“ What We Talk about When We Talk about Ethics BY JOHN D. LANTOS
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was recently invited to talk about ethics with the staff of a level-three neonatal intensive care unit. They presented a case featuring a full-term baby born by emergency caesarean-section after a cord prolapse that caused prolonged anoxia. Her initial pH (a blood gas analysis used as an indicator of newborn health) was 6.7. She was intubated and resuscitated in the delivery room. Her Apgar score remained at one for ten minutes. Further evaluation over the next two days revealed severe brain damage. Her prognosis was dismal. The doctors recommended a do-not-resuscitate order. The parents agreed. The doctors suggested a gastrostomy tube. The parents disagreed. Instead, they requested that fluid and nutrition be discontinued. The staff was aware of the American Academy of Pediatrics policy that permitted the withdrawal of artificial nutrition and hydration in cases like this after appropriate evaluations and discussions. Some staff members who were Catholic brought up church guidelines that, they thought, prohibited the withdrawal of fluid and nutrition under these circumstances. As a group, they had never had a case in which parents requested withdrawal of nutrition and hydration. Everybody agreed that all the choices were bad. The baby would either die of starvation or live but with little or no cognitive awareness. Everybody knew that a choice had to be made. There was no neutral position. Both options were legal. Reasonable people could disagree about the right choice.
John D. Lantos, “What We Talk about When We Talk about Ethics,” Narrative Ethics: The Role of Stories in Bioethics, special report, Hastings Center Report 44, no. 1 (2014): S40-S44. DOI: 10.1002/hast.269
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The emotions in the room, as we started to discuss the case, were strong and discordant. Some people thought that the parents alone had the right to make this decision and that the job of the doctors and nurses was to support them. Others felt strongly that it was wrong to withhold fluid and nutrition from a baby in these and probably in any circumstances. One doctor said, “It is like taking away a blanket. Would we leave the baby naked on the front steps?” The case had taken place some months before our discussion of it. The staff had decided to respect the parents’ preferences. The baby was not fed. She lingered for eleven days, during which some nurses refused to care for her. Their conscience-based requests were honored, and they were assigned to other babies. Other nurses bore the burden, some willingly, some grudgingly. Some staff members made disparaging comments about their colleagues. The NICU was a sad and stressful place. One nurse said, “What made it so hard was that it took so long. When we stop a ventilator, babies die quickly.” Another said, “I didn’t object to the parents’ decision. But why couldn’t they take her home? Why did we have to take care of her?” One of the nurses who had cared for the dying baby said that it was difficult but also beautiful. She admired the parents’ ability to stay with their baby, holding her and comforting her, even though the baby was unaware of their caring. She was deeply moved by the parents’ devotion. The conversation wound down. They turned, expectantly, to the visiting bioethicist. I wasn’t sure where to start. We could have focused on futility or quality of life, parental autonomy, conscience and moral distress, or the best interests of the January-February 2014/ H A S T I N G S CE NTE R RE P O RT
By talking and telling the moral stories of our lives, we can try out new ways of thinking about the things that evoke in us complex thoughts and conflicting emotions. baby. It would have been accurate, but not very helpful, to say that what they did was consistent with current AAP guidelines. They knew that. I could have discussed surveys showing that neonatologists are more uncomfortable withdrawing nutrition and hydration than they are withdrawing mechanical ventilation. I could have talked about the Groningen protocol for neonatal euthanasia and asked whether this was, in fact, a form of euthanasia and, if so, whether that made it wrong. I could have talked about resource allocation and futile treatments or about the role of ethics committees. While these were all interesting aspects of the case, what interested me more was the way in which those particular people in that particular room talked about what was at stake for them as individuals and for them as a group. In talking about the case, everybody started with a moral intuition, a gut feeling, a sense of what was right or wrong. When challenged about the validity of their intuitions, they made moral claims about them. Some explained that we should stop feeding because parents have the right to make these decisions. Others said that we should not because the baby had a basic right to fluid and nutrition. These moral claims were not actually moral arguments, and they didn’t change any minds. If anything, the reasons, rationales, and justifications for one course of action or another just strengthened everyone’s initial convictions. Talking about ethics in this way did not move us toward consensus or move anybody to reexamine their own beliefs. Mostly it just highlighted the depths of the disagreements. The inability to come to agreement or even to understand the basis of disagreement reflected Alasdair MacIntyre’s despair about the state of contemporary moral philosophy. In After Virtue, he writes, “The most striking feature of contemporary moral utterance is that so much of it is used to express disagreements; and the most striking feature of the debates in which these disagreements are expressed is their interminable character. I do not mean by this just that such debates go on and on and on—although they do—but also that they apparently can find no terminus. There seems to be no rational way of securing moral agreement in our culture.”1 In MacIntyre’s view, moral philosophers today have an impossible task. They are trying to explain what is good and right in particular cases without any overall conception of what is good and right in a human life understood as a whole. They must do that—and it is like fighting with one
