Doing the Right Thing

Much debate about health policy, or public policy in general, is confused and feckless because the participants aren't clear about when they are disagreeing about facts, and when they disagree about values or ethics. As a matter of fact, many people get confused because they aren't really clear about their own ethical preferences, or don't see where they lead.

I began to address some of these problems in my earlier posts about the Rule of Rescue. The RoR is a so-called deontological, or rule-based ethic. It says that when we see someone in immediate peril or great distress, we are obliged to help them. This rule, as it turns out, can come into conflict with so-called consequentialist or utilitarian ethics, which say we should behave so as to get the best outcome -- however defined, and that's huge, just as picking your rules is huge under a deontological approach. If the resources we expend on rescue are taken from people who are not in immediate danger, but who will ultimately suffer or die because we deprive them today, we have failed to maximize the general good.

People who write about medical ethics usually finesse this sort of problem by talking about principles, which lie somewhere in between. These are ideas like human rights, justice, freedom, etc. -- grand abstractions that we can try to apply to specific cases. In medical ethics, the current standard is a set of principles taken from Beauchamp and Childress. These are called justice, respect for persons (or autonomy), nonmaleficence, and beneficence. Be fair, let people control their own destinies, don't hurt people, try to help people. Most people think these are terrific ideas, although it is very easy to see how they can come into conflict with each other. And of course, who is to say what is just?

A more basic problem is one that some commenters have raised: where do ethics come from? The Bible? Your preacher? The Buddha? Your personal communion with the Almighty? Your parents? Your favorite teacher? The state legislature, if signed into law by the Governor or approved by a 2/3 majority? Randy Cohen, the official New York Times ethicist? And where the hell does he get his authority from anyway?

When progressives and conservatives argue about the fate of Social Security, and Medicaid, and environmental regulation, and taxation, and foreign aid, and everything else they are arguing about, facts and figures do come into it. But ethics are at the heart of the great divisions of belief in society. Where they come from, what they tell us. For those who are interested in a liberal Christian perspective on ethics, you might want to go to Adventus. I am a humanist, and I would like for there to be an opportunity for believers and non-believers to discuss ethics and truth from both perspectives. Some of that can happen here but I don't want to derail the main subject. Is there interest out there in a new forum of some kind?