I used to know what I meant when I said that I was a philosopher. What I meant was that I had gone to university to study philosophy, had stayed at university, and now taught philosophy to new generations of students, some of whom will stay in to study philosophy and teach new generations of students in turn.
More recently, I have started to sit on various Ethics Committees, including one in my local hospital which has taken me out of my study and into the real world. Many fascinating problems come up, some of a mind-boggling level of intricate complexity.
A characteristic feature of the problems is that they benefit from being discussed, and thought-through at length. The committee has members drawn from various different groups; as well as an 'ethicist' (me), we have those trained in law; the hospital chaplain; consultants; members of management; and lay people. The challenge for me has been to take something at home in a university department (highly sophisticated skills of argumentation) and apply it to these situations. In doing this, there are two things that have been quite a surprise to me.
First, it has often happened that my initial reaction - frequently of the form "oh, this is absurd; the answer is obvious" - has been modified as the full complexity of the situation is revealed. Here, I think, philosophy has been useful; if one is recommending a course of action, one needs to think through what the consequences would be - not only for the individuals involved, but for the broader policy of the hospital.
The trickiest cases are those in which it looks as if some clearly sensible principle (such as "act only in the best interests of the patient") produces, in an individual case, some distressing, unintended, result. One could avoid distress by violating the principle. However, more questions then arise:
Can one do this and stay within the law? More importantly, from a philosophical point of view, what kind of precedent are we setting in violating the principle? What are the features of this case that mark it out as different from some very similar case where such a violation would be clearly wrong?
The second thing that has surprised me is how often my philosophical skills run out when there are still things left to say.
Cases come up in which a consultant, or some other health service professional, has used their judgement and acted in such a way that either they are unsure about (and would like discussed) or there has been a complaint (which they would like discussed).
Philosophy can enable one to clarify situations that are often murky, and pinpoint precisely where the problematic issues lie. However, when it comes to expressing a view as to whether or not to support the course of action that has been taken it is not my philosophical skills that are needed, but simple decency and humanity. "What would it have been best to do here?" is sometimes a question best answered by appealing not to the head, but to the heart.
Ethics committees are both fascinating and stressful. Fascinating, as the problems are intricate and complex and difficult to straighten out; they are like the best kind of philosophical example. Stressful because one knows that, unlike the examples I use in front of a group of students, there is someone, somewhere down the line, whose life is going to be profoundly affected by our getting it right.
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