'Ethical Theories: Part 2'
CAERS SUBSTACK ARTICLE #67
‘Ethical Theories: Part 2’
CAERS Substack Article #67
To engage in honest ethical reflection requires the self-discipline to assess moral problems from many perspectives, including ones with which we are not familiar or even ones that makes us feel uncomfortable. This means that there is an inherent tension when engaging in ethics: we are often compelled to weigh opposing viewpoints in order to arrive at the most morally justifiable decision.
In my last article I explored the individual versus communal approaches (Principilism and Communitarianism, respectively). There is a certain tension between the two, trying to balance the needs of the one with the needs of the many. Feminist Ethics or Ethics of Care emphasizes something different again. In Western culture we are often very driven by results; we are ‘goal- oriented’. There is nothing wrong with that per se, but it is incomplete. Ethics of Care focuses as much on the journey as it does on the destination, so to speak. It values, of course, good results, but it cares very deeply as well with how we get those results. For example, although it supports the need for full disclosure as part of informed consent, it warns against punitive disclosure whereby we can produce harm when we are insensitive about how we communicate information, especially unpleasant news, to individuals. It also acknowledges that although the patient must ultimately process information and make their own decisions, they often do so within the context of their most cherished, and caring, relationships.
In this regard, Ethics of Care overlaps with Communitarianism to some degree. They both recognize our social nature as expressed in the African concept of ‘Ubuntu’: ‘I am because we are’. In addition, Ethics of Care looks beyond purely quantitative issues, for example how long we live, and looks at the quality of that life; palliative care not just intensive care. They emphasize that the practice of medicine is not a purely scientific endeavour; we are, after all, engaging with living, sentient human beings, not robotic automatons. Compassion is a necessary component of our care, and can radically affect treatment in very positive ways.
Similarly, Virtue Ethics advocates going beyond the minimal level of expected behaviour, as evidenced in law for example, by encouraging us to behave virtuously. We ought not reflexively engage in certain conduct just because we have the right to do so; we should first reflect upon whether it is the best that we can do. Although concerned with outcomes, it emphasizes the value in nurturing such qualities as compassion, discernment, trustworthiness, integrity and conscientiousness. It reminds us that we have advanced as a species because we have gone beyond minimal obligations and engaged in altruistic behaviours. There is ample evidence that individuals who have done so, Martin Luther King Jr. comes immediately to mind, are the ones who we most admire because they have led us out of darkness towards the light with courage, dignity and self-sacrifice.
The final ethical theory I will mention is the one with which we are perhaps most familiar, although we may not realize it: Consequentialism or Utilitarianism. It is likely self-evident that actions produce results, and we engage in specific activities to get specific outcomes. We choose certain actions because we desire the consequences such actions produce; we see the utility in engaging that way. This makes a lot of intuitive sense, and so we use such an ethic in everyday life quite extensively. The downside, however, is that it can lead us into caring so much about the ‘ends’, that we can ignore the ethical nature of the ‘means’ we use to obtain those ends, especially if we consider the ends to be noble in themselves. It’s one thing to use an inanimate object to obtain one’s goals; it is quite another to use a living creature as a means to obtain one’s ends without considering their rights as well. Sadly, throughout history this theory, despite its usefulness, has perhaps been abused more than any other, and has therefore been responsible for more suffering than we might want to acknowledge.
There are other ethical theories to consider, but the point of this article and the last has been to explore the fact that there are many aspects and perspectives to consider when engaging in moral reflection. I would encourage anyone who wants to improve their moral reasoning to do more research.
Were you aware that so many ethical theories existed? Have you seen evidence of them being utilized during the pandemic to develop and justify the various measures that have been implemented? If not, do you think it might have been helpful if the authorities had done so in a more transparent fashion?
My next article will offer a brief analysis of the pandemic from the various perspectives of these different theories.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator