First Do No Harm – Ethics Challenge – Solution
I wrote the following in a discussion on reddit on criticism of Canada’s response to the presumed pandemic. I post it here because I think it’s a strong candidate for a solution to what I think is a common ethics challenge.
I’m not a medical doctor nor a surgeon. I’m just some guy on the internet.
Consider the following. A man is dying. To save his life, his leg must be amputated. What’s the correct choice?
Answer given was “first do no harm, therefore first do not amputate” (paraphrased, see link to full discussion at the end of this post).
Incorrect, but it’s complicated to explain why. The correct choice is:
We ask the dying man what he wants.
By deciding not to amputate of our own initiative, we destroy the man’s right to choose to amputate, and take this right as our own instead. Since we now have this right, we amputate the dying man’s leg to save his life, regardless of what this man wants.
The right to choose is not ours, it’s his. So we ask him what he wants. First do no harm is the acknowledgement that we do not have the right to choose.
In the event the dying man is unable to choose, unconscious or something, now it’s the obligation to act according to the principle of the lesser of two evils. We amputate his leg to save his life. He lost a leg, but lives. The alternative is that he keeps his leg, but dies.
Once we amputate his leg in that way, it gets more complicated. Rights and responsibility cannot be dissociated. They always go together. This means since we took upon ourselves the right to choose, because the dying man was unable to choose, we also took upon ourselves the personal responsibility of that choice. The dying man, now alive minus one leg, can sue us on that basis. However, it’s unlikely that we get punished, if we’ve done our due dilligence to determine if indeed the dying man would certainly die if the leg was not amputated.
That ethics challenge is a true pickle. Also, it’s a very unlikely scenario. We can save a dying man’s life and leg, more often than not. The point of this ethics challenge is to illustrate where our right to amputate comes from – not from us, but from the dying man. It also illustrates that personal responsibility, in spite of that obligation to act according to the principle of the lesser of two evils, does not disappear simply because we’re now under that obligation to act. Accordingly, it also illustrates that we must indeed do our due dilligence.
Extend this challenge to an elected representative, who is deemed to speak in our name with our consent – we voted for him. Even if we didn’t vote for this particular representative, he still speaks in our name with our consent. This is an integral part of fundamental democratic principles. The true pickle here is whether we consented to be compelled by this representative to do things we don’t want for our own good – lockdown, etc. It’s similar to a dying man who is unable to choose, unconscious or something, but with one difference – we are fully able to choose what we want for ourselves.
That pickle can be solved in a couple ways. One, he decrees that we’re all incompetent, meaning that he can now act under the obligation to act according to the principle of the lesser of two evils. However, doing this also disqualifies him, so the decree must include an exemption for him so that he retains the right to choose. This creates a wholly undesirable situation. It’s called rules for thee but not for me.
Or two, he declares a popular vote so that each and all decide for themselves. While this sounds sensible, it’s still not optimal. Those who oppose being compelled, if they lose that popular vote, will be compelled, thereby breaching the principle of a priori competence. Those who agree with being compelled, aren’t in fact compelled – they choose willfully. Again, rules for thee but not for me.
Or three, neither of the above. Instead, ask each and all what each and all needs to get through this as they each and all see fit. This is optimal. We don’t get into a rules for thee but not for me situation. We don’t breach the principle of a priori competence. Resources are distributed according to need, and this need is determined by each and all, not by some central authority. It can be made into a robust plan, rather than some half-assed corner-of-the-table hopeful-wishful maybe-it-will-work kinda thing (as is obviously the case here and now). We do not invoke the greater good (some die so that others live), we invoke the common good (each and all benefit more than they are harmed). It mirrors what each and all already do normally, so there’s little or no disruption of everyday life.
In other words, we ask the dying man what he wants.
Martin Levac 11:53 1/22/2021
