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9.00 a.m. – Geetbets: Heerlijckyt van Elsmeren, Belgium. The course “Zin in zinderend zinnigs” (in Dutch): two-day basic course Ethics, a practical application of the major Western schools in ethics.
Price: € 850.00 incl. VAT for the two-day course with overnight stay. 25% discount for private individuals, VZW-ASBL and CV-SC in the social sector.

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9.00 a.m. – Geetbets: Heerlijckyt van Elsmeren, Belgium. The course “Zin in zinderend zinnigs” (in Dutch): two-day basic course Ethics, a practical application of the major Western schools in ethics.
Price: € 850.00 incl. VAT for the two-day course with overnight stay. 25% discount for private individuals, VZW-ASBL and CV-SC in the social sector.

REGISTER

On the occasion of the FutureProof festival of Broederlijk Delen and Oxfam Wereldwinkels, I was asked:

“When your grandchildren will look back on today, what will they find unimaginable that we consider normal today? In other words: what typifies our society today? Where are our blind spots?”

One of the things that came to mind, and which I expressed in the podcast, is the following:

The meritocracy idea gone mad: the idea as if we had eliminated fate and coincidence.

I think they are going to be surprised that we allowed ourselves to be caught up in this way at the beginning of the 21^st century

If you are successful, then that is purely your own merit, and you owe nothing or no one gratitude or solidarity; if you are unhappy or poor, that is your own fault; you should have grabbed your chances like everyone else. In my opinion, that is meritocracy gone mad.

There is nothing wrong with encouraging ambition and entrepreneurship, I am all for it; it is useful and necessary, but it is not enough.

It does not take into account the imperfection of any equal opportunities policy, or the coincidence that grants different talents to different people and that each person is faced with different obstacles.

Creating equal opportunities is hyper-important and hyper-complex; in addition, in my opinion, a society of solidarity is needed, because coincidence, history and context are not just to be put aside. Solidarity, based on equality, must take care of that, between individuals, between groups, between countries and between continents.

They are going to look back and say: ‘why was there not a greater dash of modesty and solidarity in that ambition of those boys and girls in 2020?

And what does that have to do with ethics?

With the ideas of John Rawls, author of “A Theory of Justice”, we can very easily test whether an equal opportunities policy has succeeded in making society sufficiently just.

Rawls believed that the most righteous forms of society can be achieved when people make agreements behind the “veil of ignorance”.

A simple example: there is a reorganisation in your management, and you discuss with your five-member management team the allocation of responsibilities, targets, budgets and team members to the five different departments. Your company values versatility.

  Imagine that each manager knows in advance which department he or she is going to run. Pulling and pushing, yelling and shouting, blowing and sighing fill the meeting room. The loudest caller brings in the widest resources for his or her own department. Everyone else is left behind with the idea that they have too few resources to have an equal chance to success as their neighbour.

 Rawls proposes a different approach: you say that we will first agree all allocations of resources and responsibilities, and only thereafter fate will decide who will lead which department. The ‘veil of ignorance’ means that it suddenly is no longer clear what your personal interests are. In any case, you still want to have as much chance of success as the others, but how are you going to achieve that? By giving each department an equal chance of success, with an equal balance between the allocated resources and the goals to be achieved. (*)

 This theory of justice says that people will find the outcome of the second scenario more just: once you no longer care what role you are going to take on, you will probably have found a just division of roles.

The link to the necessity of the “equal opportunities + solidarity” duo is then quickly made, through a thought experiment.

  Imagine that everyone in the world has to make a restart. Ask everyone how much money they want to give in order to have a better chance of being reborn in one particular place on earth, or just to avoid another place. Or simpler: how much money would you be willing to spend to stay in the country where you now live? Or on the continent where you now live? Or not to have to participate in the reborn-lottery? As long as there are people who want to bet money, the results of the equal opportunities policy in our world are not quite right.

 Or suppose that someone wants to switch houses and jobs with you, how much would you pay to avoid this switch, or, the opposite, to get that chance?

 Of course preferences also play a role, someone can prefer the city to the countryside or vice versa; you can neutralise this by eliminating climate-type, urban-rural-coast and other preferential elements by, for example, limiting the virtual exchange to your own municipality. Or: do you want to trade with someone with the same profession in any other country?

  As long as not everyone wants to exchange their role for any other position in society, the way in which we organise equal opportunities is not enough to satisfy your sense of justice à la Rawls. We need solidarity to make the whole thing fair.

Perhaps we should include such a veil of ignorance thermometer in our social statistics: the unequal-opportunities-perception indicator, the “uopi” : (the “I’d-rather-stay-where-I-am” monetary sum + the “I’d-rather-switch-with-another” monetary sum) / the “I-don’t-care” percentage. The lower, the better the results of our equal opportunities policy.

