An Approach to Teaching Ethical Decision Making in Medicine & Life Sciences

By Ernlé W.D. Young, Ph.D.

I'm going to talk now more generally about the way I approach ethical issues in medicine or the life sciences. Maybe I should be drawing a distinction between "ethical" and "moral". I think this is a useful distinction to draw. The two words are used synonymously, either as adjectives or, far more commonly, in the noun. So we talk about an ethical politician or an immoral physician interchangeably. But I draw the following distinction. I'd say that morality is group specific, is the intent of a group or an individual in the group, to live out that individual or that group's vision of the highest good.

What are the differences between the terms "ethical" and "moral"?

Usually, moral systems are tied to religious systems, so that Jewish medical ethics will approach problems, moral problems in medicine, quite differently, say, than Roman Catholic medical ethics, appealing to different sources, different traditions, and different authorities. And both of those will be very different from Islamic medical ethics. Again, in Islamic ethics or morality, they appeal to different texts and different authorities. Thus morality tends to be specific to groups and is tied often to the predominant religious tradition within that group. Ethics, in contrast, is a more public enterprise and has to use a common language that transcends--transcends maybe is the word--the languages used by the different groups. Or let us put it another way, enables people of all different groups to understand what is going on.

For example, if you as a devout Roman Catholic tell me that something is moral because the Pope says so, I may not buy that because I may not think that highly of the Pope. So, if you want to persuade me that this is the right thing to do, and I'm not somebody who shares your beliefs, you have to use a language that is commonly spoken, that is to say, a language of reason. You have to bring forward reasons that I can buy into or not, in support of the position you are propagating. And I think that's the job of ethics, to use a common language in a public forum for arriving at judgments about the appropriateness or the inappropriateness of attitudes, actions, behaviors that touch on the life of all of us.

A public/private distinction…

So it's that public/private distinction that I draw, and what I'm going to be doing now is try to speak the language of ethics, rather than the language of morality. That is to say, I'm not going to appeal to any private moral convictions or beliefs that I may have but try to frame it in a way that is publicly understandable. Is this a useful distinction for you? Because I think it's very important. By the way, this raises another interesting question in a multi-cultural society where there are many moralities. And it's the question of moral relativism versus what you might call moral universalism. Is morality all relative to what group you belong to geographically or historically or are there moral universals that transcend these groups? I think this is a real problem within the multi-cultural society.

For example, it may be a lot easier for the Taliban in Afganistan to come to a consensus about the right or the wrong thing to do, because that's a fairly homogeneous society and a fairly monolithic system. But we have so many competing groups, ethnic, cultural, and religious, that it's very difficult to say this is the way that everybody must follow. We have to arrive at that painstakingly through a process of public discourse and what we come up with may not be the perfect solution to the problem. It may be the best we can come up with, given our heterogeneity. So, that's the way in which I want to approach this.

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