Ethical Commandments

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Fans of Dr. Bossypants may remember that she blogged about ethics for a while before turning to trauma. Clever of her, because she firmly believes the infliction of trauma on others is unethical, so all her blogs are still relevant! And faithful readers also know she believes that trauma damages babies, children, and all people severely. Such damage may result in these same people then inflicting trauma on others later in life, perhaps not even realizing it as such. It is a vicious, potentially deadly cycle.

Philosopher Bernard Gert (1934-2011) created a list of ten moral commandments. Here they are:

  1. Do not kill other human beings.
  2. Do not cause unnecessary pain (this lets surgeons and dentists off the ethical hook).
  3. Do not disable another human being.
  4. Do not deprive another human being of freedom.
  5. Do not deprive another human being of pleasure.
  6. Do not deceive others.
  7. Keep your promises to others.
  8. Do not cheat.
  9. Obey the law.
  10. Do your duties—those required by social relationships, your job, your commitments, and so on.

Gert realized that there may be times when you are certain the deeply moral thing to do is to break one of the commandments. If so, he believed that you should only break it if you’d be willing to allow everyone else, in all times and in all places, to break the same commandment in the same situation.

It seems obvious that killing, hurting, disabling, or depriving people of freedom or pleasure causes some level of trauma in the hurt, disabled or deprived one. Being lied to and cheated isn’t much fun, and in some situations, can also be traumatic. And of course, at the social level, our culture would fall apart if everyone broke the law all the time, and/or failed to do their personal and civic duties. We’d have a broken culture.

But beyond this set of rather obvious conclusions, Dr. B would like readers to ponder another set of costs. We can easily see the cost of such actions on those acted against, or on society at large. But what are the costs of crossing those lines to the actor? The cost of breaking those profoundly basic moral edicts? The killer, the torturer, the liar, the cheat, the dictator–why are they willing or able to cross those lines, and what does it do to their psychological condition?

Dr. B believes in the long run, the actor is diminished in the process of acting unethically. But it is, perhaps, a habit-forming brutal cycle with enough shallow rewards to keep the unethical actor repeating the harmful actions.

Is there a way for society to help cheaters, liars, law-breakers, or brutal people to see the costs to themselves? Is there a way to peel back the “rewards” and help humans see that ill-gotten gains are ultimately malignant? Or could we at least stop tolerating or admiring such actions? Probably not, but Dr. Bossypants is going on record, with the wise Bernard Gert, as saying that killing, hurting, disabling, depriving, lying, cheating, breaking the law, and failing to do your basic duties—these are all unethical, psychological corrosive actions harming the victims, our community, and most likely harming the perpetrators as well.

Thank you for any thoughts you may wish to post. Also, someday soon, Dr. Bossypants promises to write something upbeat. And because of Number 7 above, you can bank on it.

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Bossiness on Healthcare

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A roving reporter chanced upon Dr. Bossypants and did a quick interview for our edification.

Q:        For our listening audience, could you tell us by what authority does Dr. Bossypants issue her edicts?

A:       Yes. Here is an abbreviated list:

  • Some people like her.
  • She has a two masters degrees and a doctorate from an accredited institution of higher learning.
  • She was a professor for 24 years, and had the good sense to retire in a timely way.
  • She’s stayed alive and in shape for many decades, produced lovely children, marrying only twice, with the second attempt lasting over thirty years and counting.
  • She has faced a deadly disease.
  • She grows a fine garden and eats healthy food.
  • She thinks she knows what’s best, but she tries to be reasonable.
  • And, as mentioned above, some people like her.

Q:        What does Dr. Bossypants have for us to consider today?

A:        The topic for today, dear readers, is greed, government, and healthcare.

Q:        Well then, hmmm. What does Dr. Bossypants have to say about these important topics?

A:        Listen up, people. Dr. Bossypants has been a keen observer of human nature for many years. Humans are greedy. We don’t have to be, but most of us are. And corporations (posing as people, or not) are greedier. We all need some limits.

