Introduction to Applied Ethics

In many fields of study there are both “pure” and “applied” versions. For instance, pure physics might focus on understanding the fundamental laws of nature and the properties of matter whereas applied physics might focus on solving practical problems using physics, such as might be used by mechanical engineers when designing machines. Pure mathematics might focus on understanding fundamental truths about how equations work, and applied mathematics could include using mathematics in real-world situations like those found in banking. Pure psychology strives to reveal truths about the many functions of the brain and about how people behave, while applied psychology applies psychological principles in specific cases like education, the workplace and even sports.

Ethics is a research field, just like the sciences and many other fields are research fields. In meteorology, researchers study weather patterns to predict storms, help people plan trips and events, and even to help save lives. Economists analyze market behaviors to understand financial trends, attempt to help control inflation, and improve economic policies. Similarly, ethicists investigate moral questions, such as what is right and wrong in various situations. By examining cases from medical ethics or environmental ethics, they help society make informed decisions, just as meteorologists and economists provide critical insights in their respective fields. For example, many hospitals hire clinical ethicists, just like they might hire social workers or pastors, to help nurses, doctors and other hospital staff with patient issues that might not be entirely medical issues, and when those issues cannot be easily resolved by consulting with the hospital’s lawyers or human resources personnel.

Ethics, as a pure field of study, focuses on right and wrong, and what it means to live well, and does so by trying to find theories and principles that support those views. Applied ethics attempts to solve practical problems and address questions by applying ethical insights in real-world situations. Common examples today include the following. Is it ethical to eat meat when the production of animals for human consumption is bad for the welfare of those animals or when the production has a negative environmental impact? When should we use and not use technology to monitor people’s locations to increase safety? What responsibilities do people in economically advantaged countries have to help people suffering in less advantaged countries? A clinical ethicist at a hospital might help family members come to a decision when faced with a loved one on life support.

There are many applied ethics occupations in the United States and elsewhere including medical ethics, accounting ethics, engineering ethics, environmental ethics, and journalism ethics. In this course, we will explore just one of these, biomedical ethics, more deeply.

Biomedical Ethics

By David Paul

Many universities offer graduate degrees in biomedical ethics. This field is sometimes called “bioethics” or “medical ethics.” While these terms are similar, there are some differences. We’ll define “medical ethics” as the ethics of patient care, focusing on the treatment of individual patients. “Biomedical ethics” is a broader term that includes medical ethics but also covers other ethical issues in medicine. For example, during a pandemic, we might need to balance individual patient needs with public health needs, which falls under biomedical ethics. Another issue in biomedical ethics could be how artificial intelligence (AI) is used in medical research, which isn’t directly about treating patients but still very important in medicine.

Biomedical ethics is important in modern medicine and healthcare for several reasons. Patients have rights and their autonomy as people sometimes conflicts with what others might think is best for them as patients. The fields of medicine and healthcare are often at the cutting edge of technological advancements and many of these come with their own ethical challenges. For example: genetic engineering, artificial intelligence in diagnostics, and advanced biotechnologies all present ethical challenges that are relatively new. Biomedical ethics helps guide the responsible development and implementation of these technologies, ensuring they benefit patients without compromising moral standards. Biomedical ethics also addresses issues of fairness and equity in access to medical care and resources. This includes tackling disparities in healthcare based on socioeconomic status, race, ethnicity, and geography, ensuring all individuals have fair access to high-quality medical care. And, of course, these disparities aren’t limited to small areas or even nations. With global health issues like pandemics, there’s a crucial need to address ethical questions about vaccine distribution, treatment access, and public health measures. Biomedical ethics is foundational to modern medical practice. Major medical centers have clinical ethicists on their staff to assist with addressing these and other complex problems, just as they have lawyers, social workers, and clergy on their staff to assist with other complex problems that might not, at first, seem like medical or health matters.

The Relationship Between Autonomy, Consent, and Ethical Decision Making

By Levi Smith

Autonomy—simply put—is a person’s ability to control matters that are relevant to their life. For example, a person is financially autonomous if they are able to decide when and how they will spend their money. Consent is related to autonomy, but not synonymous. A person consents to something when they autonomously agree to that thing. For example, somebody consents to a contract when they—without being pressured or coerced—agree to sign it after learning all the important details of said contract.

There are interesting details of autonomy and consent that are important to note. Perhaps most importantly, consent is a matter which is binary (or black and white). One can either agree or not agree to something. Autonomy, on the other hand, is not binary but scalar (which means that you can be partially but not fully autonomous). To give an example, picture a sober man who has the ability to reason soundly and make decisions based off of their sound reasoning. Let’s now imagine that this guy has one beer. He may be able to reason fine enough, but he may be slightly more impulsive than he was before. But if this guy has a second, third, and fourth beer, then you will notice that his ability to reason soundly will go down further and further. Depending on their tolerance, somebody may be mostly autonomous after having two beers, but nearly completely non-autonomous after having six.

