This article has been developed from the original work of Revd Robert Lloyd Richards who wrote the material for the MSc in Pain Management when he was a Senior Anglican Chaplain at the University Hospital of Wales NHS Trust and has now been updated.
The ancient Stoics has a maxim let Justice be done though the heavens fall. In this way, the Stoics expressed their view that Justice was an absolute value which could never be violated under any circumstances. Immanuel Kant (1724-1804) said that good will which acts out of respect for the moral law has absolute validity, that is, it is the most important human virtue .
The concept of absolute ethical values has had a bad press during the last 100 years, mainly because human mobility and population growth have eroded the universal consciousness required for absolute values to remain in force. Thus relatively stable or isolated cultures retain many more rules and moral principles than do more pluralistic societies. The decline of orthodox religious belief has weakened the sanction for absolute moral views based on the fact that they reflected the will of God.
At best, we can say that at a personal level, certain moral stands may be treated as absolute and this is reinforced if one shares the same moral view with others who cannot imagine a particular moral stance being compromised or changed. There may be a religious sanction or a cultural consensus for this. You may have some sympathy for the view that in order to get on with everyday life, when making decisions, some moral views must be treated as if they are absolute even though we know that they may be subject to change under some circumstances.
What are objections to absolutism?
The subjectivist argument. This objection to absolute moral values is based on the assumption that there is insufficient constancy in human nature to guarantee absolute validity to any particular virtue or value. Most subjectivists would argue that moral views are no more and no less than reflections of the psychological state of the speaker.
The relativist argument
This objection has two expressions. Firstly, that there is such variety in cultures and customs within cultures that there has never been and can never be universal agreements about moral norms. Secondly, that sets of values are relative through time as well as geographically. Thus perceptions of moral good may change over time, and because the moral norms of any age are all relative, to claim that for example it is just to do something today because it was just in a previous age is a non-sequitur.
The relativist objection to absolutism relies also on what we may call the Sociology of Ethics. This is a perspective based on the sociology of knowledge. Thus, ethics is interpreted as social reality, which is both shaped, by social conditions and view of the day and also which shapes in turn the social reality of the age. Most people would agree that ethics can not be divorced from the social context in which it operatives but relativists would say that ethics is only an expression of social reality. How far do you agree with this?
Anthropologists and cultural anthropologists in particular, have attempted to show that there are connections between particular cultures and ethical precepts. Some of the well-known giants of sociology such as Weber and Durkheim have provided much of the theoretical basis for such connections. For example, social change may bring about subtle changes in moral norms, such as the ideal of fidelity in marriage. At the beginning of the industrial revolution, lifelong monogamous marriage would entail a life together of less than twenty years. Today, with better health care and greater length of years, couples might have the potential for twice that amount of time together. At the very least, this changes what we mean by fidelity within marital relations and perhaps even within the institution of marriage itself.
A final objection to absolutism can be made on the grounds that any moral view that becomes absolute cannot be viewed from a critical vantage point beyond itself. Put simply, an absolute moral view may breed injustice through ‘legalism’ or ‘moralism’. Legalism is as much a mind-fix as it is a type of ethic. Taking what is perceived to be an absolute rule, further rules are prescribed for every conceivable situation where the rule may apply. Legalistic moralists tend to be fundamentalists, and inflexible, imposing the letter of law sometimes without regard to its spirit.
Moralism similarly is the excessive, rigid and generally inappropriate applications of morality. Bernard Williams , former Provost of Kings College, Cambridge, and writer on ethical social issues, notes that moralism can be seen as a deformation of morality. Its most obvious example is in imposing a moral stigma in a situation where it is unclear whether there is a genuine choice. Imagine that all vegetarians thought that everyone who eats meat was morally evil by virtue of simply choosing to eat meat. Moralism and fanaticism are often linked, though we are not suggesting that vegetarians are fanatics.