hand tied behind one’s back—because modern moral philosophy is committed to the idea that there can be no universal conception of the good. Each individual must be free to work out his or her own idea of the good. What is good is good for an individual, an autonomous moral agent. Moral philosophers today, MacIntyre concludes, can offer only rival and incompatible accounts of the good: “Utilitarians compete with Kantians and both with contractarians, so that moral judgments . . . become essentially contestable.”2 Moral systems offer internal consistency, but they are useless as a way of adjudicating disputes between two different, equally self-contained moral systems. Rival conceptions of the good cannot engage one another’s first premises. Kantian arguments will never convince a utilitarian. Protestant arguments mean nothing to a Buddhist. So what do we do when we try to make moral judgments? We all pick and choose among rival philosophies, rival religions, and rival professional societies, creating our own amalgams. On some issues, we go with a professional society statement, on others with the Catholic church, the Supreme Court, the Republican party, or the New York Times. Oddly, we have no trouble at all citing these authorities as determinative when we agree with their positions and dismissing them as dastardly when we do not. Really, all we are doing is finding whatever support we can for our deeply held and ultimately fragile moral intuitions. This leads us to a deeper question. Where do our gut instincts about right and wrong come from? If we don’t get our moral intuitions from philosophy but only pick philosophies that are consistent with our moral intuitions, then why do we believe what we believe? Carl Elliott wrestles with some of these issues in his 1992 essay “Where Ethics Comes from and What to Do about It.” He notes that “ordinary people pay little attention to theories when they make their moral decisions.”3 In spite of that, he suggests that “our moral decisions are influenced by theories of one sort or another.”4 He illustrates this with a personal example. “I myself,” he writes, “refer to no systematic moral theories or doctrines in making moral judgments but I have no illusions that these judgments are independent of the fact that I grew up as a Presbyterian in South Carolina.”5 So that is one possible explanation for the origin of our moral intuitions. They come from the way we were raised, the teachings and experiences of early childhood. We inter-
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nalize these, and they shape our world views in ways that come to seem both intuitive and unquestionable. But if that is true, it leads to an even deeper set of questions. Are we, in fact, autonomous moral agents? We would like to think so. We would like to think that we have the ability to reason and to reason even about our deepest beliefs. But if our deepest beliefs are formed in early childhood from the way that we were raised, then it seems we have no genuine autonomy with regard to which values we hold most deeply. At the same time, perhaps even those most deeply rooted beliefs are malleable. Perhaps we can change our bedrock beliefs. To do so, though, we would need to be willing to question those beliefs, to acknowledge that they are open to question. Leszek Kolakowski played with such questions in a tongue-in-cheek essay entitled “From Truth to Truth,” in his book Modernity on Endless Trial. He proposes to create what he calls a “conversion agency” to help people change their most deeply held beliefs.6 Its advertising slogan would be “We convert from anything to anything.” One could be turned into a pious Jew, a committed Maoist, or a secular hedonist. The fees would be determined according to the degree of difficulty of the conversion. It is a lot easier, he claims, to make someone into a Unitarian than into a Sufi mystic. How would such conversions be achieved? Kolakowski is a bit coy here, but he notes that rational persuasion would not be used because, he says, it would not be very effective. Rational persuasion, he writes, is relevant for only a very few belief systems. In most, it is neither relevant nor effective in achieving total conversion. True believers, he suggests, use rational arguments not as the basis of their beliefs but only as weapons against followers of other belief systems, against heretics and skeptics. Kolakowski’s ironic essay raises an important and nonironic question. Can we change our deepest beliefs? Can an American Christian ever really become a Tibetan Buddhist? This is a fundamental question about character, about identity, about those aspects of ourselves that make us who we are. It is the question at the heart of the popular television series Homeland, in which the suspense about the main character, Brody, is whether he is, ultimately, truly an American or whether he has, in fact, been “turned” and become an agent of Al Qaeda. Can anybody change that much? Some argue that humans are not, in fact, very malleable. Psychologist Jonathan Haidt suggests that our moral intuitions are biologically based and hardwired into us.7 He suggests that all people (and many mammals) are built to feel certain emotions in certain situations or relationships —fear and vulnerability in the face of a predator, anger when hurt or insulted, love for offspring, altruistic desires S42
