Ask The Moral Guy: Epilepsy Made Me Do It

It's time again to Ask The Moral Guy, where I answer all your most difficult ethical dilemmas in 500 words or less. Today's question deals with medical conditions and when they excuse bad behavior.

Last week I had two people over to my house, one a good friend and the other more of an acquaintance I knew from work. While we were talking in my living room, the acquaintance (I'll call him Peter) stood up and jerked his hand out in front of him, breaking a picture frame and tearing a cherished family photo. Peter didn't apologize, though after a few days he did offer to pay for the frame. Later my good friend, who knew Peter better than I did, took me aside to tell me Peter had a medical condition which caused him to involuntary move his body. My friend seemed to think I shouldn't hold a grudge, but I'm not so sure. Even though Peter offered to pay for the damage, I felt I was still owed an apology. Is it OK for me to be upset about this, or am I just being insensitive to someone with a disability?

--Anonymous

Like a lot of ethical questions, it depends on the details of the situation, specifically whether or not Peter made any effort to avoid causing damage:

If Peter made an honest effort to make sure his condition didn't break that great picture of your little bro--if he tried staying away from breakable items and faced away from fragile objects--then he didn't do anything wrong. It would be no different than if your friend was careful, but tripped over your rug and shattered the expensive china--an unfortunate accident. We can't reasonably expect people who suffer from relatively minor medical conditions to become hermits and cloister themselves off in child-proof rooms.

If, on the other hand, Peter didn't care enough to avoid getting near the expensive stuff, and just assumed that his condition would excuse any minor destruction he might wreak, then he acted unethically: he knew he was running a risk picking the chair next to your valuables, and he chose to sit there anyway. In that case, he owes you an apology.

On a totally unrelated note, I toyed with the idea of calling this post "Conditional Excuses." Am I trying too hard for the cheap pun?

Circumstantial Luck: Another Response!

Very few things in life get me more excited than a response to one of my posts (OK, maybe more than a few, but it's still pretty great). This comment was a counterpoint to my July 1st post on the topic of circumstantial luck. I admit this post gets a bit technical, but I promise to try and keep it as layperson-friendly as possible (if you want an even more technical treatment, check out my response to Kyle's post, on that same page). Here we go:

Circumstantial Luck, or CM for all you sweet abbreviators out there, deals with the different ways we treat two people: the person who actually did do something wrong, and the person who would have done the same bad thing, but got lucky and was never put in a circumstance where he had to make that decision (recall my example of Mary, Joe and the Nazis). My argument is that we have to hold Joe, the guy who would have, but didn't do the bad thing, equally culpable as we do Mary, who actually did do the bad thing.

Kyle's response had to do with Joe. Here's what he said:

Even if, say, Joe told us he would act like a Nazi, we simply can't know for certain. There are surely people who think of themselves as unethical in certain ways but, when presented with an actual chance to act, choose rightly. In short, I'm not sure there is any substitute for acting like a Nazi.

That's definitely an interesting point, but I don't think it poses a problem to my example, for two reasons:

1. I think that we can know what people would do in lots of different circumstances. If I gave you a gun and said "shoot your parents," would you do it? I bet (for your mom and dad's sake!) you can truthfully say you wouldn't. The fact is that human behavior is awfully predictable most of the time, and even if there are some cases where we don't really know what we would do, we can still usually predict what our actions will be.

2. Even if it's impossible for us to know what we would do in some particular set of circumstances, that fact doesn't make us any more or less blameworthy. Let's say it really is impossible for me to know if I'd help the Nazis out if I lived in Germany in 1938. That doesn't change the fact that, if I were placed in that situation, I really would make a decision, either to collude or not to collude. Take a different example: I have no idea if I would be a courageous soldier if I enlisted and fought in a war, and I don't think I would know until I actually did it. But that doesn't change the fact that I am a courageous or cowardly person: I still have that attribute (courage or cowardice), and it just won't "show up" until I'm forced to act. In the same way, I still do have either a good or a bad moral character; I just might not know which one I have until I'm in a tough spot and have to make a decision.

And that brings me back to my original point. Assuming Mary did collaborate with the Nazis, and assuming we know that Joe would have collaborated if given the chance, shouldn't we blame them both the same?

Kickbacks: The Easy Way To Get Great Patients

It's been long established by the American Medical Association that it's unethical for a physician to give another physician money for a patient referral--what many would call a kickback.

In other words, let's say I go to Dr. Bob, my primary care doctor, complaining of back pain. He takes a look at me and says I should go see a back surgeon, Dr. Sue, who will likely perform an operation that my insurance will pay $50,000 for. Dr. Sue is grateful for the referral, and to show her appreciation she gives Dr. Bob $5,000 for his efforts.