If you think, for one minute, that medical insurance companies have the health of those they cover at heart, you’re a fool. Admittedly, government is a clumsy expression of the common good. It functions only insofar as those comprising the “common” take responsibility and stay involved. Yes, Medicaid and Medicare are fraught with fraud and tomfoolery. All human institutions suffer from such. But the profit-motive in healthcare needs to be removed or minimized.

And yes, as humans, we will err. It’s better to err on the side of the collective good than on the side of making the rich richer. Eventually, things get top-heavy and dynasties topple. Dr. Bossypants hastens to assure everyone that toppling is something to avoid. Middle-class is a good, good thing. Trust us on this, dear reader.

Q:        So Dr. Bossypants thinks a single-payer medical system is the way to go?

A:        Basically, yes. Dr. Bossypants is not an economist, but she suspects in the long run, Medicare for all will cost less in taxes than random and inadequate emergency care provided to the poor and uninsured.

It is to a society’s advantage to attend to the health of its citizens. Healthy people are smarter people. They work more. They take better care of their offspring. They are happier. Of course, there are limits to what should be provided, but we can figure that out.

Q:        Where would Dr. Bossypants draw that line?

A:        Cosmetic surgeries that are for appearance only. People need to pay for their own hair implants or facelifts. Also, we need to pull back from excessive medical testing, when whatever the results are, we can’t fix it anyway. These are a couple that come to mind. Dr. Bossypants has a tiny modicum of faith in the collective wisdom of ethically-minded professionals who can develop these difficult guidelines. But the basics of health care should be provided collectively, by all of us, paying taxes. Period. First things first.

Q:        What are “first things,” Dr. B?

A:        Full availability of primary care, nutritional education, preventative care, emergency services, life-saving surgeries and treatments, every possible form of birth control, sex education, (K through graduate school), abortion for those who do not wish to bear a child, fantastic prenatal and postnatal care for all who do wish to bear a child, basic dental care, basic mental health care, and support and education for those who choose to smoke or are obese, to name a few. But I would defer to the collective wisdom of an appointed team—a team absolutely and completely stripped of any chance to benefit monetarily from the decisions the team needs to make.

Q:        My, you’re judgmental and a bit nasty.

A:        Indeed. And hopelessly optimistic. We can do this, people. We can. We do it fairly well for soldiers and those imprisoned, and my yes, for those in congress. We CAN do it for the rest of us.

Cue, here, the maniacal laughter necessary for such situations.

 

Ethics. Bioethics. Health Care. Oh My.

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Being human, we’re accustomed to eating contradictions for breakfast. Even if we eat little else. We intend to behave quite a bit better than we usually do, and we squabble over what it means to be moral, or to live a good, fulfilling, worthy life.

Even if we agree on a moral rule, or make a law, we might observe the rule or obey the law for radically different reasons, or break the law for reasons we believe to be moral. Yes, indeed, dear readers. Dr. Bossypants knows it’s difficult to sort this all out, even though she has tried mightily to blog about morality and ethics in a most intriguing and approachable manner. Now, we have one more lens through which we might view moral decision-making, and then a bit of a summary, so those of you determined to put these ethical thoughts into ethical actions might do so. Right away. Please.

In the late 1970s, bioethics became a recognized specialty as hospitals and healthcare providers grappled with ethical decision-making in the increasingly contentious, conflicted, expensive world of healthcare.

Tom Beauchamp and James Childress identified four  guiding principles in the first edition of their influential book Principles of Biomedical Ethics:

  • Autonomy (Human beings should have authority over decisions affecting their health and well-being.)
  • Beneficence (Decisions should be made on the basis of doing good and being of help to others.)
  • Nonmaleficence (People should strive to do no unjustified harm.)
  • Justice (All people should be treated equally and benefits and burdens should be distributed fairly.)

