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Ethical Theories

Original Editor - Wanda van Niekerk based on the course by Andrea Sturm

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

Healthcare professionals are often confronted with making difficult decisions in their professions. Ethics provides the foundation for this decision-making. Understanding different ethical frameworks or theories may help healthcare professionals to address complex situations where values may conflict and clear solutions are not always apparent. Ethical theories that inform decision-making in healthcare include virtue ethics, deontology, utilitarianism, contractualism, ethics of care and principlism. Ethical theories that respect different cultural perspectives include Confucianism, Ubuntu, and Islamic medical ethics. Each theory provides a unique perspective on what is the right or wrong action and moral responsibility. These theories provide healthcare professionals with tools to assess and analyse ethical dilemmas and to develop well-reasoned responses and decisions that respect their professional obligations and the needs of their patients.

Deontology

Deontology (or duty-based ethics) focuses on duty and moral obligations. It dictates that the rightness of an action is determined by its adherence to moral principles, irrespective of the consequences.[1] Deontology teaches that the motivation behind an action is irrelevant and a person has a duty to do the right thing; thus, a decision cannot be justified solely because it had a good outcome or condemned simply because it had a bad outcome.[1]

Examples of deontological ethics or duty-based ethics are seen in the professional standards documents of healthcare professions. For example, in the American Physical Therapy Association's Guide for Professional Conduct, Principle 2C on patient autonomy states that “physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research.”[2] This is interpreted as the physical therapist being required to respect patient autonomy and provide all information, including the risks to patients and respect every patient’s right to make their own decision regarding the care they want to receive.

The optional video below provides a short summary of deontological ethics and its advantages and disadvantages.

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Utilitarianism

Utilitarianism focuses on the outcome or consequences of an action rather than the action itself (the rightness or wrongness of a decision or action is judged by its consequences). The principle of utilitarianism is based on the idea that “the end justifies the means” and “decisions are made based on the greatest amount of benefit obtained for the greatest number of individuals.” It is a society-centred approach. Utilitarianism is a consequentialist ethical theory, as the outcomes determine the morality of the decision or action.[1]

This optional video looks at consequentialist ethics, in particular utilitarianism. It also provides some examples of consequentialist ethics in medical practice.

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Virtue Ethics

Virtue ethics is based on the moral task of "being a person of good moral character and virtue."[5] Importance is placed on the character of a healthcare professional, and virtuous practice argues that morality stems from an individual’s character or identity, rather than being a reflection of the individual's actions. It emphasises the character and intentions of the person making the decision, considering what kind of person they are and should be. In virtue ethics, the question of "what is the right thing to do" can be answered by considering what "a good healthcare professional would do."[5] The four cardinal virtues, as described by ancient philosophers and applicable to healthcare professionals, are prudence, temperance, fortitude, and justice.[6] Other virtues include moral reasoning, altruism, honesty, integrity, trustworthiness, compassion, discernment, discipline, conscientiousness and self-effacement.[7]

This optional video explores virtue ethics and professionalism in healthcare settings.

[8]

Principlism

The four most prominent principles in bioethics are autonomy, beneficence, non-maleficence and justice.[9] In this model developed by Beauchamp and Childress,[10] the principles of non-maleficence and justice are deontological, while the principles of beneficence and autonomy are teleological[11] (exhibiting or relating to design or purpose).[12]

Respect for autonomy means respecting an individual’s decision-making capacity and enabling individuals to make reasoned, informed decisions by themselves over matters concerning themselves. The principle of beneficence governs that a healthcare professional should “do good” and promote the interest of the patient. Non-maleficence means avoiding causing harm, and justice emphasises fairness and equality among individuals.

The following four optional videos introduce each of these concepts.

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[14]
[15]
[16]

Contractualism

Contractualism avoids controversial assumptions and employs rational self-interest and bargaining power as a starting point, with a reasonable or fair outcome as the result.

A key concept in contractualism is that, when considering how society should be constructed, rational, self-interested individuals should decide on social foundations without knowing their eventual status, abilities or circumstances in this society[17] (i.e. they "must deliberate behind a veil of ignorance"[18]). This approach allows for fairness with decision-making, as we do not know how a decision will personally affect us. In this way, an ethical framework is created that evaluates actions based on whether they align with reasonable, fair and moral rules that others cannot reasonably object to. Contractualism suggests that fair and just arrangements and moral choices will come from considering what would be acceptable to all parties if personal advantage were removed from the equation.[17]

This optional video explores the underlying principles of contractualism.

