Practical ethics

Updated Wednesday, 13th February 2008
How do you decide when to give fertility treatment, or when to go to war? The answer lies in practical ethics

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We make decisions all the time. Some of these can be trivial (should I wear the white or the blue shirt?) and some can be important (should we operate or leave the patient to die?). Some of these decisions will involve thoughts about ourselves and what we want (where should we go for the weekend?) and some thoughts about other people (should we close the firm and make everyone redundant?). Some of these decisions will involve tastes and appetites (which chocolate?) and others questions of morals and ethics (should I tell my partner about my affair?).

With some of these it may not matter what we decide (the shirt, the chocolate); we may as well simply toss a coin. However, we’d be very alarmed if the doctor, considering whether or not to operate, took the same attitude. We’d expect them to make a considered judgement, taking all the relevant considerations into account. Making and justifying these considered judgements is the stuff of ethics.

Some of the considerations that go into such judgements will be matters of fact (is the patient strong enough to survive an operation?) and some will be matters of judgement (is it worth it?). Sometimes these decisions can be inordinately complicated.

Here’s another example from the world of health care: As part of a reaction to various scandals involving the use of organs and tissue taken from patients, the Government passed a law that made it a criminal offence to perform any medical procedure (which would include the removal of tissue and organs) on a patient, unless either the patient gave their consent, or it was in the patient’s best interests. This prevents a hospital from using an unconscious patient to benefit someone else; that is, they wouldn’t be allowed to remove their blood, tissue or organs for the sake of some other person.

Unfortunately, in a hospital environment, nurses and doctors occasionally scratch or prick themselves with needles that have been used on patients. In such cases, there’s a danger of infection from the patient to the nurse, and the nurse needs to take action to minimise the chances of such an infection.

In order to know what action to take, the nurse needs to know what infection he or she is in danger of catching. If the patient is unconscious, they cannot be asked. In such circumstances, the nurse would need to take various drugs to minimise the chances of a whole range of infections, including HIV. The side effects of such preventative drugs are unpleasant, and the effects on long-term health unknown.

If the hospital could simply test the blood of the unconscious patient, they’d know which (if any) preventative steps were necessary. In most cases, this wouldn’t affect the patient in the least, as blood is extracted for other reasons. It’d simply be a matter of testing the blood the hospital already has.

However – as you might have guessed – this would count as a medical procedure to which the patient has not consented, and which isn’t in the patient’s best interest. Hence, it’s against the law. In this instance, a law that looks well motivated and sensible has consequences that are detrimental to the health of nurses for no good reason. What should be done? The answer isn’t obvious. The principle of not using someone to benefit someone else is clearly a sensible one, yet the consequence in this case is clearly not.

What needs to be done with this problem, and others like it, is for it to be subject to some clear and rigorous thinking. As I’ve said, such problems are often difficult (indeed, as I write this, the problem described above is unsolved). However, it isn’t as if we need to start from scratch; great thinkers throughout the ages have attempted to lay down starting points and guidelines to solve such problems.

The study of such systems of thought falls within a branch of philosophy, known as ‘ethics’. The stereotype of a philosopher is of someone who is impractical and other-worldly. Of course, there are some philosophers who conform to this, and there are some branches of philosophy where the subject matter itself is rather impractical and other-worldly. However, ‘practical ethics’ (or ‘first-order ethics’ as it’s sometimes called) isn’t one of them.

Hence, it’s usual to find philosophers serving on hospital ethics committees, or serving on (or even chairing) some of the great committees of State. For example, Bernard Williams served on Government committees on gambling, drug-abuse, social justice and the role of public schools, and chaired the Committee on Obscenity and Film Censorship. Mary Warnock has chaired inquiries into special educational needs, animal experimentation and human fertilisation and Stuart Sutherland chaired the Royal Commission on Long Term Care.

However, Ethics is more than some very clever people being particularly effective at problem-solving by committee. Let us divide all those things we know into two sorts: stuff that we can be told about, and stuff that we need to think through for ourselves.

In the first category comes everything that we learn from books. There is no sense in my settling down and trying to think through what happened at the field of Waterloo on the 18th June 1815; where would I start? A much more sensible approach is to get a good book on the Battle of Waterloo and take my facts from there.

On the other hand, there’d be something rather peculiar about someone who was wondering whether a certain film was any good, and decided to find that out from a book. Instead, they should go and see it and make up their own mind. That’s our second category: stuff we need to think through for ourselves. It’d be a bit peculiar if someone came rushing up to you to tell you a certain film was wonderful and that you simply must go and see it, and then it turned out they hadn’t seen it themselves, they had simply read that it was wonderful. We expect such judgements to come out of personal acquaintance with that which is being judged.

Much of ethics is surely in our second category. That is, there’s an expectation that we’ll have thought about these issues ourselves. People say “What do you think about fox-hunting?” in a way in which they don’t say “What do you think about the Battle of Waterloo?” (unless of course they are asking our views about the ethics of Waterloo, or a judgement about its sense or importance).

You won’t be surprised to hear we’re facing some difficult ethical challenges these days. The so-called ‘war on terror’ throws up some dilemmas that pitch security against human rights. Globalisation has made apparent the vast inequalities in wealth and power in the world’s population. The phenomenon of global warming means that we need to decide between current convenience and long-term sustainability. There are many more examples that you can think of yourself.

In the Ethics Bites you’ll hear some of the leading contemporary philosophers talking about a whole range of issues. Some of these deal directly with ethical theory – for example, Miranda Fricker talking about making moral judgements about people distant from us in time or space – and some with issues of immediate practical relevance – for example, Peter Singer on the treatment of animals.

Although listening to them, and thinking about the issues, is satisfying in itself, the more important aspect is that they contribute to keeping us all literate about ethics: that is, they provide us with the material to think the issues through for ourselves. As we head into what looks to be a dangerous period of history, having the ability to do this will be a useful check against mistakes, and will do much to keep us all (especially our leaders) honest.




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