Principles don’t offer concrete answers, but provide a framework to begin the hard work of ethical decision-making in the face of competing needs and limited resources.

Robert Bellah said “Cultures are dramatic conversations about things that matter to their participants.”

Listen, dear readers. Right now, we are engaged in a monumental conversation in our culture. We’re talking health care. Is it a basic human right? If so, how much health care should we make available in a world of apparently limited resources? Who should profit in the provision of health care, and how much profit is justified? Who should pay, and how should that duty be distributed?

Should we provide abortions to those who do not wish to be pregnant? Should we provide viagra to those who wish to have a pharmaceutically-assisted erection? Should we provide a means by which someone suffering, or near death, could choose to die with medical assistance? Oh, the inflammatory and politically-loaded questions just go on and on. They require deep thought. They require wisdom. These matters are seething with ethical quandaries.

Kant reminds us we should never treat people as a means to an end, nor deny anyone rights we would wish for ourselves.

John Stuart Mill reminds us we should choose paths, practices, and laws that insure the greatest possible good (health) for the greatest number.

Aristotle urges us to find the golden mean, the balancing point between excesses. And to be generous, courageous, and prudent.

Feminists remind us of the huge, destructive problems that arise when power is used to abuse others, to deny basic rights, and to enrich the already-rich.

Those who practice relationship-inclusive ethics remind us that we must always consider the direct impact of our actions–and our goal should be to take the most compassionate action possible.

The bioethicists offer us principles to consider, though admittedly these principles might actually conflict with each other sometimes.

We do not live in a perfect world. It is our job to make it better, not to give up in anger or despair. The ability to reason, converse, and find common ground is a human attribute we should treasure. Courage, dear ones. Be good people.

Ethics of Care

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Dr. Bossypants wrote much of this blog some years ago. Clearly, it has not changed the course of history yet. But onward, dear readers. Ever onward. Western ethical theories have been said to be driven by concern for individual rights, rather than informed by the intricacies of human relationships. Originally dubbed “feminist ethics,” the addition of a relationally-oriented moral viewpoint was ushered into Western view primarily by the work of Carol Gilligan. Gilligan worked with Lawrence Kohlberg, famous for his hypothesized six stages of moral development. Subjects in Kohlberg’s research had most often been boys.

In early studies that included girls, Kohlberg and associates found that girls were scoring statistically lower than boys in terms of moral development on their measures. This intrigued Carol Gilligan, and thus her groundbreaking research began. She and her research team conducted interviews with young women to better understand the moral substance of their reasoning and choices. She reported this research in her bestselling book, In a different voice.  Although her work opened new avenues in ethical reasoning and research, ironically, the original assumption of a difference between boys and girls, like many such assumptions, turned out to be false! Males and females attend to justice concerns at roughly equal levels in most research projects. Further, more current research shows that all adults make moral choices inconsistently, depending on the dilemma, and each person’s social and personal goals in that moment.

Care ethics argues that moral decision-making should directly include concern for others and their well-being. Emotions of love, compassion, and empathy motivate us toward the care of others, thereby enhancing the relationships around us, and Dr. Bossypants would argue, the general condition of humankind. Those who advocate care ethics draw sharp distinctions between care reasoning and the approach reflected in Kohlberg’s work, called justice reasoning.  Propensities toward one or the other orientation were initially purported to fall along gender lines, but in fact, males can be morally guided by concern for relationships and the welfare of others, and females by concepts of justice.

Joan Tronto  wrote, “Care itself is not gendered.  Care is a species activity that includes everything we do to maintain, continue, and repair our world, so that we can live in it as well as possible.”

Care ethics place relationship in the center of the moral vision. Ecofeminist theorist, Karen Warren, stated:

If we dare to care, if we dare to enter into community with others through an honest recognition of our commonalities and differences, we will be poised to create generally respectful, nonviolent, care-based, intentional communities where commonalities and differences are just that . . . Such intentional communities are a creative alternative to violence-prone communities where order is imposed from outside through unjustified domination.

