Ethical Theory and Moral Practice

Ethical Theory & Moral Practice

Debates about theory and practice are ancient. Each generation considers the dynamics that surround issues about the interdependency of theory and praxis to be uniquely challenging. Complexity is a variable closely linked with knowledge. As science has added layer upon layer of knowledge, decision-making dilemmas have been confounded by new and staggering concomitant factors. In concert, theoretical frameworks for social science disciplines have been adapted to accept newly identified moral imperatives and ethical considerations.

This paper offers a discussion about the nexus of epistemology, ethics / morality, and praxis. An examination of the historical development of the paradigm and the assumptions of post-positivism is presented as an introductory foundation for the discussion. Next, is a discussion about ethical theory, followed by an exploration of the increasing division between philosophical frameworks and evolving modern science. Particular note is made of the theory-practice gap in healthcare, which stands in stark contrast to the apparent need for integration, given the substantive and compelling decisions that are now commonplace in the field. The application of ethical theory and moral practice to multiple disciplines is addressed in several sections of the paper, highlighting the relation with law, education, psychology, and other social sciences. Ethics in medicine and healthcare is a thread which runs though the body of the paper, in part as a heuristic, and also because ethical theory and moral practice are at the heart of medical science. The paper concludes with a retrospective on the axiological assumptions regarding ethical theory and the moral practice in medicine and healthcare.

Paradigm and Assumptions

This section provides some definitions of terms and basic philosophical orientation relevant to the subsequent discussion of ethical theory and moral practice (Musschenga & Heeger, n.d.). That the two distinct components are joined -- referred to as thought they are one construct -- is indicative of the interplay between the two conceits. Ethical theory and moral practice is a multidisciplinary and multifaceted theory that allows for almost any epistemological paradigm. However, post-positivism is a unifying epistemological paradigm in which ethical theory and moral practice may be grounded. Post-positivism, or post-empiricism, is a meta-theoretical position of critical theory that amends positivism. Post-positivism is meta-theoretical in the sense that it is a theory about theories. According to positivism, authentic knowledge is acquired through the senses, through experience, and through positive verification -- which is synonymous with empirical science.

Although post-positivists assert that knowledge is based on conjecture, they also tend to hold to the construct of objective truth. From a post-positivist perspective, extant knowledge can be challenged and constructed through scientific investigation, the process of which is driven by conjectural thinking. A variant of post-positivism, the popular notion of paradigm shift is fundamentally a critique of positivism which carries the ideas of post-positivism to the level of scientific worldview -- or more, loosely, to the popular zeitgeist -- a state vulnerable to alteration based on evidence.

The scientific method is not rejected by proponents of post-positivism -- nor do post-positivists discard the foundational positivist assumption of ontological realism. In other words, empiricism is healthy but limited. Practitioners should expand their locus of understanding about ethics and morality without becoming too rigid, as it is impossible to know anything with complete certainty.

The epistemological foundation of post-positivism undergirds the position of ethical theory and moral practice as valuing many different types of ontological input. In fact, a central tenet of the theory is that there is no one right or wrong way of looking at a moral issue. Post-positivism is not inherently ethical, but its axiology does suggest that values are almost always based on assumptions. It is impossible to measure or quantify value. Ethical theory and moral practice is multifaceted and welcoming of points-of-view that are undervalued or devalued in other fields, which makes the post-positivist axiological position an excellent fit for multidisciplinary endeavors. There are many ways of reaching the truth, and multidisciplinary inquiry is fruitful. The post-positivist position encourages the use of as many different methods as possible. From this, it can be seen that ethical theory and moral practice welcomes a range of diverse perspectives on issues related to applied ethics.

Ethical Theory in Modern Science

Ethical theory and moral practice have a direct and strong bearing on the social sciences. The theory comprises two distinct but interconnected components: theory and practice. The dual focus of ethical theory and moral practice give rise to a plethora of possible applications in the social sciences. Ethical theory and moral practice is a "remarkably heterogeneous" area and one that includes "many positions and theories, approaches and questions," ("Ethical Theory and Moral Practice: How do they Relate?" 2008).

