This is the twentieth Chapter from the online book: Living Ethics: The Way of Wholeness. See: 1) How Should We Live? 2) Ethics and Civilization 3) Worldview and Ethics 4) Self View and Ethics 5) World as System 6) The Material Cosmos 7) Biological Systems 8) Human Systems 9) Psyche as System 10) The Collective Unconscious 11) The Collective Conscious 12) Emerging From Chaos 13) The Emerging Worldview 14) The Psychological Problem 15) Approaches to Natural Ethics 16) Good, Ethics, and Evil 17) Reverence for Life and Natural Ethic 18) The Ethical Field 19) MetaEthics
Donivan Bessinger, MD
The enterprise of making correct decisions is confounded by the profound changes that are taking place in civilization at large. All of the forces of the ethical field are intensifying rapidly, as evidenced by extraordinary growth in scientific information, technologic capability, entanglements of law, and complexity of the socioeconomic order, the last compounded by ethnologic diversity and philosophic heterogeneity.
The philosophic heterogeneity is a special challenge to consensus on ethical issues. The history of philosophy gives quite a shopping list of concepts intended to govern right action. These concepts have their own hierarchy, and have been variously taught as theories, principles, and rules of conduct.
Any concept claiming the attention of decision makers must compete vigorously and strongly in a diverse marketplace of ideas. A natural ethic is no exception, even when (especially when) it claims the distinction of being based in a “new” world view. Even the claim to being based in a worldview seems strange in today’s market, for today’s metaphysical and positivist ethical systems seem to define their worldview according to their philosophy, not vice versa.
Advocating ethics according to natural principles is by no means a new enterprise. Hugo Grotius (1583-1645) gave the classical ball a new push in the days of the infancy of the natural sciences. There was a Stoical echo in his view of a universe dominated by a rational law of nature, as well as a modern humanist element in his arguments for an ethics based on a universal view of man. Now a twentieth century systems ethic, based on a universal view of all life, must undergo comparison with other ethical arguments.
As a natural attitudinal ethic, systems ethics provides both a theory of ethics (a system of thought by which ethics is described) and a principle (an irreducible—i.e. fundamental—premise which governs ethical action). By contrast, our meta-ethical postulates are neither. They are derived from the one principle of respect for life seeking its balance, and they define the application of the principle to decision-making.
Keeping that in mind, it will be instructive to consider how these postulates or statements relate to other systems of ethical thought. The scope of the work permits only a bare outline of topics worthy of further investigation.
First, we consider various ethical theories. (1)
(a) Axiology
Axiology (from the Greek axios, meaning that which is worthy) is the study of value systems. Valuing is an operation of consciousness, and consciousness determines rather capriciously where it places its value, defining it in such subjective terms as pleasure (hedonism), happiness (Aristotle for example), beauty (idealism), denial (Schopenhauer), etc.
As we have discussed, classical ethics begins by defining the ultimate value—the good. Our modern systems worldview provides the understanding that the natural good is that toward which life is ordered, that is, homeostatic balance for survival and development. The good values will-to-live, and arising from awareness of will-to-live, reverence for life values life. Under the influence of reverence for life, consciousness derives its secondary values consistent with life’s needs.
(b) Deontology
Deontology (from the Greek stem deont-, referring to that which is binding) deals with duty. Deontology was the title of a book by Jeremy Bentham (1748-1832) which held that one has the duty to serve “the greatest good (or greatest happiness) for the greatest number.” That theory is most widely known today as utilitarianism, and is primarily concerned with the ends, or consequences, of actions.
Kant is associated with “rules-based” deontology, in which one’s moral duty lies in applying correct motives in following moral rules. The morality is in the means, and an action may be seen as moral even if the consequences are unpredicted and unfortunate. There is a correlation between Kant’s “categorical imperative” and the “Think globally, act locally” formula. Kant directs that one must act (locally) in the way that one could will would become a general (global) law of nature.
The systems ethic is concerned with both the means and ends of actions. As we have emphasized, it does not lend itself to reduction to rules. Where rules or laws are required, they ought to be devised in accordance with reverence for life, in consideration of maintaining life’s balance.
The systems ethic affirms that the greatest good for the greatest number comes in serving life’s needs for balance. The metaethical statements define the considerations which must be answered in both the means and the ends of action. Life is considered in both individual and collective dimensions. Life needs are defined by the life process itself, rather than by any sort of majority concept of happiness.
