Monday, June 5, 2017

Euthanasia and Healthcare Ethics: An Ethical Dilemma

Euthanasia and Healthcare Ethics: An Ethical Dilemma

Dawn Pisturino 


Healthcare ethics deal with life and death situations which involve every member of the healthcare team.  But the patient is at the heart of healthcare ethics, and the rights, safety, and well-being of the patient must come first in all healthcare decisions.  It is not up to healthcare personnel to decide who will live and who will die.
Euthanasia and Healthcare Ethics: An Ethical Dilemma

       Every discipline has a code of ethics to follow when it comes to making ethical decisions, and healthcare is no exception.  Ethics in healthcare is so important, in fact, that most organizations have a process through which tough ethical decisions, such as end-of-life decisions, can be made.

The Hippocratic Oath and Modern Healthcare Ethics

       The origin of healthcare ethics dates back to the Hippocratic School of 200 B.C. (Geppert & Roberts, 2008).  Hippocrates devised the Oath of the Hippocratic School, which includes confidentiality, nonmaleficence, and beneficence (Geppert & Roberts, 2008).  Since then, technology has forced changes in healthcare ethics, adding principles of autonomy, respect for persons, compassion, privacy, and honesty (Geppert & Roberts, 2008).  Most of these principles can be applied to end-of-life issues.

The End-of-Life Debate 

       The end-of-life debate has been fueled by the preponderance of chronic disease in modern society, quality of life issues, and the soaring cost of healthcare.  In most countries around the world, euthanasia and patient-assisted suicide are illegal.  Hippocrates himself said, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” (Doukas, 1995).

Dr. Jack Kevorkian

       In 1999, Dr. Jack Kevorkian was found guilty of second-degree murder by a Michigan jury in the death of Thomas Youk (Charatan, 1999).  Dr. Kevorkian had administered a lethal dose of
medication to Youk, who was suffering from ALS (amyotrophic lateral sclerosis).  He could not prove that Youk had asked him to end his life.
       The Hemlock Society, a proponent of physician-assisted suicide, condemned the verdict (Charatan, 1999).  But many organizations devoted to disability rights applauded Dr. Kevorkian’s conviction, claiming that euthanasia is a threat to people with disabilities (Charatan, 1999).  The American Medical Association issued a statement by Dr. Nancy W. Dickey, who was president at the time: “Patients in America can be relieved that the guilty verdict against Dr. Jack Kevorkian helps protect them from those who would take their lives prematurely” (Charatan, 1999).
       John Roberts, North American editor of the British Medical Journal, labeled Dr. Jack Kevorkian “a medical hero.”  He considered Kevorkian an honest man who was acting according to his personal moral principles (Roberts & Kjellstrand, 1996).  Still, most physicians want to be perceived by the public as healers – not death dealers (Doukas, 1995).

Dutch Euthanasia Act

       In 2002, the Netherlands passed the Dutch Euthanasia Act, sparking a world-wide debate on end-of-life issues (Van der Heide, 2007).
       Euthanasia, as defined in the Netherlands, is “death resulting from medication that is administered by a physician with the explicit request of the patient” (Van der Heide, 2007).  In physician-assisted suicide, the physician prescribes the medication and the patient administers it himself, leading to death.  In both cases, the physician is legally protected by the Dutch Euthanasia Act for ending life “at the request of a patient who was suffering unbearably without hope of relief” (Van der Heide, 2007).                                                                                                                                      
      Before making a decision, physicians are required to discuss euthanasia and physician-assisted suicide with the terminally-ill patient and his relatives.  If there is any question about the ethical nature of the decision, physicians may discuss the matter with colleagues.  In 2005, in the Netherlands, 73.9% of all patient-requested deaths were the result of neuromuscular relaxants or barbituates; 16.2% were the result of opioids (Van der Heide, 2007).

