What is ethics really all about?

The word “ethics” has been used in various contexts – from legal mine fields to coffee table discussions. Given this versatility, what really is ethics all about? In a general context, ethics is about giving priority to an individual’s needs and moral values in an attempt to curb and control potential societal abuses. In a health care situation, ethics would involve concern about the patient and protection of the patient from exploitation or abuse. The relevance of ethics lies in its ability to make cultures more tolerant of diverse views. Its utility is contained in its capacity to change the decision-making process and influence social policy.

While this describes ethics as it should be, ethics as it exists seems to be much more utilitarian. Personhood does not seem to be a central tenet. There are arbitrary conventions that do not take into account the uniqueness of a given situation. Recourse to universal guidelines leads to the real danger of an institutionalisation of ethics. This leads to a loss of flexibility in individual situations. And because every situation is unique, this loss of flexibility makes ethics lose its relevance.

A case in point is KV, who was terminally ill with Duchenne’s muscular dystrophy. He wanted to donate multiple organs while he was alive. It was an informed, independent choice. His mother petitioned the high court on his behalf. The court ruled that it was not permissible according to the existing guidelines of medical ethics and the laws of the land. KV died without being able to donate his organs. His mother decided to petition the Supreme Court in an attempt to help other individuals in a similar situation. This case leads to the interpretation that in uncomfortable decisions, the main aim seems to be to avoid litigation—the courts and health care workers tend to safeguard themselves, not the patient’s choices.

This raises pertinent questions. Does ethics uphold the rights of one individual at the cost of another individual’s choices/rights? After all, the needs of health care workers also come under the purview of ethics. Harvesting organs from a live young boy may be morally repugnant to the workers. Who, then, has the capability to decide whose needs, choices and values are more important? Does any human being have the capacity to judge the validity of another’s choices?

The much-publicised Terri Schiavo case in the US brought up other complexities. Terri was in a vegetative state for 15 years. After much public legal wrangling about the ethics of the presence or absence of any medical intervention, she was taken off life support. Any attempt to understand Terri’s wishes was largely drowned out by a loud, self-interested public debate under the ubiquitous banner of ethics. She became a symbol instead of a unique human being. Was she a victim of the institutionalisation of ethics?

In both cases, the question that needs to be answered is whether ethics is innately biased towards the more “fit” individual/s in a given situation. Is ethics just an extrapolation of “the survival of the fittest”? Are we deluding ourselves about the fundamental aims of ethics?

Bioethics has a more difficult mandate. It deals with life sciences and has to handle time-bound, rapidly changing individual needs on either side of the fence. While flexibility is required to make ethics relevant, the question still remains as to who has the greater right to ethical considerations. Is it feasible to respect every individual’s free will or choice? If the choice has to be one over the other, will any decision ever be ethical? In which case, does ethics really exist?