Doing Good and Avoiding Evil
II. Decision Procedures for Ethics: ORDER
A problem of moral concern--like the heirs desire to dispatch their rich father, the boss's desire to make a quick profit, or the starvation of the African children--is not the same as an ethical dilemma. In a moral problem, we know what is right, but we may be puzzled about the right way to say "No" or the best means to obtain the best outcome. (Additionally, we may be tempted to preserve our level of comfort by doing nothing at all!) In an ethical dilemma, we really do not know what is right. Consider the following case:
In our attempts to reach the good or just solution in this case, what approach do we take? Typically, if we are (personally) in the middle of cases like this, we are strongly tempted to grasp at whatever "solution" appeals to us at the moment: that is, whatever solution accords with our previous prejudices and tendencies. But one of the major objectives of the teaching of ethics is to draw us beyond that subjective stance to one where all rational persons could agree that the right course, or a right course, is being pursued. That means that we must reach a course of action that is objectively right, or at least open for public scrutiny.
What would constitute an orderly approach to such problems? First, as participants and decisionmakers, we should organize our options in the situation--what alternatives are really open to us? and note the probable outcomes of each. What, in this situation, is it possible, and reasonable, for us to do? And what will be the likely results of each of those choices? Which of the outcomes on the list are totally unacceptable? They should be eliminated, and the rest left for further consideration at a later stage. In this step, we are reasoning teleologically or consequentially (more on these terms below), looking to the means that will produce the most desirable ends.
Before they act, however, they must review the rights of the various participants, for legally protected rights, in our system, trump, or override, considerations of right outcome. We must also respect moral (usually legally enforced) rules that are held to be valid regardless of the consequences. That is an important point: in this step we are reasoning deontologically or non-consequentially; that which violates a rule is prohibited by that rule no matter what consequences flow from doing or omitting the act.
Two of the most powerful rights and rules confront us in this situation:
Meanwhile, there are other rights to be taken into account. The minor children have an absolute right to their parents' support, for maintenance (food and shelter), affection (yes, that's a right), and provision of education. To what extent will care for Mother have an impact on them?
When we have our options clear and our rights and rules factored in, we should
determine our decision, make a disposition of the problem, for the moment. The situation will not wait, after all; an initial decision must be taken immediately. For the moment, Mother is rational, and peaceable, enough to be kept at home with her family; also, during her periods of lucidity, she enjoys being with them and they enjoy her. Perhaps a local daycare program can take her during school hours, and the teenagers can switch off afternoons to be with her before Pete and Dora come home from work. Nurses can be hired in occasionally to give everyone a break. The solution can't last forever; will it work at all? Note that the family must act, with very incomplete information; that is typical of such dilemmas. Pete and Dora decide to try it. And then, in a few days, weeks, or months, they must
evaluate the effects of the decision. The decision and the action do not, as Macbeth pointed out, trammel up the consequences. The world continues. We need to follow up, to find out what results our decisions have had. The Vlasovics, in this situation, will not be able to avoid the results; Mother is still in the house with them. How much are the teenagers losing from their sacrifice of their afternoons? The answer to that will depend very much on the peculiarities of this family's situation. How is Mother responding to the new program? That depends very much on the peculiarities of Mother. The trouble with ethical dilemmas, as opposed to ethics as a discipline, is that the real solution is empirical, day to day, trial and error. Finally, we have to
review the situation, reconsider the decision, with an eye toward revision. Nothing, in human affairs, is ever set in stone. We make our decisions, usually, for today, knowing that the decision will probably produce a new situation, with its own new dilemmas, and we will have to take on the whole problem again. The Vlasovics' decision to keep Mother home without round-the-clock nurses, bringing her to day care as often as they can, has saved them money, but after awhile it will not work any more: most day care programs cut off when the disease renders the patient violent or incontinent, and new arrangements will have to be made. But by then, there will be a new situation, with a different set of options, and possibly, a revised set of rights. The children, for instance, will eventually leave home, and confront their parents with a completely different set of demands. The federal government, for another instance, changes its mind every month about what programs to fund for the elderly; these will have to be taken into account in future deliberations.
