2. (Bio)Ethics in a Pluralist Society
2.1. Clinical Bioethics
“We will call the set of universal norms shared by all persons committed to morality “the common morality.” It is not merely a morality in contrast to other moralities. The common morality is applicable to all persons in all places and we rightly judge all human conduct by its standards.
2.2. Culture and Cultural Competence
“Being a member of a culture surrounds a person with a set of activities, values, and experiences which are considered to be real and normal. People evaluate and define members of other cultural groups according to their own norms.”
“a dynamic system of rules—explicit and implicit—established by groups to ensure survival, involving attitudes, values, beliefs, norms, behaviours, shared by a group, but harboured differently by each [individual] within the group communicated across generations, relatively stable but with the potential to change across time.”(p. 24)
“To set standards of clinical competence, cultural competence, and ethical conduct to be observed by health practitioners of the profession.”(sec 118(i))
“Cultural mores identified by the Council are not restricted to ethnicity, but also include (and are not limited to) those related to gender, spiritual beliefs, sexual orientation, lifestyle, beliefs, age, social status, or perceived economic worth.”
”a process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners.1-2,7 It is a process that requires humility in how physicians bring into check the power imbalances that exist in the dynamics of physician-patient communication by using patient-focused interviewing and care.8,9. It is a process that requires humility to develop and maintain mutually respectful and dynamic partnerships with communities on behalf of individual patients and communities in the context of community-based clinical and advocacy training models.”(p. 118)
2.3. New Zealand Political Practice
2.4. International Politics
“Any disintegration of multilateralism, any undermining of climate related targets and agreements aren’t interesting footnotes in geopolitical history. They are catastrophic…together, we must rebuild and recommit to multilateralism. We must redouble our efforts to work as a global community. We must rediscover our shared belief in the value, rather than the harm, of connectedness. We must demonstrate that collective international action not only works, but that it is in all of our best interests. We must show the next generation that we are listening, and that we have heard them.”
3. An Expansion of (Bio)Ethics
3.1. The Ethics of Compromise
a compromise is a position that, with respect to the issue at hand, is from the point of view of parties locked in debate or negotiation inferior to the positions that both (or all) bring to a decision making process (a negotiation, an election, or more trivially a decision-oriented discussion among friends), but which both have reason to accept instead of the position they favour. They may favour X, when only the issue at hand is in view, but favour Y when all things are duly considered.The notion of compromise is to be distinguished both from consensus and from what I will here be calling a “settlement”.When a process of deliberation generates consensus, this means that both (or all) parties agree that the position agreed upon is superior to the one they held at the outset, with respect to the issue at hand. (The limit case here is one in which all parties converge upon the position initially held by one party. For that party, the consensus will not be superior, but rather identical, to their initial position.)A settlement is an outcome that simply reflects the balance of power obtained between the parties. A settlement puts an end to conflict, at least as long as the balance of powers remains unchanged, by allowing the distribution of advantage and disadvantage to determine the outcome. Here, the exchange of reasons that standardly occurs in the attempt at reaching a consensus (or a compromise) does not obtain, or if it does it is not operative in generating the outcome.(p. 539)
When an agreement reflects a modus vivendi [settlement], it has come about as a result not of the exchange of reasons as to how best to realize some set of values that one feels are at stake, but rather as a result of the balance of forces. A modus vivendi [settlement] therefore, does not embody the values that we have seen inhered in consensuses and in compromises. Parties to a modus vivendi [settlement] are not committed to finding a solution to a problem of collective action that evinces respect or reciprocity.(p. 639)
What determines whether deliberation aiming at compromise adopts a compromise-promoting rather than a compromise-inhibiting direction? Compromise will be made easier where trust exists between the deliberating parties. Trust exists where all parties believe that those with whom they are negotiating are not ill-disposed toward them, or their core interests and values. If I feel as if someone is favourably disposed and respectful toward my most important commitments, I may be disposed to define those core commitments more parsimoniously than if I feel that my deliberation partners are not well-disposed toward me. Now, trust is easier to achieve with respect to a given disagreement where there is already a history of trust between deliberating parties. Conversely, where prior deliberations have given rise to suspicion on the part of the deliberating parties, subsequent deliberations may be more difficult to set on a course favourable to compromise.(p. 73)
3.2. Descriptive Ethics versus Normative Ethics
General normative ethics addresses the question “which general moral norms for the guidance and evaluation of conduct should we accept and why?” …descriptive ethics…is the factual investigation of moral beliefs and conduct. It uses scientific techniques to study how people reason and act.(p. 1–2)
“Descriptive ethics…[are] nonnormative because their objective is to establish what factually or conceptually is the case, not what ethically ought to be the case.” (p. 2)
3.3. Respecting People Who are Different from Me
3.4. Spiral Dynamics and the Hierarchy of Needs
Impulsive, seeking respect, honour, and avoiding shame and establishing the self, might is right. The world is adversarial, uncaring, only raw power will let me prevail.
cannot do it on my own and need to collaborate with others, group membership highly valued, tolerates ambiguity by encountering diverse perspectives, requires trust, does not want to hurt others, high empathy and sensitivity to others – everybody counts.
most of the young men who come into this unit arrive with a host of problems: trauma, gang connections, developmental delay, lack of education, poor communication skills, and drug and alcohol addictions.
3.5. Values and Traditions of Minority Groups
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|Graves Level of Psychological Existence||Life Conditions||Coping Mechanisms|
|Level 3 Red (c-p)||egocentric. power/action, asserting self to dominate others, control, sensory pleasure||Breaking away from the tribe, impulsive, seeking respect, honour, and avoiding shame and establishing the self, might is right. The world is adversarial, uncaring, only raw power will let me prevail.|
|Level 4 blue (D-Q)||absolutistic: stability/order, obedience to earn reward later, meaning, purpose, certainty||Emerges from the chaos of C-P—obedience to rightful authority, binary thinking, categorising, deny self for ‘the one right way,’ stability and security is achieved through sacrifice and submission, doing things by the book/manual, bringing in new norms undermines control/authority.|
|Level 5 ORANGE (E-R)||multiplistic: opportunity/success, competing to achieve results, influence, autonomy||Emerges from the rigidity of D-Q, how to manoeuvre rather than comply, many ways and criteria rather than one right way or set of standards, goal directed, independent, self-sufficient, confident, experiment to find the best among many possible choices, future oriented and competitive. Working for a good life and abundance, the winners deserve their rewards.|
|Level 6 GREEN (F-S)||relativistic: harmony/love, joining together for mutual growth, awareness, belonging||Emerges in response to the excesses of E-R, cannot do it on my own and need to collaborate with others, group membership highly valued, tolerates ambiguity by encountering diverse perspectives, requires trust, does not want to hurt others, high empathy and sensitivity to others – everybody counts.|
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