Ethical Dilemma Case Example

       Physicians are not the only healthcare workers faced with ethical dilemmas.  Nurses also find themselves in situations where they must apply ethical principles.
       The Charge Nurse at a local hospital wanted to open up a patient bed in order to admit a patient from the emergency room.  She asked this author – the patient’s nurse – to give a dose of intravenous morphine to a patient who was dying of end-stage kidney disease.  Legally, the patient was a “Do Not Resuscitate.”  The family was at the bedside.
       “Ethical dilemmas often provoke powerful emotions and strong personal opinions; however, emotions and opinions alone are not a satisfactory way of resolving ethical dilemmas” (Lo, 2013).   Faced with an ethical dilemma of tantamount importance, this nurse had only a short time in which to make the right decision.
       The first thing to consider was the law and the legal ramifications of any decision made in this situation (Pojman & Fieser, 2017).  How would the decision affect the Charge Nurse and the patient’s nurse?  Would we be held legally liable if the patient died after receiving an extra dose of morphine?  Would we lose our nursing licenses?  Would the family sue?  Would we lose our jobs?  Euthanasia in Arizona is against the law.
       Secondly, would the patient want to be given an extra dose of morphine?  A “Do Not Resuscitate” status merely indicates that the patient does not want to be revived if the heart stops beating or respirations cease.  It is not a request for euthanasia.  Would it violate the patient’s personal or religious beliefs to administer an extra dose of morphine?  Would it violate her core ethics?  Would it take away her right of self-determination and autonomy (Pojman & Fieser, 2017)?
       Thirdly, to go into the patient’s room and administer an injection of morphine without just cause would violate the culture and ethics of the hospital, the doctor, and most of the nursing staff (Pojman & Fieser, 2017).  It would look suspicious to the family.  They would question what this nurse was doing.  It would place this nurse in an uncomfortable situation.
       The ethical dilemma posed here is this: should the patient’s nurse do what the Charge Nurse requested or refuse?  In order to make a rational and ethical decision, the patient’s nurse must first analyze the situation.  According to Pojman and Fieser, “most ethical analysis falls into one or more of the following domains: (1) action, (2) consequences, (3) character traits, and (4) motives.”


       Giving the patient an extra dose of morphine would be the right action if the patient was in pain and wanted the medication.  It would be the right action if the patient seemed uncomfortable and the patient’s family requested it.  It would not be an obligatory act if it was too soon to give the medication or if the patient did not need it at that time.  It would be considered an optional act, based on the nurse’s professional judgment and opinion.  On the other hand, it would be a wrong action to give the morphine if the patient did not need it or the patient’s family did not want it given.  If euthanasia were legal and the physician was at the bedside and requested the patient’s nurse to draw up the medication, it would be considered a supererogatory act if the physician administered it to the patient.  He would be ending the patient’s suffering.  The nurse would be involved in a legal and compassionate act.


       If the patient was in pain and needed the medication, giving the morphine would be the right action because it eased the patient’s pain.  If the patient died as a result, there would be no legal or professional consequences because there is no way to predict if that particular injection will cause the patient to stop breathing.  The morphine was given according to medical guidelines ordered by the physician.  If the patient was not in pain and the extra injection of morphine caused the patient to stop breathing, it could raise ethical and legal issues for the nurse who administered the medication.  Those issues would most likely be raised by the family, if they were concerned.

Character Traits

       The Charge Nurse was more concerned about opening up a patient bed than respecting the rights of the patient who was dying.  It seems callous, malevolent, and unfeeling.  The patient’s nurse must examine her own feelings and attitudes and decide if the Charge Nurse was right or wrong in her request.


       The motive of the Charge Nurse was clearly to give in to pressure from the emergency room to admit a patient.  She showed no concern whatsoever for the patient who was dying.  She had no respect for the patient’s rights and autonomy – or for the patient’s family.
       The nurse’s motive should be to protect the rights and safety of her patient.  She is the patient’s advocate.  If she gives in to pressure from the Charge Nurse, she will fail in her duty to her patient.  Even if she believes that euthanasia is a moral act, neither she nor the physician has informed consent from the patient or the family.

What Happened

       The patient’s nurse evaluated the motives of the Charge Nurse, felt disgusted, and went into the patient’s room to check on her condition.  She was resting quietly with her eyes closed, and the nurse saw no evidence of pain or discomfort.  When the nurse asked the patient’s family if they wanted the patient to receive a morphine injection for pain, they agreed with the nurse that the patient was resting quietly and did not need it.  Relieved, the patient’s nurse reported all of this to the Charge Nurse.  As a parting shot she added, “And I’m not Dr. Kevorkian!”


       Patients and their families have the final say in what happens to terminally-ill patients.  It is not up to healthcare personnel to make decisions about end-of-life care for a patient.  This will be particularly true if euthanasia and patient-assisted suicide ever become legal on a widespread scale.  The medical community, in line with its own ethical principles, must respect the right of self-determination and autonomy of terminally-ill patients.



