Prepare an applied ethics presentation.

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Prepare an applied ethics presentation (12-15 slides, with speaker notes) on an ethical issue related your academic discipline, program, or area of study or interest. Select an ethical dilemma topic for analysis and evaluation from one of the Topic 8 articles (attached below), or the Issues & Controversies and Opposing Viewpoints databases. (You may select an alternative topic from a different database or website with instructor approval.) Be sure to address all of the following in your slide presentation.

  1. Outline both sides of the debate. Address all relevant issues associated with your topic. Note both positive and negative arguments concerning each side of the issue.
  2. State the topic in terms of an ethical debate/dilemma (within your academic discipline, program, or area of study or interest). Relate the issue to at least two ethical theories and/or thinkers discussed in the course (one of which must be Kant and the Categorical Imperative). Propose how each ethical theory and/or thinker presumably would response to the ethical dilemma.
  3. Incorporate applicable biblical, theological, philosophical, and/or historical Christian ethical norms or principles that bear (or may well have a bearing) on the ethical dilemma.
  4. Utilize an ethical decision-making model in helping to determine your ethical position vis-à-vis a step-by-step process. Review “Making Ethical Decisions” located in the Topic 8 materials.
  5. Give your own well-argued and reasonably supported conclusion regarding the ethical debate, including specific moral actions envisioned from your conclusion.

Be sure to limit the background information of the debate. The presentation should focus on the ethical questions and dilemma involved.

Include a minimum of four academic references, which may include course materials and additional academic sources.

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Journal of Medicine and Philosophy, 37: 417–424, 2012 doi:10.1093/jmp/jhs038  Bioethics and the Metaphysics of Death JAMES S. TAYLOR* The College of New Jersey, Ewing, New Jersey, USA *Address correspondence to: James S. Taylor, PhD, Department of Philosophy, Religion, and Classics, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08534, USA. E-mail: jtaylor@tcnj.edu In recent years there has been a tremendous resurgence in philosophical interest in the metaphysical issues surrounding death.1 This is, perhaps, not surprising. Not only are these issues of perennial theoretical appeal but they also have significant practical importance for many debates within applied ethics—especially bioethics.2 And the bioethical debates that these issues are relevant to happen to be some of those that are currently the most pressing, having risen to prominence either as a result of contemporary public health concerns or as a result of recent advances in medical technology. Keywords: bioethics, death, metaphysics, posthumous Harm That the fundamental issues of the metaphysics of death are both relevant to and important for many pressing bioethical issues can be illustrated through considering the ethical questions that concern the procurement of transplant organs. The recognition that there is a drastic and chronic shortage of organs available for transplantation has led to a heated debate over the ethics of various proposed means of increasing their supply. These proposed measures range from legalizing markets in human organs to introducing a policy of presumed consent, whereby a person will be presumed to have consented to have her organs removed post-mortem for transplantation into another unless she has expressly “opted out” of this. The ethical debate that surrounds the possibility of using a presumed consent policy to (try to) increase the number of organs that are available for transplantation rests on the explicit assumption that a person must (at least typically) consent to the post-mortem removal of her organs for this to be ethical, and hence that such removal is acceptable if consent can legitimately be presumed. (If this assumption were not in place one might simply advocate © The Author 2012. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 418 James S. Taylor a policy of post-mortem organ conscription—or, more accurately, organs takings—independently of the wishes of the persons whose organs they once were.) And this assumption, in turn, rests on the implicit assumption that it matters to a person what happens to her body after her death, not only in the (subjective) sense that a person might take an interest in what happens to her body after she dies, but in the sense that the thwarting of such a subjective interest could (objectively) either harm or wrong the person whose interest it was. But once this implicit assumption underlying the debate over the ethics of using a policy of presumed consent to procure transplant organs is uncovered it becomes clear that this very practical bioethical debate is directly linked to the metaphysical questions of whether one can harm or wrong the dead. If one can harm or wrong the dead then it would make sense to be concerned about securing persons’ consent to how their post-mortem remains are treated. However, if one can neither harm nor wrong the dead then the justification for needing to secure a person’s consent concerning the treatment of her post-mortem remains is considerably lessoned, since nothing that could be done to these remains could adversely affect her. This outline of the relationship between posthumous harming, posthumous wronging, and the moral importance of securing persons’ consent to the post-mortem use of their bodies is intended here merely to illustrate the general point made above: That the fundamental issues of philosophical thanatology are both relevant to and important for pressing bioethical issues. A more complete account of this particular issue, namely, the relationship between posthumous harms, posthumous wrongs, consent, and the use of the bodies of the dead, is taken up by T. M. Wilkinson, who in his contribution to this Thematic Issue “Consent and the Use of the Bodies of the Dead,” addresses the question of when it is permissible to use persons’ post-mortem remains. The questions of whether the dead can be harmed or wronged are also clearly relevant to discussions of the ethical issues that surround research on the dead. For example, when it was revealed that Alder Hey Children’s Hospital in Liverpool, England (along with other hospitals in the British National Health Service), was removing, retaining, and disposing of patients’ remains (including those of infants and children) without authorisation public outcry focused not only on the harm caused to the surviving relatives of those whose post-mortem remains had been misappropriated but on the posthumous harm (and the posthumous wrong) that had allegedly been visited upon the individuals whose remains they were. In a related vein, recent advances in DNA testing have led to a considerable discussion over whether this should be used to secure new information about persons now dead—especially if it is known that the persons concerned took pains while alive to conceal the information that such testing might now reveal. There is, for example, an ongoing debate over whether or not it would either harm or wrong Queen Christina of Sweden (who died in 1689, and who was long Bioethics and the Metaphysics of Death 419 rumoured to be a hermaphrodite) to test her genetic material to discover her true gender.3 Less academically, there has also been considerable discussion over whether or not DNA evidence should be legally admissible in establishing the right of nonmarital children to inherit from their fathers’ estates.4 The question of whether persons can be harmed or wronged by events that occur or actions that are performed after their deaths is also of obvious relevance to such bioethical issues as (among others) posthumous medical confidentiality, whether or not there should be a policy of presumed consent or presumed refusal with respect to assisted posthumous reproduction, the moral status of post-mortem pregnancy, and the morality of markets in cadaveric organs. Given this, Christopher Belshaw’s contribution to this volume, “Harm, Change and Time” is of significant bioethical import, for in it he argues against the standard philosophical view that persons can be subject to posthumous harms. Whether persons can be harmed or wronged after their deaths are not, however, the only metaphysical questions associated with death that are directly relevant to bioethics. The need to increase the supply of human organs that has led to the debate over the ethics of using a policy of presumed consent to (try to) achieve this is motivated in part by the concern that persons should (ceteris paribus) be saved from death, on the grounds that death is a harm to the person who dies. But this common-sense view has been famously (or notoriously) challenged by Epicurus, who in his Letter to Menoeceus wrote: Make yourself familiar with the belief that death is nothing to us, since everything good or bad lies in sensation, and death is to be deprived of sensation. Hence the right recognition that death is nothing to us makes the mortality of life enjoyable, not by adding infinite duration to it but by removing the desire for immortality. For there is nothing to be feared in living, for one who has truly comprehended that there is nothing to be feared in not living. So one who says he fears death, not because it will hurt when it is here, but because it hurts when it is coming, talks nonsense, since whatever does not hurt when it is present hurts for no reason when it is expected. So that most fearful of all bad things, death, is nothing to us, since when we are, death is not present, and when death is present, then we are not. So it is nothing to the living and nothing to the dead, since with regard to the former, death is not, and as to the latter, they themselves no longer are.5 The standard response to Epicurus’ argument (and those of his