Ethics for Everyone A Skills Based Approach 1st Edition
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Contents
Acknowledgments xi
Introduction: Purpose and Uses 1
Why This Book? 1
How to Use This Book: Suggestions for Beginning Students,
Professional Students, Clinical Ethicists, and
General Readers 4
1. Dimensions of Moral Experience 9
Varieties of Moral Perplexity 9
Curiosity and Wonder as the Impetus for Ethics 10
Ethics Belongs to Everyone 12
The Humanizing Function of Ethical Dialogue 15
Ignorance, Learning (and Relearning) What Moral Values
We Hold 18
Ethics as Ongoing 20
Obstacles to Ethics 21
1. Moral Arbitrariness 21
2. Absolute Certainty 23
3. Perfectionism 25
The Aims of Ethics 26
Teaching, Learning, and “Catching” Ethics 28
2. Basic Skills I 31
Probing Skill: Interrogating Our Moral Prehistories 31
Decentering Skill: Taming Moral Vanity and
Recognizing Others 38
Relinquishing Skill: Giving Up the Comforts of
Moral Certainty 43
Emotional Skill: Learning from Our Feelings 47
Cognitive Skill: Thinking Slowly 50
viii Contents
3. Basic Skills II 53
Imaginative Skill: Expanding the Reach of Our Empathy 53
Assertive Skill: Claiming Our Own Moral Authority 56
Connective Skill: Linking Goodness and Happiness 59
Narrative Skill: Story-Making at Intersecting Life
Trajectories 61
4. Exercises Using the Skills 71
Nineteen Exercises in Eight Groupings 71
Curiosity about One’s Moral Sensibility 72
Broad Empathy 73
Conceptual Agility 73
Identifying Emotional Registers 74
Sensitivity to Suffering 75
Moral Certainty/Uncertainty 75
Moral Authority 76
Happiness 77
Assessing Responses 77
5. Some Common Pitfalls 79
The Trap of Either/Or Thinking 79
Expecting Too Much from Theory 81
The Desire for a Unifying Definition of Ethics 86
Restricting What Experiences Have Ethical Weight 89
Treating Mysteries as Moral Problems 92
6. Moral Concepts in Practice I 95
The Anchoring Value of Truth 96
Forgiveness and Freedom 101
The Varieties of Love 104
The Moral Uses of Spirituality 107
The Persistence of Hope 111
7. Moral Concepts in Practice II 115
Voluntary and Nonvoluntary Responsibilities 115
Justice and the Measure of Impartiality 118
Liberty and Its Limits 122
Contextualizing Rights 125
Conscience: Within—Not Above—the Moral Fray 128
How Death Enables Ethics 132
Contents ix
8. Skills and Concepts for Ethics beyond the Lifespan 137
Skills and Concepts in the Context of Global Warming 138
Five Morally Debilitating Features of Our
Current Thinking 141
1. Focus on the Present 142
2. Political Ineptness 143
3. Humans as the Crown of Creation 144
4. Consumerism 145
5. Mechanistic Views of Nature, Including
the Human Body 146
Getting Grounded 147
9. Cracking the Case, and Cases to Consider 151
Cracking the Case 151
Cases to Consider (or to Rewrite as Cracked Cases) 159
1. Adderall for Nonprescription Uses 159
2. Programming a Self-Driving Car 160
3. Buying and Selling Organs 161
4. Businesses That Provide Services Selectively 162
5. The Magnifying Effects of Social Media 163
6. Choosing the Sex of One’s Children 164
7. Vaccine Refusal: Personal Health and Public Health 165
8. Cows and Global Warming 166
9. Age as a Screen for Expensive Therapies 167
10. Arming Schoolteachers 168
11. Paying Student-Athletes 169
12. Divisive Monuments 170
Notes 171
Bibliography 181
Index 187
for
David Schenck
ingenious colleague and inspiring friend,
who believed in this book before I did
and
my many students—undergraduate, medical, graduate,
and adult learners,
from whom I have learned so much about ethics
Acknowledgments
I am happy to acknowledge, with thanks, the many people who
helped in the writing, reviewing, and final production of this book.
This volume has had a long gestation. One of the fortunate things
about my entry into ethics is that I was nested in an interdiscipli-
nary department at the University of North Carolina at Chapel Hill.
