INTRODUCTION

‘Ethics’ is a word derived from the Greek ethikos, which means ‘habit’ or ‘custom’. Put simply, in modern usage it is the study of how we ought to live or act in response to the situations confronting us in daily life. Medical ethics in particular is a branch of bioethics and is the study of how we ought to live or act as doctors. Ethics, being a branch of philosophy, relates to things such as ‘right’, ‘wrong’, ‘duty’ and ‘morality’. Making decisions of an ethical nature in medical practice is often difficult and demanding, and the clinician has to balance medical considerations with legal and moral ones.

Taking the time to reflect upon ethical issues, and having a structured approach to doing this, can help clinicians to navigate through many potentially challenging situations. Not taking time for this can compound ethical and moral concerns. This has effects upon our wellbeing and can also have medico-legal implications. As with many medico-legal dilemmas, ethical problems are often compounded by poor communication.

This chapter does not present a detailed analysis of particular and complex bioethical issues such as euthanasia, stem cell research or abortion. Nor does it make concrete pronouncements about the ‘correct’ view on given topics or course of action in given situations. It does, however, give an overview of generic ethical terms, concepts and methods that can be applied by the clinician to particular situations. We are interested here in ‘applied ethics’ and not simply ‘theoretical ethics’ or ‘meta-ethics’.

DEFINITIONS, TERMS AND MEANING

Many ethical conflicts lie in our understanding and interpretation of words. It is therefore useful before considering principles and concepts in more detail that some remarks are made about the language of ethics and the meaning of words commonly used in ethical discourse. It is easy to assume that different people mean the same thing by a word when they use it. This assumption gives rise to many misunderstandings. For example, one person might interpret ‘freedom’ as having all external restraints removed from their behaviour, whereas another might equate freedom with an internal state of self-awareness, balance and self-control. One person might equate happiness with pleasure or wealth, whereas another might equate it with spiritual enlightenment. One of the first points is that we should reflect on the meaning of the words we often take for granted.

As was mentioned, there is a distinction between meta-ethics and applied ethics. Meta-ethics is the ‘philosophical inquiry into the concepts, theories, language and intellectual foundations of ethics—as opposed to practical ethical questions’.¹ So when a moral philosopher seeks to say what it means to say that something (a value or action) is ‘right’ or ‘wrong’, they are seeking to clarify the language or concepts of moral judgments rather than to say what one ought or ought not to do.² It is like standing beside (meta) ethical actions and seeking to provide conceptual clarity to the usage of moral language.

Normative ethics is ‘concerned with establishing basic ethical principles or standards (“norms”—from the Greek for builder’s rule or square). Examples include normative theories (e.g. deontology or teleological), normative principles (e.g. the principles of bioethics), and declarations or statements whether on the core values of medicine or on specific duties of doctors and nurses in particular circumstances’.¹ The following definitions of terms commonly used in ethical discourse are from the Oxford Dictionary.

ETHICAL APPROACHES