Tuesday, April 27, 2010

Moral Character

By Tom L. Beauchamp, James F. Childress
Principles of Biomedical Ethics, Oxford University Press, 2008

Part I, 2 - Moral Character

In Chapter 1, we concentrated on the analysis and justification of acts and policies. We featured the language of ethical principles, rules, obligations, and rights. In this chapter, we concentrate on the moral virtues and moral character. Whereas ethics grounded in principles emphasizes action, character ethics or virtue ethics emphasizes the agent who performs actions. We also extend our analysis to the domain of moral ideals. These categories complement the analysis in the previous chapter without undermining principles and rules.

Often, what counts most in the moral life is not consistent adherence to principles and rules, but reliable character, good moral sense, and emotional responsiveness. Even specified principles and rules do not convey what occurs when parents lovingly play with nature their children or when physicians and nurses exhibit compassion, patience, and responsiveness in encounters with patients and families. Our feelings and concerns for others leads us to actions that cannot be reduced to instances of rule-following, and we all recognize that morality would be a cold and uninspiring practice without various emotional responses and heart-felt ideals that reach beyond principles and rules.

Moral Virtues

Some philosophers have criticized a heavy emphasis on the virtues. They see the virtues as lacking order and as difficult to unify in a systematic fashion. Though we accept the view that principles and virtues are very different in nature and are taught very differently, we believe that we can bring some order to standards of virtue. Some forms of order emerge directly from the connection between moral virtues and moral principles and rules. In addition, the goals and structure of medicine, health care, and research themselves give some order to the virtues in biomedical ethics.

We begin by analyzing the concept of virtue and considering the special status of the virtues. We then examine virtues in professional roles and explicate five focal virtues that are of particular importance in medicine, health care, and research.

The Concept of Virtue

A virtue is a trait of character that is socially valuable, and a moral virtue is a morally valuable trait of character. It is not sufficient that social groups approve a trait and regard it as moral for it to be morally virtuous. A claim or perception of moral virtue must have the support of moral reasons. Communities sometimes disvalue persons who act virtuously or admire persons for their meanness and churlishness. Moral virtue, then, is more than whatever is socially approved.

Some define “moral virtue” as a disposition to act or a habit of acting in accordance with moral principles, obligations, or ideals. For example, they might understand the moral virtue of nonmalevolence as the trait a person has of abstaining from causing harm to others when it would be wrong to harm them. However, this definition unjustifiably derives virtues wholly from principles and fails to capture the importance of motives in the virtuous person’s actions. We care morally about people’s motives, and we care especially about their characteristic motives, that is, the motives deeply embedded in their character. Persons who are motivated in this manner by sympathy and personal affection, for example, meet our approval, whereas others who act the same way, but from motives of personal ambition might not.

Imagine a person who discharges a moral obligation because it is an obligation, but who intensely dislikes being placed in a position in which the interests of others override his or her own interests. This person does not feel friendly toward or cherish others, and he or she respects their wishes only because obligation requires it. This person can nonetheless perform a morally right action and have a disposition to perform that action. But if the motive is improper, a critical moral ingredient is missing; and if a person characteristically lacks this motivational structure, a necessary condition of virtuous character is absent. The act may be right and the actor blameless, but neither the person nor the act is virtuous. In short, people may be disposed to do what is right, intend to do it, and do it, while also yearning to avoid doing it. Persons who characteristically perform morally right actions from such a motivational structure are not morally virtuous even if they always perform the morally right action.

Aristotle drew an important (although underdeveloped) distinction between right action and proper motive, which he also analyzed in terms of the distinction between external performance and internal state. An action can be right without being virtuous, he maintained, but an action can be virtuous only if performed from the right state of mind. Both right action and right motive are present in a virtuous action: “The agent must … be in the right state when he does [the actions]. First, he must know [that he is doing virtuous actions]; second, he must decide on them, and decide on them for themselves; and third, he must also do them from a firm and unchanging state,” including the right state of emotion and desire. “The just and temperate person is the one who [merely] does these actions, but the one who also does them in the way in which just or temperate people do them.”

We can conclude our analysis of the nature of virtue by incorporating Aristotle’s observations. In addition to being properly motivated, a virtuous person will experience appropriate feelings, such as sympathy and regret – even when the feelings are not motives and no action can result from the feelings. However, some virtues have no clear link to either motives or feelings. Moral discernment and moral integrity – two virtues treated later in this chapter – are examples. Here psychological properties other that feelings are paramount. We will integrate these virtues into our analysis later in the chapter.

The Special Status of the Virtues

Some writers in character ethics maintain that the language of obligation is derivative from what they view as the more basic language of virtue. They think that a person disposed by character to have good motives and desires provides the basic model of the moral person and that this model of action-from-obligation, because right motives and character tell us more about moral worth than do right actions performed under the prod of obligation.