This scenario is a huge ethical no-no in the practice of medicine, but it might not be entirely clear why it's viewed as such a serious breach of good conduct. After all, in most business ventures it would be perfectly acceptable for me to, say, give my friend over at Circuit City $100 for sending a customer to The Moral Guy's Electronics Emporium (where we're obligated to give you a great deal!) for an item Circuit City didn't have in stock. The common explanation for this prohibition is that giving doctors money for referrals leads to a lower standard of care to the patient: if the doctors care more about referring their patients and getting a big payday when the patient has an expensive procedure, they'll be less likely treat the patient more conservatively and avoid major operations. Back to our example, maybe my back pain could have been treated with a simple steroid injection by my primary care doc; but because Dr. Bob wanted the $5,000 from Dr. Sue, he referred me over to her and caused me to go through a difficult, painful operation I didn't really need.

But what about the argument that a customer could be taken advantage of in the same way in any business transaction? After all, most people have a story about how a mechanic demanded $600 for some brand new parts the car didn't actually need replaced; doesn't the Latin phrase caveat emptor ("let the buyer beware") apply to all business transactions?

Here's my take: medical practice is fundamentally different from just about any other profession because of the inherently unequal relationship between the doctor and the patient. The fact is, when you go to a doctor because you're sick you aren't in the same position as when you go into buy a stereo at a store: you're going to a person who's had four years of medical school and at least two further years of residency and knows more about medicine than you ever will; the doctor has seen and treated dozens, hundreds, perhaps thousands of other patients; you're expected to talk to a complete stranger about the most intimate details of your life; and most importantly, you're there to treat a problem which could permanently affect your well-being or even cause your death. Going in to see a doctor can be a terrifying experience where no one could reasonably expect you to be a rational consumer.

That's why I believe in the oft-repeated adage about the medical profession: Lawyers and whores have clients--doctors have patients.

To be fair, I think a lot of these issues come up in the legal profession as well--a person facing a felony conviction is in much the same situation as a patient going to see a doctor. But the basic point remains: given the nature of the relationship between the two, physicians have a greater obligation to the well-being of their patients.

Do You Feel Lucky?

Well do you?

No, seriously, today's post, like this one from a few days ago, has to do with the problem of moral luck, which is just when we blame a person for something that isn't under her control. In the last post, it looked like we were blaming Bob more than we were Fred, even though the only difference between their two situations was totally outside their control. To push that same intuition even more, consider this:

When Germany was controlled by the Nazi's in the 1930's, many ordinary citizens were faced with a difficult dilemma: cooperate with the current regime and in some small way aid in their evil acts, or refuse and be persecuted and ostracized from their community. Consider someone, let's call her Mary, who was placed in this situation and made the wrong moral choice: she helped the Nazis.

We're assuming in this case that Mary made the unethical choice (fill in the details how you like to make that true), and as a result she clearly deserves some blame for what she did.

Fair enough. But what do we have to say about the person (calling him Joe) who would have done just as Mary did, but never had to face that difficult moral decision? Mary's certainly to blame--after all, she did something wrong. But do we just let Joe off the hook because he got lucky and never had to make a tough choice in his life? It doesn't seem fair to throw Mary to the wolves but give Joe the Ethical Guy Award if we know he would have done just as Mary did.

Here's what I think: the two are equally blameworthy.

***

Briefly, here's my reasoning: people aren't responsible for their actions per-se--luck plays too large a role in determining what we do--but for their moral character, which is their set of conditional dispositions, a fancy way of saying the way you would act if placed in different situations.

Check out this Wikipedia article if you want to read a bit more about moral luck.

Ask The Moral Guy: Underage Driving

This is the first of what will hopefully become a regular addition to my blog: taking an ethical dilemma and explaining what I take to be the right thing to do. I obviously welcome any submissions you might have (go for it!), but for now I'll settle with the much more old-fashioned talking with friends and family and getting their suggestions. So, without further delay, the very first addition of Ask The Moral Guy:

For the last few months, I've been allowing my 14 year old son drive around in our apartment complex's parking lot, with me in the passenger seat. As you might guess, he isn't old enough to apply for a learner's permit, and so he would be in quite a bit of trouble if a cop were to catch us. Last week we nearly got into an accident with another car that would clearly have been the other driver's fault. At the time I was convinced that, if we did have an accident, I should switch places with my son and assume any fault. Would it be ethical for me to take the wrap for him?