The ethics component of ethical theory and moral practice has roots in philosophy, but is "rapidly becoming a field of disciplinary cross-pollination," ("Ethical Theory and Moral Practice: How do they Relate? 2008). In fact, philosophy alone no longer forms the fundamental foundation of ethical theory and moral practice, just as religion no longer forms a single foundation for a rational ethical theory. But, philosophy does offer the logic and rhetorical tools within which to frame an ethical theory. And from this base, "research is being done in biology, psychology and sociology, as well as in educational science," that can inform the totality of a moral code ("What Makes Us Moral?"). For this reason, an academic foundation in both Western and Eastern philosophical traditions can aid in the development of cogent ethical arguments. Those arguments in turn can inform moral behavior on the personal or community level. Moreover, philosophy of ethics helps social scientists present coherent arguments that underwrite policy and international law in order to reflect emerging trends in social justice.

There is always a double component to ethical theory and moral practice, after all. The theory must have in the end a moral practice application, one that is practical and hopefully measurable. While not all moral action or ethical theory can be measured empirically, the social scientist endeavors to make it so. Social science research that is rooted in ethical theory gives rise to unique hypotheses that might not bear fruit without a holistic understanding of philosophy. Those hypotheses also have real and practical applications in politics, economics, or social work. The cross-pollination of multiple fields also enables fruitful research in every area of the social sciences. For example, the introduction of ethical theory and moral practice in the area of psychology or sociology sparks questions related to altruism and benevolence outside of the context of religion. When ethical theory and moral practice are applied to biology, neuroscientists are better able to formulate hypotheses related to the organic underpinnings of morality. Applied to gender studies, ethical theory and moral practice can inform policy related to parity. The potential for future research is practically limitless, which is why ethical theory and moral practice is an emerging international trend in social science scholarship.

Ethics in real life. Beauchamp (2007) has explored the problematic relationship between ethical theory, which is a mainly intellectual and philosophical endeavor, and moral practice, which is the application of ethics to real-life situations. Bioethics is a field in which ethical theory and moral practice are particularly salient. Specifically, Beauchamp's (2007) review of the literature examined the role and relevance of ethical theory on healthcare practice. The primary questions Beauchamp sought to answer emphasized the relation between professional healthcare endeavors and philosophical theory. As practitioners and the public become increasingly conflicted about both the potential benefits and problems inherent in healthcare, there is a growing awareness about the tension between ethical theory and moral practice. The idea of bioethics existing without a philosophical underpinning is sobering, and certainly brings to the forefront concerns about the dangers of abandoning theory altogether (Beauchamp, 2007).

Gastmans (1998) employed a philosophical-ethical interpretation of nursing in order to present a comprehensive view of nursing from the perspective of ethical theory and moral practice. Gastmans reviewed the literature with an eye toward exploring the evolution of the theory of care in the nursing field. A particular goal was to determine the role played by ethical theory and moral practice on this evolution. Ethical theory and moral practice became especially relevant in the nursing profession because of the evolution of the theory of care, which transformed nursing from a pragmatic profession only to one imbued heavily with ethical merits and concerns (Gastmans, 1998). The "fundamental ethical view on nursing care considered as moral practice" makes ethical theory and moral practice meaningful to the healthcare professions (Gastmans 1998, p. 43).

An important issue that Gastmans targeted was if it is even possible to distinguish ethical theory from moral practice in the field of nursing. In pursuit of clarity regarding these objectives, Gastmans reviewed the philosophical works of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. The study findings demonstrated illustrate a strong relationship and absolute relevance between ethical theory and moral practice and the nursing profession.

The work of Beauchamp (2007) and Gastmans (1998) is consistent with the methodological assumptions of the epistemological paradigm of post-positivism, which suggests that knowledge is imperfect, subject to revision, and not at all objective. Their work shouldn't be interpreted as a move to jettison the pursuit of objectivity, however. Rather, it is an effort to identify how "to triangulate across multiple fallible perspectives" (Trocham, 2006) in order to achieve objectivity. According to Trocham (2006), objectivity can be obtained through the efforts of many individuals -- through the conscientious critique of science by truth-seekers in their respective fields -- and not by any one individual. Trocham reminds the reader that "[w]e never achieve objectivity perfectly, but we can approach it" (2006).

