Chapter 3 Topic 2: Reason and Impartiality as Minimum

Requirements for Morality

Nominal Duration: 1.5 hours

Learning Outcomes:
Upon completion of this topic, the student must be able to:
1. explain reason and impartiality as minimum requirements for morality; and
2. evaluate a moral dilemma using the 7 step moral reasoning model.

Einführung

The Greek philosopher Aristotle regarded that human beings have a rational
soul that makes us different with that of animals and plants. Rationality (n.d.) is the
capability for logical thought with the ability to reason towards sound conclusions
based on facts and evidence, draw inferences from situations and circumstances, and
make sound well-reasoned judgments based on factual information. Plants and
animals are incapable of complex reasoning and introspection, much more so in
distinguishing good from bad and right from wrong. A person is called “rational or
reasonable” (Korsgaard, n.d.) when his beliefs and actions conform to the dictates of
those principles, or when he is subjectively guided by them. Reason is also identified
with the capacity that enables us to identify “reasons,” the particular considerations
that count in favor of belief or action. Since human beings are rational, they have
“freewill to strive for perfection” (n.d.). By achieving this fulfillment and well-rounded
development, they would somehow attain happiness. It follows that in order to be
ethical, an individual should decide on actions that properly express his rationality.

Moral judgments must be backed by the best arguments or reasons out there,
not only good reasons or better judgments. Our decisions must be guided as much as
possible by reason. The morally right thing to do is always the thing best supported by
the arguments. Morality requires impartiality with regard to those moral agents affected
by a violation of a moral rule. Morality requires the impartial consideration of each
individual's interests. For example, being partial toward friends is not morally allowed.
Impartiality (fair-mindedness) is a principle of justice holding that decisions should be
based on objective criteria, rather than on the basis of bias, self-interest, prejudice, or
preferring the benefit to one person over another for improper reasons. Other elements
of impartiality are accuracy, fairness, balance, context, and no conflicts or
prejudgments. The respect for truth at all costs is necessary (Khatami, 2009; Rachels,
2018).

The minimum conception of morality is: Morality is the effort to guide one’s
conduct by reason – that is, to do what there are the best reasons for doing – while
giving equal weight to the interest of each individual affected by one’s decision
(Rachels, 2018).

Models in Ethical Decision Making

There are several models of ethical decision making and action. Powers and
Vogel (1980) have identified six aspects that affect and are included into moral

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reasoning and decision making: (1) moral imagination; (2) moral identification; (3)
moral evaluation; (4) tolerating moral disagreement and ambiguity; (5) integration of
moral competence with other competencies; (6) a sense of moral obligation and moral
motivation. Rest (1994) proposes that moral decision-making involves four
psychological processes: moral sensitivity, moral judgment, moral
motivation/intention, and moral character/action.

Before anything else, one must recognize that there is an ethical issue. Could
a decision or situation be damaging to someone or to some group? Is this issue more
about that what is legal or what is most efficient? If so, how? The decision making
process could be usefully demonstrated in a Seven Step-wise Model of Scott Rae
(2009) presented below.

Situation – "Please Don't Tell!"

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. 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 insure
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.

The patient's physician is bound by his code of ethics that places a very high
priority on keeping confidentiality. That is, information about someone's medical
condition that he or she does not want known cannot be divulged by the physician.
Some would argue that the responsibility of confidentiality is even greater with
HIV/AIDS since disclosure of someone's homosexuality normally carries devastating
personal consequences for the individual who is forced "out of the closet."

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 On the other hand, the patient's sister is putting herself at risk by providing
nursing care for him. Doesn't she have a right to know the risks to which she is
subjecting herself, especially since she willingly volunteered to take care of her
brother?

If you were the physician, what would you do in this case? Would you breach
the norm of confidentiality to protect the patient's sister, or would you keep
confidentiality in order to protect the patient from harm that would come to him from
his other family members, especially his father?

Perhaps as good a question as "what would you do" in this situation is the
question, "how would you decide what to do" in this situation? The process of making
a moral decision can be as important as the decision itself, and many ethical decisions
that people encounter are so complex that it is easy to exhaust oneself talking around
the problem without actually making any progress toward resolving it. The response
to many moral dilemmas is "where do I start?' and the person who is faced with these
decisions often needs direction that will enable him or her to move constructively
toward resolution and "see the forest for the trees."

