Medical Ethics I - Basic Moral Concepts

1. MEDICAL ETHICS LECTURE I BASIC MORAL CONCEPTS

2. INTRODUCTION • BASIC MORAL CONCEPTS • MORALS AND LAW

3. 1) INTRODUCTIONWhat are the basic questions, when somebody starts studying moralphilosophy?a) WHY DO WE SPEAK ABOUT MORALS AT ALL?b) WHAT IS THE BASIS OF THE MORALS?

4. WHY DO WE SPEAK ABOUT MORALS AT ALL?The reason for that seems to be very simple: ALLEGEDLYthere is a moral content in our activities and there are moral norms. BUT!BUT, are there any simple, EMPIRICAL sign of morals in our everyday life?

5. Yes, thereare!! These are our remorse and grumble. What is remorse, and what is grumble? When do we have remorse and grumble, and what do they prove?

6. We can experience that different problems cause remorse at different people. Somebody has remorse already in a case, if he or she offended somebody’s self-respect verbally, and others do not even have any remorse in a case, if they stabbed somebody to death! We can recognize a similar situation regarding grumble. Somebody does have grumble, if the youngsters do not offer their seats for the elders, and others do not even have any grumble, if they get to know for example a huge lie or bribery. Not speaking about more, morally interesting situations, by all means, these cases show us that morals and morality DO exist! Namely, we cannot have remorse and grumble, if we do not have conscience, and we cannot have conscience, if morality does not exist, because conscience and morality are essentially identical.(Compare conscience and soul!) On the other side, morals are – beside the legal norms – the organizing rules of our society. Without morals and law we would live in anarchy.

7. THIS IS THE EMPIRICAL EVIDENCE of the existence of morals!NOW look at for a moment the necessity of morals!!I am persuaded that we need a FOUNDATION THEORY as a proof of this necessity.

8. b) WHAT IS THE BASIS OF THE MORALS?The different moral opinions can be true if they are proved. However, it is not worth writing even a basic theory of moral norms and connections if we cannot give any foundation of morals.“Morality does exist – how is it possible?”This Kantian question shows our task. I want to research the conditions of practical possibility of morals, in order to give a plausible interpretation of the basic ethical concepts. We do this in order to think over, to create a basic ethics. This is a primary task, more original than every specific orappliedethics, and the central question of the task is, whether we can found morals theoretically?In other words: Why do we have to be moral?More radically: Do we have to be moral at all?

9. The essence of the answer is out of question, especially in Europe, close to the former Vernichtungslager (exterminating camps [1]), Auschwitz (Jan. 27th, 1945), Buchenwald, Treblinka, etc. and after “Nine-Eleven” (Sept. 11, 2001). ([1] The exterminating camps were not identical with the working camps!)

13. Why do we have to be moral?Do we have to be moral at all?Attila Jozsef, one of the famous Hungarian poets in the 20th century, grasped the problem and gave his answer in this way: “Why shall I be honest? I will die anyway! Why shall I not be honest! I will die anyway.” This is a private decision of his conscience, which can have whatever basis: from the religious one, through the moral one, to the simple “yet”. But theoretically it is not enough! If we do not have any foundation, morality remains only the question of the private individual decisions.

14. What can be the foundation of morals?I am persuaded that we cannot keep the traditional, metaphysical basis, which has absolute and apodictic[1] claims, because rationally we cannot prove its essence: the absolute transcendence (e. g. God). It follows from this, that it is possible only a relative, social basis. Regarding morals, we have to re-interpret the concept of “foundation.” That is, morals cannot be founded in a metaphysical, absolute way, but only in a social and relative way. We cannot write ethics forever based on metaphysical foundations. However, we can say that it is based on a social foundation, which is relative but it functions, and it is enough for our moral practice. What is this social foundation of morals? This foundation manifests in the fact that morals and the specific moralities exist more than 2000 years, and its essence is the social function of morals: to maintain the existence of community and assure its optimal function. Without this public, social function morals and moralities already had ceased to exist, like those other social phenomena and institutions, which have lost their social functions in the modern societies (e.g. slavery, inquisition, etc.).[1] Necessarily or demonstrably true; incontrovertible.

15. What would then be theminimal conception of morals? It is not a moral code, it would be only a short theory of- basic moral values (life, freedom, solidarity, impartiality,truth-telling, etc.), which come from the everywhere similar manner of human being, and that of- basic moral connections, which include first of all the foundation of morals as its public, social function.

16. 2) BASIC MORAL CONCEPTSThe idea on which my train of thoughts is based sounds that - as we cannot speak about medicine without medical concepts,- about mathematics without mathematical; - about physics without physical concepts, etc. - sowe cannot speak about morals and ethics without ethical concepts, Forthisspecial, ethicalapproach we need a special language, a specialethical terminology.