(c) Teleology
Teleology (from Greek tele, end) is the doctrine that design and purpose are apparent in nature. Teleological ethics is ethics concerned with fulfilling natural purpose, or in particular, with fulfilling one’s own humanity. Such an argument focuses on ends rather than means, and leaves action open to arguments of “ends justifying means.”
The systems ethic is also concerned with fulfillment and development, but it is also concerned with means, for it is concerned with all life, and means influence life.
(d) Casuistry
Casuistry is concerned with cases, and seeks (often disingenuously) to find and answer legal and moral subtleties in specific ethical situations. While law and precedent must be acknowledged, they are not sufficient guidance for ethical practice, in a medical context or any other. Reverence for life, in its attitudinal approach to right action, and the systems worldview, in its understanding of the homeostatic dynamics of life systems, stand in sharp contrast to the legalistic instincts of casuistry.
(e) Contextuality
Contextuality theories of ethical practice are concerned with analysis of given situations, with a particular emphasis on the human interactions inherent in the situation. They seek to correctly apply the values and principles of the group and the individuals involved to seek a consensus on right action, and they are concerned with interactions. However, the context (situation) itself generates no ethical principle for guidance.
The ethical field theory discussed earlier is a presentation of the larger context that encompasses decision-makers. As we remarked there, the forces in the field are not themselves forces that tend toward ethics. A defining principle must be brought to the context of the decision-making, if right action is to be achieved.
Next we consider four commonly stated principles by which actions often are judged: autonomy, beneficience, non-maleficience, and justice. The only shortcoming of these four concepts is that the principle on which they are based is not defined. As we asked before, What more basic principle brings us to these? What principle governs their application in decision making? They are not sufficiently fundamental to be considered the basis for a system of ethics and metaethics. These too operate at the metaethical level, in that they suggest the way decisions are to be applied to real situations.
(a) Autonomy
Autonomy is the concept that an individual human has the right of self-determination in matters affecting the individual’s own person. Considerations of the right of privacy and the obligation to obtain informed consent to actions involving another person derive from the concept of autonomy. However, autonomy of the human person is not a self-evident proposition, and must derive from some other principle.
Reverence for life supports the concept of autonomy, for it values all life, seeks to meet all life needs (including the need for integrity and freedom for personal development), and seeks to conserve individuality and to conserve responsibility and thought. Reverence for life engenders respect for all other individuals and enriches the concept of “person.” Reverence for life influences all relationships.
The attitude of reverence for life toward other persons is informed by the systems worldview. That view, in its understanding of psyche, sees other persons not in terms of mask (persona) and ego, but in terms of the self and its potential for balance (good).
(b) Beneficence
Beneficence is the concept that actions must seek benefit to the people affected, or in our broader context, to any life affected. Benefit is commonly assessed in terms of a “cost-benefit ratio,” and is thus, in its broadest sense, an economic argument. As such, it properly belongs as much to “field theory” as to metaethics.
Like autonomy, benefit is not self-evident. Benefit must be assessed in some subjective term of valuation. Increasingly, benefit is evaluated directly in monetary terms as concerns about scarce resources become factored into ethical decisions at all levels, medical and otherwise.
By contrast, reverence for life finds benefit in respecting, promoting, and serving life needs. Benefit is not defined in terms of monetary gain (though that may occur in the process) or in terms of statistical indices (though they may be helpful in determining trends). Benefit is apparent in the survival and in the development and fulfillment of all life, individually and collectively.
In accordance with autonomy, the people affected by the decision must participate in defining benefit. However, the benefit defined by an individual must be consistent with needs of other life. A definition of individual benefit that fails the metaethical tests must be considered misguided and invalid.
(c) Non-maleficence
Primum non nocere: First and foremost, do no harm. The concept of non-maleficence is that ancient guiding rule of ethics, the rule of avoiding injury. It is an idea that is readily understood and has great appeal. On close examination, however, one can not find in the statement itself its principle of origin, or any guidance for defining harm. As is true for benefit, each defines harm in one’s own way, according to context.
Even pain, which seems a harm that we all want to avoid for ourselves, may be instead a benefit which serves the restoration of health. Like benefit, harm must be defined in terms of some more fundamental concept.
