By Caroline Whitbeck. In this essay, Whitbeck surveys the recent practical turn in the study and teaching of research ethics. Beginning with the recognition that ethics is an aspect of social life (rather than a body of universally applicable abstractions), ethicists have increasingly turned to case study and related approaches in teaching and writing about ethics. Topics addressed include: assessing behavior in context; cases, casuistry, and case methods; dilemmas and decision problems; and problems experienced by agents. This essay appeared in the Fall 1996 issue of Professional Ethics.
Ethical discussion has taken an increasingly practical turn in recent decades, and in the 1990s has provided new ground for the development of areas of practical ethics, such as research ethics. Now, more often than not, inquiry starts with specific situations posing ethical issues. Increasing recognition is given to the complex ethical presuppositions and commitments implicit in the practices of communities and social groups. Ethics does not await the scholar to introduce it.
The first element in this new view of ethics is the recognition that, as Annette Baier put it, ethical understanding is a cultural product.1 Therefore, scholars may contribute to reflection that develops ethical understanding, but should not presume to construct that understanding. This major insight began to influence philosophical ethics in the 1980s, after many decades in which an abstract view of ethics dominated. That abstract view had taken for granted that in all intellectual endeavors the achievement of a perspectiveless view-the "view from nowhere" 2 as Thomas Nagel put it- is the pinnacle of rationality; reasoning in philosophical ethics was represented as akin to deductive logic. Today this view that has been explicitly rejected by many, who have given renewed attention to what Seyla Benhabib calls the "situated self."3
By the 1970s philosophical ethics had become considerably less abstract than in the previous two decades. Recognition of the need for more ethical discussion in such domains as medicine and nursing had given rise to bioethics. However, in the 1970s the dominant approach to such fields was the "applied ethics" approach. Applied ethics accepted the abstract view of ethics, the belief that, as Alasdair MacIntyre put it, "we can first and independently comprehend the rules of morality as such and then only secondarily inquire as to their application in particular specialized social spheres."4 ; Although applied ethics was a step toward the particular, it maintained the fiction that the particular was merely that to which abstract moral truths were "applied."
Critics of the applied ethics approach rejected the very idea that philosophical ethics was an abstract discipline. MacIntyre, one of the most thorough-going of these critics, drew on Aristotle's approach to ethics and argued that ethics is an aspect of the life of particular communities rather than a body of abstractions with universal application to all persons. He observed that moral rules and principles are always learned in application to particular social circumstances. Ethics and fields like bioethics are continuous, differing only in the generality of their conclusions.4 Many thinkers agreed that ethics is a subject to which social observation and the social sciences are relevant, rather than being a "pure" abstract subject. In this spirit, Kathryn Addelson, for example, titled her first book in ethics Impure Thoughts.5
A second element in the move to a more practical focus in philosophical ethics has been the awakening of interest in subjects, such as trust, that are especially ill-suited to treatment in abstraction from context. As the philosopher Bernard Williams argued in 1988, building the trust required for a complex cooperative enterprise requires understanding that situation. As he says, "There is no one problem of cooperation: the problem is always how a given set of people cooperates."6
A third element has been the renewed attention to the centrality of character in moral life. From the 1960s philosophical ethics had examined the role of intention in differentiating outwardly similar acts-for example, chopping down a tree in one's yard to provide more light to the understory, as contrasted with chopping down the tree to spite the neighbors. Philosophers such as G.E.M. Anscomb and Donald Davidson responded to the difference between physically similar acts by analyzing descriptions of acts or "acts under a description" -two descriptions mentioning different intentions are different. Attention to the centrality of virtue in moral life has used examination of intention to show how character develops and is displayed in intelligible action. For example, in theological ethics, Stanley Hauerwas and Martin Rhonheimer discuss the difference in character traits manifest in, for example, killing someone because the person is threatening one's own life, and engaging in self-defense that ends in killing the aggressor. The agent intends something quite different in the two cases. In the first case the agent intends to kill the other and thereby eliminate the threat. In the second case the agent merely wants to limit the other's aggression, and so uses no more force than is required to do so.
MacIntyre has observed that the fundamental category in ethics is not action, but intelligible action and this requires a narrative context. Building on the philosophical and literary work of Iris Murdoch7scholars like Hauerwas and MacIntyre interested in moral character have placed greater emphasis on narrative and literature. A person's identity and self-understanding, and hence her moral integrity is conveyed in her story. The importance of literature for philosophical ethics and for practical ethics has been taken up by Martha Nussbaum in two recent books, Love's Knowledge: Essays on Philosophy and Literature and Poetic Justice: The Literary Imagination and Public Life in which she questions whether literature can be considered a special form of moral philosophy and argues for the importance of literature, or at least realist novels for the development of practical ethical evaluation of concrete problems.8
Literature has come to particular prominence in research ethics and health care ethics. In research ethics the novels of Carl Djerassi, Cantor's Dilemma and The Bourbaki Gambit, have displayed the morals of contemporary scientific research.9The use of novels and short stories transformed much of the teaching of ethics to medical students in the 1980s by providing an opportunity for medical students to develop a delimited empathy with ill characters. (Literature gives one a chance to feel with the characters without, for example, being overwhelmed with grief if they die.)