Charatan, Fred. (1999). Dr. Kevorkian found guilty of second degree murder. British medical

       journal, 318(7189), 962. Retrieved from

Doukas, D.J., Waterhouse, D., Gorenflo, D.W., Seid, J. (1995). Attitudes and behaviors on

       physician-assisted death: A study of Michigan oncologists. Journal of Clinical Oncology,

       13(5), 1055-1061

Geppert, M.A., & Roberts, L.W. (Ed.) (2008). Book of ethics. Center City, MN: Hazelden


Lo, Bernard. (2013). Resolving ethical dilemmas: A guide for clinicians. Philadelphia, PA:

       Lippincott, Williams and Wilkins

Pojman, L.P., & Fieser, J. (2017). Ethics: Discovering right and wrong. Boston, MA:

       Cengage Learning

Roberts, J., & Kjellstrand, C. (1996). Jack Kevorkian: a medical hero. BMJ: British

       Medical Journal, 312(7044), 1434

Van der Heide, A., Onwuteaka-Philipsen, B.D., Rurup, M.L., Buitina, H.M., van Delden, J.M.,

       Hanssen-de Wolf, J.E., . . . van der Wal, G. (2007). End-of-life practices in the Netherlands

       under the euthanasia act. New England Journal of Medicine, 356 (19), 1957-1965.
Dawn Pisturino
April 2017
Ethics 151
Mohave Community College
Kingman, Arizona
Copyright 2017 Dawn Pisturino. All Rights Reserved.
(The formatting for this paper did not come out quite right online. My apologies.)






Tuesday, April 18, 2017

Virtue Ethics and Virtue Theory: Strengths and Weaknesses


After centuries of debate, many modern philosophers have concluded that both virtue ethics (character) and virtue theory (action) are inadequate on their own merits.  They must compromise and support one another. 
Virtue Ethics and Virtue Theory: Strengths and Weaknesses
       While utilitarians emphasize the consequences of actions that promote the most good, and deontologists like Kant point to rules and duties, virtue ethicists hold up moral character as the highest form of normative ethics (Hursthouse & Pettigrove, 2016).
       Traditionally, virtue ethics encompass the ideas of “virtues and vices, motives and moral character, moral education, moral wisdom or discernment, friendship and family relationships, a deep concept of happiness, the role of the emotions in our moral life and the fundamentally important questions of what sorts of persons we should be and how we should live” (Hursthouse & Pettigrove, 2016).  Virtue ethics are teleological in nature because they deal with human reason and the purpose of human existence (Frost, 1989).  They address “the goal of life: living well and achieving excellence” (Pojman & Fieser, 2017).
       It’s important to separate “virtue ethics” from “virtue theory.”  Virtue ethics is an approach to ethics apart from utilitarianism and deontology.  Virtue theory addresses virtue as it is found in ethical systems (Hursthouse & Pettigrove, 2016).
       Virtue theory is considered “action-based theory” (Pojman & Fieser, 2017) and calls on people to act virtuously by following certain rules.  People are judged by their actions and not whether they possess virtuous character traits.  Virtue theory is strong on action-guiding rules but weak on producing people with solid moral characters.
       Virtue ethics, on the other hand, are founded on ancient Greek philosophy and include the concepts of arĂȘte (excellence), phronesis (practical wisdom), and eudaimonia (happiness, flourishing) (Hursthouse & Pettigrove, 2016).  Aristotle believed that humans are the “highest
creation,” endowed with the “spark of the divine” (Frost, 1989).  For him, the goal of life for humans is to achieve the highest self-realization (Frost, 1989).  He saw God as “pure intelligence . . . [and the] unifying principle of the universe” (Frost, 1989).  God is the reason that all things, including humans, strive for realization (Frost, 1989).  But humans “use reason in pursuit of the good life” (Pojman & Fieser, 2017).  This is what separates humans from animals.   
       A virtue is an inherent character trait that makes somebody “a certain sort of person” (Hursthouse & Pettigrove, 2016).  The virtuous person consistently behaves in a way that reflects his or her deepest-held convictions.  Virtuous does not mean perfect — even the most virtuous people have flaws.  But truly virtuous people, according to Aristotle, “do what they should without a struggle against contrary desires.  The continent have to control a desire or temptation to do otherwise” (Hursthouse & Pettigrove, 2016).  A virtuous person “does these things because he desires to do them from the depths of his own being” (Frost, 1989).  A virtuous person will not be tempted to do wrong.  He will do good because he is good (Pojman & Fieser, 2017).  The more “good” people who live in society, the more society benefits.
       Phronesis is moral or practical wisdom (Hursthouse & Pettigrove, 2016).  Without wisdom to back up virtue, even the most virtuous people can use their virtue in the wrong way.  And they are held accountable when their actions go wrong.  Virtuous people have a firm understanding of situational ethics and apply their virtues accordingly (Hursthouse & Pettigrove, 2016).  But wisdom comes with experience, and moral virtues must be lived in order to be fully realized (Pojman & Fieser, 2017).  Some people will never develop wisdom, no matter how long they live.  Wisdom, common sense, and critical thinking skills cannot always be learned.
       Aristotle placed emphasis on the Golden Mean — or moderation — which he considered the “rational attitude” (Frost, 1989).  Moderation leads to balance.  Living a moderate life develops “noble, just, honest, considerate” (Frost 1989) character traits.  But Aristotle also believed in free will.  People are “free to debase [themselves] or strive for self-realization” (Frost, 1989).  Therefore, it is not guaranteed that people will choose to become virtuous people or follow action-guiding rules.
       According to Aristotle, “man is by nature a social animal” (Frost, 1989).  He can only flourish and achieve self-realization within the context of the state.  In fact, “the goal of the state . . . is to produce good citizens” and “to the extent that the state does not enable the individual to live a virtuous and happy life, it is evil” (Frost 1989).  If a person is unlucky enough to live in a country where human rights are not respected, it is unlikely that he will have the opportunity to achieve self-realization and live a happy life.
       Although people can be born with good or bad character traits, Aristotle believed that “the aim of education should be to make people virtuous” (Frost, 1989).  But what traits make people virtuous? According to Pojman & Fieser, moral virtues include “honesty, benevolence, nonmalevolence, fairness, kindness, conscientiousness, gratitude.”  But this leads to a conundrum.  People with virtuous character traits must still be guided by action-guiding principles.   Otherwise, they have no parameters by which to act (Pojman & Fieser, 2017).  As philosopher William Frankena said, “Traits without principles are blind, but principles without traits are impotent” (Pojman & Fieser, 2017).
       Action-guiding principles, as found in virtue theory, are uninspiring and do not produce people with inherent moral characters.  Virtue ethics, on the other hand, strive to produce people with strong moral characters but fail to provide guidelines to put those traits into action.  Virtue theory and virtue ethics must compromise and support one another in order to provide a complete moral system.
Frost, S.E. (1989). Basic teachings of the great philosophers. New York, NY: Anchor Books
Hursthouse, R., & Pettigrove, G. (2003). Virtue ethics. In E.N. Zalta (Ed.), The Stanford
       encyclopedia of philosophy (winter 2016 ed.). Retrieved from
Pojman, L.P., & Fieser, J. (2017). Ethics: Discovering right and wrong. Boston, MA:
       Cengage Learning
Dawn Pisturino
March 2017
Mohave Community College
Kingman, Arizona
Copyright 2017 Dawn Pisturino. All Rights Reserved.


