Doing Good and Avoiding Evil
II. The Establishment of the Fundamental Premises
If the legitimation of applied ethics as a field lies in the recognition that theory and practice must be mutually accountable, the central quest of the field must be the reconciliation of the two in a common structure, a core of ethical imperatives or fundamental values equally validated in literature and tested in practice. It should be possible to articulate classical ethical theory, or some portion of that theory, as the formal side of a body of such imperatives or values, while the empirically discovered rules of thumb of practice, guiding day to day decisions in professional and business practice, comprise the practical or material side of the same body. The best interpretation of the literature of the field, as it is at its best and as it should be always, is that it attempts to identify the contents of that core of belief, to articulate its formal side in the terms of the traditional language of ethics, and to show its applications in the language of medicine, business, or whatever practice is in question.
The presupposition that grounds the quest is the possibility of its success, in the attainment of such a core of imperatives or values. In this foundation, applied ethics sheds both the tendency toward relativism (or non-cognitivism) of the analytic philosophical tradition, and the tendency toward privatist arrogance of the professions, who had imagined that their principles were unique to their own expertise and practical commitments.
The change that generated the field of applied ethics was the decision, on the part of serious philosophers, to take very seriously the challenge of articulating the imperatives that guide the fields of professional practice. In what follows I suggest a simple outline of the imperatives that govern the profession. There is always a certain arbitrariness in the choice of the words, and others in the field may put the arguments in different order and the emphases on different themes. I will present the core in the form in which I have found it most useful, and leave it to the next generation to find more coherent forms for the same substance.
It makes good sense to start an ethic designed for the professions with the imperative that the professionals take as central. Granted that the definition of "profession" or "professional" has become one of the footballs of the Western tradition, all essays at that definition include the notions of an expertise, a body of knowledge and a set of skills, by application of which the professional performs a service, for a public or a private client. A relational imperative of care for that client is entailed without further premise: if it is your job to serve a client, and if your expertise renders your power positions unequal (and thus renders caveat emptor inappropriate), then you must take care of, or look out for the interests of, that client, just because you are a professional and the client has come to you for help. In some professions, law will crystallize that duty of care as a "fiduciary" relationship; the duty is there, just the same, even when the law does not recognize it.
"Beneficence" is simply that imperative to "do well" for the client. Several sub-imperatives are conjoined in it, in a simple order of priority: First, to do no harm (primum non nocere), second, to prevent harm or protect from harm, and third, to serve the interests or happiness of the client. Beneficence is the central ethical command for any profession, or for any field of practice generally: to justify the American business system as a whole, for example (as opposed to the individual market transaction), we appeal to a straightforward utilitarian standard--this system does less damage, and promotes more happiness, than any alternative.
B. Respect for Persons
The command to respect the autonomy, or dignity, of the individuals with whom we deal, to attend to their reasons and honor their self-regarding choices, plays two roles in the ethics of practice. First, and most obviously, it is the command underlying all of our interpersonal dealing: professional or not, no matter what the purpose that brought us together, I must recognize and respect you as a free person, and your right to exercise control in your ambit of freedom. Second, in professional relationships specifically, this duty limits the ambit of professional beneficence. My expertise may tell me that your best interests will be served by certain services that I am able to provide; it may even tell me that you need, on pain of loss of life or liberty, certain of my services. But if you choose not to avail yourself of them, and only your own interests are concerned, I may not impose them on you. The conflict between respect for autonomy and beneficent paternalism is most striking in the practice of medicine, of course, where the gap between professional and lay expertise is most extreme and the stakes are highest. But it surfaces in law, in any business where the products are complex (how hard do I try to sell the customer the mid-size computer that is best for his business, before I go along with his choice for the fancy one with all the bells and whistles, or the cheaper one that won't do him much good?), in education and in the arts. Do we provide the core education that we think is best for students, or the employment-oriented courses they want? Do we contract for the best of the contemporary artists, or do we stick with the safe popular performers that we know will fill the house?
