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10/13/2014

Belief In Ultimate Truth: Does it make for peaceful living?

As I have been saying in recent blogs, most of what we do in
clinical ethics, but also in most areas of bioethics, is procedural ethics.
That is when we are faced with an ethical dilemma, our approach, whether
consciously or unconsciously is usually to try to reach a reasonable compromise
or consensus among the key participants that are in conflict consistent with
well-established values and principles. This tendency reflects an obvious
reality about the nature of contemporary ethics that we often ignore: in the
current Western moral setting, our only viable methodology for resolving value
laden disputes, whether at the micro level in clinical ethics or macro level in
healthcare policy, is to attempt to craft an agreement or consensus among those
with a say. Whether we are dealing with patients and families at odds with
their physician on how to define the goals of care in the hospital setting or
trying to build a consensus of opinion among voters in the political arena, we
assume there are no final, authoritative moral answers that avail themselves to
us. Whether we like it or not, we humans must figure out ethical dilemmas for
ourselves and learn to get along.

Yet the idea of procedural ethics remains very worrisome for
many people, including such bioethicists and Tristram Engelhardt, Jr. He believes
that procedural ethics, such much of what we do in clinical ethics, is not
really ethics in because it is based on convention and legalistic type
standards. For him ethics worthy of the name must flow from a content-rich,
canonical moral tradition that provides moral authority to our everyday ethical
and moral judgments. The prototype ethical tradition was the medieval Christian
Natural Law perspective grounded in Aristotelian philosophy. Aristotle assumed
the inherent order and intelligibility of the cosmos, which also permeated his
understanding of ethics. Humans, like all natural things, had a natural
function, which was to be rational. But rational did not mean to that ethics
was about finding intellectual or theoretical basis for right action according
to rational rules in order to know and perform one’s duty—this was Kant’s
(1724-1804) ethics during the 18
th century following the rise of
modern science. For Aristotle, the question was, how can one live and embody
the good life; so rationality in this sense meant internal harmony between
emotions and decision-making that resulted in well-established habits or states
of character. This means finding in all of one’s activities the balance between
excess and deficiency, or what he called the “mean”. Over time, forming the
right habits according to the mean in all areas of life lead to excellence and
happiness or what he called the good life. This was the natural fulfillment of the human function in practical terms consistent with the Aristotelian understanding of the rational life.

This way of thinking greatly influenced Christian
theologians, such as St. Thomas Aquinas (1225-1274), who incorporated this way
of thinking into Christianity. The source of reason becomes the God of
Judeo-Christian faith, instead of a metaphysical prime mover, so the natural
function of humans meant following God’s plan or purpose for humans. In short,
the philosophy of Aristotle is adapted to fit Christian moral theology. In a
nutshell, the natural function of human was based on basic Aristotelian human
characteristics such as the desire to understand to know and understand,
sociability, procreativity, and the desire to live. From these natural
characteristics, it was postulated that humans have a natural obligation to
learn, love their neighbor and how them respect, have sexual relations only for
the purpose of procreation, and not directly kill either oneself or others.
From an ethical perspective the source of authority was from God and any
variability to these natural laws were inherently wrong. Of course this was a
pre-modern moral perspective, before both the rise of the modern science and
democratic systems. So, moral truth was enforced within a closed, authoritative
social and political system that was by nature theocratic.

Though the modern world of modern science and democratic
system upended this absolutist moral perspective, it did not prevent
individuals from particular faith communities from making them central to their
lives, e.g. the early American Puritans. In the United States where we have a
democracy based on separation of church and state, individuals are free to
believe as they wish. But their absolutism must only apply to themselves.
Within a democratic society each individual has a right to adopt his or her own
version of moral truth and it is respected within the procedural process. For
example, a person has a right to abstain from abortion or assisted suicide and
make healthcare decisions according to their understanding of divine law; but
they cannot expect others to follow the same standard. For some, abortion or
assisted suicide may be a viable option to a difficult situation. For them, the
manner in which ancient natural laws and divine authority has simply lost its
relevance and application to the present circumstances. For contemporary
context of procedural ethics, mutual respect for a plurality of moral values is
key, which means that no single source of ultimate, objective truth can be
presumed to have authority. This presumption, the mark of a secular society, is
offensive to many people who are committed to their religious faith tradition
and believe it should apply to everyone.

Sadly, in my judgment, there are many religious
fundamentalists in the world today, including Christians, Muslims, Jews, and so
on, who cling to an ancient view of reality that they feel cannot mix with a
secular society. Indeed they feel that secularism has become itself a type of
religion that limits their own religious practices, such as saying prayers at
football games, posting the Ten Commandments in front of a public building.
Moreover, fundamentalists condemn people who engage in many common activities,
such as having premarital sex, living together without marriage, women making
their own life style choices, etc., that they feel are indications of a corrupt
and evil society. In short they feel such activities are violations of God’s law.

It is interesting how ancient world cosmologies have evolved
and become hardened into unreflective, rigid moral perspectives that have
become divisive and contrary to peaceful, living in a world that is manifestly
diverse. Moral truth in today’s world must accommodate diversity consistent
with respect and good will. It is evident that any type of ultimate moral truth
is anathema for contemporary bioethics and clinical ethics, but at the same
time we must accommodate moral absolutism at the individual level.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website

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