Dr.

O’s Lesson 1 Notes: Ethical Concepts, Principles and Theories

How many of you have not taken a Philosophy course before? Some of

you might well ask, "What is Philosophy?” I don’t think there is a single,

universally accepted definition of "philosophy", so my (brief) answer shows my

particular approach. Philosophers have traditionally tried to CLARIFY and

explore certain basic issues, concepts, values, assumptions and beliefs, about

the soul (or mind), life and death, the meaning of life, and so on. The best

philosophers have also tried to evaluate, to critically assess, any and all claims

either in a specific area or regarding just about everything. In this course, you

are expected to think for yourself! You will be exposed to conflicting views on

just about every topic we look at, so you will not be able to agree with everyone

in the textbook! You'll have to make up your own minds on all of the issues or

reserve judgment if that is your choice.

To return to the question “What is Philosophy?”, above all, it should make

us think. For example, what does it mean to say that life is precious or valuable?

What does it really mean, what is it really, to be a person or for a person to be

dead?

Now, what about ethics itself? What exactly is ethics? Before we get to

the substantive issues in the course, I will say a few things about ethics in

general. It helps to have some background in ethical theory and I'll briefly

discuss a few of the most influential ethical theories in Philosophy. Remember,

however, that this is not a course on the theories of ethics; it is a course in

applied ethics. So, we just do not have the time in this course to explore the

main ethical theories in much detail.

Ethics may consist in examining the nature and functions of ethical

judgments and/or in trying to find some criterion or standard of right and wrong

which could lead us to "the correct" ethical solution, or to an acceptable and

rationally defensible solution to any ethical problem. Biomedical ethics is a

branch of applied ethics, or practical ethics, not theoretical ethics. Applied ethics

concerns the search for what we ought to do in a given case or class of cases, or

what we should not do, and it looks for the best reasons available in order to

justify its claims. So, applied ethics is a kind of normative ethics—not just

descriptive and explanatory, but prescriptive, evaluative and critical. So, we are

not trying to do anthropology, sociology or psychology in this course. Some of us

will likely be making all sorts of value judgments here and no doubt we'll get into

a few arguments, or at least disagreements, but this is the sort of thing that

should keep you from falling asleep, I hope!

One thing to remember throughout the course is that the distinctions we

make when doing ethics are usually much more subtle than that between

something simply being right or wrong. For example, suppose I asked the

following question: "Is lying right or wrong?" Well? What is the answer to this

question? What is problematic about this question? What is wrong with it? I

would argue that this type of question is problematic or misleading because it

suggests that every case of lying is either completely right or completely wrong.
However, it may be the case that lying is wrong only in general, that is, not in all

cases. Lying may be wrong just conditionally or prima facie, that is, conditionally

and not absolutely. In fact, in my view, lying or other sorts of deception are not

absolutely wrong, not unconditionally wrong, but are wrong only prima facie or

conditionally.

In many cases, lying is simply wrong and one should not do it. On

occasion, however, and in certain circumstances, it may be morally acceptable to

lie. For example, in order to save a life or even to avoid hurting someone’s

feelings or to avoid devastating them with bad news before they are ready to

hear it. For example, suppose that an armed and dangerous-looking stranger

came into my classroom and asked me where one of my students was. Would it

be acceptable for me to say, "Oh yes, sir, there is the student you want. May we

watch while you shoot him?”

Surely it would be morally better to try to save a life whenever we can.

Now, this point about lying may be said to apply to most or all other acts too

(e.g., killing, abortion, etc.) and perhaps any other act you can think of. In some

circumstances, even the most reprehensible act may be the lesser of two evils!

There are some acts that seem to many of us to be inherently, absolutely and

always wrong (e.g., rape or sexual assault). However, at least one of my former

students in this course tried to imagine a case of justified sexual assault.

(Very briefly, two examples, the first one from a former female student in

this course): After a nuclear war there are only two survivors—a young virile man
and a nun. When the man suggests that they should try to perpetuate the

species by having sex together, she refuses on religious grounds. Now, my

student actually sided with the man here and said that it would be okay for him to

rape her if that were the only way to perpetuate our species, but I disagreed with

her about this. (I said that if this were the only way to preserve our species, then

I did not think it was worth it (especially in light of a catastrophic nuclear war!).

