Working as an ethicist in a professional work environment, you quickly realize that any ethical advice worth giving to practitioners must always be relevant to real problematic, human situations. Ethics must make a difference. Elucidating one’s obligations in particular problematic situations enhances insight and confidence in working through troubling value-laden dilemmas both in individual circumstances, as in clinical ethics, and also with regard to larger social problems at the macro policy level. Most ethical solutions are provisional recommendations, i.e. always amenable to revision based on new data, based on ethical reasoning in light of the particularities of each case that may ameliorate an impasse and often helps decrease suffering: Ethics helps make the little corner of the world with which it deals a little better off.
Though I am laying out a pragmatic ethical framework, I want to be clear that ethical principles are essential to ethical problem solving. Following Kant but with a pragmatic twist, the foundation of ethics is the duty to treat each individual human being with respect and, as much as possible, to be fair to everyone. This duty reflects the two fundamental moral principles of respect for autonomy and justice. In the application of the principle of individual autonomy, respect is expressed toward human individuals in concrete situations. For the principle of justice, respect is expressed toward a community or society or connected individuals. Elucidating the pragmatic approach further, ethical principles are not viewed as absolute, quasi-religious truths that exist independent of human experience but rather grounded in human experience.
Ethical principles from this perspective are repositories of wisdom gained through reforms primarily in the democratic process of extending the moral community by recognizing more individuals as full moral agents and guaranteeing them the rights of full citizenship. Thus, the way one thinks about ethics today in contemporary America is deeply connected to, and in a real sense grows out of, the historical process of democratic politics. Just think of the bedrock principle of medical ethics, respect for autonomy and how this notion evolved historically within the legal process and the key court cases on informed consent for the past 100 years or more. Think of the political reform movements in civil, feminist, and consumer rights, etc. movements during the 1960’s. Think of the lessons learned from the abuses of human subjects research that came to light after WWII the Nuremberg Trials. Finally, think of the violations of human research described by Henry Beecher in 1966 in an article from the New England Journal of Medicine, which led to the creation of greater protection of human subjects in research. All of these and other historical events helped to give rise to a full-blown concept of individual autonomy as well as the rights of all patients and subjects to voluntary informed consent. To reiterate, ethical principles emerge historically from real human experience, not from out of the blue sky above, based on meaningful progress in the respectful and fair treatment of all human beings as full moral agents.
The larger point I am getting to is that the ethical and moral life of humans as individuals cannot be separated from the life of humans as they struggle together in community, in groups, pursuing their own interests within the political process over and against the interests of others within a legal and political process. The moral options available for individuals are always framed within the confines of a certain collective or institutional order. From this pragmatic perspective, it follows that the very integrity of ethics as an essential dimension of human life that is dependent on the integrity of the political order. Does it treat all people fairly or does it attempt to exclude and deny certain individuals their basic rights to participate in the democratic process? Think of the current commission on voter fraud investigating non-existent problems in the election process, which may result in tighter voting restrictions that will greatly impact populations not likely to vote for the current administration. Is there a commitment to truth (with a little “t”), as in empirical truth, the institution of scientific research as the principal arbiter of scientific claims, and in general to relate facts of ordinary experience? Think about the denial of the claims from climate science research or the claim made by a presidential candidate that he saw Muslims cheering at the dreadful site of 9/11. Is there commitment to treat each other with a basic respect in our interactions and dealings on the public stage? Think of all the name-calling, derogatory comments, and incitements to violence during the last presidential campaign, which has continued up to the present in the current administration. I could go on, but you hopefully get the point.
Those of us who work in areas of applied ethics must be deeply concerned about state and direction of our political process and collective life as a society. This way of thinking about ethics should cause us considerable pause as we witness the current pattern of political events in our country. Up to the present we should be grateful for the ethical framework that has emerged in the tradition that we have inherited. But there is no guarantee that we will remain so lucky. We cannot allow ourselves to reach the point, as past philosophical ethics has done, to think of ethics as an isolated, academic enterprise. It is not. It is a practical, living, and evolving, historically contingent institution of which we must be responsible stewards. That means it is important that ethicists and all concerned citizens vigilant of what is happening in politics and the larger society.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and a Graduate Certificate in Clinical Ethics. For more information on AMBI's online graduate programs, please visit our website.