[19]

Ethics of Care

Ethics of care is a moral viewpoint that emphasises relationships, human interdependence, and sensitive ethical deliberation according to the specific context instead of only applying abstract rules or principles. In care ethics, it is argued that morality stems from caring relationships where a person attends to another person’s needs, feelings and interests. It is relational and in a healthcare context, it occurs in unequal relationships, where one person is more vulnerable and receives care from another.[20] Ethics of care embraces certain core elements. It values personal relationships where a person cares for others for their own sake. It recognises a universal human interdependence, the need for care from others, and the moral significance of emotional needs in ethical reasoning. It also focuses on sensitive deliberation in a specific situation instead of just applying abstract principles.[20][21]

Ethics of care can be formulated as[21]: "I was there, I saw, I witnessed, and I became responsible.”

“Care ethics recognizes that care is a universal human experience. Care ethics is founded on relationship, based on presence, trust and respect, forged on knowing the person at the centre of care. The practice of care is holistic, is attentive, responsive, responsible and competent. The richness and complexity of the individual socioemotional context is considered, and the caregiver equally values other ways of knowing. Care ethics recognizes the asymmetry of caring relationships and attention to this power imbalance is required. Only the person being cared for can determine what constitutes ethical care."[22]

Communitarianism

Communitarianism includes various ethical perspectives. It posits that morality is developed through socio-cultural interactions and involves a dynamic interplay between individual well-being and the well-being of the broader community. The individual's value is inseparable from the socio-cultural community in which they live. Individual rights are downplayed for the benefit of an interconnected network of responsibility to others. Ethical models that incorporate aspects of communitarianism include Confucian ethics and Ubuntu.[23]

Confucianism

Confucianism is based on[24]:

  • the principles of the good life
  • loyalty and respect (for older persons and family)
  • encouraging harmony and altruism

Confucianism emphasises a set of key virtues, including Zhong (loyalty), Xiao (filial piety), Ren (benevolence), Ai (affection), Xin (trustworthiness), Yi (righteousness), He (harmony), Ping (peace), Li (propriety), Zhi (wisdom), Lian (integrity), and Chi (humility/shame).[24] As it is rooted in virtues and emphasises virtuous conduct, Confucianism traditionally prioritises the virtues and responsibilities of healthcare practitioners rather than focusing on the autonomy or rights of the patient.[25]

Ubuntu

Ubuntu is an African caring ethic which highlights the importance of care, concern and interconnectedness between people. It focuses on the community and the responsibility of individuals towards others.[26]

Ubuntu means: “I am because we are”

People who practice Ubuntu have various caring qualities, such as mutual respect, recognition, relational values, reciprocity values, compassion, honesty, trust and commitment.[26]

The following two optional videos introduce the essence of Ubuntu.

[27]
[28]

Islamic Medical Ethics

Islamic law provides a comprehensive system of morality that informs medical ethics. It aligns with the four fundamental principles of biomedical ethics, but has some differences in its application. Islamic medical ethics is deeply connected to religion, emphasising the link between body and mind, the material and spiritual realms and ethics and the theory of law. Islamic medical ethics focuses on duties and obligations, although rights and virtue also play an important role. Decisions made by Islamic healthcare professionals should prioritise the patient’s best interests, regardless of their religion. The patient should be included in the decision-making process. In Islamic cultures, access to healthcare is a fundamental individual right, and the role of the family in medical decisions should be respected.[29] [30]

If you are interested in learning more about Islamic medical ethics, please watch the following video.

