Objectives:
At the end of this lesson you should understand
- what ethics is
- when ethical questions can arise and
- how to recognize ethical questions
embedded in ordinary experience.
Definition
Ethics is the branch of philosophy that is concerned with right
behavior.
Ethics is different from the study of cultural mores because
in ethics we examine the mores of our culture to judge if they are
ethically right.
Ethics is a
normative study
and ethics uses
value
judgements.
Here is a more philosophical way of talking about ethics:
Ethical questions arise when we are making decisions in
contingent situations.
Of course we need to
understand the meaning of contingency if this statement is
to make any sense. It is worth
learning abut contingency since it is a term that
is appropriate to many situations.
See if you can follow this explanation.
There are three related philosophical concepts:
- possiblility - anything that can happen
Example: Is is possible to
transpant kidneys, to revive some hearts that have stopped beating,
to amputate a gangerous foot.
- necessity - anything that can not, NOT happen; anthing that must happen.
It is necessary that a person's blood
get purified naturally or artificially if the person is to live.
Someone who has intercranial pressure exceeding that of their
systolic blood pressure will necessarily suffer
brain damage.
- contingency - anything that is possible but is
not
necessary. Actually tranplanting a kidney, reviving a stopped
heart or amputating a gangerous foot
is contingent. It can be done or
not done. It is possible but it is not necessary. The decision to transplant or not
transplant is an decision about a contingency. The decision is a
medical decision but it is also an ethical decision because
transplantation is a contingent
matter.
Reflect: When you decided to read this
lesson, was that a contingent decision? [Was reading the lesson
something that you could do or not do?]
If it were a contingent decision, there
would be some ethical aspects to that decision. You may or may not have been aware of them but
they were there nevertheless. Example. You may have decided to
do the lesson out of a sense of duty or because you feared the consequences of NOT doing it.
You may have decided to do the lesson now, rather than earlier, because earlier you had other
more important duties to meet. Duties, consequences and values are the
substance of ethical reflection - as Lesson 5 will demonstrate.
Let us go a little further in our examination of contingency since it is so
important in ethics.
- What is possible is a question of the state of
technology.
Examples: Is it possible to intubate this person?
Is it possible for a fetus of 20 weeks to survive outside the womb?
- What is necessary is the subject of laws of the nature.
Examples: If I add a flame to oxygen, it will of necessity burn.
If a fetus is ejected in the second week of pregnancy it will not survive and develop to term.
- Contingency raises human choices; things that can be done but are
not necessities [in the philosophical sense]. Examples: Should we
restart every heart that can be
restarted? Should we restrain a patient who wanders around the facility and
frightens others?
Ethics only arises in situations of contingency.
All ethical questions are in the realm of the contingent.
Special note: Sometimes after experiencing a situation that is NOT contingent, a person may
feel guilt. This is psycholgical guilt and should not be confused with moral guilt. Example.
A parent hears a smoke alarm and immediately rushes to rescue his or her child from the
child's bedroom. But when s/he gets there, the child's room is engulfed in flames already
and the parent can not enter. Afterwards, that parent may
feel guilt but that guilt is a psychological reaction. It is not moral/ethical guilt.
The parent is not guilty of moral wrong since rescue was not possible
The situation was not contigent. It was not an ethical situation.
- If somethign is not possible, there can be no ethical obligation to do it.
- If something is a necessity, there can be no ethical
obligations involved.
- Ethical questions arise in contingent situations -
when we can do things. Ethics says that we need to ask if we
should do them.
Developing ethical awareness
Developing ethical awareness is something that every student of
ethics needs to practice. It is often difficult for professinals to
recognize ethical aspects of ordinary decisions because of habit.
If one works in a facility and
"everyone does it this way " or "this is the way we have always done those
things" it can be difficult to question whether that way of
doing things is right. It can be difficult to even think of
questioning whether it should or should not be done at all.
But, history demonstrates that it is important to develop
ethical awareness. There are many times in the past when persons in the medical profession
did things that most of us now think were wrong. Often these things were done without any
question. Doctors or nurses just went along with the mores of the society.
It was "just the way it was done in society" and because they had not studied medical ethics or developed
their ethical awareness, they never questioned whether their actions were right or wrong.
The whole purpose of studying
medical ethics is to become very aware of ethical questions.
If we are not aware, if we do not question, who will? No one else will
---- and history may find us "morally inept".
Practice