Conversely, according to Rawls, solidarity is not the only thing that makes us happy; he certainly did not say that only total equality can fulfil our sense of justice. He set out a number of conditions for people to perceive differences as being fair, and one of those conditions is precisely that everyone should have equal access to a role that benefits from an advantageous difference.

So this part could have started in a completely different way: solidarity is not enough, we also need equal opportunities. But that is for next time.

(*) If it is not very credible that any manager can run any department, another finding by Rawls suggests even more opportunities for a fairer approach to reorganizations. Involve people who have no self-interest in skewing the balance between resource goals, or arrange for group goals, or make the bonus (if you want to use it at all) dependent on the lowest result within the management team.

The mayor of Aalst says he will refuse Brussels patients because the Brussels authorities should be forced to adopt a stricter corona policy, “the limits of our medical solidarity have been reached”.

I thought, let us look at what Immanuel Kant, philosopher of the Enlightenment, would think about this. We all hang on to the Enlightenment values these days, don’t we? Many people think that these values helps to define us as a society and as a culture.

Kant looked for some criteria that would always apply to determine whether your behaviour is ethical or not. Not those sometimes-yes-sometimes-no rules, but standards that simply always apply to everything and in all circumstances. “Categorical’ that is. You have to respect them, otherwise your behaviour is in no way ethical. And “have to” is an imperative, so what he was looking for was a categorical imperative.

The starting point behind those rules was that every human being is a rational creature with a dignity that no one should deny. You are also free, and that freedom gives weight to the choices you make: your behaviour is only truly ethical if you also had the choice to act unethically, but in all freedom you consciously opted for the more ethical action. The intention counts.

He finally formulated three rules in his “categorical imperative”. One of these three is: you may not use a human being merely as a means to achieve another goal. Never treat a human being merely as a means to an end, but always at the same time as an end. If a human being is harmed, manipulated or abused, no end justifies the means, according to Kant.

It is a very appropriate rule to settle a topical issue: the drowning of refugee people in the Mediterranean, in function of an increased deterrent effect on the population in the countries of origin. Are you just using a human life as a means here? I think so, and I think it would not pass Kant’s ethical test. Kant would say: save every human being, and the effects on the perception of other candidate refugees are secondary to it.

The Aalst-Brussels issue can also be tested against it: can you deny a person intensive care in order to settle a policy issue or, worse still, a political rivalry? Let a few sick people simmer in uncertainty just to teach fellow politicians a lesson? According to the Enlightenment values, it is clear: that would be a flagrant violation of the principle of ‘person as an end, not just as a means to an end’, and that attitude fails the litmus test. It is therefore not ethical according to Kant.

As with all ethics rules, there are limits to the blinkered interpretation of this duty-based ethics. If you pay someone a wage for mowing your lawn, aren’t you just using that gardener as a tool? If you treat the gardener with respect, and the agreement on the exchange of labour against money has been freely ratified by both parties, then “merely as a means” does not apply. A different conclusion can be drawn if a person involved feels manipulated, abused or unsafe.

To treat a fellow human being merely as a means is to deliberately harm a fellow human being, in function of another purpose.

But, I can feel the objection coming, is it not possible that, during a pandemic, it is actually impossible to give everyone a hospital bed? Suppose the hospitals were flooded, you would have to choose who you would take in and who not? Is the latter not ‘deliberate harm’?

Well, first of all, it does not serve any other purpose. But Kant also felt that you should always look at the degree of freedom and intention, and not only at the observed behaviour. If you don’t have the possibility, the freedom, to take care of everyone, you shouldn’t blame yourself for not being able to fulfil that impossible option. At least as long as it was not your intention to consciously deny people care. If you behave in the same way but have the intention to cause damage without the circumstances placing you in a dilemma, then that same action is not ethical, according to Kant.

So you may wonder whether all the beds in Aalst are occupied at the moment, and whether care is being denied out of necessity or intention. A quote in the newspaper “De Morgen”:

“It is not the case that capacity is exceeded by people coming from Brussels”, says spokesman Chris Van Raemdonck (of the ASZ). “That is certainly not the case”.

Would it not be cool that on issues such as these we all just have to suggest ‘man as an end, not just as a means’, and everyone immediately understands what we argument we are trying to raise? Suppose that understanding this concept is part of our common vocabulary, that it is taught at school in order to make dialogue about our sense of justice more effective?

