Chapter One
Ethical Principles, Reasoning, and Decision Making
INTRODUCTION
Over the last 50 years, new technologies have emerged that have affected the lives of most people on Earth, and along with the benefits have come increasingly complex moral challenges. Each of these technologies has been associated with ethical issues that are new to humanity, have not been considered before, and have solutions that might have uncertain consequences that are difficult to predict. The issues are varied and the moral consequences are wide-reaching. Examples include the conflicts the new technologies present to basic rights of the individual when the technologies can benefit many, privacy rights in the face of the potential of widespread electronic dissemination of personal information, the conflict of the autonomy of the embryo vs. the rights of the parents, and conflicts over the use of stem cells. Other examples are the thirst for more energy vs. the duty to maintain an uncontaminated and sustainable environment, conflicts over the use of genetically modified foods and organisms, the increasing need for organ transplants vs. limited resources, and the conflict between a corporate goal of increasing profits and a company's responsibilities toward all of its stakeholders.
Globalization has led to the need for ethical decisions to be multicultural because decisions affecting one country or culture might have consequences contrary to the policies or doctrines of another country. Thus, both the unanticipated consequences of emerging technologies and globalization present new ethical challenges that must address differing scientific, political, religious, ethnic, and other beliefs and precedents. To address these challenges requires knowledge of the scientific facts. Moreover, it requires solutions that take into account the moral beliefs and theories that have been a part of decision making for hundreds of years but that often tend to be forgotten in today's fast-paced world. A third element is to learn and practice strategies or tools for assessing and prioritizing solutions to ethical problems. This book is designed to address all of these needs by reviewing technical information about the major new technologies so that the ethical problems can be discussed with the facts in mind by revisiting the major moral, spiritual, and ideological theories and by providing a means of approaching the evaluation and decision making that can be applied to each ethical dilemma.
We begin by presenting a case that exemplifies many aspects of this book; that is, how to identify, address, and work through solutions for the kinds of problems the scientist, engineer, corporation, or government body might encounter.
DESIGNING SOLUTIONS TO ETHICAL DILEMMAS
To help in resolving dilemmas such as those described in the above case, we introduce here the Four A's strategy, a systematic approach that can be used by individuals or institutions to design solutions to ethical problems, or to make decisions intended to prevent their occurrence. This strategy assists in organizing one's thinking about a dilemma and in coming to a decision about what action to take when there are two or more possible solutions. Even if all possible actions appear to be morally equivalent, the task of the professional is to determine the optimal solution. The strategy given here was derived from a number of sources, among them Swazey and Bird (1995), Weil (1993), Velasquez (2001), and Slossburger (1993). The Four A's strategy is simply a way to systematically apply guidelines when assessing the various aspects of an ethical dilemma so that alternate solutions become apparent and their consequences can be evaluated. The assessment includes the application of moral theories, the prioritization of stakeholders (e.g., those directly and indirectly affected by a decision), the prioritization of duties, and a formal analysis of risk where appropriate.
The four steps below form a foundation for more specific elaboration on a range of ethical problems, whether business ethics, stem cell research ethics, or considerations of risks and benefits of emerging technologies. The strategy is applicable to problems that might arise for individuals, universities, corporations, governments, or other entities.
Frequently, ethical problems can be characterized by referring to conflicting moral theories. The codification of ethical behavior seldom guides us to a clear universal solution. However, through examples and case studies, the application of the Four A's strategy is a useful decision-making guide, even when no clear "best action" appears evident at the outset.
Case 1.1 contains a number of actions whose ethical basis should have been questioned. We have selected one example of the many ethical questions apparent in this case to demonstrate the applicability of the Four A's strategy outlined in Table 1.1, that is, the act of buying eggs from students.
