The Philosophy of Ethics in Medicine

happy senior woman on wheelchair with caregiver

happy senior woman on wheelchair with caregiver

Ethics is an issue when a situation arises that questions the morals of a person or professional in what they should do or what is right or wrong, especially when it is not a matter of self interest. In nursing and medicine in particular, ethics can be a minefield of relativism that makes one question ones Hippocratic oath, as there see to be so many interpretations of what is right or wrong in connection with a split second, life or death situation. Ethicists in general, have attempted to clarify the language and justify the principles to provide guidance.

  • Ethics is reflective and critical, but does not only coincide with the generally accepted beliefs or moral beliefs. This should be determined by morality, which is an accepted belief of what culture deems should or should not be done in moral situations.
  • Ethicists attempt to view ethics in a systematic methodological manner than just moral reflection.

Why Students Study Ethics

Most people believe they make ethical decisions through what they have learned by parental influence, parental disciplinary style, peer group, family environment and other sources. But the study of ethics, especially in the context of medici does not give people good moral character since it cannot influence a person’s character. Instead it is like the study of mathematics or any other subject which provides the basic principles and strategies.

Ethics will provide the basic principles and the strategies of moral reasoning, which can be in intelligent discussion to show a viewpoint on a moral issue with evidence to back up the theory. In order to do this it will require analysis of the situation and then the addition of moral values and principles to show a rational viewpoint. Without the basics of ethics the discussion from just a moral standpoint has nothing to offer showing it is correct.

Finding the truth is different than moral reasoning in an intelligent discussion, though the moral reason can be the truth of a situation. The one thing that should be remembered with ethical discussions are:

  • Moral or ethical viewpoints should be justified with reasons for the specific viewpoint.
  • Intelligent moral discussions include tolerance of other people’s point of view when they justify their reasoning. Anyone in the discussion insisting their ethical standpoint is correct will effectively shut down any type of discussion or moral debate.

Where Moral Values Come From

Moral values vary from one individual to another and are diverse, according to John Locke and Thomas Hobbes writings moral values can be based on “natural order” in some way. What this means is that through a natural manner based on moral duty and rights can be discovered by interacting with people in their environment.

Another source of moral values is through religion or religious ethics, which includes teaching and scripture of right and wrong people are expected to live their lives and will be judged on their lives based on these standards.

In ethical discussion the evaluation of moral beliefs is not at issue to determine the source, since it is accepted and expected individuals have moral values that are used consistently.  Moral values affect all parts of life, even how our country is shaped and the value we place on all people being treated equally without being discriminated against.

Though to show an inconsistency in this would be the treatment active military personnel faced when returning from Vietnam. They were not treated as other citizens, but rather demoralized as though they alone decided to fight in another country. We know this is not true, they were sent by our elected officials and even drafted instead of being an all volunteer military that we have today.

Many people went against their own and the normal standard of moral values to treat these military members far less than equal and treating them with no respect. Through education and the accomplishments of many former military veterans or active duty personnel the public became aware of the treatment of these individuals and in many cases changed their perception or moral value in equal treatment of these people who had been treated unfairly.

Determining the source of moral values is not necessary in ethics, rather it is an admission that moral callused as part of our own conducts and other peoples conduct and can be applied consistently in varied situations using them as guidelines for conduct or action especially when there are inconsistencies.


Moral Relativism

Imagine if there were no common moral values, but instead they were opinions, which would mean there was no objective validity in ethical discussions. Then when a decision is made whether one person likes butter on toast or jam, it is an individual preference, opinion which can also be objective validity. This is ethical relativism and in the event ethical relativists are correct this would mean there are no common standards for moral judgment and ethicists defining this kind of standard would have done so without reason.

Ethical relativism varies with one being that individual relativism is that moral standards are related to the individuals moral beliefs. This would be to say that if one person beliefs are right for their own actions there is no moral argument that can be posed as being inconsistent. In other words no moral judgment could be made, because there is no common moral standard.

A second thought on ethical relativism is referred to as cultural relativism. This is belief of moral standards being connected to cultural moral beliefs. Judgment then could hinge on the culture of a person whether their actions are due to their cultural morals. Generally this is used in dealing with other cultures as a sign of respect, rather than allowing our cultural beliefs to overshadow another culture. It is fair to say that cultures across the globe have different moral standards and to base their moral standards on our culture would be prejudice in our thinking or finding fault with their moral beliefs.

While arguments can be made for ethical relativism of either type, it is plausible to be consistent relativists if an individual or group is harmed in a way that causes injury by others. Proving how difficult it would be to accept ethical relativism using hypothetical situations is the best way to show how this type of ethics can be rejected. It is important to remember using this type of ethics the person must judge their actions as wrong or right, not the moral standards that are acceptable.


Individual Relativism

An individual decides for his own enjoyment he will hold the patrons at a small diner hostage and during the time they are held the tortures them for his own amusement. One person escapes while the others die from their injuries. Using the theory of relativism if the person who is the attacker believes he has done nothing wrong, the person that escaped has no basis to hold him to his actions.

Even though the assailant acted with the knowledge the diner patrons objected to his actions and society would view his actions as immoral. In the legal sense under this theory no court could be justified on a moral basis for conviction of this individual and for the person who escaped to want revenge it would place him in the same category as the assailant of blame. For a court to convict this individual it would place it in the same category as the assailant or the court could reward the criminal for his actions by awarding monetary compensation.


Cultural Relativism

This is the other type of relativism and can be looked at through several points in history where there are distinct cultural groups, with one in the majority and finds mistrust or issues with the minority group. This could be when Protestants were in the minority and forced to leave Scotland, the gypsies and even today in Iraq where there is one culture in majority and another the minority. The minority is often seen as inferior and suspicion surrounds them.

This situation between the two cultures could result in laws against the other group that is retroactive. Then if an individual in the minority group is punished under the laws made by the majority group cultural relativism occurs. Because as long as the action taken by the majority is consistent with their cultural beliefs then there would be nothing wrong with the action.

This is true even if world opinion or world moral ethics disagrees with the actions. The reason is because even if their actions are condemned by world opinion and the minority would like the world community to step in by taking military action or placing sanctions under the theory of cultural relativism would not be right in a moral sense. Taking action against the majority would not be commendable, since it wouldn’t be different then the majority action taken against the minority.

If this theory is not is not acceptable then it is not possible to follow ethics relativism, rather than moral ethics. There have been a small minority of philosophers throughout history that have accepted moral relativism and others that have been able to accept this theory of ethics do so on a basis of simple concepts. When cultural relativism happens it is basically due to the majority insisting the people in the minority should respect their traditions and beliefs even when they are not consistent with the minorities culture.

Because of the beliefs in cultural relativism there is no moral basis for people to fall back upon, which means that this cultural group could believe they could wipe out another culture without justification for objections.
In ethical relativism there is the belief by some people that adopt ethical relativism is by rejection of relativism the other alternative is moral absolutism, which they find unacceptable. This is erroneous in thought, though they believe there are a certain set of moral rules that must be followed without exception.

Rejection of ethical relativism does not mean the other choice is moral absolutism. It can be a broader position referred to as moral objectivism or moral realism, which means that judgments can be justified on objective grounds. At the same time the moral objectivist is not bound to the claim by moral standards that are absolute, but rather common moral standards that can be understood and applied in different ways. It would depend upon the circumstances of a situation how the moral standards are applied. A lie or omission may be justified under certain conditions.

But with relativism moral beliefs are often viewed as oppressive. By rejecting ethical relativism it does not imply traditional moral beliefs need to be accepted for no other reason than the fact that it is traditional moral reasoning. In both the past and now people have held certain moral beliefs from a point of view where it could be objectionable.

This could include times in history when slavery or women were not given equal rights. In this discussion the claim that traditional moral beliefs are wrong can be only justified by a person with an objective point of view or a person that does not believe in moral ethics, but relativism. Another type of person that may use relativism is the person that is pessimistic or skeptical about an issue involving a definitive resolution of moral issues.

Discussion involving contemporary issues may come to a point where the person believes there is no truth that can be found no matter how the situation is looked at even if it is a premature assumption they become frustrated. Their assumption is that there is no reason to believe the truth, because there are different, though reasonable views on moral issues. In this situation the issue may not be resolved because the debate of the truth has yet to be resolved. Ethical issues can be complex in this type of circumstance and may only be resolved after an amount of time, such as politics or even science.

The more skeptical the individual the more difficult it may be to resolve the issue, since they may lose sight of historical moral issues that have been debated in the past. Ones resolved that a reasonable person would not object, such as the end of slavery, which morally it would be immoral under these thought or giving women equal rights. To shore up the moral dilemma laws were created to protect equal rights and religious freedom.

Though moral argument at the time these issues occurred helped in the resolution of the issues, nurses to a large degree are guided more and more by tort law as the driver in their decisions. In other words, nurses and other health care provides are forced to use defensive medicine and the “objectively reasonable nurse” control model to make those split second, life or death choices.

Under the relativism theory, people who adopted the moral understanding and beliefs of the moral understanding found those ideas being rejected in large part, because it is not the professional’s choice as to whether or not abstaining or no abstaining would have caused more problems for society but instead the choice is based upon a respect for life in general. For most, the idea of ethical relativism in these situations, especially for the moral, ethical person, is unconvincing and difficult for most people to hold this view consistently.

Citations:

Caring: nurses, women, and ethics?Kuhse – Cited by 170

Author: nursingethicsnetwork