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Posted on March 13, 2013 at 11:33 AM

Maurice Bernstein, M.D.

On my bioethics blog I wrote a post titled “Good People Do Bad Things for Good Reasons”. I suggested in that post that “what is ethical or not is often in the eye of the beholder”. An anonymous visitor wrote back the following:

“I would like to think that ethics is NOT in the eye of the beholder. That logic leaves too much room for justifications of any actions. Ethics is not religious doctrine. Ethics is not law. Ethics is not social standards. Ethics is not what feels right. These are all subjected to variables that can change the outcome of the ethical or unethical action. Ethics is simply what we OUGHT to do. Ethics is a code of values that is reasonable and well-founded. Beauty is for the eye of the beholder. Ethics is for everyone, everywhere. It is NOT subjective.”

Shouldn’t I disagree with that visitor’s comment?  If decisions and actions in ethics were immutable and fixed, documented in clear and non-ambiguous language, why would there be a need for “ethical consensus”? This need already supports my argument.

Think about the four ethical principles: autonomy, beneficence, non-maleficence and justice which are considered, for example, within clinical ethics but also in other ethical decision-making. Have decisions and actions carried out or proposed said to be in keeping with a principle actually met the philosophic or dictionary definition of each? Can there ever be decisions that are said to be and, indeed, are, actually fully faithful to autonomy (an individual’s strength of self-governing and independence), beneficence (contributing to an individual’s good), non-maleficence (doing no harm) or justice (fairness to all individuals)? Most decisions require the consideration of each of these principles in terms of the final result of the action. While the definitions of the ethical principles are “reasonable and well-founded”, their application in terms of a decision towards an action may lead, in all reality, to an ethical dilemma where it would be impossible for each to be equally applied. The solution to the dilemma would require the principles to be prioritized. But what makes an ethical dilemma most complicated is that each case may be different in that there may be a different set of facts. In addition, there may be more than one stakeholder in the results who will be affected by the decision and each stakeholder may have their own individual prioritization of the principles in order to produce a result consistent with their individual goals. So, what is necessary to proceed to a solution to the dilemma is the development of a consensus amongst the stakeholders.

Consensus means that those individuals involved have come to an agreement with regard to how the ethical principles should be prioritized. And consensus may not be a static conclusion but may vary over time depending in how people look at issues in their current environment. For example, was justice served at the onset of the second World War when American citizens of Japanese ancestry were interned for years in camps? Surely, it was the concern for the safety (beneficence) of the other American citizens that trumped the ethics of non-maleficence or justice toward those of Japanese ancestry. And yet, later, in a different time, this ethical decision was found to be unethical. In the past, medical research performed on human subjects that was carried out without fully informed consent by the subject and even with intended harm was accepted but in recent times have been rejected as unethical.

In summary, yes, ethics should be “what we OUGHT to do” but, in reality, applying all ethical principles we “ought” to do is not universally possible if we intend to come to a decision. And beyond that in practice with different cases, different stakeholders have different views of the issue and their individual visions set the ethics for the solution. Those are the eyes of the beholders.







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