In reverence for life, benefit is found in that which supports and encourages will-to-live. Harm lies in the “deprecation of the will-to-live,” as Schweitzer put it. By focusing on the needs and development of all life, the natural ethic provides guidance in defining benefit and harm alike.
(d) Justice
Justice is an elusive concept, heavily laden with considerations of value. To be just is to be guided by the principles of truth, reason, fairness, morality, equality, et cetera. Achieving justice requires building on a base of knowledge and ethics. Justice is an unlimited good, in that a society may not have too much of it, but is not itself a principle which can define ethics.
A study of the natural world yields no basis for a doctrine of natural fairness. Volcanoes and tornadoes do not exert their influences equally. Events seem driven by a randomness in which misfortune strikes good people and bad, strong people and weak. There is a natural distribution of abilities and disabilities, so that life must be interpreted, not as unfair, but as neutral. Life is fair only in that we are all at risk for misfortune.
However, though we are not equal in abilities or gains, we are equal in respect to will-to-live. Each, regardless of race, creed, color, education, etc., is equally endowed with the homeostatic impulse toward survival. It is that basic impulse that defines life, and that provides the basis for reverence for life. Reverence for life seeks to provide for the needs and development of all life. Justice lies in acting in universal respect for will-to-live.
A review of articles about ethics, particularly medical ethics, reveals a variety of other arguments that are put forward in attempting to define right action. These may provide guidance in many situations, but on analysis, none is a self-evident, self-sufficient fundamental on which to base an ethical system.
(a) Service
An argument appealing to a concept of service is an appeal to altruism, which as have discussed, is always interactive with egoism. Service is an ideal, derived from considerations of mutual benefit. An impulse for service emerges from the attitude of reverence for life. Schweitzer:
A man is truly ethical only when he obeys the compulsion to help all life which he is able to assist, and shrinks from injuring anything that lives. (2)
(b) Quality of life
Of all the arguments, “quality of life” is the most fraught with subjectivity. Certainly, quality of life is a concept which one may apply to one’s own thinking about one’s own life decisions, but it is not a judgment which most of us would want someone else, particularly a stranger, to make for us. Each person values different qualities in life in different measure. None of us can decide for someone else what is to be valued and what is not.
Even life lived within the agonizing and feared limitations of quadriplegia is not without all meaning, for such patients still contribute to the no”sphere by thinking and communicating. Many operate computers, have published books, and have created works of art. For example, the contribution of Stephen Hawking in physics is incalculable. “Who among us knows what significance any other kind of life has in itself?” (3)
(c) Boundary of the human
David “the Bubble Boy” was a congenitally immune-deficient child who was treated from infancy in a plastic isolation chamber. A chaplain concerned about the severe limitations of his life writes that as David grew older, he complained that he “had been put into a cage and treated like a wild animal.” Later, when dying out of the chamber, the patient asked whether there had been any meaning to his life.
Rev. Lawrence writes that such highly technologic isolated treatment “is only dimly aware of the subtle and delicate boundaries of the human.” Further, “If we do not attempt to clarify soon what makes human life human, we may see even more monstrous dehumanizations than those experienced by David.” (4)
Thus the concept of a boundary of the human seems to be a variation of the concept of quality of life. Reverence for life is concerned with life needs, development, individuality, ethical outcomes, responsibility, and thought. It is concerned with all life. Each life decision is difficult, and each decision must be continuously reevaluated. Each such decision is guided by respect for life in full acceptance of life’s limitations and medicine’s limitations.
Reverence for life does indeed support a concept of avoiding dehumanization. However, it does not define when a human is a human. It does not support deciding which of two human lives is the more human, or when a human is not a human any more.
(d) Covenant
The covenant or contract argument is an argument for defining the relationship between a provider of services and a client, or in medicine, between the doctor and patient. As such, it is an argument based on such concepts as service, autonomy, and beneficience.
Veatch has pointed out that because of society’s interest in the relationship, it is really a “triple contract.” As such it is a contextual concept of ethics. Like reverence for life, it is concerned with interactions. However, reverence for life finds its covenant at the level of existence, in the mutual involvement of the parties in will-to-live, not at the societal level. (5)
(e) Sanctity of life
At the superficial level, the term sanctity of life approaches very closely the idea of reverence for life. Yet, on analysis, there are significant differences. Sanctity refers to holiness, saintliness, godliness, or sacred or hallowed character. The concept of holiness is a concept of wholeness, and in that sense it comes closest. However, the other terms relate to theological arguments rather than philosophical ones. Of course, theological and philosophical arguments may coincide, making distinctions more of labeling than of substance.