Rubbing shoulders daily with colleagues in the humanities and
social sciences, and with practicing physicians, meant that theory
could not be privileged in interpreting ethics. My focus necessarily
turned to the practicalities of how ethics works and what it means
on the ground. I owe much to my astute, early Chapel Hill col-
leagues, especially to Ruel Tyson, Nancy King, Gail Henderson, Sue
Estroff, Barry Saunders, James Bryan, and the late Alan Cross. By
the time I arrived at Vanderbilt in 2002, I was firmly entrenched in
this more interdisciplinary and useful way to do ethics.
As I began to write in the spring and summer of 2018 I incurred
additional debts. Nan and Mark Van Der Puy and Jan Munroe read
drafts of chapters and were discerning and encouraging in their
suggestions. Keith Meador, Joseph Fanning, and Kate Payne, my
former colleagues at the Vanderbilt Center for Biomedical Ethics
and Society, offered reassurance that this kind of ethics book was
needed. John Churchill, my brother in blood and in philosophy, re-
peatedly heard many of the ideas in this book over coffee and bis-
cuits. His responses were always thoughtful and heartening. Alan
Murphy gave invaluable assistance in refining and sharpening
the cases.
David Schenck, my coauthor on several previous books and arti-
cles, encouraged me to write about my approach to ethics teaching
and learning. His shrewd comments on the initial drafts kept me
xii Acknowledgments
focused and hopeful that something of value would emerge from
what I then called my “quixotic book.”
Allison Adams, as with two previous books, was an especially
adroit editor. She saved readers from a great deal of academic jargon
and challenged me to say things with more clarity. Katie Haywood
did extraordinary work in formatting, correcting errant references,
and otherwise assuring that the manuscript met high standards for
accuracy and consistency.
Lucy Randall, my editor for two previous books with Oxford,
had a sure sense for what a book like this might be and how to do it
better. I am enormously grateful for her support and guidance. And
I owe much to two anonymous readers she selected for reviewing
this book. They grasped the aims of the book and offered many
suggestions for improvement. I also thank Hannah Doyle at OUP
for her diligent attention to detail during the production process.
Much of what I know about ethics I owe to my wife, Sande, and
to other members of my family, especially our daughters Shelley
and Blair. Over the past decades I have learned from them more
than I could have imagined about love, truth, courage, persever-
ance, joy, and hope. No thanks could be adequate to the deep grat-
itude I feel toward these three amazing people. I hope they will see
some of their influence in the pages that follow. And finally, the
emphasis in this book on ethics across the lifespan was inspired
by my grandchildren—Miguel, Clara June, Wade, and Sofia. Each
has helped me in his or her own way to see how we all change and
that our ethical awareness needs to be responsive to these inevitable
shifts.
The remaining mistakes and gaffes are entirely my own.
I gratefully acknowledge permissions granted to reproduce small
portions of articles already in print.
The section entitled “Conscience: Within— Not Above— the
Moral Fray” in c hapter 7 is based on my article “Conscience and
Moral Tyranny,” which was published in Perspectives in Biology
Acknowledgments xiii
and Medicine (2015) Vol. 58, No. 4, pp. 526–534. © Johns Hopkins
University Press.
The section entitled “Narrative Skill: Story-Making at Intersecting
Life Trajectories” in chapter 3 is based on my article “Narrative
Awareness in Ethics Consultations: The Ethics Consultant as Story-
Maker,” Hastings Center Report (2014) Vol. 44, Suppl 1, pp. S36–S39.
© The Hastings Center. Distributed by Wiley-Blackwell.
Introduction: Purpose and Uses
Why This Book?
This book maps the moral terrain in the grounded reality of human
experience without relying on theories or systems of ethics as the pri-
mary orienting strategy. Moral awareness needs first to be appreci-
ated for what it is before it is made to conform to theories or systems.
And moral consciousness is not a steady or stable set of perceptions;
as we change, so do the moral challenges that most concern us.
The point of entry for this volume is the raw materials of moral
life—the felt impulses of confusion, perplexity, and moral disori-
entation, as well as the satisfactions of moral growth and the en-
joyments of moral cohesion and consonance with others. This is
a book for people seeking to live a life that makes moral sense. It
argues that the best way to do this is by practicing and honing cer-
tain skills, learning to use some neglected conceptual tools, and
avoiding the inevitable pitfalls that oversimplify ethical problems
and their resolution.
