There is considerable difference of opinion and even confusion about what ethics is. Sometimes, the term “ethics” is used to refer to the conduct of a person or a group, as when it is said “His ethics are questionable”.
Sometimes, it is used to refer to the moral status of some enterprise, as, for example, “The ethics of experimentation on demented patients is a matter of dispute”.
In what follows, ethics will be used in yet a different way as a convenient shorthand for a more precise label, “normative ethics”, which refers to a type of practical activity through which we try to determine what we ought to do and how our institutions should function.
It is important to distinguish normative ethics understood in this way from other activities that are also sometimes called ethics.
Descriptive ethics is an activity carried on by sociologists, psychologists, and anthropologists.
These social scientists describe and attempt to explain what persons who are members of various groups believe to be right or wrong, just or unjust, ethical or unethical.
Descriptive ethics is not concerned with assessing the ethical beliefs it describes and explains. In other words, the descriptive ethicist as such does not attempt to determine whether the ethical beliefs he studies are correct or incorrect, justified or unjustified, or even consistent with one another.
In contrast, normative ethics is concerned with trying to determine what we ought to do, not simply with what a particular group thinks we ought to do.
Metaethics differs both from normative ethics and from descriptive ethics.
Metaethics as an activity of enquiry is concerned primarily with three sorts of questions:
(a) What are the meanings of key ethical terms (such as “ought” and “right”), and how do these terms function in ethical discourse?
(b) What makes something an ethical judgment (as opposed, for instance, to a judgment of aesthetics or of etiquette)?
(c) Are ethical judgments or beliefs true or false, or at least can they be justified or unjustified, or are they merely expressions of emotion or imperatives, which, like the exclamation “Hooray!” or the imperative “Shut the door!”, are not even the kinds of things that are true or false or that can be justified or unjustified? Metaethics, unlike normative ethics, is a rather abstract activity of logical analysis that is not itself action-oriented.
NORMATIVE ETHICS AS A RATIONAL PRACTICAL ACTIVITY
This website proceeds on the assumption that normative ethics, or for convenience simply ethics, is a rational practical activity.
In other words, in presenting commentaries that provide reasons for evaluating particular decisions as being ethically correct or incorrect, ethically justified or unjustified, or at least better or worse from the standpoint of ethics, we are taking a stand on some of the most basic metaethical questions.
Sometimes, people challenge this assumption by asserting the view known as ethical relativism.
According to ethical relativism, it makes no more sense to argue about what is the morally correct thing to do than it does to argue about whether chocolate or vanilla ice cream is best.
If one person prefers chocolate and another prefers vanilla, neither is correct and neither is mistaken; similarly if one person says that a certain action is wrong and another says it is right, neither is mistaken.
According to ethical relativism, there is simply no way of rationally adjudicating ethical disagreements. At most, a given ethical judgment is “true for” one group or society or individual but not for another.
Though at one time or another many people may say that they believe ethical relativism to be true, it is not clear that they really do believe it. In an ethics class or on other occasions when a person is struck by the urge to philosophize, he or she may say “It’s all subjective” or “It’s all relative.” Yet this testimony is usually directly at odds with the person’s attitude and conduct.
For example, the same student who claims to be an ethical relativist would be quick to protest that the instructor was treating students unfairly or doing an injustice if the instructor were to give “A’s” only to those who denied ethical relativism or only to those whom the instructor found attractive.
Even those who claim to be ethical relativists tend not only to make ethical judgments in everyday life but also to support them with what they take to be good reasons.
For example, the student may say that it is unfair to assign grades on anything other than the basis of academic performance and that attractiveness to the instructor is not the appropriate criterion of dessert.
Similarly, our alleged ethical relativism does not prevent most of us from asserting confidently that the Nazis violated the rights of the Jews they exterminated, nor does it prevent us from stating that it is a violation of a person’s rights to use him as a mere instrument.
In spite of what people may say, when the speculative mood overcomes them, they do make ethical judgments and do give reasons for these judgments. Further, they typically evaluate reasons as being more or less weighty or compelling.
GROUNDS FOR ETHICAL RELATIVISM
What might lead people to claim that they believe ethical relativism to be true even while acting as if it were not true? Any or all of several factors may be at work.
