Thursday, February 15, 2007

Friendly Atheist: Doctors and Morality

The Friendly Atheist invoked my name recently in a post on “Doctors and Morality”. In that post, he discussed a report from the Associated Press, “Study: Moral Beliefs May Sway Docs’ Care” that reported that many doctors will not refer patients to others who might provide treatment that the doctor finds objectionable.

A disturbing number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say.

He then made the polite suggestion that, “Perhaps the Atheist Ethicist can add more to this discussion.”

I would like to give it a shot.

If I were a Doctor

In the article that the Friendly Atheist refers to, the authors of the survey being reported on seem shocked to discover that people who believe that something is immoral act like they are people who believe that thing to be immoral. In fact, this is all they discovered. Expecting to discover that people who believe that something is wrong act like people who believe it is obligatory is like expecting to discover that circles have corners.

If I were a doctor, I would not help my patients obtain treatment that I found to be morally objectionable. Furthermore, I would find any request that I do so to not only be morally objectionable in its own right, but incoherent.

'Morally objectionable' means 'ought not to be done.' So, if I find some act to be morally objectionable, that means that I find it to be something that ought not to be done. If you tell me that I have an obligation to do something, then you are telling me that it ought to be done. If you insist that I ought to do something that I hold is something that I ought not to do, while saying that it is perfectly acceptable for me to hold that the act ought not to be done, then you are simply not making any sense. An act can either be obligatory, permissible, or prohibited. An act cannot, at the same time, be morally obligatory and prohibited.

In the context of desire utilitarianism, I can speak more specifically. A 'wrong act' is an act that a person with good desires would not perform. That is to say, if I hold that an act is morally objectionable, then I hold that it is an act that a person with good desires would not perform. The only way that I can perform such an act is if I failed to have good desires. In other words, I would have to be a bad person. To say that I have an obligation to do something that only a bad person would do is to say that I have an obligation to be a bad person.

That, too, is incoherent.

So, you’re still not making any sense.


One possible attempt to avoid this incoherence is to say that the act that I am being told that I am obligated to perform is one that I merely believe is morally objectionable. Yet, when I wrote the above section, I wrote as if the act was in fact morally objectionable. If we can throw out the idea that something can, in fact, be morally objectionable, then the claim that one is obligated to do that which one merely believes should not be done can make sense.

Well, actually, it can’t make sense.

A belief is a propositional attitude such that if a person believes that ‘P’ (for any proposition ‘P’), then that person has the attitude that ‘P’ is true. A person who believes that abortion is wrong is a person who has the mental attitude and is disposed to act as somebody who holds that the proposition, “Abortion is wrong,” is true.

Note: I know full well that there are theories that hold that moral statements have no truth value. I have no space in this posting to refute those theories. However, I hold that those views are mistaken. One of the reasons is that if moral statements have no truth value then it would make no sense to say that somebody has moral beliefs. Beliefs are propositional attitudes, and propositions have truth values.

In light of this, if I have a belief that X is wrong, then this means that I have the attitude that ‘X is wrong’ is true. If somebody is telling me that I ought to do X, then he is telling me to adopt the attitude, ‘X is not wrong’. Indeed, he is telling me that X is obligatory. Something cannot be both obligatory and wrong.

Note: Actually, something can be both obligatory and wrong in the special case of moral dilemma. However, moral dilemmas represent a special case and we do not need to clutter this discussion with such considerations.

If the speaker is telling me both at the same time that it is permissible for me to adopt the attitude ‘X is wrong’ and obligatory that I adopt the attitude ‘X is not wrong’, then this person is telling me that I should become insane – or at least acquire some mild mental disorder – since it would require some defect in thought to hold, at the same time, ‘X is wrong’ and ‘X is obligatory’.

Telling me that I must act like a person who believes that ‘X is wrong’ is true is the same as telling me that I must not believe that ‘X is wrong’ is true. I cannot act like a person who believes that X is obligatory unless I believe that X is obligatory.


Of course, there is an exception to this. Actors often act as if a proposition is true even when they know that a proposition is false. They act as if they are hobbits trying to destroy a magical ring even though they do not believe that they are hobbits and there is no magical ring.

So, is this claim that I am to treat ‘X is obligatory’ as true a claim that I am obligated to act like a person who believes that X is obligatory, even while I believe that X is wrong?

The problem with this solution is that acting does not free a person of moral culpability. Assume that you caught me robbing banks. When caught, I answer the charges by saying that, while I believe that bank robbery was wrong, I was only acting like somebody who believed at least in the moral permissibility of robbing banks. Clearly, my claim to be acting does not let me off of the moral hook.

