One of the first things to understand about ethics is that we all ascribe to some sort of ‘worldview’. This is a set of presuppositions by which we sort out what is meaningful in our lives. We all have one whether we like to admit it or not. It may be based on religious teaching, or rebellion against religious teaching, whatever our best mate believes, or can even be a result of our own indecisiveness.
What is important to realise is that whatever your worldview is, it will influence your decisions in life, and this becomes most evident in the life of a Doctor. We will be routinely making decisions which have much wider implications than ‘what shall I eat for breakfast?’
Any worldview should answer these questions: How do we know what we know? What is truth? What is right? How should we meet our goals? How is the world made up? Where are we heading?
A dominant worldview within Medicine and Science is Reductionism. A view glorified by Richard Dawkins and other members of ‘the Brights’. Reductionism is a world-view which sees “properties, concepts, explanations, or methods from one scientific domain (typically at higher levels of organization) can be deduced from or explained by the properties, concepts, explanations, or methods from another domain of science (typically one about lower levels of organization)” (Stanford dictionary of Philosophy).
As you can see, not all of the questions above can be answered by Reductionism. It is only concerned with what the cause of something is, not of the purpose of something. With regards to the question ‘Why did you cross the road?’ One (Teleological) response would be “to get to the other side.” Reductionism however would answer “Because I was pushed”. Reductionism is only concerned with looking back on the causality of an action and never forward to the ‘intent’ of an action. So while Reductionism seems very ‘enlightened’ it merely hides behind a barrier of science to congratulate itself on its own cleverness, pushing aside the other ‘big questions’ and passing them off as unimportant.
Another dominant worldview in our society is ‘Post-modernism’. This is where someone’s view is that ‘anything goes’ and ‘there is no such thing as absolute truth’. In my opinion this is sheer laziness. This is the path of least resistance. Someone ascribing to this is likely to encourage anybody to do anything they choose without questioning, even if they know it would be to their detriment. It in itself is also a self-refuting statement: if there is ‘no such thing as absolute truth’ how can that statement itself be true for everyone?
For an example of how this might be worked out in practice: Miss A, 19 year old student comes in requesting an abortion. As the Doctor I could answer this request without any questions because “Who am I to say that it is right or wrong”. “Whatever my views on abortion, I cannot impose them on someone else, therefore I should not question her decision.”
If I did this, exacting a postmodern worldview, I would be avoiding an opportunity to have a difficult, but necessary, conversation to ensure that the Miss A is not being coerced into this decision and is, in fact, making an informed decision. The end result may well be the same but surely the second option is the better way to really care for our patients?
These are just two of the most prevalent worldviews we encounter every day without realising it. What I would like to propose is that not enough of us take the time to think about our worldview. But by doing this we will not only clarify a lot of issues in our own mind, but also help you to understand those people who may be opposed to you… always remembering that this is just as likely to be a patient, than as a colleague, both now and in the future.