--Anonymous

I admit, this is a tough one. The short answer, though, is that no, it would not be ethical to lie to the other driver or to the police about who was operating your vehicle.

In such a case, I can't deny that you're caught in a difficult situation (which I should point out is entirely of your own making): you have, on the one hand, an obligation to be truthful to the other driver as well as to the police; on the other hand, there are serious responsibilities that come along with being a parent, which includes looking after your child's best interests.

Still, while you are required to look out for your son, that obligation does not extend so far as to permit you to intentionally deceive other people about a crime just to make life easier for him. Let us not forget that while you, as the adult, should never have offered this opportunity, your son knew full well that he was breaking the law.

Finally, you should remember that your moral obligation doesn't stop at simply refraining from lying. Since you, as the adult and legal guardian, bear a significant portion of the responsibility for your child's predicament, you are also obligated to do what you can to minimize the affect this has on him, which might include helping to pay his fine, explaining to the police or a judge your involvement and, most importantly, apologizing to your son.

A Response!

In what is the first of what will hopefully be many responses on this page, Sadeghi commented on my discussion of (uh oh!) abortion. Since I want to encourage as much dialogue as possible on this site, I'm dedicating today's column to responding to him or her (hopefully, Sadeghi, you won't mind having your comment featured so prominently!).

Here's what Sadeghi had to say about the Violinist Example:

From an evolutionary perspective, you are not in the same position as the woman impregnated by rape. Perhaps the most basic instinct of man is to reproduce replicas of him/herself. Being that this baby carries half of the mother's genes, can we really say that the rape victim and I are in the same position? I have no biological connection to this disgusting violinist hooked up to me, yet I have reason to want to save the baby carrying my DNA.

While I'm not endorsing either side of the debate, I think Sadeghi's got an interesting point: in the case of pregnancy by rape, the woman has a particular, special relationship to the fetus--she's the mother. I'm not sure it's a consideration of evolution, as Sadeghi suggests, but nonetheless it's not hard to see how the parental relationship imparts certain obligations that wouldn't otherwise exist. Since in the example I posed previously you didn't have any special relationship to the talented violinist, there's certainly an important difference.

But it's moral philosophy! We can always amend our example: let's say that the violinist is your child; would you have an obligation then? That, I think, makes Judith Jarvis Thomson's example quite a bit more controversial, but I leave it to you to consider....

Objecting to Utilitarianism

Utilitarianism is an ethical theory which argues, in its most general form, that a person is morally obligated to perform that action which maximizes overall utility, which, depending on what time of utilitarian you are, can be happiness, preference satisfaction, or whatever (happiness being the most common consideration). Consequently, utilitarians tend to believe that you are morally obligated to do that which maximizes the total amount of happiness. The most famous modern-day utilitarian is Peter Singer (he of the Animal Liberation fame), who just so happens to be a professor at my alma mater.

The theory seems pretty straight forward, and I think it has quite a bit of intuitive pull: a good deal of people will say unreflectively that what we're obligated to do is just that which causes the best outcome. Don't know whether or not to choose vanilla or chocolate ice cream? Pick the one that makes you happiest. What makes stealing wrong? It causes serious disruptions in the lives not only of the victims, but of society in general. After all, what would our country look like if everyone just took by force whatever they wanted?

There are quite a bit of objections to utilitarianism, generally focusing on some examples which, if you apply a utilitarian principle, lead you to some awfully weird conclusions. But instead I want to focus on the problem utilitarianism poses to the concept of friendship:

Every time I have a choice in how to act, there will be one action which maximizes the greatest amount of happiness, and according to utilitarianism, I am morally obligated to to perform that act. And if that's the case, then I am always required to do something, no matter what the situation.

With me so far? Okay.

Consider what it means to be friends with other people: you spend more time with them than you would a stranger; you do favors and help them out in a way you wouldn't do for others; their concerns matter much more to you than other peoples'. Utilitarianism, remember, always requires you to do some specific action. But wouldn't you better maximize happiness if you spent that Saturday afternoon tutoring underprivileged children instead of watching a movie with your pal? Or worked an extra shift to earn money to donate to Oxfam instead of consoling that buddy who just lost his job? If you buy into utilitarianism, there doesn't seem to be much of anything you could do that could constitute friendship. And so, it seems, the utilitarian has to give up on the idea of having meaningful relationships with other human beings, always obligated to sacrifice her own happiness for the greater good.

That, for me at least, is sufficient to say, Sorry, Jeremy Bentham, but you're nuts. No moral theory can seriously require I give up any human relationship. But that's just me.