Health Ethics Unit 1
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What is Ethics?
Before we attempt to answer the question 'What is Health Ethics?' we'll consider a broader question: 'What is Ethics?'
This is big question and, like most big questions, it lends itself to a lot of possible answers. What we'll sketch here is not intended to be the only way of answering this question, but it is a standard way of understanding ethics.
If we need to provide a short definition of Ethics, something like the following will do:
o
Ethics is the study of right & wrong and good & bad.
o
That is, to study ethics is to try to understand what right,
wrong, good and bad are and what ways of living are good, bad, right or wrong.
Why is ethics the study of right & wrong and good & bad? That
is, why not just right & wrong or why not just good & bad?
o
Here, the answer is just a matter of terminology. The words 'right' and 'wrong' apply most naturally when what we're talking about are actions.
o
But ethics is about more than just assessing actions, it's also about assessing individuals (and maybe even more things than that - countries, corporations?).
o
When we talk about individuals, it seems more natural to
use words like 'good' and 'bad'.
Think how strange it would be to say 'Andrew is a morally right man.' 'Andrew is a morally good man'
makes much more sense.
What is Health Ethics?
We'll consider the general area of ethics in more detail later in this unit, but
with a rough definition of ethics in place, we can now say what health ethics
is supposed to be all about.
Note: For a somewhat different general take on ethics, see the article by Simon Eassom (which is assigned reading for this unit) or the introduction to the textbook by Gregory Pence (which will be assigned reading for the next unit)
Health Ethics is the sub-area of Ethics that deals with issues of right & wrong and good & bad as they relate to medicine and human health.
That is, Health Ethics is the study of right & wrong and good &
bad in 'medical situations'. But note the following points
o
The phrase 'medical situations' is meant to be taken very
broadly
o
Distinctions are sometimes drawn between health ethics,
medical ethics, bio-medical ethics, bioethics and so on. However, we don't need to worry about such things. For us, the terms can be used interchangeably.
o
Distinctions are also sometimes drawn between the meaning of the word 'ethics' and the meaning of the word 'morality'. Again, we won't worry about this distinction. For us, these terms can be used interchangeably (as can words like 'ethical' and 'moral', etc.).
Normative vs. Descriptive Approaches to Ethics
With a rough definition of Health Ethics in hand, we return to a general consideration of Ethics.
Both this unit and the following one provide a basic introduction to some important ideas about Ethics that we will need to keep in mind as we consider particular issues in Health Ethics.
As a first step, we explore in more detail the idea that Ethics involves the study of right & wrong and good & bad. What exactly do we mean by 'study'?
It is possible to distinguish between two quite different approaches: a descriptive study of ethics and a normative study of ethics
o
A Descriptive Study of ethics seeks to investigate how particular individuals or groups think about right & wrong and good & bad (and how these thoughts affect their actions).
E.g., What does the Canadian Medical Association say about whether abortion is wrong?
Notice that such a study simply seeks to describe these ethical attitudes. It doesn't endorse or reject them.
o
A Normative Study of ethics, on the other hand, isn't primarily focussed on what people's ethical attitudes are.
Its primary focus is on investigating what people's ethical attitudes should be (and how they should behave).
Some would say that, while a descriptive study of ethics aims at investigating people's opinions about ethics, a normative study of ethics aims at investigating the ethical facts.
Although, as we'll see later on this unit, the idea that there are moral facts is highly controversial.
We will be taking a normative approach to ethics in this course. Our concern is primarily with how people should behave and what they should believe.
Should?
So, our focus in this course will be on normative health ethics, i.e., our focus
will be on how people should behave in medical situations.
Another Big Question emerges at this point: 'how people should behave in medical situations,' according to whom?
We will be considering this question for the remainder of this unit and the next one.
Here's a short answer: according to the standpoint of moral value
o
This gives us part of the picture. Ethics, no matter what it is in reference to, is about evaluating people and their actions from the viewpoint of a certain sort of value (i.e., the viewpoint of morality/ethics).
o
But notice that not all value judgments are ethical judgments.
o
Some examples of other kinds of value judgment are:
Judgments based on aesthetic value: E.g., Britney Spears has never made a good album.
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Judgments based on legal value: E.g., Speeding is inappropriate from a legal point of view.
o
One thing we need to do then is to get clearer about how
ethical value differs from other sorts of value. We begin by considering how ethical value differs from legal value.
Ethics vs. Law
What is the relationship between ethics and law?