Tuesday, March 28, 2017

Nominated March of Dimes 2017 Nurse of the Year


I was honored that one of my co-workers recently nominated me for the March of Dimes 2017 Nurse of the Year award. Thank you, Jessica!

Dawn Pisturino, RN
March 28, 2017

Wednesday, March 22, 2017

Utilitarianism and Kantianism: A Comparison


Utilitarianism is a teleological ethical theory that determines good and bad actions based on the consequences. Kantianism is a deontological ethical theory that emphasizes the intrinsic value of the acts themselves, the intention behind the acts, or the rules which govern the acts. Both theories seek to maximize good and minimize suffering for the human race.

Utilitarianism and Kantianism: A Comparison


       Classical utilitarianism originated with Jeremy Bentham in the 18th century.  He broke down utilitarianism into two basic principles: the consequentialist principle and the utility principle.
       According to the consequentialist principle, “the rightness or wrongness of an act is determined by the goodness or badness of the results” (Pojman & Fieser, 2017).  An act should result in “the greatest good of the greatest number” (Frost, 1989).  He also believed that “good and bad . . . are determined by social factors” (Frost, 1989).  From this perspective, the end justifies the means.
       The utility (hedonist) principle states that “the only thing that is good in itself is some specific type of state” (Pojman & Fieser, 2017).  A state is good if it provides more pleasure than pain.
       Bentham devised a formula, called the hedonic calculus, which assigns hedons — units of happiness — to experiences (Pojman & Fieser, 2017).  The number of hedons determines whether the act is good or bad.
       Bentham is known as an act-utilitarian.  He believed that “an act is right if and only if it results in as much good as any available alternative” (Pojman & Fieser, 2017).
       John Stuart Mill, on the other hand, wanted to distinguish pleasure from sensualism.  He believed that “intellectual, aesthetic, and social enjoyments” (Pojman & Fieser, 2017) were more important for human happiness than lower pleasures such as food, drink, and sex.  Lower pleasures can lead to pain, whereas higher pleasures tend to provide more substantial, long-term benefit. 
       Mill was a rule-utilitarian who believed that “an act is right if and only if it is required by a rule that is itself or member of a set of rules whose acceptance would lead to greater utility for society than any available alternative” (Pojman & Fieser, 2017).
       John Stuart Mill was also a Utopian in the sense that “he dreamed of a society in which the happiness and prosperity of all was certain, and in which all would share the wealth of the group” (Frost, 1989).  But he admitted that humans are complex creatures and “the factors which must be taken into consideration are so numerous that it is impossible for us to predict with any high degree of certainty” (Frost, 1989).
       Humans need action-guiding rules to help them make choices that maximize the good for the greatest number and minimize suffering (Pojman & Fieser, 2017).  At the lowest level are simple commands such as “Don’t Kill.”  On the next level, the commandment can be modified to adapt to a changing situation: “Don’t Kill Unless . . .”
       The remainder rule, as a last resort, says to use best judgment when two moral principles conflict (act utilitarianism) (Pojman & Fieser, 2017).
       Modern philosopher Kai Nielsen is an act-utilitarian who added another dimension by concluding that human responsibilities include what they do and what they fail to do (negative responsibility) (Pojman & Fieser, 2017).


