In the Nicomachean Ethics, Aristotle can be paraphrased as saying “happiness is the meaning and purpose of life, the whole aim and end of human existence.”1 Ironic, given that philosophers can be depressed from studying the absurdity of the human experience and the onslaught of answerless questions. Nonetheless, I find myself again studying ethics because like any good medical student, allowing myself to be fully happy and without stress goes against my nature. Kidding aside, there is much to be learned studying moral and ethical philosophy, and given the position and power we all hold, it seems to behoove us to ask how we should act. My intent is to start an article series with a new topic in each edition of The Differential, delving into the concepts Dr. Beyda presents in our ethics classes, to help us better approach this important, yet abstract, part of medicine.
Unfortunately, philosophy has earned itself a bad rap for being elitist and intangible. My intent here is to make this interesting and absorbable for both students and faculty. I invite you to join me on this educational journey as we study moral and ethical philosophy!
Metaethics
Long before its transformation into social slang to describe a very self-aware person, this prefix was used by toga-wearing men as a way of asking about things “beyond” the basic concept being discussed. In the case of ethics, this was metaethics, questions about ethics itself, abstracted away from opinions or presuppositions. Deep questions like: What IS ethics? Why should we be moral? Is it objective or subjective? This is metaethics, the study of not how to be moral, but what is morality itself.2
As it turns out, these annoying questions are critical to explore if we want to have a good reason for buying into any ethical theory (or none!). So, before we look at normative ethics (Deontology, Utilitarianism, etc.), we need to lay this groundwork. Plus, metaethics also has answers itself. Perhaps you are part of the Global Health program and wonder, is it ok to judge another culture’s medical ethics? Am I imposing my own morals on them? Metaethics can shine some light on this kind of question. So, let’s begin.
*A point of clarification, morals and ethics are two terms that can and will be used interchangeably in the philosophical context, although culturally they may hold different values.
So, what IS ethics?
Philosophically speaking, ethics is the study of what is morally good or bad and the principles for how we should live life. Regardless of whether one holds ethics to be a true concept or not, or has varying ideas of what constitutes ethics, this definition holds.3
Why be moral?
Whether or not you realize it, odds are you already have a preconceived notion of the answer to this question – I hope to challenge that today.
At first glance, “why be moral?” seems simple to answer. People often respond with, “because it’s the right thing to do.” However, there is a problem with this. By definition, what is moral IS what is right, so stating “because morality is the right thing to do” is the same as saying “because the right thing to do is the right thing to do.” Seems circular, but we will come back to that.
Now, “why be moral” can be interpreted and answered in two ways. The first is a more logical interpretation: You should be moral because it is X, and being X makes sense. For example, a moral realist might say “you should be moral because morality is an inherent property and therefore your actions will align with absolute truths”. This is also known as moral authority4, or the reason why claims of morality are legitimate. This is better addressed within the context of each individual metaethical theory so we will explore this deeper in the future.
The second way to interpret this question is more personal, “why should I be moral?” This is the question of moral motivation5. What reason do I have to act morally at all? For example, why should I be motivated to respect my patient’s autonomy? Or why should I be motivated to not overbill my patients? Here are some general ideas that apply across multiple metaethical theories:
- Social contract theory is a strong statement for moral motivation. As Thomas Hobbes said, without social contracts life would be “solitary, poor, nasty, brutish, and short.”6 We have moral motivation because acting so holds together the very fabric of society. I treat patients kindly so that they don’t knife my tires.
- One key drawback here is that it doesn’t say why WE should act morally. If everyone else does and we don’t, we will be fine. Also, many find it just feels impersonal.
- Self-interest is another idea employed across multiple metaethical belief systems. I want what is best for me, and so I will do that. Being seen as a doctor who saves people is an idea that brings me pleasure, so I do that. It just happens that I help people along the way.
- This sparks in many an immediate repugnance, as morality seems to be something more than doing what is best for just me.
- Lastly, employed for centuries, Duty is a famous reason for why we should be moral. Kant’s Deontology rests heavily on the idea that we have a duty to someone else and are obligated to fulfill it.7 I have a duty to help others who suffer, so I practice medicine.
- This is at first an attractive idea; doing the right thing because it is right seems very intuitive. But what reason do I have to actually complete my duty? As mentioned before, it has glaring circularity in its logic.
Now that we’ve looked at some possible moral motivations one can employ, we should address the underlying logic behind them.
Why do I want to be moral? (Internalism and Externalism)
Essentially, moral motivation can be broken into two camps: Internalism and Externalism.
Internalism claims that moral reasons come from within. That circular argument from before about “the right thing to do is the right thing to do,” is something the internalist leans upon. To them, it is akin to saying “2+2 = 4.” It simply does. The right thing to do IS the reason to do it, no antecedent is needed. Therefore, if you judge something to be ethical, then you are at least in part motivated to act on this, as this is the rational thing to do. To them, rationality and motivation are directly related. So, if you judge that you ought to respect patient autonomy, then you will be motivated to do that (if you are rational).8
To some that feels like it begs the question. “It is because it is” doesn’t sit right with a lot of people, who make up the other camp: The Externalists.
Externalism is the claim that your motivation comes from outside, and that regardless of whether an action is judged to be moral, you need personal motivation to act morally. For example: you judge overbilling to be immoral but do so anyway to get some extra cash. You judge it is wrong to do so but have a strong motivation to act otherwise.8
As appealing as this is compared to the circularity of before, suddenly morality seems optional. Also, how can you make a moral judgement and be motivated to act otherwise? Was it actually a moral judgement?
In Summary
That was a lot to take in, so I’ll stop here for this edition. A quick recap:
Metaethics is the study of the concept of ethics itself, “what is ethics?”. Moral authority is the concept surrounding the legitimacy of moral claims, whereas moral motivation is the reason why one should be compelled to act morally. Moral motivation is broken into two camps, Internalism and Externalism. Internalism is the idea that motivation for morality is inherent in the act of making a moral judgement while Externalism is the concept that motivation is needed on top of a moral judgement.
I look forward to continuing this series and am open to any and all questions. Hope to see you next time!
References
- Aristotle. Nicomachean Ethics. Irwin T, trans. 2nd ed. Hackett Publishing; 1999.
- Metaethics. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Stanford University. Accessed January 01, 2025. https://plato.stanford.edu/entries/metaethics/
- Seton Hall University Libraries. Philosophy: Ethics. Seton Hall University Library Research Guides. Accessed January 01, 2025. https://library.shu.edu/philosophy/ethics
- Moral authority. USLegal. Accessed January 19, 2025. https://definitions.uslegal.com/m/moral-authority/
- Rosati CS. Moral Motivation. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published October 19, 2006. Updated July 7, 2016. Accessed January 01, 2025. https://plato.stanford.edu/entries/moral-motivation/
- Hobbes T. Leviathan. Oxford University Press; 1996:89.
- Johnson R, Cureton A. Kant’s moral philosophy. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published April 20, 2004. Updated October 21, 2021. Accessed January 01, 2025. https://plato.stanford.edu/entries/kant-moral/
- Finlay S, Schroeder M. Reasons for Action: Internal vs. External. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published September 4, 2008. Updated August 18, 2017. Accessed January 01, 2025. https://plato.stanford.edu/entries/reasons-internal-external/
Travis Seideman
Travis Seideman is a member of the Class of 2026 at UACOM-P. He attended Northern Arizona University where he studied Exercise Science and Psychology. He is planning on practicing rural Family Medicine and pursuing a fellowship in Sports Medicine.