The essay "Ethics of Living and Dying" talks about the iatrogenesis which is often caused by medical error or negligence, instrument design, social control (in cases of psychotherapy), medical anxiety, and negative interactions between medications. Evidence points to iatrogenesis as a significant attribute of between 44,000 and 98,000 deaths in the United States per year, according to some estimates.
Given the large-scale incidence of iatrogenesis and the threat to life it poses for so many people, there are clear ethical implications for understanding the phenomenon. In bioethics, there are a number of normative frameworks from which thinkers may approach complex moral questions. In the case of iatrogenesis, it is often assumed that like other issues in medical ethics, iatrogenesis is grounded in the duty (or implicit contract) that healthcare givers allegedly have toward the patients receiving their care. However, an emerging perspective on the issue is emerging from virtue ethicists, who point to various characteristics of healthcare givers as either helpful or harmful in the incidence of iatrogenesis. The normative approach one takes, in this case, reduces to a more fundamental debate about which moral theory is more applicable to general sorts of cases, although iatrogenesis is a special bioethical issue. The purpose of this paper is to examine the implications of shifting away from a duty perspective to a virtue perspective in bioethics by examining the issue of iatrogenesis in particular. The moral concept of duty emerges strongly in 18th century German philosophy, especially with Immanuel Kant, whose three seminar works in moral philosophy laid the groundwork for an understanding of a so-called “rational” knowledge of ethics. Kant’s concept of morality is famous for describing the “categorical imperative,” which is a principle that is intrinsically valid, or good in itself. This is strongly connected to a notion of duty: that, for instance, a person has a duty to another intrinsically (or, performing the duty is good in itself). Because duties arise from categorical imperatives, they apply to all situations, and the consequences of our actions are morally irrelevant. In addition, they apply to all people, including members of the psychology, medical, and nursing professions. In their work, as well as in the personal lives, these individuals are morally bound, according to deontological theories, to the commitments naturally arising from the categorical imperative. The moral concept of virtue emerges centuries before Kantian deontology, most prominently with the works of Aristotle and his Nicomachean Ethics. Aristotle begins by setting forth the function of a human life, which is the achievement of excellence in one’s soul (or being). A human being who achieves the virtues (or excellences) will also be a fulfilled human being, which is taken to be a profoundly moral achievement. In addition, these excellences are not merely a pattern of action for the moral agent, but a series of habits (or a natural way of acting, aside from conscious deliberation). Ethical prescriptions, then, are not duties that one has to others (or to oneself), but rather the kinds of characteristics and habits that one should embody. The distinction at play between these two cases is that moral knowledge for Kant is descriptive (or capable of being laid out in written sentences as a