Notes in GE 5 – Ethics

Part II
THE ACT

Lesson 2
REASON AND IMPARTIALITY
AS MINIMUM REQUIREMENT FOR MORALITY

Genuine moral or value judgments ought to be backed up by pertinent reasons.

Moreover, they must possess the quality of impartiality, which means, among other
things that personal feelings or inclinations should be suppressed if necessary.

REASON AND IMPARTIALITY DEFINED

Moral truths are truths of reason. A moral judgment is true if it is espoused by
better reasons than the alternatives.
REASON is the basis or motive for an action, decision, or conviction. As a
quality, it refers to the capacity for logical, rational, and analytic thought; for
consciously making sense of things, establishing and verifying facts, applying common
sense and logic, and justifying, and if necessary, changing practices, institutions, and
beliefs based on existing or new existing information.
Reason spells the difference of moral judgments from mere expressions of
personal preference.
Moral deliberation is a matter of weighing reasons and being guided by them.
Truth in Ethics entails being justified by good reasons.
Being defined by good reasons, moral judgments are objective in the sense that
they are true no matter what we might want or think. Reason commends what it
commends, regardless of our feelings, attitudes, opinions, and desires.
IMPARTIALITY involves the idea that each individual’s interests and point of
view are equally important. It is also called evenhandedness or fair-mindedness.
Impartiality is a principle of justice holding that decisions ought to be based on
objective criteria, rather than on the basis of bias, prejudice, or preferring the benefit to
one person over another for improper reasons.
Impartiality in morality requires that we give equal and/or adequate
consideration to the interests of all concerned parties.
From the impartial standpoint, to say that no one is seen as intrinsically more
significant than anyone else, is not to say that there is no reason whatsoever for which
an individual might demand more moral attention or better treatment than others.

THE 7-STEP MORAL REASONING MODEL

Contemporary author Scott Rae proposes a model for making ethical decisions.
His suggested 7-step model introduces the use of reason and impartiality in deciding on
moral matters.
Rae starts presenting his model by telling the case of a twenty-year-old Hispanic
male.
A twenty-year-old Hispanic male was brought to a hospital emergency
room, having suffered abdominal injuries due to gunshot wounds obtained in
gang violence.
He had no medical insurance, and his stay in the hospital was somewhat
shorter than expected due to his good recovery. Physicians attending to him
felt that he could complete his recovery at home just as easily as in the hospital
and he was released after only a few days in the hospital.
During his stay in the hospital, the patient admitted to his primary
physician that he was HIV positive, having contracted the virus that causes
AIDS. This was confirmed by a blood test administered while he was
hospitalized.

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Notes in GE 5 – Ethics
When he was discharged from the hospital, the physician recommended
that a professional nurse visit him regularly at home in order to change the
bandages on his still substantial wounds and to ensure that an infection did
not develop.
Since he had no health insurance, he was dependent on Medicaid, a
government program that pays for necessary medical care for those who cannot
afford it. However, Medicaid refused to pay for home nursing care since there
was someone already in the home who was capable of providing the necessary
care.
That person was the patient’s twenty-two-year-old sister, who was willing
to take care of her brother until he was fully recovered. Their mother had died
years ago and the sister was accustomed to providing care for her younger
siblings. The patient had no objection to his sister providing this care, but he
insisted that she not be told that he had tested HIV positive. Though he had
always had a good relationship with his sister, she did not know that he was
an active homosexual. His even greater fear was that his father would hear of
his homosexual orientation and lifestyle. Homosexuality is generally looked
upon with extreme disfavor among Hispanics.
Now here lies the moral dilemma – the patient’s doctor is bound by his
code of ethics that puts a very high priority on keeping confidentiality.
On the other hand, the patient’s sister, without knowing the truth, is
putting herself at risk by providing nursing care for him.
So, if you were the physician, what would you do in this case? Would you
breach the rule of confidentiality to safeguard the patient’s sister or would you
keep confidentiality to protect the patient from harm that would come to him
from his other family members, especially his father?
For Rae, the question “What would you do in this situation?” is probably as good
as the question “How would you decide what to do in this situation?” He believes that
the process of making a moral decision can be as significant as the decision itself.
He admits that the model is not a formula that will automatically generate the
“right” answer to an ethical problem but a guideline in ascertaining that all the right
questions are being asked in the process of ethical deliberation.

Step 1: GATHER THE FACTS

This is the indispensable first step prior to any ethical analysis and reflection on
the case. In examining a case, we want to know the available facts at hand, as well as
any facts presently not known but that need to be determined.
The relevant facts in the case of the twenty-year-old Hispanic for Rae are
as follows:
- The patient is a young man, infected with HIV and an active homosexual.
- He suffered fairly severe abdominal wounds but is recovering well.
- Homosexuality is looked down upon in Hispanic communities.
- The patient has insisted that his physician maintain confidentiality
about his HIV status.
- The patient is afraid of rejection by his father if his homosexuality is
discovered, an understandable fear given the way that homosexuality is
viewed in the Hispanic community.
- He was wounded by gunfire in gang violence. It is not clear but is a
reasonable assumption that he is a gang member. As a result, he likely
fears rejection and perhaps retribution from his fellow gang members,
especially if they discover that he is HIV positive.
- He is uninsured and cannot afford home nursing care by a professional.
- Medicaid refuses to pay for professional home nursing care.
- The patient’s sister is willing and able to provide the necessary nursing
care for her brother. She is accustomed to providing maternal-like care
for her brothers and sisters.
- The patient has specifically requested that his sister not be told of his
HIV status. She does not know that he is an active homosexual.

