1855. You are sitting outside a large medical tent in the freezing winter on the shores of the Black Sea. Future generations will know this is the Crimean War. To you, a young woman from a sheltered background with scant medical training, it is Hell.
Here they come.
The tent behind you is partitioned in three. To the right, the wounded soldiers likely to survive without medical intervention; in the centre, those likely to die without medical intervention; to the left, those likely to die; outside, those already dead. There are three exits from the tent. The word ‘likely’ does not mean very much, but it’s the best that can be done in the circumstances.
As the first one approaches, stretcher supported by brothers in arms, you know that your split-second decision for right or left or centre (or outside) is likely to save some lives and to end others. If you do nothing, many more will die. If you try to save them all, many more will die.
You steel yourself, thrust down your feelings, and begin the first, rapid, assessment.
This scene is an imaginary illustration of very real events that have been taking place just behind the front line in many wars for many years. A complicating factor, and there are many, is that there are only so many doctors and there’s only so much time. So only those most likely to survive will receive treatment. Any time wasted on those to the right or left means more of those in the centre will die – as some will anyway. This necessary categorisation, in these circumstances, is not only life-saving; it is almost certainly a sentence of death. Someone has to do it.
As morality deals with good and evil; ethics deals with right and wrong. Their relationship is complex. The kind of ethical decision-making employed by the young woman in the illustration is today called ‘utilitarian’ – meaning that such decisions are based on their utility, i.e. the good that may come out of them. Several modern philosophers are associated with utilitariansim but the foremost champion of a single ethical imperative outweighing all others is the Enlightenment philosopher Immanuel Kant.
Kantian ethics, deriving ultimately from Plato’s Socrates (via a misreading of Aristotle) had great influence in Nazi Germany and, as I show in my thesis, continues to have great influence in the United States of America.
What a horrible thing to say! How can I compare a courageous young woman doing her best to save lives against all odds in hellish circumstances, with Hitler and then with the Land of the Free?
Firstly, as the classicist Prof. Martha Nussbaum shows, Kantian ethics are an attempt to avoid the tragic conflict of opposing ethical imperatives. In other words, the young women sitting outside the tent in the Crimean War avails herself of the clarity of these ethics so that no matter the particularities of each wounded soldier (the one whose blue eyes remind her of her brother, the one who pleads for life because of his pregnant wife, the one who has high rank in the Army) she is able to make a decision based solely on the greater good: saving as many lives as possible.
I cannot fault the exercise of Kantian ethics in those circumstances. Grave problems arise, however, when frontline decision-making becomes the basis of ethical conduct in times of peace.
Kantian ethics rely on the total removal of all other ethical considerations opposing the main imperative. A key part of this process (as modern philosopher Dr Mary Midgley shows) is the reduction of particular people and particular circumstances into universal categories. (Also reduction happens, as I show in this book, by use of language.) So, for example, sandy-haired Private Benjamin Jones, 33, a nonconformist lay preacher and amateur boxer, married and faithful to pretty brunette Nelly Jones neé MacDonald, although in love with his lieutenant, who has three kids (the youngest coincidentally resembling the postman), doting parents, a dog and likes fishing, becomes ‘suppurating wound in the thigh’ and is sent to the left (to die).
The reason why frontline ethics are a problem in peacetime is that the only thing that recommends them is their simplicity. I’m not for a moment saying that triage is simple but Kantian ethics are designed to respond only to the greatest ethical imperative and ignore all the others. As Prof. Nussbaum shows, this is the reverse of Aristotle’s teaching that it is the particulars of each person and circumstance that most surely guide us towards a wise ethical response. Not simple, wise.
This kind of sensitivity to particular ethical situations is recommended by moral philosophers such as Rev. Charles Curran, the American theologian who was in frequent conflict with Pope John Paul II. What concerns me is that it is a sensitivity increasingly under threat as more and more organisations worldwide are affected by American corporate values.
Charitable organisations are especially vulnerable as they often flounder in terms of effectiveness, communication and organisation so a hard-headed person unafraid to make tough decisions may seem like a godsend. The catch is that such decision-making may indeed be tough, for anyone with much humanity, but for those hardly burdened by conscience it is quite simple: set goals, clear obstacles, forward march!
Further complications arise because charitable organisations are full of people who feel it is uncharitable not to think the best of others. So if a candidate for a powerful position shows psychopathic tendencies, these may be interpreted as ‘focussed’ or ‘business-minded’. Freud’s rather innocent example of such tendencies (a girl who likes a boy she met at a funeral hoping for another funeral to maybe meet him again) shows that they are not just shared by the criminally insane. In fact, a recent survey of top companies found that a fifth of CEOs shared these tendencies.
It’s a commonplace in the more smug varieties of chicklit and womens’ magazines to poke fun at males (never men) making up the majority of those on the autistic spectrum; on the other end of the same spectrum psychologists are concerned that women (never females) who make up the majority of those on the psychotic spectrum are not receiving support as the condition is so badly publicised.
Adding all this together with the everyday sexism that still abounds and the trend in the third sector is for organisations to be run by someone high on the psychopathic scale, with immediate subordinates (or support from Head Office) of men who find it easier to stick rigidly to rules than interact with changing human situations (as emotional particularities are so overwhelmingly complex to interpret) and with women in the majority of grassroots workers and many of them self-sacrificing and painfully sensitive to the opinions of others.
On top of all this may be the hothouse effect that occurs when communities are cloistered canonically, isolated geographically or otherwise shrouded in secrecy due to the vulnerability/ naivety of their client group or the difficulty in getting staff. An insistence on ‘professionalism’ may mean that dissenting/ abused employees and volunteers are prevented from expressing anything other than the party line – as the psychopathic boss controls formal communication and informal communication is condemned as ‘gossip’ unworthy of good people, scandalous to the public/ clients and contrary to the exemplary values of the school/ church/ home/ charity/ community. The hallmark of the psychopath is the inability to recognise or feel any remorse for the harm they have done to people, so they move effortlessly from sadistic treatment of an individual to community schmaltz with a beaming face of innocence.
There is much wisdom in the co-dependency awareness movement but what it may fail to grasp is that everyone involved may sincerely believe that they are doing the right thing:
– Laying down the law
– Sticking to procedures
– Self-sacrificing and keeping silent
As we watch in awe the debacle of American democracy, it may help to realise that the unprecedented administration is a symptom, not a cause, of frontline ethics applied in peacetime.
The reduction of complex situations to simple categories of right and wrong, the dehumanising of people, the control of the people by force and censorship of the free speech, these are the hallmarks of military crisis and in such times the Ancient Romans accorded special dictatorial powers to a designated senator (usually a consul). The Ancient Greeks called this person a Tyrant.
Thanks to Linnaea Mallette who has released her photo ‘Funny Hospital Sign’ into the public domain.