Substances are not the only way that somebody can lose some or all of their autonomy. Outside pressures and other situational factors can also play a role. To give an example, a boss who offers his subordinate a promotion in exchange for sex has not propositioned sex in a manner that gives their subordinate an appropriate amount of autonomy (in fact, it is impossible for the boss to proposition his subordinate in a manner that maintains an appropriate amount of autonomy for the subordinate, due to the boss’ position of authority). The incentive of the promotion delegitimizes the subordinate’s autonomy and thus makes their consent invalid. Contrast this example with a boss who tells their subordinate that they will fire them if they don’t agree to sex. It seems like this instance is an even more egregious example of the delegitimization of autonomy. The pressure of losing their job is so great that the subordinate seems to have very little autonomy in the situation and their consent is thus invalid. Of course, both cases highlight a serious moral wrong; however, the second case is an even greater moral wrong since the subordinate had less autonomy than they did in the first case.

This picture of the relationship between autonomy and consent implies that—although consent is binary—the quality of that binary decision can vary based upon a person’s level of autonomy. So, if somebody is incredibly drunk then their agreement to an action seems far less legitimate than a case in which they are only slightly buzzed. This leads us to an important question; how can we determine how much autonomy somebody needs in order to make an ethical decision? Should we not let somebody decide to do something if they are not fully autonomous? Or is there some sort of threshold that they would need to meet?

I think we can derive a good answer to our question by analyzing our intuitions. Let’s imagine that the drunk man who had six beers (who I mentioned earlier) drank these beers at a nightclub. He then stumbles out of the club and walks into a convenience store to buy a bag of chips. It is intuitively moral for the clerk to sell the drunk man the bag of chips (despite the fact that the drunk man is far from fully autonomous). However, let’s say that this drunk man then stumbles out of the convenience store and calls a real estate agent that he knows. The drunk man then tells the real estate agent that he has suddenly got the idea to buy a $2,000,000 house and he is willing to sign all of the necessary contracts that night. If the real estate agent realizes that the man is clearly drunk, then it would intuitively be immoral for the real estate agent to take advantage of the man and sell him the house.

What is the difference between the two cases above? Both cases deal with a drunk man making a purchase, so why is one case clearly more ethically significant than the other? The intuitive answer is that buying a house is a much more important and impactful decision than buying a bag of chips. Thus, because the decision is more important, the man must have more autonomy to legitimately consent to buying the house than he needs to legitimately consent to buying the bag of chips. Thus, it seems like the amount of autonomy that somebody needs to legitimately consent to something is proportional to how important the decision is.

This leads us to another question; how should we react when somebody attempts to consent to an action when they do not have enough autonomy to legitimately consent to said action? After all, if somebody requests something then it may—on face value—seem to be compromising to their autonomy to decline their request (even if they lack full autonomy). The answer to our question is simple, you should act as if they said “no.” Consenting to an action is a sort of agreement between two people. If I consent to buy a bag of chips, then I agree to exchange $3 for the bag of chips. If I consent to sex, then I agree to have sex with somebody (of course, somebody should be allowed to take away their agreement to sex at any time if they so desire, which is not a standard we hold for many financial agreements). Since consent is an agreement between multiple parties, it follows that everyone has a right to decline the agreement. Thus, you are not undermining somebody’s autonomy if you decline an offer they made due to their lack of autonomy. You are merely exercising your right to decline. Beyond your right to decline, it is worth noting that you have a moral responsibility to decline an offer if the other person does not possess the appropriate amount of autonomy. Thus, if somebody consents to an action with an insufficient amount of autonomy and the other party agrees to follow through with that action, then it is the other party who is morally blameworthy.

This representation of consent explains many of the moral rules that are present in sexual ethics. Sex is incredibly important since moral sex can have a major positive impact on our wellbeing while immoral sex causes great trauma. Since sex is so important to the quality of our lives, it follows that there are extremely high standards that one must meet to adequately consent to sex. For example, since different people have different alcohol tolerances, it is reasonable to say that you should avoid having sex with somebody who has had any alcohol (even if it is just a small amount), since you have a moral responsibility to absolutely make sure that your potential sexual partner has a very high amount of autonomy prior to asking them for consent. But you would not need to proceed with that much caution if you are merely selling a drunk guy a bag of chips.

It is important for me to note that this representation of the relationship between autonomy and consent is not universally accepted. There are surely many philosophers who would disagree with some of what I have said, however, I think that this representation adequately maps and explains many of our strongest ethical intuitions regarding autonomy, consent, and ethical decision making. Furthermore, I should point out that this representation of consent prompts us to ask many important questions which I have not answered. For example, what does this imply about the ethical responsibility of people who are addicted to mind-altering substances? Do the moral requirements for sexual consent differ from those of medical consent? How much can we actually consent if our opinions are shaped by cultural norms outside of our control? These are important questions that our worth exploring further (just not in this introduction).