Roman follower, Lucretius) by those who reject his conclusion has been to argue that death is a harm to the person who dies insofar as it deprives her of the goods of life that she would otherwise have enjoyed.6 But, while this response might appear plausible it immediately leads to a further metaphysical question: When is a person supposedly harmed by her own death? As Jens Johansson observes in his contribution to this issue, “The Time of Death’s Badness,” the two most popular responses to this question are the view that a person’s death can be a harm to her before she dies (priorism), 420 James S. Taylor and the view that a person’s death can be bad for her after she dies (subsequentism). (Other possibilities include the view that a person’s death is eternally bad for her—eternalism—and the view that a person’s death can be bad for her at the time of her death—concurrentism.) Johansson observes that part of the support for priorism and subsequentism rests on the idea that that if one holds that death is not a harm to the person who dies at any particular time (the atemporal view) it would be noticeably and unsatisfyingly different from other harms. Johansson argues that this idea is mistaken, and that atemporalism avoids some of the problems that priorism and subsequentism are subject to. Of course, one might insist that unless there is a time at which a person’s death is a bad to her then it is not a bad to her, and so the Epicurean view is correct. And this, in turn, would have important implications for many debates within contemporary bioethics. Thus, if death is not a harm to the person who dies it would seem easier to justify the legalization of both physician-assisted suicide and euthanasia. Similarly, if death is not a harm to the person who dies but her pre-mortem suffering (obviously) is, it would make sense to allocate medical resources away from life-extending (and -saving) practices technologies and towards those aimed at the alleviation of suffering. But, argues Johansson, even if one insists in this way that one must find a time at which a person’s death is a bad to her this can be done by identifying periods that begin before her death and end after it. So far, then, three major metaphysical questions that surround death have been identified, together with (some of) the ways in which they are relevant to bioethics: the question of whether death is a harm to the person who dies, the question of whether persons can be harmed after their deaths, and the question of whether persons can be wronged after their deaths. (Note that these last two questions are distinct. It is possible that a person could be harmed without being wronged—subjecting her to a just punishment would be an example of this. And it is, at least according to some deontological theories of ethics, possible to wrong a person without harming her—breaking a promise to someone where this has no effect on her well-being might be an example of this.) But these are not the only metaphysical questions that death gives rise to and that are relevant to issues in contemporary bioethics. Most obviously, one might ask what death is, and hence which criteria should be used in clinical practice to identify when a human has died—should these be cardiopulmonary or neurological, and, if the latter, should they be based on whole-brain, higher brain, or brainstem criteria?7 In a related vein one could also question whether or not humans cease to exist at the moment of their death, or whether they continue to exist, either as merely physical corpses or in some form of afterlife (which might or might not include awareness). While the latter possibility is frequently dismissed out of hand by contemporary philosophers (who are often working within a secular framework) this dismissal might be too hasty. This is the view that Bioethics and the Metaphysics of Death 421 Russell DiSilvestro argues for in his contribution to this issue, “The Ghost in the Machine Is the Elephant in the Room: Souls, Death, and Harm at the End of Life,” in which he outlines some of the experiences that have led persons to believe in the existence of souls that can survive the deaths of the bodies that previously housed them. As DiSilvestro notes the possibility of some sort of post-mortem survival should alter how we approach discussions of the nature and harm of death, as well as those that concern the possibility of posthumous harm. And, like the other metaphysical questions that surround death, the possibility of an afterlife is of considerable bioethical interest. The assumption that persons cease to exist as sensate beings is the cornerstone of the Epicurean argument that death is not a harm to the one who dies—and so if it transpires that this assumption should be rejected then so too should this Epicurean argument. And, as noted above, the conclusion of this Epicurean argument has important implications for the moral impetus to increase the supply of transplant organs—as well as (among other issues) ethical questions surrounding physician-assisted suicide, euthanasia, and the allocation of medical resources. The metaphysical issues that surround death—what is death?, is death a harm to the person who dies, and, if it is, when is a person so harmed?, can a person be subject to either posthumous harms or posthumous wrongs?, and could a person continue to exist after her death?—are thus clearly both relevant to and important for contemporary bioethics. However, that this is so should not lead one to think that solving these thanatological questions will thereby enable one also to solve the bioethical dilemmas that they are relevant to. First, it might be the case that concerns other than those raised by an interest in the metaphysics of death will be relevant to the bioethical questions that these thanatological issues apply to, and so even if these metaphysical questions can be resolved further bioethical discussion will still be needed. For example, while the questions of whether a person can be harmed or wronged by events that occur after her death are important to the debate over the ethics of research on the dead, even if it could be established that such posthumous harms and wrongs are impossible this would fail to show that such research can progress with impunity. This is because these metaphysical questions are only two aspects of this debate. Others might include the question of who owns (or should own) the body in question, what limitations such ownership should place on the ways in which it is used by those who do not own it, and whether and to what extent the interests of those living persons who are concerned about how it is treated should be taken into account. (Belshaw considers the last of these issues in his contribution to this Issue, recognizing that even if one denies the possibility of posthumous harm this might not solve the ethical questions to which this issue is relevant.) Similarly, even if (in the highly unlikely event that) it could be established that persons could be harmed or wronged by (for example) how 422 James S. Taylor their post-mortem remains are treated this would not necessarily show that it is ethically incumbent on surviving persons to respect these persons’ wishes concerning the treatment of their bodies after their deaths. It might be that the posthumous harms that would be inflicted on persons through thwarting their interests in how their post-mortem remains were to be treated would be outweighed by the need to avoid imposing even greater harms on the living. One might, for example, accept that a person could be harmed posthumously by the taking of his organs for transplant into another when he had expressly stated that he wished his body to remain intact, but at the same time believe that such takings should occur if they would save the lives of third parties. Similarly, one could accept that persons could be wronged by actions that occur after their deaths but hold that these wrongs could be justified (i.e., the persons performing them would still be blameworthy for their actions, but this blame would be mitigated by the circumstances they were in) if inflicting them upon persons would prevent even greater wrongdoing. Second, it might be the case that the influence that the answers to these thanatological questions will have on bioethical debate will be muted for indirect reasons. Even if, for example, it is impossible to harm or wrong a person after her death, and even if no other concerns played a direct role in the debate that this question was relevant to, establishing that posthumous harms and wrongs are impossible might still not eliminate the possibility of needing to secure a person’s consent to the treatment of her remains. This is because it might be the case that knowing that their remains would be treated in ways they did not consent to would cause distress to persons while alive. (Such distress might occur even if they were convinced that they would be immune to posthumous harms and posthumous wrongs.) This distress would not be brought about by the putative mistreatment of their corpses. It would thus not be a case of either posthumous harming or posthumous wronging, for it would be occasioned by something that occurred while the person was still alive (i.e., the belief that her remains would be mistreated). However, its occurrence could serve to justify a social practice of respecting persons’ wishes concerning the treatment of their post-mortem remains as though they could be subject to posthumous harms or wrongs.8 And, if so, this would undercut any influence that the answers to the questions of whether the dead could be harmed or wronged might have had on guiding the practices that are the subject of bioethical debate. Yet even if securing the answers to the metaphysical questions that surround death might not itself decide the outcome of the bioethical debates to which they are relevant the attempt to secure them is still important to these debates, for three reasons. First, showing that an argumentative position P (e.g., that the dead can be harmed) is untenable is still important for those debates in