Western philosophical orientations are generally far more individualistic than Asian, African, and American Indian orientations.  Dr. Bossypants is worried that Western dominant culture is continuing on paths toward greater individualism, isolation, and commodified, single-purpose relationships, rather than communally-oriented and traditional, complex relationships.  Writer Jeremy Rifkin reflects on the moral power of traditional communities:

Membership in traditional communities also brings with it restraints on personal action.  Obligations to others take precedence over personal whims, and security flows from being embedded in a larger social organism. Commodified relationships, on the other hand, are instrumental in nature.  The only glue that holds them together is the transaction price.

Care ethics offers a moral alternative to an over-emphasis on individual notions of fairness and justice. It is centered both on immediate relationships and on the tapestry of relationships that extends to people of other races, creeds, and nations–and further, to all living things.

To understand how the tension between responsibilities and rights sustains the dialectic of human development is to see the integrity of two disparate modes of experience that are in the end connected.

While an ethic of justice proceeds from the premise of equality—that everyone should be treated the same, an ethic of care rests on the premise of nonviolence—that no one’s rights should be trampled, no one should be hurt. In the morally mature adult, both perspectives converge in the realization that just as inequality adversely affects both parties in an unequal relationship, acts of violence harm everyone involved. Mercy and justice are not mutually exclusive, people. We can do this. We can.

 

The Feminist Critique

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As faithful readers of Dr. Bossypant’s blogs, you may not realize how much restraint she has used writing about the moral/ethical information she has posted thus far. Regardless of the disparate views on ethics and morality summarized to this point, most originally shared a glaring omission. With the exception of the writings of John Stuart Mill, females were ignored, maligned, or “feminine virtue” was defined as women performing well in assigned positions of less influence and authority than their male counterparts. Aristotle believed that females were defective males, and punishment for doing badly as a man might be to come back as a female next time.

Taking his cue from Aristotle, St. Thomas of Aquinas wrote that in women, “reason flourishes very little because of the imperfect nature of their body.”  Freud believed that women lacked superego development, and were therefore morally inferior. Oh, sadly, there’s no shortage of such examples from religious and philosophical writings. For thousands of years with few exceptions, it has been morally permissible, or morally encouraged, to view and treat women as second-class, adjunct, inferior, and/or subjugated to men. As they say these days, Oh.My.God. What a load of hierarchical, wrong-headed bunk.

The truth is, since humans have been scratching ideas out on cave walls, women have been writing moral philosophy and psychology, often from a starting point very different from their male colleagues. But unless you take a course in the history of feminist ethics, the brilliant voices of these philosophers: Sappho, Hypatia, Hildegard, Heloise, Wollstonecraft, Harriet Taylor Mill, and Charlotte Perkins Gilman (to name but a few) are likely unfamiliar to you.

Of course, the current versions of the main ethical positions we’ve gone over in previous blogs have become, at least on the surface, gender-neutral. All humans are supposedly included. Further, feminist theorists and ethicists increasingly have a voice in the critique and evolution of moral philosophy.  And arising from Carol Gilligan’s pioneering research and thinking, feminists have added yet another lens through which we can explore and pursue moral lives. We’ll cover that one in the next blog, but for now, let’s consider…

The Feminist Critique

Over thirteen years ago, Harriet Woods wrote:

It is true that we still are far from fully represented in decision-making bodies and that politics remain a male game; but that’s no excuse for failing to use the power we have to make this a more livable world.

Dr. Bossypants is very disappointed to report that we still have a great deal of work to do to make this a more livable world.

In a word, the feminist critique of most traditional theories of morality is power.  Margaret Urban Walker wrote, “The most obvious way feminist ethics and politics connect morality and power is in examining the morality of specific distributions and exercises of power.”