Particularly where health ethics is concerned, it's almost impossible to talk about ethics without sometimes talking about the law.
But this does not mean that ethics and law are the same thing
They share many concepts
o
E.g., rights, obligations, justice
But they also differ in some significant respects
o
E.g., sanctions and enforcement - There is no 'ethics police' handing out ethical punishments, but as we all know it is quite different with the law.
So what is the relationship between the law and ethics?
o
This is a contentious issue, but the following will do as a rough account:
Ethics is a broader area than law. It provides the basic support and justification for the law (at least,
ideally), but it also covers areas that the law does not.
o
One way to get clearer on the relationship is to consider the following questions:
(i) If an action is unethical, should it also be illegal?
Not necessarily. Consider that telling lies seems to be clearly ethically wrong at least most of the time.
But do we really think that telling lies should generally be made illegal?
(ii) If an action is illegal, does it follow that the act is unethical?
Not quite. Ethics provides the backdrop for law. In order for laws to be legitimate they
must ultimately be ethically defensible. However, notice that not all illegal acts have the same ethical status.
Some legally prohibited things are clearly unethical period (e.g., killing for fun). Others,
however, are not unethical by themselves. Instead, their illegality may be defended only
at a broader ethical level, by pointing out that the prohibition against them makes sense in a larger context.
For example, why is driving when the light is red illegal? It's not because there's anything fundamentally ethically wrong with cars moving when red lights are shining. Rather, it's illegal because we needed to have some sort of sign for when cars should stop moving
and we settled on red.
Making Ethical Evaluations
So, now we know that ethical value is broader than legal value. That gets us
closer to understanding what ethical value is supposed to be, but there is still more that we need to think about.
How does ethical value differ from aesthetic value?
Judgments of aesthetic value are about the artistic value of a thing, ethical judgments are ultimately judgments about how we ought to behave. (This is another way in which ethical value resembles legal value.)
Many would argue that there is also another respect in which judgments of aesthetic value differ from judgments of ethical value.
Many argue that aesthetic judgments are ultimately nothing but statements of opinion that may differ from one person to the next. "Beauty is in the eye of the beholder," they say.
So, for example, while you and I may disagree about whether a
movie was good or bad, many would argue that there's no answer that can be given to the question "But who's right about this?" No one is, they say. We just have our individual opinions.
Are ethical judgments like this? We certainly often talk about ethical judgments as though they are not. We often argue about who's right on a particular ethical issue and seem to do so on the basis that there's some fact
of the matter to be settled here.
Is this just a mistake? Should we say that ethical judgments are really like aesthetic judgements in being all in the 'eye of the beholder.'
We will turn to the above question in the next part of the lecture. But before we do so, you should have a look at the reading for this unit.
Assigned Reading
a.
Explaining Ethics Part I by Simon Eassom (from The Philosophers Magazine).
o
This will give you a somewhat different general introduction to ethics than the one in the Course Notes.
o
The article is available in Communication/Discussions/Readings and Assignments.
b.
Ethics
(from the Wikipedia an on-line encyclopedia).
o
You will find this reading somewhat technical. It also uses some terminology slightly differently than I do in the Course Notes, but this entry should be useful nonetheless as way of clarifying some key ethical concepts. It contains a number of links you may find useful in understanding these concepts.
c.
"Metaphysical Issues: Objectivism & Relativism" by James Feiser (from the Internet Encyclopedia of Philosophy); Communication/Discussions/Readings and Assignments
d.
For a deeper analysis:
https://www.utm.edu/staff/jfieser/class/300/relativism.
htm
Parts of this reading are relevant to the next unit in this course (and will be assigned reading for that unit). For this unit, you need read only the section on Objectivism & Relativism.
The first part of the unit concluded by asking the question of whether ethical judgments are like aesthetic judgments in being only 'in the eye of
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the beholder'. We will now consider two very different answers to this question.
Moral Objectivism
Moral Objectivism is the view that there are at least some 'moral facts' that hold completely independently of any individual's or group's views about what those facts are.
In order to understand this view, it might help to compare the idea of moral facts to what we might call 'ordinary facts' or 'physical facts.' An example of an ordinary fact is the fact that there is a computer in front of you right now (unless you printed these notes out, in which case it's an ordinary fact that
there's a piece of paper in front of you right now).
