A scholar of psychology and philosophy, Josiah is a great friend who wanted to share his reflections on the tension between medicine and public health. A former Master's student at Duke, he is currently working at UNC-Charlotte - though he still remains a rabid Duke basketball fan at heart.
As I read Sanjay’s post about the tension between helping individuals and implementing more broad-brush policy changes, I couldn’t help but think that it encapsulated the tension brought about by the way the Enlightenment shifted our ethical framework. An odd thought process, I know. When you change your major once a year as an undergrad and drop out of grad school twice after that, I guess that’s just the way your mind works.
At any rate, the ethicist Alasdair MacIntyre contends that Enlightenment thinkers sought to create a rational justification for moral thought and behavior. In so doing, these thinkers abstracted moral decision-making and removed it from any broader familial or social context.
We see this all the time in the thought experiments we all have to undertake in philosophy classes. It usually follows the line of, “You are standing by a set of train tracks, and a passenger train is approaching a broken track. You can pull the switch and divert the train to another set of tracks, saving the lives of everyone on board. But if you divert the train, it will run over the 4 men working on that section of track. You can’t get their attention to warn them of the approaching train.” Of course, most people say to pull the switch and save several hundred lives while sacrificing 4 people.
This kind of utilitarian, greatest-good-for-the-greatest-number social ethic is exactly the product of such de-contextualized ethical thought. Most of us, though, rarely hang out by train tracks. Fewer of us still will find ourselves located by a track switch and forced to choose between saving a passenger train or saving 4 railroad employees.
But we DO find this type of ethic writ into the fabric of contemporary society. This is the voice of the “cost-effective,” wondering why anyone would medivac one patient out of the developing world when so many vaccines could be purchased for the same price. This is the proponent of just war, claiming “collateral damage” is a necessary sacrifice for national security.
In context, though, those lives mean a great deal. The family of the patient and the doctor treating him or her certainly value the investment made in saving the patient’s life. They would consider it $20,000 well-spent. The people who lose wives and sons and sisters and uncles to stray bullets or errant bombs view such “collateral damage” as more than the mere detritus of a utilitarian “just” war.
The alternative, I think, is an ethic of virtue. This is an ethic that asks how we go about building a better world—an ethic that views our small and large decisions as either contributing to or detracting from building that world. It is an ethic that lives in context; it says, “Yes, we do live in a violent world of suffering, famine, disease, and hard choices. But we also live in a world where the life in front of us is precious and worth saving.”
The rebuttal, of course, is that this is a horribly impractical approach, and that is why we need the abstraction. I will unabashedly say that virtue can be impractical. But would you be practical if it involved the lives of your parents? Of your spouse or partner? Of your closest friends? Can you impose that practicality on other people? Should you?
That is why contextual ethics matter. Life doesn’t happen in thought experiments.
What if we paused to mourn the loss of any life, no matter how cost-effective or justified in the abstract? What if we celebrated the saving of any life, no matter how expensive? What if we lived in a world that invested as much in life as it does in death?
We start by building that world together through conversations such as this.
As I read Sanjay’s post about the tension between helping individuals and implementing more broad-brush policy changes, I couldn’t help but think that it encapsulated the tension brought about by the way the Enlightenment shifted our ethical framework. An odd thought process, I know. When you change your major once a year as an undergrad and drop out of grad school twice after that, I guess that’s just the way your mind works.
At any rate, the ethicist Alasdair MacIntyre contends that Enlightenment thinkers sought to create a rational justification for moral thought and behavior. In so doing, these thinkers abstracted moral decision-making and removed it from any broader familial or social context.
We see this all the time in the thought experiments we all have to undertake in philosophy classes. It usually follows the line of, “You are standing by a set of train tracks, and a passenger train is approaching a broken track. You can pull the switch and divert the train to another set of tracks, saving the lives of everyone on board. But if you divert the train, it will run over the 4 men working on that section of track. You can’t get their attention to warn them of the approaching train.” Of course, most people say to pull the switch and save several hundred lives while sacrificing 4 people.
This kind of utilitarian, greatest-good-for-the-greatest-number social ethic is exactly the product of such de-contextualized ethical thought. Most of us, though, rarely hang out by train tracks. Fewer of us still will find ourselves located by a track switch and forced to choose between saving a passenger train or saving 4 railroad employees.
But we DO find this type of ethic writ into the fabric of contemporary society. This is the voice of the “cost-effective,” wondering why anyone would medivac one patient out of the developing world when so many vaccines could be purchased for the same price. This is the proponent of just war, claiming “collateral damage” is a necessary sacrifice for national security.
In context, though, those lives mean a great deal. The family of the patient and the doctor treating him or her certainly value the investment made in saving the patient’s life. They would consider it $20,000 well-spent. The people who lose wives and sons and sisters and uncles to stray bullets or errant bombs view such “collateral damage” as more than the mere detritus of a utilitarian “just” war.
The alternative, I think, is an ethic of virtue. This is an ethic that asks how we go about building a better world—an ethic that views our small and large decisions as either contributing to or detracting from building that world. It is an ethic that lives in context; it says, “Yes, we do live in a violent world of suffering, famine, disease, and hard choices. But we also live in a world where the life in front of us is precious and worth saving.”
The rebuttal, of course, is that this is a horribly impractical approach, and that is why we need the abstraction. I will unabashedly say that virtue can be impractical. But would you be practical if it involved the lives of your parents? Of your spouse or partner? Of your closest friends? Can you impose that practicality on other people? Should you?
That is why contextual ethics matter. Life doesn’t happen in thought experiments.
What if we paused to mourn the loss of any life, no matter how cost-effective or justified in the abstract? What if we celebrated the saving of any life, no matter how expensive? What if we lived in a world that invested as much in life as it does in death?
We start by building that world together through conversations such as this.
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