Ethics, Principles and Values

Original Editor - Andrea Sturm

Top Contributors - Rachael Lowe, Kim Jackson, Uchechukwu Chukwuemeka and Robin Tacchetti  

The History of Ethics

The word ethics is etymologically derived from the Greek word „ἔθος“ /Ethos for custom, habit or usage. The term bioethics is based on Greek as well, and means βιος [bios] – life, ηθος [ethos] – custom, behavior. Put in the context of the development of ethics, bioethics goes back to ancient times. Joined with the development of medicine and the medical profession it goes back to the oath of Hippocrates. In 1803 a work called Medical Ethics by T. Percival was published, in which the author sought a proper solution for the relation between physician and patient.

People became aware of the need to make a philosophical-moral reflection on the new possibilities open to the biological and medical sciences in full after the Second World War, in the course of which the latest medical accomplishments were used in the genocide of millions of people. The first important moral reaction to these crimes was the Universal Declaration of the Rights of Man on December 10, 1948 by the General Assembly of the United Nations. Bioethics as a new discipline appeared somewhat later

In the 1960s there was a rapid development in the biological sciences and extraordinary technical progress based on those discoveries. In 1970 van Rensselaer Potter, an oncologist with the University of Wisconsin in Madison (USA), used the term “bioethics” for the first time in his moral reflection on the biological and medical sciences and reflected on the methodological foundations of a separate discipline

Morals and Ethics

We could see ethical competence as an ability to reflect, to formulate and justify the own moral orientation, and further as an ability to recognize moral problems in the own practice, power of judgement and ability for dialogue (Rabe 2005).

Basically we can differentiate morality and ethics. Morality could be understood as the own approach/ attitude to questions of a right/ wrong or good/ bad act or default. Ethics as a reflection of different existing moral positions with the aim to keep a group collectively able to act (Gillen 2004).

Ethical reflection needs the permission and possibility to think alternatives to the status quo and is in that consequence basically postulated as being open to the result (Sedmak 2013).

Ethical reflection shows up contradictions that are existing. The entity of these contradictions is that they cannot be dissolved, but they have to be appreciated and worked out in a lively process and could be worked on just by communication. It requires specific abilities to perceive ethical aspects of a situation to diversify and develop respect towards other systems of value (Heintel & Götz 2000).

Understanding each other's values, obligations and rights helps our patients, us health-care-professionals, health-insurances and health-facilities to ensure a more equal and constructive decision-making-process of all involved partners. Ethics does not deliver answers to religious or legal questions. Such questions are individually regulated by religions and laws itselfs. But both, religious and legal issues could be contributing to an ethical dilemma due to a clash with ethical principles.

Please bear in mind that religions sometimes do have strict beliefs to regulate their members moral behavior. This exclusivity may create a kind of ingroup for the members of one religion and an outgroup for those who do believe or behave differently. Such kind of ingroup and outgroup-thinking could possibly be contributing to conflicts. In worst cases this might - when for example abused by political leaders by labelling persons, groups or nations who are different as “bad” or “less worth” in general - create enemy-scenarios which could be abused to justify suppression, fighting or wars against people who don't belong to the “right” nations, groups or thinking - who are “wrong”. There are probably better ways to solve such conflicts - in respecting and discussing different viewpoints for example.

If we would base our professional ethical judgement only on the moral values stated by the religion we might belong to, we could get in trouble when professionally justifying our decision. This could be because of the issue that some of religious convictions might concurrent with professional codes of conduct or ethical principles, or human rights in general. Being aware of that risk and being as reflective as possible is crucial to ensure a sound course of action in our professional ethical decision-making based on professional obligations, best available evidence, the ICF-workingframe and our understanding of the viewpoints from other involved partners.

Discussion and reflexion of ethical aspects in professional daily routine is a process, a lifelong collection of experiences, a getting-aware of values and standards which – called into question - have to be adapted always to new specific situations. Ethical principles do not exist in a vacuum. You can't apply them blindly to real-life-scenarios, even they could offer general orientation.

In professional clinical practice, the practitioner must be able to validate or justify the diagnostic and management decisions that are made. In ethical reasoning, the practitioner makes use of theories and models to guide analysis and decision-making.

Practitioners also need to utilize an ethical knowledge base that includes a knowledge of their professional code of ethics, an understanding of the underlying basis for ethical principles such as respect for autonomy and justice, and a reflective knowledge of the influence one's personal beliefs and values might exert in the decision-making process.