In order to adequately address the ethical dilemmas that people encounter

regularly, the following is a model that can be used to insure that all the necessary
bases are covered. This is not a formula that will automatically generate the "right"
answer to an ethical problem. Rather it is a guideline that is designed to make sure
that all the right questions are being asked in the process of ethical deliberation.

Given the ethnic and religious diversity of our society, it is important that the
model used for making ethical decisions have "room" in it to accommodate a whole
host of different moral and ethical perspectives. This model is not tied to any one
particular perspective, but can be used comfortably with a variety of cultural, ethnic
and religious backgrounds. This is not a distinctively Christian model, though it is
consistent with the Scripture and any Christian can use Biblical principles in utilizing
this model. Take note though that what makes many moral dilemmas so difficult is that
the Scripture does not speak to the issue as clearly as one would prefer because
Scripture has not directly addressed the issue. More general principles can be brought
to bear on the issue at hand. However, in these instances, there is often disagreement
about which Biblical principles are applicable to the specific issue under discussion.
For example, in Case 1 (Please Don't Tell) the physician could invoke the Biblical
principle of compassion toward his patient in refusing to disclose information that
would harm him. But at the same time, he could invoke the same principle of
compassion toward the sister in protecting her from the risk of medical harm. It is not
clear that appeal to principles alone will conclusively resolve this case. Thus, to insist
that all ethical dilemmas are resolved simply by appeal to Biblical principles seems to
oversimplify the case. Certainly many moral questions are resolved conclusively by
appeal to Scripture. But there are other cases in which that does not happen. That is
not to say that Scripture is not sufficient for the believer’s spiritual life, but that the
special revelation of Scripture is often supplemented by the general revelation of God
outside Scripture. This model makes room for both general and special revelation, and
gives each a place in helping to resolve the difficult moral dilemmas facing people
today.

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1. Gather the Facts
Frequently ethical dilemmas can be resolved simply by clarifying the facts of
the case in question. In those cases that prove to be more difficult, gathering the facts
is the essential first step prior to any ethical analysis and reflection on the case. In
analyzing a case, we want to know the available facts at hand as well as any facts
currently not known but that need to be ascertained. Thus one is asking not only "what
do we know?" but also "what do we need to know?" in order to make an intelligent
ethical decision.

2. Determine the Ethical Issues

The ethical issue(s) are stated in terms of competing interests. It's these
conflicting interests that actually make for an ethical dilemma. The issues should be
presented in a __________ vs. __________ format in order to reflect the interests that
are colliding in a particular ethical dilemma. For example, many ethical decisions,
especially at the end of a patient's life can be stated in terms of patient autonomy (or
the right of the individual to make his or her own decisions about medical care) vs. the
sanctity of life (or the duty to preserve life). In Case #1 above, the interests of the
patient in having the physician keep confidentiality conflict with the interests of his
sister in being protected from the risk of contracting the HIV virus.

3. What Principles have a bearing on the Case?

In any ethical dilemma, there are certain moral values or principles that are
central to the competing positions being taken. It is critical to identify these principles,
and in some cases, to determine whether some principles are to be weighted more
heavily than others. Clearly Biblical principles will be weighted the most heavily. There
may be other principles that speak to the case that may come from other sources.
There may be Constitutional principles or principles drawn from natural law that
supplement the Biblical principles that come into play here.

4. List the Alternatives

Part of the creative thinking involved in resolving an ethical dilemma involves
coming up with various alternative courses of action. Though there will be some
alternatives which you will rule out without much thought, in general, the more
alternatives that are listed, the better the chance that your list will include some high
quality ones. In addition, you may come up with some very creative alternatives that
you had not considered before.

5. Compare the Alternatives with the Principles

At this point, the task is one of eliminating alternatives according to the moral
principles that have a bearing on the case. In many instances, the case will be resolved
at this point, since the principles will eliminate all alternatives except one. In fact, the
purpose of this comparison is to see if there is a clear decision that can be made
without further deliberation. If a clear decision is not forthcoming, then the next part in
the model must be considered. At the least, some of the alternatives may be eliminated
by this step of comparison.

6. Weigh the Consequences

If the principles do not yield 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. They should be informally weighted,

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since some positive consequences are more beneficial than others and some negative
consequences are more detrimental than others.

7. Make a Decision
Deliberation cannot go on forever. At some point, a decision must be made.
Realize that one common element to ethical dilemmas is that there are no easy and
painless solutions to them. Frequently, the decision that is made is one that involves
the least number of problems or negative consequences, not one that is devoid of
them.

Back to the situation – Please Don't Tell!

