories to a Moral Situation”, as an example of how to apply moral theories to a case.

Please refer to the case 2.1 example at the end of the document

 

Case 1.1

 

Imagine now that you are an instructor at a large state university. You make a strong effort to get to know your students and are relatively successful in this. One day you are giving an in-class exam and, much to your distress, you see one of our students cheating. He is very bright and is one of the students who has come to your office several times to discuss the course material. You know from one conversation with him that his father recently died and that he has had some difficulty concentrating on his schoolwork since then. When you see him cheating, you realize that you could interrupt him during the exam, but you decide not to do so since this would humiliate him in front of his classmates. You could confront him after the exam, fail him for the test, and let the matter go at that. The university, however, has a firm policy on how cases of cheating are to be handled. The policy requires that all cases of cheating are to be reported by faculty to the administration. Faculty are expressly forbidden to use their own discretion in any case of cheating. The administration is highly intolerant of cheating and first offenses result in suspension for a semester. Second offenses result in expulsion. What should you do? On the basis of what considerations should you make your decision? Roommate

 

2-Clearly state a professional ethics issue that pertains to the case. It is recommended that you state your issue in question form.

 

3-Choose TWO out of the five moral theories studied in Unit 2, but only one version of Utilitarian theory at most (e.g. not both Act and Rule Utilitarianism).

1   Utilitarianism: Act & Rule (either one not both)

2   Kantian Deontology

3   Contractarianism

4   Virtue Ethics

5   Feminist Ethics

 

4-In essay-form[1], and in one document, apply each of the two theories to the case, focusing on your stated issue, by doing the following:

a                            For each theory, provide an explanation of the theories basic approach to moral evaluation and decision making.

b                            Ethically analyze your stated issue using each of the two theories. The idea here is to adopt the strategy of each of the theories to present what you think is a reasonable and balanced ethical analysis of your issue. In doing so, your aims are (i) to show that you understand how the theories work and (ii) to show that you can use them to express the ethical reasoning that should be brought to bear on the issue.

For each theory, if you think that it would prescribe a certain resolution or answer to your issue, state that resolution. If you think that the theory would not prescribe a resolution per se but, nevertheless, would offer some insights into how the case and issue should be dealt with, explain the insights it would offer.

 

 

Applying Normative Theories to a Moral Situation

Case 2.1

 

One evening five victims of an automobile accident were admitted to the ward of a small rural hospital. The nurse in charge knew the woman who had been driving and her four children who were also injured. Three of the children survived, but the oldest child, a daughter, died shortly after admission. The mother suffered contusions and abrasions, but her major problem was her mental anguish about her children. The nurse asked the doctor, who was busy in the operating theatre, what she should tell the mother about the daughter`s death. The doctor told the nurse to reassure the woman at all costs because she was in great distress and her husband could not be reached until the next morning.

 

All through the night the mother constantly asked the nurse about the children. As the nurse put it, “It went strongly against my conscience to have to look her in the eye and repeat a lie of such magnitude.” The doctor told the woman the truth the next day in the presence of her husband. She cried out, “Why did she lie to me?”[8]

 

Three issue questions pertaining to professional ethics stand out in this case: “Was the doctor justified in instructing the nurse to deceive the mother?”, “Should the nurse have lied to the mother?”, and “What should the nurse have done?” All of these are important and controversial questions, but only one issue should be addressed at a time. Each of the first two issues has only two possible answers, “yes” and “no.” The third question is more open-ended and there are several possible answers or courses of action that would be reasonable to examine. To keep things simple, we will examine the second question about whether or not the nurse should have lied.

 

The options for directly answering this issue question are “Yes, the nurse was right to lie” and “No, the nurse should not have lied.” In a more complete analysis of this case and issue, we would not limit ourselves to applying particular normative ethical theories, but would be less constrained and consider, among other things, different moral values, rules, and principles that are relevant, various relevant facts (e.g., the location is a small town), and objections that may be brought against each of the respective answers. In any case, if it turns out that one or more of the moral theories would help us to present a complete and thoughtful analysis, then it would be wise to use it or them; but it is not always necessary to incorporate these theories into an analysis of a moral issue. For explanatory purposes, here, we will limit ourselves to approaching the case above and addressing the issue posed only by the light of the five theories underscored in this unit.

 

Given that act utilitarianism judges each individual action, as opposed to types of actions, as morally right or wrong, it would concern itself straightforwardly with the consequences of the nurse`s lying or not lying. In this case, which of these two actions is likely to result in less unhappiness? Act utilitarianism would consider the interests of all parties, which would at least include the mother, her children, the father, the nurse, and the doctor. It is likely too, however, that others will be affected, especially since this situation occurs in a small town. If other community members disapprove of the nurse`s lie, their unhappiness will be even greater, whereas if they are grateful that the nurse spared the mother a terrible shock at a crucial time, then they will be less unhappy. The hospital also has a stake in this, in terms of its reputation in the community.

