This is the fourteenth 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
Donivan Bessinger, MD
I swear by Apollo Physician … that I will carry out, according to my ability, this oath … I will use treatment to help the sick according to my ability and judgment but never with a view to injury and wrongdoing. I will keep pure and holy both my life and my art… And whatsoever I shall see or hear in the course of my profession … if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets … —Hippocrates
For approximately twenty three centuries, the Physician’s Oath of Hippocrates (460 – 377 BCE) has stood as a major symbol of the ethical commitment of the healing profession. As other professions have developed, they too have devised codes of rules which guide the teaching of initiates, and which govern members of the profession in their daily work. Such rules are commonly understood to be the ethics of the profession. In society generally we expect conduct to be governed by codes of law, so that in common parlance, the word ethics seems to apply only to the relatively narrow scope of the problems of a particular profession.
Such a code of rules for only one profession must consider a wide range of ideas. For example, the committee which devises the rules must consider the general philosophic and religious ideas in the culture, as well as the laws, economics, and social structure of the society. It must consider the base of knowledge with which the profession deals, that is, its science. It must consider the capabilities of the tools with which it works, that is, its technology.
If the rules are to be accepted as applicable, they must appeal to a consensus of the whole professional group involved. There must be some general agreement on principle, or set of principles, which cause the stated problem to be answered a particular way. Further, such rules must be reviewed regularly, and are subject to frequent change in a changing world. The Oath of Hippocrates above included a rule against “cutting for stone” and a rule against abortion. Now of course, there are many instances in which not “cutting for stone” would violate the rule against injury, for science and technology have made operations for gallstones and urinary stones the preferred method of minimizing pain and further injury for many patients.
Practice has also changed with respect to abortion. Even though science and technology have certainly made abortion safer for the mother than in Hippocrates’ day, nothing has changed the issue of the taking of the fetal life. The major determinant of change in abortion ethics has been change in the social and legal climate of medical practice. In the United States, the philosophic and social diversity is so great, and society so angrily divided, that the medical profession has virtually abandoned abortion as an ethical issue. It now says, in effect, that with respect to this difficult issue ethics sets no higher standard than the law. In the absence of a consensus on principle, no ethical code of rules can long stand.
Certainly, when dealing with small homogeneous groups and with easily-stated problems, simple rules may suffice. If all of the group adheres to the same religion, one may simplify the problem by citing religious authority as ethical authority. But in a pluralistic society, and certainly at the global level, we must deal with many differences. Would not ethics demand, at a minimum, that we avoid cultural and religious bias?
How then, at the societal level and especially at the global level, can ethics help us? If ethics is based on rules, and if ethical rules are so variable and so subject to the whims of consensus, we can expect little help with the complexities of constantly varying large-system problems.
The answer of course is that ethics is not rules. Rules, after all, are only another form of law, subject to another level of enforcement. Ethics is the study of “What ought we to do?” Ethics is the inquiry into “How should we live?” at all levels of action in global society. If there are to be rules, ethics is the study of the principles behind the rules. Granted, ethics is a study. It is a branch of philosophy, an academic enterprise. Many in the world outside of academia think of ethics as an ivory tower diversion. There is an vast difference between study and the broad idea that ethics is the complete enterprise of making correct decisions.
If that is what ethics is, is not ethics too broad a subject to be manageable? Making correct decisions involves knowing what the problem is, knowing what the options are, knowing what the effects of each option would be, and then trying to figure out which option is best. And of course, complex problems confront us with complex options. If ethics is defined that broadly, is it defined at all?
Well, the world is complex. The problems we face, individually and collectively, have many facets. The problems occur at many levels, and often appear at many levels at the same time. We usually don’t know what all the effects of each option would be. Often the effects appear at some entirely different level. Often we cannot know which option is best. If we try to solve the problem a part at a time, we usually loose sight of the problem as a whole. We end up in an attitude of frustration and usually defeat.
Faced with these many dilemmas, we have tried to evolve a small set of principles on which there is broad consensus, then try to apply the principles rationally and sequentially, perhaps by some sort of algorithm, a heuristic rule or decision at a time. These efforts are particularly prominent in current approaches to medical decision making, but are seen in other fields as well. In fact, the complexity of medical decision-making makes that a good model for the study and illustration of ethical decision-making generally. (1)
Among the commonly cited principles are autonomy, non-maleficence, beneficence, and justice. The principle of autonomy directs that one decide with a respect for the individual rights and independence of will of the other human beings involved. Non-maleficence directs that we avoid injury in what we do. Beneficence directs that we seek actions that bring benefit. Justice directs that we seek to be fair and even-handed in our dealings with others.