Secondly, there is the case where a convicted rapist, and especially a

rapist who has committed this crime more than once, is put into jail. Some

people would argue that it would not be wrong to let such a person be raped

himself by his fellow prisoners (or by anyone else for that matter) in order to see

what it is like to be sexually violated and especially violently so! I must confess

that I sympathize with the sentiment being expressed by these people, because I

share their hatred of people who perpetrate such crimes. In general, I think that

the punishment should fit the crime, but let’s not make a federal case of this!

Now, we do not just have the concepts and words 'right' and 'wrong' to

work with in ethics. It may be that in some cases, this or that act is morally

acceptable, or morally permissible, or morally justified, even if perhaps

regrettable. So, there is a whole range of ethical concepts at our disposal and

we ought to be careful when trying to find the appropriate one in any given case.

So, it may well be the case that rightness and wrongness are not a matter of all

or nothing, but rather one of degree. Actions or policies may range all the way
from obligatory (a duty) to absolutely wrong or morally abhorrent or abominable

(a “no-no”, so to speak).

An act may not be the ideal thing to do, but in the circumstances, it may

be morally understandable, permissible, acceptable, and so on. It is crucial to

see that questions concerning right and wrong require very close attention to the

detailed, empirical facts in each individual case you look at—the details and the

facts about the persons involved can make all the difference as to how one will

judge a specific case. All actions take place in particular circumstances and

these are crucial in determining the merit of the action.

There is also the issue of precedent. Sometimes we judge or act, and we

thereby set a precedent—we establish a principle or a priority. Although our rule

may not be written in stone, the fact is that in law and perhaps in ethics,

precedents are thought to be very important and to carry a lot of weight. For

example, suppose a university professor accepted a bribe from a student in order

to enable the student to pass the course. In accepting the first bribe, the

professor is setting a precedent and in this case, it is a terrible one.

Another point about ethics is this: it requires consistency, as any good reasoning

does, but one can be consistently evil or bad as well as good. So, consistency is

necessary, but not sufficient, in order to do the right thing. (Just as being female

is a necessary but not sufficient condition for pregnancy.) This making a moral

choice commits one, prima facie, and all other things being equal, to making that

same moral choice in similar circumstances.

 In my opinion, we cannot expect to find absolute, unconditional or

exceptionless rules in ethics, which would always guide us infallibly to the moral

truth. We can hope for guideline—and I'll make some suggestions here myself—

we can hope for guidelines and general principles that hold prima facie (on the

face of it, at first sight or conditionally—but not absolutely). This is a similar point

to the one about lying. For example, "Thou shalt not steal" is a good example of

a prima facie rule of action, or a prima facie duty not to steal anything, but there

may be circumstances where stealing is permissible, acceptable or even a duty.

For example, Jean Val Jean in the book Les Miserables stole some bread to feed

his starving wife and children and he had no viable option, I presume, unless he

were willing to let his family die. Thus, a prima facie wrong act may be one's

actual duty, or one's "all things considered" duty, in certain circumstances. That

is, it may actually be right or morally acceptable in some circumstances.

Another point about ethics: value judgments may not be mathematically

demonstrable or totally verifiable empirically, but this does not necessarily mean

that they are merely arbitrary, irrational, totally subjective or meaningless. I

believe that good reasons can usually be given for and against some ethical

judgments and, of course, when we make such judgments, I hope that we'll help

each other to find such reasons.

Now, why is it sometimes so difficult to determine what is the right or the

best thing to do? You can't merely look with your eyes and see what is right or

wrong. This is not the sort of thing that is empirically observable. Even when
you see something that you know is wrong, say, a child being brutally beaten by

a big person, you can't just see visually that it is wrong. (A psychopath can see

these things, but may have no feelings whatsoever about them or may have

utterly inappropriate feelings about them). It is partly a matter of feeling or

values. But here you can find obvious reasons why it's wrong to beat a child.

For example, it is a violation of the basic human right to be free from harm at the

hands of others. Now, you cannot see rights with your eyes! Rights are a

normative concept and phenomenon, not an empirical one.

We often hear the term moral dilemma. A dilemma can be defined in at

least two ways: 1) a situation requiring a choice between equally undesirable

alternatives or 2) any difficult or perplexing situation or problem. Now, one

example of a moral dilemma that might come immediately to mind is the issue of

abortion.

