Introduction
Ethics and morality are a branch of philosophy dealing with moral principles. Morals conceptualise the tenets of human character or behaviour as good or bad, right or wrong. However, morals are an individual and subjective concept which vary across individuals, cultures and time. Intentions, decisions and actions which may be considered moral by one individual or society may be considered amoral by another. The need for an organised system of guidelines, which can be universally applicable to all members of a society and against which all moral or immoral actions can be judged is the driving factor behind foundation of ethics.
History of Ethics
A study of ancient Mesopotamian, Greek and Indian cultures over the millennia give a unique insight into ethics as a structural foundation of civilised society. The historical aspect of ethics and ethical systems helps guide present and future generations towards a harmonious and secure society across regional, organizational and global stages.
Study of Ethics
A study of moral philosophy endeavours to classify ethical systems based on various schools of thought which act as the guiding principle on which an ethical system is structured. The major branches of ethical philosophy include descriptive ethics which studies the prevalent ethical and moral standards, normative ethics which evaluates the prevalent moral norms and their interpretation and application, meta-ethics which reevaluates the prevalent ethical systems and applied ethics dealing with ethical considerations specific to a particular field.
Importance in Life and Clinical Orthopaedics
In this chapter, the authors have attempted to outline the importance of a structured ethical system in various walks of life, including personal, professional and social. A sound ethical system clearly outlines moral versus amoral behaviour, provides an objective means for judging the morality of decisions and actions, provides aids to teaching moral behaviour to new members of a society, defines behaviour of individuals professionally and personally, guides individuals in making decisions over issues of moral conflict or ambiguity and helps maintain structure and order in society so as to achieve the greatest good for the greatest number. The authors also discuss the essential role played by ethics in the life and practice of the modern-day Clinical Orthopaedician.
Keywords: Applied ethics, Meta-ethics, Descriptive ethics, Normative ethics, Morality, Morals, Values, Fundamental rights, Humanity
Introduction
The Oxford English dictionary defines morals as—Of or relating to human character or behaviour considered as good or bad; of or relating to the distinction between right and wrong, or good and bad [1].
Morals are a deeply individual and subjective concept and people often have strong and stubborn beliefs differentiating right from wrong, good from bad and just from unjust. An individual's perception of morals is often influenced by life experiences, cultural norms, religious beliefs and upbringing. It evolves as one grows and encounters various experiences throughout their lives. As no two individuals grow through identical circumstances and formative experiences, there is often significant ambiguity between individuals regarding which intentions, decisions and actions may be considered moral or immoral.
Certain morals may be identified as universal, stemming from basic human nature and emotions. These values are considered virtuous by all individuals across cultures, beliefs, religions and time—wisdom; courage; justice; temperance to name a few.
In cases where moral intentions, decisions and actions of individuals do not concur, it is necessary to have a set of guidelines agreed upon by society to define moral or immoral behaviour by an individual. Thereby, arises the concept of ethics and morality.
Ethics and Morality
Ethics is defined in the Oxford English dictionary as—Of or relating to moral principles, esp. as forming a system, or the branch of knowledge or study dealing with these [2].
Ethics (Greek ethos: way of living) is a philosophical branch that studies human conduct specific to individual's behaviour in society. They are moral principles that govern a person's behaviour or the conduct of an activity.
Morality (Latin moralitas: manner, character, proper behaviour) is defined as the principles concerning the distinction between right and wrong or good and bad behaviour. It is the moral beliefs, views and attitudes of given individuals, societies and groups [3].
Ethics and morality are used interchangeably in the study of philosophy. Ethics deals with systematic reflections on moral views and standards (values and norms) and how one should assess actions, institutions and character traits [4]. Ethics will assess and evaluate the rational justification of an individual's moral judgements of what is right or wrong and what is just or unjust [5]. These act as both, a code of conduct for the practice of moral behaviour by an individual or group and as a benchmark against which morally questionable decisions and actions may be judged. These provide a reference and aid in the teaching of moral behaviour for members of the society.
Ethics are formulated by a society based on reflections over moral views and standards. Being founded on the basis of systematic review of moral standards and values, they are grounded in logic and reasoning. They are instituted in a society as a formal system to guide an individual's behaviour and tend to be objective and universally applicable in contrast to individual morals.
History of Ethics and Morality
Ancient Cultures
Ancient Greece and Mesopotamia are recognised by most historians as the cradle of human civilisation. It follows that the concepts of Ethics and Morality were first given shape from these cultures.
Moral thought during the ancient Greek era was originally based on mythology. These mythological stories, which were meant to instruct and teach, provided moral meaning, but no comprehensive framework. The earliest known literatures from ancient Greece and Mesopotamia, notably Iliad by Homer and the Epic of Gilgamesh set forth a set of values for influential members of society, which are considered desirable and worthy of honour [6]. Ethical claims are also found in ancient Egyptian and Sumerian scriptures, advocating practices of caring for the less fortunate as a means to please deities [7]. It was also in these scriptures that the primordial version of the Golden Rule of Morality first appears: do unto others, as you would have them do unto you [8].
The noted Greek philosopher, Socrates (circa 600 BC), is first credited with attempting to establish a framework of ethics using rational arguments and evaluation of current moral concepts. He advocated establishment of moral truths by rational questioning of the beliefs of others. He opposed the moral relativism of prevalent teachings during that era and insisted on formulation of moral principles from the beginning which would be equally applicable to all members of society. Similar works by Aristotle and Plato slowly gave structure to the concept of rthics in society and regulation of an individual's moral behaviour according to a standard framework of guidelines [6]. Aristotle advocated "While many different goods were being pursued by different people and activities (as per their beliefs of what is good and bad), that good which is being pursued for its own sake is the supreme good." Teachings by Aristotle extolled the importance of virtues and fixed habits of behaviour in moral life, such as courage, justice, prudence and temperance [9].
