Moral Uncertainty and Its Consequences

By Ted Lockhart | Go to book overview

EMR(I) - EMR(not-I) = p1p2p3p4m1 + p1p2(1 - p3)m2 + p1(1 - p2)m3

+ (1 - p1)p5m4 - p1p2p3(1 - p4)m5

- (1 - p1(1 - p5)m6

+ 2p1[p2p3(1 - p4) + p5 - 1] - 2p5 + 1

We want to know whether EMR(1) > EMR(not-I) or, equivalently, whether EMR(I) - EMR(not-I) > 0.

There is not enough information about the magnitudes of the ps and the ms to say with certainty whether this is the case. Therefore, PR4 is not applicable. However, we can apply PR5 if we assume that each 11-tuple <p1, p2, p3, p4, p5, m1, m2, m3, m4, m5, m6> that satisfies the preceding constraints on those 11 quantities is as likely to contain the true values of the ps and ms as any other 11- tuple that satisfies those constraints. We need only calculate the mean value of EMR(I) - EMR(not-I) over the region determined by the constraints on the ps and the ms. If it is positive, then EMR(I) is probably greater than EMR(not-I); if it is negative, then the opposite is true. It turns out that mean value of EMR(I) - EMR(not-I) is approximately -0.0984. 11 Therefore, the physician's not informing the fiancée in the situation we are examining is more likely to maximize expected moral rightness than his informing the fiancée. PR5 thus implies that the physician should (rationally) choose not to inform the patient's fiancée that the patient has tested HIV-positive.

The result just obtained accords with the preceding conclusion, which assumed the traditional two-valued concept of moral rightness. Therefore, it appears not to matter which concept of moral rightness we assume for the physician's decision in this case. However, as we have already seen, degrees of moral rightness can make a difference for some decisions. And if we had ranked the ps and ms differently, then PR5 might have produced a different result.

Conclusions

Our study of the medical ethics case in this chapter indicates how compelling the physician's obligation of confidentiality is, even if that obligation is sometimes outweighed by conflicting obligations. There are very few situations in which questions of confidentiality arise where a better argument could be made for not maintaining confidentiality than in the medical ethics case we have examined. Of course, we have confined our discussion to the arguments advanced by Winston and Landesman in their commentaries on this case. Possibly our conclusion would have been different if we had considered other arguments. 12 The revelation that confidentiality should be given such high priority will, I suspect, come as a surprise to those of us to whom it appears initially that the physician should inform the fiancéc of his patient's medical condition. Surely other surprises are in store if we apply the decision strategy based on PR4 and PR5 to other problems in applied and professional ethics.

Our inquiry has shown how our decision strategy can, for practical purposes, adjudicate between opposing moral arguments even if we cannot decide which argument is sound. It is important to note that we did not settle the debate be-

-122-

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Moral Uncertainty and Its Consequences

• Title Page iii
• Preface vii
• Acknowledgments xiii
• Contents xv
• One Decision-Making Under Moral Uncertainty 3
• Two Principles for Decision-Making Under Moral Uncertainty 22
• Three Abortion and Moral Uncertainty 50
• Conclusions 72
• Four Degrees of Moral Rightness 74
• Conclusions 96
• Five Shall I Act Supererogatorily? 98
• Conclusions 110
• Six Confidentiality and Moral Uncertainty 111
• Conclusions 122
• Seven a Decision-Theoretic Reconstruction of Roe V. Wade 124
• Conclusions 140
• Eight Long-Run Morality 143
• Nine Retrospective 169
• Appendix: Decisions with Uncertain Probabilities 171
• Notes 177
• Index 207
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