'Ethical Theories: Part 1'

CAERS SUBSTACK ARTICLE #66

‘Ethical Theories: Part 1’

CAERS Substack Article #66

As I stated in my last article, robotic automatons do not need ethics—they do as they are programmed. Sadly, many humans have behaved this way in the past and there is a real risk that we are drifting, or even speeding, more in that direction today. This tends to occur when primitive emotions and feelings are being triggered—the quest for pleasure and the avoidance of pain. For eons those in positions of power have known that if they keep people mesmerized with things that entertain them, or scare them enough with the risk of pain, it is easy to get them to ignore the kind of deeper thoughts inherent in critical thinking and ethics, for example.

Each of us has likely noticed that the raw emotions and feelings that arise quickly within us seldom inspire our best behaviour; jealousy and envy are good examples. When we slow down and reflect before speaking and acting, we are more likely to engage in ethically defensible conduct. Although it is true that our logical brain, usually the left side, is involved in developing rational ethical principles, the other side of our brain plays a major role as well. It is likely on that side that we truly understand and appreciate that there is something unique and special about things that are alive, especially fellow humans, and that realization prompts us to develop rules about how we ought to treat one another: ethics. We intuitively know that our duties to animate objects transcend those we have to inanimate objects; harming an animal is intrinsically and radically more disturbing than smashing a rock.

I have alluded to a number of ethical principles in previous articles, such as truth-telling, transparency, open-mindedness, compassion, thinking along a spectrum, etc. As well, I have explored values as being critically important when pondering moral issues. One of the biggest challenges when engaging in ethical reflection arises from the fact that various principles and values often come into conflict with each other and we must resolve these conflicts in order to make the most morally justifiable decisions. To facilitate this, ethical theories have been developed that assist with this adjudication process.

One of the most popular theories today is Principilism, based on four principles which it considers fundamental (known as prima facie): autonomy (literally ‘self-governing’), beneficence (doing good for others), non-maleficence (avoiding doing bad to others) and justice (fairness for all). All ethical theories address the last three to varying degrees, but what distinguishes Principilism is its emphasis on autonomy. This is understandable as its origins relate back to a philosopher, Emmanuel Kant, whose rules, known as categorical imperatives, state that we have a duty to develop rules to treat others that we would agree to have used on us (i.e. they are universal), and that we should never treat others primarily as a means to an end. In other words, each of us has an ethical responsibility to be self-governing: the right to make our own decisions and to be held accountable for them. These form a crucial foundation for Principilism, and modern medical ethics in general, and have arisen in part as a response to the horrors of Nazi Germany when people were experimented upon without their consent.

Not surprisingly, Principilism focuses a lot on rights, and well it should, but it has the potential to downplay the fact that humans are very social and we live in community. The ethical theory referred to as Communitarianism highlights the fact that although rights are important, we must balance one’s individual rights with those of all other individuals within the collective: we cannot have rights without having corresponding obligations to one another. As well, some things we consider to be rights may be better viewed as privileges bestowed on the individual by the collective. The sentiment is that we are defined significantly by our relationships; we don’t live in isolation. We are molded by, and mold, the culture which we inhabit. In general, Western society tends to be more focused on autonomy whereas many Eastern cultures more highly value our place within the community and the responsibilities that accompany that.

It’s not that one theory is necessarily better than the other, but rather that each offers a unique vantage point from which to consider moral problems. Different situations may call us to contemplate using one theory more than the other depending on the contextual details; we are individuals but function within communities. When faced with an ethical conundrum, it can be surprising how many possibilities open up when one is prepared to use a different lens that offers an alternative perspective.

What do you think? Are you more of an autonomy person or more a person of the collective? Or have you found over the years that perhaps you are a bit of both, depending on the circumstances? Do you see them complementing each other?

Although these two theories differ most in terms of the individual versus the collective, there are other dimensions to moral problems that are best captured by other ethical theories, and I will examine those in my next article. In my third and final article in this series, I will explore the relevance of the various ethical theories to the pandemic.

J. Barry Engelhardt MD (retired) MHSc (bioethics)

CAERS Health Intake Facilitator