In this paper I examine which is the most appropriate moral theory for dealing with disaster bioethics contexts. It is pointed out that, contrary to what is usually believed, moral theories of right action cannot actually guide us in such difficult situations. Instead, it is claimed that a virtue ethics theory of an Aristotelian version, which gives emphasis not only on the virtuous person but also on the relevant developmental process of becoming virtuous, can provide us with the right theoretical framework for coping with the problems which the victims of such disastrous situations face.
Bioethics, the contemporary discipline which deals with the ethical problems and dilemmas that arise from the application of the contemporary medical science and technology and, also, from the high technologically-developed way of life, has been facing from its very inception an important methodological problem. As the bioethical problems are very complicated and range from simple questions of personal choice on the one hand to problems of social, political and economical policy on the other, it is quite difficult to come up with a well-defined method, theory or decision-making procedure, which will enable us to get the answers to our problems right (Kalokairinou, 2007). The issue becomes even more complicated when we come to discuss and to find answers to problems which arise in a particular type of bioethics situations, the disaster bioethics situations. If we face serious methodological difficulties when we deal with bioethical problems that emerge in normal social and political contexts, then we can imagine in how much more a difficult position we are when we have to attend to ethical problems which arise in settings in which “nothing is normal”(O’Mathuna, Gordijn, & Clarke, 2014) . For, absence of normality, absence of normal circumstances, is what characterizes disaster bioethics situations. Since we are going to examine which is the most appropriate moral theory for dealing with disaster bioethics situations, it will be a good idea if we attempt to throw some light on them and understand them better.
We, human beings, tend to live, grow and flourish in a context of normality. This is to say that we can live better, cultivate our physical and mental powers and so develop, in a social context that has a kind of normality. We know, for instance, that we become gradually familiar with the natural and social environment in which we live, and this helps us acquire a sense of stability and security, both necessary conditions for developing our abilities and our well-being. There are times, however, when the basic conditions of normality are badly affected: unexpected natural events of a wide range take place, earthquakes, floods, tsunamis. As a consequence, thousands of people die unexpectedly, thousands of others are made homeless and get badly injured. In a few hours every sense of normality could be lost. The same happens in cases of great pandemics, pests, plagues, or even in cases of accidents caused by industry and transportation, in cases of war, terrorism, migration (O’Mathuna et al., 2014). In this kind of chaotic situations and quite often in the middle of dangerous circumstances, the humanitarian aiders are called to offer help and support to the survivors of the disasters and to make difficult decisions. These decisions vary in many respects, but for the present purposes let us distinguish two fairly wide categories: (a) decisions as to how to intervene and help the disaster victims, and (b) decisions as to how to pursue research in disaster settings (O’Mathuna et al., 2014). And the question they face is, which moral theory is more appropriate and, for this reason, more likely to help them find answers to their problems. In other words, which ethical theories are more likely to give guidance to humanitarian aiders, when they wonder how to distribute medicaments and medical support, food and other basic goods among disaster victims in cases of a triage?
If lack of normality in a disaster bioethics setting is the first practical problem we face when dealing with disaster bioethics issues, the moral theory we employ to solve these issues is our main theoretical problem. In other words, what exactly do we expect from the moral theory we apply in a disaster bioethics context to do? We have been told and we have come to believe that a moral theory, if properly and correctly applied, can actually guide us to do the right thing under the circumstances. We have been taught by moral philosophers to think about the primarily prescriptive character of moral language. That is, if I sincerely believe that I ought to do A under the circumstances x, y, z, and these circumstances arise here and now, then I ought to do A. This came to be known as “the action-guiding force” of moral language (Hare, 1952).
The claim of these moral thinkers, among whom R.M. Hare presides, is more problematic than appears at first. If anything, their claims are presumptuous. Do moral theories actually have a guiding force? Do moral theories really tell us what to do, when we are trying to cope with the victims of a natural disaster such as, i.e., an earthquake? And if they do, given in particular the lack of normality that prevails in such chaotic disaster settings, in what way and in exactly what sense do they tell us what to do? Three remarks are apposite at this point.
(a) The first remark refers to the nature of moral theory. How do we conceive of a moral theory? Or, what conception of moral theory do we have? As the Code of Conduct for the International Red Cross and Red Crescent Movement and NGO’s in Disaster Relief says in the opening clause:
Purpose: This Code of Conduct seeks to guard our standards of behavior. It is not about operational details, such as how one should calculate food rations or set up a refugee camp (O’Mathuna et al., 2014, p. 205).
