The Problem with Trust and Sympathy

Christopher Meyers, a philosopher and clinical ethicist at several hospitals, argues in this issue that ethicists' goals are "structurally in conflict" with their incentives. The most obvious and important incentive is that the person draws a salary from the hospital. A more subtle "and insidiously influential" incentive is the intangible benefit of "being accepted into the club"—of acquiring the prestige and authority of a physician. These incentives make it extremely difficult for the ethicist to preserve the independence that is vital to the role. Ethicists, asserts Meyers, are no one person's agent; their task is rather to act "on behalf of doing the right thing."

I wondered, studying Meyers's paper, if even something more could be said here: is part of what makes the notion of moral independence so elusive that affiliation is so integral to the very structure and point of morality? Meyers compares ethicists to scientists, who serve truth rather than any particular client. This notion of independence is especially compelling for scientists because, in some sense, the very point of science is to get at independent truths—to figure out what "really is" and peel away any confusing social overlay. In contrast, moral values are, at least arguably, nothing but social phenomena, and moral reasoning nothing but a kind of social skill. From any perspective, figuring out what is good or right depends on enculturation in a way that science does not: it requires that one read complex social scenarios, see how they might play out, gauge motives, apply and parse shared understandings, and intervene in human relationships. It is fundamentally a social process, and that makes the urge to depend on the views of trusted people around one very great. If one works in a setting long enough, one is likely to come to trust some of the people one works with and to count them as moral experts of a sort.

Also, maybe the scientific method strives for independence in a way that moral deliberation does not. Part of the point of morality is to foster trust and social cohesiveness. Perhaps one could go so far as to say that where good science is competitive, moral deliberation encourages affiliation. Thus, when one becomes part of a community, more than just the crass business of acquiring power in it can encourage one to side with its members. Becoming part of a community almost inevitably leads one to identify with its members and to share their interests. So maybe the notion of acting on behalf of what is right, though useful to a degree, actually obscures some of the issues. It begins to look like trust and sympathy themselves are partly at odds with ethicists' goals. The problem is somewhat like the one "embedded journalists" face in the Iraq war.

It's not a fault of Meyers's paper that it does not wander off down these paths, but for me, these musings help me think about the problem he takes on. He thinks ethicists' conflicts of interest cannot be resolved. Ethicists need to be paid—should be paid—and if they are accepted in the hospital community and have influence over doctors, then they will be part of the club. Thus hospital ethicists should be, but cannot be, independent. If the very structure and point of morality also incline people established in a social setting to accept the understandings and positions of that setting, and to trust and sympathize with the people there, then the structural conflict is just that much worse. The only solution would be an overhaul of the very institution of ethical consultation. Perhaps, ideally, ethics consultants would be organized in the same way as discussion facilitators, labor arbitrators, and judges—people whose trust and sympathy are structurally regulated by ensuring that they have no preexisting relationships to the people they work with.