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Notes in GE 5 – Ethics
- The patient’s sister would be changing fairly sizable wound dressings for
her brother and the chances are high that she would come into contact
with his HIV infected blood. The probability of her becoming infected with
the virus from this contact is difficult to predict.

Step 2: DETERMINE THE ETHICAL ISSUES

The moral issues should be correctly stated in terms of competing interests. It is
these conflicting interests that practically make for a moral dilemma.
The conflict in the case of the twenty-year-old Hispanic is the need for
patient confidentiality versus the duty to warn the sister of risk of harm.

Step 3: IDENTIFY THE PRINCIPLES THAT HAVE A BEARING ON THE CASE

In any moral dilemma, there are sure moral values or principles that are vital to
the rival positions being taken. It is very significant to recognize these principles, and in
some cases, to decide whether some principles are to be weighted more heavily than
others.
The case is about a conflict of rights, a conflict of duties that the
physician has toward his patient and toward his sister.
Two principles are thus dominant. First is the widely acknowledged
principle that patients have a right to have their medical information kept
confidential especially when the information could be used to harm them if it
would be revealed. Second is the duty of the physician to warn interested
parties other than the patient if they are at risk of looming and considerable
harm.
No doubt, the principle of confidentiality is deemed virtually sacred in the
medical profession and most physicians will argue that it is necessary to keep
confidentiality if patients are to trust their physicians and continue coming for
treatment. However, confidentiality is often measured as subordinate to the
duty to warn someone who will likely be harmed if that information is not
revealed.
The crucial question in weighing the two conflicting principles is the
degree of risk that the patient’s sister is taking by providing nursing care for
her brother.
Considering that the sister has volunteered to perform a very self-
sacrificing service for her brother, it can be argued that self-sacrifice is an
additional factor that weighs the duty to warn principle more heavily. Some
would even claim that the patient’s HIV is an example of “reaping what one
sows,” and that all the more minimizes consideration of the patient’s desire for
confidentiality.
Another element that should be considered in the deliberation is that the
risk to the patient, though it may have a higher probability of happening, is not
as severe as the risk to the sister.

Step 4: LIST THE ALTERNATIVES

This step involves coming up with various alternative courses of action as part of
the creative thinking included in resolving a moral dilemma.
One option is to tell the sister that her brother is HIV positive. A second
option is to refuse to tell her that information.
One alternative is for the physician to warn the patient’s sister in general
terms about taking suitable precautions for caring for these types of wounds.
Another alternative is to request the patient to inform his sister of his
condition. If the patient declined, then the next step might be to say to him in
effect, “If you do not tell her, I will.”

Step 5: COMPARE THE ALTERNATIVES WITH THE PRINCIPLES

This step involves eliminating alternatives, according to the moral principles that
have a bearing on the case. As a matter of fact, the purpose of this comparison is to

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Notes in GE 5 – Ethics
determine whether there is a clear decision that can be made without further
deliberation.
The alternative of “encouraging universal precautions for the sister but not
telling her why” comes very close to satisfying all pertinent principles.

Step 6: WEIGH/ASSESS THE CONSEQUENCES

If the principles do not produce a clear decision, “then a consideration of the
consequences of the remaining available alternatives is in order. Both positive and
negative consequences are to be considered.
Each option/alternative in consideration has effects on the sister, the
patient and the physician.
The option of telling the sister (or insisting that the patient tells his
sister) has the following likely consequences:
- The sister would be properly warned about the risks of taking care of her
brother, minimizing the risk of her contracting HIV, and saving her from
the risk of developing a fatal illness.
- The brother’s HIV status would be out in the open, leaving family and
gang friends to draw their own conclusions about his homosexuality.
Should they draw the right conclusion, which is likely, he suffers
significant psycho-social harm from his gang members, and possibly
(though not certainly) from his family.
- Trust with the physician and the patient suffers and he may refuse to see
that physician, or any other one again until a dire medical emergency.
This would be unfortunate since due to his HIV status, he will need
ongoing medical care.
In the alternative of the physician refusing to disclose the information,
the following may be estimated as the likely consequences:
- The sister would not know about the risks she is taking, making her
vulnerable to contracting an infection for which there is no cure. The
degree of risk that she is taking is open to debate, but some would argue
that if the degree or risk is any more than minimal, that justifies warning
her since the virus produces a fatal disease.
- The patient’s HIV status is a well-kept secret, as his homosexuality. But
it is not likely that either his HIV status or his homosexuality can be kept
a secret forever, since as HIV develops into full-blown AIDS, both are
likely to come out at some point in the future.
- Trust between the physician and patient is maintained.
Now, if the alternative of telling the sister to take general precautions is
adopted, the following are the likely consequences:
- She may exercise appropriate caution in taking care of her brother, but
she may not. She may treat the precautions casually and unknowingly
put herself at risk. If the physician tells her about the precautions in very
strong terms to ensure her compliance, that may start her asking
questions about why the doctor was so insistent on her following his
precautions. In fact, one of the motives of the physician might be to
nudge her toward asking some of those questions, of her brother, to
further minimize the risk of contracting HIV.
- In general, the patient’s HIV status and homosexual orientation are kept
secret, and confidentiality is honored, but the question of how long it will
remain a secret is unknown and it is likely that it will become known
eventually.
- Trust with the physician and patient is maintained. However, if the sister
is nudged to ask her brother some pressing questions about why these
precautions are so important, he may conclude that the physician has
prompted his sister to ask these questions, leaving him feeling betrayed.