Using the model, let's return to the case at hand. This will illustrate how the
model is used and clarify exactly what is meant by each of the elements in the model.

1. Gather the Facts: The relevant facts in this case 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 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.
– 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.

2. Determine the Ethical issue(s)

The competing interests in this case are those of the sister who will provide the
care and the patient who will receive it. Both have interests in being protected from
harm. The patient fears being harmed in a psycho-social way if his homosexuality and
HIV status were discovered. Thus he has put the physician in a difficult situation by
demanding that his right to confidentiality be kept. Though she does not know it, his
sister fears medical harm due to the risk of contracting the HIV virus from contact with
her brother's blood. This could be stated as a conflict between confidentiality for the

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patient vs. the right to know the patient's condition for his sister due to the risk she
would be taking in giving him nursing care. The conflict could be summarized by the
need for patient confidentiality vs. the duty to warn the sister of risk of harm.

3. What Principles have a bearing on the Case?

Two moral principles that speak to this case come out of the way in which the
ethical issue is stated. This case revolves around a conflict of rights, a conflict of duties
that the physician has toward his patient and toward the sister. He is called to exercise
compassion toward both, but what compassion (or the duty to "do no harm") demands
depends on which individual in the case is in view. Thus two principles are paramount.
First is the widely recognized principle that patients have a right to have their medical
information kept confidential, particularly the information that could be used to harm
them if it were disclosed. But a second principle that comes into play is the duty of the
physician to warn interested parties other than the patient if they are at risk of imminent
and substantial harm. One of the difficult aspects of any ethical decision is knowing
what weight to give the principles that are relevant to the case. Here, the principle of
confidentiality is considered 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. But confidentiality is often
considered subordinate to the duty to warn someone who will likely be harmed if that
information is not disclosed. For example, if a psychologist believes that his patient
will kill his wife, or beat her severely, he has a moral obligation to inform the wife that
she is in danger from her husband. The duty to warn someone from imminent and
severe harm is usually considered a more heavily weighted principle than
confidentiality in cases like these.

The key question here in weighting the principles of confidentiality and the duty
to warn (both fulfilling the Biblical notion of compassion toward those in need of it) is
the degree of risk that the patient's sister is taking by providing nursing care for her
brother. If the risk is not substantial, then that weights confidentiality a bit more heavily.
But if the risk is significant, then the duty to warn is the more heavily weighted principle.
This is particularly so given the fact that the sister has volunteered to perform a very
self-sacrificing service for her brother. Some would argue that her altruism is an
additional factor that weights the duty to warn principle more heavily. Others would
suggest that his contracting HIV is an example of "reaping what one sows," and that
minimizes consideration of the patient's desire for confidentiality. An additional factor
that should be figured into 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. After
all, if the worst case scenario happened to the patient, his father would disown him
and the gang would throw him out (though their action could be more severe than
that). He would recover from all of that. But if his sister contracted HIV, she would not
recover from that. Though the probability of the worst case scenario is higher for the
patient, the results of the worst case are clearly higher for the sister.

4. List the Alternatives

In this case, there are a number of viable alternatives that involve compromise
on either the patient's part or his sister's. However, there are two alternatives that do
not involve compromise and they each reflect a weighting of the principles.

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 One alternative would be to tell the sister that her brother is HIV positive. This
alternative comes out of taking the duty to warn principle as higher priority. On the
other hand, a second alternative is to refuse to tell her that information, upholding the
patient's request for confidentiality and taking the confidentiality principle as the one
that carries the most weight. However, there are other alternatives. For example, the
physician could warn the patient's sister in general terms about taking appropriate
precautions for caring for these types of wounds. She is to wear gloves and even a
mask at all times when handling the bandages. Should she get any blood on her
clothes or body, she is to wash immediately with a disinfectant soap. In other words,
she is to take universal precautions that any medical professional routinely takes in
caring for patients. A further alternative is to request that the patient inform his sister
of his condition. He could then request that she not tell any other family member or
any or his friends. If he refused, then the next step might be to say to him in effect, "If
you don't tell her, I will."

5. Compare Alternatives with Principles

In many cases, the principles resolve the case. Depending on how one
assesses the relative weight of the principles, which may be the case here. In fact, it
may be that the alternative of encouraging universal precautions for the sister but not
telling her why, comes very close to satisfying all the relevant principles. But certainly
there are questions about the adequacy of those precautions. Will she follow them, or
treat them casually? However, assume for the moment that appeal to principles does
not resolve the dilemma.

