Moral Reasoning Ravi Vaswani MD PGDBEME PGDHPE Professor, Department of Medicine Yenepoya Medical College, Mangalore - Yengage
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Moral Reasoning Ravi Vaswani MD PGDBEME PGDHPE Professor, Department of Medicine Yenepoya Medical College, Mangalore
The Heinz Dilemma
• Heinz’s wife is suffering from cancer for which there
is only one form of treatment
• This is available with the local pharmacist who has
discovered this treatment at a cost of $ 20,000.
• He is selling it at $ 500,000
• Heinz can’t afford it. Asks it for free, which the
pharmacist refuses. Then at cost price which also
the pharmacist refuses. Then in installments which
also is refused
• Heinz decides to come back at night and steal drug
08 Feb 2021 Ravi Vaswani CFE YU 2Group activity • Should Heinz steal the drug? 08 Feb 2021 Ravi Vaswani CFE YU 3
Objectives
• By the end of this session you will be able to
– Position moral values in the context of day-to-day actions
– Understand the common theories behind moral development
– Apply these principles to real life situations
08 Feb 2021 Ravi Vaswani CFE YU 4What would you do? • You have a doctor sticker on your car. You have an apron in your car. You are on your way home. You have just jumped a red signal, you are stopped by the traffic policeman. She asks you what was the reason for breaking the rule. What excuse will you give her? 08 Feb 2021 Ravi Vaswani CFE YU 5
What would you do? • You have just diagnosed your 45-year old patient to be terminally ill with a medically untreatable condition. You have not yet disclosed this to the patient. His wife approaches you and requests you not to tell him as he will “die of shock” • What will you do? 08 Feb 2021 Ravi Vaswani CFE YU 6
Position of morals
Moral values
Thoughts
Actions
Consequences
08 Feb 2021 Ravi Vaswani CFE YU 7Definition • The process in which an individual tries to determine the difference between what is right and what is wrong in a personal situation by using logic • Important and often daily process that people use in an attempt to do the right thing • Every day people are faced with the dilemma of whether or not to lie in a given situation • People make this decision by reasoning the morality of the action and weighing that against its consequences. 08 Feb 2021 Ravi Vaswani CFE YU 8
Moral Reasoning - four stages • Identify the dilemma • Reason for and against a particular action • Choose one option • Determine moral behaviour 08 Feb 2021 Ravi Vaswani CFE YU 9
Moral behaviour - 4 components
• Moral sensitivity: the ability to see an ethical dilemma
• Moral judgment: the ability to reason correctly about what
'ought' to be done in a specific situation
• Moral motivation: a personal commitment to moral action,
accepting responsibility for the outcome
• Moral character: a courageous persistence in spite of fatigue
or temptations to take the easy way out
08 Feb 2021 Ravi Vaswani CFE YU 10Piaget’s model
• Stage 1: Heteronomous moral development:
– Rules come from authority figures in one's life such as parents,
teachers, and God
– Rules are permanent
– “Naughty" behavior must always be punished and that the
punishment will be proportional
• Stage 2: Autonomous moral development:
– Intentions behind actions as more important than their
consequences
08 Feb 2021 Ravi Vaswani CFE YU 11Kohlberg’s stages of moral development
• Level 1 (Pre-Conventional)
– 1. Obedience and punishment orientation (How can I avoid punishment?)
