Most of the time, it’s pretty clear what’s right and what’s wrong. But sometimes it’s not. A famous example that promotes endless debate is the trolly problem: a runaway trolley is about to hit five innocent people on a track. You can pull a switch, diverting the trolley so it hits only one innocent person. What should you do? Of course, most of us don’t often have to make life or death decisions like this, but we all have to decide what’s the right thing to do. I’m going to give you a 5-step method for making ethical decisions. (Actually, it works for all important decisions.) It may not give you the one and only answer, but it will help distinguish good decisions from bad ones.
Ethics courses often suggest using ethical theories, like utilitarianism (produce the best consequences for everyone involved) or Kant’s view. (Kant says to follow rules you can want everyone to follow and to respect people and not use them.) So pull the switch to save five lives rather than one, because that would produce the most overall welfare, or don’t pull the switch because killing [the one person] is worse than allowing [the five] to die. Some ethicists focus instead on being a good person. Aristotle’s “Goldilocks” theory of virtue says vices lie at the extremes. It’s a vice if you have too little regard for danger (you’re reckless) or too much (you’re a coward). The virtue of bravery is somewhere in the middle (having just the right regard for danger).
Rules like this, hotly debated by philosophers, are pretty much always wrong. Any decent ethics text points out their well-known flaws.* But they do point to important ethical considerations. Promoting good consequences is important (but not always the most important thing). Actively harming someone is often (but not always) worse than doing nothing to stop a harm.** Common sense says we have to weigh these moral factors in each case. But how? John Rawls suggests there are only two possibilities. We can have a set of rules or principles that are “lexically ordered”—that is, just as A always comes before B in the alphabet, this rule always has priority over that rule. The other possibility he sees is “piecemeal intuitionism”—we just see, or intuit, in each case, which rule or feature is more important in that case. (Jonathan Dancy is an example of a very insightful and sophisticated piecemeal intuitionist.) But of course people notoriously have different intuitions. Some people think it’s wrong to abort a fetus to save a mother’s life and others think it’s wrong not to. I want to give you a third possibility, a 5-step process that’s the right way to make difficult ethical decisions.
The 5-Step Process
Suppose you work in a medical office. Looking over your brother’s girlfriend’s medical records, you see she is on the pill. Your brother has had a vasectomy. While there are other reasons for taking the pill, you suspect she is cheating on your brother. Do you tell him? There are five steps in deciding.
- Define the problem and identify your options.
What do you have to decide? What choices do you have? What information might you need to make a good decision? How can you get that information?
In this case, you must decide whether to leak a patient’s confidential medical information to your brother. Your options are to keep silent, tell him, or hint.
- 2. Identify relevant ethical factors.
Family loyalty is a factor. The duty of confidentiality is a factor. Promoting good consequences is a factor. (There are others, but let’s stick to these three.)
- 3. Weigh the factors: give reasons for thinking some factors are more central or relevant for this case.
Hinting is probably not a good idea, as it leads to misunderstanding and your brother is likely to demand details. The consequences are hard to predict here, and it’s not clear which option would work out best for all involved in the long run, especially as her taking the pill is not a smoking gun that she is cheating: the pill is prescribed for a variety of medical reasons. She may not trust his vasectomy and may want additional precautions against pregnancy. Family loyalty is important, but it’s worth noting that confidentiality here was set up precisely to override personal loyalties. You were only given access to her records because you were trusted to keep her information confidential, even when you have personal reasons for spilling the beans. People would not give medical providers sensitive information if they didn’t trust their providers to keep it confidential, and people really need to give their providers information to get proper treatment, which is often a life or death issue. Your brother won’t die because his girlfriend is cheating and he has other ways of finding out. So, in this case, confidentiality seems more important than family loyalty. (In a different case, it could go the other way.) Important: you are giving reasons, not just going by your feelings. Reasons are general, but you are giving reasons for this case. If your brother has consistently betrayed your family, family loyalty may not be as strong a factor here as it would be for a brother who has stood by you through thick and thin. Reciprocity and earning loyalty are general reasons that sometimes come into play, but sometimes they’re not relevant.
- 4. Design a solution. Decide and act.