which P plays a role even if its elimination from those debates will not determine their outcome. Second, while reasoned argument concerning such (possibly) emotionally charged issues as the prospect of one’s Bioethics and the Metaphysics of Death 423 one death or the posthumous treatment of one’s corpse might not have a significant effect on one’s emotional responses to these issues it might have some effect on this. Acceptance of the Epicurean position concerning the putative harm of death, for example, might not actually extinguish the fear of death that lurks within a secular breast entirely, but it might serve to assuage it. And, finally, even if the answers to these thanatological questions will not themselves solve any of the bioethical issues that they are relevant to, both recognizing the questions and possessing the answers would (both separately and together) give one a far better understanding and appreciation of the issues themselves. For these reasons, then, persons interested in either contemporary bioethics or the metaphysics of death will find much of value in the arguments of the papers contained within this Thematic Issue of the Journal of Medicine and Philosophy. Not only does each make an important positive contribution to the debate in which it plays a role but in so doing they each illustrate how issues in applied ethics can be usefully illuminated through careful attention to the philosophical theory that undergirds them. NOTES 1. See, for example, Warren (2006), Scarre (2007), Sperling (2008), Luper (2009), May (2009), Belshaw (2009), Bradley (2009), Taylor (2012), Kagan (2012), and Taylor (forthcoming). 2. The current relationship between the metaphysics of death and many contemporary bioethical debates thus resembles that which existed between autonomy theory and bioethics in the late 1970s. It remains to be seen whether interest in the metaphysics of death will permeate bioethical discussion in the same way that the concept of autonomy has done over the last four decades. 3. See, for example, Masterton (2007) and Masterton et al. (2010). 4. See, for example, Cooper (2006). 5. Epicurus, Letter to Menoeceus. This translation of this key passage is from Furley (1986). 6. See, for example, Nagel (1993). 7. These issues are discussed in (for example) Younger, Arnold, and Schapiro (1999), and in the papers contained in The Journal of Medicine and Philosophy 35, 3 (2010): 223–380. See also Ewin (2002, chap. 6). 8. These two points are made in the context of outlining the possible bioethical implications of the (full-blooded Epicurean) position that death is not a harm to the person who dies, that posthumous harm is impossible, and that persons cannot be wronged after their deaths in Taylor (2012, 3–5). References Belshaw, C. 2009. Annihilation: The Sense and Significance of Death. Montreal: McGill– Queen’s University Press. Bradley, B. 2009. Well-Being & Death. Oxford: Oxford University Press. Cooper, I. S. 2006. Posthumous paternity testing: A proposal to amend EPTL 4-1.2(a)2D. Albany Law Review 75:947–967. Epicurus, Letter to Menoeceus. Furley, David., trans. 1986. Nothing to us? In Schofield, M. and Striker, G., eds. The Norms of Nature: Studies in Hellenistic Ethics. Cambridge: Cambridge University Press. 424 James S. Taylor Ewin, R.E. 2002. Reasons and the Fear of Death. Boulder, CO: Rowman and Littlefield. Kagan, S. 2012. Death. New Haven: Yale University Press. Luper, L. 2009 The Philosophy of Death. Cambridge: Cambridge University Press. Masterton, M., Hansson, M. G., Hoglund, A. T., and Helgesson, G. 2007. Can the dead be brought into disrepute? Theoretical Medicine and Bioethics 28:137–149. Masterton, M., Hansson, M. G., and Hoglund, A. T. 2010. In search of the missing subject: narrative identity and posthumous wronging. Studies in the History and Philosophy of Biological and Biomedical Sciences 41:340–346. May, T. 2009. Death. Stocksfield, UK: Acumen. Nagel, T. 1993. Death. In Fischer, J. M., ed. The Metaphysics of Death. Stanford: Stanford University Press. Scarre, G. 2007. Death. Montreal: McGill–Queen’s University Press. Sperling, D. 2008. Posthumous Interests: Legal and Ethical Perspectives. Cambridge: Cambridge University Press. Taylor, J. S. 2012. Death, Posthumous Harm, and Bioethics. New York: Routledge. Taylor, J. S., ed. Forthcoming. The Metaphysics and Ethics of Death. New York: Oxford University Press. Warren, J. 2006. Facing Death: Epicurus and his Critics. New York: Oxford University Press. Younger, S. I., Arnold, R. M., and Schapiro, R., eds. 1999. The Definition of Death: Contemporary Controversies. Baltimore: The Johns Hopkins University Press. Copyright of Journal of Medicine & Philosophy is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Journal of Medicine and Philosophy, 31:667–673, 2006 Copyright © Taylor & Francis Group, LLC ISSN: 0360-5310 print/1744-5019 online DOI: 10.1080/03605310600806075 “Life is Short, Medicine is Long”: Reflections on a Bioethical Insight ALBERT R. JONSEN California Pacific Medical Center, San Francisco, California, USA The famous first aphorism of Hippocrates, “Life is short, the art is long” was long considered a perfect summary of medical ethics. Modern physicians find the words impossible to understand. But it can be interpreted as a fundamental insight into the ethical problems of modern medicine. The technology of modern scientific medicine can sustain life, even when life is losing its vitality. How should decisions be made about the use of technology and by whom? This is the incessant question of modern medical ethics. Keywords: Hippocrates, aphorism, ethics, life-support, technology In 1975, the founding year of The Journal of Medicine and Philosophy, my article, “Scientific Medicine and Therapeutic Choice” appeared in The New England Journal of Medicine (Jonsen, 1975). That short essay was inspired by the case of Dr. Chad Calland which had occured at University of California School of Medicine in 1972. Dr. Calland was a cardiologist on the UCSF faculty who had become a renal transplant patient. He received five kidney transplants before he committed suicide. On the day of his death, his own article, “Iatrogenic problems in end-stage renal failure,” appeared in The New England Journal (Calland, 1972). In that article, Calland complained that his physicians and surgeons had failed to comprehend his feelings about life on dialysis and after transplantation. He felt he was the object of competition between his nephrologists and his surgeons and was “distressed by the controversial dialogue that separates the nephrologists from the transplant surgeon, so that in the end, it is the patient who is given short shrift” (p. 334). Chad Calland’s death, and his article, caused dismay at his institution. A combined medical-surgical Grand Rounds reviewed his case. The surgeon, a pioneer of renal transplantation, admitted in emotional words that in his Address correspondence to: Albert R. Jonsen, Program in Medicine and Human Values, California Pacific Medical Center, San Francisco, CA 94115, USA. E-mail: arjonsen@aol.com 667 668 A. R. Jonsen therapeutic zeal he had transplanted his friend and patient, Chad Calland, five times, with little attention to his desires or his feelings, and without sufficient concern for his deteriorating health as one graft after another failed. I had joined the UCSF faculty as professor of bioethics several months before Calland’s death. I knew his surgeon and several other physicians. I was asked to speak at the Grand Rounds. I proposed that the case revealed “an inverse relation between scientific, technological medicine and freedom of therapeutic choice.” I meant that physician and patient interpret success differently: the physician sees success in maintenance of physiological state, the patient views success as restoration of his or her previous quality of life. This, I concluded, was “the most crucial ethical problem of modern medicine.” In those days, I, and everyone else in the nascent field of bioethics, was looking for “most crucial ethical problems.” We had only recently appeared on the medical scene. Bioethical literature was almost non-existent. Two remarkable books of very different tone, Fletcher’s Morals and Medicine (1954) and Ramsey’s Patient as Person (1970), stood almost alone on the shelf marked “bioethics.” Indeed, “bioethics” itself was a neologism, hardly known and barely understood. At The Hastings Center and at occasional meetings, a few scholars engaged in intense discussions about death and dying, genetic engineering, behavior control and human experimentation. The handful of ethicists who had joined medical faculties had no standard curriculum to teach and often no classes to teach to. Still, we were talking and writing and trying to create the “discipline” that Daniel Callahan had described in 1973 (Callahan, 1973; Jonsen, 1989). A discipline is not easy to create. One needs a field of investigation— we were all wandering in the wide fields of the biomedical sciences and of medicine, of philosophy and theology, and social sciences. One also needs questions—we certainly had those. But a discipline also needs a central insight to organize those questions and to suggest a rational and empirical methodology to begin the search for answers. We did not have that central insight. Each of us neophytes was on the hunt. Most of us were sure that it had something to do with the appearance of technology in medicine. My version of that common belief was the “inverse relation between scientific medicine and therapeutic choice.” I never attempted to develop that thesis in a theoretical way, probably because theoretical expositions do not appeal to my casuistic mind. Still, I think that it took hold of my thinking and that it has persistently guided me through thirty years of bioethical consultations, communications and reflections. I wish in the next few pages to say a bit more about it. I fancy myself a historian of medical ethics. I believe that historical words and deeds somehow portend the present. It occurred to me that one of the most famous sentences in medical literature, the