Our commonsense way of thinking about such an ordinary fact is that these facts hold regardless of what anyone thinks about
whether they hold or not. So, for example, even if some weird sort of delusion came over you right now and you came to believe that there wasn't a computer in front of you, most of us
think this wouldn't change the fact that there nonetheless would still be a computer in front of you. Just because you develop this weird delusion, it doesn't mean that the computer ceases to exist.
Moral objectivists claim that moral facts share this property with ordinary facts. The moral facts are what they are, independently of what any individual or group might think about what they are.
A Very Important Poin
t: Moral objectivists are not claiming that everyone necessarily agrees about what the moral facts are. All they're claiming is that there are some objective moral facts, not that we necessarily know what they are. Again, think
of a comparison to ordinary facts. We don't all agree about how big the world's oil reserves are, or about who shot President John F. Kennedy or whether Elvis is alive. But we do think there are objective facts about these things. The identity of JFK's killer wouldn't be changed if everyone changed their beliefs about who the killer was.
Moral Relativism
Moral Relativism is the view that what is morally right or wrong and morally
good or bad depends on what the prevailing view is in the society or culture
we happen to be dealing with.
Moral relativism is thus the view that Moral Objectivism is incorrect.
Moral Relativism claims that there aren't really any moral facts. The 'moral facts', if we insist on calling them that, are relative to the culture and place we happen to be dealing with.
They may change over time.
In other words, there's no such thing as right or wrong period (or good or bad period). All there is is right and wrong relative to a particular time and place. [Think about this as you do the discussion assignment for this unit.]
A Very Important Point
: The Moral Relativist is not just making a descriptive claim. He or she is making a normative claim (see part I of this unit for the distinction). That is, the Moral Relativist is not just claiming that different cultures sometimes hold different views regarding moral issues. Almost
anyone, including most moral objectivists, would agree with this claim. The Relativist is instead making the stronger claim that if we then ask which of those cultures' views on a particular moral issue is correct, we are asking a nonsensical question. According to the relativist, there's no such thing as right or wrong outside the standards of a particular culture.
The Popularity of Moral Relativism
Moral Relativism has been an increasingly popular view since the late 20th century. Some would argue it is now the majority view in North American society, particularly on university campuses.
Consider, for example, the results of a
survey on moral relativism
done through
Lawrence Hinman's Ethics Updates
webpage
o
Approx. 61.5% of those surveyed either disagreed or strongly disagreed with the statement "Ultimately, there is only one right standard of moral evaluation." (Only approx. 24% of those surveyed either agreed or strongly agreed)
o
Approx. 48.5% of those surveyed either agreed or strongly agreed with the statement "What is right
depends on the culture you are in." (Approx. 40% disagreed or strongly disagreed)
o
[Note that these figures may change somewhat over time.]
What accounts for this popularity?
o
Many explanations have been offered. A common one is that believing in Moral Relativism will help us avoid some of the mistakes of the past. In particular, some hope that believing in Relativism will help avoid the tendency to judge cultures that behave differently than ours to therefore be inferior to ours.
Although does this actually make sense? After all, if Moral Relativism is true and you happen to live in a culture in which the prevailing belief is that people have a duty to look down on other cultures, it seems to follow that you have a moral duty (within that culture) to look down on other cultures.
o
Other common explanations include:
The idea that, when people become frustrated with
endless disagreement over moral issues, they turn to Moral Relativism as a way of avoiding those disagreements.
The idea that people turning away from traditional religion at the same time gave up on the idea of objective morality.
The important point for us is that the popularity of Moral Relativism is beside the point, philosophically speaking. Even if Moral Relativism is an enormously appealing theory, that doesn't necessarily mean it's an accurate theory.
o
As the history of science shows, the most popular theory at any given time isn't necessarily the correct theory.
o
What matters, from our point of view, is what sort of arguments can be offered in support of Moral Relativism or in support of Moral Objectivism.
o
In the remainder of this lecture, we turn to a commonly made argument in favour of Moral Relativism. In the next unit, we investigate the idea of Moral Objectivism in
more detail.
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The Cultural Differences Argument for Moral Relativism
So is Moral Relativism true?
o
As just noted, this is a question about what sort of arguments can be offered in support of Moral Relativism.
o
The most commonly appealed to argument in support of moral relativism is what has come to be known as The Cultural Differences Argument for Moral Relativism
A Point about Notation: We will often need to consider particular arguments in this course. It will be useful to have a shorthand way of presenting those arguments.
o
First of all, what is an argument?
An argument is a set of statements of which it is claimed that one of those statements (the conclusion) is supported by the others (the premises).
