Morality and ethics

This topic is an introduction to morality and how we think about it in the context of what is “right” and “wrong”. You should try to consider the role of society, culture, religion, and gender on the development of your own moral worldview.

Often in clinical practice we come across patients whose actions have been contrary to what we believe is “the right thing” and which offends our moral sensibilities. The conflict arises when our mandate to provide equal care to all is challenged when we don’t believe our patients are deserving of equal care (or sometimes, any care at all e.g. murderers, drug dealers, women who have had an abortion).

In a narrow sense morality deals with personal values, religious views or social norms that do not emphasise professional ethics, whereas a more mainstream understanding of morality encompasses both professional and personal perspectives. Moral reasons for doing (or not doing) something would include honesty, integrity, justice and fairness, decency and compassion. Most dictionaries define morality as an understanding of what is right or wrong, good/bad, ought/ought not to do etc., but this then goes beyond morality. For example there is a right/wrong way to use a goniometer, a good/bad way to grow tomatoes or mix paint one ought/ought not park one’s car in a certain place. It is therefore difficult to define morality comprehensively and informatively and more so what is morally justified- is it that which is obligatory or permissible or desirable? This leads to obligatory principles to which health professionals have to adhere or they will be found culpable and personal ideals and commitment which motivate, guide and give meaning to professional practice, even if not incumbent to do.

Also, the concept of morality is deeply grounded in the social norms of a specific community and therefore is not necessarily applicable in all other contexts. This makes it difficult to develop a universal set of principles or guidelines that everyone would consider to be an acceptable framework for making choices about what is right and wrong.

Why be moral?

A variety of reasons can be cited, namely that it appeals to virtues or desirable features as dishonest acts make one dishonest i.e. One is no longer a person of integrity as is required by the health professional ethical standards of a responsible professional to be the kind of person aspiring to the relationship sought by the community being served. Doing what is required leads to being a responsible person of integrity i.e. a responsible, compassionate healer/health professional. It also challenges one’s entire moral life, such as moral character and conduct in general i.e. it is a way of living. Is there self interest in this? Plato, in his Republic recites the legend of Gyges, where gaining absolute power leads to an overwhelming, uncontrollable appetite for more, which eventually leads to unhappiness and destruction of mental health and well being. He states: “virtue is, as it were, the health and comeliness and well being of the soul, as wickedness is a disease deformity, and weakness.”

There are many other philosophies regarding moral endeavours and happiness producing aspects of the life that overlap, but none of these justify morality or moral values otherwise. This could lead to ethical egoism i.e. one should only care about one’s own self- interest. Yet one must value the self as having inherent worth in order to value others. The Golden rule states that one should do onto others as one would have them do unto one. In this way one could consider ethical egoism as a form of ethical scepticism about the validity of moral reasons, whereas human right claim all human have rights that makes claims on one. In this sense, ethical egoism becomes self-defeating as the person becomes self-centred/selfish/self-seeking and thus cut off from love, friendship, deep commitments to humanitarian, environmental, spiritual and other involvements, i.e. Caring for others for their sake. However, if “self” is defined as caring relations with others, then self interest- I know what is best for me! – then everyone will benefit. Unfortunately, thus does not hold water, as we all need the help of others- when very young, very old, sick, frail etc. – and do we really always know what is good for us?

Why study ethics and human rights?

It is impossible to “teach” morality at undergraduate or post-graduate level. As this is already installed at a very young age, thus moral decency begins very early. However, further study and reflection-in-practice can still contribute significantly to moral development, which is life-long process enabling one to grapple with the complexity of moral issues, thus increasing one’s capacity to deal with moral vagueness, uncertainty and ambiguity, as well as moral dilemmas and disagreements. This can be done by:

  • Identifying and clarifying moral issues and reasons
  • Weighing conflicting moral reasons
  • Forming consistent and well developed moral perspectives
  • Maintaining imaginative awareness and alternative viewpoints and integrating conflicting perspectives
  • Using moral reasons and arguments with increased precision, both in writing and dialogue with others, concentrating on cognitive skills, which lead to moral respect and concern, BUT this could also be abused to rationalise immoral conduct

Thus the student also needs to acquire:

  • The ability to argue in morally reasonable ways towards beliefs that are justified, taking into account wide legitimate differences
  • Strengthening attitudes of care and respect for other persons, as well as for oneself
  • Developed and nuanced appreciation of diversity, manifested in moral tolerance (non-coercive behaviour), being open-minded (receptive of new ideas) and broad-minded (acknowledging a range of morally reasonable differences)
  • A tendency to act in morally responsible ways as professionals
  • The ability to maintain integrity by integrating one’s personal and professional life

All courses or work shops should aim at increasing cognitive skills. In the classroom students and teachers are equal as there is no right or wrong answer or solution. All can only increase their skills of moral argument and appreciation of alternative perspectives and important variables in decision making.

In South Africa our behaviour as professionals is guided by the HPCSA Guidelines on Conduct and Ethics and the SASP Code of Conduct. We also have the Patients Rights Charter and the Bill of Rights in the Constitution. But, in addition to these policy guidelines (and legal framework in the case of the Constitution), we also need to acknowledge the powerful role that beliefs play in influencing our professional behaviour. This week is about exploring the relationship between the law, ethics, morality and professional guidelines.

Questions to guide your thinking on the topic. Note that you don’t have to try and answer these questions, they are simply meant to stimulate your thinking:

  1. How has your own sense of morality been informed? What continues to inform it?
  2. What is the relationship between belief and behaviour? How do our morals (what we believe is right) influence our behaviour (what we have to do)?
  3. What is the relationship between your morality and professional practice?
  4. Can you think of any situations where your ethical treatment of a patient would be challenged by your belief system?
  5. It’s easy to highlight the unethical behaviour in others, but how do you perceive your own practice? Are you perfectly ethical? Is it possible to be perfectly ethical?