First, they may be assuming that whenever people disagree about what is the ethical thing to do, there is a fundamental disagreement in ethical beliefs.
Disagreement about what is the ethical thing to do, however, need not imply any disagreement in ethical beliefs, much less an irreconcilable disagreement about fundamental ethical beliefs.
Instead, two people may be in total agreement in their distinctively ethical beliefs but simply differ in their beliefs about the facts. An example will illustrate this simple but important point.
Suppose that an anthropologist visits a tribe in a remote region of the Amazon basin. He observes and he learns the rudiments of their language. He then notices that they have a shocking custom.
When a member of the tribe shows signs of old age (gray hair, loss of teeth, and so on) — say when he gets to be about 50 years old — his children strangle him.
The anthropologist hastily concludes that this tribe has radically different ethical principles or values from ours. We believe that children have an obligation to attend to the welfare of their aging parents, but these folks apparently do not.
However, after he has learned a bit more about the tribe, the anthropologist discovers that he is dead wrong. It turns out that the members of the tribe do not disagree with our basic values.
They espouse the same ethical principles that we do: namely, that children ought to attend to the welfare of their aging parents. However, the members of the tribe act differently toward their aging parents than we do because they have different beliefs, not about ethical principles but about the way the world works.
They believe that when you die you go to another land where you live forever in whatever physical condition you were in when you died.
They do not want their beloved parents to exist through all eternity without teeth, arthritic, impotent, and so on, so they kill them just as they begin to decline, at the end of their period of vigorous life.
The moral of this story is that it is a mistake to assume that whenever people disagree about what they ought to do when confronted with an ethical choice, they must disagree on basic moral values. Instead, they may simply disagree about the facts of the matter.
To bring this point a little closer to home, consider the widely publicized Baby Doe case in Bloomington, Indiana.
Baby Doe was a Down’s syndrome baby with esophageal atresia (blockage of the esophagus which prevented him from eating normally). The parents, after consultation with their family physician, decided not to allow an operation to correct the esophageal anomaly, even though they knew the baby would die without it.
The baby starved to death, or died of dehydration, in the newborn intensive care unit. Many of us think they made the wrong choice.
We believe that the primary factor in making the decision should have been: What is in the baby’s best interest? Or to put it differently, would the quality of life for the baby have been sufficiently high that it would have been better off alive than not alive?
We also believe that the life of an individual with Down’s syndrome, for the individual himself, is not typically so miserable that we can truthfully say that his life contains more suffering than pleasure and that he would be better off dead.
However, it would be a mistake to jump to the conclusion that the family had different basic ethical values from those who would have saved the baby’s life.
According to some reports, the parents made the decision they did on the basis of the family physician’s advice, and he misinformed them about the facts. First, it has been reported that the physician told them that the success rate for the surgery was only about 50%.
If this was his view, he was mistaken: experts agree that the success rate for the procedure in the Bloomington area was between 90% and 95%. Second, the physician seemed also to have been misinformed about Down’s syndrome; he told them that a child with Down’s syndrome is little more than a vegetable. This view of Down’s syndrome was common 20 years ago, but it is discounted today.
With proper care and stimulation, many Down’s individuals can care for themselves and work at simple jobs; and, more importantly, it is relatively easy to make them happy.
So once again, what looked like a disagreement over fundamental ethical principles really may have been a disagreement about the facts — a disagreement that could have been resolved by better information, without changing anyone’s distinctively ethical beliefs.
A second factor behind the popularity of ethical relativism may be the mistaken belief that unless we are ethical relativists, we must be ethical absolutists.
Ethical absolutism is the view that moral principles hold unconditionally and without exception. Thus an ethical absolutist might hold, for example, that lying is always wrong — even if telling a minor lie would save someone’s life.
Because most of us are convinced that it would be better to tell the lie than to allow the person to be killed, we find the extreme prohibitions of ethical absolutism to be unsatisfactory.
But one need not embrace ethical relativism in order to reject ethical absolutism.
One can consistently hold that ethical disagreements — for instance, over whether it is ethically justifiable to withhold information about the prognosis of his disease from a dying patient — can sometimes be settled by rational argumentation, yet still admit that there are no hard and fast principles to the effect that withholding is either always correct or always wrong, regardless of the circumstances.