The need to develop ethical guidelines for novel situations-from the clinical application of molecular genetics to the biomonitoring of communities contaminated by toxic substances-has added a further impetus to the shift of attention in ethics to the practical and particular.
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Recognition of the ethical importance of the social context in which an act is carried out has proved important in professional ethics where it helps to clarify why the moral rules and guidelines vary from one profession to the next without recourse to "role morality".10 When ethics was taken to be a set of abstract rules with universal application, it seemed puzzling to think that there might be medical ethics, nursing ethics, engineering ethics and legal ethics. Surely honesty, would be the same thing for a physician, a nurse, an engineer, or a lawyer. However, both the pitfalls or temptations people are likely to encounter, and the courses of action open to them vary with the character of their daily work. Being a responsible physician requires care about matters distinct from those that concern an engineer, a nurse or a lawyer because each profession addresses different problems with differing ramifications for a particular response. Physicians seek to provide the best outcomes for their patients, engineers have obligations to their client or employers and additionally a responsibility for public safety, for example.
One finds rules about client confidentiality in law, engineering and health care, but physicians and nurses have no rule precisely corresponding to the rule in engineering codes against paying or accepting bribes. (Lawyers are forbidden from offering inducements to witnesses for false testimony.) Physicians, nurses and lawyers do not consider taking bribes any more ethical than do engineers. The difference is that being offered a bribe is not a common moral hazard in medicine, nursing or law. Codes of conduct for professional groups address only problems and abuses that commonly occur within them. Fee splitting, a form of kickback for referral, does occur in medicine, for example, and the American Medical Association (AMA) proscribes fee-splitting.
Even more telling for the importance of the social context of problems is the recognition that acts that are injurious in one profession may be for harmless in another. For example, the AMA code forbids physicians to withdraw from a case without first finding another physician for that patient. The American Bar Association specifies a more limited obligation about withdrawal of services by lawyers. Engineers, however, have no such generally recognized obligation to continue rendering their services until replacement engineers can be found. Unlike clients of engineers, patients are commonly much more emotionally as well as physically dependent on their health care providers, and hence vulnerable to injury by abandonment. (One can, of course, imagine emergencies in which engineers ought to ensure that the necessary engineering services would continue.)
The professions differ in how they handle conflict of interest. Attorneys, whose clients may be legal adversaries of one another, must adhere to a host of conflict of interest provisions that have no counterpart for other professions. In many cases, a law firm may not represent both of two parties who are legal adversaries in an unrelated matter. Health care providers are not prohibited from treating two athletic competitors, for example. Engineers need not refrain from constructing buildings for two competing manufacturers. The social context which helps to define each profession influences the needs that its practitioners are prepared to address, the obligations they have and the temptations they must especially guard against. Professional practice has been a major source of practical ethical problems in recent decades.
Stephen Toulmin and Albert Jonsen brought forward theoretical considerations in favor of starting with particulars in ethical reasoning. They revived casuistry- the judgment of new cases by analogical reasoning from other, better understood, cases-as a method of reasoning in ethics. Their casuistic method provided a model of moral judgment alternative to that which sought to evaluate situations by applying general ethical principles to them.11 (Toulmin had previously argued from his experience as staff to a presidential commission examining questions in bioethics that commissioners usually could agree in their assessment of cases although often disagreed in the ethical principles they would accept.12 ) Their method has been taken up in other areas of practical ethics, such as research ethics.13
For decades cases of a sort had been used in philosophical ethics even by those who embracing an abstract model of ethics. If based on real events, their grounding in reality was not an important feature. Many were not only hypothetical but were "science fiction." Constructed as thought experiments to test purported ethical generalizations, these cases functioned more like counter-examples in logic, than like Jonsen and Toulmin's reference cases which were based on actual events.
Even cases based on actual situations vary widely. They differ in the familiarity of the situations they recount, for example. The media covers events that are newsworthy. They usually omit events that are the staple of moral life in favor of the dramatic and exotic. To be sure, some newsworthy events, like, say, the story of the Exxon Valdez oil spill, illustrate common moral failings, and are newsworthy because of their disastrous outcome. (In the case of the Valdez, alcohol abuse by the captain, poor organizational response to reports of that abuse, and a short-sighted decision to save money with a vulnerable hull design all contributed to the disaster.) Other news stories concern behaviors or events so extreme or bizarre that it is not clear how they might shed light on common situations.