to help someone from our group who is in trouble. These biologically based psychological responses become the basis of the moral systems. Moral arguments, by this view, are not the basis for these feelings. Instead, they are stories that we tell ourselves in order to feel as if we have chosen to feel those things, that we are altruistic because we are good or angry because we believe an injustice must be corrected. This view seems reductionist and would seem to lead to a world in which everyone had the same moral beliefs. But that isn’t necessarily the case. Identical feelings can lead us to tell different stories, to elaborate very different moral systems. Haidt makes an analogy between moral intuitions and taste. We all have the same taste buds. They lead us to enjoy things that are sweet, salty, sour, bitter, and savory. From these basic biological building blocks, though, we don’t all develop the same tastes. Instead, we generally develop tastes for the foods we grow up with, the foods of our culture. Many people have preferences for the foods they grew up with, and sometimes they don’t even know how powerful these can be. Turkish writer Elif Batumun describes her experience eating in a traditional restaurant in Istanbul: “Having read Proust, and also neuroscientists on the direct connection from smell and taste receptors to the hippocampus, I have long been aware that eating is, for many people, an emotionally and mnemonically fraught activity. But, that night at Çiya, I viscerally understood why someone might use a madeleine dipped in tea as a metaphor for the spiritual content of the material world.”8 While eating a meal there, she feels powerful and surprising emotions about her parents, her grandparents, and her place in the world. She is overwhelmed and mystified. Maybe we have similar collective moral memories that lead us to certain instinctual responses to morally challenging cases. And, if so, it may, perhaps, be hard either to explain or share the basis for those feelings. We might just say that we feel the way we do because it is who we are. By this argument, taste, like morality, is both universal and particularistic. It is both culture bound and biologically predetermined. Everybody likes spices, but not everybody likes the same spices. Everybody is repulsed by cruelty, but everybody defines cruelty slightly differently. In every culture, some cruelty under some circumstances might sometimes be morally acceptable. Some cultures find punishment by whipping to be acceptable and appropriate but would find long-term solitary confinement inhumane. Other cultures come to different conclusions about these forms of cruelty. To Haidt, it makes no more sense to ask whether one moral system is superior to another than it does to ask whether one cuisine is somehow intrinsically better than another. With food, it seems uncontroversial to claim that there is no “right” answer. January-February 2014/ H A S T I N G S CE NTE R RE P O RT
The NICU staff were asking how to go on, as a moral community, after this baby died because they hadn’t fed him and some thought that was the right thing to do and others thought it was abhorrent. In many ways, our primal moral responses are similar to our primal gustatory reactions. Both are deeply ingrained but not entirely immutable. We love the foods of our childhood, but most of us have different food preferences than did our parents or grandparents. There are things that we once thought to be inalterably wrong but have now come to accept. One might look at issues like polygamy, slavery, abortion, gay marriage, or euthanasia to see moral reevaluation at work. It used to be okay to smoke in hotel rooms, but you had to go out to a dark alley to find pornography. Now, you have to go to the alley to smoke, but you can choose your fetish on television or on the Internet. Gambling was once illegal and morally condemned. Now it is state sponsored. So how do our ideas about right and wrong, our moral tastes, change? Only by talking together about ethics, talking out loud, telling each other about our deepest convictions, our fondest and most fragile hopes, our darkest fears. By talking and telling the moral stories of our lives, we can try out new ways of thinking about the things that evoke in us complex thoughts and conflicting emotions. The title of this paper is an homage to Raymond Carver’s short story “What We Talk about When We Talk about Love.”9 In that story, Carver explores the complex nature of conversations about love in a way that is similar to what I’m suggesting we do when we talk about a difficult ethics case. In Carver’s story, two couples, Mel and Terri, Nick and Laura, are drinking together on a summer afternoon and talking about love. Mel, a cardiac surgeon, is the most talkative of the four. Before medical school, he studied in seminary. He is smart, driven, opinionated, and somewhat world-weary. He is married to Terri. Both were married before. Terri’s first husband, Ed, was physically abusive. Terri said, “He beat me up one night. He dragged me around the living room by my ankles. He kept saying, ‘I love you, I love you, you bitch.’ He went on dragging me around the living room. My head kept knocking on things.” Terri looked around the table. “What do you do with love like that?” (p. 310). She knew what to do. She left him. Ed was so bereft and depressed that he shot himself. He didn’t die immediately. While he lingered for days in the intensive care unit, Terri visited. She sat at his bedside as he was dying. Mel thought this was crazy. Terri explained that, even though Ed beat her, she still had feelings for him. What’s more, he had loved her deeply: “‘It was love,’ Terri said. ‘Sure, it’s
