Biomedical Ethics: Telling the Truth

Running head: BIOMEDICAL ETHICS Biomedical Ethics: Telling the Truth Completed by: YOUR NAME University of Outline 1. Abstract 2. Introduction 3. Conflict in Biomedical ethics a. Difference between tragic and epic conflict 4. Telling the truth or concealing it 5. Conclusion 6. Works Cited Abstract This paper analyzes the matter of bioethics, mainly whether it is morally right to conceal the truth from the dying patient in order not to exacerbate his already weak condition. To begin with, the general distinction between ethics and etiquette came into full recognition comparatively recently. The significant difference between basic moral problems and matters of mere etiquette and courtesy were, of course, strikingly apparent in connection with the various atrocities committed by Nazi physicians on prisoners and minority groups during World War II. It was the general world-wide revulsion against these acts which resulted in the Nurenberg Code of Ethics for the health professions, which is simply a modification of the ancient Hippocratic Oath to include interdiction of any experimentation upon human subjects without their consent. This led later to the Helsinki declaration and then to the Geneva form of the Hippocratic Oath which was adopted by the United Nations and is in general use throughout the world (Cassel 34-37). Introduction A systematic analysis of basic moral, and thus ethical, problems associated with the health professions was initially undertaken by Joseph Fletcher, the brilliant theologian of Cambridge Theological Seminary. His study Morals and Medicine raised those sticky problems which the members of the health professions have usually tried to avoid. These concern abortion, contraception, euthanasia, the right of a patient to die, the right of a patient to know the truth, and the specific responsibilities of physicians in connection with genetic deformities. The ethical position proposed by Joseph Fletcher has much significance for the health professions. He was developing "situationalism," the belief that careful consideration of the consequences of action, in relation to the situation, may result in the most satisfactory procedure. This, of course, marks the end of any absolutism in ethics, except in the sense of potential ideals. Telling the whole truth is no longer absolutely moral; right action depends upon the situation, and upon the welfare of the various personalities and conditions involved. If the health professions are to maintain their prestige, it is essential that their members not merely understand the standards of etiquette they are supposed to follow, but also that they appreciate some of our growing difficulties with conflicting ethical theories.

People generally are becoming aware of these problems. Humanism remains as a paramount factor in the success of health professional practice. The association of agapic love of the art (philotechnia) with love for humanity (philanthropia) is quite as pertinent now as it was in Hippocratic times. Conflict in Biomedical ethics The generic trait of any moral problem in life is conflict. The rules of conduct and the principles of ethics would be utterly superfluous if we did not experience conflicts over how to live. Now, moral conflict is of necessity bipolar, because it logically takes two poles of opposing value to make a conflict between them possible. But what precisely are the two poles of a moral conflict? Conventional morality and traditional ethics assume as a self-evident truth that there is only one type of moral conflict whose two poles are good and bad (or their equivalents). One obvious consequence of this deep-seated assumption is the traditional definition of ethics itself (Cassel 34-37). Another, less obvious consequence is an unwitting but serious gap in practically all the existing literature in ethics: The traditional concept of moral struggle concentrates so much on the problem of evil that it pays no real attention to the more tormenting problem of good in human life. Ever since the publication of G. E. Moore's Principia Ethica (1903) there has been considerable discussion of his miscalled "naturalistic fallacy" in ethics. However, in the heat of all the polemics, scholars have neglected a more common and much more serious instance of reductionistic fallacy--"the rigoristic fallacy," to coin a name for it. While the first fallacy is a technical error in those ethical theories which reduce moral to factual terms, the second fallacy is the traditional mistake stemming from the reduction of the moral itself to right-and-wrong terms alone. This oversimplification of the grammar of ethics is reflected implicitly or explicitly in almost all the classical systems of morality. Even John Dewey, who is far from narrow in his whole approach to moral conflict, follows tradition in defining ethics as "the science that deals with conduct, in so far as this is considered as right or wrong, good or bad." (Dewey and Tufts 3) Ethics so defined is, at most, only half the story, resting as it does on the unwritten but erroneous assumption that all moral struggles are reducible to a single type.