The systems ethic does not originate in a concept of divinity, but it is not in conflict with the view that the universe is created by and contingent on a divine creator. In modern political usage, the term sanctity of life often defines a slogan of a particular political movement. Reverence for life is not a political theory. It seeks to be implemented in the lives of individuals and groups, but it does not presume any particular political agenda.
(f) Humanism
An ethic based on humanism is an ethic that seeks its authority in a consensus of shared values, especially such values as justice and compassion. Humanism views mankind as set off from other life, and aspires to the fullest development of human potential. The systems ethic, which we equate with reverence for life, does not derive from a concept of humanism, but it affirms humanism in its fullest meaning.
Those who politically affirm sanctity of life often also rail against “humanistic philosophies,” especially “secular humanism.” If “secular humanism” refers to humanitarian sentiments derived on philosophical rather than theological grounds, then the systems ethic is both secular and humanistic. However, if secular humanism is understood as an egoistic humanism, denying the validity and depth of human spirituality, one should object to it.
The systems ethic supports a “true” humanism, in which the fullness of human aspirations and potential are realized in the context of, and in consideration of, all life.
(g) Human rights
The concept of human rights is at its base a political concept derived from philosophy, and does not itself have the weight of a primary philosophy. There are essentially two general theories of the derivation of human rights. Positivists hold that rights are created by society. This may be an objective positivism, deriving its concepts of rights through objectivist deduction. It may be a collective positivism, holding that rights are created by actions of the state, thus making the individual in some measure subservient to the state.
A naturalist philosophy of human rights holds that rights derive from the natural state of mankind, and holds “this truth to be self-evident, that all men are created equal.” Thus states are subservient to the people, in that the people create the nation-state. The systems worldview presented here is consistent with that view.
The state does not exist naturally, and cannot exist as an entity isolated from and independent of life. It is a creation of life itself, namely of the no”sphere. It is a product of the world of thought. The state does occur in nature since mankind is a part of the natural world. However, the state’s jurisdictional boundaries, though drawn in the earth by mankind, are not features that exist independently.
A natural systems view makes obvious that people differ in abilities as well as disabilities, as we mentioned above. Our equality is not an economic, intellectual, or morphologic equality. Our equality lies in the degree to which we are human—which is completely. Our equality is a spiritual equality, and it is only that equality which may, and must, be recognized by the state.
Rights derive from this aspect of individual humanity, not from membership in any particular group. Thus it is appropriate to think of human rights, but not of rights based on distinctions of race, religion, gender, age, sexual orientation or some other descriptive category.
In its view of the world as system, reverence for life offers an attitude and perspective which harmonizes many of the seemingly competing theories, principles, values, and arguments which seek to guide right action. When such theories and arguments conflict in a particular context, reverence for life provides the insights necessary to correctly choose and apply the various theories for the maintenance of the balance of life. On comparative examination, reverence for life stands as the first principle of ethics.
Copyright 2000 by Donivan Bessinger. All rights reserved.
Next Chapter: The Ethical Model
More by Donivan Bessinger, MD
References:
(1) ETHICAL THEORIES—For a useful abbreviated summary of ethical theories, see Samuel Gorovitz: “Moral Conflict and Moral Choice” in Doctor’s Dilemmas: Moral conflict and Medical Care. New York: Oxford University Press, 1982. p 83 ff.
(2) “A MAN IS TRULY ETHICAL ONLY”—Schweitzer. PC, p 310.
(3) “WHO AMONG US KNOWS WHAT SIGNIFICANCE”—AS.OMLT, p 271.
(4) “IF WE DO NOT ATTEMPT TO CLARIFY”—Raymond J. Lawrence. “David the ‘Bubble Boy’ and the boundaries of the human.” Journal of the American Medical Association, 1985 (Jan 4). 253: 74-76.
(5) “TRIPLE CONTRACT”—Robert M. Veatch. A Theory of Medical Ethics. New York: Basic Books, 1981. Cited in review, JAMA 1982 (April 23); 247: 2293.