abnormal in most people’s eyes. But he was willing to die for it. He did die for it.’ ‘I sure as hell wouldn’t call it love,’ Mel said. . . . ‘I’m not interested in that kind of love. If that’s love, you can have it’” (p. 313). Mel was also married before, to Marjorie. About her, Mel says, “Sometimes I have a hard time accounting for the fact that I must have loved my first wife too. But I did, I know I did. . . . There was a time when I thought I loved my first wife more than life itself. But now I hate her guts. I do. How do you explain that? What happened to that love?” (p. 315). After a few more drinks, Mel describes his homicidal fantasies about her. “She’s allergic to bees,” he says. “Sometimes I think I’ll go up there dressed like a beekeeper. You know, that hat that’s like a helmet with the plate that comes down over your face, the big gloves, and the padded coat? I’ll knock on the door and let loose a hive of bees in the house. But first I’d make sure the kids were out, of course” (p. 321). That’s not all Mel has to say about love. He tells a story about an elderly couple he cared for who had been severely injured in a motor vehicle accident. Both ended up in casts and bandages in the ICU. Mel says, “[T]he husband was very depressed for the longest while. Even after he found out that his wife was going to pull through, he was still very depressed. Not about the accident, though. I’d get up to his mouth-hole, you know, and he’d say no, it wasn’t the accident exactly but it was because he couldn’t see her through his eye-holes. He said that was what was making him feel so bad. Can you imagine? I’m telling you, the man’s heart was breaking because he couldn’t turn his goddamn head and see his goddamn wife. I mean, it was killing the old fart just because he couldn’t look at the fucking woman.” “Do you see what I’m saying?” Mel said (p. 320). The story is about how they do and don’t see what he is saying, how they are starting to see him in a whole new way. In talking of love, Mel is revealing things about himself that neither his friends nor his wife had ever seen before. As the characters in the story talk and drink, they come to know one another. Talking about love becomes an enactment of love. Love is obviously central to each of their lives, yet it remains fundamentally mysterious. Morality is a bit like that. Just as we needn’t agree about what love is in order to try to understand how to love one another, we needn’t agree about what is ethical in order to work together on projects that express collective moral val-
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ues. Sometimes, in ethics committee meetings, it is hard to keep things in focus. Sometimes we wonder, as we talk, whether we’re talking about the case, talking about ourselves, or talking about something else altogether. The tough cases are the ones that demand of us that we interrogate our own deepest beliefs. We find that the same facts—and similar moral principles—can lead to opposite conclusions. This challenges our fundamental ideas about who we are and why we do the work we do. Such cases test the bonds that hold us together in communities. Did Ed love Terri? Can withdrawal of nutrition be not just ethically defensible but a deep expression of love? In talking like this, we are trying to understand the range of disagreements that exist among people we thought we knew and define the limits of our tolerance for moral differences. We do so by telling each other the stories of our own lives, stories that explain what we believe and why we have come to believe it, in the hope that others, especially others who disagree or simply don’t understand, will at least come to share our moral universe, even if they don’t share our beliefs. The best of such storytelling becomes literature. The staff in the NICU faced a collective decision. They had to think about how to care for a baby under difficult circumstances. They also had to look at one another and ask, “Can I still work with you? Are we in this together?” They were asking how to go on, as a moral community, after this baby died because they hadn’t fed him and some of them thought that was absolutely the right thing to do and others thought it was abhorrent. When we talk about ethics, we are telling stories about ourselves as rule followers and rule breakers. We know that
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we are inadequate to question received wisdom. But we also know that true freedom means that we must question that wisdom. Rules sometimes must be broken. Ethics is a living thing and, like all living things, most evolve and adapt. Such freedom is a scary thing. The end of the Carver story could be the end of a good ethics discussion. After all the revelations, after the two couples have seen new things about each other and thought new thoughts about the meaning of love and loyalty and fear and trust, Nick thinks, “I could hear my heart beating. I could hear everyone’s heart. I could hear the human noise we sat there making, not one of us moving, not even when the room went dark” (p. 322). 1. A. MacIntyre, After Virtue (Notre Dame, IN: University of Notre Dame Press, 1997), 6. 2. MacIntyre, After Virtue, 3rd ed. (Notre Dame, IN: University of Notre Dame Press, 2007), x. 3. C. Elliott, “Where Ethics Comes from and What To Do about It,” Hastings Center Report 22, no. 4 (1992): 28-35, at 30. 4. Ibid. 5. Ibid. 6. L. Kolakowski, “From Truth to Truth,” in Modernity on Endless Trial (Chicago: University of Chicago Press, 1997). 7. J. Haidt, The Righteous Mind: Why Good People Are Divided by Politics and Religion (Vintage, New York, 2013), 211. 8. E. Batumun, “The Memory Kitchen,” The New Yorker, April 19, 2010. 9. R. Carver, “What We Talk about When We Talk about Love,” Raymond Carver: Collected Stories (New York: Library of America, 2009), 310-22. Page numbers for quotations from this story are provided parenthetically in the text.