This decision procedure, like many others in the field of ethics, covers all necessary bases for rational decisions. I prefer it to the others only because it builds in, as others do not, the recognition that nothing is ever decided‹not well, anyway‹once for all. The temptation to come to resolution, to solve something forever, is enormous. Resist it. Situations change, and the more flexible our decision procedure, the better suited it is to the messy world of human conduct.
Like ADAPT, this decision procedure for ethical dilemmas can be remembered easily by its acronym, ORDER:
While we're at getting down procedures that are easy to remember, we may take note of three preliminary steps that have to be taken before we can put things in ORDER:
First, we have to define the dilemma that we are facing. What conflicts make the situation difficult to deal with?
Second, we have to conduct empirical inquiries as appropriate, discover the facts, get as much information as we can.
Third, we have to sort out the stakeholders. We mentioned above that it is important to know whose interests are to be taken into account in making any decision.
So our first three determinations, in any ethical decision process, are of the definition, the factual information, and the stakeholders. If it makes it any easier to remember, think of these steps as a "DIS" preface to the "ORDER" decision procedure:
This leaves us with a procedure whose steps are easy to remember, but leaves the field of ethics in DISORDER! Insofar as this DISORDERed formula helps us to remember the essential messiness and anguish of ethical dilemmas, that serves our purposes very well.
Let's revisit cases A and B in the last section, and add some complications:
Case A, but Dad is unconscious, and expected to remain so. He apparently has no sense or feeling, is unable to think or communicate. He may be in some pain sometimes, however, and the children, backed up by the court-appointed conservator, request that he be given quite a bit more morphine "to make sure he doesn't suffer at all."
Case B, but your boss suggests only that you speed up the process from penicillin culture to filling the ampules, raising a 2% probability that the drug dispensed will not be up to strength. That doesn't sound good; but there is no evidence that such a change will hurt anyone at all. Meanwhile, the extra income generated will pay off some serious short term debt and put the company in a better position to carry on its research. The quality control manager, who would prohibit this change on general principles, has just retired, and the company is "searching" for another, so you have a probable three-week window during which you can get the new standard drug on the market.
In these cases, the need for higher level reasoning is evident. Terminally ill patients should certainly be kept comfortable; there is nothing to be gained from prolonging this man's life, but a heavy dose of morphine? A balancing act begins, weighing the legitimate, if distasteful, interests of the heirs against the duties associated with the practice of medicine, especially the duty to protect one's patients, especially against this sort of proposal. Ultimately the principle that prevails will be an intermediate one, grounded in the practice of the profession: drugs are there to heal, not to kill, and the patient, probably unable to feel anything and certainly defenseless, may not be subjected to the needs and desires of others.
In case B, the harm caused by the acceleration of the manufacturing process is not at all certain--even if penicillin was never prescribed unless it was needed, the mix of batches would ensure that no patient actually got perceptibly less than the proper dose. Here an appeal to a middle level principle is necessary. The manager must ask himself, not, what are the consequences of this action? but, what would happen if everyone did this? what would be the general consequences of a rule that permitted or required this action? (That formulation of a middle level principle is found, by the way, in the major works on ethics of Immanuel Kant, John Stuart Mill and John Rawls; see the reference section at the end.) The "Golden Rule," Do Unto Others As You Would Have Them Do Unto You, is a similar principle. Research is important, and debt-retiring is surely good, but for now they may have to wait for alternative sources of funding.
Materials prepared by Lisa H. Newton, Ph.D. 1998
Copyright © 2002, Hale Chair. All rights reserved.
Created by Elsi Caldeira
Last modification Tuesday, 22-Jan-2008 09:34:31 EST
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