First Aphorism Reflections on a Bioethical Insight 669 of Hippocrates, might be mined for its meaning to modern medicine. The First Aphorism, possibly uttered by the master physician of Kos in the 4th century BCE, reads, in its standard translation: “Life is short; the medical art is long. Opportunity is fleeting, experience perilous and decision difficult” (Hippocrates, 1962, IV, 97). I say that those words are the most famous sentences in medicine, although possibly most modern physicians have never heard them, because generations of physicians, over many centuries, knew them well and considered them the epitome of medical ethics. Innumerable commentaries were written on the First Aphorism. Galen and Maimonides and hundreds of other physicians expounded on those enigmatic words (Galen, 1965; Bar-Sela, 1963; Richards, 1961). Most interpreters suggested that “Life is short, the medical art is long” meant that the body of learning called medicine was so large that no physician would ever live long enough to master it. I am going to make the sentence mean something quite different—something that Hippocrates and his commentators could not have imagined. Permit me a bit of exegesis before I return to my original insight. The medical art is long. The Greek word “macros” means “long,” either in distance as “far” or in time as in “long-lasting.” The “art” or “techne” is either a body of knowledge and skills or a practice, a piece of work: it is the root of our word “technology.” I want this sentence to mean that technological apparatus of modern medical practice function with incessant, infallible efficacy: technology is long-lasting. Life is short. The Greek “brachus” is short in time, brief, as well as short in distance (Radiologists will recognize “brachytherapy”). It is also used to mean small, insignificant, petty. In my interpretation, this phrase is an existential statement about the human condition: human life is fragile and fated to deteriorate and die. A modern Hippocrates, reflecting on the technological array at the command of the modern physician, might note that those pieces of machinery, such as dialysis machines, ventilators, pacemakers, defibrillators, scanners, and so forth, are not just metal and plastic cobbled together but are the incorporation of a plan, a program, an algorithm. The machinery functions to fulfill its internal plan. Computer software writes that internal program for much of modern medical technology. The machine will incessantly produce the results planned for it; it will do so infallibly. While it may break down, it can easily be fixed. Its failures are disconnects that can be reconnected by those who know the internal plan. So a dialyzer will incessantly and infallibly maintain creatinine at appropriate levels; a ventilator will do the same for oxygen saturation. When failure sets in it is not the fault of the technology but of the body that it is working in: life is fragile; technology is powerful. Medicine’s technology is not confined to its machines. Organ transplantation is a technology where the machines are made up of flesh and blood. Drugs are a technology as well. Hippocrates had drugs compounded from 670 A. R. Jonsen plants, made up for each episode of illness and each patient. Modern drugs are synthesized according to formula and, because the molecular structure is known and can be manipulated, can be reformulated again and again. So antibiotics incessantly are pushed ahead of resistant strains of bacteria; chemotherapy is infinitely refined to master recurrent disease. Wherever it is blocked, technology can in principle be liberated and set to work again. The revived Hippocrates would recognize that these powerful technologies do conquer and abate disease. He would be pleased that he once said that medicine’s goals were to mitigate suffering and lessen the violence of disease. He would see that modern medical technology does this much more effectively than any tool or technique that he possessed. But he would be proud that he concluded this advice with the words, “and not to attempt to cure those who are mastered by their disease.” (The Art iii, in Hippocrates, 1962). He never forgot that “life is short and fragile.” The crucial ethical problem, then, is to measure the use of technology to the fragility of life. The fragility of life had dominated medicine since its inception; now the power of technology has assumed priority. My very first contact with a bioethical problem came almost a decade before the Chad Calland case. As a graduate student in ethics at Yale, I was invited to join discussions about a peculiar problem. Persons who were being chronically dialyzed (a technology then only some five years old) were asking to be taken off dialysis. Some of these patients could be transplanted; many others would die without dialysis. The director of the Yale dialysis unit and the consulting psychiatrist on that unit were attempting to understand this “dialysis suicide” and to formulate an ethical response to such requests (McKegney & Lange, 1971). Dialysis was the first genuinely life-sustaining technology; it was truly a “medical miracle” for persons with end-stage renal disease. But some of these patients on the artificial kidney discovered that their life was smaller, more fragile than the technology. Before long, patients sustained on ventilators, or the families, were discovering the same disproportion. The case of Karen Ann Quinlan galvanized the nation. The case of Terri Schiavo, sustained by the technology of artificial feeding, aroused controversy that reached the White House and the Congress. My first service on a government advisory group showed me and my colleagues another life-sustaining technology, the totally implantable artificial heart. Our committee learned that a device powered by a capsule of plutonium could replace the failing human heart. Ironically, we also learned that the device would continue to pump long after its bearer had died from some other cause than heart failure (Jonsen, 1973). That star-wars device was not developed. Now, thirty years later, a new version of this implantable heart device, the left-ventricular assist device, is being used as “destination therapy,” that is, not as a bridge to transplant, but to extend for several months Reflections on a Bioethical Insight 671 the life of persons not eligible for transplant. The technology is long-lasting; life is brief. In my first article, I had said that the technology of medicine conflicted with the freedom of therapeutic choice. Freedom is at the heart of the ethical problem. Technology in principle should expand freedom. It should lift human activities above the capabilities of the human hand and arm; it should span distances far greater than eye or voice or ear can reach. Yet we know from experience that technology, born to expand freedom, often restrains it. The automobile has become the paradigm: invented to speed up travel, it has, in cities and on freeways, reduced speed back to pedestrian or equestrian rates. Medical technology undoubtedly provides options for treatment and cure that were previously unimaginable. Yet, because technology has the brand of incessant and infinite efficacy, it has become imperative. We use the phrase “technological imperative” often enough without appreciating its moral meaning. An imperative is a strong moral word: it is a command, imposing an obligation without exception. An imperative is incompatible with freedom: one chooses to reject an imperative at peril to self. Commands come from authority; in medical technology the authority is the technology’s internal plan and program made for healing. It expends the energy to repair and replace damaged physical and physiological processes. The technology presents itself as the necessary and indispensable instrument to fulfill the primary moral obligation of medicine: to benefit and not to harm. There is no room for discretion. It is psychologically, emotionally, and morally difficult to depart from an imperative course. Therapeutic freedom, which includes the freedom to forgo technological intervention, is often obscured by the illusion of efficacy; it is also the illusion of an imperative. The freedom at stake is the physician’s as well as the patient’s. But on the patient’s side, it is less an imperative generated by medicine’s moral purposes than a belief in the incessant, infallible efficacy of technology, linked to a desire to be healed. It is my impression that over the last thirty years, physicians have become more skeptical about the imperative of technology while patients and their families have become more credulous about its powers. Physicians have become more ready to acknowledge futility, the point at which the brevity of life overcomes the longevity of medicine. It is a moral mistake, I think, to allow medical technology to assume an imperative role. Instead of an imperative, technology offers an invitation. It presents possibilities whose realization depends on many circumstances, arising from physiology as well as preferences. Allow me to return to the exegesis of the Hippocratic aphorism. It goes on: “opportunity is fleeting, experiment treacherous, judgment difficult.” Again, enigmatic words. They seem to reflect certain features of the Hippocratic theory of disease and treatment. 