Summary

This chapter briefly explains ethical theories, principles and issues of relevance in health and social care including some recent trends in contemporary policy and practice with ethical implications. The first section, ‘What is “ethics”?’, separates ethics from morality. The question ‘What is “ethics”?’ leads to an examination of distinctions between normative and non-normative ethics, virtue ethics, ethics and law. In ‘Applied and professional ethics’, examples of ethical challenges are identified highlighting issues common to health and social care. Finally, the changing nature of professional roles and relationships, the role of protocols in relation to professional autonomy, lack of trust, changing social trends, potentially infinite demand with finite resources, increasing ethnic diversity, policy drivers towards quality and targets and a focus on risk assessment and risk management are explored.

What is ‘ethics’?

‘Ethics’ and ‘morals’ are often used interchangeably. A useful separation is to use ‘morals’ for those personal values and beliefs formulated in the uniqueness of our individual life experiences and ‘ethics’ in relation to professional values and philosophies. Beauchamp and Childress (2001) argue that philosophical ethics form the highest level of abstraction from which key principles can be extracted. These principles may then be reshaped as rules guiding behaviours. Professional ethics can be defined as the philosophy or principles central to the accepted attitudes and behaviours of a professional group such as nurses, doctors or social workers. Most professional groups articulate the rights and responsibilities of their members via rules or codes of professional conduct, the breaching of which may result in censure or exclusion from the professional group, since ethical decision making cannot rest solely on individual moral judgement. The word ‘ethics’ is derived from ‘ethos’, Greek for character or disposition. Health and social care professionals are expected to demonstrate certain characteristics such as caring, empathy, honesty and trustworthiness.

Ethical theory and principles

Falling into a trap of believing that “cultures manifest preferences, motivations and evaluations so wide and chaotic in their variety that no values nor practical principles can be said to be evident to human beings” is easy as these issues are so wide, and “no value or practical principle is recognised in all times and all places…” (Finnis, 1980, p 83). Ethical theory is constantly evolving from the virtue ethics espoused 2,500 years ago to the Rights movements and Gaian (environmentalist) ethics of the 20th century.