– 2. Self-interest orientation (What's in it for me?)(Paying for a benefit)
• Level 2 (Conventional)
– 3. Interpersonal accord conformity(Social norms)(The good boy/girl attitude)
– 4. Authority and social-order maintaining orientation (Law & order morality)
• Level 3 (Post-Conventional)
– 5. Contractual orientation (Institutionalized rules)
– 6. Universal ethical principles (feedback & reinforcement)
08 Feb 2021 Ravi Vaswani CFE YU 12Alternate hypothesis - David Hume • Philosopher David Hume claims that morality is based more on perceptions than on logical reasoning • People's morality is based more on their emotions and feelings than on a logical analysis of any given situation • Hume regards morals as linked to passion, love, happiness, and other emotions and therefore not based on reason 08 Feb 2021 Ravi Vaswani CFE YU 13
Alternate hypothesis - Jonathan Haidt
• Psychologist Jonathan Haidt agrees, arguing that
reasoning concerning a moral situation or idea follows
an initial intuition
• Haidt's fundamental stance on moral reasoning is that
"moral intuitions (including moral emotions) come first
and directly cause moral judgments”
• He characterizes a moral intuition as "the sudden
appearance in consciousness of a moral judgment,
including an affective valence (good-bad, like-dislike),
without any conscious awareness of having gone
through steps of searching, weighing evidence, or
inferring a conclusion”
08 Feb 2021 Ravi Vaswani CFE YU 14A True Story - Paxton & Green 2009 • Greg and Adam are friends. Adam is a vegetarian. Greg is not. Both enjoy eating meat, but Adam has given it up after concluding that eating meat is morally wrong • Over many months, Adam and Greg argue about the ethics of eating meat. Adam agrees with Greg that hamburgers taste better than veggie burgers, but he argues that the additional enjoyment that we humans derive from eating meat is not enough to justify the suffering and ultimate death inflicted on animals such as cows 08 Feb 2021 Ravi Vaswani CFE YU 15
• Greg is not easily convinced. He observes that eating meat is perfectly natural, pointing to his canine teeth. • Adam replies that many things, such as wars of aggression, may be perfectly natural, but that such things are not necessarily right. • Greg points out that the animals he eats owe their very existence to the demands of consumers such as himself. 08 Feb 2021 Ravi Vaswani CFE YU 16
• Adam replies that most animals raised for food live miserable lives and would be better off not existing. Through the course of many such discussions, Greg’s mind is changed and he, too, becomes a vegetarian 08 Feb 2021 Ravi Vaswani CFE YU 17
A Hypothetical Story • Barbara wants to kill her husband, John. When they are eating at a restaurant, Barbara slips some poison into John’s dish while he isn’t looking. • Unknown to Barbara, the poison isn’t strong enough to kill her husband. However, it makes the dish taste so bad that John changes his order. • When he receives his new order, it contains a food that John is extremely allergic to, and which kills him within minutes. • Is Barbara to blame for John’s death? 08 Feb 2021 Ravi Vaswani CFE YU 18
Another scenario • It’s wartime. You and your fellow villagers are hiding from nearby enemy soldiers in a basement. Your baby starts to cry, and you cover your baby’s mouth to block the sound. • If you remove your hand, your baby will cry loudly, and the soldiers will hear. They will find you, your baby, and the others, and they will kill all of you • If you do not remove your hand, your baby will smother to death • Is it morally acceptable to smother your baby to death in order to save yourself and the other villagers? 08 Feb 2021 Ravi Vaswani CFE YU 19
Moral Reasoning - Conceptual Framework
Moral Moral
Reasoning Intuition
Thought/ Action
Intention
Consequence
Context
08 Feb 2021 Ravi Vaswani CFE YU 20Case scenario • Shankar, an 18-year old beedi worker, wants to commit suicide • He approaches you and asks you to give him a prescription for morphine in a dose you know is likely to kill him • You refuse/You accept • The context makes all the difference 08 Feb 2021 Ravi Vaswani CFE YU 21
The Heinz dilemma
Stage 1 (obedience): + Stage 1 (obedience): -
• Heinz should not steal the medicine • Heinz should steal the medicine
because he will consequently be put in because it is only worth $20,000 and
prison which will mean he is a bad not how much the druggist wanted for
person. it; Heinz had even offered to pay for it
and was not stealing anything else.
08 Feb 2021 Ravi Vaswani CFE YU 22Stage two (self-interest): + Stage two (self-interest): -
• Heinz should not steal the • Heinz should steal the
medicine because prison is medicine because he will be
an awful place, and he much happier if he saves his
would more likely languish wife, even if he will have to
in a jail cell than over his serve a prison sentence.
wife's death.
08 Feb 2021 Ravi Vaswani CFE YU 23Stage three (conformity): + Stage three (conformity): -
• Heinz should steal the medicine • Heinz should not steal the drug
because his wife expects it; he wants because stealing is bad and he is not a
to be a good husband. criminal; he has tried to do everything
he can without breaking the law.
08 Feb 2021 Ravi Vaswani CFE YU 24Stage four (law-and-order): + Stage four (law-and-order): -
• Actions have consequences. • Heinz should not steal the
And if Heinz is willing to medicine because the law
face the consequences then prohibits stealing, making it
it is okay for him to steal illegal. If he goes to jail who
will look after his wife?
08 Feb 2021 Ravi Vaswani CFE YU 25Stage five (human rights): Stage five (human rights):
• Heinz should steal the medicine • Heinz should not steal the medicine
because everyone has a right to because the scientist has a right to fair
choose life, regardless of the law. compensation. Even if his wife is sick, it
does not make his actions right.
08 Feb 2021 Ravi Vaswani CFE YU 26Stage six (universal human ethics): Stage six (universal human ethics): • Heinz should steal the medicine, • Heinz should not steal the medicine, because saving a human life is a more because others may need the medicine fundamental value than the property just as badly, and their lives are equally rights of another person. significant. 08 Feb 2021 Ravi Vaswani CFE YU 27
08 Feb 2021 Ravi Vaswani CFE YU 28
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