Rules and consequences
Deontology literally means the ‘science of duty’. The word today usually implies an ethical view that stresses the rightness of acts in themselves linked to duties and obligations that flow from the act itself. Deontological ethics are often thought of as ethics based on rules (or Law) because duties and obligations that flow from the rightness of an act are often codified.
In contrast, teleological ethics (telos meaning end or goal) concentrate on the rightness of an act in relation to its (good) outcome. Therefore, we would call someone who used a teleological ethic a consequentialist. The term teleological is very broad just as is the term consequentialism, but both are based on the assumption that the rightness of wrongness of an action depends entirely upon the effects that the action has. Utilitarianism, which we will look at in a little more detail later, is the most obvious as well as the most influential and pervasive consequentialist ethical theory. If we were to subdivide consequentialist ethical theories further then we can identify two types:
Hedonistic consequence theories hold that the rightness of wrongness of an act depend on whether the consequences are painful or pleasant;
Agathistic consequence theories hold that the rightness or wrongness of an act cannot be reduced to something else such as pain or pleasure; acts have to be judged simply on how much goodness or badness they produce.
Applying rules and consequences
So why is it important to maximise pain management in the surgical setting? Lets consider the views of the deontologist and the teleologist.
Deontologist: as a carer, I have an obligation to relieve pain and suffering and not knowingly by act or omission to inflict pain. The act that brings pain relief is the only moral action open to me. (By the way, Mike may have said something similar about Tom as he risked his life in the river, if he was a deontologist!).
Teleologist: I know that in the act of relieving pain, I am bringing about a more comfortable state for my patient and that must be good. I might not be too concerned about the way I bring about this result because making the patient more comfortable is my primary aim. (If Mike was a teleologist, he is motivated by the fact that Tom is his friend. Not to save him would result in great sadness for his wife and children, not to mention the tragedy of Tom’s death itself, so in he dives).
Before we move on we must note another kind of ethical theory, which again is probably difficult to find in its ‘pure’ or extreme form. Motivist theory holds that the rightness or wrongness of an act depends on the motive from which the act was done. Kant is probably the best example of a motivist ethical theorist and John Stuart Mill (a utilitarian we shall talk about in a moment) a good example of someone who rejected the idea that motive had anything to do with the morality of any action. He who saves a fellow creature from drowning does what is morally right whether his motive by duty or the hope of being paid for his trouble . The most obvious difficulty with an ethical theory based only on good motive is that the most terrible wrong may be done if the good motive is only the subjective judgement of someone whose ‘good’ motive turns out to be ‘bad’.
Do not confuse motivist theory with emotivist theory, which holds that moral judgements are neither true nor false, but merely reflections of those who hold them. Emotivist are not always easy to spot because they often wrap their arguments up in what appears to be moral theory, but on close examination turn out to be a collection of subjective assumptions. Lisson  gives us one definition of ethics as a systematic method of making value judgements upon human actions. Thus, at a practical level this makes ethics essentially a systematic method of resolving value conflicts.
What is the problem with this definition? Ethics is seen as having two functions, a means of arriving at value judgements and a way of giving primacy to one judgement when many are in competition. The problem first is that it is unclear how ethics works as a means of arriving at value judgement. In other words, there is no obvious theoretical basis on which to base an assessment of what ought to happen. Second, it is unclear how and on what basis judgements can or should be made between competing value judgements. Ethics by this definition is exposed as little more than emotivism.
- Kant, I., 1963. Fundamentals of the Metaphysics of Morals and What is Enlightenment. Trans. James Ellington. Indianapoligs:Bobbs-Merrill.
- Smart, J.J.C., Williams, B.Arthur Owe, 1973. Utilitarianism : for and against. Cambridge University Press, London.
- Mill, J.Stuart, 1954. Utilitarianism. London: Penguin.
- Lisson, E.L., 1989. Ethical issues in pain management.. Semin Oncol Nurs, Semin Oncol Nurs 5, 114-9.