 

It is probable that most of the persons who will be affected by the nurse`s action will be influenced by the mother`s feelings and reaction. The father and community members are likely to be supportive of the mother in however she feels and will empathize with her. The children are likely to follow their mother`s lead. Since the case itself indicates that the mother feels the nurse has added “insult to injury” by lying, it seems that the mother`s unhappiness is made even worse by the lie. It is possible that the mother will be better off in the long run for the nurse`s lie, and that she and others will be grateful, but her not being so seems just as likely. The case also indicates that the nurse is unhappy about lying. It seems that she deceives the mother out of an obligation to follow the doctor`s order, and that she is not pleased with having to do so. Of all the interested parties, it seems the doctor is the only one who may be pleased that the nurse did not disobey the order. Overall, act utilitarianism would judge the nurse`s lying to be morally wrong, since it would not have been the “least of two evils” in this particular case.

 

Rule utilitarianism would probably reach the same conclusion as act utilitarianism, in this case, but by different reasoning. Rule utilitarianism judges an individual action as right (or wrong) on the basis of whether (or not) it accords with a rule that, when generally followed, promotes happiness and diminishes unhappiness. In this situation, we are considering whether lying accords with such a rule. It doesn`t. Rules that require truth telling are rules that promote happiness and good things and avoid unhappiness and bad things, generally speaking. Since lying is contrary to truth telling, rule utilitarianism would judge that the nurse should not have lied (even if her lie, in this particular case, would produce less unhappiness in the long run).

 

Kantian deontology requires that one`s actions are performed from duty. We can come to know our duties by testing our action through the fundamental principle of the categorical imperative. So, if we suppose that the nurse in Case 2.1 is considering either following the doctor`s order and deceiving the patient or not following the order and being truthful with the patient, then we should express one of these contrary actions as a maxim (or rule) and test it against the categorical imperative. The nurse`s maxim could be “I should deceive an anguished person (at least temporarily) if telling them the truth will hurt them.” Generalizing this maxim, the nurse would get “Everyone should deceive an anguished person . . . if telling them the truth will hurt them.” Would this generalized rule pass Kant`s categorical imperative?

 

First, we ask whether it could be universally followed and not be self-defeating. It couldn`t. Kant contends that lying cannot be universalized because it would become senseless. If it were a universal action in situations similar to the situation of our case, then both lying and truthtelling would be rendered illogical. The Kantian conclusion, here, would be that the nurse should not lie.

 

Contractarianism demands that we evaluate the situation according to the conditions of the (hypothetical) contract that (we imagine) the parties agree to. There are some fundamental conditions that every moral contract satisfies but, beyond these, what matters are the details of the contract as specified by the parties involved. In this case, there are (at least) two relevant contracts that are importantly relevant, one between the mother and the nurse and another between the nurse and the doctor. Ideally, it would be possible to satisfy both contracts simultaneously; however, this doesn`t seem to be the case, here.

 

What conditions have the nurse and doctor likely agreed upon in their working agreement? One condition would be that the doctor is authorized to determine treatments for patients, and that the nurse will follow doctor`s orders. It may also be a condition, though, that the nurse may conscientiously object to the orders and discuss this with the doctor or bring her concerns to a higher authority if the two of them cannot agree. Other conditions may be involved, but we will limit ourselves here. It seems that there is no time for the nurse to discuss the issue with the doctor or bring her concern to the attention of someone else such as the hospital board. Supposing that it is not within the conditions of the contract for the nurse to act independently on her conscientious objection, then the nurse should follow the doctor`s order and lie.

 

The (hypothetical) contract between the nurse and the mother would include the condition that the nurse cares for the health of the mother qua patient to the best of her abilities as a health care expert. It is safe to assume that the mother implicitly agrees. Currently, it is also commonly thought that nurses have a responsibility to advocate for their patients. So, it seems that both mother and nurse would agree that the nurse should act on behalf of the patient, at least so long as the nurse has no clear reason to reject the patient`s wishes. Where does this leave truth telling between them?

 

Arguably, if the nurse as a health care expert thinks that it is important to deceive the mother as part of caring for the mother`s health (like the doctor thinks), then the duty to care can be taken to override the nurse`s duty to act as the mother`s advocate, because caring for the mother is a reason to reject the mother`s expressed wishes. On the other hand, it seems that the nurse herself thinks that lying to the mother is wrong. But is this belief personal or professional? It is difficult to separate the two, especially in a profession such as nursing, where it is important to care for a whole person, not just their condition and to establish interpersonal trust and rapport. From what the nurse says, it seems that her ill feelings about lying indicate her professional as well as her personal position. It seems she thinks that good care for the mother would not include lying.

