Before we start: a Brief Primer on Ethics
Ethical issues, or challenges – or puzzles arise in all areas of our professional and personal lives. The purpose of this blog which will run irregularly is to explore some of those challenges as they crop up in our work lives. The plan is to take situations – stories and then explore the ethical dimensions of those stories. Sometimes there will be an obvious “right” answer, but far more often the situation will embody more than one competing value. Then we are faced with making a choice, we need to come to an ethical decision. Those decisions are often contested, after all if the answer were obvious the situation would probably not have presented itself as a dilemma, but, even though the decision is contested not every answer is as good as any other – ethical decision-making is not simply a matter of personal preference. What we are looking for are the best possible decisions – made for the best possible reasons, in the circumstances in which we find ourselves. So let’s begin
Definitions
Ethics -- from the Greek ethos, originally of character -- concerns questions of good, right, duty, obligation, virtue
Morality, from the Latin mores, custom or habit, is Cicero’s transliteration of the earlier Greek, ethos.
Some people tend to use “moral” of personal conduct, and “ethical” of professional or institutional standards.
So ethics is concerned with questions of good and right, -- but alone that does not tell us very much. It is goodness and rightness of a particular type -- moral (ethical) goodness and rightness.
Every attempt to define ethics is controversial and contested, the definition and scope of ethics depends on the moral theory one is using at the time. That should not be cause for despair, but rather should prompt a recognition that discussions of ethics will always be challenging and should be conducted in such a way that we recognize the potential for disagreement but share the commitment to solutions.
There are however, some general points of agreement in the way we talk about and reason in ethics.
First, our moral decisions, judgments and reasoning should be consistent. That is, a moral judgment, statement, or obligation applies impartially to any relevantly similar person in any relevantly similar situation
Second, our moral judgments or conclusions are motivating -- a moral judgment, statement, or obligation provides a motivation for acting
Third, and this is one of the most significant features of ethical deliberation and judgment, ethical reasons are compelling. A moral judgment, statement or obligation supercedes other reasons for acting
If that is a word about the form or structure of ethics, what about the content? Ethical issues can arise in any aspect of our personal our professional lives. In our personal lives ethical issues or questions can arise in our dealings with other people (many of our ethical principles concern how we should treat others.) Many people also argue that our ethical commitments extend to our treatment of other animals too. In our professional lives ethical issues can arise in any aspect of health-care from the bedside to the boardroom.
Ethical principles and values
Our ethical reasons often get presented in the form of principles or values. A simple ethical principle would be “Do not lie,” and a corresponding value would be “honesty,” or truth-telling. Our ethical challenges often arise when we worry about the applicability of a principle in a particular situation. Yes, we accept the principle “Do not lie,” but what if lying was the only way to save an innocent person’s life? What happens if the principle “do not lie” comes into conflict with the principle “save a life where possible?”
This is the realm of ethical debate and discussion. What do we do, how do we choose, when our ethical principles or values come into conflict?
Ethical issues in health-care
Some ethical issues in health care are obvious. We all accept that there are important ethical decisions to be made about end-of-life care, resuscitation and so on. But the issues in patient care are far broader. For example, the very requirement that we gain “informed consent” before embarking on a course of treatment is an ethical requirement grounded in the principle that we should respect people’s personal autonomy, and not do things to them without their permission. But what are the limits of consent – and as important, what are the limits on a patient’s refusal to accept treatment?
The very process of priority setting in health-care, is a process of allocating scarce resources to one area rather than another. Given that there is always more that can be done in health-care, and given that resources are always limited. , any decision to do one thing entails a corresponding decision not to do something else. How do we decide that we value this service, for these patients, over that service for these other patients?
The Role of Reason
A couple of things should now be clear. Ethical issues, questions, choices, arise in any aspect of our personal or professional lives, and when they arise we are a faced with a choice. That process of choice-making is a reasoned process, where we seek to do the best that we can. In health-care we typically make these difficult decisions as professionals and members of teams, who have a commitment to the patients, clients and the communities we serve.
Any list of principles that may be applicable in reasoning about an issue in health care will necessarily be incomplete. You might remember the famous “four principles of bioethics” autonomy, beneficence, non-maleficence and justice, popularized by Beachamp and Childress, but that is just a starting point. Recognize first, that you may well express the same idea using completely different words, and that’s OK; and second you may well bring in other and relevant considerations – and that’s not just OK, it’s essential.
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