Societal paradigm and “ethics talk”…
We form society through evolving and buying into a “shared story” – the collection of principles, values, attitudes, beliefs, myths, and commitments that form the societal paradigm on which the society is based. This story has always included a focus on the major life events of birth and death. In short, we search for meaning in life, for a world view, and to structure both our rational and non-rational knowing in a coherent framework, through focusing on human beginnings and endings. Indeed, much ritual, celebration and mourning, and the sense of community that we use these to create, has human beginnings and endings as a pivotal motif.
In the past, we wove the metaphysical tissue with which we surrounded the events of birth and death, and incorporated this into our shared story, mainly through religion. In post-modern, secular, multicultural, pluralist societies, such as Canada, as is clear from the definitional description of these societies, religion can no longer be used in this way, at least not as a sole mechanism. It merits keeping in mind, however, that for many people religion remains a very important lens on life and the values and meaning that we attribute to and find in it. In some respects, “ethics talk” has replaced this function of institutionalised religion and become a foundational discussion through which we are evolving the “shared story” we need to form community and society.
Contemporary “ethics talk” in relation to birth and death often focuses on the possibilities that our extraordinary scientific and medical developments have opened up in relation to these events – in vitro fertilisation and other new reproductive technologies, human cloning, genetic manipulation, for example, to create disease-proofed children, the allocation of very expensive life prolonging treatments, terminally ill peoples’ access to research treatments, xenotransplantation (the transplantation of animal organs to humans) or euthanasia. In Canada, our debates on access to healthcare and powerful defences of Medicare are often characterized as important forums for establishing and affirming our national identity.
Other ways of knowing ...
Probably because, in Western democracies, much of the societal level “ethics talk” centres around scientific developments that relate to birth and death, it often purports to be based only on reason. In reality, however, other human ways of knowing are at least as important to this talk and their use cannot be excluded. A major challenge in doing ethics, is to accommodate these other ways of knowing in a structure that fully integrates both them and reason. Other ways of knowing include “examined emotions”; intuition - especially moral intuition; human memory (to use John Ralston Saul’s term for history); and imagination and creativity.
Both as individuals and as a society, we presently have an extreme need for a sense of control. I cannot speculate, here, on the myriad forces and trends that have resulted in this. Somewhat paradoxically, they range from globalisation to the emergence of intense individualism – a focus on individual rights to the exclusion or the loss of any sense of the common good and of the need to maintain and protect the latter. This need for control does, however, have important impact on the nature and content of our “ethics talk”. It means, for instance, that there can be strong opposition to incorporating into this, at least overtly, input from other ways of knowing. One reason is that these other ways are much less hard-edged than reason and, by comparison, can seem difficult to verify, classify, and quantify. As a result, they do not give one a sense that one fully understands a situation perceived through the lens of these other ways of knowing. Indeed, they are likely to do the opposite. Therefore, they can intensify the feeling that one is not in control of the situation.
The “do something” syndrome – when something seems to be or is wrong or threatens us, we can feel better if we act to do something (to feel we are taking control) than if we do nothing – is much more difficult to implement in response to what we learn through these other ways of knowing, than as a response to hard data. This is particularly relevant to politicians, whose electorates often call on them to “do something” in response to threats to their safety, well-being or way of life, that they feel powerless to control. Consequently, it is not surprising that politicians rely largely on statistical, apparently hard-edged data that they hope are correct and not open to challenge. Although the data may not be correct and a response based only on (even correct) statistics, may not be ethical, this is safer politically than relying on claims that are not “evidence based” - as can be true of responses founded on other ways of knowing - or, simply admitting to uncertainty – which seems to be a political “mortal sin”. Some very interesting research carried out in British Columbia by Dr. Rosemary Ommer of Memorial University, Newfoundland, and her colleagues, is a good example of the need to heed knowledge, the source of which is beyond statistics. They found that the traditional knowledge of fishermen is more accurate as a basis for assessing what is happening to fish stocks and, therefore, saving these from possible extinction, than are some elaborate statistical studies carried out by scientists.
