CAERS SUBSTACK ARTICLE #29
CAERS SUBSTACK ARTICLE #29
There is an old joke in which someone confuses ethicists with aestheticians, anaesthetists and exorcists. The ethicist explains that although ethics can be beautiful in its own way, it is not the same beauty for which aestheticians strive. Equally, although some may find ethics to be sleep- inducing, it is not the same unconsciousness provided by an anaesthetist. As for exorcists? Well, let’s hope the difference needs no explanation.
But it is fair to ask, who are ethicists and what exactly do they do? Are they the mountaintop yogis to whom we turn for ultimate wisdom in matters of morality? Are they noticeably more ethical than other mere mortals? Perhaps, but many great coaches cannot play a sport as well as those they coach, even though they understand the sport very well at an intellectual level.
In 2004, when I had been in practice nearly twenty years, I entered a master’s degree program in bioethics. This may sound odd, but I realized that although I had a broad experience in family practice, from obstetrics to palliative care and everything in between, I really didn’t understand the deeper nature of my job as a family doctor. Even though I considered myself reasonably ethical, I had a sneaking suspicion that something was missing. Immediately upon starting my studies, I realized that my doubts were well-founded.
I don’t know whether I am considered an ‘ethicist’ or not, but I do know that I have studied and taught ethics and I have tried diligently to apply ethics in every patient interaction. If I am deemed by some to be an ethicist, I am more of a practising ethicist than an academic one, more along the line of the Greek ‘techne’ (practical knowledge, like a mechanic) than ‘episteme’ (academic knowledge, like an engineering professor).
It can be tempting to think of ethicists as experts who are only called upon to solve esoteric moral problems too complex for the public to understand. However, all medical decisions have an ethical dimension because they go beyond just what can be done to ask the question ‘what should be done?’. Which means that the overwhelming majority of medical ethical situations are rather ordinary, even mundane, but it is in these common situations that we can easily get tripped up, ethically speaking.
When I practised medicine, I did not feel that my goal was to tell patients what medical decisions to make, but rather to offer my medical knowledge, experience and unique perspective to assist patients in making their own decisions in the context of their own values. Similarly, the ethicist in me may know more about ethical principles and theories than the general public, but my goal is to share that knowledge, experience and perspective with them so that they can make ethical decisions as well as I can, or even better. Which means that perhaps the greatest role of an ethicist is to encourage everyone to engage as deeply and wisely in moral reflection as possible and to nurture that ability constantly. I do not need to promote myself as a lone and brave white knight who seeks truth, because ethics should not be a domain exclusive to one group of privileged experts.
Equally, rather than allowing themselves to be seen as the repositories of ‘truth’, ethicists can help us realize that the ‘truth’ is much harder to find than we often realize. In other words, the starting point in finding truth is to begin with honesty, truthfulness and being true to oneself, important ethical principles. That in turn can lead to a humility that minimizes the self- righteousness that can so easily get us into trouble. Sharing our understanding of reality at any given moment in respectful and open-minded dialogue with others is the best way of getting closer to the ‘truth’.
Avoiding binary reacting, controlling our passion, and thinking more critically are skills that we can all nurture, and ethicists can help with that. You likely heard a lot about medical science during the pandemic, and saw many examples of binary reacting and uncontrolled emotion. Did you hear much about medical ethics? Might it have helped if you had? And would it be beneficial to focus more on ethics for the rest of this pandemic and the next ones we will undoubtedly face?
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
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