Reason as the Leading Motive

Posts Tagged ‘moral dilemmas’

Medical Ethics and Moral Dilemmas

Posted by Jerry on December 19, 2007

A story came up on Yahoo! News today about 49 highly infectious tuberculosis patients in South Africa who escaped from their hospital isolation units where they were being forcibly confined for treatment.

The last paragraph of the story evoked some interesting thoughts on the moral nature of this situation:

Although forced confinement of patients violates most medical ethics, authorities say they have no choice but to put the wider public good above individual rights. Confinement for XDR-TB is at least six months.

I can reasonably assume that the South African authorities are functioning on a utilitarian ethical system in their decision-making: individual rights are dispensable in the name of “public good” as defined by authority. 

Is having an infectious disease grounds for limiting–or even denying–the right to liberty? Is it a crime to live in a society with a highly infectious disease?

I am not entirely confident of the answers I am about to offer and of all their implications. My aim, however, in writing this post is to clarify the moral and legal dilemmas that arise from health-related conflicts of interest. More importantly, I wanted to examine these apparent conflicts from an Objectivist perspective because, largely, the field of medical ethics has been dominated by utilitarian, altruist, and religious moralities–often proposing grotesque solutions that makes one wonder if the situation hasn’t been worsened further.

I believe that the Objectivist theory of rights offers by far the most robust framework of principles against which such moral dilemmas can be analyzed and successfully resolved. Having said that, what follows is my own application of the Objectivist ethics to the situation being discussed; this does not mean that my application is accurate or that this is what Objectivism prescribes.

The Yahoo! news report only states that the individuals have highly infectious tuberculosis. There are several kinds of tuberculosis and it should be clear that to have a highly infectious disease is not necessarily to have a contagious or communicable disease. Tuberculosis of some kinds are highly communicable, but not all of them are.

Individuals with fatal, life-threatening, and communicable diseases pose a real and direct threat to the lives of healthy individuals in their normal surroundings. In this sense, the existence of such a disease in a general environment can be thought of as the existence of force or threat to individual rights in society. To illustrate:

A person who walks on a busy street with a knife in his pocket has not committed any crime and is well within his rights. However, the moment he draws his knife menacingly at another unsuspecting and innocent individual and stands poised to attack, he has created a context of force, introduced a threat to life, and has abandoned the context of freedom that makes rights possible. Therefore, at this moment, even if physical contact between the attacker’s knife and the other individual has not occurred, and even if he has not lunged forward with his knife to attack, the man has committed a punishable crime.

Likewise, an individual with a highly infectious but non-communicable disease existing in a public environment has committed no crime and remains well within his rights: he is like a man walking with a knife in his pocket. However, if the individual is aware that his infectious disease is communicable and life-threatening, then he properly should choose to or be forced to separate from healthy individuals in his environment.

Further, despite his knowledge that his disease is life-threatening and communicable, if the man makes a deliberate, careless, or negligent act of transmitting the life-threatening disease to another unsuspecting or unwilling person, he has introduced the threat to life and relinquished his right to live freely among healthy individuals in a non-threatening environment in society.

Yet, this does not mean that the person with the disease should be imprisoned as a criminal; it certainly does mean, however, that such a person with a life-threatening and communicable disease must be isolated and quarantined. And then, it is up to the victim of this person’s actions whether or not to pursue criminal or civil charges against the infected individual for his negligent or deliberate endangerment.

Going by the above framework, a communicable disease that is not life-threatening does not meet the criteria for isolation from society or legal charges, because there is no actual threat to life, which is necessary to invalidate the existence of rights. Likewise, a highly infectious individual with a non-communicable disease poses no threat to the lives and rights of other individuals and therefore cannot be denied any of his own legitimate legal rights.

Thus, it is not matter of public good versus individual rights but an issue of force (or threat to life) versus rights.

Posted in My Theories and Ideas, Objectivism, Philosophy, Political Issues, Rights and Morality, The Best of Leitmotif, Uncategorized | Tagged: , , , , , , , , | 8 Comments »

Moral Dilemmas

Posted by Jerry on August 21, 2007

Philosophers love to conjure up thought experiments that create exceptionally improbable–even impossible–situations of moral dilemmas and then test out their moral theories. I suppose, since they believe that this method comes closest to emulating the method of controlled experimentation in scientific inquiry, philosophers derive some sense of psychological confidence and satisfaction.

However, the most crucial element in a moral dilemma is the moral agent, i.e., the human being. Therefore, if the purported goal is to test or validate some profound moral theory, it should necessarily be tested in scenarios and contexts relevant and probable to human beings, i.e., that in which humans regularly find themselves, because only humans are moral agents to whom the problem of morality is even applicable.