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was recently invited to talk about ethics with the staff of a level-three neonatal intensive care unit. They presented a case featuring a full-term baby born by emergency caesarean-section after a cord prolapse that caused prolonged anoxia. Her initial pH (a blood gas analysis used as an indicator of newborn health) was 6.7. She was intubated and resuscitated in the delivery room. Her Apgar score remained at one for ten minutes. Further evaluation over the next two days revealed severe brain damage. Her prognosis was dismal. The doctors recommended a do-not-resuscitate order. The parents agreed. The doctors suggested a gastrostomy tube. The parents disagreed. Instead, they requested that fluid and nutrition be discontinued. The staff was aware of the American Academy of Pediatrics policy that permitted the withdrawal of artificial nutrition and hydration in cases like this after appropriate evaluations and discussions. Some staff members who were Catholic brought up church guidelines that, they thought, prohibited the withdrawal of fluid and nutrition under these circumstances. As a group, they had never had a case in which parents requested withdrawal of nutrition and hydration. Everybody agreed that all the choices were bad. The baby would either die of starvation or live but with little or no cognitive awareness. Everybody knew that a choice had to be made. There was no neutral position. Both options were legal. Reasonable people could disagree about the right choice.
John D. Lantos, “What We Talk about When We Talk about Ethics,” Narrative Ethics: The Role of Stories in Bioethics, special report, Hastings Center Report 44, no. 1 (2014): S40-S44. DOI: 10.1002/hast.269
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The emotions in the room, as we started to discuss the case, were strong and discordant. Some people thought that the parents alone had the right to make this decision and that the job of the doctors and nurses was to support them. Others felt strongly that it was wrong to withhold fluid and nutrition from a baby in these and probably in any circumstances. One doctor said, “It is like taking away a blanket. Would we leave the baby naked on the front steps?” The case had taken place some months before our discussion of it. The staff had decided to respect the parents’ preferences. The baby was not fed. She lingered for eleven days, during which some nurses refused to care for her. Their conscience-based requests were honored, and they were assigned to other babies. Other nurses bore the burden, some willingly, some grudgingly. Some staff members made disparaging comments about their colleagues. The NICU was a sad and stressful place. One nurse said, “What made it so hard was that it took so long. When we stop a ventilator, babies die quickly.” Another said, “I didn’t object to the parents’ decision. But why couldn’t they take her home? Why did we have to take care of her?” One of the nurses who had cared for the dying baby said that it was difficult but also beautiful. She admired the parents’ ability to stay with their baby, holding her and comforting her, even though the baby was unaware of their caring. She was deeply moved by the parents’ devotion. The conversation wound down. They turned, expectantly, to the visiting bioethicist. I wasn’t sure where to start. We could have focused on futility or quality of life, parental autonomy, conscience and moral distress, or the best interests of the January-February 2014/ H A S T I N G S CE NTE R RE P O RT
By talking and telling the moral stories of our lives, we can try out new ways of thinking about the things that evoke in us complex thoughts and conflicting emotions. baby. It would have been accurate, but not very helpful, to say that what they did was consistent with current AAP guidelines. They knew that. I could have discussed surveys showing that neonatologists are more uncomfortable withdrawing nutrition and hydration than they are withdrawing mechanical ventilation. I could have talked about the Groningen protocol for neonatal euthanasia and asked whether this was, in fact, a form of euthanasia and, if so, whether that made it wrong. I could have talked about resource allocation and futile treatments or about the role of ethics committees. While these were all interesting aspects of the case, what interested me more was the way in which those particular people in that particular room talked about what was at stake for them as individuals and for them as a group. In talking about the case, everybody started with a moral intuition, a gut feeling, a sense of what was right or wrong. When challenged about the validity of their intuitions, they made moral claims about them. Some explained that we should stop feeding because parents have the right to make these decisions. Others said that we should not because the baby had a basic right to fluid and nutrition. These moral claims were not actually moral arguments, and they didn’t change any minds. If anything, the reasons, rationales, and justifications for one course of action or another just strengthened everyone’s initial convictions. Talking about ethics in this way did not move us toward consensus or move anybody to reexamine their own beliefs. Mostly it just highlighted the depths of the disagreements. The inability to come to agreement or even to understand the basis of disagreement reflected Alasdair MacIntyre’s despair about the state of contemporary moral philosophy. In After Virtue, he writes, “The most striking feature of contemporary moral utterance is that so much of it is used to express disagreements; and the most striking feature of the debates in which these disagreements are expressed is their interminable character. I do not mean by this just that such debates go on and on and on—although they do—but also that they apparently can find no terminus. There seems to be no rational way of securing moral agreement in our culture.”1 In MacIntyre’s view, moral philosophers today have an impossible task. They are trying to explain what is good and right in particular cases without any overall conception of what is good and right in a human life understood as a whole. They must do that—and it is like fighting with one
