Ethical choices involve more than just the facts

Dr Dan Fleming (The eRecord/Matthew Lau)

There is a common saying in moral philosophy that good facts are essential to good ethics, writes St Vincent’s Health Australia’s Dan Fleming. Source: InSight+ MJA.

Resting behind is the observation that it is difficult to make a genuinely good choice unless one has an accurate understanding of what they are confronting. To take an analogy from driving – you can’t make good choices on the road unless you can see what’s around you. This insight is all the more important in our so-called post-fact world, in which sources of authoritative information are regularly undermined and truth is seen as a mere matter of opinion.

Even so, when we confront ethical choices it is typically the case that not all of the facts are available to us. We have to work with ambiguities: using the best and most accurate insights available to inform our choices.

In this sense, ethical decision making is more like driving on a country road in the twilight: the road ahead is part illuminated by headlights, part hidden in shadow, and part invisible. Our choices are as much about what we can see as what we assume and predict and – if we are wise – we drive all the more carefully because of this.

Since March 2020, Australians have seen something of this intersection, between what we are able to know and the choices we make, play out regularly in response to COVID-19.

As the facts of our situation have changed (eg, variants of COVID-19 have arrived and so have vaccines) and our foresight has been refined (we can now better predict how the disease spreads and responds to vaccination rates), decision making has followed suit.

It is true that good facts are essential to good ethics, but good facts alone are insufficient for making ethical choices.

That there are choices available to governments, and that the prioritisation of certain goods informs these choices, brings us into the terrain of ethics.

This is significant because differences in policy in response to COVID-19 are not differences of knowledge or circumstance – they are also matters of ethics. What a government determines is “public health” is not neutral. Each vision of public health includes an ethical framework – whether implicit or explicit – which embeds assumptions about what constitutes health for the community, and what common goods are worth pursuing (and sacrificing) to secure health.

Why is this important? There are better and worse ethical frameworks.

We can and should pursue good ends, but always by means that are consistent with good ethics.

Dr Daniel Fleming is head of ethics for St Vincent’s Health Australia. From 2022 he will begin an appointment as Adjunct Professor in the School of Medicine at the University of Notre Dame, Australia.


Epidemiology and ethics are different (InSight+ MJA

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