Philosophers and other scholars who began to draw on actual events in the 1980s did not always show much concern for historical or sociological accuracy, however. Some molded cases to their own preconceptions undercutting the value of their case for moral education.14
Although the wider use of cases from life led people to talk about "the case method" in teaching, many methods actually use such cases. The cases themselves are diverse in both subject matter and in the responses they are meant to elicit. Many cases used in teaching were written for a variety of other purposes: news reports, personal recollection, and historical investigation. Some were written to show the need for new policies (for example, studies of cases of toxic contamination such as occurred at Love Canal) or to define a domain of investigation and its characteristic problems (such as those developed for presidential commissions).
Even those constructed specifically for teaching differ greatly. The Harvard case studies present a extended case histories typically including decisions of the general type that the students who discuss them will someday make. These cases are quite detailed although the case typically lacks the unity of an historical account, presumably because part of the task for students is to organize the information presented. In this collection, too, the cases are usually complete, or almost complete stories so the discussants have primarily make an evaluation, judging the actions and events recounted, although some call for one final decision.
The cases in the widely distributed Association of American Medical Colleges collection of research ethics cases are brief and authored by many individuals who seem to have been concerned to bring tales of common abuses to the attention of the research community. The pedagogical vision underlying this collection is unclear, since it is difficult to see what students can gain from the sad stories of unopposed abuse of power that predominate.15
Some cases prepared by professional groups for teaching professional ethics, such as the cases of the Board of Ethical Review of the National Society of Professional Engineers (NSPE)16, have the purpose of educating professionals about how the ethical norms of their profession and how they are applied in the ethical assessment of particular situations. These cases, like the others discussed so far, are primarily complete stories that call for ethical assessment of actions already performed.
Cases, even those drawn from life, are often forced into the form of dilemmas, or some other sort of multiple-choice problem.17The issue is not just that people use the term "dilemma," which means "a forced choice between two unacceptable alternatives," when what they mean is a challenging moral problem. The difficulty is that they then treat moral problems as if they were dilemmas. In actual practice options are rarely limited to two, and morally significant problems almost never come with possible responses specified.
An example from Carol Gilligan's 1981 book, In A Different Voice nicely illustrates the contrast between a moral problem as it actually unfolds and the constricting form of a dilemma. Gilligan (who made a rather different use of this evidence) recounts the response of children to the "Heinz dilemma" devised by developmental psychologist Lawrence Kohlberg. Kohlberg indeed constructed this problem as a dilemma. Children are asked to decide whether Heinz should steal a drug he cannot afford to save his wife's life. When eleven year-old Amy is asked this question she says, "Well, I don't think so," and seeks to escape the dilemma by proposing new alternatives to either stealing or letting Heinz's wife die:
"I think there might be other ways besides stealing it, like if he could borrow the money or make a loan or something, but he really shouldn't steal the drug-but his wife shouldn't die either." (Gilligan, 1982, 27.
When pressed about why Heinz should not steal the drug, Amy reasons "[I]f he stole the drug, he might save his wife then, but if he did, he might have to go to jail, and then his wife might get sicker again, and he couldn't get more of the drug, and it might not be good. So, they should really just talk it out and find some other way to make the money." (Gilligan, 1982, 28.)
Amy's new alternatives - "borrowing the money" or, as Amy elsewhere suggests, persuading the druggist to lower the price-would be appropriate responses to the situation if it were an actual problem. Yet Kohlberg scores her responses as deviant, and therefore, immature. He uses the applied ethics model and is influenced by the view, articulated by the philosopher John Rawls in 1957, that philosophical ethics ought to provide a decision procedure-a way of settling matters, especially in the case of conflicting values or interests-and do so by formulating and ordering principles. In this case, valuing life more than property is the sort of 'principle' that, in Kohlberg's view, a mature child would invoke. Whatever else can be said about the model Kohlberg uses, it does not give insight into the reasoning required to find the kind of generally satisfactory solution that Amy was attempting to devise.
The structure of the Heinz dilemma is a clear example of a widespread tendency evident in the media and in popular culture, as well as in philosophical circles, to represent moral problems as conflicts between opposing sides or principles.
Even when people see that a moral problem is more than a choice between two alternatives, they nonetheless often discuss it as some sort of multiple-choice problem. In particular the representation of a moral matter as a "decision problem" - a problem for decision analysis- makes it into a multiple-choice problem. The first step in decision analysis is to "define," or "identify and bound," the problem. This means to formulate possible alternative responses, types of information available and relevant, the possible results expected from each response, and considerations such as cost and societal impact. One can simply identify the possible responses only in special circumstances, however-only when the circumstances predetermine the responses; only, that is to say, if the problem is a multiple-choice problem. Even when one understands the situation well enough to articulate the problem , the possible responses to it are predetermined only in rare cases (as when one must decide which way to go at a crossroads).
