HCA 415 Module 2 Major Moral Theories Compared Example

Twelve Patients or Four Hundred? Five Moral Theories Applied to One Budget Decision

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Health Care Administration Program, Aspen University

HCA 415: Healthcare Ethics

Instructor Name

Month Day, Year

Twelve Patients or Four Hundred? Five Moral Theories Applied to One Budget Decision

Moral theories offer different ways of deciding what is right. Comparing how they handle the same case shows what each notices and what each overlooks. This paper applies five theories to a composite decision at a community health center and considers what administrators can learn from their agreements and disagreements.

The Case

A community health center has $300,000 in unrestricted funds for the coming year. The medical director proposes using it to cover a new, expensive medication for 12 patients with a severe liver condition who have no other way to obtain it. The community health manager proposes a diabetes prevention program for 400 patients with prediabetes, expected to prevent many future cases of diabetes. The board must choose.

Utilitarianism

Utilitarianism judges actions by their consequences, favoring the option that produces the greatest overall good. A utilitarian would estimate the benefits of each option, perhaps in years of healthy life gained, and choose the larger total. The prevention program likely produces more total benefit, though for each individual the benefit is smaller and less certain. The theory's strength is attention to outcomes; its weakness is that it can overlook the claims of individuals in desperate need.

Kantian Duty Ethics

Kantian ethics judges actions by whether they respect persons as ends in themselves and follow principles one could will as universal rules. A Kantian would ask whether abandoning 12 identifiable patients treats them merely as means to a better aggregate, and whether a rule of always favoring larger numbers could be universally willed. The theory highlights duties to individuals but gives little guidance when duties conflict, as they do here.

Virtue Ethics

For virtue ethics, the key question concerns character, so the board should ask how a wise, fair and caring institution would act, drawing on virtues such as compassion, justice, prudence and integrity. A virtuous board would take both groups seriously, seek creative options and make the decision transparently. The theory focuses attention on character and process, but it does not by itself specify which option to choose.

The Ethics of Care

The ethics of care emphasizes relationships, responsibility and attention to particular needs. It would give weight to the center's existing relationships with the 12 patients, who rely on it, and to the vulnerability of their situation. It would also ask how the center can remain responsive to the wider community. Its strength is attention to relationships; its weakness is less guidance on fairness across large groups.

Principlism

Principlism works with four mid-level principles, autonomy, nonmaleficence, beneficence and justice, weighed against each other in the details of each case (Beauchamp & Childress, 2019). Gillon (1994) argued that these principles, with careful attention to their scope, can structure moral reasoning across different cultures and theories. Here, beneficence supports both options, justice raises questions about fair distribution and priority to the worst off, and nonmaleficence warns against abandoning patients already in care.

Comparison

The table summarizes each theory's focus and likely direction.

Where Theories Converge

Despite differences, the theories agree on several points: the board should consider both groups seriously, should not decide on convenience or bias, should be transparent and should look for options that reduce harm to whichever group is not funded. Convergence gives the board confidence about process even when outcomes are contested.

Where Theories Diverge

The theories diverge on whether numbers or identifiable need should weigh more. Utilitarianism favors the larger group; care ethics and Kantian concern for individuals lean toward the 12. This disagreement mirrors a long debate in public health between rescuing identified individuals and preventing harm to statistical ones.

A Possible Resolution

The board, guided by virtue ethics' push for creativity, explored options. The center found that the drug manufacturer had a patient assistance program covering 8 of the 12 patients; the remaining 4 could be covered for about $100,000, leaving $200,000 for a smaller prevention program for about 270 patients. The compromise did not satisfy every theory fully, but it honored duties to current patients while serving the community.

Lessons for Administrators

No single theory settles hard cases. Administrators benefit from using several: consequences to estimate impact, duties to protect individuals, virtues to guide process, care to honor relationships and principles to structure deliberation. Explaining a decision in terms of more than one theory also helps stakeholders who hold different moral views accept it.

The Role of Evidence

Ethical reasoning depends on facts. The utilitarian estimate required data on the prevention program's effect; the compromise depended on discovering the assistance program. Administrators should gather evidence before deliberating, since many apparent dilemmas shrink when the facts are known; clinical ethicists likewise begin cases by clarifying the medical facts before weighing preferences and context (Jonsen et al., 2022).

Rights-Based Views

Some ethicists add a rights-based perspective: people have claims that others must respect, such as a right to necessary care. From this view, the 12 patients might claim a right not to be abandoned once care has begun, while the 400 might claim a right to fair access to prevention. Rights language sharpens the stakes but, like other theories, needs a way to resolve conflicts between rights.

Explaining the Decision Publicly

The board explained its decision to staff and patients in terms each theory could accept: it honored commitments to current patients, sought the greatest benefit with remaining funds, acted transparently and looked for creative solutions. Public reasoning of this kind builds trust even among those who would have chosen differently.

Conclusion

Utilitarianism, Kantian ethics, virtue ethics, the ethics of care and principlism each illuminate part of the choice between 12 patients and 400. They converge on fair, transparent process and diverge on the weight of numbers versus identifiable need. Using them together, and gathering facts, led the board to a compromise that none would have produced alone.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. BMJ, 309(6948), 184-188. https://doi.org/10.1136/bmj.309.6948.184

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2022). Clinical ethics: A practical approach to ethical decisions in clinical medicine (9th ed.). McGraw Hill.