In short, relying solely on reason to the exclusion of other ways of knowing, is not just of concern at the theoretical level, it can result in harmful outcomes in practice. For example, such an approach can mean that we focus on quantitative (measurable) features of a situation and ignore qualitative ones. The latter can be crucial in an adequate assessment, for instance, of health care and decision-making about this. We can measure the efficiency of health care professionals, but we cannot measure their sense of caring in any quantitative way. Caring is a qualitative feature and, if it can be adequately assessed at all, it can only be assessed as such. Caring is at least as important to most patients – and indeed to the health care system as a whole, especially its “ethical tone” – as efficiency. We are currently in danger of making decisions that will damage or eliminate features, such as caring, if, as seems to be happening, a purely quantitative approach is taken in assessing health care. I should be clear here: quantitative assessment of quantifiable elements of a system is necessary. But it is not a sufficient basis on which to make sound ethical decisions concerning a health care system.
Levels of ethical decision-making …
We sometimes distinguish different levels of decision-making: micro or individual (e.g. a physician and patient); meso or institutional (e.g. a hospital administration or board); macro or societal or governmental (e.g. ministries of health); and mega or global. The ethics governing a particular decision, can differ at different levels. For instance, it would be unethical for an individual physician faced with an individual patient to give priority to the efficient use of health care resources, at the patient’s expense. In contrast, it could be unethical for a ministry of health not to give priority to efficiency in order to save health care resources.
Elements of a health care system, such as caring, may not be seen as relevant above the micro or individual level – although this view is often in error – and, therefore, the necessity to protect and promote these is not taken into account at those other levels of decision-making in the health care system. This can be unethical.
Involving the public ...
One of the basic principles of applied ethics is that “doing ethics” requires shared decision-making among all the people who ought to be involved. On many occasions, the public must be one of the participants in the decision-making. It is difficult, however, to define what constitutes sufficient public involvement from an ethical perspective, and how this can be achieved.
One experiment tried in Alberta and Sydney, Australia, was to set up a citizens’ forum, the members of which were randomly chosen from the general population employing the same approach as that taken to calling up a jury for a trial. Expert witnesses were called to give evidence before these forums, which were both on the controversial topic of the labelling that should be required on food that has been subject to genetic alteration. The citizens’ forums in both countries reached a consensus conclusion that genetically altered foods must be clearly labelled as such.
But what if such a consensus could not be reached, what decision should be taken regarding the labelling of such foods? What if a majority decides that labelling is not needed, how should we handle the reality that one cannot “do ethics” simply by majority vote? Who should have the burden of proof of the reasonable safety or ethical acceptability of marketing genetically altered foods?
Basic presumptions ...
This is to raise the issue of the choice of a basic presumption on which to base the ethical analysis of a given situation. Many people do not recognise the major impact that this choice can have on a decision. For instance, we can compare a basic presumption that genetically altered food may be marketed until there is evidence that it is unsafe (this is a yes…but presumption – yes, it can be marketed, but not if it is shown to be unsafe), with a no…unless presumption (genetically altered food may not be marketed, unless it is shown to be reasonably safe). People wanting to market such food are favoured by the former presumption, those opposing it by the latter one.
This is the case because in situations of equal doubt as to safety, the stance of the person whom the basic presumption favours will prevail. The person relying on an exception, must prove that, in all the circumstances, the exception should apply. This may not be easy to do, especially in relation to the rapidly evolving, unprecedented breakthroughs we are seeing in science, especially in the area of molecular biology and genetics.
"Doing ethics" in practice ...
There are two stages at which people without training in ethics, who are involved in “doing ethics”, can need assistance.
First, they can need assistance to recognise that an ethical issue is present. Sometimes, people simply fail to realise that a situation raises ethical difficulties, or, other times, by mistake, they identify the ethical issues that are present as public relations or communication problems.
Second, when people do recognise that they are facing an ethical issue, they need to know enough about ethics to be able to determine whether or not they have the necessary competence to handle the issue, or need assistance in doing this. This, of course, raises the question of where they can find such assistance. One possibility is to consult an ethicist, another is to consult an ethics text.