17. What are the basic concepts of ethics?These are first of all- “morals”, - “morality” - “ethics”, but “norm”, “value”, “interest”, “freedom”, “responsibility” and “obligation” also belong to here.

18. LET’S TAKE FIRST THE THREE MOST IMPORTANT CONCEPTS: “morals”, “morality” and “ethics”. What are the differences? A) ETIMOLOGICAL APPROACH: Focusing on terminology it is worth saying that in the American Applied Ethics books I have found basically two main terms, ‘morality’ and ‘ethics’ (or ‘moral philosophy’). ‘Morality’ means basically the practical side and ‘ethics’ the theoretical side of thissocial phenomenon. Europeans use three terms. I am mentioning here first the Latin and the German terms and only finally the Hungarian ones which correspond to those ones.

19. In Latin we can find the word ‘moral’ which is the social side of the practical dimension, and ‘moralitas’ which is the personal side of the same. Beside that they use the word, ‘ethica’ which comes of course from the Greek ‘ethos.’ (I do not want to deal with the original Greek meanings of these words, because it would be too time-consuming.)The proper German translation of the Latin ‘moral’ is ‘die Sitte’ (in Hungarian ‘erkölcs’) and for ‘moralitas’ ‘die Sittlichkeit’ (in Hungarian ‘erkölcsiség’). Naturally, they also apply the noun, ‘die Ethik’ (in Hungarian ‘etika’) for designation of the theoretical reflections on morality and ‘morals’[1] which would be perhaps the best translation for the Latin ‘moral’ and the German ‘Sitte’.1] English words are here: moral, morale, morals.

20. B) THE CONTENT OF THE CONCEPTS:What are the so called “morals” and what is “morality”? If we look at the difference between them, it is the best way to learn their meaning.What is the difference between "morals" and "morality"? I think these are just two sides of the same moral phenomenon. Morals are first of all the social side and morality is the individual side of the same phenomenon.I would emphasize here that the moral phenomenon does NOT exist in nature! The moral phenomenon is exclusively a social phenomenon!!Somebiologists and ethologistssaythatthebiologicalbasisof morals is alreadygivenintheanimalworld. I acceptthis, butthebasis of the house is notidenticalwiththewalls and theroof!

21. MORALS mean the moral norms and moral principles of the community that is someunwritten patterns ofconductor action which are accepted by the members of a social community.InotherwordsMORALS mean therelativelyindependent social sub-system of the mostly unwritten rules and principles of conduct – that is moral norms – which regulate the relationships among people and between the individuals and their communities.MORALITY means the personal, individual moral values, principles which regulate really my behavior and our human abilitytodistinguishbetweengood and bad. Morality, on the other hand, is nothing else likeourconscience, which is the interiorized form of the moral norms and principles that isthat of the morals!!So, morals are the whole of such behavioral patterns, first of all the moral norms which are accepted by the members of a human community and they regard them as obligatory.Morality is „only” thewhole of thepersonal, individualvalues and principles.

22. What is a moral norm? What is a norm at all?I think it is obvious that the norms guide and rule our behavior. That is why we can say that a NORM is a rule of behavior, and usually it is expressed by a statement in imperative form: - “You shall not murder!”; - “You shall not commit adultery!”; - “You shall not steal!”; - “You shall not bear false witness against your neighbor!”etc. if we quote some of the Ten Commandments from the Bible.

23. However, it is not clear, how a sentence can rule our behavior! It is obvious that its ruling force does not come from its imperative form, because we can create other imperatives ( e. g. “Love the Gipsies!” or “Love the pan-cake!”; etc.), but these are not norms. What is the reason for the ruling force of a norm?We can get closer to the solution, if wehave a glance at the birth of moral norms. Granted that moral norms are born in human communities, we see that community members are living their everyday life, while they do several conscious actions. Some of these actions have advantages and others disadvantages for the community. The members and the leaders of the community prohibit obviously the harmful actions and praise, promote the good actions. We can see that the actionswhichare good for the community become good patterns, values and norms for the community in the practice of the everyday life!! WHY?

24. The reason is that they are valuable for the community. They become common values, values of community! It means thatMORAL NORMS are born in the social practice in a spontaneous way.Actions, behaviors serving the need of community become community patterns, community values and moral norms!! The essence of a moral norm is always a community value and never a private value!Private value can never become the basis of a moral norm. If members of some community accept it, it has already become a community value; it is not merely a private value! That is why we can say, that a MORAL NORM IS ALWAYS AN UNWRITTEN RULE OF CONDUCT BASED ON A COMMUNITY VALUE.Now, let us see the other important concepts!

