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Big E Ethics and the tide of progress

By Miles Little - posted Monday, 18 October 2004


We expect too much of Ethics (with a capital E). It’s been around forever, I suppose, from the moment that our remote ancestors realised that they needed to collaborate to survive, and developed the language to talk about collaboration. Ethics is all about human relationships - relationships with one another, with animals, with the environment, with the universe, with the sacred. Every philosophical system has developed an ethics which has examined the ontology of categories such as ‘the Good’ or evil (metaethics), developed accounts of how it would be best for us to behave in our relationships (normative ethics), or described the way that people actually behaved (descriptive ethics).

In the West, the Greeks mixed relationships to the divine with secular rationality in their search for ‘good action’ and for phronesis, or practical wisdom. The church deployed a religious ethics for centuries, in which the relationship to the divine was centrally important. The power of God and the threat of divine punishment lent an external power to the ethical code of behaviour promulgated by churches. Since the Enlightenment, secular versions of ethics have gained ground, but sacrificed the compelling authority of religion. The great deists, like Leibnitz, gave ground to the sceptical secularists like David Hume. Kant – still profoundly influential in ethical thought – was a religious man who elaborated a rational and basically secular ethics.

Perhaps the most powerful stimulus to ethical thought in recent times emerged from responses to the Second World War, a war that seemed to mock Kantian notions of human beings as ends in themselves, rather than means to an end. Both Allies and Axis covered themselves with inglory by bombing non-combatants and by escalating the magnitude of ‘weapons of mass destruction’. The Nazis practised extreme racism in their attempts to exterminate Jews, gypsies and other ‘undesirables’. They also perverted the practice of medicine by their experiments in the camps, as did the Japanese in Manchuria.

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The 1940s saw the emergence of bioethics as a discipline - largely in response to Nazi extremism - and the development of principle-based ethics as a ‘modern’ way of bioethical thinking. The principles developed by the Georgetown bioethicists are still much employed - respect for each individual’s autonomy, the practice of beneficence, avoidance of maleficence, and respect for justice in the equal treatment of people regardless of sex, race, income or social class. Attempts to develop an equally clear-cut business ethics or an ethics of politics have been generally less successful.

In today’s secular society, we face a curious problem. We are devoted to the Western liberal notion of individualism and complain about every perceived infringement of our liberties. At the same time, we complain that there is not enough ‘law and order’, not enough control on the individualism of others. When doctors do bad things, make bad clinical judgements, overcharge Medicare, are ignorant of current advances, and so on, we want rules, controls and guidelines put in place so that this or that ‘will never happen again’. As the rules, controls and guidelines take effect, and as the law intrudes further and further into the practice of medicine, patients and their families complain that individual consideration is disappearing from clinical medicine. “Everything is done according to rule. I might just be a number.” This is the common complaint, and it’s frequently justified.

We can’t have individual transactions with our doctors unless we have trust. And rules, regulations, guidelines and laws intrude into the territory of trust, which is central to our ethical relationships with one another. They replace trust and discussion and flexibility with things that must be done.

Ethics has never been a monolithic structure determining in a stable fashion how we should behave. We look at Plato’s or Aristotle’s attitudes to women and to slavery, and cannot really accommodate them. Closer in time, some of the ethical values of the 18th and 19th centuries were very different to those we hold now. A famously ethical physician and surgeon in 19th-century Dublin wrote extensively on the treatment of syphilis. He gave the full names (and sometimes addresses) of poorer patients when he reported their cases in his papers. His well-to-do and more socially prominent patients were coded as ‘Mr D_’ or ‘Miss A_’. He was no respecter of the privacy of the poor, yet he was still regarded as a paragon of moral behaviour in his day.

Ethics are changing in our time of change. There are still values that matter, and they have to do with our autonomy, the integrity of our community, with human security and human flourishing. Most societies have ways of considering those fundamentals. In today’s pluralism, we can scarcely expect unanimous agreement on ethical details. The best we can hope for is the development of a discourse in which our ethical values are explored and developed, honoured and respected, and refined over time into expressions of security and flourishing for us as individuals and the communities in which we live. It would help if schoolchildren could learn that this discourse is vital to them, their society and the world at large.

Schoolchildren are often remarkably idealistic, and equipped with shrewd insight into the hypocrisies of the adult world. They need to discuss openly the pros and cons of the war in Iraq and the Tampa affair, the nature of the debates about funding for health and schools. We adults might learn a lot from listening to them.

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We may not have ethical reform in our time, but our children and grandchildren may yet have a different idea of ethics as a dynamic, discursive practice, rather than a set of immutable principles inherited from their elders. If they do develop such a notion, politics, the professions and commerce could all benefit. In some of those areas, the ethical situation could hardly be worse than it is now.

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About the Author

Emeritus Professor Miles Little is Director and founder of the Centre for Values, Ethics and the Law in Medicine at the University of Sydney, which is a Cornerstone Member of National Forum.

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