Abortion is surely a case where both alternatives are unpalatable to many

people. Take, for example, the case of an 11-year-old girl who is the victim of a

sexual assault and becomes pregnant as a result. (In case this seems far-

fetched to you, I have been told by nurses at the Montreal Children’s Hospital

that abortions have been performed on girls as young as 10 and 11.) Now

suppose this child is totally incapable of carrying the fetus to full term and that in

fact it would kill her to try to do this. It looks as if we are faced with the following

dilemma: forbidding abortion completely and forcing the girl to carry the baby to

full term, thereby simply condemning her to death (and the fetus is doomed one
way or the other). On the other hand, we are faced with destroying a living,

genetically human being that is at least a potential person.

Actually in the case I cited, there is hardly a moral dilemma since it is

seems obvious to me that it is morally better to save a life when we can and

when the fetus is doomed in any case! It would be more of a dilemma if the

woman were able to carry the fetus to full term and if she had not become

pregnant by being raped, but rather by voluntarily engaging in sexual intercourse.

The dilemma would then be forcing her to stay pregnant and then having to face

the risks of pregnancy and childbirth and then perhaps having to give the child up

for adoption or making her take care of the child reluctantly or to kill a perfectly

healthy potential person—the fetus.

Regarding abortion, I want to show you how important it is to be clear

about the words and concepts we use. In the fall of 2001, one student in this

course claimed that abortion is never a moral dilemma since a human fetus is

really just a parasite. I rejected this claim on the following grounds:

In my Webster’s Unabridged Dictionary, we find the following definitions of the

word ‘parasite’:

“1. An animal or plant that lives on or in an organism of another species,

[emphasis mine] known as the host, from the body of which it receives nutriment.
2. A person who receives support, advantage, or the like, from another or others

without giving any useful or proper return, esp. one who lives on the hospitality of

another.”

Now, the fetus is not a parasite by either of these definitions. It is not of a

different species and it is not a person (an actual person) at all, though it usually

is a potential person. But even if it were an actual person, in most cases it does

produce much happiness in the pregnant woman (and often in her mate too) just

by virtue of being a fetus, in particular her fetus (or baby, as many people might

call it). Many women, perhaps even most women, have a bond with their fetus

that is often quite remarkable and beautiful. So, the fetus DOES “pay back” in a

way!

One last word on this: calling a fetus a parasite is something like calling a

person a thing. To call someone a thing implies that they are nothing but a

physical object, whereas in reality most or all people are living, breathing,

conscious, self-conscious and feeling beings who are subjects too—not mere

objects.

But let us not quarrel about words. Even if fetuses were technically or

biologically defined as parasites, they would be regarded and treated as

“parasites” with a very special moral status that should be valued as much for

what they will become as for what they are now.

 Serious moral dilemmas or problems occur very often because there is a

conflict of interests, rights, duties and/or principles involved. There may be a

conflict in prima facie duties (tell the truth versus keep your promise) or a conflict

in ultimate ends or goals (relieve pointless suffering whenever you can versus

always prolong a human life whenever you can). There can be conflicts of prima

facie rights, for example the right on the part of the woman to privacy, to bodily

integrity, to her own life and her self-determination versus the prima facie right of

any human being to live.

I am not claiming that these principles or duties always conflict. It is just

that in certain circumstances, they may conflict. Then you might have to decide

which principle, duty or right should be given priority in this particular set of

circumstances. Not all of you will have the same ethical priorities. This is just

one reason why we will often disagree about what is right or wrong in a given

case. Let us not even try for a consensus here. Our aim should be to enlighten

ourselves about the things that matter in biomedical ethics—the sorts of

principles and guidelines that have been worked out—and to sensitise ourselves

to the complexities of typical ethical problems in this area.

It can be helpful at times to take an obvious and extreme example of something

that is wrong and to analyze what makes it wrong. This exercise might help you

decide some problematic cases. (You will notice that I am claiming that there are

good reasons and there are bad reasons for making ethical judgments!) I’ll

briefly mention just two examples, and please note that I am also making a claim
about the possibility of some degree of objectivity in moral reasoning and

therefore a claim against ethical scepticism and ethical relativism.

