Part 1: The Mission
To understand why it is important to identify and consider the ethical implications of decisions made in the field of science and risk communication.
- To explain the difference between the utilitarian and deontological ethical frameworks.
- To be able to use these frameworks to discuss ethical issues in the context of real-world scenarios.
Ethics are norms, standards, or expectations that can be used as a guide for making any decision that might result in harm, or as a framework from which to retrospectively judge past decisions and actions. Ethics tends to be a neglected area in science, particularly in the field of science and risk communication. Some might argue that this is because people think that communicating can’t cause significant harm compared to more physical or direct interventions, such as performing a medical procedure. However, philosopher Dr. S. T. Gardner argues that the more plausible explanation is that people, in general, don’t take ethics seriously enough because they don’t understand what ethics truly are. ‘Who you are is what you do. From the playground to the grave, every action contributes to your creation. Nothing can be undone.’ – S.T. Gardner Most people think that ethics are primarily used for preventing harm to others, and given that most of us live in countries where the rule of law and other institutional policies are in place to prevent and mitigate the harms that we might cause one another, ethics is often perceived as largely irrelevant. This perspective misses the point entirely. Ethical decisions — which all of us make every day of our lives — are the most important choices we will ever make because they are about who we are and who it is that we want to become.
Ethical frameworks for decision making
There is no single ethical standard. Rather, there are a variety of different ethical perspectives or frameworks that have been developed to tackle potentially harmful scenarios. The two predominant ethical frameworks are utilitarianism and deontology.
In utilitarianism, whether an act is or is not ethical depends on the mathematical balance of the benefits versus harms. The ethical choice is the one that results in the greatest good for the greatest number of people.
Deontology, on the other hand, is a negative limiting framework — it does not tell you what you should do, but rather outlines what you ought not do. Specifically, under this framework it is never ethical to treat another person as a means to an end; one should always treat another person as an ‘end-in-itself’. In other words, you must never treat another person in a way that you, yourself, would not want to be treated.
The trolley problem is helpful to illustrate the difference between utilitarian and deontological ethical frameworks.
You are on a bridge overlooking a track on which there is a runaway trolley. The trolley is headed toward five people tied to the train tracks and unable to move. You are standing next to a lever and if you pull the lever, the trolley will divert to another track were a single person is tied down. The utilitarian will pull the lever and intentionally kill the one person in order to save the five. In a second scenario, the trolley is still headed toward five people tied to the track. This time, however, there is no lever, but there is a very large man who, if pushed onto the tracks, will stop the trolley. For a strict utilitarian, this shouldn’t make any difference; it would, though, for a deontologist. Pushing the man onto the track would be using him as a means to an end, so a deontologist would not push the man.
It is important for you to know which ethical framework you use in any given situation because you will need to use that framework in order to justify your decisions — not only to others but, perhaps most importantly, to yourself. The framework you choose will be highly dependent on the specific situation that you are dealing with. That being said, although public health might be viewed as being utilitarian in nature, many are more comfortable with the deontological framework as few of us would ourselves consent to be treated as means to an end. As well, since the utilitarian framework is outcome-focused (the greatest good for the greatest number) it renders any decision intrinsically problematic as it is not at all clear who decides what is a “good” or who/what ought to be included in any ethical calculus, to say nothing of the fact that it is difficult in principle to predict all of the short- and long-term consequences of any given action. A utilitarian also has the added burden of often being viewed as arrogant and highly paternalistic in the sense of assuming that her decision-making capacity is superior to those whose choices they potentially override.
The deontological framework, which is intent-focused (i.e., primarily concerned with the intent of the decision-maker); however, is not problem-free either. The core assumption of the deontological framework is that a human being’s self-conscious rational nature is of supreme value and therefore, for any decision, we ought to reason together so as not to override anyone else’s autonomous choice. However, this background assumption that all parties will engage in an issue in an impartial, objective, and rational manner seems naively optimistic. Even Immanuel Kant, the father of deontology, recognized that, aside from our rational nature, we also have to deal with humanity’s ‘sensuous’ nature. Thus, it is not at all clear how we proceed once it becomes evident that an individual’s rational nature seems out of reach, particularly when issues of emotion and identity are involved. Additionally, what if you are dealing with a scenario in which those involved are harming others? In these scenarios, should one switch to a utilitarian framework, try a combination of utility and deontology, or continue valiantly to invest efforts to reach a cooperative, reasoned solution?
