If you missed the intro to my Ethics series where I covered Utilitarianism, catch it here.
That’s Ancient History
Today I take you back to the shores of Ancient Greece. Here Aristotle, Plato’s most famous student, built upon the philosophy given to him by his teacher. Aristotle’s ideas were hugely influential. You can find pieces of him in theories of Biological Classification, Physics, and the Scientific Method itself. Aristotle is one of the first in the Western tradition to codify a system of empiric observation as the basis of knowledge, a departure from his teacher Plato who focused on the unreliability of empiricism.
Aristotle also set the stage for an entire Ethical theory, today known as Virtue Ethics.
I Virtue-Choo-Choose You
Virtue Ethics differs from Utilitarianism in that it focuses much more in the thoughts of the individual, rather than their action. Aristotle believes that there exists certain characteristics, called Virtues, that typify the healthy soul. According to Aristotle, the aim of all rational beings is to achieve Eudaimonia.
Eudaimonia comes from the Greek daimoni meaning ‘spirit’, and eu meaning ‘good’. You hear that Britain? The EU is literally good.
Often translated as “flourishing”, “happiness”, or “well-being”, Eudaimonia is the kind of happiness that only rational beings can have, representing an intense thriving beyond simple happiness. While Utilitarianism and Virtue Ethics both seem to want to maximize happiness, not all types of happiness are created equal for the Virtue Ethicist.
According to Aristotle, the only things that can bring upon Eudaimonia are virtues. Good people will act with bravery, kindness, justice, friendship, etc. He also believes that humans will form habits, and learn to act automatically according to their old ways of being. Aristotle therefore argues that we ought to act so that Virtuous activity becomes like second nature to us. By doing the right thing, it will make us better people and more able to do the right thing again in the future.
A first problem arises, because we might argue that the virtues might conflict in some situations. Suppose you’re a judge and have someone in front of you who has committed a crime. Justice might seem to demand punishing this criminal, while Kindness would dictate to never subject someone to punishment at all. What are you to do? I mean, assuming that we aren’t abolishing the prison system.
Aristotle believes that all Virtues exist in moderation. For every virtue, there’s two corresponding Vices that exist on the extreme end. Take the virtue of Bravery. A deficiency results in Cowardice, whereas an overabundance results in Recklessness. Being not Charitable enough results in Greed, while being overly charitable can cause you to give every ounce of your time and energy to others. It’s really a scale between Jeff Bezos and my mom.
Phronesis and Nephews
The ability to judge what Virtue demands of you in a given situation is known as Phronesis or “Practical Wisdom”. Developing your Phronesis will let you know what to do and how to do it. Someone with a well-developed sense of Phronesis will both know the likely consequences of a given action, as well as know what to prioritize in a situation.
Returning to the example of the Judge, you need to ask what Virtue to prioritize. Is it a major crime that you’re willing to let slide completely? Perhaps you would then be acting with an overabundance of Kindness, one that leads you to overlook problems and create future dangers. If it’s a minor crime, perhaps you are acting with an overabundance of Justice, the one that makes you an inefficient stickler beholden to little rules? A well-developed sense of Phronesis will let you know what consequences your judgement may bring, as well as whether Kindness and Justice is more important in the moment.
Vice City
One problem arises for Virtue Ethics, namely that Aristotle doesn’t exactly give you an exhaustive list of Virtues. He gives several examples through his writing, but it seems a bit ad-hoc. Why are virtues like Wit, Pride, and Magnificence on his list? Being witty, proud, and larger than life hardly seem like matters of moral worth. Any list of Virtues you develop will represent the culture you’re working within. Other cultures may look down on what you might call a Virtue, or place worth in something we may call a Vice. The only way to justify something’s existence as a Virtue is saying that it leads to Eudaimonia, which still leaves room for a lot of disagreement.
The Good Doctor – Medical Ethics and Virtue
Virtue-based theories of Ethics aren’t only confined to general human activity. Recent Medical Ethics, the system of Ethics concerned with Medical Care, has often used a Virtue-based system. In 1979, Tom L. Beauchamp and James F. Childress published the first edition of Principles of Biomedical Ethics. In it, they assign value to four major virtues that should guide the actions of the Ethical medical professional. Medical Ethics, a subset of Bioethics, is my ethical area of choice. Expect a lot more on it in the coming months, with reference to these principles:
Beneficence
First, the duty of a medical professional is to maximize the benefit to their patient. Rather than do the bare minimum, acting with Beneficence dictates that they should improve the patient’s condition to the highest degree possible. Beauchamp and Childress were really breaking ground with the idea of “you should help people”.
Non-Maleficence
Similar to the previous criterion, acting with Non-Maleficence means inflicting as little harm or hardship as possible to the patient. Causing undue suffering is a big time very much no-no, as they call it in the field.
Justice
The principle of Justice asks that we give everyone their due. This is typically thought of in terms of Distributive Justice, the branch of Justice that pertains to the allocation of scarce resources. Principles of Justice argue that we’re all entitled to care in some form or another, though they will disagree about how exactly that distribution should work.
Informed Consent
Finally, Patients should be made aware of their situation, including the current severity of their condition (diagnosis) as well as the likely path their health will take (prognosis). They should also be made aware of the various treatment options available to them, including how likely they are to succeed and their future quality of life after having received such a treatment. Having this information, the principle of Informed Consent means that the patient should be given the freedom to choose between these various forms of treatment, or to receive no treatment at all.
Get Me 20 CCs of Nuance, Stat!
As we saw with Aristotle’s classical Virtues, the principles of Medical Ethics can also come into conflict. For instance, Non-Maleficence asks you to minimize harm and suffering to the patient, while Informed Consent asks you to allow the individual to decide their treatment. People, even possessing all relevant information, might still choose the course of treatment that fails to minimize pain. A pregnant person having a baby may choose to forgo their epidural, thus opening them up to greater pain than if they chose to receive it.
Justice routinely conflicts with the other principles when it comes to matters of Distributive Justice. Acting in accordance with the other three virtues will require a great expenditure of medical resources. Maximizing benefit, minimizing suffering, and giving patients what they ask for can sometimes be untenable. Invoking the principle of Justice will mean failing at one or more of these principles in order to achieve some greater good. If the patient demands an expensive and scarce drug for their mild cold, it’s okay for the doctor to say no, even though that conflicts with Informed Consent.
A final note. A lot of Bioethicists fixate on Informed Consent, calling it the most important principle of the four. As we saw in Virtue Ethics, no Virtue is necessarily more important than the others. The reason this misconception has arisen is because Informed Consent is the hardest to grasp, or most contentious, and therefore has seen the bulk of attention in the literature. The four don’t exist in a hierarchy, as different situations and contexts will inevitably complicate that hierarchy. What is required is a good head on one’s shoulders, and a set of principles, that will allow one to adequately balance Beneficence, Non-Maleficence, Justice, and Informed Consent in a given situation.
ZAMA 