This is also a book that recognizes that the messy business of
trying to live a moral life goes on much longer than most models
of ethics typically account for. Indeed, every phase of life seems to
present new moral challenges and requires rethinking old assump-
tions and habits. There are, to be sure, some patches of smooth
sailing, but as humans change over time, so do the seas that must
be navigated. That means that the exercise of skills for ethics, the
meaning of important concepts, and the relevance of various
pitfalls are to be learned and then relearned. Their importance must
be reassessed at major life junctures.
Ethics for Everyone. Larry R. Churchill, Oxford University Press (2020) © Oxford University Press.
DOI: 10.1093/oso/9780190080891.001.0001
2 Introduction
This way of thinking about ethics as a field of inquiry and ac-
tivity began for me about 25 years ago when I realized that I was
fundamentally engaged in teaching students rather than teaching
a subject matter. I was, of course, teaching ethics, as I had always
done, but what now motivated me was less a desire to impart
the fundamentals of a discipline than an interest in the students
themselves, who were often at crucial junctures in their moral de-
velopment. As I began to play out the implications of this pivot,
I became far more interested in what the medical and undergrad-
uate students were saying in class and less inclined to “cover the
material.” I wanted to hear them out, even when it took discussions
in different and unpredictable directions. I became less concerned
with whether I had done an adequate job of explaining Kant’s cat-
egorical imperative and more focused on whether I had met the
students where they were, in terms of those moral concerns and
interests that emerged in the class. With this focus on students also
came less emphasis on reasoning with standard moral concepts
and more concern with other skills: how to deal with affective
responses to difficult cases, how to accredit and respect—rather
than label and dismiss—the differing opinions of others, and gen-
erally what counts as growing and maturing morally. The classes
themselves became more fluid, less predictable, and thereby more
fun, both for the students and for me.
Around that same time, I began anew the practice of clinical
ethics consultation in a major tertiary care hospital, following
several years of absence from this activity. Listening to patients,
families of patients, and those who cared for them professionally
was much like listening to students. Both groups—and indeed
all of us—enter ethics from distinctive perspectives, with diver-
gent preparations, and with unique histories. The task became re-
specting and learning from this diversity rather than regulating
it into some standard way of proceeding. I also began to see that
the key ingredient in “doing” ethics—that is, carrying on the moral
Introduction 3
inquiry when the class or consultation ended—was curiosity and
wonder about one’s own moral sensibilities.
With this new approach came the need for different ethics
texts, but none satisfied me. Typically, textbooks in ethics written
by scholars and teachers of philosophy focus on describing and
clarifying the standard ethical theories and rehearsing the cus-
tomary problem list. In some books, this combination of theories
and problems is done with insight and finesse, while in others it
seems ham-handed and robotic. But in neither case is it a sound
starting place if one wants to make ethics come alive to people
where they are, rather than where we want them to be. Such texts
usually excel in illuminating only one aspect of moral delibera-
tion: clear-headed reasoning that follows the linear implications
of arguments.
One of the things I noted in listening to both students in the
classroom and patients and families on the hospital floors is that
people are seldom argued out of their moral stances. One reason for
this is that moral values reside in places other than our reasoning
capacities. They reside as well, and more deeply, in our feelings,
our imaginations, and our histories and in the parables, maxims,
wisdom sayings, and short stories we tell ourselves about who we
are and what we stand for. This book is the result of my search for an
approach to ethics in this more multitextured way, a way that will
speak to the larger range of human capacities that ethics engages.
Ethical reflection is one of the principal ways we become more fully
human. This reflection cannot occur if it is confined to reasoning
and theory application. We need a view of ethics that engages a
broader range of human capacities and one that takes in a wider
field of inquiry and activity.
The distinguishing features of this volume are
• a concern with curiosity and wonder as a chief impetus for
ethics;
4 Introduction
• a focus on the broad range of human moral experiences rather
than narrowly on problem-solving;
• ethical activity as requiring a range of skills and capacities and
not just clear-headed thinking; and
• an understanding of ethics as changing over one’s lifetime,
rather than remaining static.
This book is not a guide to problem-solving; it is an invitation to
explore the human moral sensibilities. The guidance offered aims at
competence in those skills that are necessary for ethical inquiry to
succeed. Most works in ethics skip this essential, preliminary step
and go straight to a problem list and theoretical applications. Yet if
we are to have any appreciation of how theories might be helpful we
must first deal with ethics as a complex form of human skills and
interactions. This is where ethics begins—and where this volume
begins. My goal is to describe some of the basic workings of ethics
for the human species and entice readers into an ongoing inquiry
into how ethics shapes our lives.