Empiricism -- as a methodological assumption of the epistemological paradigm -- is a limited means of acquiring truth and knowledge. Therefore, an exploratory review of literature is an apt choice. Gastmans (1998) and Beauchamp (2007) reveal ethical theory and moral practice to be a refreshing perspective that can heal many of the current rifts in the healthcare industry, and especially within bioethics. A cohesive vision, such as that presented by Beauchamp and Gastmans, is both necessary and desirable in healthcare in which ethical theory cannot be distinguished from moral practice. Theory without practice has no relevance; moral practice without theory has no guidance.

A widening schism. Ethical theory and moral practice is a hybrid construct that melds the historical, theoretical base of ethics with the ever-changing demands of contemporary praxis. This new construct -- termed ethical theory and moral practice -- seems rooted in the perception of an evolving schism between theory and practice in a number of scientific fields. For instance, the relationship between bioethics and philosophical ethical theory has been described as "contingent and fragile" (Beauchamp 2007, p. 209). Certainly, there are examples where practitioners are able to condition their work on the basis of the philosophical theories prevalent in their field of endeavor, but it is becoming increasingly apparent that philosophical theories can be neatly severed from their application in clinical practice.

According to Beauchamp (2007), published literature in the field of bioethics from over the course of the past twenty-five years illustrates a "successful and stable marriage" between philosophical ethical theory and applied ethics in multiple fields including healthcare (p. 209). However, "the marriage is troubled. Divorce is conceivable and perhaps likely," notes Beauchamp (2007, p. 209). The philosophical works of Ruth Macklin, Norman Daniels, and Gerald Dworkin were dominant in Beauchamp's research. Beauchamp's research conclusion was that the work of these major philosophers reveals a potentially dangerous schism between ethical theory and moral practice. The danger is especially acute in the healthcare industry because the implications of the gap have a profound impact on the lives of individuals.

Bioethics may be morphing into a "more interdisciplinary and practical field," whereas, ethical theory may retreat into the realm of the lofty philosophy department (Beauchamp 2007, p. 209). Musschenga & Heeger (n.d.) argue that what is needed is an amalgamation of "theoretically relevant 'practical' ethics and practically relevant 'theoretical' ethics" such as that described by Beauchamp (2007).

Ethical theory and moral practice has emerged as a salve to reduce the cognitive dissonance between the theoretical ideals and the practical realities -- as such, ethical theory and moral practice is a bridge spanning the theory-practice gap.

Symbiotic mutualism. Ethical theory and moral practice is a relatively new and emerging theory that attempts to thoroughly synthesize and integrate both theory and practice. In organic terms, ethical theory and moral practice can be thought of as symbiotic mutualism -- an arrangement in which benefits accrue to both through their association. This configuration is preferable to a symbiotic commensalism in which one side benefits from the association, while the other does not benefit or, at least, is not harmed.

Lines of distinction. Ethical theory and moral practice are distinct from applied ethics. Although applied ethics is similar to ethical theory and moral practice, in that both are concerned ultimately with the impact of theory on clinical practice, applied ethics resembles more what Beauchamp (2007) refers to as the "interdisciplinary and practical" field of bioethics (p. 209). Bioethics and applied ethics share in common a specific focus on issues that are definitively and unavoidably controversial. This would rule out ethical theory as an exploratory philosophical discipline, and precludes scholars from pursuing abstract lines of thinking to create best practice guidelines. Ethical theory and moral practice recognizes the weaknesses inherent in completely distinguishing theory from practice.

The most fundamental assumption posited by ethical theory and moral practice is that "distinctions between theory and practice are, to a large extent, artificial" (Musschenga & Heeger, n.d.). It is, however, increasingly difficult to define this separation as advances in science and technology pose decisions of such caliber that they are intrinsically and heavily-weighted by ethics and morality. This is especially true in the social sciences, nursing, education, and other fields in which daily decisions are unavoidably moral decisions. The effectiveness of professional choices related to counseling and related practices depends directly on awareness of ethical theory. It would be impossible to make choices that impact the lives of others without taking a moral or ethical stance. Although some issues have more controversial implications, such as abortion or euthanasia, nearly all moral choices made in a clinical or professional practice are on some level moral ones. Thus, another key assumption of ethical theory and moral practice is that best practices in all social science fields are linked to morality.

