Tag Archives: ethics

Academia, Clinical, Culture, Emergency Medical Services, Health Care, Society

Quality and Safety Measurement

In regards to the incident surrounding the death of Josie King (Josie King Foundation, 2002), there have been many great improvements in the delivery of care at Johns Hopkins (Niedowski, 2003; Zimmerman, 2004). Those aside, and if I was faced with having to develop performance measures of quality and safety in the context of such a tragedy, I would strive to ensure that my measures were accurate and valid to identify areas of grave concern where Johns Hopkins would do good to improve.

First, I would consider measuring the structure of the care delivered. In Josie’s case, a medical response team responded when it was identified that she was in the midst of a medical crisis. The first measurement would serve to identify the availability of such teams and the adequacy of the team’s staffing. The measure would indicate the response time of the team and the licensing and certification level of each team member.

Second, I would consider measuring processes that might have contributed to the death of Josie King. In this instance, Josie was administered a narcotic while suffering acute dehydration. The administration of this medication was contrary to the physician’s orders regarding pain medication for this patient. This measure would indicate the appropriate use of narcotic analgesia in patients faced with contraindications, such as acute dehydration or shock. This measure would be a cross tabulation of recent vital signs and laboratory results.

Third, I would consider measuring outcomes. In cases where pediatric patients are downgraded from the pediatric intensive care unit (PICU) to a general ward, any adverse condition should prompt an upgrade back to the PICU. This measure would identify the number of cases in each reporting period that any recently downgraded patient was upgraded back to the PICU. This measure should account for the time between a crisis and upgrade along with a statement indicating the cause of the crisis and resultant upgrade. This measure should be augmented by a mortality and morbidity subset involving any patients who were downgraded from PICU.

My considerations for these processes are to determine if general ward nurses should be administering any medications on standing order or if there should be a requirement to ensure that any medication administered to a general ward patient is explicitly written in the patient’s chart at the time of administration. Also, nurses should be acutely aware of the contraindications of any medications that they are administering. The process measure will, hopefully, identify misuse of narcotic analgesia and any failure to assess the patient for other possible causes of distress before assuming the distress is in response to pain. Ultimately, a more timely and efficient use of medical response teams should result, which would avail physicians and more experienced nurses to the original patient care team. This should lead to an open discussion of how to better manage the patient post crisis. Also, a greater understanding of medication administration concepts should result, benefiting all patients.

References

Josie King Foundation. (2002). About: What happened. Retrieved from http://www.josieking.org/page.cfm?pageID=10

Niedowski, E. (2003, December 15). From tragedy, a quest for safer care; Cause: After medical mistakes led to her little girl’s death, Sorrel King joined with Johns Hopkins in a campaign to spare other families such anguish. The Sun, pp. 1A. Retrieved from http://teacherweb.com/NY/StBarnabas/Quality/JohnsHopkinsErrors.pdf

Zimmerman, R. (2004, May 18). Doctors’ new tool to fight lawsuits: Saying ‘I’m sorry’. Wall Street Journal, pp. A1. Retrieved from http://www.theoma.org/files/wsj%20-%20medical%20error%20-%2005-18-2004.pdf

Academia, Clinical, Emergency Management, Emergency Medical Services, Health Care, Public Health, Society

Medical Error: The Josie King Story

Josie King’s story (Josie King Foundation, 2002; Niedowski, 2003; Zimmerman, 2004) is heartbreaking, but the events told herein empowered Sorrel King, Josie’s mother, to take on a mission responsible for numerous patient care recommendations that have enhanced the safety of pediatric patients throughout the country. Josie King was only 18 months old when she climbed into a hot bath and suffered 1st and 2nd degree burns which led to her being admitted to Johns Hopkins pediatric intensive care unit (PICU). Within 10 days, Josie was released from the PICU and brought to the intermediate floor with all assurances that she was making a remarkable recovery and would be released home in a few days. Josie did not continue her remarkable recovery, however.