Sweatshops: unethical because of ‘person as an end, not just as a means’! Putting children out of the country who have grown up here because ‘the law is the law and we do not want to create a perception of lawlessness’: do not do it, ‘person only as a means’! Deliberately destroying relationships on an island for the sake of a challenging TV format: Kant says no. A pharmaceutical company that has a hand in the media coverage of the distress cry of parents of a sick child, just when an agreement is being made with the Minister of Health about the price of the medicine: unethical, and we have an understanding for that: “‘man only as a means’!
Not bad, this Enlightenment!

https://www.demorgen.be/nieuws/aalst-wil-brusselse-coronapatienten-weigeren-grenzen-van-medische-solidariteit-zijn-bereikt~bfc14944/

https://www.standaard.be/cnt/DMF20130503_00566874

https://www.tijd.be/politiek-economie/belgie/algemeen/ziekenhuizen-elke-dag-opnieuw-moeten-we-puzzelen/10256174

Health economists, in justifying their positions, often emphasize research into the positive and negative consequences of their proposals, arguing that it is best to choose the action with the greatest net positive impact on society. A kind of accounting of the pluses and the minuses as a result of an action, and the action with the greatest net gain is then the most ethical choice (“A cost-benefit analysis, therefore”, vrtnws.be 31/3/2020).

Is this type of moral decision making based on historical thinking?

Yes: in the 18th century there was a reaction to the domination of ethics imposed from a religious point of view, which meant that you had to lead a virtuous life, otherwise God would punish you. Consequentialism, or utilitarian ethics, no longer wanted this fear-based moral compass, and stated that every single person could weigh up what was best for him or her; consequentialists were committed to impartiality and usefulness: the greatest good for the greatest number (of people). You are responsible for the consequences of your actions, and you are only ethical if you examine the consequences for each person affected by your actions, and if you then act according to what is most beneficial overall.

This ethical movement has historically promoted many good things,

This ethical school has historically promoted many good things, such as universal suffrage; it still has many and influential supporters, e.g. Peter Singer who has greatly influenced the thinking on animal welfare and effective altruism. It can also be said that climate change policy would benefit from a little more awareness of the long-term consequences of the current policy.

But pure reasoning according to the ethics of consequences also ultimately hits its boundaries.

Imagine you are an emergency doctor, and in your ward there are four patients: one almost healthy man, and three people who each have a different failing organ. Without a donor organ, those three will die quickly. The consequence-based ethics would suggest: the best thing you can do is sacrifice the healthy man (one minus) and save the three others with the organs of that one man (three plus). Net effect: + two. Everyone will feel that this clashes with your gut feeling about justice: apparently there is also something like the individual right to autonomy over your body. The eye of the consequentialist seems to see the forest, but not the trees.

A limit in the application of consequence ethics, then, is that it puts minorities under pressure: the basic rights of a few threaten to be outweighed by the total benefit to the majority. Very often, the concept of ‘public support’ is the expression of a consequentialist thinking process: an example in covid-times: ‘the majority yearns for more freedom of movement, so I think that the many small pluses involved in giving back that freedom of movement to the majority are decisive, regardless of the major negative consequences for a few’.

Another difficulty is that not all consequences can be quantified, and that consequences can sometimes be misjudged. For example, according to recent studies, the impact of strict social corona measures on the economy is less than initially thought (as Gert Peersman and De Grauwe, among others, emphasize), apparently it is the inflicted fear of the virus and its consequences that causes economy to falter.

Consequence ethics are therefore very sensitive to the care with which the consequences are studied.

And it often helps to improve ethical reflection if you combine it with thinking about other ethical concepts, such as duties and rights, freedom, autonomy, responsibility and virtues.

Fortunately, health economists sometimes reluctantly confirm this: ‘In some cases, the health economist’s calculation does not count’. (De Standaard, 1/4/2020)

What would happen, for example, if hospitals were to start refusing corona patients and abandon the principle that society should take care of everyone? Perhaps healthcare personnel would then refuse work, on the grounds that it is unfair that those who are at greater risk of infection would no longer be able to receive care if infected. What will be the political consequences if citizens who have contributed throughout their lives to the financing of the social welfare state notice that the state says it is fine not to do its best for everyone anymore?

It seems that it is a good thing that policy should not be geared to a one-sided examination of the consequences, but that other principles should also play their part.

Perhaps rights and duties, virtues and justice should set the lower limit of the policy and, within that framework, we can choose the policy with the most positive welfare effects.

9.00 a.m. – Geetbets: Heerlijckyt van Elsmeren, Belgium. The course “Zin in zinderend zinnigs” (in Dutch): two-day basic course Ethics, a practical application of the major Western schools in ethics.
Price: € 850.00 incl. VAT for the two-day course with overnight stay. 25% discount for private individuals, VZW-ASBL and CV-SC in the social sector.

REGISTER

VVirologists in Belgium are bound by the Doctor’s Oath and the Code of Doctors. The essence of this is “quality medicine at the service of all persons and society …”, with guiding principles such as professionalism, respect, integrity and responsibility.

