Uncovering ethics: The first steps

Professionally when “Ethics” is mentioned it is usually in fairly specific ways.  In a health care context Ethics is often associated with particular areas of question or conflict.  Ethics is the process that we have to satisfy to be able to do the research that we think is indicated.  My decision about whether Mr Smith has the “right” and the “capacity” to be able to make a particular decision is an ethical one.  I use words like “autonomy” and “justice” to explain the reason why Mrs Tran should be offered a treatment.  Our clinical teams have policies about our duty to provide ethical care for violently confused patients. We debate about issues like euthanasia on grounds that we describe as ethics focused on the rights and wrongs of changing our current clinical approach. Each of these are complex questions and the fact that they are so divisive demonstrates to us the difficulty (or even impossibility) of determining a path forward that satisfies everyone.  Sometimes I wonder if it is for this reason that Ethics seems like such a frustrating topic.  Why spend time thinking and talking about Ethics when the only thing we can be confident about is that someone’s answer is always going to be, “I disagree”?
Now, which way to I go today?

Now, which way to choose?

It is a hard question to answer, but I would make two points that may seem a little controversial at first.  Firstly, that a singular focus on these areas of conflict are actually a distraction from the ethics that we are all involved in all of the time, and  secondly is that while frustrating disagreement when considering ethics is actually a critical part of the process.

As clinicians, researchers, carers,  and administrators, or better yet, as people we are all constantly engaged in a process of determining a right way forward.  This process occurs within and between all that we do and this is our constant creation and reworking of our sense of what is morally appropriate.  The decisions here can seem intuitive or instinctual, and the acts can be simple or even silent.  Staying by the bedside for an extra moment to provide comfort, choosing to maintain a professional distance with a blank glance when we hear an inappropriate comment in the staff cafeteria, or pausing the days activities to provide feedback to a colleague are important moments and actions which express and are our ethics.  If you spend a moment thinking back on your working day you will note that on many occasions the decision to do or say as you did arose naturally within the context of the situation with the other people involved.  This ethics, sometimes called microethics, arises from us being ourselves and being with others.  It is within our constant fluid and unavoidable interaction with the world around us that shapes us and our choices as we move through it.  But, this sphere of ethics is hard to describe and capture.  It doesn’t have buzz words or get much air time, and yet all of the big health care Ethics questions above fundamentally rest on these fragile momentary interactions between people. This link is easy to lose though as the big Ethics questions are often built on abstract ways of viewing the world which lead to fixed points of view which may seem to have little relationship to the circumstances unfolding around us.  Considering the big questions as all of Ethics while ignoring what we all engage in all of the time is akin to missing the forest outside for the trees, or perhaps more appropriately missing the forest for the static photo of the trees that we have hanging on the wall.  In the attempt to capture the forest its dynamic life is lost.

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I also make the claim that disagreement in ethics is necessary, and that is simply because ethics requires constant questioning.  To be truly ethical we have to re-assess, we have to challenge, and we have to disagree.  Doing ethics is in a sense challenging ourselves to see  what happens between people as a problem, so that we can seek to learn from it.  If we all always agreed about the right way forward there we wouldn’t be engaged with this constant need.  We would be forever mired in the view that what was right before must still be right now.

So in this spirit this blog marks the beginning of a new series called “Uncovering ethics” to try and explore some of the hidden parts of the ethics of health care research and practice within the palliverse.  I will contribute periodic blogs to this series but in the spirit of ethics being a process of dialogue I would welcome any comments, suggestions for topics, and in particular potential authors who wish to embark on this journey with me.

Travel well

Michael

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