According to Sorrel King (Josie King Foundation, 2002), Josie began acting strangely, exhibiting extreme thirst and lethargy, after her central intravenous line had been removed. After much demanding by Sorrel, a medication was administered to Josie to counteract the narcotic analgesia she had been administered. Josie was also allowed to drink, which she did fervently. Josie, again, began recovering quickly. Unfortunately, the next day, a nurse administered methadone, a narcotic, to Josie as Sorrel told her that Josie was not supposed to have any narcotics… that the order had been removed. Josie became limp and the medical team had to rush to her aid. Josie was moved back up to the PICU and placed on life support, but it was fruitless. Josie died two days later and was taken off life support.

The Institute of Medicine (2001) published six dimensions of health care: safety, effectiveness, patient-centered, timeliness, efficiency, and equality. In Josie’s case, the care was not delivered efficiently, effectively, safely, or in a patient- or family-centered fashion. The overuse of narcotics in Josie’s case was certainly not effective or safe. Additionally, withholding fluids and allowing her to become dehydrated was detrimental to her recovery, which was neither safe nor effective. As Josie exhibited extreme thirst, her symptoms were dismissed, which does not follow patient-centeredness. Moreso, when the nurse administered the narcotic to Josie despite the pleadings of her mother, it demonstrated a lack of family-centered care, safety (in that, the order should have been double checked), efficacy (further demonstrating overuse of narcotic analgesia), and efficiency, as medication orders were either unclearly written or removed.

This story is clearly a demonstration that mistakes can happen at even the best of hospitals.

References

Institute of Medicine. (2001, July). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Josie King Foundation. (2002). About: What happened. Retrieved from http://www.josieking.org/page.cfm?pageID=10

Niedowski, E. (2003, December 15). From tragedy, a quest for safer care; Cause: After medical mistakes led to her little girl’s death, Sorrel King joined with Johns Hopkins in a campaign to spare other families such anguish. The Sun, pp. 1A. Retrieved from http://teacherweb.com/NY/StBarnabas/Quality/JohnsHopkinsErrors.pdf

Zimmerman, R. (2004, May 18). Doctors’ New Tool To Fight Lawsuits: Saying ‘I’m Sorry’. Wall Street Journal, pp. A1. Retrieved from http://www.theoma.org/files/wsj%20-%20medical%20error%20-%2005-18-2004.pdf

Academia, Culture, Emergency Medical Services, Health Care

Motivation: A Career that I Enjoy

I am lucky to work in a career that I absolutely enjoy. As a paramedic in the emergency medical services (EMS), I am called upon to help those in my community in the worst of circumstances to help them when they feel helpless. There are drawbacks, however. Many people rely on EMS for problems that even they do not view as emergent, and others just plainly abuse the system. Still, I enjoy being the one called upon to help. My primary motivations are my sense of community, my ability to reduce suffering, and my ability to raise the standard of care within the system. Maslow (1943) includes some of the earliest accepted work on motivational theory, and more contemporary work is based on the acceptance, rejection or modification of his theories, so I will focus on Maslow to begin. My needs, according to Maslow, are not as important to motivation. Need fulfillment will not motivate me to perform; however, a lack of fulfillment may prevent me from performing. This is especially true for Maslow’s lower-order needs. Maslow discusses how emergency situations can “obscure the ‘higher’ motivations [and create] a lopsided view of human capacities and human nature” (p. 375), and while my career is focused on responding to emergencies, this may hold true for me. While Maslow’s theory is not wholly accepted motivational schema (Robbins & Judge, 2010), EMS managers, and other public safety managers, would do well to understand this exception to motivational theory.

Many EMS managers, it seems, subscribe to McGregor’s (1957/2000) theory X without understanding the ramifications or the competing theory Y. There is a deep-seated belief that the workforce is lazy and will do anything possible to undermine the operation. This results in micromanagement tactics that seem to promote an unwillingness to promote the goals of the employer. McGregor highlights this and cautions that it a result of poor management technique, not a cause that is easily rectified by the chosen technique.

Other theories, such as goal-setting, equity theory, and expectancy theory, as described in Robbins and Judge (2010), are all lacking in one particular constant: there is no constant in human behavior. There are a number of ways that a single motivational factor might influence a particular person on any particular day. For any theory to always be true in every situation, it would cease to be a theory and become a law. This being said, as managers, we need to measure the importance of certain tasks and focus our efforts on communicating this importance to the workforce. It is the manner of this communication that will tend to fail or succeed, based on both the needs of the manager and the needs of the employee at the moment the message is passed.

