The Scoundrel’s Plea
ROBIN HOLTOM argues that William Blake’s epithet ‘the general good is the plea of the scoundrel’ supports the view that Medical Ethics has become separated from Ethics generally.
The chaplain in a psychiatric hospital I used to work in was an even tempered and conscientious Welshman but on one occasion I noticed he was uncharacteristically upset. I asked him what the trouble was. He explained that he had asked if he could become a member of the Hospital Ethics Committee. It seemed a reasonable request as he was probably one of the few people in the hospital who had actually studied Ethics at university. After some weeks he had been informed that the committee was not really ‘Ethics’ but it was ‘Medical Ethics; and it would not be appropriate for him to be a member.
Throughout the Victorian era what we would now regard as a talking cure was described as ‘Moral Treatment’ in order to distinguish it from physical and medical remedies. When Victorian morality was vigorously rejected in the 20th century, we may have thrown out a baby with the bathwater because medicine became much further separated from morality. The ascendancy of the modern drug manufacturing industry regularly presents examples whereby ethics and practice have become uncoupled. Thalidomide and the Sackler opioid scandal are among obvious examples. Medical Ethics has clearly split off from Ethics.
Medicine is not the only example of this split but it is a particularly telling one which impacts us all. The Military Industrial Complex (the relationship between a country’s military and the defence industry that supplies it), which can shorten life, influences politicians’ decisions about war. The Medical Industrial Complex, (the relationship between pharmaceutical companies and health care practitioners) which can lengthen life, influences doctors’ decisions about our health. All are ‘ethical’ on their own terms of course, and they certainly claim to promote the general good. But they are also profitable and especially good for some.
Blake was objecting to the utilitarian project of creating the greatest good for the greatest number – an appealing idea at first sight. But a problem arises when one realises that different people have very different beliefs about what is good for the greatest number. Not only do they have different views, but some of them also are often convinced that their ideas are ‘right’ and others are ‘wrong’. Religious beliefs amplify these convictions and this may give people the self-confidence to kill each other.
It is a truism that we project onto others those characteristics that we are unable to recognise in ourselves. Right and wrong, good and bad are ways of classifying events by pre-established categories and these categories are easily substituted for real ethical soul-searching. Thus our uncertainties and, their twin, our bigotries, are sidelined and we can persuade ourselves that we have ‘Right on our Side’. Yet time and again we are forced to realise that apparently good things have bad consequences. Fossil fuels warm the planet to dangerous levels. Overuse of antibiotics damages our immune systems. Over fertilised soil becomes barren. More convenient and faster private cars make journeys across London’s roads slower than in the days of horses and carts.
Blake had a point.
We hope you have enjoyed reading this article. The future of our volunteer led, non-profit publication would be far more secure with the aid of a small donation. You can also support local journalism by becoming a friend of HIP. It only takes a minute and we would be very grateful.
Leave a Reply