A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.- Principle VII of the AMA Code of Medical Ethics
Hold paramount the safety, health, and welfare of the public.- Fundamental Canon 1. of the NSPE Code of Ethics for Engineers
Ethics is about character and courage and how we meet the challenge when doing the right thing will cost more than we want to pay.- Michael Josephson, Josephson Institute of Ethics
Each year around this time, we hear frequent reminders about our good fortune to live in a country where we enjoy freedom. As we hear it, across the world, millions to billions languish under oppressive regimes, cultures, or economies, but in America, we have freedom. Recently, we have called into question much about the civil liberties portion of that freedom, especially as it pertains to electronic forms of communication that only in the second half of my lifetime have become ubiquitous enough to merit questioning whether they constitute public or private communication. In this debate, we consider how much freedom do we have to speak our mind, and how much privacy does a "free" society afford to our interpersonal communication. In the focus on wiretapping, email reading, and phone record scanning, we tend to ignore, either because we do not wish to know or because we cannot comprehend the scope and scale of the question, the other aspect of freedom: our choices. How much freedom do we have to make decisions that harm us? Does that freedom extend to decisions that would harm others? Should someone have the freedom to place before us an option that will cause us or another harm, placing the burden of understanding and recognizing that harm only on our individual shoulders? The first two quotes above state part of the ethics associated with two of the most important professions to our health and safety: medical professionals and engineers. We cannot understand the ramifications of these statements in isolation, but must consider them in the context of our personal choices in order to understand to what extent we rely on this ethical behavior for our quality of life. The third statement highlights that ethics becomes most important in a circumstance in which resources dwindle, and we must make hard choices about the best course for all.
As we read the ethics statements above, we can all fairly readily agree that doctors should not neglect the health of their patient, and that engineers should not design products or buildings that will knowingly or unknowingly injure someone. Similarly, in our personal lives, we accept that intentionally causing harm to another violates our collective morality and merits consequences ranging from limiting of economic freedom to limiting of physical freedom. What happens though, when we enter a more grey area? What do we think about doctors who want to further medical research that could save the lives of many, but will cost the lives of those in the control group of a study? To what extent does a doctor have an obligation to provide all of the information a patient needs to make the decision to participate in such a study? What about an engineer who designs a car that can move at speeds over seventy miles an hour, above which fatalities increase geometrically? Does relying on the actions of the operator to stay within a safe speed limit absolve the engineer of any responsibility to limit the car physically from traveling that speed?
On an even grayer level, can a doctor take on a patient load that hinders their ability to truly know their patients, a time constraint that may potentially jeopardize their ability to detect conditions that could lead to lower quality of life for their patient? Or can an engineer employ building systems that provide comfort to the occupants of the building, but rely on energy sources that jeopardize the lives of people located near the sources of that raw energy or the generating plants that convert it to useful form? In our own lives, how much freedom do we have to smoke around others with no opportunity for another to avoid the pollutants that result? If I go to the store and buy the ingredients to make sugary, non-nutritional cupcakes, does that differ from a company mass producing them with chemical additives and pricing them at a point where it is easier for a poor consumer to buy them than fresh fruits and vegetables? How do we reconcile our ethics, our laws, and our concept of freedom?
Thirty years ago, although we knew that the pollutants from smoking shortened lifespans even of those who did not directly smoke, people could smoke in the rear part of a plane on the theory that people in the front part were too far away. Nowadays, one cannot even smoke in the airport. Ten years ago, if anyone had said that we would live in a world where patrons in a bar can drink without having to breathe in second-hand smoke, that person would be laughed out of the room. College campuses have now gone so far as to ban smoking on the entire campus, under the guise that forcing smokers outside only pollutes the air around building entrances and that no one should have to encounter the pollutants. That begs the question: whose freedom is more important? The smokers to make their damaging choice where and when they want, or the non-smoker to know that they can go anywhere in public - including the sidewalks of a city - and not have to encounter pollutants they do not want. Our social ethics - as reflected by our laws - over the past three decades has moved dramatically on this issue, however we do not seem to recognize the error in judgment that led us to this point, even as we establish laws that impinge on one freedom to bestow another.
The issue of smoking highlights one of our primary human fallacies: we assume we know everything we have to know in order to make a decision. This happens especially when we look at issues of materials that improve quality of life: lead in paint and gasoline, asbestos in ceiling, flooring, and insulation, cigarettes. In each of these cases, we considered that because the material brought us comfort or pleasure, and worked excellently in doing so, that we had the freedom to use it as we would. We under-calculated the risks, or ignored them completely, because of the increased utility. Our economy rewarded this thinking, our society accepted the utility as an entitlement, and our government fought action until we had already lost lives in large numbers to the consequences. In each one of these cases, we not only took the life and freedom from those who knew the risks and still made the free choice to expose themselves, we affected those who either did not understand or in many cases did not know.
This joust with freedom has significant consequences in today's society. Within forty years we will have nearly four-hundred-and-fifty million people living on the space and resources we currently allocate to a little over three hundred million Americans. In that same timeframe we will grow as a world population from seven billion to almost ten billion, and within that ten billion, almost five billion looking to develop from an impoverished or semi-impoverished standard of living to a "nearly-Western" standard of living. The demand on resources will challenge every facet of our society, and will cause us to innovate and push boundaries in order to maintain or grow our standard of living. We can either continue the cycle of expanding the freedom of one segment of the population while limiting the freedom of another, or we can make smarter choices. We can create a truly free world, where lack of access to clean water, clean air, and clean earth no longer constrain the ability of any individual to make choices that will better their lives.
It starts with our choices now. It starts with recognizing that the freedom to make bad choices does not mean that it is ok to make them. It starts with our most trusted professionals standing up and refusing to participate in any decision that will limit the freedom of a human being. Almost anything we do to ourselves and for ourselves gets reviewed, approved, and certified by a medical professional or an engineer. If medical professionals and engineers not only refused to endorse decisions limiting quality of life and freedom, but also called out those making the decisions, we could stop detrimental behavior within five years and begin restorative action within this generation. Holding those professionals to those standards starts by each one of us holding ourselves to a higher standard, and accepting the real definition of freedom…the absence of necessity, coercion or constraint in choices…and making sure we are working for the freedom of all.
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