You want to find a solution that best balances what you came up with in steps 3. And 4.
Here, you might decide not to say anything to your brother about his girlfriend taking the pill, but look for other, legitimate ways to get evidence that she is cheating on him. That way you are still looking out for your brother but staying true to your professional duties.
- 5. Monitor the unfolding situation.
Once you’ve made your decision and acted, keep an eye on how things are going. Sometimes, once you’ve acted it is out of your hands. But sometimes you can still influence what’s going on. If things are not going well, you can intervene, when appropriate.
The pill is at best 99% effective (less so when doses are missed). Suppose she puts in for pregnancy benefits. Your brother proposes to her. He doesn’t know she is pregnant. These developments increase the urgency for your brother to know what is going on. You might need to seek urgently another way for him to know without your directly revealing her confidential medical information.
Most of the time you will not need to go through such an elaborate process. This is for making difficult and important decisions. In fact, it is a good way to make any important hard decision. (For example, in Ethical Engineering I applied this method to buying a car.)
Developing an Ethics Toolkit
The key to success in using this method is developing a good ethics toolkit that you can draw on in steps 2. and 3. Your toolkit should include an array of ethical factors: your values (for example, you might value honesty), principles (it is generally good to promote good consequences), guiding ideas, both specific and general (it is more important to stick strictly to the rules in a competitive situation, like a race, than in a non-competitive situation), people worth emulating (what would Gandhi do?), and much more. Ethical Engineering has much to say about how to go about choosing your toolkit rationally. It also gives you many ideas for what to put in your toolbox (even if you’re not an engineer), as well as cases and examples of using the method. Building an ethics toolkit is a lifelong process.
Who’s to Say What’s Right?
Of course, people may reasonably disagree about what to do in tough cases. The method of giving reasons and designing a solution is not like adding two numbers. It’s like most things in life: there are some reasonable solutions, some wrong or bad decisions, and some gray area in between, just as there may be several decent choices for a car for your family. But some choices are clearly wrong. If you have one car for a struggling family of four and you buy an expensive two-seater, you made the wrong choice. You can’t tie the kids to the roof or have them run alongside you as you drive. (See, that’s a reason for thinking, in this case, adequate passenger room is more important than how exciting the car is.) So, who is to say what’s a good choice and what’s a bad choice? The reasons say, that’s who. When you’ve completed the five-step process, you have not only (hopefully) a good decision, but also a strong justification for it.
So the next time you have to make an important, difficult decision, think about using this five-step process.
Philosophical Postscript: Justifying Reasons and Principles
Where do reasons and moral factors come from? Is there somewhere a master list of reasons factors and how strongly they weigh (so Rawls was right, after all), or do we just intuit them? Neither. Reasons are drawn from the moral edifice, a complex, interconnected structure of facts and moral ideas. The importance of autonomy, for example, is rooted in the psychological importance we put on making our own choices, on our nature as moral decision makers and creators of value, on one of the things a government must make feasible in order for people reasonably to try to live good lives (see A Holistic Approach to Rights for more about this), on how respecting autonomy leads to social co-operation and peace, and much more. These ideas in turn are supported by other ideas and arguments. They connect in different ways. Inference is one way. Another is being part of a common picture. One thing that strengthens our sense that something is a good human life is whether enduring societies, interacting in the right ways, would tend to agree that kind of human life is a good one. No one strand stands alone—each can be challenged. The power of the moral edifice is how it holds together, how the diverse strands support each other and how the structure as a whole shelters a life we can live in and find good. (I’ve written more about the moral edifice in Responsibility Beyond Our Fingertips.)
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*For more about moral theory, look at Julia Driver’s Ethics: The Fundamentals https://download.e-bookshelf.de/download/0010/7860/80/L-G-0010786080-0026170562.pdf, Simon Blackburn’s Ethics: A Very Short Introduction, or Appendix II of my Ethical Engineering.
**A famous article about this is James Rachel’s “Active and Passive Euthanasia.”
Nothing that appears on this blog is meant to replace legal advice, therapy, or medical treatment. I am not providing legal, medical, or mental health advice. Always seek the advice of your own attorney or medical or mental health provider about specific questions concerning your specific health or legal issues.