The ethical relativist says that there is no genuine objectivity involved in

moral reasoning or in making ethical judgments. The relativist claims that all

ethical values and judgments are strictly relative to one’s particular culture and

that there are no objective or universal or cross-cultural criteria of right and wrong

or factors that make certain acts wrong and others morally acceptable. The

relativist says that slavery was right, and is right, in those places where a culture

believes that it is right, but that slavery is wrong for those cultures that believe it

to be wrong! For the relativist, in other words, rightness or wrongness is in the

eye of the beholder (or culture).

My first example is a case that many people would judge to be morally

acceptable, or perhaps even a moral duty: to let an abortion be performed. For

example, suppose a woman is sexually assaulted, becomes pregnant, and the

fetus lodges in a fallopian tube instead of in the uterus (the womb). This is called

an ectopic pregnancy. According to one of my medical dictionaries, "The most

common type of ectopic pregnancy is a tubal...pregnancy, which occurs in

Fallopian tubes that become blocked or inflamed. The growth of the fetus may

cause the tube to burst and bleed". (There is no mention here of risk to the

woman's life or health, but I understand that there is a high risk to her in these

cases.) The dictionary continues: "In most cases the fetus dies within three

months of conception and is absorbed into the woman's body. However,

development sometimes continues to a stage at which a live baby can be

delivered by Caesarean section."

Now, even aside from the issue of a serious risk to the woman's life and/or

health, in cases of sexual assault and/or incest resulting in pregnancy, many

people would say that the woman (or child) has a right to an abortion because

she did not willingly consent to engage in the sexual act and she did not get

pregnant deliberately, voluntarily or knowingly. However, there are some people

who would argue that the fetus is just as innocent as the woman, that it is a

human life with a right to life and that an abortion on these grounds alone (rape

or incest) should never be sanctioned. Regarding the threat to the woman's life

or health posed by an ectopic pregnancy, most people would probably recognize

the reality of an "innocent threat" and many would agree that no woman should

be forced by law to risk her life or health because she too has a right to life and

because she may be able to have a healthy pregnancy in the near future, etc.

(We'll get into the issue of abortion later in the course. I realize that abortion is a

very controversial subject and I promise we’ll discuss the pros and cons of it

later!)

My second example of a case where most of us would say there is a

clear-cut right and a clear-cut wrong is that of female genital circumcision (also

known as “female genital mutilation”).

In some cultures, there are certain people who perform this act. To

simplify what the act consists of, female circumcision usually involves the
removal of part, or all, of the female external genitalia (e.g., the clitoris, etc.). The

reasons given to explain and defend this act are as follows: it is a tradition in

these cultures and therefore ought to be respected; it is required in order for a

female to be accepted in her society and no man will marry her unless she has

had this done to her; it enhances fertility; it is supported by the religious texts of

these peoples; it prevents promiscuity and finally, it makes for a cleaner and

more aesthetic appearance.

Now, when you read the articles on this topic, you’ll see that there are

excellent criticisms of each of these professed reasons for performing the act. In

fact, probably the main reason for doing it is not usually stated at all, namely, to

enable the males to control the females. The most important thing to see,

though, is that the act causes many serious harms to the young children or

women who are circumcised (or mutilated, as some say) and sometimes even

death. These are just plain facts. Please note that it is the harm caused that

makes female genital circumcision wrong.

I conclude that ethical relativity is morally bankrupt. It is also incoherent

because the relativist tells us that it is wrong to judge other cultures or some

practice in them, but at the same says that there is no real right or wrong, aside

from what this or that culture or group claims is so. I am suggesting that when

one makes a moral judgment, it is presupposed that one is claiming that the act

is objectively or really right or wrong, not just deemed to be so by some group.

One point that I have tried to make here is that there is some degree of
objectivity in ethics and that it is not a hopelessly arbitrary or irrational exercise.

Another point is that there are some cases where any sane, objective person

would declare an act right or wrong, and where the reasons offered by the other

side can be shown to be empirically false, dubious or irrelevant. Sometimes, we

can detect very bad reasoning in ethics, including irrational, dubious appeals and

false claims.

Now, another important distinction in ethics: we can distinguish among

three different aspects of an action: the motive, the action itself and the

consequences of the action. Any one of these might be right or good,

independently of the other two aspects. However, I would say that in general,

you cannot assess the moral worth of an action without taking into account its

consequences, just as you cannot assess the moral worth of a person without

taking into account his or her motives. Now, there do seem to be some acts that

are morally reprehensible in themselves (for example, sexual assault).

