Applied Ethics and Bioethics

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Consent, capacity, end-of-life decisions, reproduction, genetics, research ethics, rationing, and the animal, environmental, and global-poverty debates, taught through the landmark cases and arguments. For students who already know the main moral theories.

Applied ethics vs normative ethics

Normative ethics builds general theories of right action; applied ethics uses those theories, plus mid-level principles and case comparison, to settle concrete questions in medicine, research, the environment, and public life.

The four principles of biomedical ethics

Respect for autonomy, nonmaleficence, beneficence, and justice. They are prima facie duties: each binds unless it conflicts with a weightier one, and conflicts are settled by specifying and balancing.

Nonmaleficence vs beneficence

Nonmaleficence is the duty not to inflict harm; beneficence is the duty to act for others' benefit. Most ethicists rank the negative duty as stricter: we owe everyone non-harm, but positive help only within limits of cost and relationship.

Doctrine of double effect

An act with both a good and a bad effect is permissible when the act itself is not wrong, the bad effect is foreseen but not intended, the bad effect is not the means to the good one, and the good is proportionate to the harm.

Acts vs omissions doctrine

The claim that doing harm is morally worse than allowing the same harm to occur. It underlies the traditional view that withdrawing treatment is permissible while killing is not.

Trolley problem

A runaway trolley will kill five people unless diverted onto a side track where it will kill one. Most people say diverting is permissible, yet most refuse to push a large man off a footbridge to stop the trolley, even though the numbers are identical.

Casuistry

Case-based moral reasoning: settle a new case by comparing it with paradigm cases whose verdicts are agreed, moving from the clear to the unclear by analogy rather than by deducing from a theory.

Reflective equilibrium

A method of justification: adjust general principles and judgments about particular cases against each other until they cohere. Neither level is fixed; each can revise the other.

Slippery slope argument

The claim that permitting act A, itself acceptable, will lead by steps to unacceptable act Z, so A should be forbidden. It is sound only when the causal or logical link to Z is actually shown.

Moral status

The standing that makes a being's interests count morally in their own right. The central debates in bioethics concern which properties confer it: sentience, rationality, self-awareness, species membership, or potential.

Paternalism

Interfering with a person's choices, against their will, for their own good. Soft paternalism restricts only choices that are not substantially voluntary (uninformed, coerced, impaired); hard paternalism overrides even fully informed voluntary choices.

Harm principle

The only purpose for which power can rightfully be exercised over a member of a civilized community, against their will, is to prevent harm to others. Their own good is not a sufficient warrant.

Libertarian paternalism (nudging)

Designing choice architecture so that people are steered toward better options while remaining free to choose otherwise, for example by setting a default.

Primum non nocere

Latin for first, do no harm. The phrase is not in the Hippocratic Oath; the nearest Hippocratic line is in Epidemics: to help, or at least to do no harm. It is the traditional shorthand for nonmaleficence.

Conscientious objection in medicine

A clinician's refusal, on moral or religious grounds, to provide a legal service such as abortion or assisted dying. Most professional codes permit it if the patient is informed and referred so that access is not blocked.

Informed consent: the five elements

Disclosure of relevant information, understanding by the patient, voluntariness (no coercion or undue influence), capacity to decide, and an actual decision to authorize or refuse.

Which court decision first framed treatment without consent as a violation of bodily self-determination?

Schloendorff v. Society of New York Hospital (1914). Judge Benjamin Cardozo wrote that every human being of adult years and sound mind has a right to determine what shall be done with his own body.

Reasonable patient standard vs professional standard of disclosure

The professional standard asks what a reasonable physician would disclose; the reasonable patient standard asks what a reasonable patient would want to know before deciding. US law shifted toward the latter in Canterbury v. Spence.

Decision-making capacity: the four abilities

The ability to understand the relevant information, to appreciate how it applies to one's own situation, to reason about options, and to express a choice. Capacity is decision-specific and can fluctuate.

Substituted judgment vs best interests

Substituted judgment asks what the patient would have chosen, based on their known values; the best-interests standard asks what a reasonable person would choose for their welfare. Substituted judgment is preferred when the patient's wishes are knowable.

Therapeutic privilege

The exception allowing a physician to withhold information when disclosure itself would seriously harm the patient, for example by making them unable to decide at all. Modern codes read it narrowly.

Truth-telling about diagnosis

Patients have a strong claim to know their diagnosis and prognosis. The norm reversed within a generation: a 1961 US survey found most physicians did not tell cancer patients their diagnosis; by 1979 nearly all said they did.

Confidentiality and its classic exception

Clinicians must not disclose patient information without consent, but the duty yields when disclosure is needed to prevent serious harm to an identifiable third party.

Refusal of blood transfusion by a Jehovah's Witness

A competent adult may refuse a transfusion even if death follows; the refusal is respected. Courts do not extend that right to the child of a Witness parent, and will authorize transfusion of a minor.

Mature minor doctrine and Gillick competence

Minors below the age of majority may consent to treatment when they show sufficient understanding of what is proposed. In England the standard comes from the Gillick case on contraceptive advice to under-16s.

Shared decision-making

A model in which clinician and patient reach a decision together: the clinician supplies evidence about options and outcomes, the patient supplies values and preferences, and the choice reflects both.

Ulysses contract

An advance agreement in which a person, while competent, binds their future self to a treatment they expect to refuse when ill, as Ulysses had himself tied to the mast. Used mainly in psychiatry.

Therapeutic misconception

A research participant's belief that decisions in a trial are made for their individual benefit, when in fact the protocol, randomization, and placebo are designed to produce knowledge.

Active vs passive euthanasia

Active euthanasia is deliberately killing a patient, for example by lethal injection; passive euthanasia is letting the patient die by withholding or withdrawing treatment. Law and most professional codes forbid the first and permit the second.

Voluntary, non-voluntary, and involuntary euthanasia

Voluntary: at the competent patient's request. Non-voluntary: the patient cannot express a choice (infant, permanent unconsciousness). Involuntary: against a competent patient's wishes, which is murder under every view.