E.g., Consider the following argument that's meant
to prove the very boring claim that the city of Ottawa is in Canada.
You should believe that Ottawa is in Canada because Ottawa is the capital of Canada and the capital of a country is always located in that country.
Here, the premises are:
Ottawa is the capital of Canada
The capital of a country is always located in that country.
The conclusion is:
Ottawa is in Canada
When we're analyzing an argument, we're going to adopt the practice of labelling the premises of an argument as P1, P2, ... and the
conclusion as C
.
Hence, the boring argument above becomes.
P1: Ottawa is the capital of Canada
P2: The capital of a country is always located
in that country.
C: Ottawa is in Canada
We can now use this notation to present The Cultural Differences Argument. It turns out to be a very simple argument. It essentially claims that given the huge diversity of moral beliefs held by different groups around the world, there must be no such thing as objective moral facts.
o
P1: There are huge differences in moral beliefs from culture to culture and era to era.
E.g., The classic example is the claim that some aboriginal groups in North America followed the practice of abandoning elderly members of the tribe when it became too difficult for the tribe to take care of them.
It is worth noting that there is some disagreement as to how common this practice ever was, but we shall set that aside for now.
C:
There must be no objective fact as to which of these beliefs is correct, morality is relative.
Assessing the Cultural Differences Argument
Is the Cultural Differences Argument convincing?
o
Any time we are asked to consider an argument, we need
to consider two questions:
i. Are its premises true?
ii. If its premises are true, do they give us good reason to believe its conclusion is also true?
The Cultural Differences Argument is open to challenge on both of these grounds
First, regarding the truth of its premise. It's worth asking whether there is really such a huge diversity of moral beliefs as the premise suggest.
o
Perhaps what we see in considering different cultures is not so much disagreement about basic moral principles, but local differences in how those principles are applied in particular circumstances.
We would need to investigate, for instance, why this was done, as well as how the tribe felt about doing it.
Perhaps, for instance, this was only done when the tribe was in a particularly dire situation in which caring for the person really would pose a threat to everyone. If so, can we be so sure we wouldn't act the same way?
o
It would take much more empirical investigation to settle
this issue, but we can take one point from this criticism: we should be careful about assuming that 'surface' differences in how cultures behave represent 'deep' differences in the moral beliefs prevalent in those cultures. They may or may not.
A more important criticism of The Cultural Differences Argument focuses on whether the premise provides a good reason for believing in the argument's conclusion.
o
Here, we can offer a more devastating criticism of the argument.
o
The central idea behind this criticism is this one: It is a mistake to conclude that there are no facts about an issue based only upon differing opinions about that issue.
o
To see why this is so, consider this parallel argument which might have been offered before Columbus' voyage in 1492.
P1: There is widespread disagreement about the shape of the earth. Some people say it's flat, others
say it's spherical.
C: There is no objective fact about what the shape of the earth is. It's all just a matter of opinion.
o
Clearly, this is a bad argument. The mere fact that there's a disagreement about some issue doesn't prove there's no objective fact being disagreed about.
o
This is a very powerful criticism of The Cultural Differences Argument. Notice what this criticism amounts to: it shows that even if the premises of the argument are true, we are not provided with a good reason to believe the argument's conclusion.
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o
Thus, despite its popularity, The Cultural Differences Argument is not convincing.
More About Moral Facts
What do the problems with the Cultural Differences Argument tell us about whether Moral Relativism is true or not?
o
This is something we need to be very careful about.
o
The last section should make it clear that the Cultural Differences Argument does not by itself make a convincing case for moral relativism.
o
However, this doesn't prove that moral relativism is false.
o
All it proves is that the cultural differences argument isn't a good reason for believing in moral relativism.
A general rule for philosophy/ethics: if you don't have a good reason for holding a particular belief, you should question that belief.
Our next move could therefore be to look for other arguments for moral relativism, but in the next unit we will take somewhat a different approach.
After all, why should all the pressure be on the Moral Relativist?
o
In the next unit, we investigate what the Moral Objectivist can say in defence of his view.
o
In particular, we take up the following issue. As you know from this lecture, Moral Objectivists say there are moral facts. But we haven't thought at all yet about what
those facts might be. What are these facts?
o
We will consider some influential theories that attempt to tell us how to figure out what the moral facts are.
This should help you consider how plausible moral objectivism is.
Additional Material: For another perspective of the issue of moral relativism, you might want to check out a
video of a lecture by Lawrence M.
Hinmann
.