[As written/circulated 2008-09 for the Barnes-Jewish Hospital Ethics Committee members]
Defining ‘ethics’
Each individual forms a personal sense as to what is of ultimate value and what is of lesser value. These core values serve as a filter through which information is interpreted before being applied to life’s decisions. Certain relationships, experiences, circumstances, and objects are thus regarded to be of such importance to an individual that s/he is prepared to suffer great loss rather than to violate them. Judgments about what ought or ought not to be done can usually be acted upon safely without much conflict. However, some situations require a collective judgment from a number of individuals with competing goals or divergent viewpoints. In such situations, a reflective approach to decision-making -- i.e., ethics -- is necessary.
Ethics has to do with the determination of what ought to be done in a given situation, all things considered. Some differences in judgment can be traced to variations in reasoning patterns. For instance, one person may be very logical, deductive, abstract. Another person may be more intuitive, pragmatic, affective. Other differences in judgment can be traced to variations in what is taken into consideration and the value given to what is taken into consideration. For instance, one physician may support a woman in her desire to obtain treatment for her infertility, while another physician -- the gatekeeper for the patient’s health maintenance organization -- may be most concerned with providing cost-effective primary care for a large number of patients. Before a thorough analysis of options can be undertaken, the participants in the decision-making process must respect each other enough to listen carefully in order to recognize and understand these differences.
The intent is to place the subject of ‘ethics’ quickly/clearly near to individuals directly/actively involved in patient care. The words ‘ethics’ and ‘ethical’ are used frequently in routine discourse (and not, therefore, limited to intentionally/formally ‘ethics’ discussions). In seeking to understand how these words are being defined, I look for opportunities to draw attention to the phrase – “the ethical dimensions of patient care” -- in the BJH Basics poster re the hospital’s ethics consultation assistance. When appropriate I often ask caregivers what they understand to be the ethical dimensions of care in their patient care settings. The two linked definitions of ‘ethics’ above focus on the way we make decisions, first in reference to core values and then in reference to the interests of others affected by our decisions. If/when ‘ethics’ needs to reduce to a single concept, I invariably point to the resolve to be respectful. By pausing to consider the etymology and component parts of ‘respect’ (i.e., L., re + specere), this very common word regains its force as a prism by which to analyze our decisions. I find that many enjoy creating the cluster of words that share the root verb -- specere.
