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Rhodes seeks to defend her ‘conclusion that everyday ethics and medical ethics [are] incompatible’.1 She challenges ‘views that medical ethics is nothing more than common morality applied to clinical matters’ (Rhodes, p2).1 Beauchamp and Childress explicate the term ‘common morality’ at length.2 Nowhere do they claim that medical ethics is ‘nothing more than common morality applied to clinical matters’. Here is what they do say: “The origin of the norms of the common morality is no different in principle from the origin of the norms of a particular morality for a medical or other profession … The primary difference is that the common morality has authority in all communities, whereas particular moralities are authoritative only for specific groups” (Beauchamp and Childress, p8).2
This critique discusses the seven examples Rhodes uses to illustrate her main point: that common morality and medical ethics are radically different. I contend that common morality accounts for the purported differences she cites.
In ordinary life, people can simply mind their own business, whereas physicians have a duty to act in their professional setting. On this view, common morality cannot explain the moral obligation people have to prevent easily avoidable harm to others. A bystander who sees a young child about to drown in a shallow pool cannot morally justify doing nothing by saying ‘my moral responsibility is to refrain from harming others by not killing, stealing, injuring, or deceiving’. We would rightly condemn a pedestrian who fails to warn a person crossing the street that a car is rapidly approaching from another direction. Many situations exist in which people have positive duties to warn or help others. For medical professionals, those duties are an essential part of their role.
‘In everyday life people are free to make decisions anyway they like’ (Rhodes, p4).1 Rhodes argues, in contrast: “medical professionals … are expected to rely on scientific evidence” (Rhodes, p4).1 Increasingly today, governments prohibit unvaccinated children from attending school when their parents cite their unscientific belief that vaccination causes autism. In both situations—physicians caring for patients and parents deciding for their children—failure to rely on scientific beliefs can result in harm. A fundamental precept in common morality is ‘do no harm’ (with all the appropriate caveats).
In ordinary life, “exceptions typically require explicit request for keeping divulged information secret” (Rhodes, p4).1 In medicine, although confidentiality is presumed, some exceptions can be justified, as Rhodes acknowledges. The only difference between the medical context and the situation in ordinary life is where the presumption lies. Both situations require and permit breaches of confidentiality. What justifies the breach is the prospect of harm or other undesirable consequences that may result from not divulging information. Here again, principles of common morality underlie the justification.
The two situations Rhodes describes in this paragraph are not comparable. In ordinary life, we associate with whom we choose in situations that normally do not involve role responsibilities. Choosing friends is not comparable to physicians caring for patients. Physicians do not ‘associate’ with their patients, at least not in the same way that people associate with friends and colleagues. Indeed, too close an association between physicians and their patients may be ethically suspect (example 5). The duty of physicians toward those in need of medical care is the chief responsibility of their professional role. Common morality includes the notion of role responsibilities, paradigmatically the responsibility parents have for their children.
Common morality readily explains the prohibition of physicians’ sexual involvement with patients. The relationship between doctor and patient is not one of equality, which is presumed to exist between consenting adults in ordinary life. As is abundantly clear, however, even ‘ordinary life’ contains situations in which the consenting sexual partner (usually a woman) is in a subordinate position. Without deceit, force, or threats, a consenting partner may recognise an advantage to herself in submitting to sexual advances by a person with greater power or authority. If the ‘me too’ movement has revealed anything, it is that ‘consent’ is a more complex concept than previously considered.
The duties of physicians require that they probe and ask patients questions that would be rude or unacceptably intrusive in ordinary social life. Yet situations commonly occur in ordinary life where questions that would normally be out of bounds are nevertheless acceptable. A parent hiring a nanny could reasonably inquire about the applicant’s use of alcohol or drugs, a question that would be considered intrusive in social interactions with strangers. A loan officer in a bank is required to ask a prospective client about her income and outstanding debts. Ordinary life contains many instances of role responsibilities analogous to those of physicians. The four principles of common morality are central to these particular moralities, as well.
Rhodes’s discussion illustrates the difference between physicians’ role responsibilities in the professional setting and those in their everyday lives. Common morality embraces a variety of contexts in which people live their lives. What is acceptable at a celebratory party may not be acceptable in the workplace. How a mother might admonish her daughter would most likely be out of bounds to say to the neighbour’s daughter. It is not only medical ethics that allows or requires certain behaviours in a professional or work-related context that would be impermissible for these same persons in ordinary life. Teachers, parents, supervisors, and anyone subject to particular moralities may have a specific duty in that context that would be inappropriate in everyday life.
Ordinary life contains myriad examples of behaviours that are ethically acceptable or required in some contexts and prohibited in others. In this respect, the ethics of medicine is not ‘distinct and different from common morality’ (Rhodes, p2).1
Contributors RM is the sole author of this article. No one else contributed to the research or writing of the article.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.
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