 

So, the nurse is truly in conflict over the two contractual agreements. Further contractarian reasoning might indicate how the scale should be tipped; however, at this point in the analysis (where we will leave it), it seems that contractarianism gives us no clear answer as to which of the nurse`s options is morally best.

 

Virtue ethics focuses on moral character and only derivatively on right and wrong actions. To understand how a virtue ethicist would approach this situation, then, we should consider the virtues and vices that are relevant to it. Since virtues are characteristic dispositions occupying the mean between the extremes of excess and deficiency, the nurse should consider what this mean would consist in, given her dilemma. A virtue ethicist could argue that it is excessive to obey orders no matter what and that it is deficient to disobey orders, say, just because one feels like it or because one is lazy. An Aristotelian moral virtue that is relevant here is courage. Courage, according to Aristotle, lies between the excesses of rashness and cowardliness. One should not follow orders hastily and foolishly; nor should one spinelessly avoid challenging them. The nurse, in this case, should exhibit courage in her approach to her decision. She should be willing to defy the order if her practical judgment determines this to be necessary. Although the nurse`s comment does not clearly indicate that she thinks defying the order is necessary, it points in this direction. In this situation, defiance might be the proper exercise of courage that morality requires.

 

What other virtues arise in this situation, say, in relation to the nurse`s interactions with the mother? Care and compassion come to mind. Aristotle would say that in caring and being compassionate one should not indulge another too much or too little. One should exercise temperance in approaching the other and be neither overemotional nor insensitive. We can imagine ways in which the nurse could exercise temperance with the mother`s sensitive situation. Although, again, this doesn`t clearly tell us whether it is morally better for her to lie or to tell the truth, a case could be made that she should tell the mother the truth in a sensitive way but without being overly protective. A full application of virtue ethics here may consider other important virtues involved and whether they would indicate lying or truth telling; but the analysis thus far suggests that virtue ethics would favour the nurse telling the mother the truth.

 

Approaching Case 2.1 from the perspective of feminist theory, we would attend to the contextual details of the situation so as to understand the relationships among those involved more fully. Feminists would contend that it is important to consider the interpersonal and the institutional/professional relationships, as well as the more general social and political relationships involved. It is relevant that the setting is a small town, where much of the community would be affected by the tragedy and, perhaps, also by the nurse`s action, and that the nurse will directly experience the reaction of the community. It is relevant that the nurse is a person and a community member and not just a professional; likewise the mother is a person and a community member and not just a mother and a patient.

 

It is also relevant that, traditionally, the profession of medicine has been dominated by men and the profession of nursing has been dominated by women, and that nurses have been expected to be subservient to doctors and compliant with their orders. Additionally, however, it is relevant that this gendered division of labour is changing and that an increasingly popular view holds that a nurse`s primary obligation is to serve her (or his) patients rather than the doctors. Doctors still hold authority over nurses in certain ways, and based on some justifiable reasons; but their authority is no longer taken to be unconditional. Feminist theorists would favour the current view of entrusting nurses to use their own judgment in deciding how to best do their jobs, and would reject the idea that the traditional hierarchy of dominance and subordination should be respected. Defying doctor`s orders is perfectly legitimate so long as, all things considered, one`s moral reasons for doing so are stronger than one`s moral reasons not to.

 

It is also relevant that the nurse and the mother know one another and, although it is not explained in the case, a feminist theorist would want to know, further, how well they know one another and what their relationship has been. If the nurse knows the mother to be a strong person with good personal and social supports available to her, then she has more reason to be forthright with the mother than if she knows her to be fragile and without support.

 

Although feminist theory doesn`t tell us whether the nurse should lie or not, it does tell us that there is good reason to permit the nurse to decide this for herself. She has relevant professional expertise and experience; she knows the mother to some extent and, presumably, knows something about how the mother will likely be supported (or not) by her family and the community; and she is the one who must live with her decision personally, socially, and professionally. These things, among others, mean that the decision should be hers.

 

This application of moral theories to Case 2.1 shows that Kantian deontology clearly responds to the moral issue of “Should the nurse have lied to the mother?” with the answer “No, the nurse should not have lied.” Both forms of utilitarianism point to the conclusion that she should not have lied, as does virtue ethics, but their respective lines of reasoning, as presented here, are not conclusive. Neither contractarianism nor feminist theory directs us toward a determinate answer to the issue; however, both of these theories provide us with information about what is morally important to consider and about how decision making by the nurse should be approached.

 

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