Professional ethicist ...
Who is an ethicist and how an ethicist should function are still topics of serious debate almost thirty years after the emergence of a group of professionals referred to collectively as ethicists. These debates are not academic, but have major impact in practice. One school of thought is that a variety of professionals – physicians, lawyers, philosophers, psychiatrists, certain social scientists, people with training in religious studies or theology – can, with appropriate training and experience, become ethicists. The other view is that this should be the domain of philosophers – who, some rudely point out, have at last found something useful to do, professionally.
The former school of thought is often more open to a transdisciplinary approach to doing ethics, than the latter. It recognises that transdisciplinarity does not just occur automatically by mixing together people from different disciplines and that the knowledge base that needs to be used in addressing ethical issues, is presently divided on disciplinary lines. Consequently, efforts have been made to develop integrative methodologies that can be used to create the required knowledge base. It is intended that these methodologies will allow people with different disciplinary training and expertise to structure the tension between them (often, tellingly, referred to as “turf wars”) in such a way that new insights, which would otherwise be unavailable, will emerge. (This topic is explored in M.A. Somerville and D.J. Rapport (eds.) Transdisciplinarity: Re-Creating Integrated Knowledge, EOLSS Publishers, Oxford U.K. 1999).
Schools of ethics ...
As well as disagreement on who should do ethics professionally, and the methodologies that should be used, there is also disagreement on the basis on which this should be done. The intellectual approaches used by different ethicists are sometimes roughly divided into different “schools of ethics”. These include:
-
In a moral relativist approach, personal preferences play a central role and there are no absolute rules, rather what is ethical must be determined by balancing the claims, rights, and responsibilities of all persons involved in the situation—that is, what is ethical in a given situation is always
-
Utilitarian ethics focuses on seeking the greatest good for the greatest number of persons.Consequentialist ethics, a variation utilitarian ethics, gives priority to attaining certain other consequences that are selected on the basis that they are ethically preferable outcomes and, in being such, justify the harms that realising them involves.
-
Feminist ethics focuses on the preservation of individuals’ relationships, rather than on the individuals as such - this school places heavy emphasis on an, which can translate into a greater emphasis on responsibilities than on rights.
-
And in virtues ethics or character ethics, we find an ethical response by allowing persons of virtue to make the decisions that must be made - we rely on right-thinking, right-feeling, morally sensitive decision makers.
If everyone agrees on what is ethically required in a given situation, there are no ethical conflicts. Such agreement occurs much more frequently than one might expect, given the diversity of the schools of ethics and of the belief systems and methodologies of their adherents. When there is ethical conflict this must be resolved or a compromise reached (care needs to be taken that a compromise does not end up being unethical by the standards of everyone involved), or values must be prioritized, in which case those lower on the list will not be respected. This can give rise to a situation that Professor Nuala Kenny calls ethical distress: a person involved in a situation firmly believes that there is a breach of ethics occurring, but does not have the authority to stop this. For instance, a junior nurse observes certain conduct towards a patient in a hospital that she regards as unethical but she has no power to intervene.
The role of ethicists ...
No matter which school of ethics one follows, most people agree that ethicists must be able to identify the ethical issues that are raised by any given situation, and structure and articulate the alternative analyses that could be applied. Sometimes, when asked and with great care, they may give their own personal value judgement as to which course of action is preferable in any given set of circumstances. In short, the fundamental role of ethicists is to help others to make ethical decisions, not to make those decisions themselves.
Some people confuse acting in good conscience with “doing ethics”. While personal good conscience is necessary for acting ethically, it is not sufficient. There is also confusion of so-called “codes of ethics” which are really codes of professional etiquette - for instance, between physicians or between lawyers - or which define unprofessional conduct, with codes of ethics properly so-called. Just because certain conduct does not breach professional norms, does not necessarily mean that it is ethical. Examples of this can be seen in the context of industrial action, such as strikes, taken by health care professionals. It may not be unprofessional conduct for physicians to go on strike (although it can be), but it may be unethical to do so, at least in certain circumstances.