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References

  1. ↑ 1.0 1.1 1.2 Chukwuneke FN, Ezenwugo AC. Deontology vs. utilitarianism: Understanding the basis for the moral theories in medicine. International Journal of Medicine and Health Development. 2022 Jan 1;27(1):19-23.
  2. ↑ American Physical Therapy Association. Guide for Professional Conduct. 2019.
  3. ↑ .Healthcare Ethics and Law. Healthcare Ethics and Law - Duty Based (also known as deontological or non-consequentialist) Ethics. Available from: https://www.youtube.com/watch?v=8tgVO_-RfJw [last accessed 05/05/2025]
  4. ↑ Healthcare Ethics and Law. Healthcare Ethics and Law - Consequentialism and Utilitarian Ethics in Healthcare. Available from:https://www.youtube.com/watch?v=UC9kSeUnJUI [last accessed 05/05/2025]
  5. ↑ 5.0 5.1 Allan S. Law and Ethics for Health Practitioners-E-Book Epub. Elsevier Health Sciences; 2024 Sep 30.
  6. ↑ Sládek K. Virtue Ethics in Medical Practice during the COVID-19 Pandemic. Acta Universitatis Carolinae Theologica. 2022;12(1):161-73.
  7. ↑ Doukas DJ, Ozar DT, Darragh M, de Groot JM, Carter BS, Stout N. Virtue and care ethics & humanism in medical education: a scoping review. BMC Medical Education. 2022 Feb 26;22(1):131.
  8. ↑ Healthcare Ethics and Law. Virtue Ethics and Professionalism in Healthcare. Available from: https://www.youtube.com/watch?v=G8TnR8U-w5U [last accessed 05/05/2025]
  9. ↑ Pilkington B, Giuliante M. Nursing ethics as a distinct entity within bioethics: Implications for clinical ethics practice. Nursing Ethics. 2023 Aug;30(5):671-9.
  10. ↑ Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 8th edition. New York: Oxford University Press; 2019. 512 p.
  11. ↑ “Teleological.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/teleological. Accessed 2 May. 2025.
  12. ↑ Lopes MV, França AJ. Bioethics and speech-language therapy in palliative care: an integrative review. Revista Bioética. 2025 Jan 10;32:e3730PT.
  13. ↑ Dr. Ollie Burton. Autonomy | Medical Ethics Made Easy. Available from:https://www.youtube.com/watch?v=7Fnt59_3erM [last accessed 05/05/2025]
  14. ↑ Dr. Ollie Burton. Beneficence | Medical Ethics Made Easy. Available from: https://www.youtube.com/watch?v=481DviNjeVk[last accessed 05/05/2025]
  15. ↑ Dr. Ollie Burton. Non-Maleficence | Medical Ethics Made Easy. Available from: https://www.youtube.com/watch?v=E7bNbEeN-Lw [last accessed 05/05/2025]
  16. ↑ Dr. Ollie Burton. Justice | Medical Ethics Made Easy. Available from: https://www.youtube.com/watch?v=88YBqHcKgOU [last accessed 05/05/2025]
  17. ↑ 17.0 17.1 Kühler M, Wint N, Hillerbrand R, Gimenez-Carbo E. Ethical theories. InThe Routledge International Handbook of Engineering Ethics Education 2024 (pp. 44-59). Routledge.
  18. ↑ Savulescu J. Collective Reflective Equilibrium, Algorithmic Bioethics and Complex Ethics. Cambridge Quarterly of Healthcare Ethics. 2025 Feb 3:1-6
  19. ↑ Heresjohnnynava. The Good Place Philosopher, Pamela Hieronymi on "What is Contractualism?" | Don't Panic Podcast. Available from: https://www.youtube.com/watch?v=6S3l1a0ElmM [last accessed 05/05/2025]
  20. ↑ 20.0 20.1 Doukas DJ, Ozar DT, Darragh M, de Groot JM, Carter BS, Stout N. Virtue and care ethics & humanism in medical education: a scoping review. BMC Medical Education. 2022 Feb 26;22(1):131.
  21. ↑ 21.0 21.1 Ramvi E, Hellstrand I, Jensen IB, Gripsrud BH, Gjerstad B. Ethics of care in technology‐mediated healthcare practices: A scoping review. Scandinavian Journal of Caring Sciences. 2023 Dec;37(4):1123-35.
  22. ↑ Buchanan K, Newnham E, Ireson D, Davison C, Geraghty S. Care ethics framework for midwifery practice: A scoping review. Nursing Ethics. 2022 Aug;29(5):1107-33.
  23. ↑ Searight HR. Ethical Challenges in Multi-Cultural Patient Care: Cross Cultural Issues at the End of Life. Springer; 2019 Aug 13.
  24. ↑ 24.0 24.1 Badanta B, González-Cano-Caballero M, Suárez-Reina P, Lucchetti G, de Diego-Cordero R. How does confucianism influence health behaviors, health outcomes and medical decisions? A scoping review. Journal of religion and health. 2022 Aug;61(4):2679-725.
  25. ↑ Fan R. A Confucian view of informed consent in biomedical practice. In: Tham J, García Gómez A, Garasic MD. Editors. Cross-cultural and religious critiques of informed consent. Routledge: London, 2021. p.71-78.
  26. ↑ 26.0 26.1 Mulaudzi F, Gundo R. Perspective chapter: Ubuntu model of health care–re-envisioning nursing practice in the digital era. InNursing Studies-A Path to Success 2024 Apr 24. IntechOpen.
  27. ↑ Desmond Tutu Peace Foundation. Ubuntu: The Essence of Being Human. Available from: https://www.youtube.com/watch?v=44xbZ8MN1uk [last accessed 05/05/2025]
  28. ↑ BBC Global. What we can learn from the African philosophy of Ubuntu - BBC REEL. Available from: https://www.youtube.com/watch?v=7UojwMiRpNM [last accessed 05/05/2025]
  29. ↑ Chamsi-Pasha H, Albar MA. Western and Islamic bioethics: How close is the gap?. Avicenna journal of medicine. 2013 Jan;3(01):8-14.
  30. ↑ Woodman A, Albar MA, Chamsi-Pasha H. „Introduction to Islamic Medical Ethics”. Journal of the British Islamic Medical Association. 2019;2(1):1-5.
  31. ↑ Islamic Knowledge Network. What Is Islamic Medical Ethics? - Islamic Knowledge Network. Available from: https://www.youtube.com/watch?v=CSnm9R-RTM4 [last accessed 05/05/2025]
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