The moral use of power is a complicated endeavor. This may come as a shock to you, but we don’t tend to select leaders based on their overall moral fiber. In an ideal world, those entrusted with power would be the more virtuous among us, and thereby freer from corruption, bias, and self-serving practices. The reality with which most of us are familiar is quite the opposite. The more power someone has to influence others and the social order, the more susceptible they become to misuse of the power.

Access to shared power is a global moral issue. In Beijing, at the UN Conference for women in 1995, Madeleine Albright stated, “Enter any community in any country, and you will find women insisting—often at great risk—on their right to an equal voice and equal access to the levers of power.” Still true. Still tragically costly. Holy ****, so very, very costly. Ok. Calm down, Dr. Bossypants. Social change take a very long time, requiring enormous sacrifice, enduring many regressions and backlashes….

So, dear reader, what is your experience with and attitude toward power? Have you seen individuals wield power in mostly positive ways or mostly negative ways? The need for power (or recognition or achievement) is a natural human need. Is it possible that racism, sexism, and all the other “isms” originate in the fear of loss of power? What is it like for you when you have power over others? What do you think is necessary so that power does not have a corrupting effect on people?

At this point in our “his” story, the earth is screaming for some answers and some new ways of being. We owe it to our species to get this figured out a bit better.

Utilitarian Ethics–a Tall Order

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Let’s face it folks. We live in a broken world. Let’s not get into who broke it, but we can all pretty much agree things are far from ideal, or perfect, or even as good as they could be. So how do we make it better? We ask ourselves the question made famous by Jeremy Bentham and his protege (and admirably early feminist) John Stuart Mill, the forefathers of Utilitarian Ethics. The question is this: What action will bring about the greatest good for the most people?  This approach is also known as consequentialist or teleological ethics–the focus is on the outcome of an action. It is a good, or moral, action if it beings about the most good possible for the most people.

Englishman, Jeremy Bentham (1748-1832), believed that pleasure or happiness was the “substance” that should be measured in this equation. To evaluate the moral merits of one action over another action, you assess how many people would be made happy, or be given pleasure by each action. Bentham wrote, “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure.  It is for them alone to point out what we ought to do…”

Bentham’s thinking was heavily influenced by the enormous social upheaval that gripped 18th century England.  He witnessed tremendous affliction all around him and sought a basis for morality that was both practical and social in nature. Bentham’s claim was that all acts and institutions must justify themselves by their utility—hence, the label “utilitarian.”

John Stuart Mill (1806-1873) was Jeremy Bentham’s godson and Bentham was a close friend of the Mill family. Though in basic agreement, as Mill developed his thinking, he came to believe that Bentham was wrong on one important point. Bentham believed that any kind of happiness was of the same value as any other kind of happiness. Mill argued that some forms of human pleasure was of higher quality than others, and therefore worth more in the utilitarian equation. He argued for the betterment of all humankind.

People are social beings. We tend to want to be in harmony with our fellow human beings.  Mill believed that at our core, people want the best for each other and are inclined to promote the common good. Wouldn’t it be nice if he was right about this??

Modern day utilitarians no longer try to quantify or qualify pleasure in a specific equation. They simply assert that morality is based on finding outcomes that will increase the common good, and decrease human suffering.

In contrast to deontological approaches (see the DUTY blog), utilitarians abandon any claim to moral certainty, because as I noted at the beginning, we live in an imperfect and fluid world. How could anyone assume moral certitude in an uncertain world? The best we can hope for is finding the greatest balance of good over evil in a world that has no perfection, no absolute goodness.

Many social reform movements can be seen as expressions of broadly-defined utilitarian thinking.  The welfare of the weak and disenfranchised members of society is counted as having equal weight and import in the overall fabric of society.  For instance, John Stuart Mill along with his wife, Harriet Taylor, was an early and articulate advocate for equal rights for women.

