First Person

The importance of learning
to think and act ethically

"Can you teach ethics?" I hear that question almost every time I tell someone what I do for a living. I often want to respond mischievously. "Of course you can teach ethics. I do. And I get paid for it. Mind you, I have no idea if anyone's learning anything."

A smart-aleck response? Yes, but it gets to the point of the question: Can we teach and learn to think and to act ethically? If so, how? Skeptic or not, you might be surprised to learn that ethics can be taught and learned. This knowledge has been tested and re-tested around the globe. But I'd wager that even if the current state of our knowledge were more widely known, skepticism would remain. The unsettling events of each day must shake our confidence in the fact that ethics can be taught. These all-too-human realities contain a lesson: if ethics can be taught, then as a species we're not doing a very good job of either teaching or learning ethics, or both. Clearly, it's both.

So what can we do to improve the teaching and learning of ethics? In a nutshell, teaching and learning ethics requires developing four skills and capacities: the ability to recognize and interpret ethical situations; the ability to form ethically sound judgments; the ability to prioritize ethical values; and the ability to implement ethical judgments.

Let's take these abilities in order. To begin with, we need to know what ethics is if we ever hope to recognize it. I like the following definition: Ethics has to do with "establishing and maintaining vital and significant relationships" (J. Thiroux). Ethics is a dimension of all our relationships. It's the dimension that creates and fosters vitality and significance in our relationships. Ethics touches on the essential meanings and purposes of the relationship and blooms wherever we relate to others in a vital and significant manner.

We tend to think of ethics only when things break down. That's too bad, because focusing solely on ethical dilemmas, quandaries and tragedies obscures our many ethical successes and skews our view of ethics. We can learn a great deal about ethics by reflecting on what makes vital and significant relationships vital and significant. At the Ethics Center, we do that reflection.

We also reflect on the dilemmas and quandaries, on the relationships and interactions that frustrate our purposes and challenge our sensibilities, threatening to leave our relationships unfulfilled. It's no mistake that most people associate ethics with quandaries and dilemmas. A great deal of ethical learning takes place around quandaries and dilemmas precisely because we only confront them at the edge of our knowledge and competence.

We can learn to rise to our ethical challenges. Take a case from our "Clinical Medical Ethics" course. The head nurse on the psychiatric ward wants to sedate a psychotic and potentially violent patient. What's the ethics decision? The patient, a 27-year-old vegetarian woman, was found hallucinating in the health food store where she worked. Her mother had recently died, and she was hearing her voice. The patient refused all medications. She insists on keeping her body pure of unnatural substances and wants to be treated with psychotherapy alone. Is she competent to refuse the drugs? Should you force her to take the antipsychotic in order to protect the safety of the others on the ward?

While you're considering what to do, the patient, obeying a voice, attacks another patient, crying out "He's the devil." After the patient has been subdued, the head nurse confronts you, demanding that you give the patient a shot of haliperidol decanoate. One shot will sedate your patient for about a month. It can have nasty, long-term side effects. What will you do? Why?

In working through this dilemma, the students not only learn to recognize and interpret the ethical dimensions of their medicine, they also begin exercising the second set of skills and capacities that make for ethical living, namely, the ability to form sound ethical and medical judgments. They consider possible diagnoses and treatment options. They strain to honor the patient's rights and dignity while providing the best treatment and preserving the safety of the ward.

Ethical learning also requires that we rise from our "armchairs" and relate our ethical judgment to our judgment about what's possible and wise. In this case, as the student, you're getting pressure from the head resident. He wants to force your patient to take the antipsychotic medication simply to placate the head nurse. And you've got your grade to think about. What will you do?

The students role play their actions. They have the conversations. They feel the frustrations. They learn to prioritize and communicate and implement. These last steps-prioritizing and implementing-complete the ethical learning.

Experience has taught me that most ethical judgments, however sound, come to grief over our inability to prioritize and implement them. Ethically speaking, we're not so much numb or dumb as "incompetent"-if we know what is ethically right, very often we don't know how to achieve it. That is why ethical learning requires cultivating those personal and interpersonal skills, capacities and habits we too often say with our lips only-things like courage and prudence and honest communication.

Our lesson is almost complete. Let's get back to the ward. If we've done our ethical learning well, what's the medical-ethical prognosis?

Pretty good, I'm happy to say. Like the real life doctor who submitted this case, we have effectively communicated our ethical concerns to the resident. He decided to give the patient a short trial of the haliperidol, not the one-month knockout. She calmed down. The medical student talked to her, and she eventually agreed to begin taking the medication voluntarily. She's getting the treatment she needs. She'll be able to return home soon. The ward is quiet. Ethics lesson is over. Grade: A plus.

Steven Olson is program director for professional ethics in the Ethics Center. This article was excerpted from the Center for Ethics News (Spring 1997).

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