I think this Code brings out something which often remains unclear. A Code of Conduct and for that matter a moral theory is not concerned with how to calculate food or medicine rations or how to set up a refugee camp. Quite correctly the present Code calls these instructions operational details for which a kind of managerial expertise is required by those humanitarian aiders who undertake to realize them. On the contrary, the Code of Conduct is concerned with the moral standards the humanitarian aiders should follow, when they manage natural disasters and when they offer humanitarian relief to disaster victims. We should not therefore expect a moral theory to tell us what to do on a disaster camp. On the contrary, the only thing it can do is to guide us with regard to the particular standards we should obey, when managing disasters and relieving their victims.
(b) The second remark has to do with the kind of guidance we are supposed to expect from a moral theory and, in particular, from a theory of right action. In what exact way does a theory of right action guide us in the given circumstances? Philosophers usually argue that if I feed my theory with the details of the problematic situation I am facing, then it tells me what is the right thing to do in that situation.
However, not all moral philosophers agree with such a claim. Julia Annas, for one, insists on bringing out the particular sense in which a theory of right action tells me what to do (Annas, 2004). She compares John’s and Dick’s case (Annas, 2004, p. 65). John always does what his mother tells him to do. His mother usually gets it right. As a consequence, he is happy when he follows her instructions and he feels guilt and remorse if he fails to follow them. Dick, on the other hand, does what “a decision procedure backed up with a theory of right action” tells him to do (Annas, 2004, p. 65). As Annas points out, we of course disapprove of what John does, because we would expect that an adult is mature enough to decide for himself and not to be told what to do. But in a similar manner she does not seem to be satisfied with Dick either. No doubt, the difference now is that a theory of right action is something that Dick can internalize and so eventually come up with the criteria for deciding to do this rather than that. There is therefore a sense in which the theory of right action tells me what to do or, more accurately, “enables me to tell myself what to do” (Annas, 2004, p. 66). So it is really through my internalization and the interpretation of the theory of right action that I can tell myself what is the right thing to do (Annas, 2004, p. 66). Consequently as Julia Annas points out, there is no such thing as a theory telling me what to do. On the contrary, it is through submitting my theory to my thinking and judging abilities that I can eventually be led to conclude what is the right thing to do. In addition to a theory of right action, we need an agent or a good person who, after having worked out the formal details of the theory, will end up with the answer or the suggestion of what is the best thing to do under the circumstances.
(c) The third remark runs as follows. Theories of right action normally operate by focusing on the common features of the situations to which they are applied. They proceed by virtue of the common characteristics that different situations have and so they can give help and offer guidance. However, as we have pointed out, normality is completely lacking in disaster bioethics settings. If normality is lacking in such contexts, then it would seem that there are no features which the different disaster situations have in common. It follows therefore that theories of right action can hardly apply in such contexts. As it turns out, under these circumstances we are left with two alternatives. Either we will have to look for a different logical basis by virtue of which the theories of right action can operate. Or we will have to give up the theories of right action in the cases of disaster settings and, instead, employ a different type of theory which will operate on the basis of a different logical framework.
As already hinted at, Julia Annas suggests that we could perhaps look into another kind of moral theory, the virtue ethics theory. As she makes clear from the beginning, she does not wish to offer a virtue ethics account which could be defined in terms of a theory of right action and vice versa. This would be circular. Her point is rather different. She intends to give an alternative account of moral theory which will involve the following three elements: a theory of right action, an account of the virtuous person, and the relevant developmental process (of becoming virtuous) (Annas, 2004, p. 68).
As she claims, she finds the roots of this alternative moral theory in Aristotle’s work on Ethics. According to Annas, Aristotle tends to think of virtue and of becoming virtuous along the lines of learning to become a builder (Annas, 2004, p. 69). He urges us to think of becoming virtuous as learning a practical skill or techn . In attempting to explain what an ethical virtue is, (as opposed to intellectual virtues), he claims that we say of someone that he is a grammarian, when he has learnt to memorize the grammar rules; but we do not say of someone that he is virtuous, when he has simply learnt to mimic the virtues which are prevailing in his society (Aristotle, 1990, 1105a17-1105b1). As Annas sees it, acquiring a virtue, according to Aristotle, implies that the virtuous person possesses the following three elements: that he chooses to act knowingly from a firm disposition. In other words, the virtuous person chooses freely, he is well aware of what he does, and he acts from a firm and steady disposition. This notion of firm disposition is very important in Aristotle’s account. On certain occasions Julia Annas calls it an “intelligent” disposition (Annas, 2015, p. 3). But the most important is that this disposition leads us to conceive of learning to be virtuous as a kind of process and, therefore, in Aristotle’s understanding, as developing a kind of practical techn or skill.