References

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. doi:10.1037/h0054346

McGregor, D. (2000). The Human Side of Enterprise (Reprinted from Adventure in thought and action: Proceedings of the fifth anniversary convocation of the School of Industrial Management, Massachusetts Institute of Technology, Cambridge, 1957, April 9. Cambridge, MA: MIT School of Industrial Management). Reflections, 2(1), 6-14. doi:10.1162/152417300569962

Robbins, S. P. & Judge, T. A. (2010). Motivation concepts. Essentials of organizational behavior (pp. 62-79). Upper Saddle River, NJ: Pearson Prentice Hall.

Academia, Clinical, Culture, Emergency Medical Services, Health Care, Politics, Public Health, Society

Physician-assisted Suicide

I have always maintained that the best thing that I have ever done for a patient was to hold their hand as they died; however, there are few scenarios that I can posit where I would ever cause the death of another, and I would never do it in my capacity as a medical professional. In the State of Connecticut, assisting a patient in their suicide is illegal (Kasprak, 2003; Saunders & Smith, 2010). Saunders and Smith (2010) describe the use of “semantic ploys” (para. 3) in arguing for physician-assisted suicide and how the court deemed the “issue rests with the legislature, not with the court” (para 4).

Two states have laws permitting physician-assisted suicide, Oregon and Washington (Death with Dignity Act, 1997; Death with Dignity Act, 2008). The other 48 states either have laws forbidding assisted suicide, such as Connecticut, rely on common law, or have no laws permitting or forbidding the practice (Kasprak, 2003). Personally, my thoughts on the matter are clearly reflected in my opening statement. More compelling, however, is a recent discussion on the discontinuation of implanted cardiac devices in patients with a desire to “refuse continued life-sustaining therapy” (Kapa, Mueller, Hayes, & Asirvatham, 2010, p. 989). Many of the respondants to this study viewed the discontinuation of pacemakers akin to physician-assisted suicide, whereas less felt the termination of cardioverter-defibrillator therapy was an ethical issue. Oddly, lawyers indicated less problems discontinuing therapy than did physicians.

There are conditions that are so intractably painful and wrought with suffering that I would not even consider thinking less of a person suffering such a malady who took their own life. Death, for many people, is a fear beyond fear, and for a person (of considerable sound mind) to choose death as a viable alternative to such suffering, I commend their bravery and choose not to judge them negatively. No physician or other health care provider should cause the death of a person directly, but acknowledging the patient’s will to die is another matter. In lieu of providing a chemical means of ending life, a physician could, in my mind, counsel a patient on the means and methods that might be viewed as more effective and humane than other means which might result in unwanted suffering. I do believe that a person has the right to choose an alternative to a surely painful and agonizing death, regardless of the presence of depression. If a person is suffering from depression because of a terminal illness that is causing physical suffering, it is hard to imagine this person will resolve the depression before succumbing to the causal disease process. In these cases, the person has the right to choose a more dignified death. For those cases where the person is incapacitated and cannot make health care decisions, I feel that any friend or family member, or a consensus of available friends and family members, should be able to make the decision to continue or discontinue life-sustaining measures. Even if the decision is wrong for the patient, most of the time the decision is for the benefit of the family and friends and lacks medical relevance aside from resource management, though there are spiritual, emotional, and moral considerations that the next of kin may face which are no less relevant.

Personally, I grant any person permission to end my life if they see me engulfed in flame or if taken on the battlefield by an enemy known for public torture. Beyond these two circumstances, I will always choose to live so long as I have my thoughts. I have heard some people intimate that they would wish to die if they were conscious but perpetually paralyzed (i.e. locked-in syndrome); however, I am not so sure that I would want to die just for lacking the ability to communicate with others. I would want to view the world, though, perhaps by television or radio. I am too curious as to what comes next for the world. As we interfere with the dying process, it does make sense that we address the morality in which we do this. It does not seem right to have brain dead patients connected to ventilators and feeding tubes forever. It’s Orwellian.

References

Death with Dignity Act of 1997, O.R.S. 127.800 et seq. (1997).

Death with Dignity Act of 2009, R.C.W. 70.245 (2008).