672 A. R. Jonsen In my interpretation, they explain how the invitation of technology should be met by physician and by patient. “Opportunity is fleeting” literally reads “the critical time is narrow.” The invitation of technology should be accepted in those specific times when the expectations of efficacy can be justified by the circumstances and by evidence. “Experiment is treacherous” is a phrase most difficult to translate: its words literally mean “trying is likely to make you stumble, slip, or trip.” In my interpretation, it means that any application of technology is itself a trial that might go wrong. The final phrase is “decision is difficult.” This advice should surprise no one, physician or patient, who must make decisions about treatment: the decisions are tough to get through. However, the Greek word means more: hard to accomplish or hard to bear. It suggests that one needs considerable competence to make a good decision and that one undertakes responsibility for its consequences. These characteristics of the clinical decision reveal its freedom: to do something at the right time, for the right reasons, to do so with awareness of the possibility of failure and error and to take responsibility for the action. This is the proper response to the invitation of medical technology. It is the refutation of its imperative nature. It is, in my view, the reconciliation of technology and therapeutic freedom. There is another sentence in the First Aphorism: “The physician must be ready, not only to do his own duty, but also to secure the co-operation of the patient, of the attendants and of externals.” This is astonishingly modern. I do not know what it meant to the Hippocratic physician but the modern physician should see it as a terse treatise on how to use technology. The patient must make a free decision (the Greek text actually says the patient should “be brought alongside”). The “attendants” might be the doctor’s assistants or the patient’s family and friends. Decisions to use technology should be understood by everyone who is engaged in the case. Finally, the strange word, “externals” appears. What can it mean to secure the cooperation of externals? Classical commentators were puzzled by the phrase. The most compelling interpretation comes from Maimonides. He wrote, “Physicians should not be content with doing what is (medically) proper and stop there, for that is often not sufficient for the health of the patient … rather he must remove all external impediments that prevent the healing of the sick. For example, if the patient is poor and in a place that increases his illness but he can afford no other place, the physician should see that he is removed to a place conducive to healing. He should also provide such a patient with nourishment and drugs if the patient does not have them. These are the externals for which the physician is responsible.” (Bar-Sela, 1963). Reflections on a Bioethical Insight 673 This is beautiful but sadly antiquated advice. Perhaps, in our world, these externals of Maimonides can stand not only for the medicines and nourishment and lodging of the patient but also for the institutional systems, insurance policies, the government regulations, the practice patterns, the financial structures that surround the application of medical technology. The success or failure of the technology will often depend as much on their “cooperation” as on the physiology and preferences of the patient. We today would rarely say “These are the externals for which the physician is responsible.” Yet, if those who must make the difficult decisions about using technology at the right time and for the right reasons are not responsible, who should be? REFERENCES Bar-Sela, A. (1963). ‘Maimonides’ interpretation of the first aphorism,’ Bulletin of History of Medicine, 37, 347. Calland, C. (1972). ‘Iatrogenic problems in end-stage renal failure,’ New England Journal of Medicine, 287, 334–336. Callahan, D. (1973). ‘Bioethics as a discipline,’ Hastings Center Studies, 1, 66–73. Fletcher, J. (1954). Morals and Medicine. The Moral Problems of the Patient’s Right to Know the Truth, Contraception, Artificial Insemination, Sterilization, and Euthanasia. Princeton, NJ: Princeton University Press. Galen. (1965). Hippocrates Aphorismi et Galeni in Eos Commentarii. C. G. Kuhn (ed.), Claudii Galeni Omnia Opera (Vol. XVII, pp. 345–355). Hildesheim: G. Olms. Hippocrates. (1962). The Arch. W. H. S. Jones (trans.), Works of Hippocrates (Vol. IV, pp. 95–98). Cambridge, MA: Harvard University. Jonsen, A. R. (1973). ‘The totally implantable artificial heart,’ Hastings Center Report, 3, 1–4. Jonsen, A. R. (1975). ‘Scientific medicine and therapeutic choice,’ New England Journal of Medicine, 292, 126–127. McKegney, F. P. & Lange P. (1971). ‘The decision to no longer live on chronic hemodialysis,’ American Journal of Psychiatry, 128, 264–273. Ramsey, P. (1970). The Patient as Person. New Haven, CT: Yale University Press. Richards, D. W. (1961). ‘The first aphorism of Hippocrates,’ Perspectives in Biology and Medicine, 5, 61–64. The Art iii, in Hippocrates (1962). (Vol. II) (trans. W. H. S. Jones). Cambridge: Harvard University Press. Applied Ethics: An Interdisciplinary Approach Neil Vance The University of Arizona Ashley Harris The University of Arizona Katie Parissenti The University of Arizona Mark Cromey The University of Arizona Assuming applied ethics is more than moral reasoning, the authors look to their experiences as instructors and students. Comprised of moral reasoning, intuitionist ethics and organizational ethics, this approach is truly inter-disciplinary. Moral reasoning in the social sciences tends to concentrate on teleology and deontology. This approach also incorporates virtues ethics. Rooted in social psychology, intuitionist ethics examines the powerful role of emotion in our applied ethics. Using some of the best practices or organizational behavior, the article describes how the enlightened leader can prevent inappropriate behavior and facilitate more ethical behavior. INTRODUCTION This article is a summary of 15 years of teaching applied ethics in public administration. It is also a journey through three (3) academic disciplines: philosophy, social psychology and organizational behavior. Our discussion begins with philosophy stemming from the Greeks, particularly Aristotle, since nearly all ethical considerations are derived from this foundation. Using a triangle as a visual teaching aid, Deontology, Teleology and virtue ethics are described. Consistent with the philosophical tradition, the emphasis is on the individual and rational reasoning. We then explore an exciting new approach to ethics from social psychology: intuitionist ethics. Instead of rational reasoning, intuitionist ethics examines ethics from an emotional point of view. Rather than the solitary self-making of an ethical decision, intuitionist ethics is interactive and subconscious. Third, we shift our discussion from the individual to the organization. Using organizational management literature, we develop a line of thinking that has not been explored adequately in applied ethics. We ask what can the organization due to facilitate more ethical behavior and prevent inappropriate behavior? Using a circle as a teaching aid, we examine four aspects of organizational life: membership, leadership, organizational culture, and organizational structure. Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 11 Finally, we hint at the possible future of applied ethics, specifically neuroscience. Using brain scans and other devices, neuroscience is beginning to expand our understand decision-making, which has exciting implications for applied ethics. RATIONAL MORAL REASONING Foundational to this approach of moral reasoning is the nature of the ethical dilemma. Instead of a choice between right and wrong or moral and immoral, the learners are confronted with a choice between what seems to be two right acts. Borrowing from Kidder, the “Right vs. Right Dilemma” is described with the following example: Is it right to take the family on a much needed vacation or is it right to save the money for the children’s education? Right vs. Right is at the heart of our toughest choices. The world faces plenty of Right vs. Wrong choices but the most difficult may be the choice between two right acts (Kidder, 2009, p.4). In order to introduce students to the idea of rational moral reasoning, a triangle is utilized. This shape showcases the differences and the commonalities between the three main ideas presented under this section on personal moral reasoning: Consequences (Teleology), Rules/Principles (Deontology), and Virtue (character). Each of these categories represents a different point of view when looking at or deciding personal moral reasoning. This representation is unique in that virtue ethics is at the top since it is somewhat discontinuous from the dynamics of moral reasoning between the Teleological and Deontological. It is important to point out that in utilizing the triangle, it is not simply a matter of choosing one polarity over another. Rather, moral decision-making is much more about accessing an amalgamation of the three poles. FIGURE 1 MORAL REASONING Virtue The Personal Character Concerned with the Act Consequences • • • 12 Teleological Situational Ethics Utilitarianism Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 Rules/Principles • • • Deontological (Duty Based) Kant Bok The Telelogical The Teleological pole of the triangle is further separated into two distinct philosophies: situational ethics and utilitarianism. Historically, situational ethics was a theological category, reflecting the idea that “the ends justify the means” (Fletcher, 1965). This concept resonates with students as it is seen as an easy way to “scientifically” judge any circumstances and justify actions that otherwise may be a major moral dilemma. It is important to note that this brand of moral reasoning can be easily perverted. In nearly any situation, one could find a way to justify their actions; potentially leading down a slippery slope of unethical choices consequentially justified using a form of ethical moral reasoning. On the other hand, utilitarianism is a reflection of the notion of “greatest good for the greatest number.” Conceptually, Utilitarianism is a straightforward concept, and many people will wholeheartedly agree with it. Those hailing from the Western world are especially drawn to this notion, likely due to their exposure to democratized systems of “majority rules.” However, this concept is often widely misunderstood by students, possibly because it is an arduous ethical position. If one considers the work of Peter Singer, it is easy to see why this position is a much more difficult locus. In his book Practical Ethics, he draws upon the genuine idea of Utilitarianism, giving examples of the redistribution of wealth to ameliorate absolute poverty and the