Difference between tragic and epic conflict The difference in polarity between a tragic and an epic conflict may now be deduced from the foregoing and stated technically. Whereas in the epic type of conflict one pole enjoys the positive value of good and the other suffers from the negative value of bad, in the tragic type both poles are positive in value; hence the problem of good arises from their mutual incompatibility. Logically speaking, the difference between epic and tragic conflicts as types of moral struggle may be restated as one between antithetic and antinomic situations, respectively. A moral antithesis is a situation in life where there are avoidable conflicts between two possibilities of conduct, one of which is accepted as right, the other as wrong. Hence the possibility of pathetic misconduct, due to wrong choice. A moral antinomy, on the other hand, is a situation in life where there are unavoidable conflicts between two possibilities of conduct. They are considered as apparently of equal merit per se, yet one is chosen at the sacrifice of the other. Hence the possibility of tragic misfortune, due to fatal choice. This implies that life's problem of good is much more serious than its problem of evil. It is easier in principle, if not in practice, to overcome evil than to abandon good, notwithstanding that in a tragic situation the gain of one good inevitably incurs the loss of the other, thus spelling ultimate defeat (Munson 89). To see concretely in two classical models why the problem of good is greater than the problem of evil, compare the difficulties of the Sophoclean Antigone with those of the Homeric Odysseus. It also follows that the conflict of right and wrong, which is the primary concern of traditional morality and organized religion, does not exhaust the entire class of moral situations. Therefore, an adequate theory of ethics, to be complete in its coverage of moral questions and relevant to the complexity of life, must not overlook its tragic manifestations, however poignant and disconcerting they may be. Otherwise, for one thing, those who consider a critical variety of humanistic naturalism as the most reliable and viable philosophy for the guidance of mankind will be in no position to meet effectively the most weighty objection of our critics, who accuse the naturalistic ethic of being insensitive to the tragic dimension of life. Telling the truth or concealing it An excellent confirmation that traditional ethics concerns itself primarily with the problem of evil in general and with the right-versus-wrong kind of moral conflict comes from the popular handbook of the A.

M.A. entitled Principles of Medical Ethics (American Medical Association 40). Apart from the niceties of professional etiquette, the handbook focuses on "malpractice" in the broadest sense (including the legal); that is, on professional misconduct. (Interestingly enough, the medico-legal term malpractice conveys the meaning of "bad" or "evil" in its very etymology.) To select a typical example of professional misconduct from the Special Edition of the Principles, "fee-splitting" is condemned as "unethical" essentially because it "invites physicians to place the desire for profit above the opportunity to render appropriate medical service" (American Medical Association 40). It is obvious that the A.M.A.'s official condemnation of fee-splitting belongs to the traditional right-versus-wrong species of moral problems, declaring flatly as it does that it is morally wrong for members of the medical profession to put the profit motive above the service motive in their professional life. Carping cynics would be quick to deny that the medical profession actually believes what it preaches (let alone practices it), but that is irrelevant to the point in question. Violations of a moral rule, however frequent, do not necessarily invalidate it, though they cause at least embarrassment to the violators who merely preach it. Besides, out of fairness, it should be added that the A.M.A. has always been quite cognizant of the extensive fee-splitting abuses in the medical world. In fact, its stand on this point is equally firm: "Wide extent of an unethical practice," the A.M.A. has stated categorically, "does not make it ethical. Ethics has to do with principles, not numbers or locality" (American Medical Association 41). In other words, moral truth is not determined by counting noses or taking a Gallup Poll. Thus, in theory at least, the A.M.A. is not on the side of ethical relativity, even if it is not on the side of the angels. On the contrary, the old relativist and the new "situationist" in ethics, whatever their differences, would contend that what is morally right or wrong depends on the particular circumstances. As circumstances vary, so our judgments of right or wrong must vary accordingly. Unfortunately, I cannot enter here into the grand old debate between absolutism and relativism in ethical theory, so may I refer in passing to my brief examination of the subject elsewhere (Romanell 69-81). As regards the current view called "situation ethics," which seems to be a new name for the old utilitarian way of moral thinking illegalized and personalized, suffice it to say for the moment that its motto could well be the proverbial saying: "New circumstances teach new duties.

"True, but what do we do when new duties for the benefit of each and every person conflict with old ones? Reach a working compromise to fit the situation? Fine, but "compromise" is a political term, strictly speaking, not a moral one. Whether we are relativists, absolutists, or neither in our general approach to right-versus-wrong questions, there is no easy way out of the daily problems of morality. That this is the brute fact of the case becomes even more clear when we turn to better-versus-worse questions in medical ethics. Better-versus-worse problems are harder to resolve than right-versus-wrong ones in that they require more decision-making. To illustrate, take the question: Is it better or worse for doctors to treat people while they are well, or wait till they get ill? Needless to elaborate, this is not the same kind of question as the one asked by the A.M.A.: Is the solicitation of patients" right or wrong? (American Medical Association 28). Conclusion In conclusion, there are two pure or absolute types of moral conflict in life: (Cassel 34-37) good-versus-bad (the essence of an epic situation), and (Munson 89) good-versus-good (the essence of a tragic situation). In addition to these two absolute types, there is a third or relative type of moral conflict, falling in between the other two, namely, better-versus-worse. All these three distinct types of moral conflict are found throughout life, but perhaps appear most clearly in the daily practice of medicine. The doctors are constantly presented with the dilemma, “to tell the truth and harm the patient or to conceal the real condition but to save the patients’ moral well being, at least for some time when he or she is alive”.