hand tied behind one’s back—because modern moral philosophy is committed to the idea that there can be no universal conception of the good. Each individual must be free to work out his or her own idea of the good. What is good is good for an individual, an autonomous moral agent. Moral philosophers today, MacIntyre concludes, can offer only rival and incompatible accounts of the good: “Utilitarians compete with Kantians and both with contractarians, so that moral judgments . . . become essentially contestable.”2 Moral systems offer internal consistency, but they are useless as a way of adjudicating disputes between two different, equally self-contained moral systems. Rival conceptions of the good cannot engage one another’s first premises. Kantian arguments will never convince a utilitarian. Protestant arguments mean nothing to a Buddhist. So what do we do when we try to make moral judgments? We all pick and choose among rival philosophies, rival religions, and rival professional societies, creating our own amalgams. On some issues, we go with a professional society statement, on others with the Catholic church, the Supreme Court, the Republican party, or the New York Times. Oddly, we have no trouble at all citing these authorities as determinative when we agree with their positions and dismissing them as dastardly when we do not. Really, all we are doing is finding whatever support we can for our deeply held and ultimately fragile moral intuitions. This leads us to a deeper question. Where do our gut instincts about right and wrong come from? If we don’t get our moral intuitions from philosophy but only pick philosophies that are consistent with our moral intuitions, then why do we believe what we believe? Carl Elliott wrestles with some of these issues in his 1992 essay “Where Ethics Comes from and What to Do about It.” He notes that “ordinary people pay little attention to theories when they make their moral decisions.”3 In spite of that, he suggests that “our moral decisions are influenced by theories of one sort or another.”4 He illustrates this with a personal example. “I myself,” he writes, “refer to no systematic moral theories or doctrines in making moral judgments but I have no illusions that these judgments are independent of the fact that I grew up as a Presbyterian in South Carolina.”5 So that is one possible explanation for the origin of our moral intuitions. They come from the way we were raised, the teachings and experiences of early childhood. We inter-
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nalize these, and they shape our world views in ways that come to seem both intuitive and unquestionable. But if that is true, it leads to an even deeper set of questions. Are we, in fact, autonomous moral agents? We would like to think so. We would like to think that we have the ability to reason and to reason even about our deepest beliefs. But if our deepest beliefs are formed in early childhood from the way that we were raised, then it seems we have no genuine autonomy with regard to which values we hold most deeply. At the same time, perhaps even those most deeply rooted beliefs are malleable. Perhaps we can change our bedrock beliefs. To do so, though, we would need to be willing to question those beliefs, to acknowledge that they are open to question. Leszek Kolakowski played with such questions in a tongue-in-cheek essay entitled “From Truth to Truth,” in his book Modernity on Endless Trial. He proposes to create what he calls a “conversion agency” to help people change their most deeply held beliefs.6 Its advertising slogan would be “We convert from anything to anything.” One could be turned into a pious Jew, a committed Maoist, or a secular hedonist. The fees would be determined according to the degree of difficulty of the conversion. It is a lot easier, he claims, to make someone into a Unitarian than into a Sufi mystic. How would such conversions be achieved? Kolakowski is a bit coy here, but he notes that rational persuasion would not be used because, he says, it would not be very effective. Rational persuasion, he writes, is relevant for only a very few belief systems. In most, it is neither relevant nor effective in achieving total conversion. True believers, he suggests, use rational arguments not as the basis of their beliefs but only as weapons against followers of other belief systems, against heretics and skeptics. Kolakowski’s ironic essay raises an important and nonironic question. Can we change our deepest beliefs? Can an American Christian ever really become a Tibetan Buddhist? This is a fundamental question about character, about identity, about those aspects of ourselves that make us who we are. It is the question at the heart of the popular television series Homeland, in which the suspense about the main character, Brody, is whether he is, ultimately, truly an American or whether he has, in fact, been “turned” and become an agent of Al Qaeda. Can anybody change that much? Some argue that humans are not, in fact, very malleable. Psychologist Jonathan Haidt suggests that our moral intuitions are biologically based and hardwired into us.7 He suggests that all people (and many mammals) are built to feel certain emotions in certain situations or relationships —fear and vulnerability in the face of a predator, anger when hurt or insulted, love for offspring, altruistic desires S42