Doing ethics” especially by an ethicist, requires one to undertake an informed structured analysis that will assist in the identification and prioritisation of the full range of values relevant to, or affected by, the various decision options that are open in any given situation. It is inevitable that one’s own values come into play, but they should be identified as such and the other people involved advised of this. I sometimes imagine that “doing ethics” can be compared with opening a beautiful, intricately painted fan. The struts are the different schools of ethics, or the fundamental bases of the alternative analyses that could be used. The fabric that joins the struts may display one or several scenes. When we all agree on the outcome, although we do so for different reasons, we are choosing a different location in the one scene. When we disagree on the outcome, we are identifying several scenes and arguing that one scene is fundamental and should take priority in setting the overall tone or interpretation of the painting that the artist has portrayed on the fan, and that the other scenes must be interpreted in light of this.
Ethics literature ...
Rather than turning to an ethicist – which some may be reluctant to do having read this essay - the other possibility for “doing ethics” is to turn to ethics literature. There is a wealth of literature dealing with ethics in a wide variety of situations. But most of this is not directed at the general public. Moreover, while there are books on ethics for physicians, nurses and social workers, there are few, if any, for policy makers, bureaucrats, teachers or simply citizens. As well, even within a context such as medicine or health care, many texts are focused on a particular area, often a highly specialised and narrow one, in which we need to “do ethics”. Many of these areas involve avant-garde scientific developments that may or may not, depending on one’s views and values require avant-garde ethics. Examples include human cloning, animal-human hybrids, designer children, enhancing human intelligence, etc. In the medical context, one also finds texts on what can be called “everyday ethics” – for instance, the ethics of nursing care or of social workers in dealing with delinquent children. But what books on ethics are there for the general reader?
In fact, the origin of this essay was a request by the Literary Review of Canada to review a book on ethics in the light of whether it might be suitable for the general public. It was not. After a lengthy, somewhat difficult to read, introduction to various ways of “doing ethics” (it described some of the “schools of ethics”) the text consisted of medical cases accompanied by an articulation of the range of questions these raised. Very few answers to these questions were included – obviously intentionally. Interesting stuff for a medical class with an ethics professor to help sort out a range of possible responses, but not helpful or enlightening to a general reader.
One of the problems with using ethics literature to help members of the public to “do ethics” is just this, the difficulty of writing or finding a suitable text. We would need to produce ethics texts that are sufficiently sophisticated and nuanced, yet understandable and comprehensive. They must avoid inappropriate or misleading, formulaic approaches which are sometimes proposed as a simple solution for eliciting a response which will be properly informed by ethics. Ideally such texts would also encompass different value systems and religions and would deal with these openly and fairly. Not an easy task, which probably explains why it is not easy to identify such texts. And yet to leave the impression that this is impossible would be nihilistic, defeatist and irresponsible on my part.
Conclusion ...
We all need to learn how to do ethics, even if we do not always succeed in doing this. As I hope this essay conveys, “doing ethics” is not a simple task; it is a process not an event; and, in many ways, no matter in which capacity or context we do ethics, it is a life long learning experience. I believe that it is not an accident that “ethics talk” has emerged as a dominant form of societal level conversation at this time of both globalisation, with the diversity this opens up, and the biotechnology and information technology revolutions of which we are in the midst. If, as some commentators believe, we are, moving from an age of materialism to one of post-materialism in terms of our values, we need a new bottom line, whether we describe this, for example, in the context of commercial activity, as “new capitalism”, “the third way”, or “post-capitalism”. In a globalized world such new bottom lines will require us to search for a “shared ethics” – which is an ongoing process – and will consist of a complex integration of the old bottom line of profit, with protection of the environment, concern for maintaining a sense of community and social cohesion, greater sensitivity to justice issues, and ethics. It might even be that this fivefold combination will prove to be a “fifth way” - or even a fifth dimension of the human spirit.
|
button (top left)