HOW FAITH INFLUENCES ETHICAL CHOICE. Ann Boyd or

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1 ETHICS AND FAITH HOW FAITH INFLUENCES ETHICAL CHOICE Ann Boyd or WHAT IS ETHICS? Ethics begins at the intersection of conflict of competing claims. Is morality and ethics the same thing? How do we decide what is right and good to do in a given context? What role does our faith tradition play in ethical analysis? 1

Ethics begins at the intersection of conflict of competing claims.

2 ETHICAL CASES CONTAIN FACTS, ISSUES AND CONCEPTS A case describes a situation where the action to take is not obvious. The case could deal with the allocation of a scarce resource, or equal access to care/treatment, or deciding to use a procedure that may not improve quality of life but extend quantity. There may be more than one justifiable path, specifically if there is diversity of opinion about the facts, or differing priorities about moral values. VALUES Making ethical decisions requires that a person be aware of, clear about, and able to articulate his/her values. Values are qualities of a person, group, which may reflect religious beliefs, education, culture, family influence. Values help us prioritize what is important and guide us in making choices. We have theological sources, faith based values, e.g. sanctity of life, respect for dignity of all people, love of neighbor, etc. 2

There may be more than one justifiable path, specifically if there is diversity of opinion about the facts, or differing priorities about moral values.

3 ETHICAL ISSUES INCLUDE: End-of-life decisions Termination of treatment, appointing a proxy, writing an advance directive Genetic medicine Screening, testing, pharmacogenetics, risk assessment Reproductive medicine In vitro fertilization, stem cell therapy Justice and equality in health care Access to care/treatment Public health issues e.g. HIV/AIDS MAKING ETHICAL DECISIONS VIRTUE ETHICS An approach which deals with what a virtuous agent would do (virtue being a character trait human beings need to flourish or live well) MORAL STANDARDS Reasoned based application of a moral theory, standard or principle. Moral theories define goodness so actions are based on what is good. 3

4 VIRTUE ETHICS Virtue Ethics emphasizes development of character The virtuous person does good things We learn virtue by practice: we deliberately and consistently choose the mean between excess and deficiency until it becomes second-nature. Four cardinal virtues: temperance, courage, prudence, and justice. Piety* is considered a fifth virtue. *obey God ~ Word (revealed in Son or written text?) t?) MORAL THEORIES Moral theory guides but does not dictate what is right or good to do. Useful methods can be used by both sides in a debate about any issue, e.g. single payer insurance, war, human rights The moral theory should help provide a clear reasoned explanation for why one ought to act in a particular way in a particular situation that can be consistently used with other issues involving the same concept. Ex: do we have the same perspective about quality of life at its beginning as at its end? 4

5 NATURAL LAW Natural Law: reason and revelation are the keys to understanding the created world. Natural reason will reveal divine will. Our moral obligation is to promote the natural inclinations of human beings: preserve life, procreate, search for truth (education), and form stable social relationships. Holding all 4 values in tension, we may feel trapped and want a simpler approach e.g. love your neighbor. RESPECT FOR PERSONS Deontological: duty of human persons to self and others Act as though the principle of your action were to become by your will a universal law Always act to treat humanity whether in yourself or in others, as an end in itself, never merely as a means. Echo here of baptismal promise to respect the dignity of every human being. Who does not qualify and why? 5

Holding all 4 values in tension, we may feel trapped and want a simpler approach e.g. love your neighbor.

6 UTILITARIAN Teleological: outcomes/consequences dictate goodness of the act The moral maxim is to maximize happiness, measured by pleasure and pain. The calculus determines the most pleasure for the most people, now and in the future, or at least as much as any alternative. A rule/act is right that promotes the most happiness/pleasure and least pain or at least as much as any alternative rule/act. Take care in the calculus, it can turn hedonistic NURSING CODE OF ETHICS Conventionalized set of rules or expectations for a select purpose. Revised several times, but consistently holds that nurses shall: Respect for persons Practice competence Protect patient confidentiality Do Not discriminate among patients Be ethically accountable. There are also codes of business ethics, medical ethics, etc Does this mean a plurality of ethical values or methods? 6

A rule/act is right that promotes the most happiness/pleasure and least pain or at least as much as any alternative rule/act.