Kapa, S., Mueller, P. S., Hayes, D. L., & Asirvatham, S. J. (2010). Perspectives on withdrawing pacemaker and implantable cardioverter-defibrillator therapies at end of life: Results of a survey of medical and legal professionals and patients. Mayo Clinic Proceedings, 85(11), 981-990. doi:10.4065/mcp.2010.0431

Kasprak, J. (2003, July 9). Assisted suicide (OLR Research Report No. 2003-R-0515). Retrieved from http://www.cga.ct.gov/2003/olrdata/ph/rpt/2003-R-0515.htm

Saunders, W. L. & Smith, M. R. (2010, June 21). Assisted-suicide advocates fail in Connecticut. National Review Online. Retrieved from http://www.nationalreview.com

Academia, Health Care, Society

Henrietta Lacks

Grady (2010) offers the circumstances of Henrietta Lacks for discussion as it pertains to medical ethics. Henrietta Lacks was a young woman who succumbed to cervical cancer in the early 1950s at Johns Hopkins Hospital (Grady, 2010; Sorrell, 2010). Grady describes Henrietta Lacks and her family as “poor, with little education and no health insurance” (para. 10), yet she was cared for and her cancer was treated with radium, the standard treatment of the day. Despite treatment, Henrietta passed away. During the course of her treatment, however, a small sample of cancer cells were removed from her cervix for testing, and they continue to be tested to this day (Grady, 2010; Sorrell, 2010). Additionally, this line of cells, now known as the HeLa cells, has become commercialized, as they are bought and sold for millions on the biomedical research market (Grady, 2010).

Assuming no consent was given by Henrietta or her family, this raises a few questions. Did the physicians at Johns Hopkins have a right to these cancer cells? Did they have a right to transfer ownership to third parties? Does the estate of Henrietta Lacks require royalties be paid when others profit from what amounts to a donation to the public domain?

No person can own another person (or, a part thereof). This is consistent with the moral society of the United States. However, Henrietta Lacks presented herself to Johns Hopkins hospital with the express desire to rid herself of the cancer cells causing her illness. This alone could mean that the cells are refuse and able to be salvaged, and according to Fost (2010), this is agreed to be the law of the land. Fost describes the circumstances surrounding the HeLa cells as normal course of medical business, and I agree for the most part: “If tissue removed during an operation is about to be thrown out with the garbage and has no identifying information, it should be permissible to use it for research without the patient’s consent” (2010, para. 1). In this case, however, the researchers later approach the Lacks family to obtain DNA samples to discriminate between HeLa cell cultures and non-HeLa cell cultures. This mere fact offers evidence that the tissue is identifiable with Henrietta Lacks and her lineage, and I feel, as does Fost, that this is where the researchers erred, in asking for continued support of the cells by obtaining further comparative specimens for analysis yet not clarifying the misconceptions of the family. The researchers should not have requested further tissue (i.e. blood) donation without obtaining informed consent from the donors. Further, the cell line were given a name representative of Henrietta Lacks, HeLa, and she was named as the donor and widely known as such throughout the biomedical research community. Ergo, there were certainly identifying data linking Henrietta Lacks to the specimen.

Remuneration

Certainly under normal circumstances the cells should be made available for research purposes, but they should not be sold for profit, only for the costs of storage and maintenance. Any tissue freely used for medical science should be in the public domain. Further, if a specimen is found to have financial worth, I feel that the custodial researchers should set aside a royalty account allowing a small percentage of the proceeds to be returned to the donor’s estate. I also feel that if researchers have any special interest in further donation, then those donors should be offered remuneration for their donation which should be commensurate to the gains assumed to be made by their donation.

I find no issue with how the cancer cells were used initially, however, the sample should not have been attached in name to the donor. Though not required, it would have been nice if the researchers provided a royalty to the estate of Ms. Lacks, however, to thank her for her contribution to medicine and science.