The essence of these guidelines is that you will respect the dignity and autonomy of the person in need of care with integrity and professionalism in your attempt to restore their health. And first and foremost: do not harm anyone.

Virtue ethics:

Part of this code is based on the idea that a doctor has to behave virtuously: you have to do your utter best, you have to be brave, treat everyone equally, avoid excesses, show common sense and in all circumstances take responsibility not to harm the profession. “Improve the world, start – as a doctor – with yourself.”

In ethics, this is the school known as virtue ethics. From a historical point of view, this has been going on since Greek philosophers and is still very much present today, as the virtue ethicist Alisdair MacIntyre has e.g. strongly influenced the integrity policy of governments.

Indeed, setting a good example yourself often works to positively influence your environment (mirror neurons, remember?), and it’s something you can control yourself and it avoids fatalism.

The central theme of courage and responsibility also explains that the virologists sometimes indignantly suggest that politicians did not dare to defend policy decisions in the media. And the do-not-harm principle explains the expectation that funds will be allocated to provide a hospital bed for everyone.

But too narrow a focus on your virtuous self is not always blissful: if your opinion unnecessarily hurts somebody, wouldn’t you leave your virtuous honesty behind for a while? It seems that sometimes you have to look at the consequences and not only at your virtues. To put it crudely: the gaze of a virtuous ethicist often only sees his tree, and loses sight of the forest. For epidemiologists, they obviously avoid this pitfall; they look beyond the treatment of each individual patient anyway, but they sometimes miss the non-medical consequences in their analysis.

Duty-based ethics:

Another part of the thinking behind the code of medical doctors is that every human being has a dignity and autonomy that everyone must respect. That is also the central thesis of Immanuel Kant, the Enlightenment philosopher who pointed out the responsibility we have for our actions. He argues that we are free and rational creatures, and that rights and duties flow from that; we should only act with respect for the dignity and freedom of every human being. Hence the emphasis in the Code of Doctors on autonomy of and respect for the patient.

The blossoming of the idea of human rights is the main historical achievement of this philosophy, which remains burningly topical today. The fact that so much attention is paid to attempts (via language, via framing) to dehumanise groups such as boat refugees or immigrants could be seen as confirmation of the fact that respect for the rights of our fellow human beings is ingrained in everyone’s sense of justice: it is only when we no longer regard others as human beings that our conscience allows us to deny them their rights and dignity.

The problem with the blind application of this principled approach lies in the scarcity of resources. Even a doctor sometimes has to resort to triage: who am I going to treat first and who can wait? Another example: you cannot keep testing for every drug endlessly until you are sure that there really is no side effect on every possible different disease pattern. Sometimes you have to have the courage to make a decision the moment you say that you have done your best and that the consequences of doing even more would be negative. “Le mieux est l’ennemi du bien”.

Do we also need consequence-based ethics and justice-as-fairness ethics?

The guidance given to doctors by the code and the oath is guided by virtue ethics and duty-based ethics, it seems an excellent guide because it encourages action, takes into account the rights of the patient and sets the bar very high for the doctor himself. However, the need for a broader social perspective, and the scarcity of resources in our society, mean that this virtuous and dutiful approach to social issues is best complemented by a critical examination of the consequences.

Everyone its individual moral compass that bears traces of all ethical concepts.

I believe that virologists, health economists and politicians are indeed willing to compromise and are aware of the difference in the principles that go with their specific role. No doubt they are all rationally capable of recognising the limitations of the dominant ethical reasoning in their craft, and each undoubtedly has an individual moral compass which bears traces of the other ethical concepts.

However, I believe that actively recognising the type of moral consideration that structurally drives you or your interlocutor can lead to more conscious and balanced dialogue. Recognizing individual responsibility (virtue), as well as responsibility for your actions (duty-based ethics) and for the consequences of your actions (ethics of consequences), is crucial among policymakers because all three have their place in our civil ethical gut feeling.

PS: We will talk about the justice-as-fairness ethics later on.

https://www.ordomedic.be/fr/code-2018

https://www.ordomedic.be/fr/l-orde/serment-belgique/

9.00 a.m. – Geetbets: Heerlijckyt van Elsmeren. The course “Ethiek, zin in zinderend zinnigs” (in Dutch): two-day basic course on Ethics, a practical application of the major Western schools of ethics.
Price: € 850.00 incl. VAT for the two-day course with overnight stay. 25% discount for private individuals, VZW-ASBL and CV-SC in the social sector.

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Podvis, vrtnws.be, 10 June 2020:“Clean money, does it exist? (in Dutch)”

Jan Holderbeke figured it out, Christine Van Tichel edited this podcast.

With Koen De Vidts, Sebastien Mortier (Fairfin) and Geert Noels (Econopolis).