This position is attractive, because we are often more concerned about the character and motives of persons than about the conformity of their acts to rules. When a friend performs an act of “friendship”, we expect it not to be motivated entirely from a sense of obligation to us, but because the person has a desire to be friendly, feels friendly, wants to keep friends in good cheer, and values friendship. The friend who acts only from obligation lacks the virtue of friendliness, and, absent this virtue, the relationship lacks moral merit.

Some writers in biomedical ethics also argue that attempt in obligation-oriented theories to replace the virtuous judgments of health care professionals with rules, codes, procedures will not produce better decisions and actions. Rather than using institutional rules and government regulations to protect subjects in research, they claim that the most reliable protection is the presence of an “informal, conscientious, compassionate, responsible researcher.” From this perspective, character is more important than conformity to rules, and virtues should be inculcated and cultivated over time through educational interactions, role models, and the like.

This conclusion provides a significant reason fro incorporating the virtues into biomedical ethics and into medical and nursing education, but it needs elaboration. A morally good person with the right configuration of desires and motives is more likely than others to understand what should be done, more likely to perform attentively the acts required, and even more likely to form and act on moral ideals. A person we trust is one who has an ingrained motivation and desire to perform right actions. Thus, the person we will recommend, admire, praise, and hold up as a moral model is the person disposed by character to be generous, caring, compassionate, sympathetic, fair, and the like.

A person’s character informs our judgment of the person and our assessment of his or her actions. If a virtuous person makes a mistake in judgment, thereby performing a morally wrong act, he or she would be less blameworthy than an habitual offender who performed the same act. In his chronicle of life under the Nazi SS in the Jewish ghetto in Cracow, Poland, Thomas Keneally describes a physician faced with a grave dilemma: either inject cyanide into four immobile patients or abandon them to the SS, who were at that moment emptying the ghetto and had already demonstrated that they would brutally kill all captives and patients. This physician, Keneally reports, “suffered painfully from a set of ethics as intimate to him as the organs of his own body.” Here is a person of the highest moral character and virtue, motivated to act rightly and even heroically, yet who at first had no idea what was the morally right action. Ultimately, with uncertainty and reluctance, the physician elected active euthanasia (using 40 drops of hydrocyanic acid) without the consent or knowledge of the four doomed patients – an act almost universally denounced by canons of professional medical ethics. Even if one thinks that the physician’s act was wrong and blameworthy – a judgment we reject – no one could reasonably make a judgment of blame or demerit directed at the physician’s motives or character. Having already risked death by choosing to remain at his patient’s beds in the hospital rather than take a prepared escape route, this physician is a moral hero who over time displayed an extraordinary moral character.

Judgments of agent’s praiseworthiness and blameworthiness are significantly tied to agent’s motives, which serve as sign of their character. However, in contrast to radical forms of character ethics, we do not hold that the merit in an action resides in motive or character alone. The action must be appropriately gauged to bring about the desired results and must conform with relevant principles and rules. For example, the physician or nurse who is appropriately motivated to help a patient but who acts incompetently in seeking the desired result does not act in a praiseworthy manner.

Tuesday, April 6, 2010

Virtue Ethics

Stephen Darwall
From "Virtue Ethics", pp.1-4

Consequentialism, contractarianism/contractualism, and deontology are all moral theories. (1) They concern distinctive moral notions of obligations, concern and respect and, ultimately, questions of right conduct: what we can be held morally accountable for doing. The approach called virtue ethics is orthogonal to these theories in both respects. First, virtue is concerned primarily with character rather than conduct – with how we should be rather than what we should do. And second, a virtue ethics can be advanced, not as a moral theory at all, but as an account of other, ethically deep aspects of human life that are, it is sometimes argued, potential rivals to and perhaps replacements for morality and its distinctive forms.

The conception of a set of universal and finally authoritative norms or laws by which all moral agents are categorically obligated is far from the only form that ethical reflection can take. (2) The modern idea of morality derives from a distinctive historical tradition, the Judaeo-Christian-Islamic idea of divinely ordained law, to which it is a secular successor. Some philosophers have argued that this conception of morality is seriously defective in various ways and that our ethical reflections might more profitably take other forms. Several who have made this argument have looked to Aristotle’s Nicomachean Ethics for more promising ethical conception. (3) For Aristotle, the fundamental question is not, as for Mill, Hobbes, or Kant, What is the fundamental principle of moral right or duty and how might this be defended philosophically? Aristotle asks, rather, What is the goal of human life? What kind of life is best for human beings?

Nonmoral Virtue Ethics

Aristotle provides a distinctive example – a paradigm, really – of a nonmoral virtue ethics. (“Nonmoral”, again, because, although his translators frequently use “moral virtue” to signal that he means excellences of character concerned with choice, Aristotle does not relate these to any conception of a moral law under which all are accountable as equals.) Virtues, for Aristotle, are dispositions to choose what is fine or noble (kalon) for its own sake, and to avoid what is base. The operative notion is what Nietzsche called a “rank-ordering” ideal with respect to which one can be better or worse, not a norm or law that one complies with or violates. For Aristotle, the operative ethical emotions are shame, esteem, pride and disdain or contempt, not guilt, respect, self-respect, and moral indignation.