We are still left with many questions. How many other human beings must be respected and consulted? When obtaining benefit requires some measure of injury, what then? And what of justice? When resources are limited, what are the limits of our even-handedness? Has life ever been fair?
And more to the point: What more-basic principle brings us to these? Do we not indeed need to find some unifying idea? By what idea shall we live? Despite the philosophical difficulties, do we not need to define a natural ethic, an ethic built into nature? Is ethics perhaps as much a matter of attitude and understanding as of rules and principles?
A search for a unifying idea is hampered by our general reliance on a principle of tolerance. It has become fashionable to think that any idea is acceptable if one is sincere. Making distinctions has often been confused with being intolerant. It is also fashionable to think that ideas cannot be held to be wrong since they cannot be tested objectively against some standard that everyone agrees to.
Yet it should be obvious that ideas do have survival value. Since one acts according to one’s thoughts, what one thinks may save or kill. Word is deed. Though an individual person’s thought and act may be inconsequential, the summation of collective thought is very much of concern for the survival of civilization, as the current nuclear fear so pointedly shows. Thus while we must be tolerant of people, we may not be tolerant of all ideas.
But what is the operative force in selecting ideas for affirmation in society? We must tolerate a variety of ideas if we are to generate new ideas to solve new problems. One cannot have life without new problems. But if we are to have civilization, we must rigorously select the ideas which are to be affirmed. What is a reliable process for that?
Censorship is undesirable. Censorship, or any suppression of creativity, is even contrary to society’s survival interests. The process of affirmation of survival ideas must be dispersed throughout society. There must be an operative ethical process that is reflected in decisions and affirmations at every level of choice. That of course requires some sort of consensus, and that consensus is difficult to come by.
The traditional formulation of the ethical problem asks simply “How should we live?” Since right action is action in service of the Good, the classical point of departure for ethics is to define the Good. For example, Aristotle begins his Ethics with a definition of the Good, and then develops the point that it is Happiness which is the Good.
It is thought that every activity, artistic or scientific, in fact every deliberate action of pursuit, has for its object the attainment of some good. We may therefore assent to the view which has been expressed that the good is that at which all things aim. (2)
Happiness then, the end to which all our conscious acts are directed, is found to be something final and self-sufficient. (3)
However, Aristotle finds that the end of activities (“that at which all things aim”) is defined differently in the various enterprises in society. He gives several examples: “The end of medical science is health; of military science, victory; of economic science, wealth,” and of course, other personal and collective enterprises have other ends. (4)
However, in seeking the happiness that comes from achieving the various ends, one must be moderate. Temptations to excess must be adapted to a consciously determined golden mean. In considering ethical regulation in accord with a golden mean, Aristotle affirms an ideal much like homeostasis. In that sense, he has appealed to a natural element in ethics, but his golden mean operates in consciousness, and achievement of excellence or virtue in Aristotle’s system is not attained through application of external principle. (5)
As interpreted by Durant, Aristotle holds that “Virtue … is not the possession of the simple man, nor the gift of innocent intent, but the achievement of experience in the fully developed man.” (6)Appealing solely to individual conscious formulation and to gained experience presents problems both for the individual seeking ethical guidance and for society in seeking to educate its youth in ethical principles.
In the history of philosophy, various ethical tests have been proposed. For example, Confucius taught that one must avoid doing unto others what one does not want done unto oneself. Since he defined it as a principle of reciprocity, he intended it as a bilateral rule enjoining each party to operate in the interest of the other. Equally ancient is the Jainist principle of ahimsa, or non-violence to all life, a theme taken up in modern times by Gandhi, with momentous political result. Jesus, in his Great Commandment, presented a test of personal relatedness: In addition to loving God (and deriving from that), one must love one’s neighbor as one’s own self.
Kant, in his categorical imperative, presented a test of universality: One must act as if the act would become a universal law. Bentham offered the test of utility: One must act to provide the greatest good (happiness) to the greatest number.
Modern writers have offered additional tests. Writing about the ethics of justice, John Rawls spoke of the “veil of ignorance”: One must act evenhandedly as though unaware of the outcome on specific persons including oneself. He also offered a “maximin principle” of acting (in society) to maximize the benefit to those minimally advantaged. (7) Biomedical ethicist Tristan Englehardt, though not seeking to elevate the idea to a principle, suggested a cosmological test of reason: Act as would a reasonable being anywhere in the cosmos. (8)
Though these tests do not carry equal weight, each may provide some guidance in deciding whether a proposed action is ethical. Yet it is not always clear which best applies to the situation at hand, and one can envision that in some situations the tests might be in conflict. In many situations, there will be considerable leeway in deciding which of several proposed actions is the best, and how much action is sufficient to its end.
