Thursday, October 22, 2009

Morality of healthcare

The healthcare debate is on everyone’s mind these days with many arguments and discussions presented about costs, efficiency, utility, demand, supply, government control, and private enterprise etc. etc. However, it seems to me the most important topic that would settle most of the decisions about what to do hinges on: What is our moral responsibility? Yet no one seems to be putting forth a rational defense of moral principles that guides one’s actions.
The American psychologist, Lawrence Kohlberg, generalized his findings on moral development as occurring in three levels. First, is the preconventional level, a phase as kids where we don’t know the moral concepts and principles of right from wrong. There is no concept of morality and praise and punishment teaches right from wrong. The second phase, conventional role conformity, we come to understand how a good boy/ good girl is supposed to act and this then progresses to “law and order” stage where we as members of society live within the conventional rules.
Most adults live out their lives at this conventional level of morality. Most never get beyond this level and all of us spend a good part of our lives on this level. Stealing is wrong, murder is wrong, slavery is wrong, lying is wrong. Why? Because everyone knows these actions are wrong. There are laws against these actions.
Many adults will never reach level three or principled level. This, of course, is the most important level; a level of self accepted moral principles that are accepted not because society says they are right and acceptable but because one knows what it means to say principles are right and understands what makes them right. Most people simply accept the conventional morality of society but at level three one understands and accepts the binding nature of moral principles without some foreign constraints imposed on them.
It is this ability to examine why actions are morally right and wrong beyond the conventional morality that we must now examine the healthcare issue. We know from the past that conventional morality can be wrong with the best example being the acceptance of slavery in the United States. Operating at level three one would have reasoned slavery was immoral then as it is now. In fact, many did argue that it was immoral, despite the fact that it was part of conventional morality.
Because we are fallible in our moral judgment; because we sometimes believe an action to be right when it is objectively wrong; because we disagree on moral judgments; and because we live in a pluralistic society were the norms of conventional morality are sometimes not clear; people adopt a moral tolerance toward others. They refuse to judge others and refuse to judge their own actions. Their inability to reason why actions are right and wrong leads them to a position that; “there is no objective morality” or “morality is purely subjective”. Thus we consider ourselves personally moral when we act as we believe we should or others, though acting differently, can be acting morally too. This thinking, wrong thinking, pushed to its conclusion claims that what anyone considers moral is thereby moral. This abandons the very universal nature that morality possesses.
Universality is a defining characteristic of morality since it demands application to all. If an action is right for me, it is also right for anyone else in the same circumstance. If it is wrong for you, it is also wrong for anyone else. This universal application is easy to apply to murder, stealing, lying, bribery, and slavery. There is nothing subjective about these moral principles.
Secondly, moral judgments are important and so important, in fact, that they override other considerations. We are morally obligated to do what we sometimes may not want to do. Convenience, personal gain and even legal requirements take a back seat to our moral obligation.
Moral law states what everyone must do because it is a command of reason. It is an imperative that is unconditional; it states a command that must be done. It is not a hypothetical command like if you want to do well in school, study! Not everyone is required to attend school and not everyone is required to study. We can’t choose to follow or not based on whether we wish to achieve this or that end. It is categorical and we are bound by the moral injunction no matter what else we wish to do. The moral law binds unconditionally.
Moral law is the statement of the form of rational action and there are explicit characteristics that are central to reason. One is consistency. Moral actions must not self contradict nor contradict other moral laws. Second, is universality. Reasoning is the same for all, what is rational for me is rational for everyone else and what is rational for everyone else is rational for me. The third characteristic of reason, which is exemplified in mathematics, is that it is not based on experience. It applies to experience but is not derived from experience, nor is its truth dependent on it. For example, we know two plus two equals four regardless of what a teacher may tell you. Two plus two equals four for all rational beings even if they don’t know it or add two plus two and get a different number. The validity of this does not depend on experience but on rational self consistency of the mathematical operation.
Before proceeding, let’s put an end to the bogus question: “Whose morality?” Morality presupposes society, and if a society is to function, it must have a large core of commonly held values and norms. These norms and values form the common morality of society. They are mine, yours and ours and are applicable to everyone. When moral views clash then moral debate must take place until moral arguments reach clarity. It is not true, therefore, that when faced with moral claims against me or my business practices I can dismiss them as being your moral views and not mine. Moral claims are universal!
The three important elements of morality are universalization, respect for rational beings, and acceptable to rational beings. If a moral rule fails anyone of these three tests then it is immoral. As applied to universal healthcare in America, we know that we have a moral duty to help those in need. The obligation to help those in need passes the test of the three elements of morality: The obligation is self consistent since we can continue to help each other indefinitely. Second, providing aid to others is respecting the dignity of human beings and treats them as ends instead of means. We would all wished to be helped when in need and thus the rule of mutual help is acceptable to rational beings and can be universalized.
However, the moral rule to help those in need differs from certain moral rules because our duties or considered imperfect. Perfect duties describe both the action to be followed. and to whom it pertains( namely everyone). For example, we can not steal and it applies to everyone. Our obligation to help those in need is imperfect since there are so many in need and we each have limited resources. Since the command to help others is dependent on our ability to help others our obligation has a certain amount of freedom in fulfilling it. There are two sources that limit our obligation. First is that we are morally obligated to do only that which we are capable of doing. Second we are not required to help if by so doing we experience equal or more harm. I’m obligated to help a drowning man if I can without endangering my own life. Our obligation to help the poor depends on our own affluence; thus the wealthy have more of an obligation to help the poor. Although our moral obligation to help those in need has imperfect duties, there is a positive side to this since it creates an environment where we can exceed the moral minimum. We are not obligated to impoverish ourselves to help the needy but some in history have become saints by exceeding the moral minimum. Some have endangered their life to save others and are considered moral heroes.
Universal healthcare in America is helping those in need and is a moral obligation that can not be excused away by the argument of capability since our country certainly is capable of doing this. Secondly, it can not be excused away by claim that it will produce equal are greater harm to us by providing the aid. One must keep in mind what I stated earlier that that moral law overrides all other considerations. We can not ignore our moral duty based on convenience, efficiency, personal gain, nor legal requirements.


  1. I attempted to be brief and concise to convey my position and hope that my point was made as a result.

  2. Hi Nohelp and thanks for a thought provoking article. Are you saying that all is black or white and that there are no gray areas? And are you saying that things that may be wrong in one situation cannot be the best possible choice in another?

  3. Mullet, I posted a long response Tom and it was lost because I was not signed in--- Nothing I hate more than retyping a response-- Nothing -- I will attempt to do so later-- Dang it!

  4. Tom what is right for me is right for you in the "same circumstance" and what is wrong for me is wrong for you in the "same circumstance". The gray areas that you ask about are present because some moral rules have imperfect duties. I know I must help those in need but the gray area is that the moral rule does not specfically state what it is I must do, who specifically that is in need that I must help when there are a great many in need. Additionally, when you ask about things that maybe "wrong", in one situation but best in another, I think that it is the semantics of the word wrong that maybe inappropriate to what the choices are. We are ineffect selecting the best choice of action that fulfills our obligation. Also, not all actions we take have a moral significance. Whether I choose to play chess instead of chinese checkers has no moral significance.Choosing to play chess maybe"wrong" in one situation and the best possible choice in another circumstance.