to help someone from our group who is in trouble. These biologically based psychological responses become the basis of the moral systems. Moral arguments, by this view, are not the basis for these feelings. Instead, they are stories that we tell ourselves in order to feel as if we have chosen to feel those things, that we are altruistic because we are good or angry because we believe an injustice must be corrected. This view seems reductionist and would seem to lead to a world in which everyone had the same moral beliefs. But that isn’t necessarily the case. Identical feelings can lead us to tell different stories, to elaborate very different moral systems. Haidt makes an analogy between moral intuitions and taste. We all have the same taste buds. They lead us to enjoy things that are sweet, salty, sour, bitter, and savory. From these basic biological building blocks, though, we don’t all develop the same tastes. Instead, we generally develop tastes for the foods we grow up with, the foods of our culture. Many people have preferences for the foods they grew up with, and sometimes they don’t even know how powerful these can be. Turkish writer Elif Batumun describes her experience eating in a traditional restaurant in Istanbul: “Having read Proust, and also neuroscientists on the direct connection from smell and taste receptors to the hippocampus, I have long been aware that eating is, for many people, an emotionally and mnemonically fraught activity. But, that night at Çiya, I viscerally understood why someone might use a madeleine dipped in tea as a metaphor for the spiritual content of the material world.”8 While eating a meal there, she feels powerful and surprising emotions about her parents, her grandparents, and her place in the world. She is overwhelmed and mystified. Maybe we have similar collective moral memories that lead us to certain instinctual responses to morally challenging cases. And, if so, it may, perhaps, be hard either to explain or share the basis for those feelings. We might just say that we feel the way we do because it is who we are. By this argument, taste, like morality, is both universal and particularistic. It is both culture bound and biologically predetermined. Everybody likes spices, but not everybody likes the same spices. Everybody is repulsed by cruelty, but everybody defines cruelty slightly differently. In every culture, some cruelty under some circumstances might sometimes be morally acceptable. Some cultures find punishment by whipping to be acceptable and appropriate but would find long-term solitary confinement inhumane. Other cultures come to different conclusions about these forms of cruelty. To Haidt, it makes no more sense to ask whether one moral system is superior to another than it does to ask whether one cuisine is somehow intrinsically better than another. With food, it seems uncontroversial to claim that there is no “right” answer. January-February 2014/ H A S T I N G S CE NTE R RE P O RT
The NICU staff were asking how to go on, as a moral community, after this baby died because they hadn’t fed him and some thought that was the right thing to do and others thought it was abhorrent. In many ways, our primal moral responses are similar to our primal gustatory reactions. Both are deeply ingrained but not entirely immutable. We love the foods of our childhood, but most of us have different food preferences than did our parents or grandparents. There are things that we once thought to be inalterably wrong but have now come to accept. One might look at issues like polygamy, slavery, abortion, gay marriage, or euthanasia to see moral reevaluation at work. It used to be okay to smoke in hotel rooms, but you had to go out to a dark alley to find pornography. Now, you have to go to the alley to smoke, but you can choose your fetish on television or on the Internet. Gambling was once illegal and morally condemned. Now it is state sponsored. So how do our ideas about right and wrong, our moral tastes, change? Only by talking together about ethics, talking out loud, telling each other about our deepest convictions, our fondest and most fragile hopes, our darkest fears. By talking and telling the moral stories of our lives, we can try out new ways of thinking about the things that evoke in us complex thoughts and conflicting emotions. The title of this paper is an homage to Raymond Carver’s short story “What We Talk about When We Talk about Love.”9 In that story, Carver explores the complex nature of conversations about love in a way that is similar to what I’m suggesting we do when we talk about a difficult ethics case. In Carver’s story, two couples, Mel and Terri, Nick and Laura, are drinking together on a summer afternoon and talking about love. Mel, a cardiac surgeon, is the most talkative of the four. Before medical school, he studied in seminary. He is smart, driven, opinionated, and somewhat world-weary. He is married to Terri. Both were married before. Terri’s first husband, Ed, was physically abusive. Terri said, “He beat me up one night. He dragged me around the living room by my ankles. He kept saying, ‘I love you, I love you, you bitch.’ He went on dragging me around the living room. My head kept knocking on things.” Terri looked around the table. “What do you do with love like that?” (p. 310). She knew what to do. She left him. Ed was so bereft and depressed that he shot himself. He didn’t die immediately. While he lingered for days in the intensive care unit, Terri visited. She sat at his bedside as he was dying. Mel thought this was crazy. Terri explained that, even though Ed beat her, she still had feelings for him. What’s more, he had loved her deeply: “‘It was love,’ Terri said. ‘Sure, it’s