What is it about this act that makes it so very wrong? Sexual assault violates

one's basic right, or legitimate claim, to one's own life. That is, one's basic right

to determine for oneself what shall be done to or with one's own body and mind.

This is one of the most fundamental rights that every human being has, or should

be seen as having, in my view. Certainly, in biomedical ethics, this right must be

recognized and constantly taken into consideration. Why is this?

What is the alternative to being able to determine your own life? (Of

course, your right to determine your life is not absolute. It must be consistent
with the rights of other human beings to determine their lives). What is the

alternative to each of us having the right of self-determination?

I think that the only alternative is some sort of slavery or bondage—some

sort of ownership by another person or persons. Women were in such a position

in many societies and in some ways they are still often treated as second-class

citizens. Let’s try to avoid trying to discuss and to solve every problem we

encounter along the way, though.

To summarize, the right to self-determination of all competent adults and

even, I would say, of mature minors, is very fundamental in ethics! Yet we must

also remember that rights need not be absolute or unconditional to be

fundamental and important!

I mentioned earlier that I would be suggesting that certain principles or

guidelines can be found which would be helpful to us in discussing problems in

Biomedical Ethics. Surely, the right to self-determination is one of these

principles.

There is another rule or principle that is closely related to this one (call it

“Ornstein's principle” or whatever you prefer). It concerns the issue of who has

the right or even the duty to make the decision in any given case. Here is the

principle:
 In general and as much as possible, let those who have to live with the

consequences and are able and willing to cope with them be the ones to make

the decision. Otherwise, someone else will have to do it.

I don't claim any originality for this rule, just for its particular formulation.

This rule captures two important things: the right of each of us to self-

determination and the duty that we each have to take responsibility for our own

lives (and health) insofar as we are able to do this.

Now, a very important distinction in ethics is that between legality and

morality. Some things are better left to the decision of private citizens and others

are matters for the law to decide. Another way of making this distinction is

between private morality and public or social morality. Two examples: some

people think that homosexuality is immoral and some think that all abortions are

immoral. Does this mean that we should make these things illegal and

punishable by the law? There are many today who would insist that these are

matters for individuals themselves to decide. After all, it is their lives and their

bodies, not some public property. (It was Pierre Elliot Trudeau who said that the

government has no place in the bedrooms of the nation.)

Now, if I am right that we have the prima facie right to be self-determined,

and if I'm right that we have the duty to take at least some degree of

responsibility for our own lives, then these principles or rules will have serious

consequences for how we decide what should or should not be done in many of

the situations we'll be discussing. However, suppose we have a sceptic who

demands that we prove that our ultimate principles, rules or values are the true or

correct ones? This raises the next major question I want to raise about ethics in

general, namely: how can we know what is right or wrong? How can we find out

or decide what is right or wrong in any given situation?

First of all, one might argue that there is some absolutely dependable and

universally applicable and infallible authority in matters of right and wrong. Does

anything or anyone in particular come to your mind?

Conscience. Will that do? (No. Sometimes different people have

conflicting consciences on the same issue and your own conscience may differ

from time to time, age to age, etc. Furthermore, a person may not get any clear

message from his or her conscience. In addition, what is the conscience

anyway? Is it the voice of God or an angel or what?

One’s conscience is formed in childhood by one's parents and other

authority figures. Consciences differ from culture to culture and from person to

person. If the late Mother Theresa had had children, I believe that their

conscience would differ from that of the oldest son of a Mafia kingpin. So, appeal

to conscience alone does not provide us with a universally valid and dependable

guide to right and wrong.

How about God? Would He or She solve our moral problems for us? No.

In general, it is a logical fallacy to try to appeal to any authority or alleged

authority in ethics because one can always ask Plato's question from the
Euthyphro, namely, ‘Does God say something is right because it is right or is

something right or wrong because God says it is right or wrong?

In the first case, we would be able to see what is right or wrong

independently of what God (or some alleged God) says about it. The act or

policy will have features about it that make it right or wrong.

In the second case, where an alleged God's will makes things right or

wrong, we still have not got a universally valid criterion of right and wrong

because God might change His or Her mind or God might have willed entirely

differently, or we might DISAGREE about what this alleged God's will actually is.

Not to mention the obvious problem that not everyone believes in a God and the

problems of how to interpret the alleged will of an alleged God and so on and so

forth.