       By contrast, Immanuel Kant believed that “by reason we can form an idea of this world, this universe” (Frost, 1989).  Humans need “an absolutely necessary Being, God, who is the cause of everything” (Frost, 1989) in order to perform good acts.  They must act “as if this kind of a
world existed” (Frost, 1989), whether real or not.  The moral law, for Kant, is derived from reason and shapes human values.  This is called rational intuition (Pojman & Fieser, 2017).
      The phenomenal world, according to Kant, is based on experience (Frost, 1989).  The noumenal world is based on reason (Frost, 1989).  Reason leads to the practical experience.   In developing his overriding  doctrine of the categorical imperative, Kant commanded humans to “always act so that you can will the maxim or determining principle or your action to become universal law [the principle of the law of nature]; act so that you can will that everybody shall follow the principle of your action [the principle of autonomy]” (Frost, 1989).
       Kant believed that the Good Will is the only thing that is intrinsically good (Pojman & Fieser, 2017).  Mental intellect and talents do not qualify because they can be corrupted.  But they are redeemed if accompanied by a Good Will.
       He further believed that humans have a “dominant place in the universe” (Frost, 1989) and should be treated as an end rather than a means.  This is called the principle of ends (Pojman & Fieser, 2017).
       Kant was a rule-intuitionist and continued Samuel Pufendorf’s list of duties that humans must perform: duty to God, duty to oneself, and duty to others (Pojman & Fieser, 2017).  But the most important duty is to fulfill “moral duty solely for its own sake” (Pojman & Fieser, 2017).


       While utilitarians were empiricists who considered the consequences of their actions to determine good and bad, Kant was an absolutist and rationalist who believed that a transcendental world could be detected through reason and intuition.  He believed that a higher power was necessary in order for humans to understand the moral laws that would guide their actions.  An inherent Good Will, accompanied by mental acuity and talents, was also necessary to ensure good acts that would influence universal law.


Frost, S.E. (1989). Basic teachings of the great philosophers. New York, NY: Anchor Books

Pojman, L.P., & Fieser, J. (2017). Ethics: Discovering right and wrong. Boston, MA: Cengage

Dawn Pisturino
Ethics 151
Mohave Community College
Kingman, Arizona
March 8, 2017
Copyright 2017 Dawn Pisturino. All Rights Reserved.