He wrote “…the principle which regulates the existing social relations between the two sexes—the legal subordination of one sex to the other—is wrong in itself, and now one of the chief hindrances to human improvement; and it ought to be replaced by a principle of perfect equality, admitting no power or privilege on the one side, nor disability on the other.”

Democracy, as a form of government, could also be seen as an expression of utilitarian orientation. Robert Bellah and his co-authors have pointed out that the right to vote in a democracy is one in which we ask the individual to assess and support the common good.  If a politician makes decisions based only on personal gain, we consider that politician corrupt (or at least, we used to…). This is equally true of the voter who votes not for the common good, but for their own personal gain. As moral citizens in a democracy, we are charged to evaluate and support what is best for the whole community.

In summary, utilitarian morality requires that we consider the outcome of our actions, and act to bring about the greatest good for the greatest number of people. It is immoral not to do so. This requires us to go beyond our own desires and preferences, and act in ways likely to enhance the lives of everyone around us, close by and far-flung. We are increasingly connected globally as a human community. floating along on our little blue earth. The moral challenge, to consider the common good, has never been more complicated, nor has ever been more crucial.

It’s All About Duty

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Why, oh why is Dr. Bossypants yammering on about morality…?? Three posts already, and more to come. Ugh. It can be SO boring. Yes. True. Boring. And vital. Do you want to survive as a species or not? Well. Then…

Onward in our journey through the land of morality. Someday, maybe soon, you’ll use this blog to scold or defend yourself. It will all be worth it. Today, we’re looking at morality through a lens called Deontological Ethics, a lens provided by Immanuel Kant (1724-1804).

Kant was the original “just do it” moral philosopher.  Regardless of how one feels about it, and regardless of outcome, there are moral duties that are applicable at all times and in all places. Some actions are morally wrong, no matter where or when they are enacted, and some are right. No weasel clauses allowed.

Kant also understood that we are mere mortals, incapable of always doing the right thing. He insisted that we at least be aware of when we are failing. For example, Kant argues that lying always causes some damage, even if that damage is no more than the liar knowing that he is choosing to do something wrong. But Kant also knew that people lie. He did not expect humans to completely stop lying, but he did urge people to consciously admit that they weren’t making a moral choice.  For Kant, lying was never, under any circumstances, morally correct.

Of course, the big question is this:  How do we know which actions qualify as always morally correct?  Kant came up with a guide for judging moral actions. He called it the Categorical Imperative–the ultimate yardstick for checking the morality of the action.  One of his formulations of the categorical imperative is this:

So act that you could will your action to be a universal law for all humankind. This is very similar to Jesus’s instruction: Do unto others as you would have them do unto you. Or remember when your parents said, “Now how would you like it if everybody acted like you’re acting?”

Another take on this imperative is this: So act as to treat humanity, whether yourself or another person, as an end-in-itself, never as a means only

Kant argued that even though there will be compelling practical or emotional factors in a given situation, it is our duty to consider the action through the lens of “always, everywhere, for everyone.”  Regardless of the circumstances, and regardless of the outcome, there are moral actions that are always right or always wrong.

Kant also believed that ethical principles apply to anyone capable of deliberation and reason. He believed there were three ways rational beings could interact with their duty, but only one would yield moral behavior.

  • They could act in ways that are clearly bad: actions such as lying, cheating, stealing, or torturing people.
  • They could act dutifully, but only for the show of it. Not because it is simply the right thing to do.
  • They could act from, or because of their duty–doing the right thing for the right reasons.

Only the third is a genuinely moral action. If you do the right thing for the right motives, then you have acted morally.  In fact, the less benefit you derive from doing your duty, and the less you actually want to do it, the more you can be sure your action is truly moral.

So, to sum up this stern Kantian input: You cannot use other people as a means to your own end. You must always evaluate your actions and act in ways that you would want everyone to act, in all times and in all places. An you simply cannot make yourself an exception to the rule.