While we must respect an individual's religious convictions—for example,

an adult Jehovah's Witness has the legal and moral right to refuse a blood

transfusion—while we must respect his or her religious belief where it concerns

only the believer, there is no way of inferring from any alleged authority to a

sound moral judgment. Furthermore, when it comes to many issues we will

discuss (e.g., abortion, euthanasia, the futility of medical treatment and so on), a

particular religion may have very definite beliefs and very strong feelings about

this or that practice and we will have to deal with this fact.
 All of the problems and criticisms I mentioned above apply to any

authority, be it supernatural or natural. We will just have to try to solve our moral

problems on our own. We may get some valuable hints and other help from

some religious traditions, but ultimately it is up to each of us to try to come to a

reasoned and sensitive moral judgment on any given case. A moral judgment is

just that—a judgment. It is not a royal pronouncement or proclamation. As I

have already noted, what is right or wrong cannot be determined by merely

looking, nor can it be determined by pure reasoning from x to y.

But this does not mean that moral judgments are groundless; often we can

and do find good reasons for moral and other value judgments. However, both

the heart and the mind are needed—not just intelligence, but some genuine

concern and sympathy.

There are certain people who apparently lack any sympathy whatsoever

for others. Sometimes they are called psychopaths or sociopaths or persons

with an “antisocial personality disorder”. Whatever we might call them, their

moral blindness does not mean that ethics is an illusion on our part.

Moral blindness is like colour blindness in this respect. The fact that some

people cannot appreciate the difference between right and wrong does not mean

that there is no difference—just as the fact that some people cannot make certain

colour distinctions does not mean that the rest of us can't either. Apparently,

there are about 300,000 psychopaths in Canada, many with sub-clinical

symptoms.
 There is a set of symptoms that are characteristic of psychopaths, one of

which is the total lack of sympathy or empathy or genuine connection with other

people. Lacking this capacity, we can begin to understand why a psychopath

might lack a conscience. Why feel guilty about anything or feel sorry for anyone

when people are just like so many other objects in one’s environment?

Just a word or two now about a couple of well-known ethical theories (see

your textbook for further details). There is Immanuel Kant's theory that the only

thing that really matters in ethics is the good will: the will to do your duty. That is,

you totally disregard the actual consequences of an act or policy and you ask the

following question in order to determine if something is right or wrong: could the

maxim (rule or principle) of this action be generalized or universalized without

contradiction? That is, could you consistently will it to become, as it were, a law

of nature? If you can, then it is the right thing to do; if not, then it is not. So, that

is the test of universalizability or generalizability. Kant’s “Categorical

Imperative” tells us that one should only act only on that principle which one

could will to become a universal law.

In addition, Kant wisely said that under no circumstances should we treat

another person as a means only, but always also as an end in himself (or

herself). Nobody should be used as a means to my ends unless he or she is

also being treated as an end (a subject of value) in himself or herself.

Kant argued that one should in no circumstances whatsoever tell a lie.

This is always and necessarily to use another as a means—to treat the other as
less than an end in himself or herself. To lie to someone is to disrespect him or

her. Nor should one ever under any circumstances commit suicide, Kant argued.

In suicide, one treats oneself as a means only, he claimed. He also claimed that

it was self-contradictory to will such acts and therefore one should never commit

them.

Now, an obvious problem with this sort of theory is that sometimes ethical

rules can conflict in a given situation and if we cannot follow both rules at once, it

would seem that we must make an exception of one of them. Thus, moral rules

do not seem to be categorical at all, but rather conditional or prima facie. There

is also the obvious fact that it would seem to be absolutely necessary to consider

the consequences of our actions or policies. How else are we to discern whether

they would be wise or at least acceptable? Actions are performed in order to

produce consequences in the world, so how could these simply be ignored?

A more sound and important ethical principle, in my opinion, is that

persons are not things or mere objects, but rather they are centres of value.

Kant thought that it was our rationality that made us valuable in ourselves, but I

would say that sentient beings are to be valued for their own sake as long as

they are capable of being conscious from time to time and are capable of valuing

their own existence. Thus I would say that this moral rule applies not just to

persons but to all sentient (conscious) beings.

 Finally, on Kant and deontology (a duty-based theory), one could say that

Kant was looking for the uniquely moral motive and he found it in a sense of duty.