Monday, March 6, 2017

Ethical Egoism: Strengths and Weaknesses

Ethical Egoism: Strengths and Weaknesses
Dawn Pisturino
Mohave Community College
Ethical egoism urges people to do the things which best serve their own self-interest.  They should strive to become the best they can possibly be.  In order for this moral principle to hold up, however, it must meet certain criteria.
Ethical Egoism: Strengths and Weaknesses
       Before the principle of ethical egoism can be legitimately defined as a moral code, it must contain certain characteristics.
       Tibor R. Machan (1979) describes ethical egoism as “morality that is tied to benefiting the agent.”  As a moral code, it guides people to be the best they can be and to pursue the best possible goals (Machan, 1979).  It sets a standard of excellence for ambitious people.  In corporate America, the prescriptive statement would be, “Do Your Best!”  In the college setting, the commandment would be, “Follow Your Dreams!”  On the surface, this sounds reasonable enough.  We want our best and brightest to succeed.  But not everybody is ambitious or able to follow this moral code.  Many people are lazy and want to work just hard enough to get by.  Others do not have the necessary talents or mental capacity or stamina.  Ayn Rand believed that a person’s own life is the ethical purpose for his life (Machan, 1979).  If this is true, nobody is obligated to pursue goals that are self-enhancing and ambitious.  People have the right to be lazy and to live a mediocre life.  Therefore, ethical egoism does not guarantee any benefit to society.  It can serve as a prescription for success for some people, but it cannot command people to strive for success.
       According to Pojman and Fieser (2017), moral principles “must apply to all people who are in a relevantly similar situation.”  But many egoists, like Jesse Kalin, believe that ethical egoism is a “personal ethical doctrine” that does not have to apply to all people (Machan, 1979).  This
frees people from conformity, but it opens the door to contradictions because people will not behave consistently (Machan, 1979).  In fact, James Rachels condemns ethical egoism as a threat to society because it undermines social cohesion (Machan, 1979).  Ethical egoism satisfies the characteristic of universalizability in the sense that every person has the right to make his own choices and pursue his own goals.  But it fails in providing a consistent guiding action for individuals to engage in positive conduct that promotes the welfare of society.
       Can ethical egoism as a moral principle override other principles?  J.A. Brunton believes that “the egoistic part in all of us will always find rules, reason, and justification” for our actions (Machan, 1979).  All moral codes contain biases, no matter how noble, because they reflect the individuality of human beings.  Ethical egoism is biased towards the self (Machan, 1979).  The egoist may be able to override his sense of self long enough to help another human being, but only if it best serves his own self-interest (Machan, 1979).  At the very least, he would act “with prudence” to protect his own reputation and social standing (Machan, 1979).  If his own self-preservation is more important to him than his “social commitments,” however, he will not care about engaging in altruistic behavior (Machan, 1979).
       Moral principles that have authority to consistently guide people are widely known and publicized.  Most people have heard the commandment, “Thou Shall Not Kill.”  It has become part of the culture.  Most corporations try to project a benevolent and altruistic image in order to earn the public’s business and respect, whether or not they engage in that kind of behavior.  Corporations notoriously try to save money by cutting corners and reducing jobs in order to maximize profits.  Corporate executives view this as goal-directed actions that provide value to the corporation (the ethical egoist point of view).  If the corporation is producing unsafe products and working conditions as a result of its actions, however, it cannot publicize the results of these actions because the public will object.  Therefore, the ethical egoist point of view only works when corporate executives choose to engage in positive behavior that does not cause harm to others.  Eric Mack confirms this when he states, “the morally good, with respect to each human being, is the successful performance, and the results of the successful performance, of those actions that sustain [living things]” (Machan, 1979).
       Thomas Hobbes stated that it is in the best self-interest of people to obey the rules because “people are inherently selfish” (Pojman & Fieser, 2017).  Without an overriding moral code, society would fall into chaos.  But the moral code must be universal and agreed on by society.  And the threat of punishment or exclusion should be enough to prevent people from breaking the rules.
      David Gauthier describes the ethical egoist as “a person who on every occasion and in everrespect acts to bring about as much as possible of what he values” (Machan, 1979).  By this reasoning, anything can be considered valuable by individuals.  If a drug addict values the effects of heroin, he will devote his time to finding and using heroin.  If a business owner values profit, he will devote his time to making money.  The drug addict is satisfying his own needs.  But if he is stealing in order to support his habit, he is not only acting in his own self-interest but behaving selfishly and harming others.  The business owner may try to deal with his customers honestly, but if he is feeling stressed about money, he may deliberately cheat someone in a moment of need.  He is fulfilling his own self-interest but behaving selfishly by harming the customer.
       In both cases, a standard of excellence was not pursued or achieved, so ethical egoism failed to provide practical and positive effects for society.
       Ethical egoism only works as a legitimate moral code if the agent performs the right action to achieve the right result with the right intention from the beginning (Pojman & Fieser, 2017). 
Machan, T. (1979). Recent work in ethical egoism. American Philosophical Quarterly, 16(1),
       1-15. Retrieved from
Pojman, L.P., & Fieser, J. (2017). Ethics: Discovering right and wrong. Boston, MA:
       Cengage Learning
Dawn Pisturino
February 27, 2017
Ethics 151
Mohave Community College
Kingman, Arizona
Copyright 2017 Dawn Pisturino. All Rights Reserved.

Tuesday, February 7, 2017

Attachment Disorder and Crime



Attachment disorders arise when children experience prolonged and persistent abuse and neglect.  They are unable to form attachments and respond to the world with anger, defiance, and aggression.  They resist authority figures and defy social rules.  Without early intervention, these children are at high risk for delinquency, criminality, and the commission of violent crimes.
Attachment Disorder and Crime

       Criminologists recognize that antisocial behaviors, which are more common in males, can lead to an increase in criminality and violent crime (Siegel, 2012).  Much of their research has been based on John Bowlby’s attachment theory.

       Psychoanalyst John Bowlby studied Lorenz’s research on imprinting.  He concluded that “children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive” (McLeod, 2007).  Failure to make secure attachments can lead to “affectionless psychopathy” later in life (McLeod, 2007).