The ethical question here is whether buying eggs violated the autonomy or rights of the students. One problem is that, because the large monetary offering of $10,000 might overly tempt students to donate their eggs, this could be considered a form of coercion. Another ethical question that might be raised is whether the donor has violated a duty not to sell body parts, but for the present, we will address the dilemma of improper coercion and the violation of the individual's autonomy. We proceed as follows:
Acquire facts:
The corporation scientists can learn from asking others what precedents have been established for egg buying. What is the experience of others in terms of price and method of acquisition? What prices are being offered in local university newspaper advertisements? What rules have been established regarding this type of human research by the National Institutes of Health (NIH) or by the Federal Drug Administration (FDA)? Does it appear that the FDA will allow this project to proceed in the absence of its approval to proceed? Does the university have any rules barring this type of activity since it represents a form of selling of body parts that may be illegal? What will the university's Institutional Review Board (IRB, an ethics board that reviews protocols and ensures that study participants are fully informed of all aspects of the study) require in order to clear the protocol to begin? Could nonhuman primate eggs be used? Are there medical risks to the product that result from the manner of acquiring the eggs? Alternatives: There being no other alternative but to use human eggs, the corporation might consider establishing its own ethics board. One of its functions might be to establish a policy on the method of advertising and the amount of remuneration. What method of seeking volunteers for egg donation would be most feasible? Are there other procedures that need to be followed to perform the proposed research activities? Has this project been sufficiently evaluated for the company to allow it to proceed? Are there sufficient company quality assurance and clinical guidelines in place to carefully evaluate the project for early warning signs of possible problems? Assessment: Assess the possibilities with regard to the moral theories: Is the student egg donor being unduly coerced by the high fee you are willing to pay? Is the donor being informed of the risks of ovarian stimulation and egg retrieval? The bioethics board might be seen as a rubber stamp committee, paid by the corporation and a target for criticism. Would this board be objective in determining whether the risks to student egg donors were fully disclosed and that there was not undue monetary inducement or coercion violating the autonomy of students? Thus, in order to reduce bias in the ethics board's decision making, the board could decide to reduce reimbursement to the board members to that normally paid scientific review panels, as was done by another company doing the first therapeutic cloning (Green et al. 2002). Reevaluate the safety of the project and whether everything has been done to assure the best interests of the egg donors and those to receive the product. Action: Establish the bioethics board and heed its advice. Contact the NIH to determine the accepted procedure. In evaluating the safety of the procedure to the egg donor, the bioethics board also should investigate the safety of the product itself. The bioethics board should monitor animal experiments that must be done to detect unanticipated consequences of the procedures. In the actual initial experiments, it was the bioethics board's vigilance that led to methods to avoid allergic reactions (Green et al. 2002). Thinking through the strategy of the Four A's systematically has the advantage of identifying other areas of concern, and perhaps preventing events that could be disastrous for the company.
Other ethical issues in this text are approached through similar examples and solutions. The Four A's strategy brings decision makers' thought processes to bear on a seemingly unsolvable dilemma by providing a framework for a systematic, thorough analysis. Case studies, discussions, debates, and the problem sets will help hone these problem-solving skills.
Another approach to ethical engineering practices, described by Pinkus and coauthors (1997a), can also be applied to scientific innovations as discussed in Chapter 12. The framework for evaluation of ethical aspects of new projects utilizes three core concepts described in Table 1.2. These core concepts were the common themes that evolved from analyses of large engineering projects. The ethics of good engineering goes beyond the individual and includes the responsibilities of the organization and responsibilities to the public.
EVOLUTION OF ETHICAL PRINCIPLES
To design a solution to an ethical problem requires knowledge of the principal moral theories. The major ethical theories (i.e., virtue, justice, duty, rights, and utilitarianism), as well as the concepts they have in common (autonomy, beneficence, non-malfeasance, and justice), are fundamental to evaluating alternative approaches to ethical problems. Selecting the appropriate alternative solutions is basic to selecting the right course of action. While these topics may seem abstract and even dry, they enter into our everyday decision making along with other sources of guidance. These other sources (such as legal, religious, scientific, cultural, ideological, and historical precedents) are sometimes helpful but often have less relevance than the basic moral theories when resolving difficult ethical problems. Frequently, the moral theories are in direct conflict with one another, and no simple codification can show the way to a solution.