References

Fost, N. (2010). A cell’s life: The immortal life of Henrietta Lacks. Issues in Science and Technology, 26(4), 87+. Retrieved from http://ic.galegroup.com.ezp.waldenulibrary.org

Grady, G. (2010, February 1). Second opinion: A lasting gift to medicine that wasn’t really a gift. The New York Times. Retrieved from http://www.nytimes.com

Sorrell, J. M. (2010). First do no harm: Looking Back to the Future [Editorial]. Journal of Psychosocial Nursing & Mental Health Services, 48(9), 2-3. doi:10.3928/02793695-20100730-07

Academia, Culture, Emergency Medical Services, Health Care, Society

Codes of Ethics

Of the three ethical codes presented by Lewis and Tamparo (2007), I align myself most with the Principles of Medical Ethics: American Medical Association (AMA). The AMA promotes honesty, integrity, compassion, respect, and most importantly, responsibility. In all manners of occupation, it is virtuous to remain honest; this is paramount in medicine. Physicians, nurses, paramedics, and other health professionals may make mistakes during their career, and it is important that these mistakes be corrected as soon as possible and understood to promote practices that may minimize the same mistake from happening. Honesty leads to integrity. Integrity is a hallmark of professionalism and, in conjunction with honesty, promotes trust. Having compassion and respect for patients regardless of political, societal, economic, or other divisions allows a provider to actually care for his or her patients rather than just deal with them. As a paramedic, I try to be as trustworthy and caring as possible to each and every patient I see. Ultimately, I understand my responsibility to my community, to fellow clinicians and technicians, to patients, and to myself. I hold ultimate responsibility for my actions and inactions, and I take care to not let these adversely effect the perception others hold of me as a professional. The AMA expects this of all physicians, and as an extension of the physicians I work for, I must strive to meet the same demands.

The Hippocratic Oath is dated in its language and demands. Though the oath can be approached as symbolism, the metaphor can be lost on some. I appreciate the Hippocratic Oath for what it is (a foundation for the ethical practice of medicine), but contemporary words, meanings, and application serve me better.

I find the Code of Ethics of the American Association of Medical Assistants lacking in context, applicability, and substance when adopted for paramedicine, my chosen occupation; therefore, I do not align as well with this code as I do with the previously mentioned codes of ethics.

Codes of ethics provide baseline philosophies that serve to direct the actions of groups. By ascribing to such, the professional belonging to such a group allows the code to guide moral judgments when the answer is unclear. In medicine, this is especially true. Medical professionals deal with life and death decisions which stretch the boundaries of personal moral beliefs. By ascribing to a notion of a slightly higher directive than one’s self, the professional can remove his- or herself from the situation with more clarity and less bias.

My personal ethics are bound by a sense of personal liberty and the responsibility of that liberty. Without responsibility, there are no consequences. Without consequence, there is no learning. I like to learn so that I may be the best paramedic that I can to the next patient in my care. For me, it is always about the next patient; they deserve the best that I can offer.

References

Lewis, M. A. & Tamparo, C. D. (2007). Codes of ethics. In Medical law, ethics, and bioethics for the health professional (6th ed.; pp. 241-243). Philadelphia, P.A.: F. A. Davis.

Academia, Society

Occupational Social Responsibility

According to Barendsen (2007), my profession is a caring one. I am a paramedic and I serve my community. I am also a firefighter who serves his community without compensation. It could be said that I blur the lines between my professional and personal life, but I enjoy great satisfaction doing so. I am by nature a very socially responsible person, but I extoll the virtues of taking personal responsibility. As a paramedic, I have a mantra: we combat stupidity.

As Barendsen (2007) points out, “workers in caring professions typically describe themselves as filling in or taking over a responsibility that others have abandoned” (p. 173). Everyone at some point in their lives makes stupid decisions. This is part of human learning, but some of these mistakes can unfortunately be lethal. This is where I feel that I make a difference in the lives of others. Driving too fast, smoking, eating too many fatty foods, or incidences of drunken abilities (in Texas, we had a saying that no good can from the statement: hey, hold my beer; watch this!). We all make these mistakes, thus we are all prone to stupidity from time to time. I enjoy the fact that many times I can help to allow others to learn from these mis-steps and reduce the lethality of their decision matrix.

There are times, however, that I have to get away from my occupation for my own sanity. I enjoy a number of hobbies and friends with varying interests that I can rely on to take my mind off of the worries of work. Also, attending school gives me added balance in the personal development side of life. Though attaining my degree will certainly better my professional outlook, I am seeking a degree solely for personal achievement. The prevalence of burnout in my profession is extremely high (Felton, 1998; Neale, 1991), so I make great efforts to balance and separate my personal life from my professional life. Admittedly, this is difficult at times because I am almost always on call.