       “Attachment is an enduring affective bond characterized by a tendency to seek and maintain proximity to a specific person, particularly when under stress” (Levy, 2000).  This bond is created between mother and child during the nine months of pregnancy and the first two years of life (Levy, 2000).  The mother-child bond is unique and forms through social releasers — behaviors that ensure a reciprocal response between mother and child (McLeod, 2007).  Smiling, eye contact, holding, rocking, touching, and feeding are cues which create a “mutual regulatory system” (Levy, 2000).

       When the mother-child bond fails to develop, infants can suffer from severe colic and feeding difficulties, fail to gain weight and reach important developmental milestones, remain detached and unresponsive, refuse to be comforted, and respond too readily to strangers (Attachment Disorders, 2014).

       Children need a “secure base” to learn trust and reciprocity, qualities which lay the foundation for all future relationships (Levy, 2000).  They must be able to explore their environment without fear and anxiety so they can attain full cognitive and social development (Levy, 2000).  A strong, secure attachment between mother (or other primary caregiver) and child helps the child to learn self-regulation (self-management of impulses and emotions) (Levy, 2000).  The child has the opportunity to form a strong self-identity, competence, and self-worth and to create balance between dependence on the mother and his own autonomy (Levy, 2000).  A secure base allows the child to learn empathy and compassion and to develop a conscience (Levy, 2000). A well-established core belief system helps the child to evaluate himself, his caregiver, and the world around him (Levy, 2000).  He learns resourcefulness and the resilience to cope with stress and adverse events (Levy, 2000).

       Even adopted infants can “develop healthy attachment relationships” in the first year of life if raised in a safe and secure environment by a caregiver who is consistently responsive to their needs (Reebye, 2007).  Children with Down Syndrome tend to develop attachments later, during the 12-24 month period (Reebye, 2007).

       Secure attachment allows children to develop positive patterns of cognition, behavior, and interaction which help them to survive successfully within the family and society at large (Levy, 2000).  They internalize altruism, empathy, compassion, kindness, and morality, qualities which lead to proper social behavior and social cohesion.  They learn to view themselves, the caregiver, life, and the world as essentially good, safe, and worthwhile.

       Children who do not develop secure attachments experience just the opposite.  They learn to view themselves, the caregiver, life, and the world as hostile, dangerous, and worthless (Levy, 2000).  By age four, these children exhibit symptoms of chronic aggression — “rage, bullying, defiance, and controlling interactions with others” (Levy, 2000).  These are the children who overwhelm the child welfare and juvenile justice systems and carry diagnoses of conduct disorder, oppositional defiant disorder, and antisocial personality disorder.  Children with severe attachment disorder typically engage in cruelty to animals, bed-wetting, fire-setting, pathological lying, and self-gratification at the expense of others.  They are predatory and vindictive, controlling and manipulative.  They lack empathy, remorse, and a moral conscience.  They are unable to form close relationships with others because they never experienced it themselves.

       Adults with these traits are often labeled psychopaths and may become serial killers and mass murderers (Levy, 2000).  The motivations for their crimes are manipulation, dominance, and control.  They feel powerless and inferior, committing horrific crimes against others as a way to release their frustrations and hostilities (Levy, 2000).

       But why do some children fail to develop a secure attachment to their mother or other primary caregiver?  Researchers have determined several common factors — “abuse and neglect, single-parent homes, stressed caregivers, parents with criminal records” (Levy, 2000).  Other factors include parental mental illness, substance abuse, and a history of maltreatment.

       Within the family, persistent conflict and violence lead to childhood anxiety, fear, and insecurity.  Children learn that violence is an acceptable way of dealing with life (Levy, 2000).

       Poverty, living in an unstable community rife with violence, access to weapons, and graphic depictions of violence on TV and in the movies desensitizes children.  They learn to “express feelings, solve problems, boost self-image, and attain power” through aggression and violence (Levy, 2000). 
       Prenatal drug and alcohol abuse, maternal stress,  birth complications, prematurity, nutritional deprivation, and genetics can lead to inherited personality traits and brain damage that interfere with learning, attention spans, and impulse control.  Compound this with a firmly-established attachment disorder, and a child is likely to be difficult to control, impulsive, hyperactive, defiant, aggressive, indifferent to learning, and angry (Levy, 2000).

       Children who are maltreated are often found in foster care, kinship care, adoptive care, and orphanages (Chaffin, 2006).  This includes children adopted from other countries.  They grow up in unstable environments, without the consistent affection and nurturing required to develop secure attachments (Chaffin, 2006).  They may grow up with suppressed anger that causes them to “seek control, resist authority, engage in power struggles and antisocial behavior” (Chaffin, 2006).  They become self-centered, resist close attachments, and eventually fall into delinquency and criminality (Chaffin, 2006).