25. WHAT IS VALUE?WHAT IS INTEREST?

26. VALUE and INTEREST are very similar, and at first sight it is difficult to give precise definitions of them.But let us see some examples and the differences between them!WHAT IS THE DIFFERENCE between VALUE and INTEREST?EXAMPLE(1):See for example some thirsty people in the desert! A glass of water has much higher value for them than a diamond.It means that VALUE can be whatever thing which can satisfy human needs. As many types of needs we can differentiate, as many types of values we can speak about. From moral point of view the most important distinction is that of the private and the community values.EXAMPLE(2): If I do not know that I am talented at drawing, I have no interest to attend an art school, etc.It means that INTEREST is a conscious human need. If we do not know something, that is if we are not aware of something, we cannot say that it is our interest!

27. What is DETERMINATION?What is FREEDOM?

28. DETERMINATION and FREEDOM- DETERMINATIONmeans that we do not have any free choice! We only believe that our decisions are free, but actually our actions and decisions are (pre-)determined. – FREEDOM is the reality of choice between alternatives. Human being is a choosing being. Human being is not able NOT to choose!!WHY are we choosing beings? See the alternative structure of human actions! When we posit ends and means, we already choose between alternatives; and we also choose in every moment, when we carry out our planned actions!BUT this concept of FREEDOM is an abstraction (every concept’s meaning is an abstraction!!), because in our life we have only special freedoms (political, religious, scientific, moral, etc. freedom; freedom of the individual, that of the family, the team, the nation, the mankind, etc.). We can cluster as many special freedoms as many types of activities or subjects we can distinguish.

29. What is RESPONSIBILITY?What is OBLIGATION?(Whichone is theprecondition of theotherone?)

30. - OBLIGATION (DUTY) – MORAL OBLIGATION IS a requirement which follows from the community value content of the moral norm.Itfollowsfromthisthat MORAL OBLIGATION is, inotherwords, theinteriorizedcommunityrequirement. – MORAL OBLIGATION is NOT IDENTICAL withtheconsciousness of obligation! (I mighthave an obligationwithout being aware of it!)- RESPONSIBILITY is a normative value-relation between a moral norm and our decisions, actions. – RESPONSIBILITY is NOT identical with the consciousness of responsibility! – Presumptions of the moral responsibilityare: freedom and intention.

31. What is MORAL COMMUNITY?

32. MORAL COMMUNITY is the highest form of human community, becauseit isvoluntary!! The members of a moral community have a “WE-INTENTION”.I decide whether I want to live according to the values and principles of a community or not. That is why it is possible that my moral choice contradicts even with my family values. In this case I belong to the family only on the basis of blood, but not that of my moral values. That is I do not belong to my family as a moral community! (The same can be said in connection with a religion, with a party, etc.) It followsfrom this that the moral norms of my moral community are obligatory for me, because I want to live according to them!

33. SUMMARY- THE MORALS are the social side of the practical moral phenomenon.- MORALITY is the individual side of the practical moral phenomenon. The morals and morality belongs to practice, but ethics is a theory.- ETHICS is a theory about the morals and morality. Ethics is also called „moral philosophy”.

34. 3) MORALS AND LAWBoth morals and law are behavioral norms and fall into the category of value for maintaining social interests. In essence, they are coordinated, dependent and complementary one with the other.In the ancient Western society the theoretical difference between morals and law was not established for a long time. In the life of theprimitive society, morals and law were fused to constitute the body of CUSTOM which was the most important form of moral norm. At the end ofthe primitive society,STATE LAW came into being, but the separation of morals and law still did not gain full recognition in ancient Greece. The ancient Greek philosopher, Plato, assumed that morality was the righteousness produced by subjective thinking; law was considered to be based on morality and to provide guidance for rightful living. During the Roman periodlaw and morals were separated, but no precise theory for differentiating the two emerged. Some moral sayings such as "live rightfully" and "kind and fair actions" were applied to legal definitions. This did not change until the German natural jurist Thomasius (1655-1728) made a relatively clear distinction. Kant inherited Thomasius’ theory, but did not provide a justification for the distinction.

35. Thus, therelationshipbetweenlaw and morals is not an easyone. Moralrules and legalruleshavesomesimilaritiesanddifferences. Beforewearelookingattheseconnectionsbetweenmorals and law, letussee a diagram regardingtheirgeneralrelationship:FIND OUT WHICH ONE OF THE OVERLAPPING CIRCLES IS THE LAW? TELL US WHY?