Note; there is a clear difference between the type of acting I am talking about, which creates actual instances of a wrongful act, and acting that involves simulated instances of a wrongful act. I am not talking about the latter form of acting, only the former.

You are still asking me to adopt an incoherent set of beliefs if you are requiring me to act like somebody who believes ‘X is obligatory’ while saying that I am, at the same time, permitted to believe, “X is wrong.”


Here is another way of interpreting your claim that I am obligated to help my patients obtain medical treatment that I hold to be immoral:

When you tell me this, you are saying, “Your belief that these treatments are immoral is mistaken. As a matter of fact, these treatments are obligatory. As such, I am going to require that you at least act like a person who believes that helping a patient acquire these forms of treatment is obligatory.”

In desire utilitarianism, a right act is the act that a person with good desires would perform. In judging an agent’s action, it does not matter what that agent believes or desires. All that matters is whether his act is the act of a person with good desires. So, it makes sense to assert that my obligations as a doctor are to act like a person who believes that these forms of treatment are not wrong.

However, this counts as forcing one’s morality on others. In this case, those who hold that these forms of treatment are morally permissible are forcing doctors who believe that they are impermissible to act as if they are permissible.

For political and social reasons, it may be useful not to put too much pressure on the doctor with the mistaken beliefs about the wrongness of these treatments. We may allow a slight concession. “You do not have to perform the treatment yourself, but you must make sure that the patient gets the treatment.” Still, even requiring this of me is to require that I act as a person who holds that the treatment is permissible.

By analogy, consider telling a person, “We do not require that you kill the Jew yourself. We only require that you help to make sure that the Jew gets killed,” or “We do not require that you apprehend the escaped slave. We only require that you help the slave catcher to apprehend the escaped slave.”

We can see here that this type of command is one in which the agent is being told to act as if he is somebody who believes that the execution of Jews or the institution of slavery are permissible. One is still forcing their morality on those who hold that these acts and institutions are immoral.

Forcing Morality on Others

Is it permissible to force one’s morality upon others?

I assure you, if you come after me with a knife saying that you are obligated to kill me, I am not going to stand here and passively respect your moral beliefs. I am very much going to enforce my moral beliefs on you (by prohibiting you from killing me) by whatever means are at my disposal.

And if you think it is morally permissible to rape my niece, I will once again take whatever steps available to me to force my contrary moral views on you.

The same is true if you attempt to destroy my home or take my money.

As a matter of fact, forcing our morality upon others is a daily occurrence.

There is a problem with forcing one’s morality upon others. If you believe that something is obligatory, and I believe that it is wrong, one of us must be mistaken. However, there is no prima facie way of determining who it is. Of course, you will believe that I am mistaken, and I will believe that you are mistaken. However, the question remains, “Who is mistaken in fact?”

The possibility of error suggests that there is room for a principle that states that we each be given some permission to act on our own beliefs. If what is at stake is not large, then we may be better off to allow you to act on what you believe, while I act on what I believe, as long as the harm done to others is minor.

Yet, as the harms done to others by those who are mistaken become greater and more obvious, there is less room for allowing those who would do harm the freedom to do so. When it comes to those whose moral opinion permits the killing or maiming of hundreds or thousands, we have greater reason to demand that those people not act like people who hold such an opinion.

Given that people who believe that X is wrong will behave like people who believe that X is wrong, if we are going to force them to behave differently, then we are forcing our morality on them. There is a strong impulse to deny this fact, but it remains a fact nonetheless.

There are good reasons for being concerned with forcing one’s morality upon others. There are good arguments for freedom that state that people should be allowed to do as they please, and the burden of proof is always on those who would destroy freedom. People who force their morality upon others often make mistakes, and those mistakes often have dreadful consequences. There is reason to be nervous about doing this and to limit such actions to those where the need to force morality on others is clearly established.

However, we cannot ignore the fact that this leaves us with an important question to answer that we cannot avoid answering. “What moral beliefs should we force upon others?” We cannot avoid the question by hiding from it.


The Barefoot Bum said...

I'm very glad you're not a doctor, and I think your view is in direct conflict with customary medical ethics.

More on my blog: Medical Ethics.

Jess said...

In your essay you deliberate a lot over what is “right,” saying that in the case of two people with incompatible opinions, one must be wrong. If these people were discussing the wavelength of blue light, a single right answer is plausible.
However, doctor/patient moral dilemmas are a rather different beast in that disagreements are generally about matters of definition and human constructs (ownership, rights, “souls,” deservingness). In the absence of people, blue light will still have certain physical properties. Ownership and rights, on the other hand, are meaningless without individuals to interpret them. I can't think of a reason to give greater consideration to a doctor's interpretation than a patient's.