By reasoning about particular ethical problems we can refine our ethical principles, in part by qualifying them with appropriate exception clauses.
Thus just because an absolute prohibition against killing human beings is implausible — because killing in self-defense is sometimes justifiable — it does not follow that the rightness or wrongness of all or even most actual cases of homicide is “subjective” or “relative” to one’s particular society, social class, or individual belief system.
The third reason that some people are led to assert that they believe ethical relativism to be true may be that they focus exclusively upon the most perplexing ethical dilemmas and overlook the rather large areas of ethical agreement.
No reasonable person would seriously claim, for instance, that burning babies for fun is ethically right, just as no one would seriously claim that aiding the poor is ethically wrong. In fact, it is extremely unlikely that each of us has utterly different basic ethical beliefs.
There are two reasons for this. First, ethical beliefs have an important social function — they serve to resolve conflicts of interests and to coordinate one individual’s activities with those of others in a reasonably peaceful and efficient way.
In order to fulfill these functions, they must appeal to our mutual advantage on some level, and the prospect of mutual advantage gives us a reason for agreeing on ethical principles.
Second, most of us who live together in this society have been subject to similar general cultural influences, one of the chief functions of which is to instill in us a common core of ethical values.
This is not to say, of course, that there are no areas of ethical disagreement; obviously there are.
The point, rather, is that focusing exclusively on the hardest cases — the cases in which no amount of rational discourse seems capable of producing agreement — obscures the fact that we do agree on many ethical issues and that we can sometimes resolve disagreements by further rational discussion.
Preoccupation with very hard cases may also lead some people to assert ethical relativism for yet another reason.
After grappling with an especially hard case, we may quite reasonably come to the conclusion that there is no one right answer, no uniquely correct decision to make.
It is a mistake, however, to draw the additional conclusion that no answer is better than any other or that one decision is as good as the next.
For even if there is no one uniquely right answer, there may be some clearly wrong answers. Often, all we can hope for is to determine a range of reasonable alternatives by eliminating the wrong answers.
If we assume that reasoning about ethical problems is only successful if it leads to a uniquely correct solution, we will be easily frustrated, and frustration may lead us to jump to the misguided conclusion that reason has nothing to offer.
Finally, there is one further mistaken inference which may lie behind the tendency to embrace ethical relativism (or at least to talk as if one does).
We are often told nowadays that “everyone’s opinion is valid” or that “everyone is entitled to his or her own opinion” or that we must “respect other people’s values.” No matter how noble the intent, these slogans are dangerously ambiguous.
It may be true that everyone’s opinion is valid or that everyone is entitled to an opinion — if this simply means that people ought to be allowed to have and express their own beliefs without interference.
However, even if in that sense everyone is justified in having and expressing an opinion, it certainly does not follow that everyone’s opinion is justified.
Nor does it follow that opinions are neither right nor wrong. Similarly, although it is important to respect other people’s opinions, showing proper respect does not preclude criticizing their opinions.
Nor does it preclude sometimes preventing people from acting on their opinions — as in the case of someone who thinks he has a right to kill any black man whom he sees touching a white woman.
In sum, it does not follow that ethical relativism is true even if there is widespread disagreement on what is the ethical thing to do, even if ethical absolutism is false, even if there is no uniquely right answer to some ethical problems, and even if everyone’s opinion is equally “valid” in the sense that everyone has the right to have and express an opinion.
Instead, we are able to reach agreement on many ethical issues in part because we already share a common ethical foundation and in part because we are able to reason carefully about our ethical beliefs.
An important task of normative ethics is to uncover this shared basis for determining how we ought to act and then attempt to extend it through rational discourse into areas in which agreement has hitherto been lacking.
Indeed, even if better reasons than those considered thus far could be produced for believing ethical relativism, it would still not follow that we cannot reason about ethical beliefs.
If ethical relativism is true, you and I cannot settle our disagreements with one another by reasoning about them (so long as the disagreement is really ethical, not merely factual as in the examples cited earlier).
Nevertheless, I can still reason about my own ethical beliefs, and you can reason about yours. Each of us can strive to make his or her own set of beliefs consistent.
ETHICS, THE LAW, AND RELIGION
Ethics (more precisely, normative ethics) is distinct from the law. Too often, discussions about ethical problems that arise in health care settings degenerate into arguments about legal liability.
