has ethics gone too far?

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Permalink Reply by Jody Jakob on March 16, 2008 at 9:48am

Yes I do think I will treat my patients differently as a result of this discussion......

At least I will THINK about it more....I will be more sensitive and awake to my patients needs because we have dialogued about this and for me one of the most important things when treating patients is to be enthusiastic and switshed on....to discuss with colleugues who make us think!!
Thank you, Leyla

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Permalink Reply by Leyla Okyay on March 16, 2008 at 9:55am

Apologies, didn't mean to shut the discussion down.

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Permalink Reply by Jody Jakob on March 16, 2008 at 10:49am

No need to apologise and please don't shut it down if you have something to say!!
If I can add something I will most certainly contribute.
by the way...how are things in New Zealand!!
Do you know Clive Standon?
He was in the year just above me at the BSO London
Cheers

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Permalink Reply by Yan-Chee Yu on March 16, 2008 at 5:06pm

hi leyla and jody

The question was never what to do in a practical situation. The question is how you decide what to do in a practical situation. To recap: The question which I posed at the start was to demonstrate that an ethical framework consisting of rules leads us to some very strange conclusions. We cannot sometimes choose not to follow the rules, because this would defeat the point of having rules in the first place!

Alternatively, we can use a particularist standpoint instead of a universalist one, but I think (and perahaps Jody has a different view) that if this moment in time is unique (in the biggest possible picture we can imagine), then we cannot use logic or reason to guide us, because they are the means to manipulate abstractions of real world events. In essence, they allow us to treat two different situations as instances of the same abstract concept, contradicting the notion that situations are unique.

[NOTE: you might like to consider where you get your notions of logic and reason from: are they fundamental to the universe, or are they merely very useful human inventions? You might like to note that you can't justify the use of logic - any such argument would use logic and be self-validating!]

I think intuition is key. However, for most people, intuition is not something which they have trained in the same way as their logic and reasoning skills - western education spends an awfully long time training people to reason. But, could we sharpen our intuition to the point where it is as powerful and sharply focussed a tool as (we believe) reason is for gaining knowledge? Would intuition, polished to this point, be sufficient to guide us, instead of ethics, but without the possibility of self-contradiction? Perhaps this could be achieved by removing obstacles to the health of our intuitive processes, and letting our consciousness do the rest, instead of approaching from the opposite direction of trying to engineer a logical framework?

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Permalink Reply by Ronan O'Brien on March 16, 2008 at 6:24pm

Very interesting question. I tend to go with my gut (i.e intuitive) feeling over my logical reasoning. I don't know whether my intuition is honed or not but my experiences have taught me to listen to it.

I feel it is to the detriment of western education that the focus is on left brained logic/reasoning skills to the sacrifice of creative, empathetic & intuitive right-brained skills.

If intuition is the power of non-conscious awareness, I think a key tool for honing it would be meditation. For sufficient non-conscious awareness to get past our monkey minds, reigning in the monkey is a step in the right direction!

In a utopian society where everyone was deeply rooted in intuitive awareness perhaps there would be no need for an ethical framework in which to work in (perhaps no need for osteopaths either!). Until then I think some degree of ethical guidance is necessary, if only to serve as guidance to those without intuitive/common sense. Would intuition always serve the best purpose?

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Permalink Reply by Leyla Okyay on March 17, 2008 at 12:04am

How much intuition is actually involved in the case of deciding whether or not to ask a patient for consent. Of course it depends on how you define intuition but on the whole there wil be a reasoning process going through your head: What are the implications of asking/not asking the patient for consent? Will I cause harm? May I get sued? etc...
This will be influenced by past experiences, education, cultural norms and so on. Is there a part for reasoning in intuition or would this not be 'true intuition'? Is reasoning related to logic?

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Permalink Reply by Yan-Chee Yu on March 17, 2008 at 8:10am

Ronan - I'd have to agree with your last paragraph - rules can be a very useful way of developing the awareness required to proceed without rules! However, rules for their own sake, which seems to be the current state of affairs, don't teach awareness by themselves - we need people to be actively teaching people how to be aware as a crucial part of Osteopath training! So, if anyone is reading this who has influence in an Osteopathic school - why isn't this a vital part of the curriculum?

Leyla - interesting point, but it does beg the question: even if you consider reasons when making a decision, it is still you, at some level in your consciousness, who makes the decision; it is not a fait accomplit, uniquely determined by the decision inputs considered. In short, based on any set of evidence, you could still decide to go either way, and this is not possible within a logical/reasoning system. So again, this comes back to my original question of "what is it that allows us to make decisions?", or to rephrase using your last post: "what is it that allows us to use reasoning to make decisions?"

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Permalink Reply by Austin on March 18, 2008 at 2:03pm

Perhaps rather than asking "what is this unknown thing that allows us to make decisions", we should instead ask how best to harness it - something which you hinted at before, Yan.

I'd suggest that the reason this isn't a "vital part" of Osteopathic curriculum (in our school, anyway) is that it's a larger question that applies to the entireity of human experience. Also it's unanswered, to the best of my knowledge. Educational systems in the west focus on evidence, tests, exams, and quantifiable results. It seems that, for the moment, this question is unquantifiable, so a student's response couldn't easily be graded. (That's not to defend the situation, just to state it.) I do agree though, that some sort of philosophical discourse on this area should be part of any educational course that deals with human interaction.

However, we have touched on this. In one of our lectures on the Conceptual Basis of Osteopathy, the lecturer briefly discussed the beneficial "naivety" that fresh students bring with them when they start the course. They look at a person and see the whole picture (to some degree) without getting bogged down in biomechanics. We talked about how we'd been disappointed by the mechanistic/biological approaches we'd witnessed from some students in clinic -- they seem to have lost the ability to see the whole patient, at a glance. That naive wisdom is something I hope I retain, although I'm sure it will get lost, just the same as everyone else ;-)

There's a book called "Blink" by Malcolm Gladwell that deals with some similar areas, but I haven't read it. I'm sure there are plenty of philosophical essays on this subject too; it would be very interesting to read them.

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