36. If you have chosen the bigger circle for the morals, you are right.Morals cover namley every human relation which is in conncetion with a community value. In contrast with this law regulates first of all those social relations which are important from the state’s point of view. Moral rules and legal rules are certainly not the same: there are some legal rules that are not moral rules and vice versa. In some cases the moral view and the legal view overlap each other. There are several differences between law and morality, but let us see first their similarities:

37. SIMILARITIES:- Both morals and law are systems of norms.It is unquestionable that the moral and legal norms are different, but both contain and defend some kind of values, in order to express social requirements. - Both morals and law serve to channel our behavior.Law accomplishes this primarily through the threat of sanctions if we disobey legal rules. Morals too involve incentives: bad acts may result in guilt anddisapprobation, and good acts may result in virtuous feelings and praise.

38. Nevertheless, morals and law are separate social phenomena with significant differences in their emergence, nature and sanction.DIFFERENCES:- First of all, the backgrounds of the emergence of morals and law are different.In the course of historical development morals appeared earlier than law. Before the existence of the state morals already had been formed in social life, though no law had been established. Only after the emergence of the state did the governor, in accordance with his own will, formulate legal norms in order to consolidate his regime. As the fundamental issue of the state is political power, the government naturally takes law as a weapon for maintaining its political power.

39. - Secondly, though both morality and law belong to the norm of human behavior, they are different in nature.The legal norm is enforced: though the evaluation of human behavior is ground for establishing and administering legal norms, people are required to observe them. Whether they are for or against them, people are compelled to obey the law established and enforced by the state. This compulsion is a unique feature of legal norms in contrast with moral norms.On the other hand, moral norms are not imposed coercively by the state. To be put into action, this sense of moral obligation depends on the impact of public opinion, people’s beliefs, customs, traditions and education. It is evaluated in terms of the benevolence and malevolence, justice and injustice, fairness and unfairness, honesty and dishonesty of human behavior. The moral norm has no specific form, but exists in the social ideology and the popular views and beliefs of current society. Hence morals and law are different norms.

40. - Thirdly, the intervention taken when moral and legal norms are violated is not the same. It means that sanctions are also different not only emergence and existence of these norms.There are times when something that is within the law may not be moral. In such circumstances, the immoral behavior is beyond the power of legal norms, but will be variously condemned by social opinion, public denunciation, troubled conscience and so on. These are the resources of the moral norm. The society, family and organizations supervise actions in terms of moral requirements inspite of the fact that their methods do not have the compulsive quality of legal norms and do not need a special agency to enforce punishment. Besides, the pressure of social opinion is a kind of public judgment, and the mind’s uneasiness is a kind of mental force.Behavior deviating from the moral norm cannot escape moral convictions. For this reason, it is quite wrong to regard criminal behavior as only immoral and to fail to inflict legal penalties. For the same reason, in order not to impair normal civil rights, legal penalties should not be administered for immoral behavior as is done for criminal behavior. The legal character of criminal law requires that the line between crime and non-crime be clear, and that civil cases not be mistaken for criminal cases. Generally speaking, moral norms have far broader effect than legal norms because the moral has an imperceptible influence on human behavior which transcends the law.

41. The difference between morals and law is reflected in the legalist spirit.On the one hand, one should not regard law as something superior and should not make use of some behavior beyond the power of law to degrade social morals. On the other hand, we should not look upon morals as something superior, so as to blur the boundary between crime and non-crime with the effect that criminals are forgiven. What is most important for research into the difference between morals and law lies in discovering a way of applying their mutual action, for only a clear idea of their difference can help us make better use of their mutual action to drive our society forward. For this reason a major tendency of modern legal philosophy and moral philosophy is to emphasize the common points of morals and law and their basic unity and compatibility.

42. The mutual action of morality and law can be elucidated in two aspects.- Firstly, the moral norm can be used to defend law and to keep it stable, authentic and perduring. For instance, any behavior forbidden by law, such as betrayal of one’s motherland, embezzlement and robbery, can be viewed as an immoral, illegitimate and ignominious act. A criminal act often starts from an immoral one and progresses from a breach of a moral norm to breach a legal norm: hence, morals can prevent acts forbidden by law. - Secondly, the legal norm has coercive power to maintain and carry out moral norms. Many legal norms not only display the requirements of moral norms, but serve also as effective elements for the moral education of people. The law concerning keeping state secrets, protecting public property, observing social order and so on belongs not only to legal, but to moral norms. One who violates these laws not only will be subject to legal punishment, but also will be morally condemned by public opinion and the masses. This is a way to prevent crime and immoral acts and to stimulate people to develop the noble moral quality of observing law and order. Proper use of the mutual action of morals and law is necessary for the modernization of social life.