How to Use This Book:
Suggestions for Beginning Students,
Professional Students, Clinical Ethicists,
and General Readers
Working through the book from beginning to end is one option.
Beginning with Chapter 1 can clear away misconceptions and set
realistic expectations. I would recommend this approach for first-
time ethics students, although other useful strategies for begin-
ners are discussed next. Students with a fair amount of ethics study
under their belts will find the skills-based approach of the early
chapters adds important tools to their repertoire. Chapter 5 speaks
especially to those who tend to get caught up in debates about
which ethical theories are best.
Introduction 5
Concepts are introduced after the chapters on skills and pitfalls,
but you can have recourse to the concepts at any point they are
needed. Discovering that you need a conceptual tool to adequately
describe a moral experience or analyze a problem is far more ef-
fective than being asked to study that concept cold. For example,
the first time the term “truth” or “deception” comes up in a discus-
sion is a good time to refer to the section in Chapter 6 entitled “The
Anchoring Value of Truth,” or when “fairness” emerges in a conver-
sation, the section in Chapter 7 entitled “Justice and the Measure of
Impartiality” becomes relevant.
One of the aims of this book is to promote reflection on our own
moral experiences and curiosity about the shape and contours of our
moral sensibilities. Adult learners typically have many such experi-
ences; students in their late teens have fewer. I encourage readers of
all ages to work out of their own life experiences, but this may not
always be feasible. One strategy to accommodate for less experience
is to go immediately to the 12 cases in Chapter 9 and write a response
to one or more of them. Understanding the moral tension in these
cases requires no specialized knowledge. This could be followed by
working through the first part of Chapter 9, “Cracking the Case,” to
promote critical reflection on how cases are constructed and how
they might be presented from a different vantage point. A second
analysis of the cases you select after you have finished the book can
solidify and underscore your gains in greater dexterity with moral
skills and the ability to interpret concepts.
Another starting point could be the exercises in Chapter 4. Like
beginning with cases, this strategy also grounds the study of ethics
in something you bring to the course. Efforts to tell a story of how
you changed your mind or the difficulties of describing suffering,
for example, can then be related to the discussion of the relevant
skills in Chapters 2 and 3. Working to get both you and your in-
structor or conversation partners to invest something that comes
out of your lives and experiences is one of the most important fea-
tures in successfully engaging ethics.
6 Introduction
If you are a student in professional education such as med-
icine, nursing, law, business, or ministry you may come to this
book with either a lot of ethics preparation or very little. If you
have had a standard ethics course that emphasized the applica-
tion of theories to vexing dilemmas you will find this skills-based
approach more immediately serviceable. Because the practice
of your profession routinely requires dexterous personal inter-
actions with your patients, clients, or parishioners, the skills-
based approach will find numerous everyday applications.
Chapters 6 and 7 can be used selectively. Law students may find
the sections on concepts like justice, rights, and responsibilities
of greater interest, while students in the health sciences and min-
istry may find the sections discussing love, hope, and forgiveness
carry special relevance.
Clinical ethicists, who do some of the most challenging work
I have ever experienced, were never far from my mind as I con-
ceived and wrote this book. In an ethics consultative role, we are al-
most always constrained by time, by the question or crisis at hand,
and by the wide range of patients, families, and health professionals
we encounter. For this specialized work the most obviously helpful
skills are what I identify as relinquishing, emotional, and cognitive
skills, described in Chapter 2 and especially the imaginative and
narrative skills discussed in Chapter 3. Finding emotional equi-
librium and slowing down the process of ethical deliberation are
almost always required in clinical consultative work. Stretching
empathic capacities to tell a credible narrative about the issues is
critically important. The basic task for the clinical ethicist is mod-
eling these skills and, by so doing, showing that better decisions
and better relationships can emerge. Short training sessions can be
devised around each of these skills, a task I have begun in the exer-
cises in Chapter 4.
Notwithstanding the professional uses of this text, my aim has
been to focus on skills and concepts that are relevant to people
Introduction 7
not only in their professional roles, but also in the whole of
their lives and over the long term. My aim has been to design a
book that will not only be worth the initial read, but also worth
a second reading 10 years later, as the contours of our lives shift
and develop.