       Teenagers still need a “secure base” as they wrestle with independence versus security (Mathew, 1995).  If a teenager has developed a secure attachment to his mother or other primary caregiver, he will weather the storms of adolescence with more resilience and adaptive abilities to cope with stress and change.  A strong, loving family environment teaches teenagers social competence and self-confidence.

       Adolescents who grow up in unstable, inconsistent homes torn apart by conflict and violence develop “psychopathology resulting from the inability to function competently in social situations” (Mathew, 1995).  “Delinquency, addiction, and depression” grow out of “inadequate problem-solving” (Mathew, 1995).  The teenager suffering from attachment disorder is incapable
of interpreting and responding to social cues in appropriate ways (Mathew, 1995).  They view the world as a hostile place, attribute hostile intentions to other people, and respond aggressively.

       Decades of research have found clear links between early childhood abuse and neglect, attachment disorder, and delinquency and violence later in life.  It is not surprising, then, that children under age twelve have committed some of the cruelest crimes or that adolescent males are three times more likely to commit violent crimes than their female counterparts (Levy, 2000).



       Research was conducted online through EBSCO and Google Scholar using the keywords “attachment disorder,” “John Bowlby,” and “attachment disorder and crime.”


       Attachment theory has been around for a long time.  It has been studied and expanded on by others.  A lot of research is available concerning attachment theory, maternal deprivation hypothesis, reactive attachment disorder (RAD), disinhibited social engagement disorder (DSED), secure base distortion, rage theory, disordered attachment, disorganized attachment, disoriented attachment, and insecure attachment.  These are all variations on the same theme — early childhood abuse and neglect lead ultimately to emotional detachment, dysfunction, anger, defiance, and aggression.


       Traditional psychotherapeutic tools are ineffective on children suffering from attachment disorder because these children are unable to trust others and form the therapeutic bond
necessary to engage in treatment (Levy, 2000).  Without early intervention, however, these children are at high risk for risky behaviors, criminality, and incarceration.

       Several treatment modalities have been developed to help children overcome their attachment difficulties.  Most focus on learning how to trust and feel secure.  One of the more controversial, Holding Nurturing Process (HNP), involves forcibly holding the child and maintaining eye contact, which is supposed to promote secure attachment and self-regulation (Chaffin, 2006).  HNP has been associated with the death of several children, however, and criminal charges have been filed against some attachment therapists and parents (Chaffin, 2006).

       The most effective attachment therapies allow the child to gradually build up trust with a committed therapist who then works with the child to re-program patterns of negative thinking and behaving (Levy, 2000).  Therapy is based on the individual needs of the child and involves family, school, and community.  The child learns positive coping skills that help him to function successfully within the family and society.

       Parents and other primary caregivers can undergo Corrective Attachment Therapy in order to enhance their parenting skills and learn specific tools for dealing with a difficult child (Levy, 2000).  Parent and child must go through therapy simultaneously so that they both learn mutual caring and respect; open up to feelings of affection; set up limits, rules, and boundaries; share empathy and compassion; and learn how to be in tune with one another (Levy, 2000).

       If high risk families can be identified early in the process, families can be enrolled in special programs and children can receive the treatment they need to overcome the damage already done.   

Attachment disorders. (2014, January). American Academy of Child & Adolescent

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Chaffin, M., Hanson, R., Saunders, B., Nichols, T., Barnett, D., Zeanah, C., Berliner, L.,

       . . . Miller-Perrin, C. (2006). Report of the apsac task force on attachment therapy, reactive

       attachment disorder, and attachment problems. Child Maltreatment, 11(1), 76-89. doi:


Levy, Terry M. & Orlans, M. (2000). Attachment disorder as an antecedent to violence and

       antisocial patterns in children. In Levy, Terry M., Editor, Handbook of attachment inter-

       ventions (pp. 1-26). San Diego, CA: Academic Press.

Mathew, S., Rutemiller, L., Sheldon-Keller, A., Sheras, P., Canterbury, R. (1995). Attachment  

       and social problem solving in juvenile delinquents (Report No. 143). Washington, D.C.:

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McLeod, S. (2007). Bowlby’s attachment theory. Simply Psychology. Retrieved from

Reebye, P. & Kope, T. (2007). Attachment disorders. BC Medical Journal, 49(4), 189-193.

Siegel, Larry J. (2012). Criminology. Belmont, CA: Wadsworth.
(The references did not all format correctly.)
Dawn Pisturino
Mohave Community College
Criminology 225
November 29, 2016
Copyright 2016-2017 Dawn Pisturino. All Rights Reserved.