7 ELEMENTS OF ETHICAL DECISION MAKING How does ethical decision making apply to spiritual care? How can the nurse in the faith community use skill in ethical decision making within his/her ministry? How do the various ways of doing ethics, of making ethical decisions provide a framework to use in your faith community? ETHICAL ANALYSIS PROCESS Know the facts: get the story straight What are the issues in conflict? What are the values involved? Why are these values important and to whom? Are there legal issues involved? Can I (the parish nurse) maintain my integrity in this situation? 7

How do the various ways of doing ethics, of making ethical decisions provide a framework to use in your faith community?

8 VALUE CONFLICT Few ethical cases have one and only one right answer. Most cases contain more than one issue, and there may be more or less moral weight given to one issue over another by different parties. All options should be explored, not with an eye to fixing the problem, but with an open mind about what action will be good and why. PRACTICE - APPLICATION Cases are the lens through which we view ethical issues and concepts. Small groups will be asked to a) identify what value conflicts are in each case and b) propose an ethical action for the faith community nurse with an explanation of why this action is right or good. 8

All options should be explored, not with an eye to fixing the problem, but with an open mind about what action will be good and why.

9 EXAMPLE: NASH CASE Mr and Mrs Nash had a daughter, Molly with Fanconii anemia and then developed leukemia. The Nash family did not have a compatible donor so the parents decided to use IVF-PGD to select an embryo that would match Molly. Embryo #28 did and the child born was named Adam. The cord blood was used to treat the leukemia but the FA remained. ISSUES What issues are in the case? Procreative liberty, In-vitro fertilization (industry without oversight), serious life threatening illness and parental obligation to help, genetic testing (accuracy, benefit, harm), justice as equal access. Can you think of others? 9

Embryo #28 did and the child born was named Adam. The cord blood was used to treat the leukemia but the FA remained. ISSUES What issues are in the case?

10 MORAL RULE/ACT A parent may choose IVF-PGD to select an embryo to obtain cord blood to treat an existing seriously ill sibling, so long as the parents plan to raise the donor sibling without future rescue expectations. Would this rule pass Natural Law, Utilitarian, or Respect for Persons? Would a virtuous person agree? Does it fulfill guiding principles of your faith tradition? How does your faith influence your reasoning and choice? GROUP WORK-PRACTICE Each table has a case. Discuss the case. Identify the issues. What is the ethical conflict? What ethical or personal values or beliefs pertain to this case? What would you do? Can you construct a rule for similar cases? What if any consensus does your group recommend? 10

Does it fulfill guiding principles of your faith tradition? How does your faith influence your reasoning and choice? GROUP WORK-PRACTICE Each table has a case. Discuss the case.

11 A Framework for Doing Theological Ethics* Reflect on contemporary experience as a foundational source for subsequent moral reasoning Analysis of Sources Tradition: theological and church Sacred Texts Disciplines: philosophy, social & physical science, history, theology Contemporary Experience Reflect on the central questions of life, the central features of human experience.which is brought to bear on particular situations yields a Theological Perspective Formulated in terms of doctrines of God, creation, the human person, the church, eschatology, reconciliation etc. Reflect on concrete, specific situations, experiences, domains of human life, e.g.: Medical issues Sexuality & family life Economic & political life Individual, society & institutions.which is crafted into an Ethical Perspective May be formulated in terms of deontology, utilitarianism, virtue theory etc. Reflect on the key dimensions of the moral life: Moral agency Situation Principles & Rules *Adapted from Prof. Margaret Farley, Gilbert Stark Professor of Christian Ethics Emerita, Yale Divinity School 11

which is brought to bear on particular situations yields a Theological Perspective Formulated in terms of doctrines of God, creation, the human person, the church, eschatology, reconciliation etc.

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