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Notes in GE 5 – Ethics
Step 7: MAKE A DECISION
Since deliberation ought not to go on forever, a decision must be made at some
point.
Normally, the decision that is made is one that possesses the least number of
problems or negative consequences.
Rae offers no definite decision under this final step but instead leaves us the
following further guiding questions:
- What would you decide in this case?
- Which principles are the weightiest?
- Are there others that you would include?
- Which alternatives are the most viable?
- Are there others that you would suggest?
- Which consequences seem to you the most severe?
- Are there others that you think will occur?
Indeed, it is significant to understand that at some point, we must stop deliberating and
make a decision, as uncomfortable as that may be.

For one thing, Rae’s model is good in the sense that it has room in it to
accommodate a whole host of different moral and ethical perspectives, considering the
ethnic and religious diversity of our society. The model is not necessarily tied to any
one specific perspective, but can be employed comfortably with a variety of ethnic,
cultural and religious backgrounds. Finally, it promotes the primal consideration of
reason and impartiality in ethics without necessarily eradicating the role of feelings in
ethical deliberation.

Main Reference:
ETHICS: Principles of Ethical Behavior in Modern Society
by Jens Micah De Guzman et al.
Reason and Impartiality as Minimum Requirement for Morality, pages 61 – 74

CASE ANALYSIS – THE KOKO PIMENTEL DILEMMA

As a trio/duo (refer to the attachment for group assignments), use the 7-step
moral reasoning model to solve the following case:
Koko Pimentel, a namesake of a Philippine senator, is a healthcare
worker attending to the call of duty in the midst of the COVID-19 pandemic. He
is the breadwinner of his family. He takes care of his aged parents and he has
young children.
Every health care worker counts during these times and there have been
instances where entire hospitals have been forced to shut down because of
presumed exposure or suspected status of one health care worker. In such an
all hands-on deck scenario, to try to push oneself to the limits of endurance,
neglecting physical symptoms and needs, is par for the course. In the hospital
where Koko is working, there is limited availability of personal protective
equipment (PPE) and inequitable distribution of available equipment like
ventilators.
How should he balance his ethical duty to care for his patient against
genuine concerns of contacting COVID-19 and spreading it to his family? If he
thinks he has some respiratory symptoms and he thinks he may have been
exposed, should he open up about his symptoms and stay at home, risking
social and workplace discrimination, or continue to go about his work as
usual, risking his colleagues’ health, until his test comes positive?

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Notes in GE 5 – Ethics
GUIDELINES FOR THE CASE ANALYSIS
FORMAT
SURNAME, Given Name MI (Person 1) GE 5; Class Time; Class Days
SURNAME, Given Name MI (Person 2) Date Submitted
SURNAME, Given Name MI (Person 3)
Course, Year and Section

AN ANALYSIS OF THE KOKO PIMENTAL DILEMMA

I. FACTS
(text)

II. ETHICAL ISSUES

(text)

III. PRINCIPLES THAT HAVE A BEARING ON THE CASE

(text)

IV. ALTERNATIVES
(text)

V. COMPARISON OF THE ALTERNATIVES WITH THE PRINCIPLES

(text)

VI. ASSESSMENT OF CONSEQUENCES

(text)

VII. DECISION
(text)

MECHANICS
- Paper Size: Letter (8.5” x 11”)
- Margins: 1” on all sides
- Spacing: Single
- Font Style: Times New Roman
- Font Size: 12
- Number of Pages: Not less than two (2), not more than three (3)

DEADLINE
It is due for submission in PDF format through Google Classroom by May 09,
2020 (Saturday), 11:59 pm, through the group leader.

Prepared by:
MICHAEL ANGELO F. EMPIZO
Saint Louis College, City of San Fernando, La Union
Memorial of Saint Athanasius, Bishop and Doctor of the Church
May 02, 2020

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