“I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm…”– Hippocratic Oath
These words, found within the oldest surviving version of an ethical standard, are attributed to the Father of Medicine and date back to Classical Greece. Passed down over two and a half millennia, to this day physicians continue to be administered a version of the creed. Most of us have come to know the oath by its unwritten essence:
Do No Harm.
Christians have their own, expanded corollary of this fundamental human ethic:
Do unto others as you would have them do unto you.
It makes perfect sense- without absolute knowledge that you are safe from the excesses of others, there can be no order, much less the basis for a progressive society. If you can’t trust your neighbor not to rob you, enslave you, or kill you then you are living in a state of constant fear… and fear brings about the breakdown of ethics. That credo goes something like this:
Do unto others before they do it to you.
With the loss of an ethical foundation, a vacuum is created, sometimes filled with chaos and the complete collapse of a civilization, more often times the vacuum is filled with the establishment of cultural morality. Then collapse slows… to a state of decay from within.
There would be those who will claim that an ethical society is based upon a bedrock of cultural mores. I would claim that not only do these poor souls have it backwards but they and their perception of the world are a dangerous part of the problem we face as a civilization today.
Saving the comparison of the differences between ethics and morality for another day, let us establish an easily understood and verifiable premise: ethics at their core are an expression of basic human rights, whereas morality is a function of culture and tradition.
Deep in the core of our being, we acknowledge this, even going so far as to verbalize it. We don’t say a person has bad ethics, we say that a person lacks ethics. Everywhere on the planet, there are basic, universal rules that permit a society to function within its own parameters and in its interaction with other societies. Theft is bad because it discourages stable wealth building and the rewards of innovation. Falsehood is bad because without the establishment of agreed upon, fundamental truths about reality there is no trust of institutions. Without that trust, there is no will to contribute to those institutions, either financially or intellectually.
Morals can have absolutely no basis in reality or the improvement of the human condition. Far from being universal, morality can shift into a polar opposite with the simple crossing of a border. One blatant example would be female circumcision, a practice considered to be such a foundational cornerstone of some societies that its greatest advocates are often the very women on whom it is performed.
Why is this such a vital component of the social order? Because women who don’t undergo the procedure might begin to display a sex drive, and women who desire sex can become promiscuous, which is immoral because they may want to have sex with someone other than their husband, which is bad because they are his property.
In our part of the world, we call this practice genital mutilation and people who practice it here go to jail. We find this distasteful display of misogyny to be immoral… because we see it as a form of torture.
You say tomato…
Which brings us full circle back to the cornerstone of our ethical reality- do no harm.
I’ve been doing a great deal of thinking about this idea lately and I believe that within this simple concept arises the solution to our divide. If we all established as the fundamental creed of our lives to do no harm to others, we could rationalize our way to consensus on a great many of the problems of our time. Problems that have been politicized and relegated to a “left verses right” stigma.
Of course, in the complexities of today’s modern civilization, it is impossible for anyone to not harm another person at some point in their lives, even in the most ambivalent manner. Does a woman buying a shirt in New York contribute to the denigration and poverty of another woman sewing that shirt in Bangladesh? Or does a fairly priced shirt purchased at wholesale and sold for a few dollars more at retail help to empower the seamstress and lift her family from poverty?
If we can’t keep the principle pure, perhaps instead of using that as a premise to abandon it (after all, ethics are hard to have, that’s why they aren’t morals), we should instead look to strive for the next best thing.
I present to all the Hippocrates Principle. It has two basic tenets:
- When at all possible, do no harm to others;
- In the circumstance that it is impossible to keep the first tenet, do the least amount of harm possible to the fewest number of people.
This is a very simple, easy-to-understand guideline but admittedly it takes both some thought and some flexibility in its application. However, the results can be dramatic. If politicians were forced to make their decisions based upon the Hippocrates Principle, imagine how easily it would be to come together on almost every issue. Even more so, imagine if their constituents based their vote upon the Hippocrates Principle.
This isn’t a wacky, leftist idea. In fact, the Hippocrates Principle is devoid of the concept of left or right- there is only correct. Decisions using the Hippocrates Principle are not driven by cultural morality, there is only ethic.
As an example of this process, I will offer up one extremely prickly and divisive subject for review- abortion and a woman’s right to choose.
Those who are against abortion have a strong belief in the idea that humanity begins at conception. For them, all human life is sacred and aborting a life at any stage of its development is unethical.
Although I have been a solid supporter of choice in the past, taking into account the Hippocrates Principle of doing no harm, I can empathize with this viewpoint. Let’s say it’s a correct viewpoint, life begins when a human egg is fertilized. In this case, I have to support the idea that abortion is the taking of a human life, the ultimate harm.