Virtues are excellences, traits, that is, that make something an excellent instance of its kind. In this way, Aristotle’s theory is a kind of perfectionism. It is a virtue in a knife, for example, that it have a sharp edge so that it can cut well. In general, we reckon which traits are excellences (excellent-making) in relation to a thing’s function (ergon) or characteristic activity.(4) As Aristotle believes that the characteristic activity of human beings is action (praxis) that expresses a distinctively human form of choice, namely, of actions valued in themselves as noble or fine (kalon), he concludes that the virtues are traits of character, that is, settled dispositions to choose certain actions and avoid others as intrinsically noble or base. We might put his point by saying that human excellences are states of character concerned with choices that are themselves guided by an ideal of human excellence.

In general, any such (nonmoral) human ideal can be a nonmoral virtue ethics. Although it might involve a teleological or perfectionist view of human nature, like Aristotle’s (according to which there is something human beings are inherently for or to be), it need not. A nonmoral virtue ethics may be advanced simply as a normative view about which traits in human beings are worthy of esteem (or disdain).

Moral Virtue Ethics

Analogously, a moral virtue ethics is a theory of what is worthy of distinctively moral esteem, that is, worthy of esteem in a moral agent. The best example of such a view is the eighteenth-century Scottish philosopher Francis Hutcheston. Hutcheston argued that the basic moral phenomenon is a distinctively moral esteem for benevolence, the desire to benefit others and make them happy. Moral esteem, he held, is not primarily for any outcome, but for a motive or trait of character, namely, the desire to produce good outcomes for human beings and other sentient beings.

Virtue and Conduct

How, then, do virtue ethics bear on what to do? First, nonmoral virtue ethics remind us that questions of right and wrong are far from the only, or perhaps even the most important, ethical questions we can ask, even about what to do. Thus, it might be that failing to do significantly more to relieve world hunger, although famine relief is not morally obligatory, nonetheless manifests vices of complacency and self-satisfaction. Or, for another example, even if the environment cannot be wronged or unjustly treated, clear-cutting may still manifest an inappropriate attitude towards the environment or unlovely traits that are at odds with living a fully satisfying human life.

Second, in considering what to do, it can be helpful to ask what a virtuous person, or someone with a specific virtue (say, generosity), would do. This may simply be a useful heuristic, but it may also reflect the Aristotelian view that there is no way of formulating ethical insight that can be grasped and applied by someone who lacks the wisdom or “sense” of the virtuous person. As Lois Armstrong is reputed to have said about jazz, “If you have to ask, you’ll never know.”

Third, virtue ethicists sometimes put forward conceptions of virtue, not simply as guides to appropriate (or morally right) action, but as accounts of what makes an action appropriate or morally right. Thus, it can be held that an action is the right or appropriate thing to do in some case or circumstance just in case it is what the virtuous person would (characteristically) do in that circumstance.(5) Such a view might depart from the letter of Aristotle’s position, since he identified virtues as settled dispositions to choose specific actions for their own sake (as noble). This would seem to make which traits are virtuous depend on which actions are noble, not vice versa. Nevertheless, since it would hold that no access to the appropriateness of action is possible save through the wisdom or conduct of a virtuous person, such a view would remain quite close to Aristotle’s in fundamental spirit. What is common to any virtue ethics is the idea that guidance on controversial questions of case ethics can be gained only by looking to the virtues or the virtuous person as a model.

Stephen Darwall, Virtue Ethics, Blackwell Publishing, 2003.

(1) For classical and contemporary readings on these theories, see the following Blackwell anthologies (detailed on p. ii): Consequentialism, Contractarianism/Contractualism, and Deontology.

(2) G. E. M. Anscombe argued that since, as she claimed, the conception of morality is unintelligible without the idea of divine sanction, it cannot be secularized (“Modern Moral Philosophy”). Alasdair MacIntyre also advanced a very influential critique of orthodox moral philosophy (After Virtue [Notre Dame, IN: University of Notre Dame Press, 1981]). Bernard Williams also influentially criticized the idea of morality and its distinctive form of obligation (Ethics and the Limits of Philosophy [Cambridge, MA: Harvard University Press, 1985]). These writers all pointed toward Aristotle as an alternative model. See also Michael Slote, From Morality to Virtue (New York: Oxford University Press, 1992).

(3) For a discussion of Aristotle’s ethics, see my Philosophical Ethics (Boulder, CO: Westview Press, 1998).

(4) See pp. 8-9 of this volume.

(5) For an example of such view, see Rosalind Hursthouse, On Virtue Ethics (Oxford: Oxford University Press, 1999).