relocation of refugees on a large scale to industrialized countries (Singer, 1979). These concepts are much more difficult for people to grasp, causing many students to struggle with (and ultimately turn away from) Utilitarianism. It is interesting to note that in classes, most students align themselves with the Teleological pole. It is unclear whether they identify with consequentialist thinking mainly because they, as 21st century citizens, are all empiricists or because moral relativity resonates with them (Rachels, 2006). Teleology is generally the less rigorous (and arguably more flexible) than Deontology, so it is an attractive choice during the development of moral reasoning stances. The Dentological Moving across the footing of the triangle, we come to Deontology. This pole focuses on rules and principles, drawing on one’s inner need to conform to law and duty. In contrast to Teleology, duty-based ethical decision-making does not necessarily produce the greatest good for the greatest number nor the best consequences given the circumstances. Rather, it is more concerned with one following rules and principles. In order to enhance the understanding of Deontology, we use the ideas of two Deontological philosophers, Emmanuel Kant and Sissela Bok. Kant argues that it was not consequences that determined the morality of a decision but the motives of the person carrying out the action. In his exploration of Deontology, he developed the idea of the Categorical Imperative. Broken down, the categorical imperative can be explained using two main ideas: 1.) Universal Law 2.) End-in-itself Kant argues that when utilizing Deontology to make a decision, one should act only according to the maxim that one can at the same time resolve that it should become a universal law and simultaneously always act such that you treat humanity, whether in your own person or in that of another, always as an end and never as a means only. These concepts, especially the Universal Law, are extremely rigorous and difficult to apply to contemporary problems, ignoring details and context. Given the historical perspective of when Kant was developing his ideas, this is to be expected. However, we cannot dismiss his efforts as he sets out a sphere of rights/protections and warns of the danger of ethical rationalization. While both Kant and Bok contribute greatly to foundational concepts of Deontology, Bok is often better accepted by students due to her more “modern” (or less rigorous) interpretation of duty-based ethics. In her classic work Lying, Bok, like Kant, believes that lying causes problems, but she diverges from Kant in her proposition that there are times when lies are justified. She uses the typology below to illustrate those rare times when a lie is justified. Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 13 1.) 2.) 3.) 4.) Harm can be averted Duty to protect colleagues Duty to protect peers/clients Noble lies She starts her argument with the notion of the white lie. This is something we are all guilty of: we lie to our friends and partners to safeguard their self-esteem; we lie to our children to safeguard their innocence, etc. Bok contends that these lies are necessary in order to keep the peace and ultimately harm no one (in fact, they usually comfort and support people). Next, Bok explores the idea of avoiding actual harm by utilizing a lie. The best conceptualization of this idea is the example of the inquiring murderer. Consider a friend running to you for shelter from an attempted murderer and the murder shows up at your doorstep, looking for information. Under Kantianism, you would be duty-bound to expose your friend. Bok believes this to be preposterous and holds that you instead have a duty to avert harm by lying. The next two exceptions to lying also center on a duty to protect. These are easily explained through the examples of a person whistle blowing about a sexual-harassing boss to protect a meek coworker and a physician protecting the privacy of a patient. Finally, there is the noble lie. Bok contends that this is the most difficult type of lie to tell due to its implications. A great example of this would be the President of the United States lying to assuage the public to avoid mass hysteria (Bok, 1999). It can be argued that in today’s world, Bok’s conceptualizations of justified lies make her a more attractive voice for Deontology. Virtue Ethics Moving away from moral reasoning concerned with the act, we come to virtue ethics. While all of moral reasoning is focused on individual ethics, virtue ethics is inherently more focused on the actor vs. the act. Espoused by Aristotle, virtue ethics is an important part of personal moral reasoning. Aristotle calls virtue ethics a “habituated action” and a state of being (Annas, 1993). This is a vital piece of virtue ethics—most people misinterpret this by thinking acting virtuously in one dilemma or simply wanting to be more pious makes them a virtuous actor. However, this is simply not the case. It is difficult to teach Aristotle to 21st century students, but they seem to understand “character.” Utilizing the work of Martin Seligman and others, Paul Tough published a New York Times article, Character, that resonates with today’s students. The article seems to articulate some 21st century virtues (Tough, 2011). Utilizing a triangle as a teaching tool can help students conceptualize the connections between the three moral reasoning poles without constraining them to previously held ethical attitudes. Teleology and Deontology are concerned with the act; therefore they provide the base of the triangle to showcase their interconnectedness. Virtue ethics is primarily concerned with the actor’s moral DNA. Given this divorce from the action, this pole is disjointed from the other two at the peak of the triangle, without being completely detached. This visual aid helps students understand that each pole is separate but also interwoven in the grand idea of personal moral reasoning. Intuitionist Ethics One of the most exciting new domains of the social sciences is intuitionist ethics. Pioneered by a small group of social psychologists, intuitionist ethics examines our actions from a non-rational basis. Scholars such Jonathan Haidt and others challenge the basic assumption of moral reasoning, rational decision-making (Haidt, 2001). 14 Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 FIGURE 2 INSTITUTIONIST ETHICS The Worship of Reason Perhaps the most foundational contribution to intuitive thinking is Kahneman’s “Thinking Fast and Slow.” As the phrase indicates, Kahneman breaks down thinking into 2 modes/systems. Referred by Kahneman as System 2, slow thinking is the system that we normally think of as thought. It is deliberate, conscious, and we naturally feel as though we are in control of it. System 2 is in play when we actively make everyday decisions or when we perform a mathematical calculation (Kahneman, 2011). In Applied Ethics, Moral Reasoning is System 2 thinking. In contrast, System 1 is automatic and natural without active deliberation and operates within intuitive ethics. In order to fully examine intuitionist ethics, we are in need of another metaphor for thinking that is non-rational. Borrowing from philosopher Tom Arnold, we use the term “transrational” instead of nonrational. According to Arnold, “Transrational Thinking is a combination of the rational-analytical power of thinking and the intuitive creative side of our mind that is not analytical but rather synthetic in character” (2003). Transrational Thinking directly taps into reality, which is termed “Hyponoesis” by Arnold. He surmises that it can access the totality of information in Hyponoesis (reality) directly, without the need to acquire knowledge or information first (Arnold, 2003). In order to fully understand this abstract concept, one can turn to other intuitive ethics scholars for further examination. The leading scholar in intuitive ethics, Haidt, best explains the trans-rational dynamic in his article “The Emotional Dog and its Rational Tail: A Social Intuitionist Approach to Moral Judgment,” But in recent years, the importance of moral reasoning has been questioned as social psychologists have increasingly embraced a version of the “affective primacy” principle, articulated in the 1890s by Wilhelm Wundt and greatly expanded in 1980 by Robert Zajonc (2). Zajonc reviewed evidence that the human mind is composed of an ancient, automatic, and very fast affective system and a phylogenetically newer, slower, and motivationally weaker cognitive system. Zajonc's basic point was that the brain is continuously and automatically evaluating everything perceived, and that higher-level human thinking is preceded, permeated, and influenced by affective reactions (simple feelings of like and dislike). These push us gently, or not so gently, toward approach or avoidance (Haidt, 2007, p.998). Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 15 The journalist David Brooks further explains the “trans-rational,” [There are] several problems with the rationalist folks theory of morality. In the first place, most of our moral judgments… are not cool, reasoned judgments, they are deep and often hot responses. We go through our days making instant moral evaluations about behavior, without really having to think about why. We see injustice and we’re furious. We see charity and are warmed” (Brooks, 2011, p.280). Emotional The second foundation of intuitionist ethics is the element of emotion. Rational moral reasoning assumes a non-emotional stance. For instance, utilitarianism assumes an impartial rational actor. With non-emotion, the utilitarian would decide what is, “ the greatest good for the greatest number” (Haidt, 2001). If that calculation collides with someone close to you, likely we would allow emotion to intercede. In Jonathan Haidt’s notable metaphor, it is the rational tail that wags the emotional dog. He explains: Research on moral judgment has been dominated by rationalist models, in which moral judgment is thought to be caused by moral reasoning. Four reasons are given for considering the hypothesis that moral reasoning does not cause moral judgment; rather, moral reasoning is usually a post-hoc construction, generated after a judgment has been reached. The social intuitionist model is presented as an alternative to rationalist models. The model is a social model in that it de-emphasizes the private reasoning done by individuals, emphasizing instead the importance of social and cultural influences. The model is an intuitionist model as it states that moral judgment is generally the result of quick, automatic evaluations (intuitions). The model is more consistent than rationalist models with recent findings in social, cultural, evolutionary, and biological psychology, as well as anthropology and primatology (Haidt, 2007, p.1). Social The social intuitionist model posits that moral reasoning is usually done interpersonally rather than privately. As Haidt explains, “The social part of the social intuitionist model proposes that moral judgment should be studied as an interpersonal process” (2007). The social intuitionist model presents people as intensely social creatures whose moral judgments are strongly shaped by the judgments of those around them. But whose judgments have the strongest effects on children? Harris (1995) points out that a child’s task in late childhood and adolescence is not to become like their parents but to fit into their peer group, for it is among peers that alliances must be formed and prestige garnered. She therefore proposes a group socialization theory in which children acquire their culture – including moral values – from their peers, just as they acquire their phonology (i.e., children of immigrants copy the accent of their peers, not their parents). Concerning right and wrong in adulthood, it is primarily through participation in custom complexes (Shweder, et al., 1998) involving sensory, motor, and other forms of implicit knowledge (Fiske, 1999;Lieberman, 2000; Shore, 1996), that are shared with one’s peers during the sensitive period of late childhood and adolescence (Harris, 1995;Huttenlocher, 1994; Minoura, 1992) that one comes to understand physical and emotional feelings (Damasio, 1994). Whether the social aspect of intuitionist ethics is due to immediate family, peer groups or the broader culture is an open and debated question. Organizational Ethics All organizations are susceptible to unethical action. This behavior can be traced not only back to the individual, but also to the organization itself. Two different theories and four different processes can be utilized to examine factors that play a key role in this type of behavior. Agency Theory suggests that an individual person is solely responsible for his or her actions, both ethical and unethical, and the company has no influence on these actions. Structural Theory focuses on the organization and its effect on individual behavior in the work place. The four themes discussed are 16 Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 leadership, membership, structure, and culture and their effect on misconduct in the work place and how this can be remedied. These concepts are demonstrated using the shape of a circle, to illustrate the equal importance of each theme. FIGURE 3 THE CIRCLE Traditional Assumptions Agency Theory is a more traditional way of explaining poor ethics and morality in the work place. It presumes that any negative actions can be contributed to the individual alone for personal gain. M. David Ermann and Gary A. Rabe wrote that this theory is the “result from deliberate decisions made by corporate personnel to increase or maintain organizational resources or profits” (Ermann, et.al., 1997). In contrast, Structural Theory concentrates on the organization and its affect on individuals. The four themes of leadership, membership, structure, and culture will help illustrate this idea of the organization influencing behavior. Many times, organizations respond to ethical issues in a knee-jerk fashion. These actions often include making sweeping changes to leadership, updating the company code of ethics, mission and vision statements, or hosting “ethics seminars” that employees must participate in. Since all of these focus on Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 17 changing the individual, Structural Theory indicates that these resolutions will not really change anything—they are simply actions that make people feel good. Change In Leadership In many instances, companies believe the best solution to a breach in ethics is to remove the current leadership and bring in someone new who is known for his/her morality. This leadership overhaul is done so that the company looks as though substantial changes have been made to remedy the wrongdoing under the previous leader. However, reality is that a new leader will not solve all of the organization’s problems. As ethical issues tend to stem from a multitude of issues, a simple change in leadership will not remedy the situation since the previous issues will continue to plague the organization. More significant, meaningful changes must be made throughout the company in order for to avoid making the same mistakes as the past. Code Of Ethics/Vision/Mission Many believe that a good way to ensure ethical behavior within an organization is to have an acrossthe-board, unifying code of conduct. The thought process is that if the organization lays out a set of rules, no one will act against that code. However, this is not always the case. There have been numerous examples of misconduct in a company that has advertised just how ethical and moral their employees behave. Ethics Officer Organizations are not always naïve to the fact that some of their employees’ actions are unethical. In order to deal with ethical conundrums, an ethics officer (typically a lawyer) is brought in to remedy problems that may have resulted from this case of misconduct. However, because this legal advisor is hired to deal solely with legal situations, there may be other areas where an action or behavior is legal, but may not be ethical. The line between legality and morality is often ambiguous. Sometimes illegal actions can be morally just and other times legal actions can be immoral. A simple, but moving, example of this ambiguity can be seen in the case of Rosa Parks. When she sat at the front of the bus and refused to move, it was illegal for African Americans to sit anywhere but the back of the bus. Hence, what is legal may not always be ethical. Re-Training There have been numerous studies that aim to understand where moral reasoning comes from. One study points towards family life over actual moral teachings in school as the main source of ethics in a person’s life (Mahdavi, 2008). In cases of ethical misconduct, many companies present lectures or seminars in an effort to “retrain” their employees to be more ethical. However, this type of instruction does not usually have the desired effect. Realistically, a person’s moral compass will not change—it is set far before they enter the workforce. Therefore, this training primarily shows employees why they think the way they do and what kind of moral reasoning they use in their everyday lives—an endeavor that can be enlightening, but it is not effective in changing behavior. Discussion In order to realize legitimate change in organizational ethics, people’s thinking, and subsequently, their behavior, must be altered. To achieve a positive change in the ethical climate of an organization, the four themes of membership, leadership, structure, and culture can be employed as ways to understand why people misbehave in an organization in the first place, how to fix this behavior, and how to prevent it from happening again. Membership The term "member" specifies that a person is an active part of an organization. They are not there against their will. It is a mutually beneficial arrangement between an organization and its employees and that all parties succeed and fail together, as one. 18 Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 Facilitators for Misconduct The organizational structure itself has the capacity to create unethical behavior. A rigid chain of command has the ability to do this. With rigid rules and standards, it is possible for employees to rebel against such harsh conditions, much like rebellious teenagers. With this strict structure, where leaders hold all the cards and decision-making capabilities, members often feel apathetic to anything that goes on within the organization. Without being allowed any say in the day to day running of the organization, members care less and less about what happens to the company, which can lead to unethical behavior. Strategies to Address Membership Challenges Members must see their contributions to the organization as important and appreciated. There is nothing worse than not being recognized for hard work. The more the members feel like an integral part of an organization, the more likely they are to feel a sense of belonging and responsibility and the less likely they are to turn towards ethical misconduct. Members not only need to believe their work is being valued; they also need to feel as if their opinions (both negative and positive) will be respected and considered. An atmosphere that makes an employee feel uncomfortable standing up for what he/she knows to be right does not make for a productive or ethical work environment. Individual Leadership In the context of this paper, a leader takes on many facets. However, the leader of an organization often specifically takes main responsibility for his/her organization's scandals and has a responsibility to mend broken areas. Facilitators for Misconduct According to Craig E. Johnson’s book Ethics in the Workplace, facilitators for misconduct from a leadership perspective come from different arenas: power, privilege, information management, and consistency (2007). Privilege and power, which usually go hand in hand, can be very seductive motivators in the work place that can lead down a dangerous path. Leaders are drawn to both, which creates a divide between them and their employees. The larger this separation of power