References

Barendsen, L. (2007). Service at work. In H. Gardner (Ed.), Responsibility at work: How leading professionals act (or don’t act) responsibly (pp. 172-195). San Fancisco, CA: Josse-Bass.

Felton, J. S. (1998) Burnout as a clinical entity — its importance in health care workers. Occupational Medicine, 48(4), 237-250. doi:10.1093/occmed/48.4.237

Neale, A. V. (1991). Work stress in emergency medical technicians. Journal of Occupational and Environmental Medicine, 33(9), 991-997.

Academia, Society

Social Justice vs. Social Responsibility

Recently, I find myself reacting the most to the progressive social justice movement. Social justice, “often employed by the political left to describe a society with a greater degree of economic egalitarianism, which may be achieved through progressive taxation, income redistribution, or property redistribution” (Social justice, n.d., para. 2), is a political push towards socialism. I do not view this movement as socially responsible, and I will explain why.

I was a high school student during the Clinton presidency, and when he announced a national rebate based on the federal surplus of tax dollars. Though I believe the economic boon was due to comprehensive reforms under President Reagan, I will give President Clinton credit for maintaining it as long as he did. It was at this point that I decided that I needed to understand politics and economics in a way that would allow me to make more responsible choices as a voter. Since then, I have watched as Presidents Clinton, Bush, and Obama have squandered our money for their supporting political allies, forsaking the people of the United States.

I had considered myself a Democrat until I took the time to understand the simplistic nature of economics. Obviously disagreeing with left-wing politics, I analyzed the right and found much more of the same waste, fraud, deceit, and callousness in the Republican party. I found that I had to understand my own values before I could vote again. My values are much more in line with the libertarian philosophy that once made this country great. Libertarianism is about freedom, freedom to make choices, freedom to succeed, and most importantly, freedom to fail. For failure is the greatest teacher and motivator.

The United States is heading for a disastrous economic climate where millions of people who rely on government subsidy will find themselves without benefit. Government-subsidized social programs, such as welfare, Medicare, et al., are meant to be stop-gap measures designed to temporarily fix problems to extend the time available to find more permanent solutions. For welfare, short-term use precludes this necessity, but abuse assures the programs demise.

The greater social responsibility is understanding that as a member of our great society, and in order to help many, we need to support the survival of our society. This means that we, the individuals, need to be self-sufficient. This means that we, the communities, need to be self-sufficient. This means that we, the states, need to be self-sufficient. This means that the next larger government is there to help the next lower government recover from the unforseeable. As individuals, we need to rely on ourselves, our families, our neighbors, and our community before asking for a hand-out from the state, and we should never have to ask for hand-outs from the federal government.

This post may seem like political ideologue drivel, but I assure the reader that it is not. Some, like the author of our class text, would have you wave a sign for the sake of political or environmental activity (Loeb, 2010, p. 10), but I argue that if we all minded our own homes with such conviction, then no one would dare stand up to advocate diminishing us as people. So long as an action benefits society, it is socially responsible. And, I am socially responsible.

References

Loeb, P. R. (2010). Soul of a citizen (2nd ed.). New York, NY: St. Martin’s Griffin.

Social justice. (n.d.). In Webster’s online dictionary. Retrieved from http://www.websters-online-dictionary.org/definitions/Social+Justice

Politics, Technology

Indigenous People

In order to define a term, such as “indigenous peoples”, one must examine the words that make up the phrase. “Peoples” are collections of societies, and “indigenous” implies nativity or autochthony. I have always considered “indigenous peoples” to be those societies that have an intrinsic relationship to the land inhabited. Ergo, when a society is provided for by the land, the act of habitation changes the land, and that land changes the society in a fundamental way. Whenever this is true and can be applied to a society, then it is a society of indigenous people.

The largest difficulty in defining or categorizing human beings is the resultant scale upon which they are measured as a group. I do not hold such inclinations as to group and sort people based on ethnicity, societal values, economics, or any other humanly devised subjective measures. The United Nations (2008) requires a society to be impoverished or suffer some other gross inequality in order to claim indigeny. I feel that this approach only serves to feed ideologic notions by marginalization and deprives the society from a rightful claim. By attempting to create a system to help indigenous peoples from inequality, the United Nations has sought to identify these peoples and have instead cast a definition upon them. Certainly, this is a problem.