Also, he said that we should ignore the empirical facts when making an ethical

judgment because morality concerns how we should act, not how we do act.

Now, while I agree that ethics has a primarily normative task (a

prescriptive and proscriptive one as opposed to a descriptive one), I think that

judgments about what should be the case simply cannot ignore what the case

actually is. The empirical facts in a case (for example, the tremendous harm that

female genital circumcision can cause) are certainly relevant to whether or not

the practice should be continued and approved or stopped immediately.

Regarding the ethics of abortion, the empirical facts about a particular pregnancy

are obviously crucial in determining what is morally acceptable or not. I believe

that this is the case in all moral decisions.

The second major ethical theory I'll just mention here is utilitarianism.

Jeremy Bentham and John Stuart Mill are the two people usually associated with

this theory. They were looking for an objective criterion of right and wrong and

they thought they had found it in the principle of utility. This principle means the

greatest happiness for the greatest number.

To put it very briefly, an act is right if it produces more happiness (or good

over evil) for all those people concerned than any other act that is being

considered at the time, or if it minimizes the unhappiness (or evil) of those

involved. So, utilitarianism is very different from Kant's theory in that it does
consider the consequences to be crucial and in fact it sees them as the only

ethically relevant and important data. This is a consequentialist theory of

ethics, and while happiness is of course a wonderful thing, there have been

many criticisms of utilitarianism. Can you think of any problems with it?

Briefly: is happiness really an objective criterion of right and wrong? How

is it to be measured? Is each person's happiness to count as much as another?

(Mill said yes!)

Now, suppose something would make three of us absolutely ecstatic but

would make the rest of you uncomfortable, inconvenienced or perhaps pained.

Who is to say where the greater quantity of happiness (versus unhappiness)

would lie? Also, if the end (happiness) justifies the means (the act), could a

person do anything to someone else if this were to make him or her very happy,

even if it were to hurt the other person considerably? Or (similar to the case in

the textbook), suppose a city were in the grip of a mad killer and the citizens

were crying out for revenge. Would this justify punishing an innocent person or

torturing the insane killer?

One problem with utilitarianism is that it cannot account for human rights.

J.S. Mill tried to justify rights in terms of their utility (consequences), but in

general, if maximizing pleasure or happiness and minimizing pain are the only

factors that matter, then utilitarianism has a problem. It would seem to justify

acts that we know are wrong.

 However—and this is crucial—this criticism applies to every major ethical

theory that I know of! This is my main point: we judge the adequacy of any

ethical theory or standard against particular cases which we all agree are right or

wrong (e.g., punishing an innocent person, sexually assaulting someone, beating

a child until it dies, etc.).

That is, I think that we are all in a sense situationalists (as we should

be!). We judge each act or situation by its own merits. We might have

guidelines, principles and moral rules, but ultimately when it comes down to the

crunch, we have to apply these to a particular set of circumstances. Each case

has its own particular characteristics, so it is we who must decide what is right or

wrong. No single ethical theory and no other person can tell this to us, nor could

a computer simply grind out the right answer for us.

The best we can say (as W.D. Ross would put it) is that there are several

prima facie (conditional) rights and duties and in each case we have to consider

these, weigh them, and see which ones deserve to get the priority in these kinds

of circumstances. For example, a physician has the prima facie duty to save a

life but she also has the prima facie duty to respect the wishes of a competent

patient. Yet suppose the patient wants to refuse the life-saving treatment or

suppose the doctor has a prima facie duty to relieve suffering and the prima facie

duty to prolong the life of the patient, but suppose these two duties conflict. In

other words, what your actual or “all things considered” duty is in any given case
will be determined after weighing your various prima facie duties. The same

applies for the actual or “all things considered” rights that a person has.

Another crucial point: often in ethics there just is no ideal solution to a

problem. Just think of the controversy surrounding the abortion issue. Where

there are conflicting values, priorities or principles, the best we can hope to do in

any given case is to try to minimize the evil, harm or pain, and we sometimes just

cannot arrive at a consensus. We cannot always please everyone. So, then the

issue usually becomes a matter of deciding who is entitled and/or best placed to

make the decision in the matter at hand. We try for the least negative or least

evil solution in any given case. In many cases, the best we can do is to try to

minimize the misery and/or harm, and this not always easy, as you can see.