Multiple-choice problems require only the evaluation and comparison of the choices. More is required for in addressing actual problems: one must figure out what to do. The subject of devising courses of action is one on which, as Stuart Hampshire observed in 1949 and again in 198918 philosophical ethics has had little to say. Courses in ethics, he said, only teach students how to be the ethical counterpart of art critics rather than the ethical counterpart of artists. As Hampshire observed, a judge's skills are part of what a person seeking to respond well to a moral problem must exercise, since these are used in the assessment of candidate responses to one's situation. If one would disapprove of another person for acting in a certain way, that is a good reason for not acting in that way oneself. However judging proffered alternatives does not show how to devise alternative.
Hampshire's point was ignored in the work that came to dominate biomedical ethics, Principles of Biomedical Ethics.19The author/editors Tom Beauchamp and James Childress raised the topic of the agent's deliberation only to ignore those aspects of agent's deliberations that go beyond justification.20
The construction of open-ended situations that pose moral problems calling for action, written from the perspective of an agent in that situation attempts to address the deficiency that Hampshire observed in ethics education. In calling for the formulation of responses and in supplying only the information that a finite human in the situation would have, such problem statements, or scenarios, simulate the moral problems in life. Such cases are intended to complement rather than displace the use of judgment cases, since judgment cases usefully clarify ethical standards and their application in particular situations.
To illustrate the difference between the judgment cases and open-ended scenarios consider the following case description: "Suppose you suspect that cold temperature compromises the performance of certain gaskets, and hence the safety of your vehicle. What should you do?" This open-ended description gives a thumbnail sketch of a situation that has with some uncertainties and calls for a response. In contrast, a question such as, "Should you report a safety problem to the media and be fired and perhaps blacklisted, or should you say nothing and keep your job?" presents an unambiguous situation that requires but only that you evaluate two proffered responses.
Even open-ended scenario descriptions may present moral problems as clear and unambiguous, but people who must decide what to do often do find ambiguity in their situation. Often too little attention is given to how to act in the face of ambiguities. One can rarely achieve certainty before acting. What is needed are responses that will prove prudent and fair to everyone however uncertainties are resolved.
The latest (1995) edition of On Being a Scientist, provides many scenarios constructed as to present moral problems as they appear to those who must respond to them along with some cautionary tales and judgment cases. One of the open-ended scenarios concerns John, a third-year graduate student who is participating in a department-wide seminar in which students, postdocs, and faculty members discuss work in progress. "An assistant professor prefaces her comments by saying that the work she is about to discuss is sponsored by both a federal grant and a biotechnology firm for which she consults. In the course of the talk John realizes that he has been working on a technique that could make a major contribution to the work being discussed. But his faculty advisor consults for a different, and competing, biotechnology firm
Formulating cases to reflect the situation from the point of view of the person who must devise a response has several goals:
When some situation has ended badly, or when a notorious accident or mishap is used to illustrate the importance of some responsibility, the tendency is to reason as though that outcome ought to have been prevented at any cost. Preventing a particular negative outcome at any cost does not illuminate how to respond in a way that takes into account all of the relevant factors.
Taking a problem-solving approach can. It represents a stance in which responses to a problem can be improved upon, even when ethical norms are clearly established, and the initial response is extremely good. Therefore scenarios that simulate problems experienced by agent are an important adjunct to the cautionary tales, historical studies, news stories and judgment cases that formed the case collections of previous decades.
To frame moral problems only from the vantage point of the moral critic, rather than from that of the person facing the problem, associates ethics with judgment and criticism. It creates incentives for people to insulate themselves from that criticism, either by narrowing the scope of the problems they address or by developing ready rationalizations for their behavior. However, the pressing problems of both individuals and society are multiply-constrained. Deciding how to be a good nurse, teacher, parent or friend, or how to protect the environment, requires continuing input and oversight, often from many individuals and organizations. Recognition that good resolutions of moral problems can be improved upon dispels the impression that ethical discussion is a zero-sum game in which one person's achievement or gain is another's loss. Instead, discussion can benefit from honest disagreement to arrive at solutions and ways of coping that are acceptable in terms of diverse ethical considerations.
by Caroline Whitbeck
This article first appeared in Professional Ethics 5:3 (Fall 1996 issue). 3-16.
* This paper summarizes many points developed in detail in the Philosophical Appendix to Ethics in Engineering Practice and Research, which was published by Cambridge University Press in 1998. I thank Diane Greco for discussions of Martha Nussbaum's work.