Ethics in the Mainstream

by Elder M. Lindahl

Our local chapter of Trout Unlimited is an organization of ecologically-minded flyfishing fanatics. This summer we gathered on the banks of a small pond in Lake County, Illinois, to practice flycasting techniques and socialize around a smoking grill of brats and burgers. That is where I met Dr. Malcolm Rice, a staff physician at the Veterans Hospital in North Chicago. Hearing of my philosophy background, he asked whether I would be interested in getting involved in a bioethics committee at the hospital. Not realizing what challenging new experiences were to begin for me, I said, “Sure.”

In the last thirty-five years, a revolution has occurred in the area of ethics. Advances in medical technology have forced us to face moral issues and dilemmas that were unimaginable in earlier times. Authors of old ethics textbooks used to invent contrived illustrations of the principles they wanted to clarify. Authors today look into the medical journals and the legal literature for actual cases that focus their discussions. Medical doctors, challenged by vexing life and death decisions, have become increasingly aware that easy answers are hard to come by. As Malcolm put it, “I no longer think, as I did in college, that philosophy is an esoteric area for liberal arts types.”

Since the days of Socrates, ethics has been an essential part of a philosophical education. I studied with two important ethicists — Professor William Frankena at the University of Michigan and Professor Eliseo Vivas at Northwestern University. As a part of my doctoral research, I read the huge, untranslated volume, Filosofisk och kristen etik (Philosophical and Christian Ethics) and discussed it with the illustrious author, Bishop Anders Nygren. I have taught both philosophical and Christian ethics courses at North Park College. Still, I wondered, what might an academician, especially one who has more questions than answers, have to offer? Will they think I am a morality expert, an authority on ethical cases who can provide ready-made principles right off the rack?

The first meeting of Veterans Hospital personnel — physicians, psychologists, nurses, pharmacists, social workers, chaplains, dietitians, administrators, and other staff — was on July 24th. I went as an observer and was introduced to thirty people who assembled as an ethics task force. A former NPC student and philosophy major, the Rev. George Philippas, now a Greek Orthodox Chaplain, hugged me as I entered the room and provided a familiar face among the many “Whitecoats.” I was impressed with Dr. Rice’s handling of the meeting, especially with his emphasis on education. He suggested that the group become self-educated in ethics through readings and discussions. Co-leader, Ms. Kathy Devaney, R.N., shared some insights she had gained from attending a bioethics conference. She, too, stressed the importance of ethics education. Malcolm handed out copies of three chapters from the American Hospital Association volume, Handbook for Hospital Ethics Committees, for us to read in preparation for the October 2nd meeting.

The ring of the word “education,” and the possibility of both receiving and sharing some, got to me. After the meeting, I asked Malcolm if he wanted me to say something at the next meeting about ethical theories and practices from the side of the philosophical tradition. He checked with Kathy and said there would be time, possibly 10-15 minutes, following the discussion of the assigned chapters.

What had I done? On resonating with the word “education,” I up and volunteered. You would think that an old soldier like me would have remembered the wise saying of enlisted men in all wars, everywhere — “Never volunteer for nuttin’.”

In the three-page handout I prepared for the October 2nd meeting, I posed the question of the nature of ethics. In contrast to three popular, conventional viewpoints, I stated that ethics is the study of the reasons we call certain actions right or wrong, good or bad. I described briefly the ways philosophers classify ethical theories and concluded with a summary of how I see the role of an ethicist on a bioethics committee. The handout was comprehensive enough for a syllabus in a semester course in ethics! Oh well, I had to be prepared for my 10-15 minute talk.

At the October 2nd meeting, Dr. Rice reviewed the assigned chapters. He spoke about the different functions bioethics committees might have and some of the issues that could be handled: withholding and withdrawing support systems, amending hospital policies, determining the meaning of the phrase “quality of life,” distinguishing between clinical and administrative issues, and educating on all levels. I sat there, with some fear and trembling, wondering what profound, relevant words could possibly come out when I was called on.

My prepared handout comforted me like a rod and staff. I led off with the question, “What is ethics?” and a few remarks about the difference between conventional and philosophical ethics. The group listened attentively and became involved in some discussion. One fellow, however, brought up this statement: “It is wrong not to do right!” When I responded that it sounded tautological, he assured me that it came from Schopenhauer and, turning to the group, mentioned that he, too, had been a professor! Anyway, the group became involved, and we made it through about half of the first page of my tightly-packed handout.

November 6th was our next meeting. Following the discussion of the chapters assigned, I was to continue my presentation from my handout for 15-20 minutes. I still had some strange feelings while sitting through Malcolm’s discussion. I thought to myself, do they really need to know the difference between metaethics and normative ethics?¹ What, if anything, does the ethical theory of Immanuel Kant (1724-1804), which I will be talking about shortly, have to do with these medical people, in this room, at this time? Good Heavens, what am I doing here!

I began by telling the group that I felt differently about facing medical people like them now than when I came to the Veterans Hospital as an outpatient in the early ’80s. Also, I told them of my experience, after the October 2nd meeting, of receiving my own VA medical identification badge, with mug shot and all. I said I was quite surprised to find that somehow my badge read: ELDER LINDAHL, M.D. I thanked the group for the honorary M.D., which I said I took as an expression of their desire to make me one of them. I assured them that I had not, prior to turning it back for more appropriate notation, given any physical examinations or written any prescriptions.

As we got into the subject through the distinction between metaethics and normative ethics, they seemed eager to hear about Kant’s thoughts on the starry heavens above and the moral law within. There was consensus on the continuing relevance of Kant’s claim for the absolute importance of always treating people as ends and never as means only. This principle of autonomy is especially relevant even, or possibly especially, in a changing world of technological wonders.

The bioethics advisory committee, pioneered by Malcolm and Kathy, will soon be functioning at this immense Hospital complex. My personal involvement, which incredibly began alongside that small pond in Lake County, is an exciting and unexpected opportunity to encourage people to think critically about right and wrong courses of human action. Ethics has always been an essential part of a good liberal arts education, but increasingly, people are coming to see the need for sound reasoning about the tough moral dilemmas that confront us in the mainstream of human existence. And we are coming to understand, too, the ambiguities that are involved in making life and death decisions. The letters between Doctors C. Everett Koop and G. Timothy Johnson, recorded in their recent book, Let’s Talk, show that medical-legal-ethical issues are never simple and neat. Negotiating the mainstream can be treacherous. Although one never steps into the same situation twice, applying general moral principles is an essential part of making every-day as well as medical-legal decisions.