At first glance the process of finding solutions to problems of an ethical nature (known as dilemmas) seems simple. First of all, the key issues that are causing the dilemma need to be identified. The people involved, their values and principles, alongside other external and internal considerations need to be located. To solve the issue, a set of ethical guidelines steer the decision maker down the best route to take, to a conclusion which can be properly justified, even if it does not make everyone happy.
The problem is that this decision making process can become full of complexities when the decision maker takes full account of all the details, influences, and idiosyncrasies of every individual involved. This makes weighing up the correct decision harder, and so more care must be taken when making such decisions.
Ethical dilemmas versus practical dilemmas
There is a clear distinction between dilemmas of a practical nature and dilemmas of an ethical nature. Ethical dilemmas will occur due to the average collective perceptions of social norms within a group. Social norms vary from culture to culture, nation to nation, and of course from person to person within a culture or nation, so ethical dilemmas will arise from differing situations depending on the society, and one person's ethical dilemma might be non-existent to another. Take the example of somebody finding a wallet full of money on the sidewalk. The decision of whether or not the wallet should be handed in to the police, or the money kept, will be based on the dilemma of ethical righteousness, and the personal need for the help that the money would provide if it was kept. Both the ethical righteousness and the personal need will vary from person to person, and these differences, plus their comparison, will ultimately lead to the decision.
One way to help develop decisions in difficult circumstances would be to clearly define the difference between a moral claim and a non-moral claim. A non-moral claim is a claim which has no component of morality, or in other words, has no affect on other people. For example, if someone claimed that they prefer one drink over another, this is a non-moral claim. A moral claim on the other hand will affect others. For example, the claim "stealing from others is wrong" is a moral claim. For the situation of the money in the wallet, the moral claim component will have a lot of weight, and the feeling that it would be wrong to take the cash is a moral claim, since taking the cash would affect the owner of the wallet. The non-moral part of the argument would be the potential things that could be done with the money (unless of course those things were in themselves immoral).
These examples clearly highlight that moral dilemmas are common, and we face them practically on a day to day basis. In contrast, a practical dilemma will have a tangible affect on the public consciousness of morality and social norms. For example, take somebody who is trying to answer whether or not abortion will ever be moral. The decision made in this case will not only have an impact on that person, but over time with perceptions at a larger social level. Once the perception is public in scope, public policies are changed and adapted to keep with these norms. A simple example of a practical dilemma would be for a physician trying to determine the best medical route to take for treatment of a patient.
Morality, emotion and reasoning
If we add reasoning and emotion together, the sum is morality. Academics are always debating which one is weighted more than the other, but what is agreed upon is that both play their part. Emotion is what gives the basis for a moral enquiry, and is the motivation for the questions that are presented. Reasoning is what allows us to traverse the moral ambiguities of difficult situations, keep our emotions in check, and to make sure we make well thought out and appropriate choices.
Take the relationship between a nurse and a patient. It is often the case that the relationship between a nurse and a patient is more trusting than the relationship between the patient and the physician. This can often lead to moral dilemmas.
For example, patients often confide in nurses where they wouldn't with their physicians, and in one case a patient disclosed pertinent health history to the nurse, but asked that the nurse promise not to tell anything to the physician. Naturally the nurse was facing a dilemma in which either decision would cause emotional turmoil. Should the nurse break the ethical bond between them, in the interests of better medication and treatment for the patient, or should she adhere to this bond but decrease the chances of the patient's recovery? This moral quandary and the questions that arise in the nurse are the result of his or her emotions, and these considerations would not exist if it was not for them. The reasoning of the nurse was what guides him or her towards the solution which he or she can defend when it has been made. The process towards resolution would thus be the identification of the relevant factors and their respective weights, and the ethical principles that need to be followed.
Remembering what was earlier said about money in the wallet, we can now address this issue with greater precision. Emotions lead us to ask questions, such as "would keeping the money be illegal?". After this question, the values of the person in question, and the affect that keeping the money would have on the person who dropped it would be considered. The choice to keep the wallet is a moral choice is because it would affect the person who dropped it. Handing in the wallet is obviously the right and morally correct decision because of this affect.
Morality is a dynamic entity, and is constantly shifting in response to changing social norms. This alongside our individuality as humans ensures that the moral perspective will vary from person to person. For some people, the moral choice is based solely of reason. Others base their choice primarily due to emotions, and most have a mixture of both to work with. Ethical decision making means taking into account the moral perspectives of other people, not just yours, and that is why it is so important for the decision maker to understand who will be affected by the decision, and to what extent.
Where does legality and law come into play in this issue? Law is generally accepted to be a framework of accepted and unaccepted conduct based on the morality of the relevant society. When there are situations where different moral perspectives are in battle, law is designed to determine what the best course of action is. This does not mean that law will address the moral issue for everybody involved, and often far from it. For the industry of medicine, a code of conduct based on ethical principles will set the standard for the physician and other practitioners to try and follow. Given this, decision making in response to the ethical dilemma must be completely explainable and defendable for the people affected, and the ability to give an answer and address the dilemma is often very good at reducing dissatisfaction and malcontent.
The recent Michael Jackson enquiry is one of the most prolific ethical debates of recent years, since it was a very good case study on how some practitioners will take their personal ethical duty for their patients above the law. Some people see any law-breaking as non-ethical, and see law and ethics as practically the same thing. No matter what the opinion of an individual is, the law will always have a high influence on the decision making process, and for the majority of people in society, it is ethical to always stay within the law. Having said this, others see laws as counter-ethical, and act to oppose them and to get laws changed.
In conclusion, the ethical decision making process is never easy. There are always many influences, and there is never a case where everyone is pleased at the resolution of an ethical dilemma. Using an established and relevant framework in which to make ethical decisions in situations where there is much gray area is the best thing to do. Anybody who wants to work and succeed in healthcare must be more than willing to face up to these dilemmas, and provide solutions to them.
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