It is, of course, both understandable and appropriate for physicians and other health care professionals to be concerned about potential legal liability, but this is no excuse for ignoring the ethical issues or for trying to reduce them to legal ones.
There are two good reasons to distinguish ethics from the law. First, the law has little or nothing to say about many ethical problems, particularly in health care.
Especially where rapid technological advances are creating new ethical dilemmas almost daily, the law simply has not kept up, and in some instances in which the law is not silent, it is ambiguous or even self-contradictory.
By participating together in ethics as a rational practical activity, interested and conscientious persons can contribute to an emerging ethical consensus upon which new and more responsive laws can be developed. In some cases, a stronger social consensus may even make new laws unnecessary.
Second, and just as importantly, questions of ethics cannot be conclusively settled by finding out what the law is, because laws themselves are subject to ethical criticism. Some laws, even laws made by representative legislative bodies in democracies, are merely stupid or bothersome; others are morally pernicious.
An example of the former is a law passed several decades ago by the legislators of a midwestern state proclaiming that henceforth the mathematical value “pi” would be 3, in order to make it easier for the children of the state to learn geometry.
An example of the latter is the set of laws mandating the segregation of blacks from whites in the South, which were in force until the 1960’s.
Nevertheless, the law is far from irrelevant in reasoning about ethical issues, including ethical issues on health.
For one thing, as already noted, the law can and should be ethically evaluated. In addition, ethical reasoning often borrows from the law not only interesting cases as examples but also, to some extent, patterns of practical reasoning.
In particular, legal reasoning has two features that profitably can be adapted to ethical reasoning without simply capitulating to the legal status quo or reducing ethical issues to legal ones:
(a) the law over hundreds of years has evolved concepts and rules designed to identify and balance conflicting interests; and
(b) the law also emphasizes fair and responsible procedures, and reliance upon procedures is especially crucial when agreement is lacking as to how to identify what would count as a correct outcome independently of the type of process that led to it.
(For example, two children might be able to agree on a procedure according to which one divides a piece of pie and the other chooses which piece he is to receive, even if they could not agree on who was to get which piece without going through this procedure.)
Finally, knowledge of the law may be necessary, though not sufficient, for sound reasoning about ethical problems for another reason. Often, the resolution of an ethical dilemma requires us to clarify the scope and limits of our obligations to act in the interest of others.
Even though health care professionals as well as parents and other family members have especially demanding ethical obligations toward patients by virtue of their special relationships with them, these obligations are still limited.
Parents may be obligated to undergo considerable sacrifices for their children, but they are not obligated to sacrifice everything. Similarly, a physician’s obligation to do what is best for a particular patient is also generally limited by the condition that the costs to the physician, whether financial or emotional, not be “excessive.”
Of course, it often is a matter of debate as to what counts as an excessive cost, but in general, the risk of legal liability and the financial losses it can bring may sometimes place legitimate limitations on our ethical obligations to help others, at least if it was not our negligence or wrongdoing that rendered them in need of help in the first place.
For this reason, knowing what one’s legal responsibilities are may sometimes be necessary (though not sufficient) for knowing what one’s ethical obligations are.
Just as ethics is not reducible to law, it need not have any connection with religion. It is true that every major religion includes a more or less comprehensive ethical code or at least provides some general guidance for ethical problems. In fact, the major religions share a great deal of common ground in their ethical teachings.
However, as the ethical case commentaries to follow clearly show, agreement on religious doctrines is not necessary (and often not sufficient) for fruitful reasoning about ethical matters.
Especially in a pluralistic society such as ours, it is important to develop methods of ethical reasoning that can be utilized by persons who do not share the same religious beliefs.
This is not to deny, of course, that many people will find in their personal religious beliefs additional support for ethical decisions which they can publicly defend, using secular arguments.
Since “ethics” as the term has been used here is a type of practical activity, merely describing it, as I have done in this introduction, can only carry us so far.
The best way to understand this activity — and more importantly, to be able to engage in it well — is to practice it, if possible with the guidance of others who have greater experience in doing so.
This volume, as an attempt to exemplify the concept of ethics as a practical rational activity, conveys more about what ethics is than any introduction could hope to do.