There is a famous story from World War II that vividly demonstrates how a clash between deontology and utilitarianism can lead to situations in which agonizing decisions need to be made. Since the start of the war, the British had been working to crack the secret code that was used to encrypt German communications. This was part of the all-out war effort as the British believed that they would only be able to rebuff a German invasion if they had an advanced warning of where the Germans would attack. The British were successful in cracking the German code, but after they had succeeded in doing so, they intercepted a German communication giving orders to bomb the city of Coventry in the UK. Churchill was thus faced with the choice of whether to scramble the British Air Force in an effort to save Coventry but, in doing so, reveal to the Germans that their code had been compromised or do nothing. Churchill ended up deciding to keep the message a secret and leave the people of Coventry to their fate. The town was decimated, and 554 people were killed. Churchill’s decision could be justified using a utilitarian framework, as the fact that they were able to crack the code and keep it a secret may have been an integral part of the Allied victory. A deontologist, however, would view the decision with dismay as the people of Coventry were clearly used as a means to an end — a fact that, no doubt, weighed heavily on Churchill’s mind.
Identifying potential ethical issues in communication scenarios
An ethical issue might be described as any situation in which a human decision might result in harm. However, identifying ethical issues in science and risk communication can be a challenge. Many assume that accessing a set of guidelines or commandments is all that is needed to avoid ethical quagmires in their work. This is impossible because communication ethics (or any ethics for that matter) are highly situation dependent. It is impossible to provide a prescriptive approach that will apply to every possible scenario. Rather, ethics requires that all decision-makers engage in deep thought and be prepared to take responsibility for all decisions that they make. Ethics are thus best learned through thoughtful practice. The following are examples of scenarios in which ethical issues are identified and discussed.
From 1932 to 1972, the U.S. government sponsored the Tuskegee Syphilis Study to better understand the clinical course of untreated syphilis among 400 African American men. The men were misled, and not informed of the true purpose of the study and therefore did not consent to participate in the research and were not given treatment even after it was determined, in 1947, that penicillin could cure the disease. A utilitarian framework could be used to justify this research on the assumption that the knowledge generated would help more than the 400 people harmed during the study. A deontological approach would consider the study as having used these men as a means to an end, and would determine that the actions of the researchers was not justified. Indeed, in 1972 an Advisory Panel concluded that the Tuskegee Study was “ethically unjustified”, citing that the knowledge gained was limited as compared to the harms and risks experienced by the subjects and their families.
Most science and risk communication efforts are intended to persuade the audience to change their thinking and/or action. However, at some point you can cross the line from persuasion into manipulation. Utilitarian ethics would tell us that manipulation could be justified if its benefits outweigh its harms. Deontology, however, would tell us that any interchange in which we purposely obstruct someone from making their own rational decision would not be justified. The problem is that the line can be hard to identify. If you lie or withhold information in order to force your audience to make a specific decision, then this would clearly not be justified under a deontological framework. However, what about using emotion as a tool to sway your audience? This 1987 Grim Reaper-themed AIDS campaign from Australia uses fear to convince people to take steps to mitigate the spread of AIDS. Is that OK?
Childhood vaccination is mandatory in several European countries with financial penalties for non-conformance and there are few non-medical exceptions. This policy can be justified under a utilitarian framework given that it has been shown to reduce the incidence of vaccine-preventable diseases, such as measles. What would a deontologist think about this situation? Perhaps a case could be made that every possible effort should be made to communicate and compromise with parents who will not vaccinate their children prior to removing their right to choose. The urgency to communicate is particularly great given that forced vaccination could be viewed as akin to physical assault, and thus could constitute a significant harm in and of itself.
