THE ETHICAL TIMES   page 2

 

Ethical behavior, as I understand it, also increases quality of work. I’m not saying that Mr. Shriver is wrong in setting his priorities and that I’m right, we merely disagree.   Why do I disagree with Mr. Shriver?  Because our backgrounds, knowledge and experiences are different.  I teach bioethics, he manages a city. We have different understandings of what is important and how things should be done and what ethical standards are.  

My suspicion is that Mr. Shriver is somewhat ignorant about what ethical standards are and how they could be employed in his everyday life.  I believe that he is confusing ethics with customer service. I find no fault for his ignorance because Mr. Shriver was not scheduled to take the county ethics course until February 15, 2002 and this information is new to him.  Prior to this course, according to his spokesman Juan Mendieta, he thought that ethics training should be a part of employee training along with customer service and procedural training with an emphasis on customer service and procedural training rather than ethics. Hence, his deletion of ethical government as one of the mandates in the Miami-Dade County’s business plan. This setting of priorities and lumping ethics into customer service and procedural training seems to me a confusing menu of topics when trying to instill a firm understanding of ethics standards and how they are to be employed in the work place as well in as in everyday life. He may agree after finishing the course, and then again, maybe not.  

Mr. Shriver is not alone in his ignorance about ethics.  Recently while teaching an Ethical Foundations course, I encountered a masters student who by this time in his life (according to Mr. Shriver anyway) should have known how to “always be ethical.  This young man was aspiring to become a biomedical researcher. He asked me, “I can understand how this ethics stuff might pertain to the students who are aspiring to get into medical school, but how will ethical principles and standards ever play a part in my life?”  He believed that knowing and employing ethical standards was for everyone but himself and that researchers never encounter ethical problems. I challenged him to think about what if he were running an experiment for a new drug to get to market and one of his managers asked him to “just change the data a little” so we can get this drug passed through the FDA sooner.  For your effort, the company will give you 1% of the sales profit until the patent expires. This sum of money could help a young researcher retire at a very early age. Would this be an ethical dilemma for a researcher? What about ethical dilemmas in his personnel life?  

This young man was from the Philippines what seems morally right to this young man (at least in part) depends on his identity as a moral agent.  His race or ethnicity or culture is central to his identity as a moral agent. His idea of what consists of an ethical problem in his profession was quite different from what he thought would be the problems that might be encountered by his fellow classmates, the majority of whom were soon to be applying to Medical School and all from different cultures. In fact he found no value in learning ethics at all, until we had this conversation.  He believed that he would never encounter a values conflict, or need to arrive at a clear consensus with others as to the right thing to do in his profession. With immigration rates increasing in Miami-Dade County no one can hope to find his or her beliefs shared by everyone. People are always at risk for misunderstanding each other  because experiences and cultures differ. A fellow professor told me he is presently teaching foreign languages and English as a Second Language in Hialeah.  He said a good dose of ethics would be invaluable to the most recently arrived students from other countries, particularly Cuba, where the everyday struggle for survival precedes autonomy, freedom, veracity, privacy, beneficence,  fidelity and justice.  Truly the experiences, knowledge and priorities are different for those people who had to perhaps lie, steal and cheat just to eat and stay alive.  These strugglers have a different, or perhaps even an absent, code of ethics. This is understandable but ultimately not acceptable when trying to assimilate into the US culture. What to do?  Teach ethics, but whose ethical standards, mine, Mr. Shivers, the Cuban refugees?  Could we ever agree with each others standards?  Is there a common ground from which we can rally around, discuss ethics and reach consensus?

In our pluralistic society, individuals often misunderstand each other. Even when they do understand each other it is possible for them to disagree. Many segments of society have found it necessary to find ways to create understanding and agreement.  With this we still struggle. Nowhere is the need for understanding and agreement of ethical standards more important today than those standards that need to be employed in healthcare. This is a topic that affects everyone regardless of age, race, culture, sex, knowledge or experience.

In the past fifty years we have seen an ethical revolution in biomedicine. Topics such as access to care, stem cell research, end-of-life care, etc., are topics in which one traditional ethical outlook gaining general assent has given way to the modern study of ethics in biomedicine; bioethics.  Bioethics is an ethical system appropriate to a wide range of cultural outlooks, but dependent on none of them.  

References:
Husted, G.L. & Husted, J. H. (1991). Ethical decision making in nursing.
      St. Louis, MO: Mosby.
Ross, K. (2002, January 26).  Shriver: “Ethical reference was superfluous.
       The Miami Herald, p. B3.

Because healthcare professionals today practice in a “mixed salad” society it is almost impossible to find his or her beliefs shared by everyone in a biomedical setting. Practitioners and patients meet as strangers from diverse backgrounds. Their ways of looking at and approaching the world may be quite different. Everyone wants to act in ways believed to be ethically right.  Whatever your ethical beliefs however, healthcare professionals will be faced with the necessity of taking actions that they may consider wrong.  As Husted says, “this is not a reason to ignore the question of right or wrong.  It is, in fact, a very important reason for one to understand their ethical beliefs.  Healthcare professionals are at a very great disadvantage if they do not understand why one may consider one action right and another action wrong.”  One would not be able to interact on an equal footing with colleagues, and not be able to objectively and effectively defend the actions one takes.  One will have no objective means of moral self-defense. Bioethics is, by conscious design, an ethic appropriate to people practicing a profession as professionals.  It is a set of standards of behavior, requiring contextual understanding, through which biomedical professionals can choose and justify their ethical decisions and actions. Bioethics create a common ground of understanding and make agreements possible. The study of bioethics is presently welcomed and being taught across all healthcare disciplines nationwide.  The study and employment of bioethics allows for health care professionals and clients to:

·        Deal with each other on a human level across cultures and disciplines.

·        Create respect for each other and clients

·        Make it appropriate for strangers to achieve understanding (if agreement is not reached, toleration often is achieved during the caring process).

·        Make it possible for health care professionals and clients to agree on and respect each others rights

·        Make it possible for this agreement to carry over into other aspects outside the classroom or clinical setting where the idea of ethics may be first introduced to a health care professional.

·        Make for the health care professional and client to interact on the basis of shared goals.

It is encouraging to know that even in this environment of managed care that in the field of medicine the healthcare professionals are insisting on promoting ethics as a mechanism of building consensus and understanding for care delivery.  They are also promoting efficiency and effectiveness in healthcare delivery, but not as their first priority. Perhaps we as residents of Miami-Dade County would be well served if Mr. Shriver took this prescription as well.

   

 

 

I asked him if he had ever told a lie during his entire life. He said “sure.”  I asked him what he thought about the ethical standard of veracity. “Oh,” he said. Obviously he understood the definition of ethical standards, due to the class and he understood that lying was wrong but he didn’t have a clear understanding about employing the standards of ethics with what he knew to be right from wrong.  He didn’t quite understand how ethics should be put to work and labeled.  Perhaps this was because we hadn’t started the case studies in the class.  Case studies help demonstrate the mergers of ethical actions like truth- telling and the definition of that action like the ethical standard of veracity.  This student might have found it difficult to work for Mr. Shriver because he wouldn’t have known “what always being ethical” meant to himself or his boss.