Making Ethical Choices

Resolving Tough Choices

At any moment in daily life, situations can arise which change things forever. So much so, attempts to even remember what life was like before can be skewed. Memorable days, such as 9/11/2001, shift our world to the point where the new world-view is just a part of life. Individually, our world-view can be changed just as drastically. Take for instance the story of a brother and sister riding the subway home late one evening. Far from a serene setting, they were treating each other horrendously. One of the nearby passengers finally spoke up to the dad, and with an obvious shortness of voice, asked him to calm his children down. The father, who until the comment, was staring off into space, stated, "Oh, I'm sorry they're acting up, their mother just died tonight, I'm sorry." This startled all the onlookers and each became much more gracious to the grieving family.

The family experienced a world-view changing moment that evening, and to a much lesser extent, so did the onlookers. Our frames of reference are always lacking information in one way or another. When news is heard which changes things, our world-view changes to a response incorporating the new information. Although tough ethical decisions need not be surprising, they are no less world altering for those involved.

The Lesser of Two Evils

Tough ethical decisions have been referred to as choosing "the lesser of two evils." Tough choices are just that: tough. When values are in conflict, decisions which place one value over another can be difficult. Take for instance, the story of a gang member whose bullet wounds need to be treated. Since he doesn't have insurance, he must be treated at home by the only available caregiver, his sister. Just before being discharged from the hospital, the doctor is faced with the decision whether or not to tell the sister, against the brother's wishes, her brother is HIV positive. Here, several values conflict. Telling the sister breeches the brother's trust, he expects the doctor to abide by the laws of medical confidentiality. However, the sister expects the doctor to do no harm, and trusts his advice. Caring for the man's wounds will no doubt, be a big risk to her.

Tough decisions have options. Often, like the story above, the decision appears to be simply "yes" or "no," should the doctor tell the sister or not. However, after reviewing the situation, there may be other options. This is where it is helpful to turn to an ethical decision making model.

Gather The Facts

A basic starting point for all decisions, tough or not, must be getting factual information. Factual information supersedes opinion and assumptions. Reality must replace perception. Many people rightly argue individual perception is reality for the individual. However, when gathering facts, perceptions change, thereby changing the individual's reality. Therefore, one must admit the possibility of incorrect perception to adjust to a reality where the decision must be made. Gathering the facts may be limited by two issues: having the ability to gather facts and openness to revealed facts. Although these both lead to the same outcome, the difference between the two factors is external vs. internal, or individual vs. circumstantial. The individual may or may not have made a choice to ignore obvious facts, those who ignore obvious facts may be mentally limited, while those who purposely ignore obvious facts are usually deemed fools. The other external or circumstantial factor limits knowledge of the issue through means other than individual perception. People who are willing to change perception, but have not been shown sufficient evidence, logically reach conclusions based on the information available.

Unfortunately with ethical decisions, there is usually no possibility of gathering all facts surrounding the decision before a conclusion must be reached. There is always something further to know, further to review, further research to perform. For instance, when deciding whether or not to have a major surgery, doctors often give percentages of success. These numbers are always changing based upon current information. There is a margin of error, based on limited opportunity to observe.

Limits of time to decide also pose a factor. Gathering the facts is restricted by time limits. Often with ethical decisions, postponement limits the choices by way of default. If the decision to order return fire comes too late, there may be no troops left to receive the order! Analyzing too much may remove the decision entirely. RIck Warren cites this as paralysis of analysis.

Thus, a decision is usually required before all facts can be gathered. However, the fact gathering stage must not be removed. Simple questions about what is known and what needs to be known allows the ethical decision process to move forward.

Determine the Ethical Issues Involved

After gathering enough facts to feel comfortable about the situation, it is necessary to determine the ethical issues involved. In the previous example of a gang member, several ethical issues are apparent. In no particular order, the issues start with the sister who has an interest in not becoming HIV positive. Her brother, however, has an interest in not letting anyone know his condition. Further, the issue with the doctor's professional relationship between the patient and the patient's sister, previously pointed out as confidentiality vs "do no harm." Here, there is a format of sorts for determining ethical issues. Usually, issues can be placed in a X vs. Y format.

Ethical issues can also be described as placing oneself in the position of another, and determining what the other could reasonably expect. For instance, in the scenario above, a reasonable person could expect the doctor, as much as possible, to place both person's well being as a priority. Reviewing the ethical issues assists in what values are at stake.

Determine the Ethical Principles

After determining the ethical issues involved, the next step is to rank, based on some criteria, the ethical issues discovered in the previous step. This process determines the ethical principles by which the decision can be rendered. Ranking issues can, however, be difficult without an external guide. For this article, and with the admission of a Christian bias, these principles are ranked by an honest hermeneutic of God's Word.

Defining "honest hermeneutic" more in-depth will be left for another article. However, the basic idea takes into consideration genre, themes of scripture, traditional interpretations, and God's guidance, or summed up in one word, exegesis. Hermeneutics in this manner, reduces the possibility of "discovering" snippets of scripture to support a previous doctrine, or reading into scripture what it does not say, or eisogesis. With an honest hermeneutic, ethical principles can be placed into an order which does not violate either each other or the Scriptures.

At this point, one might wonder if they are "qualified" to search the Scriptures to determine where to rank a particular issue. To this, I suggest first, getting to know God's Word and exploring first hand, the Scriptures on the subject. Most Bibles have some type of index in the back, where verses can be found on particular topics. Often, books on subjects are available which explore many verses, effectively doing much of the research already. However, another option is to schedule a 45-60 minute session with a chaplain or other clergy to explore the subject with somebody.

List the Alternatives

As stated earlier, an ethical decision, can sometimes be seen as an either or situation. In fact, this dichotomy can be promoted through discovering the ethical issues involved, whereas the issues are rendered through an X vs. Y mentality. Thus, caution must be taken when using the X vs Y pattern because it can seem to limit possibilities. However, this stage of proposing alternatives balances out the heavy X vs. Y pattern. In this stage of ethical decision making, the focus is on promoting reasonable alternatives. In the brain storming session, all alternatives should be considered, even if it will obviously not work.

Adding to this process, and once again from a Christian viewpoint, one should consider God's alternative, or plan. If within the process of the decision there is a peace about the course of action to take, God may be indicating the appropriate path. However, God often speaks to the individual who needs to make the decision rather than to those around. While not disregarding the one who speaks prophetically, the truth is people are more open to God's personal leading and through close relationships rather than to people who claim to voice God's opinion on particular decisions. The reality is there are many joking stories which punch-line with someone stating, "God told me you should do this."

Compare Alternatives with Principles

Within the framework of alternatives likely resides possible courses of actions which violate stated or firmly held principles. If, in our case study, alternatives arise which either purposely infect the sister with HIV or to let the brother fend for himself on the street, principles hopefully would outweigh these alternatives. It becomes apparent to eliminate the possibilities which contradict principles. Occasionally, eliminating alternative in this manner solves the dilemma. However if it does not, the alternatives are at the least limited.

Consider the Consequences

The final stage before a decision is reached incorporates considering all of the consequences. Consequences might be concerned with which course provides the greatest good. Occasionally, writing out the pros and cons assists in "keeping score" as to what course causes the least damage. Honesty in considering both positive and negative consequences of the alternative will assist in an informed decision. Each of the alternatives being evaluated must eventually be weighed and placed into a ranking.

While the alternative which tops the list may be looked at more closely, it does not necessarily default to the best choice. Ethical decisions are not strict formulas which always yield identical results. Once again, ethical decisions are tough.