Ancient India
The foundation of ethics in Indian culture is visualised in the ancient Indian epics, the Ramayana and the Mahabharata, where the concept of Dharma is defined as duties of an individual towards upholding the natural order. These epics, along with the teachings of the Bhagwat Geeta, outline the concept of Sanatana Dharma or Eternal Law, which binds all beings. These scriptures provide structured guidelines towards the practices, behaviours and responsibilities of an individual in society. The concept of Karma (the accumulated balance of good and bad actions by an individual) holds prominence even in modern day ethical philosophy and teachings [10].
The tenets of Jainism as prescribed by the philosopher Mahavira Swami extoll the virtues of a perfectly ethical life through renunciation of violence in all its forms against all living beings [11]. The teachings of Gautam Buddha revolve around the Eight-fold Path, viz. right view, right resolve, right speech, right conduct, right livelihood, right effort, right mindfulness and right spiritual awareness [12].
All these ancient Indian scriptures provide an ethical framework which an individual must follow to lead a righteous, moral and virtuous life as a productive member of society.
Kantian Ethics
Eighteenth century philosopher Emmanuel Kant propounded the theory that right and wrong are founded on duty. He postulated that questions about happiness should not a focus on ethical thought, as ethics are universal, while different people derive happiness by different means. An action is only truly moral, if done from a sense of duty and the most valuable thing is a human will that has decided to act rightly. [13]
Utilitarianism
Betham and Mill in the nineteenth century proposed that right actions are those that are likely to result in the greatest happiness of the greatest number. This philosophy has popular support even in the twenty-first century [14].
Twentieth Century
The horrors of the two World Wars in the first half of the twentieth century led to a deepening focus on distress of fellow humans as central to development of ethics. This led to the establishment of the UNIVERSAL DECLARATION OF HUMAN RIGHTS, 1948, which asserted the fundamental moral rights of all human beings to life, education and other basic goods.
In the scenario of Indian ethics and morality during the twentieth century, mention must also be made of contemporary thinkers and philosophers, most notably, Mahatma Gandhi, who preached a code of morals and ethics, universally applicable to all mankind transcending age, gender, race, culture, beliefs and religion. Mahatma's tenets of truth, non-violence, peace, dignity of labour, self-reliance, compassion and selfless service continue to inspire and impact moral codes and ethics of various societies all over the world [15].
Professional and Applied Ethics
Up until the mid- twentieth century, ethics were primarily theoretical and philosophical in nature, whereas medical ethics continued to deal with the issue of medical practice. The latter half of the twentieth century saw an upsurge in the fields of applied ethics like animal ethics, business ethics and environmental ethics.
As technological advancements continue to propel the human race ever further into the future, focus will also be required on new and emerging branches of ethics pertaining to computers, robots and artificial intelligence [16].
Medical Ethics
Hippocrates, the ancient Greek physician, known as the Father of Modern Medicine, born circa 460 BC, honoured by his contemporaries as a physician, is popularly believed to be the first Healer to introduce philosophic method in his practice and teachings [17]. He was known to be a man of impeccable moral standing and his teachings on both medical and ethical topics are relevant even in modern day medicine. The manuscript Corpus Hippocraticum not only contains information related to various medical matters, but also contains a code of principle for the teachers of medicine and their students. The Golden Rule of Medicine is also attributed to the Hippocratic manuscript: First, Do No Harm.
The Hippocratic Oath, an ethical code attributed to Hippocrates, has been adopted over the ages as a code of conduct for the medical profession and is still relevant today, often used in graduation ceremonies of medical institutions [18]. The Oath outlines the various obligations of the medical practitioner in his/her various roles as a teacher, a student and a caregiver. The physician vows to prescribe only beneficial treatments to the best of his/her ability and judgement; to refrain from causing harm or hurt; and to live a praiseworthy life as a contributing member of society, both professionally and personally. The Hippocratic Oath has undergone multiple revisions and reiterations over the years, to accommodate the progress and ever-increasing scope of medical practice.
Study of Ethics
Ethics, studied as a branch of philosophy, can be classified into four primary categories [14].
Descriptive Ethics
Descriptive ethics is a dimension that deals with the practical aspects of ethics and studies the prevalent ethical and moral standards of a society. It deals with the practical aspects of moral opinions, attitudes and actions. It describes the practice of moral behaviour by individuals in society [4]. As customs, laws, religious beliefs and circumstances vary from society to society and also within a society with the passage of time, it follows that the inter-society and intra-society ethical structure also varies. Descriptive ethics is hence a form of comparative ethics dealing with differences between societies and differences between the past and the present.
Normative Ethics
Normative ethics systematically evaluates prevalent moral norms and attempts to outline their understanding, interpretation and application on moral issues. The term normative ethics is derived from the root word 'norms' (defined as a situation or a pattern of behaviour that is usual or expected). This of ethics deals with the age-old like—How do you define whether a particular decision or action is morally right or wrong / good or ? What arethe ethical duties and obligations of members of a social , whether professional, political or economic?
The golden rule of normative ethics—"Do unto to others as we would have them do unto us" and its many variations like "People living in glass houses should not throw stones" are the foundation of normative ethics [8]. It is also called Prescriptive ethics as it outlines the principles which determine the rightness or wrongness of an action and also provides the justification for punishment in cases where these ethics are preached.
Over the centuries, theories postulated by various philosophers have attempted to frame moral foundations and guidelines for normative ethics. We briefly mention the historically important ones here.