[2.7.] Acts vs. Omissions.

 

In the case of Mr. Jones, Peter has the option of simply doing nothing. He can refrain from telling Mr. Jones the truth, and he can refrain from lying. He can simply omit any information about Sam’s earlier mistake. Would omitting information be a moral course of action?

 

From a utilitarian point of view, there is not necessarily a moral difference between lying and omitting information. If the consequences of omitting information are the same as those of lying, then the two options are morally equivalent, i.e., they are either both morally permissible or both immoral.

 

So from a utilitarian point of view, omitting information rather than actively lying does not resolve Peter’s dilemma.

 

Many people believe that the distinction between acts and omissions does make an important moral difference in other scenarios. For example, the difference between

 

·         passive euthanasia, which occurs when someone is allowed to die “naturally” by the removal of life-support (e.g., the removal of a respirator or a feeding-tube); and

·         active euthanasia, which occurs when someone intervenes in order to cause the death of the patient (e.g., a doctor injects the patient with drugs that bring about his or her death)

 

is exactly the difference between omitting and acting. (Note that the consequences and the motives are the same in both types of euthanasia—the motive is to end the patient’s suffering, and the consequence is that the patient dies.)

 

 

 

[2.7.] Virtue Ethics.

 

So far we have been focusing on the morality of actions.

 

We have asked questions like “what makes an action such as lying right or wrong?” and we have considered a number of answers:

·         ethical relativism

·         ethical subjectivism

·         Kantianism

·         utilitarianism

 

As different as those theories are, they all assume the same approach to thinking about ethics: they assume that ethics ought to provide a guide for action, to tell us how we should act.

 

But there is a very different way of approaching ethical questions, one that goes back to ancient Greece, to the philosophers Socrates, Plato and (especially) Aristotle (384 - 322 BCE) in his classic work Nichomachean Ethics.

 

Instead of asking about the morality of actions, or types of action, these ancient thinkers asked: what makes someone a good person?

·         other ways of asking this question are: what sort of person should I be? what character traits should I cultivate in myself?[1]

On this view, the primary job of ethics is to tell us what kind of people we should be.

 

In the 1950s, G. E. M. (“Elizabeth”) Anscombe (English, 1919-2001) argued that we ought to give up the modern approach to ethics that focuses on principles or “laws” of right action. We ought to give up this approach, she argued, because the idea of a “law” makes no sense without a law-giver.

 

So any moral theory that says “here is an ethical principle that you must follow” (e.g., the Categorical Imperative, or the principle that says to increase overall happiness) makes no sense, because there is no law-giver standing behind such a principle and justifying it. Anscombe’s arguments were very influential, and by the end of the 20^th century, three of the most popular ways of approaching ethical problems were utilitarianism, Kantianism, and virtue ethics.

 

virtue ethics (a.k.a. virtue theory) (df.): an approach to ethics that emphasizes morally valuable character traits rather than the moral value of actions.

 

 

[2.7.1.] Examples of Virtues.

 

The following list of virtues comes from James Rachels, Elements of Moral Philosophy (4^th ed), p.176:

 

benevolence civility compassion conscientiousness cooperativeness courage courteousness dependability

fairness friendliness generosity honesty industriousness justice loyalty moderation

patience prudence reasonableness self-discipline self-reliance tactfulness thoughtfulness tolerance

 

There are some virtues that it is especially important for a physician to have, including

·         compassion

·         conscientiousness

·         dependability

·         honesty

 

But why is honesty especially important for a physician? Pence answers:

 

                Truthfulness or veracity … is essential to empowering the autonomy of patients. If patients do not possess accurate and complete information about physicians, they cannot make good decisions about their health and lives. (Pence 14)

 

...communication is one of the most essential aspects of the physician-patient relationship. Falsehoods thwart that relationship, in both directions. ...

                Deception by physicians deeply undermines trust by patients. Lying by one physician to one patient hurts all physicians and sabotages the trust at the heart of the physician-patient relationship. But most importantly, lying by a physician to his or her patients is a terrible flaw of character of the physician as a physician. If patients cannot go to a physician and get the truth about what is wrong with them, why should they go at all? Or pay physicians? What is the point? (Pence 16)

               

Pence gives the following reasons for thinking that honesty is an especially important virtue for physicians:

·         Truthfulness respects the patients’ autonomy.

·         Truthfulness helps patients make good decisions for themselves.

·         Lying will hurt all physicians by undermining their patients’ trust

·         Lying thwarts the purposes of the patient, who has come to the physician to find out the truth about her condition.

 

 

[2.7.2.] A Criticism of Virtue Ethics.

 

One standard criticism of virtue ethics is that it ultimately “reduces” to some other, rule-based form of normative ethics.

 

When we focus on any specific virtue and ask “why is it good for a person to have this trait rather than another?” the answer will always lead us out of what virtue ethics by itself can tell us and into some other normative theory of ethics.

 

Consider these reasons why honesty is a virtue for physicians:

·         Truthfulness respects the patients’ autonomy.

·         Truthfulness helps patients make good decisions for themselves.

·         Lying thwarts the purposes of the patient, who has come to the physician to find out the truth about her condition.

These are very Kantian reasons... they both seem to involve respecting patients’ autonomy and not manipulating them, just as the second version of the Categorical Imperative requires.

 

And consider this reason:

·         Lying will hurt all physicians by undermining their patients’ trust.

This seems to be a utilitarian consideration (although it remains unclear from what Pence says exactly how physicians will be harmed). The point is that honesty between patients and physicians has better consequences than dishonesty.

 

 

[2.7.3.] Patients and Vices.

 

Pence (17) poses some interesting questions about patient behavior and casts them in terms of vices (character traits that it is bad for someone to have; the opposite of virtues).

 

At the level of public policy:

·         “Should alcoholics have the same eligibility for liver transplants as those who lost their livers through accidents or rare viruses?”

·         “Should people who eat poorly and [do] not exercise be forced to pay higher premiums for medical coverage?”

 

At the level of individual physicians and patients:

·         “Should physicians judge the [bad] behavior of their patients?”

·         “[Should they v]ent their anger at irresponsible behavior?”

 

Applied to the case of Mr. Jones: Mr. Jones’ cancer was almost certainly brought about by his smoking habit. Should Sam or Peter allow their decision whether to be honest be influenced by that fact? If not, why not? What sort of moral responsibility (as opposed to causal responsibility) does Mr. Jones bear for his own health?

 

 

See pp.18-19 for the conclusion of the Mr. Jones case.

 

 

Stopping point for Friday January 16. For next time (Wednesday Jan. 21), read Pence ch.4 pp.81-90.