Learning to become a builder, therefore, or acquiring a skill, according to Annas, requires a kind of passage from the state of beginner to the state of being an expert. As happens with all practical skills, the beginner starts by choosing a role model and by repeating his actions (Annas, 2004, p. 69). As he learns to perform his actions better, he gradually acquires a kind of intuitive understanding of his art through which he can view his actions in a unified, explanatory way (Annas, 2004, p. 69). His actions now acquire meaning within and through the understanding of his art and are derived from it as a way of furthering and accomplishing his art. His actions are not mechanical anymore, because they are now connected with his aspiration to improve his skill (Annas, 2004, p. 69).
According to Annas, in learning to become virtuous one follows the same pattern one follows in learning to become an expert in a field. We all start by acquiring the conventional virtues of our society and environment. But like the learner in other fields, we aspire to improve. In what way do we have to improve in order to become “moral experts”? Becoming a moral expert may involve that the young learner has to develop lots of different abilities in order to discern the morally relevant features of the situations, to develop rules and principles etc.. In Annas’ opinion, there is a great variety of virtue ethics theories (Annas, 2004, p. 70). However, what underlies all these different accounts is that the young man has to think for himself critically and systematically about the moral concepts and the virtues he has inherited from his society (Annas, 2004, p. 70).
It has been quite often argued that the virtue ethics accounts are conservative, because the virtues are initially learned or acquired within one’s own society. The virtues that Aristotle describes, for instance, in the Nicomachean Ethics are the virtues prevailing in Athens in the 5th century B.C. (Annas, 2015, p. 5). However, as Annas points out, the virtue ethics accounts may be more progressive than the theories of right action (Annas, 2015, pp. 4-5). A virtue is always exercised within a situation of some kind. If I have to be brave, I have to be brave in a particular situation, not in the abstract. But this does not imply that virtue is defined in terms of the situation. Courage, for example, may be shown in many different kinds of situations. One may, for instance, be courageous when one fights against the Persians who have attacked his city (an example from the Aristotelian era), or one may also be courageous when one defends an unpopular view at a tedious meeting. A disabled person is also courageous when he is performing simple movements or tasks in public for the first time. It follows from the above examples that the notion of virtue is not conservative and that it enlarges as it applies to different contexts and times. In fact the idea of a virtue as a “thick” concept involves both descriptive and evaluative meanings. It conveys information about the culture to which it is applied, while at the same time it evaluates the particular disposition. This is why understanding the virtues of another tradition presupposes first understanding the virtues of one’s own society, and secondly expanding our culture knowledge so as to be able to acquire knowledge of other cultures. However, as Annas argues, enlarging our culture knowledge does not require a different mechanism from the one employed for acquiring knowledge of our own culture (Annas, 2015, p. 5).
The moral expert, therefore, is a person who does the right thing in every situation “for the right reasons, i.e. from a disposition that has developed virtuously in both its intellectual and affective aspects” (Annas, 2004, p. 71). Given this conception of the moral expert, Annas argues that an account of virtue ethics cannot be independent of an account of right action (Annas, 2004, pp. 71-72); that right action, so to speak, has to be defined in terms of the dispositions of a virtuous person, which have been intellectually and affectively developed. One could perhaps argue that we could give such an independent account in the case of the young man who is learning to become virtuous and has knowledge only of the conventional rules. However, Annas’ answer to this claim is that the young learner does not exhaust the notion of virtue. We also have to take into account the notion of virtue as it is used in the case of the moral expert (Annas, 2004, p. 71). Moreover, the young learner is doing something more than just acquiring knowledge of the conventional virtues: he is also aspiring to become better. This is why Annas concludes that an account of right action which is independent of an account of virtue cannot make sense (Annas, 2004, p. 72). In order to reach the right action what we have to do is to go through the virtuous person in a thorough manner. We do not simply have to go through the role model and the merit of repeating his actions. We have mainly to go through his understanding of the role model, his attempt to emulate it and eventually his aspiration to develop into a better person (Annas, 2004, p. 72).
