Today’s lecture continues the combined task of

(1)   introducing some foundational theories in ethics (last time we considered two meta-ethical theories: ethical relativism and ethical subjectivism), and

(2)   examining a specific issue within medical ethics, whether it is ever morally justifiable for a physician to lie to her patients (we have considered two possible examples: lying about a grim prognosis to minimize the patient’s suffering, and lying about a medical error to avoid a lawsuit).

 

The ethical theory we will consider today is not a meta-ethical theory, but a normative theory of ethics...

 

 

[2.5.] Kant’s Normative Ethics.

 

One of the most influential theories of normative ethics is that of Immanuel Kant (1724-1804; Prussian).

 

Kant believed that...

·         morality is a matter of reason; to be rational is to be moral, and if you behave immorally, you are being irrational;

·         there are universal moral rules, rules that apply to all human beings, no matter the time or place;

·         moral rules are absolute, i.e., they have no exceptions whatsoever and should never be broken, no matter the consequences; and

·         one of those absolute rules is: do not lie.

 

 

[2.5.1.] Hypothetical vs. Categorical Imperatives.

 

In arguing for these claims, Kant pointed out that there are two different types of “ought” statement:

 

 

(i) Some “ought”s depend on our desires: if you want x, then you ought to do a (where “a” stands for some action).  For example:

·         if you want to master Guitar Hero (the video game), you ought to play it regularly.

·         if you want to make a good grade in this class, you ought to study diligently.

·         if you want to have a successful medical practice, you ought to tell your patients the truth.

 

Here you have an obligation to do something because you have a relevant desire: it is only because you want x that you ought to do a. In order to escape the obligation to do a, you need only stop desiring x.

 

Such “ought”s are hypothetical imperatives:

 

hypothetical imperative (df.): a principle or rule that you are obligated to follow because you have some relevant desire; e.g., if you want to improve your performance at Guitar Hero, then you ought to play the game regularly.

 

These “oughts” are non-moral. Moral obligation does not stem from our desires.

 

 

(ii)  Other “ought”s do not have this hypothetical character. They do not depend on what a person desires. This second sort of ought expresses things that you just plain ought to do, period. For example,

·         you ought not kidnap and torture innocent children.

 

You cannot get out from under the obligation not to kidnap and torture innocent children simply by changing your desires—in fact, you cannot escape this sort of obligation at all. You ought not to do this, period.

 

Such “ought”s are:

 

categorical imperatives (df.): principles or rules that everyone is obligated to follow, no matter what; e.g., you ought not to kidnap and torture innocent children.

 

Kant believes that “ought” statements that express moral obligation are all categorical imperatives. In other words, he believes that all moral rules are categorical: they tell you that you ought to do something, and whether you want to attain some goal is irrelevant.

 

 

[2.5.2.] The Categorical Imperative.

 

Hypothetical “ought”s are relatively easy to understand: they are possible because we have desires.

 

But how are categorical imperatives possible? I.e., how can we be obligated to do something, period?

 

Kant’s answer: categorical “ought”s are possible because we have reason.

 

This is because all categorical imperatives (and therefore all moral rules) are implied by a principle that all rational beings must accept. On Kant’s view, if you are rational, then you will accept this one central principle of behavior. All categorical imperatives follow from this central principle; so once you accept the central principle, you will come to see what other rules you should obey. 

 

The one rule or principle that all rational beings must accept is:

 

The Categorical Imperative:  “Act only according to that maxim by which you can at the same time will that it should become a universal law.” (Kant, Foundations of the Metaphysics of Morals (1785), quoted at Pence p.6)

 

 

[2.5.3.] Against Lying.

 

Kant took The Categorical Imperative to imply that lying is always immoral, no matter what the circumstances.

 

Kant’s “Categorical Imperative” Argument Against Lying

(1)   We should perform only those actions that conform to rules that we can rationally will to be adopted universally. [The CI]

(2)   If we were to lie, we would be following the rule: “Tell a lie.”

(3)   We cannot will that this rule be adopted universally, because it would be self-defeating: people would stop believing one another, so it would do no good to lie, and people would stop lying. [Kant is not saying that it would be bad if people were to stop communicating; he is saying that the rule “Tell a lie” cannot be universalized because it is self-defeating; to will that it be adopted universally is thus irrational.]

(4)   Therefore, we should never lie.

 

 

[2.5.4.] The Categorical Imperative (2^nd version).

 

Kant held that a second formulation of The Categorical Imperative said essentially the same thing, but in different language:

 

The Categorical Imperative (2^nd version): “Act so that you treat humanity, whether in your own person or in that of another, always as an end and never as a means only.”[1]

 

On Kant’s view, the Categorical Imperative requires that we respect the rationality of individuals. In other words, it requires that we respect their ability to decide how they will behave, how they will live their own lives. It requires that we respect their autonomy. This means that we can never use them or manipulate them to achieve our own purposes, even if our purposes are good ones.

 

Kant thought the two formulations of the CI were equivalent: he thought the two formulations implied all of the same specific categorical imperatives, i.e., all of the same specific rules of morality, e.g., never lie.

 

 

[2.5.4.] Lying to Patients.

 

Pence applies Kantian reasoning to the case of physicians lying to their patients:

 

If the maxim is, “Lie to patients when the truth is unlikely to do them any good,” or “Lie to patients when I may get sued for making a mistake,” then such lying undermines all communication in medicine between doctor and patient. It also erodes all trust between physicians and patients. ...

In medicine, to deceive patients on the most crucial matters is to dissemble [i.e., to conceal facts, to put on a false appearance] when it counts most: when patients most want to know the facts, and when the stakes are highest. In other words, it is like saying, “I enter this relationship committed to telling the facts” and “I do not enter this relationship committed to telling the facts.” (Pence 7-8)

 

Another way to apply Kantian reasoning to this issue is as follows:

 

·         One of the reasons a person enters the doctor-patient relationship is to find things out, to come to know things that she did not already know about her own health.

·         If all doctors lied to their patients when they thought it best to do so (either for their own sake, as in the case of avoiding a lawsuit, or for the sake of their patients, as in the case of paternalistic deception), patients would have no longer have a reason for entering into that relationship.

·         So eventually, there would be no more patients, and no more doctors, and no more doctors lying to patients.

·         Thus, lying to patients is self-defeating, and therefore irrational, and therefore (on Kant’s view) immoral.

 

Discussion: Is this a sound argument against lying?

 

 

Stopping point for Monday January 12. For next time, study today’s lecture notes, read Pence pp.9-14, and review any notes about utilitarianism you have left over from Intro to Ethics.