Theory informs moral practice. Without negating the importance of theory in developing best practice methodologies, theory depends on moral practice in action -- essentially, theory informs a moral practice. Another core assumption of ethical theory and moral practice is that the social sciences are replete with ethical and moral issues. This is as true for education as it is for psychology. For example, it is impossible to treat patients in a clinical setting without ascribing to the rules of moral practice such as confidentiality and informed consent. It is also impossible to develop school curricula without making moral choices about how to best teach children the tools with which to become responsible adults. Theory provides a framework by which professional organizations like the American Psychological Association or private institutions such as a hospital craft their ethical policies. It is rightly assumed that ethical issues within the social sciences must be addressed from the level of theory.

Interdisciplinary vectors converge. Ethical theory and moral practice are applicable to all social sciences fields. The capacity of ethical theory and moral practice to be applied to fields as disparate law, sociology, and medicine makes it possible for philosophical theory and moral practice to coexist comfortably, neglecting the importance of neither one -- as in the symbiotic relationship discussed above. Education, psychology, and criminology all benefit from a rich body of philosophical work coupled with a thorough integration of theory and practice. Ethical theory and moral practice enables what cannot be accomplished via normative ethical theories alone, or by evidence-based practice alone.

Ethical theory and moral practice "seeks interdisciplinary cooperation between ethics, theology and empirical disciplines such as medicine, economics, sociology, psychology and law," (Musschenga & Heeger n.d.). The central problem that ethical theory and moral practice addresses may be what Beauchamp (2007) calls the problem of practice itself. In the healthcare fields, the problem of practice is especially apparent -- it is a problem of omission. "The actual moral difficulties and issues presented in health policy and the health professions when decisions must be made about a proper action or policy," (Beauchamp 2007).

The theory is therefore broad in scope. Ethical theory informs moral practice in potentially any field. Moreover, virtually any aspect of ethical theory can be applied to any field. Ethical theories such as utilitarianism are built into the frameworks of professional codes of ethics, and they necessarily impact daily practice. Debates about ethical theory have a strong bearing on the social sciences, especially psychology. For example, Merritt (2000) responds to a recent trend in psychology in which virtue ethics are dismissed with a "deflationary challenge" to their merits (p. 365). Merritt (2000) argues that virtue ethics, such as those developed by Aristotle and Hume, have a strong bearing on psychological behavior and should not be discounted. In fact, the implications of virtue ethics on the psychological professions range from how the criminal justice system addresses issues such as rehabilitation.

The scope of ethical theory and moral practice is sufficiently broad to cover civilian and military law. Snow (2009), for instance, refers to the application of Stoicism as an ethical theory on the moral practice of soldiers. In particular, Snow (2009) discusses the implications of ethical theory on the Abu Gharib incident in which American soldiers tortured prisoners in Iraq. Examining the soldiers' behavior in light of ethical theory helps to reframe the issue, understand how to properly prosecute the offenders, and how to develop more robust systems of leadership and accountability within the military. Moreover, ethical theory can also help with issues such as how to counsel military officers under stress. Ethical theory and moral practice would be able to help military officers develop policies and programs that are just and in accordance with the law.

The law is a central topic of discussion within ethical theory and moral practice, because the law is essentially ethics in action. The legal system is continually in need of theoretical foundations upon which to base its tenets for criminal and constitutional law. Ethical theory is directly linked to the moral practice of law, especially with regards to issues such as due process. However, ethical theory becomes even more important when unjust laws need to be exposed for their immoral cores. The abolition of slavery, the political enfranchisement of women, and other legal watersheds were initially dependent on the application of ethical theory to moral practice.

Theory-centric threats. There are a plethora of normative principles at play in ethical theory and moral practice. Personal benefit, social benefit, the principle of benevolence, the principle of paternalism, the principle of harm, and principles of autonomy and justice are but a few of the normative ethical questions related to fields like bioethics (Fieser 2009). To take these normative ethics issues and apply them to the social sciences, helping professions, or education is the main goal of ethical theory and moral practice. Ethical theory alone is too abstract to be of any use. As Hamalainen (2008) claims, ethical theory is potentially harmful for "sound moral thought and practice" (p. 539). The potential drawbacks of a theory-centric approach include rigidity and inflexibility. A theory may be completely out of touch with the needs of patients, students, or clients. For instance, Berger, DeRenzo & Schwartz (2008) researched the disconnection between ethical theory in medicine and the moral practice of surrogate decision-making. Ethical theory and moral practice can heal the perceived gap between a theory created in a vacuum and a theory that has practice merits.