Many people recognize Bruce Lee for his martial arts. Fewer people know he was a philosophy major that wrote extensively on the subject. In his quasi-memoir Striking Thoughts I began reading this weekend, he mentions that he didn’t want his students to accept anything he taught as capital-T-truth. Instead, he wanted students to think about their lives, ask questions, and come up with a moral and ethical framework that made sense to them. I have come to a similar conclusion — that there is no prescriptive moral standard.
History’s most brilliant philosophers have struggled over millennia to determine what the “universal” moral code is, and the only clear answer is that what’s moral depends on the person and situation. The more details we have about a situation, the greater chance we have in making the more ethical choice. Even though no school of thought is objectively true, studying philosophy and ethics is imperative to developing one’s own moral compass because it gives us an idea of the questions and issues we should be considering. We usually don’t think about these problems unless we’re prompted to, and unfortunately, very few people are prompted to think about them. Our education system leaves us with a good grasp of white-washed US history and the quadratic formula but does not teach us how to lead happy, fulfilling, and ethical lives. Instead, dominant social forces “guide” us on how to live through mechanisms like media and societal pressures. Without a foundational understanding of ethics, we are not equipped to face large ethical dilemmas, such as those that arise in medicine.
Medical students should receive ethical training. Everyone should receive ethical training. It doesn’t entail reading thick philosophy books and getting into esoteric debates. I think abstraction from the real world is actually counterproductive to learning philosophy. Instead, development of one’s moral framework begins with the question: “How do I know right from wrong?” We deal with this from a very young age. We learn to follow external rules instead of our internal compass. Most of us don’t question our authorities and law. This is dangerous. Instead of being told what is right from wrong, we should be taught as children to question the difference between right and wrong. We should think about how our decisions affect others. We should question why certain “rights” and “virtues” exist. We should question what is “Good” and “True.” Above all, we should cultivate a respect for our fellow human beings, and instead of imposing our own ethical frameworks on other people, understand why they think what they think. While this sounds a bit Kantian, it doesn’t come from a place of valuing our “rationality” as an absolute good.
Ethical dilemmas can affect people on the individual and group level. Group level ethics applies more to policy and large-scale decisions and less to the decision-making required by a physician. While both paradigms should be explored by anyone who makes decisions (i.e. everyone), doctor-patient relationships involve individual ethics. Because each individual has his or her own biases, beliefs, and moral codes, it is crucial that the doctor approaches the patient from a place of understanding rather than pure prescription. As a doctor, you work for the patient. You are not their employer or parent. Your job is to make them happy and healthy, and that requires understanding what they want.
Medicine is a fascinating arena for exploring ethical conundrums because it centers around two key pairs of diametrical opposites: life and death, pain and pleasure. Often times, doctors have ideas about what they think is “right” for a patient, but this treatment doesn’t really coincide with what the patient wants. Who is a doctor to decide if a shorter, freer, life is more desirable to a patient than a longer, more painful one? It is the patient, not the doctor, that should decide whether a surgery with a low success rate is “worth the risk.” Atul Gawande explores this theme in Being Mortal, a book that has solidified my interest in medical ethics. He brought up the point that most people, doctors and otherwise, forget that medical care should be about what the patient wants. He advocates for an approach to care that first asks the patient what he or she wants from life. The doctor’s recommendations should use that answer as the deciding factor. If a decision seems “hard” it should be up to the patient to make the informed choice. The doctor’s responsibility is to ensure the patient understands the risks of treatment and what the procedure entails. Medical jargon may as well be an entirely different language to most people, and the stress of treatment, hospital bills, and potential pain and suffering makes the experience all the more traumatic.
In Sickness and In Wealth
This piece was originally written as a reflection on this PBS video
Until I took “Wealth and Poverty” last semester, I was pretty ignorant of the extent of income disparity in the United States. While the video focused more on health than general economic policy, In Sickness and in Wealth reinforced my understanding of the compounded effects of wealth inequality. What stuck with me most is the issue of control and its inverse relationship with stress levels. Indeed, the “ability to influence the events that impinge on our lives” is an important predictor of our stress levels. However, stress is largely viewed as a mental issue, rather than something that happens to our bodies. Physical manifestations of chronic stress are just beginning to be taken seriously, and studies show the terrible long-term effects of these impacts. Our bodies weren’t meant to handle chronic stress; infrequent, acute spikes of cortisol are healthier than continuous releases of the hormone.
As a public health major, I am really interested in so-called “diseases of civilization” such as diabetes and hypertension. These are conditions that commonly affect modern-day people. I’m curious as to how society can implement preventive measures, rather than the medical problem of treating existing patients. Although biology causes the problem, I believe the solution, like the video said, lies in socioeconomic policy. I am primarily motivated by the desire to have a happier and healthier population, but the economic costs, which can be used as financial incentives for less altruistically-motivated individuals or organizations, is an additional compelling argument.
Comparative healthcare studies between the United States and other industrialized (read: European) nations are often problematic. These nations have smaller populations that are more ethnically, politically, and socially homogeneous. In addition to severe income inequality, the US has extreme socioeconomic variation across 50 states, from everything like education standards to government resources. It is thus important to learn from our peers but also integrate our unique issues into a solution.
The last thing to remember is that it is easy to blame the individual, not the circumstance. Perhaps we tend to blame people because it reinforces our illusion of control. The professor for Wealth and Poverty said that the most important decision you make is who your parents are, illustrating how much of our destiny is out of our hands. For people who are unhealthy or unhappy, it is easy to point at their bad decisions without considering why they make those decisions in the first place. The video mentions that everyone goes through stress, from the sanitation staff of a building to the company’s CEO. People who worked hard to earn and maintain a prestigious job may think that it is only their hard work that got them there. However, there are innumerable factors, including luck, that plays a role in our success. Many people work very hard and do not benefit from the similar rewards. Although hard work is essential to success, it is necessary but insufficient — factors like our parents’ socioeconomic status, our neighborhoods, our health, and our education all play a role in our successes.
Conversely, it is easy to criminalize people in positions of power who were born lucky, worked hard, and achieved success. Most of the time, it isn’t their fault that they are unaware of the hardships faced by many people of lower socioeconomic status. Part of privilege is never having to face these problems and unless you are taught about them, you’ll never even realize they are there. Even if you are aware of poverty and discrimination, you would have no idea what living through these problems entails unless you really made an effort to learn and understand.
We have to do the best with what we are given. But it’s not fair that some people start the race closer to the finish line. We as a society should account for the fact that the playing field is not even. The best we can do is fund social programs and engage in preventive care so we can do the best to ensure people’s basic rights so we can move the rungs of the proverbial ladder closer together.