References

Secretariat of the United Nations Permanent Forum on Indigenous Issues, Division for Social Policy and Development, Department of Economic and Social Affairs. (2008). Resource kit on indigenous peoples’ issues. New York, NY: United Nations. Retrieved from http://www.un.org/esa/socdev/unpfii/documents/resource_kit_indigenous_2008.pdf

Academia, Society

My Ethical Reckoning and Edification

In my study of ethics, I have had some difficulty understanding the application of theories in light of the arguments from competing camps. I am finding it more reasonable to define my own value system, then compare this with the virtues of others. Only then can I truly appreciate the applicability of the ethical theories presented to me.

The most problematic theory is the divine command theory. In Thiroux and Krasemann (2009), divine command theory is told to be a nonconsequentialist theory derived from a set of edicts put forth by some absolute ruler of the universe (p. 54). First, I oppose their categorization. As most religions have some villainous being to rule over an underworld filled with those who violate these edicts, it seems to me that the threat of eternal damnation is certainly a valid consequence for believers of these religions. In contrast to negative consequences for bad acts, the same religions tell of eternal bliss for following its rules, positive consequences for good acts. More to the point, as Thiroux and Krasemann (2009) so aptly point out, there is no rational foundation for the existence of such a being (p. 57). I agree with this view, as it is illogical to base morality in such a weak argument.

Kant’s duty ethics appear to have more validity. Kant recognizes that we have a duty to act morally (Thiroux & Krasemann, 2009, p. 59). Unfortunately, Kant does not go further to explain how this duty has manifested. Thiroux and Krasemann attempt to explain Kant’s theory as nonconsequentialist based on absolute moral rules relying on poor logic such as the example provided, “all triangles are three-sided” (p. 57). It does not take a mathematician to understand that all triangles are three-sided purely by definition and not by reason or logic. Therefore, any absolute moral rule must be absolute by definition, and it must have a reason in order to be reasoned as such. It is these reasons, such as the continuum or failure of society, that would make this theory a consequentialist theory, and all of the duties of this theory are based solely on the vitality of society. Ergo, it would only be moral to work for society, and it would be immoral to work against it. This would be valid if there was truth in that any particular society should flourish over another. Nazi Germany comes immediately to mind.

With his prima facie duties, Ross, on the other hand, admits to consequences having bearing on choices, but he cautions that their import should be minimized when considering right and wrong (Thiroux & Krasemann, 2009, p. 62). Like Kant, Ross gives no thought to the origins of his duties, though those that he did enumerate seem to provide for the good of the individual and for society. I can certainly appreciate better the motifs of Kant and Ross over the weak foundations of divine command theory.

To more fully understand my ethics, I had to look past my mundane habits and take a truly in-depth look at the origins of my beliefs, then I had to question the motivation for each. For one, I ultimately believe that killing another human being is wrong, but do I find it unethical, and if so, to what degree. Is the taking of a human life ever ethical? Further, in order to understand my own ethics, I feel that I must analyze the basic motivations of our instincts and how we have evolved from primitive organisms into the social creatures that we are. It is this social bonding, after all, that creates this sense of morality that I am questioning.

It is understood that at some point in our development as a species, we appreciated that we were more effective as a group than as individuals competing against each other. In order to live together, we must have realized the need to develop rules and boundaries as they relate to our interactions within this social group. I believe that these rules were based on our primal needs and were focused on the benefits of banding together. For example, I mentioned killing in the last paragraph. As an early social group, we would benefit from safety in numbers over individually facing predation. If this is a benefit of social grouping, then why would this type of open competition be favored within the group? It would not. Another example would be the primal need for food versus the act of stealing. The social group would condemn stealing another’s food, thus stealing, itself, becomes taboo. This, I believe, is the reason that we have morality, and we have gotten so far from this basic understanding of morality that our own personal ethics have become confused and complicated. All of the basic moral understandings that are common in many cultures can be traced back to the first pre-societies: dishonesty, gluttony, murder, sloth, theft, and later, apathy, despondency, greed, lust, pride, and vanity.