Historically, the ethical thinking of the Judeo-Christian/Islamic religions contained religious and moral philosophies similar to Buddhism, such as the dictum of doing to others as you would want done to you (Golden Rule). The concepts of virtue and the creation of personal values, which led to doing the "right thing," underpin the philosophy of Plato and Aristotle. However, cultures around the world developed quite different definitions of acceptable and unacceptable individual and governmental behavior. As we shall see, a virtuous person from the East might have different ideas about political, medical, environmental, and business ethics than a virtuous person from the West. The theories and principles of ethics can be understood based on their definitions, but engineers and scientists in the modern world must also understand the conflicts between these principles and the differences in allowed ethical behavior for individuals from different social, religious, and geographical cultures. Personal, religious, and cultural values can be the determining factors underlying individual or corporate behavior in a situation demanding an ethical decision.
The material below is divided into sections showing how various moral theories arose and how they present useful ideas for many ethical dilemmas. It is imperative to keep in mind the importance of global differences in cultures and value systems while we categorize the five major moral theories of virtue, justice, rights, duty, and utilitarianism. We will also outline some prevailing ideologies and modifications of moral theories (such as rules ethics, rights ethics, and cultural relativism), as they also play some role in the logical consideration of problems associated with the new technologies. Table 1.3 gives a listing of the moral theories, principles, religions, and ideologies, one or several of which may arise in the consideration of a particular ethical dilemma.
Virtue Ethics
Aristotle advocated the ethics of virtue, defining a good person as someone with qualities such as courage, wisdom, loyalty, and fairness. However, the Greeks were also elitist, seeing themselves as superior to others. They saw eugenics (from the Greek meaning good birth) as a virtue, and even Plato wanted to improve society by creating better children through arranged breeding (Pence 2004a). In Athens in about 350 B.C., when there were only around 300,000 citizens and no competing religious doctrines or theologies, Aristotle taught the importance of attaining moral virtues. These virtues were attributes to be acquired through habit formation in order to reach a proper balance between extremes in conduct, emotion, desire, and attitude (Pence 2004b). For example, Aristotle considered truthfulness a virtue, not in the context of either telling or not telling a lie, but in terms of finding a medium between the extremes of excessive truth and insufficient truth. Thus, the virtue of truthfulness according to Aristotle is the Golden Mean between revealing too much information and giving inadequate information about a situation. For example, it is not virtuous to make negative comments about the appearance of an individual even though the comments might be truthful. Nor is it virtuous to remain silent when there is some information a person deserves to have for his or her success, or to hide fraudulent activities of a corporation.
Another example of virtue ethics dictates that it is better to achieve happiness or self-fulfillment through a life of internal good (e.g., good behavior and virtuous acts) rather than through a life of pleasure or mere contentment. The good in engineering is exemplified by the creation of useful products or technologies while respecting the autonomy of clients and the public. The internal good of science is found in discovering the truths of the physical, biological, and cognitive world. The internal good of teaching is learning, and the internal good of medicine is the promotion of health while respecting the autonomy of others.
Judeo-Christian philosophies emphasize virtue and justice under the just authority of a god or supreme being responsible for the welfare of the faithful. The associated moral thinking resisted ideas of eugenics, insisting that human beings are made in the image of God and should evolve naturally. Over time, the ideas of the early philosophers became intertwined with religious teachings. The influence of early Christian and Jewish teachings spread through the Bible and Torah to the far reaches of the Roman Empire. Teachings of Islam also emphasized the importance of virtue in the life of the individual.
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Excerpted from Ethics of Emerging Technologiesby Thomas F. Budinger Miriam D. Budinger Copyright © 2006 by John Wiley & Sons, Ltd. Excerpted by permission.
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