6. Assess the Consequences

Here the task is to take the viable alternatives that attempt to predict what the
likely consequences (both positive and negative) of each would be. In addition, one
should try to estimate roughly how beneficial are the positive consequences and how
severe the negative ones are, since some consequences are clearly more substantial
than others.

In many cases, when two opposing alternatives are presented, the

consequences of one are the mirror image of the other. This is the case here with the
alternatives of telling that sister, or refusing to tell her of her brother's HIV status.

In the first alternative, that of telling the sister (or insisting that the patient tells
his sister), the likely consequences include the following:

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 on going medical care. But if the

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physician refuses to disclose the information, the following may be expected 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 of 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. If the alternative of

telling the sister to take general precautions is taken, 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 insure
her compliance with them, 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.

7. Make a Decision

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? It is important to realize that at some point
you must stop deliberating and make a decision, as uncomfortable as that may be.

Student Activity 2: Form a group with 5 members in each group. Analyze the situation
of Rebecca using the 7 step ethical decision model. Place your output in a word
document and submit online.

You are a resident assistant in a co-ed residence hall. One evening, a first year
female resident named Rebecca comes to your apartment. She tells you that she had
been grabbed on campus by an unidentified male who released her when she
screamed. Rebecca explains that she tells you only because her best friend convinced
her to approach you. She did not want to report the incident to the campus police, and,
in fact, states she wants the information to stop at your level.

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 After speaking with Rebecca for about an hour, you convince her to inform the
police. She reluctantly details the same story to the police. Over the next several days,
you see Rebecca a number of times. The police investigation has intensified and the
information has been released to the student newspaper as a public safety
announcement. Rebecca becomes more distraught and withdrawn. You convince her
to visit a counsellor. She agrees, only if you accompany her.

One day during an emotional and vague conversation, you and Rebecca are
discussing the assault. You feel there is more to the story then you are being told. You
assure Rebecca that anything she reveals to you will remain confidential. She offers
nothing more. Over the next few days, Rebecca begins to respond to your continued
prodding and becomes more comfortable with you.

A week later, Rebecca comes to you with the "whole story." She had been
drugged, detained and raped by another student (also a resident of your building) at a
campus party. Rebecca is clearly traumatized by sharing her story with you. She
repeatedly emphasizes her desire for confidentiality. You convince Rebecca to tell
campus police the whole story, but she refuses to reveal to them the assailant. The
police finally had the details of the assault, but they had no clues to aid in their
investigation. Rebecca is the only person who knows the identity of the rapist, and
only you know that the individual resides in your building. What do you do?

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Assessment Task: (15 points each item)
Exercise 1
Name: _________________________ Course & Year: ______________
Direction: Answer the following questions in a paragraph or two.
1. “Alam natin na tayo ay tao pero kadalasan ay hindi natin alam paano
magpakatao.” Make a reaction on this statement reflecting the idea on reason and
impartiality as minimum requirements for morality.
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2. Is gender equality justifiable under the concepts of reason and impartiality?
Justify you answer.
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Learning Resources
De Guzman, Jens Micah, et al. (2018). Ethics: Principles of ethical behavior in
modern society. Philippines: MUTYA Publishing.
Khatami, M. (2009). Morality, rationality and impartiality. Falsafeh Vol. 37, No.
1, Spring 2009, pp. 91-110. http://about.abc.net.au/wp-
content/uploads/2012/06/ElementsOfImpartialitySep2007.pdf
Kohlberg, Lawrence. (1981). Essays on moral development. San Francisco,
CA: Harper & Row.
Korsgaard, C. M. (n.d.) “Rationality” https://www.people.fas.harvard.edu
Powers, C. W., & Vogel, D. (1980). Ethics in the education of business
managers. Hasting-on-Hudson, NY: Institute of Society, Ethics and the
Life Sciences.
Rachel, James and Stuart Rachels. (2018). Elements of moral philosophy, 9th
ed. New York: McGraw-Hill.
Rae, Scott B., and Kenman L. Wong. (1996). “A Model for Moral Decision
Making.” Chap. 16 in Beyond Integrity: A Judeo-Christian Approach to
Business Ethics. Grand Rapids, MI: Zondervan.
Rest, J. (1994). Background: Theory and research. In: J. Rest & D. Narvaez
(Eds.), Moral development in the professions: Psychology and applied
ethics (pp. 1–26). New Jersey: Lawrence Erlbaum Associates, Inc.
Rationality & Rational (Nov. 22, 2003) https://www.enotes.com

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