Table 1 Applied ethics framework

Virtue Ethics

 Aristotle’s “Golden Mean” defines virtue as a moderate intermediate between extreme vices of excess and deficient action. An individual’s repeated actions are habits which constitute one’s character [9]. Virtuous habits made of moderate actions demonstrate human flourishing, excellence, or role model behavior. Vicious habits made of excessive or deficient actions hinder flourishing. Virtuous habits are ethical, and vicious habits are unethical.

Avoid excessive or deficient action

Avoid actions that hinder human flourishing, diminish character

Deontology

 Kantian deontology includes three tests: intentions, universalizability, and respect. Kant describes ethics as obligations (duties) that all rational beings could discover through reason [10]. Kant focuses on the intentions that give reason to performing the action. Good intentions produce ethical actions, while bad intentions lead to unethical actions. Kantian ethics is absolute and applies to everyone equally; therefore, an action is ethical if it can be universally obligated and unethical if it would be self-defeating to obligate the action. Autonomy plays an important role since it allows the expression of reason and is the source of human dignity. Respect is then defined as honoring the autonomy of others by refusing to use them involuntarily for one’s own benefit without consent. Actions that show others respect are ethical, while disrespectful actions are unethical.

Avoid self-defeating actions

Do not use people involuntarily for one’s own gain

Consequentialism

 Consequence-based ethics, such as utilitarianism, employ a maximizing rule to seek “the greatest good for the greatest number” of people or “the most good for the most people,” called the “Greatest Happiness Principle” [11, 12]. Consequentialists typically conduct a “calculus” weighing positive and negative consequences for all stakeholders, similar to a cost-benefit analysis. They often treat the action with the highest “net good” (the total of the positive consequences reduced by the number of negatives) as the only ethical option, while other options are treated as unethical.

Avoid actions which produce more harms than benefits

Lakota Sioux

 Representing one of many Sioux tribes, Lakota ethics reflect traditional values of bravery, generosity, fortitude, and wisdom and perpetuating cycles, described as “the hoop” and “circles” of life. “Virtuous circles explicate increasingly positive human behavior in social systems, whereas vicious circles explain pathological negative spirals,” such as poverty, depression, alcoholism, violence, or greed [13,14,15,16].

Act with bravery, generosity, fortitude, and wisdom

Act mindful that actions perpetuate increasing positivity or pathological negativity

Respect all as relatives, respect the land

Navajo

 The Navajo people have terms for good (hózhó) and evil (hóchó). While Navajos are generally taught that “you can do what you want” and typically describes ethics as “relative to situation and to consequences rather than absolute,” they still condemn “actions which would make life in general impossible,” including rape, theft, molestation, jealous arguments, wishing ill of others, ridicule, adultery, killing, and lying. Navajos oppose “monsters” akin to vices, such as “selfishness, greediness, envy, hate, and jealousy.” Navajos see using someone else involuntarily for one’s own gain as a form of witchcraft, requiring restitution (nalyeeh) or punishable by death [17, 18].

Do not steal, argue jealously, wish ill, ridicule, commit adultery, kill, or lie

Honor duties to one’s kin group

Seek restitution

Respect all as relatives, respect the land