To me, it is permissible to take a human life. It is permissible to take the life of an innocent person. One example that epitomizes this position is in the face of a torturous death. The ability to, on request, peacefully end the life of someone facing death by torture is virtuous to me. Another example would be my belief in the usefulness of euthanasia. Are these examples of murder? I think not; murder involves malice, and there is no malice in these examples. With this thought, one can still hold that all murder is unethical while killing an innocent person.

As our social system evolved, so have our needs. We are no longer few in number with common basic needs, but we are many, within many societies, and with many different needs. Though, we are still human. From our origins, as I have described, we have created our rules, a common morality that should hold true in any society, except the most exotic. Within our newly formed societies, we have prescribed rules which have evolved with our societies and have grown as societies have grown and split into other societies. Cultures within societies will augment the rules, as will the various sub-cultures. Each and every amalgam, still, has evolved from a more singular set of basic rules.

These rules must be relative to the needs of the members in order to be effective, creating a more relativist morality.

The rules of life have changed. As an American, I no longer value food, water, and shelter as much as I value my freedom and liberty. How can that be? At some point in the past, food, water, and shelter were abundant, yet people were probably prohibited or limited. Our ancestors fought hard to regain their freedom, and this appreciation of liberty has been passed down in such a way that I value it more than life, itself. This, too, is an evolution of morality. This is the point that my ethics cease to remain basic and evolve with the functionality of my society, where necessity triumphs over morality.

My understanding of morality is more or less bound to social contract theory in that, as a society, we have a better quality of life. Each decision that we make ought to reflect our willingness to participate wholly within society, lest be made pariahs. Within society and personal and business relationships, we engage in interactions that involve decision-making. It is these decisions that we consider when discussing ethics and morality. Within societies, there is competition. Competition within a society is a part of nature, part of evolution, and a healthy device to ensure survival. There are also rules within this competition. Unfortunately, our society has reversed many of these rules. As we have become more ‘civilized’, we have sought to provide a common mechanism to adjudicate morality, and in turn, project our personal ethics upon others. This is an aberration of justice, yet it is accepted as part of the process. The bane of society is regulating morality in such a way that is inconsistent with truth and integrity. We have certainly fallen far from our moral high-grounds in search of a harmonious existence.

It appears that I am getting an ‘ought’ from an ‘is’. This is correct. I feel that in order to fully understand how we ought to act, I need to know why we act as we do. There must be valid reasons. It is the same reasons that we must listen to intuition. Many early philosophers have regarded our ability to reason as the one trait that separates us from all other life on Earth. This reasoning is responsible for intuition, for gut-feeling, and it should not be ignored. If we feel that something is wrong, it is most likely wrong. We do not need to understand why it is wrong for it to be wrong, but we should accept that it is probably wrong and seek out the answer why. For someone to claim that they are a consequentialist, then examine the consequences of an act to determine if it is right or wrong is ludicrous to me. It is this cart before the horse thinking that has confused me in the classroom study of ethics. We must have faith in our ability to reason and that we have probably been faced with a similar scenario at some point in the past. Intuition will tell us so.

I cannot say that I align with any one of the three theories presented. At the same time, I can both appreciate some of the positions of each and can align with some of the arguments while I find portions of each incompatible with my views and beliefs. Every decision that we make has two alternatives to choose from, action and inaction. Though decisions can seem to be complex, they are various combinations of criteria in steps of action-inaction decision modeling. For each step, we determine the value of each decision and the higher valued path is the one chosen. Unfortunately, not many people have refined critical thinking skills to allow them to consider important possibilities that might otherwise be overlooked. The resultant anemic decision-tree usually offers little in the way of true value. For this reason, it is important to challenge one’s self frequently in the practice of making difficult decisions.

In summary, morality is based on both the individuals’ needs within a society and the continuity of the society, and there are consequences that need to be considered for each decision, some great and some insignificant. Also, a person does not have to subscribe to any particular theory in order to be moral. Any one person can feel that it is their duty to perform an act while believing in the hedonistic value of performing another act, still, while considering their benefit of performing another act. There can be no hard-line rule that encompasses how we ought to act in all possible circumstances. It is my view that we should pay more attention to descriptive theories than prescriptive theories. We are smart enough to have evolved, and we should take comfort in that.

References

Thiroux, J. P., & Krasemann, K. W. (2009). Ethics: Theory and practice (Tenth ed.). Upper Saddle River, NJ: Prentice Hall.