Essentially, thus far, I have tried to demonstrate the following: that ethics

is not always easy; there is no agreed-upon decision procedure; there is no

infallible guide to right and wrong; and no single moral theory will solve all of our

moral problems for us.

But we are not left completely in the dark; we have plenty of moral rules

and these can serve as useful reminders as to what is usually morally decisive or

at least what is morally relevant (a philosopher named A.I Melden said that).

Suppose someone said that we can easily solve any moral problem. Just

look at the relevant moral code and it will solve your problem for you. What do

you think of this suggestion?

 You cannot simply appeal to any particular moral code or even several

codes to solve your moral problems. The reason is obvious: a moral code itself

can be inadequate or even immoral. For example, the medical or Hippocratic

Oath, which some medical students take upon graduation, makes no mention of

patients' rights or of the duty to tell the truth to the patient and it forbids

cooperating in euthanizing a patient and performing an abortion. However, both

of those acts are regarded by many people today as morally permissible in

certain circumstances.

I will not say much about the tradition in ethics called the Natural Law

theory because frankly I have never been able to make much sense of it. I think

that there is some truth in what I have seen and understood, namely, ethics has

content and it has objectives. These are rooted in our nature and in the human

condition. Yet, the idea that there are any rights or duties in a pure state of

nature seems to me to be a mistake. In the jungle or in a state where there is no

enforceable law, there is just the "law" of the jungle: eat or be eaten, kill or be

killed.

Furthermore, what is natural may not in fact be good at all. It may be

natural to seek revenge, it may be natural for someone stronger to take

advantage of and mistreat someone who is weaker (e.g., wife and child abuse), it

may be natural to want to make love to a stranger whom you find irresistible.

Simply acting unilaterally on these natural impulses, however, would usually be a

morally wrong thing to do.

 In fact, there is a fallacy in ethics called the naturalistic fallacy. I cannot go

into any details here. It is not necessary for our purposes, but I'll just say two

things:

1. The normative or prescriptive can never be reduced to the descriptive or the

factual. I believe that value judgments are usually intended to prescribe or

proscribe certain acts or practices, that they have a practical, action-guiding aim.

This is what makes them so much more important than mere empirical facts.

2. You should beware of the appeal to the natural. Beware of the appeal to the

unnatural as well. For example, it was thought at one time that it was unnatural

to masturbate. Masturbation was called self-pollution or self-abuse and since it

was deemed unnatural, it was thought to be wrong.

Actually, I think that the truth is as follows: people who talked like this

disapproved of masturbation. They thought that it was bad, evil or sinful and

therefore assumed that it must be unnatural. (Often, they would appeal to some

religious text to support their view and you know what criticisms should be made

of that kind of appeal.)

Regarding nature or the natural, it is sometimes argued that we should not

interfere with nature or that we should just let NATURE take its course.

Sometimes this can make sense, but often it is just an irrational appeal which

means that we should do nothing. However, the art and science of medicine

itself is an invention to improve our natural situation, and this goes for dentistry
and for engineering and for practically every other human endeavour! So, if we

really just let nature take its course, we would have to give up medicine and

dentistry, etc. altogether, not to mention the wearing of clothes and shoes.

There is another issue in Biomedical Ethics that I would just like to briefly

mention at this point. It is the issue of animal rights. We cannot spend much

time on this because we have so many other issues to discuss (see the articles

on animal research in the textbook).

Let me simply say that I do not think we should value human life alone. In

my view, it is not our rationality that makes us so precious or life so precious, at

least not that alone. It is our ability to have experiences, to be conscious, to have

experiences that we value. (Just think of PVS and victims who are brain dead).

Surely this is what makes life precious or worthwhile.

Many animals, many of our biological relatives (the non-human animals)

are both conscious and indeed can reason to some extent and there are some

humans who are incapable of reasoning. It would be unfair and dangerous to

value persons simply because they can reason (Immanuel Kant's idea). In my

view, any being that is capable of feeling pain, any animal that is conscious,

deserves at least some degree of respect and protection from us. Of course, I

cannot demonstrate that they should be valued—nobody could demonstrate this!

This issue (namely, what makes life worthwhile or meaningful) will come up again

when we discuss mercy-killing and suicide. We will also be discussing the ethics
of experimenting and doing research on human beings and at that time, we may

be able to discuss animal rights to a greater extent.