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
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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),
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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
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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.
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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.
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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
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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
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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.
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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.
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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.
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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).
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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).
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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
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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
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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.
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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
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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
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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.
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