The goal should not be to have a moral theory that works wonders in an exceptional situation but is inapplicable to the mundane and the routine; rather, it should be the opposite. Exceptional situations may inform us of certain pertinent issues by starkly highlighting them in a certain context; but otherwise, they should not be used as a standard of assessing the validity of moral theories or the moral status of actions.

By its very nature, exceptional situations are rare and fleeting. Ayn Rand made this point in her essay “The Ethics of Emergencies.” Her argument properly asserts that moral principles are guides to behavior in the normal and predominant human situations.

However, in addition to testing out moral theories in relevant and probable scenarios, it is important to realize that no one scenario, action, or situation can be examined in isolation from the context that gave rise to it in the first place. Since reality is a totality of facts and relationships, our epistemological principles must mimic this existential totality in connecting and integrating all our knowledge about reality. In other words, all knowledge should be connected; thus, it is fallacious to test a moral theory or judge the morality of an action within some hypothetically isolated scenario that does not account for its causal conditions–be they human or situational.

For example, the following moral dilemma, which resembles the kind of thought experiment often devised by philosophers to test moral solutions, commits this mistake of isolating agents from their contexts and effects from their antecedents:

You are an inmate in a concentration camp. A sadistic guard is about to hang your son who tried to escape and wants you to pull the chair from underneath him. He says that if you don’t he will not only kill your son but some other innocent inmate as well. You don’t have any doubt that he means what he says. What should you do?

The crucial point that must be identified in the above moral dilemma is that whatsoever is the end resulting action you choose to do, the moral culpability does not reside within you because you would not be the moral causal agent of your actions–even though you would be the acting agent. In other words, your act is not a moral act but a forced act; it is an effect of the nature of your context (prison, sadistic guard, etc.): the fact that you are a prisoner in a concentration camp already limits the actions for which you can be held morally responsible; the fact that a sadistic guard issues an arbitrary threat and demands a certain arbitrary act leaves you morally impotent in the face of it.

However, if the above situation involved a free man asked to freely make the choice to pull the chair from under his son (in the absence of threat and coercion), then the free man becomes the causal agent of a moral action; i.e., he originates a moral act and should therefore be morally culpable.

Thus, these exceptional situations can become superfluous exercises in mental gymnastics if they are constructed to be so removed from human realities and appropriate contexts.


[September 19, 2007: I’m including my comment up here in the post because it further clarifies the article and explicitly indicates the Objectivist approach to moral dilemmas]

In my article, I point out that the primary purpose of constructing ethical theories is to help men live their normal, daily lives in an ethical and fruitful manner. Exceptional situations–or ethical emergencies–are by definition rare, transient, and fleeting. Therefore, such situations require that men suspend their normal course of activities to engage in and resolve such ethical emergencies. However, to extract a moral theory of behavior out of these exceptional situations and apply them as the standard or rule in regular life is a logical fallacy and a moral travesty.

Therefore, what does Objectivism advise the person to do in this situation? The response is: Do whatever comes to mind as the most appropriate and swift course of action to immediately end, resolve, or minimize the urgency of the situation and return to normalcy. As I said, Objectivism offers a moral theory for *normal* and regular human life, not for exceptional situations.

However, note this very important point: the moral code you embrace as a guide for normal events will to some extent (perhaps implicitly) guide your actions in exceptional situations. For example, if you are normally a rational man, i.e., you are in the habit of thinking and acting rationally to the extent of your knowledge, then in a situation of crisis, you will most likely respond quickly and immediately in a rational and focused manner, because rationality has become a habit that you are most comfortable with. In contrast, a habitually irrational man will be an emotional wreck when faced with a crisis situation because his mind is utterly hopeless and impotent in confronting the situation; in the face of crucial or split-second decision-making, the irrational man may respond in the only manner he knows best–irrationally, to the detriment of his own cause.

Thus, note the importance of a proper moral code in normal life and its influence on how you tackle ethical emergencies.

Regarding the specific situation indicated in my post, I noted in the article that the man can choose whatever course of action that is available to him. Since the man is under the threat of force and death, he cannot make any reasoned or rational decision; whatever he chooses to do is a consequence of the unfortunate context he is trapped in. Objectivism does not (and indeed, cannot) offer any moral guide to this man because the situation does not permit any moral course of action. Indeed, no ethical theory can legitimately offer a moral course of action for the man. Where there is force, there can be no reason or rationality and therefore no moral course of action–at best, the action would have to be amoral. Thus, the man can do whatever he thinks is most appropriate or expedient at that given time based on his own best judgment–-whatever the tragic consequences may be.

Posted in Ayn Rand, My Theories and Ideas, Objectivism, Philosophy, Rights and Morality, The Best of Leitmotif, Uncategorized | Tagged: , , , , , , , , , | 13 Comments »

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