Such a conception of a virtue ethics theory sheds light on what we said at the beginning regarding the disaster bioethics situations. What characterizes the disaster bioethics settings in which we strongly feel that we ought to intervene and help is their lack of normality. The normal rhythm, the regularity of everyday life, is interrupted abruptly, as unforeseeable events and disasters happen, leaving behind great numbers of victims and casualties. This disruption of regularity makes it quite difficult to come up with a list and agree on certain “common features” that disaster bioethics contexts have. One could, of course, argue that we could perhaps reduce the features that all disaster settings have in common and come up with a very narrow list of two or three features: a great number of deaths, a great number of casualties, lack of basics like food, water, medication. Could such a theory that operated on the basis of a very narrow list of “common features” of the disaster situations help us decide or guide us as to whether and how to intervene in the particular disaster setting? Could a theory of right action be of any particular help under the circumstances? I rather doubt it.
A virtue ethics theory, on the other hand, like the one I have been trying to outline, seems to accomplish this task better. We do not actually need to be told what to do in each particular disaster setting. This is something very obvious: we ought to help. With what particular decisions and actions we are going to help is something which has to be decided by the virtuous responder in the field in the light of the circumstances. Of course, at some stage the virtuous responder will have to take into account certain operational details which require a managerial expertise on his part. However, whatever the particular operational and mechanical means he employs in the field of disaster, the virtuous responder is likely to know how to act well in the unfamiliar and inimical situations such as those encountered during and after a disaster.
This kind of situation reminds us of what happens in another more familiar disaster situation, that of severe car accident injury. When a casualty is transferred urgently to the intensive care unit of a hospital, the obvious thing the virtuous physician has to do is help. In what particular way he is going to help the person injured is something he will decide in light of the symptoms exhibited by the injured person he has in front of him and on the basis of the knowledge and experience he has acquired so far. He does not need any theory of right action to tell him what particular measures he should take, what particular therapy he should apply. But we trust the physician that, whatever is the particular medical decision he takes, he takes it in the right disposition, i.e. to cure and help the casualty. As a consequence, in the end, we are not so much interested in what kind of therapy he applies, as long as we are sure that he applies it in a virtuous disposition.
The situation seems to be similar to the kind of situation we are facing in disaster contexts. A theory of right action does not and in fact cannot tell us what to do. I rather think that the question is trivial. Because the obvious thing is that we ought to help. Now how we are going to help, with what particular actions and with what means we are going to support the people afflicted in disaster fields is something which will be determined in the light of the particular circumstances under which the disaster has occurred. No theory of right action can help us in this. On the contrary, according to a virtue ethics theory, it does not matter so much what particular practical decisions the help providers make on the disaster fields, as long as they make them in a virtuous disposition. This kind of thinking does not tell me what to do but, what is more important, it prescribes that, whatever it is I decide to do, it has to be done in the right spirit. So in a way, it filters the decisions I make.
As a consequence, deciding to act in a disaster field in a virtuous disposition provides us with the right reason for acting. As such, it excludes all the other reasons I may have to act; for in that case I will act as a vicious or an immoral character. The virtuous responder could never take advantage of the victims to whom he was offering help, because his action of providing help to the disaster victims would not be performed in a virtuous disposition, which is the only right reason for action. In the same spirit, the virtuous responder could never do a wrongful action, because there would never be a virtuous disposition which would justify a wrong action, even though there would admittedly be many other immoral reasons which would justify it. Consequently, it would seem that a virtue ethics approach, to the extent that it attempts to define the right action by means of the virtuous disposition of the person who is performing it, is a richer and more efficient way of dealing with the problematic situations which arise in disaster bioethics settings than any theory of right action.
I wish to express my sincerest thanks to the participants of the workshop, “Moral Theories and Disaster”, which took place at the University of Prešov, Slovakia (13-15 May 2015). Their comments and questions helped me clarify certain points of an earlier draft of this paper. I would also like to express my sincerest thanks to an independent reviewer for his remarks and constructive comments which helped me elaborate the ideas expounded in this article further. Funding for this workshop and open-access publication was provided by COST Action IS1201 (http://DisasterBioethics.eu).
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