abnormal in most people’s eyes. But he was willing to die for it. He did die for it.’ ‘I sure as hell wouldn’t call it love,’ Mel said. . . . ‘I’m not interested in that kind of love. If that’s love, you can have it’” (p. 313). Mel was also married before, to Marjorie. About her, Mel says, “Sometimes I have a hard time accounting for the fact that I must have loved my first wife too. But I did, I know I did. . . . There was a time when I thought I loved my first wife more than life itself. But now I hate her guts. I do. How do you explain that? What happened to that love?” (p. 315). After a few more drinks, Mel describes his homicidal fantasies about her. “She’s allergic to bees,” he says. “Sometimes I think I’ll go up there dressed like a beekeeper. You know, that hat that’s like a helmet with the plate that comes down over your face, the big gloves, and the padded coat? I’ll knock on the door and let loose a hive of bees in the house. But first I’d make sure the kids were out, of course” (p. 321). That’s not all Mel has to say about love. He tells a story about an elderly couple he cared for who had been severely injured in a motor vehicle accident. Both ended up in casts and bandages in the ICU. Mel says, “[T]he husband was very depressed for the longest while. Even after he found out that his wife was going to pull through, he was still very depressed. Not about the accident, though. I’d get up to his mouth-hole, you know, and he’d say no, it wasn’t the accident exactly but it was because he couldn’t see her through his eye-holes. He said that was what was making him feel so bad. Can you imagine? I’m telling you, the man’s heart was breaking because he couldn’t turn his goddamn head and see his goddamn wife. I mean, it was killing the old fart just because he couldn’t look at the fucking woman.” “Do you see what I’m saying?” Mel said (p. 320). The story is about how they do and don’t see what he is saying, how they are starting to see him in a whole new way. In talking of love, Mel is revealing things about himself that neither his friends nor his wife had ever seen before. As the characters in the story talk and drink, they come to know one another. Talking about love becomes an enactment of love. Love is obviously central to each of their lives, yet it remains fundamentally mysterious. Morality is a bit like that. Just as we needn’t agree about what love is in order to try to understand how to love one another, we needn’t agree about what is ethical in order to work together on projects that express collective moral val-
SPECIAL REP ORT: N a r r a t ive E t h ic s: T h e Ro le of S tori e s i n B i oe th i c s
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ues. Sometimes, in ethics committee meetings, it is hard to keep things in focus. Sometimes we wonder, as we talk, whether we’re talking about the case, talking about ourselves, or talking about something else altogether. The tough cases are the ones that demand of us that we interrogate our own deepest beliefs. We find that the same facts—and similar moral principles—can lead to opposite conclusions. This challenges our fundamental ideas about who we are and why we do the work we do. Such cases test the bonds that hold us together in communities. Did Ed love Terri? Can withdrawal of nutrition be not just ethically defensible but a deep expression of love? In talking like this, we are trying to understand the range of disagreements that exist among people we thought we knew and define the limits of our tolerance for moral differences. We do so by telling each other the stories of our own lives, stories that explain what we believe and why we have come to believe it, in the hope that others, especially others who disagree or simply don’t understand, will at least come to share our moral universe, even if they don’t share our beliefs. The best of such storytelling becomes literature. The staff in the NICU faced a collective decision. They had to think about how to care for a baby under difficult circumstances. They also had to look at one another and ask, “Can I still work with you? Are we in this together?” They were asking how to go on, as a moral community, after this baby died because they hadn’t fed him and some of them thought that was absolutely the right thing to do and others thought it was abhorrent. When we talk about ethics, we are telling stories about ourselves as rule followers and rule breakers. We know that
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we are inadequate to question received wisdom. But we also know that true freedom means that we must question that wisdom. Rules sometimes must be broken. Ethics is a living thing and, like all living things, most evolve and adapt. Such freedom is a scary thing. The end of the Carver story could be the end of a good ethics discussion. After all the revelations, after the two couples have seen new things about each other and thought new thoughts about the meaning of love and loyalty and fear and trust, Nick thinks, “I could hear my heart beating. I could hear everyone’s heart. I could hear the human noise we sat there making, not one of us moving, not even when the room went dark” (p. 322). 1. A. MacIntyre, After Virtue (Notre Dame, IN: University of Notre Dame Press, 1997), 6. 2. MacIntyre, After Virtue, 3rd ed. (Notre Dame, IN: University of Notre Dame Press, 2007), x. 3. C. Elliott, “Where Ethics Comes from and What To Do about It,” Hastings Center Report 22, no. 4 (1992): 28-35, at 30. 4. Ibid. 5. Ibid. 6. L. Kolakowski, “From Truth to Truth,” in Modernity on Endless Trial (Chicago: University of Chicago Press, 1997). 7. J. Haidt, The Righteous Mind: Why Good People Are Divided by Politics and Religion (Vintage, New York, 2013), 211. 8. E. Batumun, “The Memory Kitchen,” The New Yorker, April 19, 2010. 9. R. Carver, “What We Talk about When We Talk about Love,” Raymond Carver: Collected Stories (New York: Library of America, 2009), 310-22. Page numbers for quotations from this story are provided parenthetically in the text.
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