The varying approaches that different jurisdictions have taken about making masks mandatory during COVID-19 demonstrates the push and pull between the utilitarian and deontological frameworks. Some areas have made masks mandatory in public spaces because they view the cost of forcing people to wear masks as being outweighed by the benefit of preventing the spread of COVID-19. Other jurisdictions are concerned that their citizenry may view such authoritarian policies as an unacceptable transgression on the decision-making power of individuals, and have, instead, relied on communication to elicit voluntary compliance. Interestingly, the clash between these two perspectives seems to be less keenly felt in highly integrated societies as citizens in such societies tend to perceive decisions made for the good of community as also being good for themselves, and thus not as an egregious transgression on their autonomy. This demonstrates how ethics can vary not only by issue but also by context and audience.
Words are not so innocuous
by Riley Golby (SPPH 552 2020W1)
When scientists understand and recognize their influence over a target audience, the ethical implications of their message becomes increasingly paramount. The clinician who consents their patient for a procedure uses a shared-decision framework that preserves the autonomy of the individual – an authoritative medical opinion is provided, but ultimately the purpose is to equip the patient to arrive at a choice consistent with their values. This process exists because the intervention has risks, benefits, and implications to the future well-being of the patient that are perceived too important to be decided paternalistically.
Interestingly, communication of risk occurs mainly in the absence of consent in a more unilateral direction from scientist to audience. Perhaps the unspoken premise is that somehow words and information are perceived to be more neutral or innocuous than a particular procedure or treatment – presented in a way free of bias, in a factual manner. Within the era of Covid-19 this notion is easily disputed.
The current interrupted expansion of unfiltered, often contradictory information is unavoidable. The enormous magnitude of communication could be viewed as paralysing if the public response was seen to be apathetic; however, vocal experts – self-declared or otherwise – have espoused messages that trigger dramatic shifts in population-level behavior akin to rapid offloading of shares during a stock market crisis. This era-defining pandemic has created a particularly captive audience and it is prone to influence.
When scientists are met with such an audience, it should prompt a re-examination into the ethical implications of their message. Consider an extreme example to illustrate this point: On March 21, 2020 President Donald Trump provocatively declared that Hydroxychloroquine will be a ‘game-changer’ in the fight against Covid-19.
Most people would not consider President Trump to be a scientist. Still, I find this tweet to be an excellent portrayal of how ethical considerations relate to risk communication. He was incorrect in his assessment of this medicine and has caused enormous harm, not the least of which includes the millions of dollars and extensive resources necessary to reverse the public narrative surrounding it.
But what if he had been correct? If the sudden prescription to thousands of citizens had stopped Covid-19 in its tracks, preventing over 200,000 deaths? The utilitarian might argue that this was a justified tweet even if it was more prophetic and politically motivated than from actual sound evidence. In the end his message was ethically unsound and caused harm despite the message being about minimizing harm. The deontologist would probably conclude that President Trump’s intent was not fueled rationally, objectively, or impartially and so the ethics for proposed use of this drug were tampered with from the beginning.
I think one of the central messages is that ethical considerations in risk communication are akin to balancing measures in quality improvement. Namely, have I considered what the unintended consequences of my message could be on the population of interest? It’s certainly clear to me that words are not so neutral when the audience is attentive.
- Estimating the ethical implications of your decisions is important because these choices will define who you are as a communicator and a human being.
- Ethical decisions should be made and justified on the basis of specific ethical frameworks.
- The two most common frameworks are deontology (which is intent-focused) and utilitarianism (outcome-focused).
- The utilitarian framework is focused on creating the greatest good for the greatest number of people, while the deontological framework is focused on not using others as a means to an end.
- sir-winston-churchill-396973_1920 © skeeze from Pixabay is licensed under a CC0 (Creative Commons Zero) license
- Private: Fig 1.4.1 Photograph of Participants in the Tuskegee Syphilis Study (NARA) © National Archives is licensed under a Public Domain license