These conflicts have certain elements in common. In all of them, the expert may be right about the best course of action, but the client, audience, or other ultimate consumer has the right to refuse to go along. In all of them, the professional's self-interest is involved, and the market lurks in the background--closer with the computer salesman, furthest with the heart surgeon--so the professional can never be entirely sure that his motives are purely benevolent. In all, the thrust toward some professional ideal world--of perfect health, safety, beauty, and enlightenment, not to mention fitness of computer to user--is frustrated by the intractable, independent stubbornness of the individual. From the fact that conflict arises immediately, even between the first two, most crucial imperatives of professional practice, we may conclude that applied ethics will not turn out to be the science of easy answers.
So far, so frustrating; the two most readily identifiable moral imperatives for professional life carry with them the potential for serious conflict. Yet we may not abolish one or another; we cannot even prioritize them. To set human dignity in second place is to make the professions into tyrannies; to set beneficence in second place is to rob professional service of its meaning, and to make it a trivial pandering to preferences. With the addition of the third imperative, justice, the situation becomes more frustrating yet. For justice demands that the professional look past both art and client, and take responsibility for the effect of professional practice in the society as a whole. In every profession or practice, injustice abounds. In medicine, for instance, the rich get swift and adequate care and the poor get notoriously late and inadequate care. The inequality is profound, and rendered worse by the tendency of caregivers at the lower end of the spectrum to add insult to inadequacy. Yet no justification is possible through cost/benefit analysis; indeed, often, as in the case of prenatal care for pregnant women, the injustice is incredibly costly for the society. Yet it persists, because injustice prevails elsewhere in the society, and medical care simply inherits it. Similarly in law. the poor tend to be ill advised, and end up costing the society more in prison management than do the guilty rich, who pay their debts to society in community service programs. In business, the rich not only get richer, they get super-rich, beyond anyone's wildest dreams, beyond any relationship to a leisurely and pleasant lifestyle, while the poor gather on the gratings in the merciless winters of the city. None of this injustice is profitable to the society. It seems to be endemic to the system--no one seems to be able to do anything about it. Yet the demand of justice upon the professionals is that they work within their professional associations, and in their individual practices, to blunt the effects of injustice in their fields. Given the intractability of the problem within the society at large, it hardly seems that the demand itself satisfies the conditions of justice! Yet there it is, and the professional who ignores it to acquiesce in the injustice of the surrounding society fails to fulfill all the duties of professional status.
Again, there is an enormous potential for conflict between this duty and the others. Shall we provide technically advanced, state of the art services for the rich, or concentrate our efforts on providing the most basic services to the poor? The question could apply equally to medicine, law, education. or to a large range of product developments. Shall we concentrate our efforts on thorough, and fully paid, services to well-off individuals, or shall we sacrifice individual attention for mass effect? Justice sometimes seems to ask us to overlook the very heart of our obligation under the other two imperatives--expert service to individual clients.
So our basic ethical imperatives are rather like ourselves--individually excellent and collectively at odds. I claim no originality for this triad. It can be found in the Greeks, in the Bible, in Thomas Aquinas and in the moderns. It can be presented, not only as the trilogy of obligations incumbent upon the professional qua professional, but as the primary trilogy of obligations derivable from human nature itself. As humans are animals, capable of pleasure or pain, so we must be concerned to advance happiness and prevent pain; as humans are social animals, compelled by nature to live in large groups, so justice, rule of law, is the first prerequisite for survival; as humans are rational, capable of responsible choice, so we are obligated to respect that moral agency, that ability to make choices. From the point of view of general (as opposed to business and professional) ethics, it makes more sense to put the triad this way. Note also that the order and emphasis in this triad can change according to circumstance. The first time I saw those three imperatives set down as the basis for applied ethics, the subject under consideration was the ethics of clinical research, using human subjects to test drugs and medical treatments.4 In that practice, the major temptation is to proceed with the research without telling the subject just what you are doing, because if you tell him he might object and you wouldn't get your research done. So the major moral imperative for the investigator is the necessity of informed consent, or Respect for Persons--and that is the imperative that takes first place in that account, beneficence and justice following.
Applied Ethics, then, does have an articulable core from which we may proceed to consider the imperatives binding on any give field of practice. The simple articulation of these three imperatives does not exhaust the issue; they are not self executing. But it is, at the least, a starting point for the inquiry.
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