and privilege becomes, the more likely leaders are pulled towards unethical behavior. Information management is a difficult task for leaders to master. With leadership comes access to information not readily available to most other employees. It is vital that a leader manages and takes care of this information. They must be held accountable for the information that they do know and the information that they may not know, but should. Inconsistency is also an important gateway towards poor behavior. Leaders must treat their employees fairly and not play favorites with anyone. Consistency is crucial for a healthy, stable work environment. Strategies to Address Leadership Challenges A leader of an organization has a distinctive role within the organization. Ethical behavior starts and ends with a leader. By leading an ethical life themselves, leaders set the example for all other employees. Leaders also need to not have a bias while dealing with other employees. Everyone must be treated fairly and justly to promote ethical behavior among every person in the organization. The principles of transformational leadership illustrate strategies to avoid misconduct. A leader is seen as transformational if they give their employees a bigger role in the organization. Employees are more likely to be accountable and ethical if they feel like they have a stake in the company. An important way to encourage employees to take an active role in the organization is to open lines of communication. When an employee feels comfortable coming to a leader with any thoughts, questions, or Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 19 concerns, that employee feels like a valuable asset to the organization. It is vital that employees do not feel as if their ideas are unheard or unwanted. This will lead to a negative perception of the company, which promotes unethical behavior. A leader also has a crucial role in keeping all employees motivated. There is nothing that can bring down productivity like unmotivated employees. Leaders can motivate their staff through encouraging innovation and creativity. Employees must be able to think outside the box and not feel confined and unable to share their new ideas. Organizational Structure The structure of an organization is an important place to start when promoting ethical behavior. The basics of ethics begin with the basics of an organization, which is its construction. Facilitators for Misconduct Many organizations are structured in a traditionally hierarchical fashion. This structure can often be a facilitator for misconduct, as it usually impedes communications. A hierarchy does not promote these open lines of communication as its rigid structure prevents openness not only in communication, but also in innovation. Strategies to Address Structural Challenges One solution to the problem of structural hierarchy is to create ways in which it is more difficult to be unethical. A system of checks and balances will reduce those opportunities and promote more ethical behavior. Companies also need to have effective methods for inspecting and dealing with possible misconduct. Instead of relying on one person appointed to undertake the entire task, a committee of people could be a very successful approach. A group of one’s peers in charge of investigating ethical breaches has the ability to reduce ethical misconduct among other employees, in lieu of an outside singular entity. Another resolution to the hierarchy problem is to flatten the organizational structure. Doing away with the strict lines of a hierarchical structure and opening up positions and communications would increase transparency and accountability and decrease unethical behavior. Organizations also need to ensure that there are mechanisms in place that allow employees to voice their concerns about possible misconduct before it develops into a large scale scandal and reaches the public's eye. An organization can increase transparency by admitting that it is not perfect and adverse situations can happen. This also shows that the company is taking the necessary steps to eradicate the matter, resulting in the public having more trust in the organization and employees having more faith in their company. This would decrease cover-ups and increase trust in the organization not only by members, but also by the public and other businesses as well. All of these changes do not have be massive shifts in the structure of an organization. A simple change, such as an open-door policy, can help move the organization towards a brighter and more ethical future. Culture The culture of an organization is also a vital aspect of member perception and behavior. Much of an organization’s values are not clearly seen. It is more embodied through the work of the organization as a whole as well as each individual member. Culture is a big part of what makes a company operate. It can help or hinder the ethical behavior within the organization. It is important for a culture to be open and transparent to avoid any breaches in ethics or morality. Facilitators for Misconduct Changing a culture is a difficult task as it is the lifeblood of any organization. However, if organizational culture is toxic, something must be done. An example of a negative aspect of a company’s culture is "groupthink". This occurs when people who tend to think the same way all make decisions as 20 Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 one (Bennis, et.al., 2008). This can take a turn for the worse when everyone is apathetic towards a situation and one person believes that if everyone thinks the same way, he or she should as well. Additionally, if someone were to go against the group, it could damage him or her socially; thus, the decision to continue to acquiesce to the group, even when one knew the group was wrong. This type of attitude discourages whistle blowers and individual thinking. Innovation is lost and people feel their ideas will not be heard. Strategies to Address Cultural Challenges Surprising to some, the culture of an organization is an easier fix than its membership. It is healthier and easier to change the way a company operates and thinks in order to become more ethical than it is to bring in entirely new people with the same old problems. This is not to say that cultural change is easy. It is a difficult process that starts with leadership. An organization's leaders must embody the changes and demonstrate that these cultural changes are for the better. They set the example for everyone else. These changes must also occur in every aspect of the organization, from meetings to emails to progress reports. Everything must reflect a change in culture towards improved ethics. CONCLUSION Applied ethics is an area of study that is always developing. While this article demonstrates exciting new advances in applied ethics, intimations of the future might even be more exciting. One area that is advancing every day is neuroscience. This field may soon discover how our brain truly functions, how and why we make everyday decisions, and even how we make moral decisions. One such example is the groundbreaking work of Michael S. Gazzaniga, documented in his 2005 book The Ethical Brain. He demonstrates that “not just low-level mechanical functions such as memory and pattern recognition are instantiated in the brain but also our highest and most distinctively human mental activities, including the emotions, social life, conscience and morality, consciousness, and the self of self” (Pinker, 2010). One thing is certain; that the future of applied ethics will be an interdisciplinary venture. REFERENCES Annas, J. (1993). The Morality of Happiness. New York: Oxford University Press. Arnold, T. (2010, April 7). Introduction to Transrational Thinking. Bennis, W., Goleman, D. & OaToole, J. (2008). Transparency: How Leaders Create a Culture of Candor. San Francisco: Josey-Bass. Bok, S. (1999). Lying: Moral Choice in Public & Private Life. New York: Vintage Books. Brooks, David. (2011). The Social Animal. New York: Random House. Chaleff, Ira. (2004). No need for whistleblowing: stand up to the culture. Executive Excellence. Ermann, M. D., & Rabe, G. (1997). Controlling Unlawful Organizational Behavior: Social Structure and Corporate Misconduct. Chicago: The University of Chicago Press. Fletcher, Joseph (1997). Situation ethics: The new morality. Louisville, KY: Westminster John Knox Press. Goleman, Daniel. (1985). Vital Lies, Simple Truths: the Psychology of Self-deception. New York: Simon & Schuster. Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review. 108, 814-834. Johnson, Craig E. (2007). Ethics in the Workplace: Tools and Tactics for Organizational Transformation. Thousand Oaks: Sage Publications. Kahneman, Daniel. (2011). Thinking, Fast and Slow. New York: Farrar, Straus and Giroux. Kidder. R. (2009). How Good People Make Tough Choices Rev Ed: Resolving the Dilemmas of Ethical Living. New York: HarperCollins, Inc. Kihlstrom, John F. (2013). Threats to Reason in Moral Judgment. The Hedgehog Review, 15, 1. Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 21 Mahdavi, I. (2009). Where do men and women learn their ethics? different sources? Journal of Academic and Business Ethics, 1, 1-7. Pinker, S. (2010). Ethics and the Ethical Brain. In The cognitive neuroscience of mind: A tribute to Michael S. Gazzaniga (pp. 223-232). Cambridge, Mass.: MIT Press. Rachels, J. (2006). The Elements of Moral Philosophy. New York: Random House. Schein, E. (1992). Organizational Culture and Leadership. San Francisco: Jossey Bass. Seligman, Martin E. P. (2002). Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. New York: Free Press. Singer, P. (1979). Practical Ethics Cambridge. Cambridge University Press. Tough, P. (2011, September 13). What if the Secret to Success Is Failure? The New York Times. Vaughn, D. (1996). The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA. Chicago: The University of Chicago Press. 22 Journal of Leadership, Accountability and Ethics Vol. 12(2) 2015 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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