In any test that might be applied, consciousness must test itself and apply strict standards of objectivity to itself, if the ethical result is to be achieved. Ethics is inescapably an ego activity, for it must seek to resolve questions by the logical formulations of reason, and the processes of reason are processes of consciousness. Reason traditionally devalues the subjective work of the unconscious world, especially with respect to the “spiritual” content of the unconscious psyche.
However, principles derived purely in consciousness and analyzed solely by abstract concepts of good (or for that matter, of virtue or value) do not serve well as ultimate guides to action, for both the originating principles and their regulation are derived in consciousness. That forces the conscious into a conflict of interest, writing the law by which it audits its own accounts—an unethical situation in virtually all systems of ethics.
The conscious is capricious. It can be deluded into defining the good in many ways, and the principles which it derives are subject to wide variations in interpretation in society. To say “Pursue your own values,” or even “choose your own test,” is hardly a definitive solution to global or individual ethical problems.
Ethics, then, must appeal to a principle operating beyond consciousness. However, the principle must be one of which the conscious may be made aware, for the principle must be applied to “every deliberate action of pursuit” (Aristotle), and rigorously tested not only for result but for its concordance with reality itself.
An ethical principle operating in nature outside of consciousness is by definition, unconscious. It is that world operating outside the influence and regulation of our normal human consciousness that we commonly call the natural world. It is a fundamental premise of our systems worldview that human consciousness and human functioning are themselves integral with the world, and are indivisibly one with “nature.”
However, there is a difficulty in attempting to base ethics on nature. Writing in 1903, British philosopher G. E. Moore cautioned about the naturalistic fallacy of saying that some particular quality (valued by the conscious) is Good because it occurs in nature. That is, we may not base ethics on some good merely because it is “natural”—that could, in fact, be a special case of the ego’s conflict of interest just mentioned. (9)
His point has been very influential in strongly suppressing attempts at naturalistic ethics. Indeed the trend in academic philosophy seems to have been toward the opposite pole of deriving “ethics without biology.” For example, in an essay of that name, Thomas Nagel writes:
If [ethics] is just a certain type of behavioral pattern or habit, accompanied by some emotional responses, then biological theories can be expected to teach us a great deal about it. But if it is a theoretical inquiry that can be approached by rational methods, and that has internal standards of justification and criticism, the attempt to understand it from outside by means of biology will be much less valuable. (10)
As we shall see, biological concepts must play a greater role in ethics than his essay admits. Biology is germane to ethics because biology is the science of life, and ethics lies at the heart of our survival.
Copyright 2000 by Donivan Bessinger. All rights reserved.
Next Chapter: Approaches to Natural Ethics
More by Donivan Bessinger, MD
References:
(1) HEURISTIC RULE OR DECISION—H. E. Pople, Jr. “Heuristic Methods for Imposing Structure on Ill-structured Problems: The Structuring of Medical Diagnostics. In Artificial Intelligence in Medicine, P. Szolovits, editor. Boulder: Westview Press, 1982.
(2) “IT IS THOUGHT THAT EVERY ACTIVITY”—Aristotle. Ethics. Bk 1. Chap 1. Translation of J. A. K. Thomson. Middlesex: Penguin Classics, 1953.
(3) “HAPPINESS THEN, THE END TO WHICH”—ibid. 1: 7.
(4) “THE END OF MEDICAL SCIENCE IS HEALTH”—ibid. 1: 1.
(5) GOLDEN MEAN—For an expanded discussion of these points see Will Durant. The Story of Philosophy. New York: Washington Square Press (Pocket Books), 1953. p 74-79.
(6) “VIRTUE IS NOT THE POSSESSION”—Durant. op. cit. p 75.
(7) JUSTICE; MAXIMIN PRINCIPLE—John Rawls, A Theory of Justice. Cambridge MA: Harvard University Press, 1971.
(8) COSMOLOGICAL TEST—Tristan Englehardt: Foundations of Bioethics, page 45.
(9) NATURALISTIC FALLACY—G. E. Moore. Principia Ethica, 1903. See G. W. Stroh. American Ethical Thought. Chicago: Nelson-Hall, 1979. p 175 ff.
(10) “IF ETHICS IS JUST A CERTAIN TYPE”—Thomas Nagel. “Ethics without biology” in Mortal Questions. New York: Cambridge University Press, 1979. p 142.