So, this means I may have to alter my perspective on choice.
Conversely, what motivates a woman to terminate a pregnancy? It is obviously a traumatic decision, not one taken lightly considering that the act will impact upon her life and the lives of those around her until her last day. There has to be a powerful incentive to make this choice.
Usually it’s age or poverty or both, statistics tend to bear this out. One million abortions are performed in the United States annually. Out of that figure, half of the women obtaining an abortion live below the poverty line, a two thirds are women in their teens or early twenties. Many have other children. Most discouraging is that a significant proportion of women have had more than one abortion.
One can extrapolate from this that most women who are having abortions are doing so for economic reasons. They are teens who realize that having a child will likely mean no high school diploma, no chance for college. That condemns her to a lifetime of low wage jobs and generational poverty.
For those women in their early twenties, the choices are the same. Many already live in poverty and many already have children. Another child would simply stretch limited resources even further and condemn the existing children to generational poverty as well.
It can be argued that even a hard life is better than no life at all, or that everyone in America has an opportunity to escape poverty if they work hard enough. Again, the stats don’t really bear out the latter- poor people overwhelmingly attend underfunded public schools and less than one in five get into a college (as compared with one out of three students in the general population). Even fewer graduate, many drop out not because of a lack of desire but because they can’t pay for a higher education.
If we drill down deeper into the stats, there are some other numbers that begin to stand out:
- States with the highest teen pregnancy rates also have the highest poverty rates among their populations;
- These states are the most restrictive when it comes to having clinics focussing on family planning; fewer than 10% of counties have such a clinic;
- The same states also have restrictions on sex education courses as taught in public schools. Some have no sex-ed requirements at all in their curriculum.
- While only 17 states mandate that contraception be taught in sex-ed courses, 37 states mandate that abstinence be stressed as the primary method and 26 as the sole method of birth control.
Anyone who can remember being seventeen will also remember why teaching abstinence as the primary way to keep from getting pregnant is a recipe for disaster. Evidently, the legislators in these states have selective memory.
There is the adoption alternative- the young mother can give up her child to a family who can provide the kind of care and life she can’t. This often works well. However, there are currently half a million children in foster care waiting for adoption. That can happen too. That child now is a financial responsibility of the state.
To carry that burden out further (and conservatives will appreciate this), poor people and their families are likely to be forced into utilizing social services such as food stamps, Medicaid, housing assistance, energy assistance, childcare assistance, etc. In fact, these social welfare programs (social security aside) make up around $1.5 trillion of the annual $2.2 trillion in social assistance budgeted by federal and state governments. It can be argued that poverty itself places such a financial burden on America as to be an existential threat that needs to be eradicated by any means necessary.
But that’s an argument for another day. Let’s summarize:
We have two valid points of view. One one side there is a fundamental belief that abortion is murder and that it should be prevented at any cost. On the other side are the consequences of allowing an unplanned fetus to come to term: loss of opportunity, generational poverty, continuous requirement for state funded aid programs that become a societal burden. While these would seem superficial, they impact deeply on many more lives than that of the mother and child.
Using the Hippocrates Principle, I would argue that if abortion (with some exceptions) is to be illegal, it must be a priority to ensure that the circumstances that can lead to this road must be reduced dramatically. The most important factors in achieving this goal would be:
- Education- it should be mandatory for all school systems to provide thorough, up-to-date information about all aspects of human sexuality; including methods of contraception and STD prevention and delineating local accessibility to contraceptives;
- Access- family planning should be a mandatory requirement for all community health centers, with access to low cost or free contraceptives for everyone;
- Privacy- physicians should have the ability to discuss family planning and contraceptive methods with any person who has reached puberty and can now conceive a child- without the knowledge or permission of that person’s parents or guardians;
- Responsibility- if society is going to freely provide accessibility to contraceptives and family planning educational services, the burden then falls upon the individual to utilize these tools and services- no exceptions.
This is a compromise that requires both sides of the argument to give up something. For pro-choice individuals, it means that they are surrendering easy access abortion for easy access family planning and contraception. For anti-abortion advocates, many of whom take this stand on religious principle and morality, they will have to accept a society that openly encourages family planning, the right to privacy, and easy accessibility to contraception for everyone.
This idea will not do away with abortion or unwanted pregnancy completely but what if it reduces both by ninety percent? What if, instead of one million abortions there were only one hundred thousand? In lieu of seven hundred thousand unplanned teen pregnancies, what if there were seventy thousand? How many lives are improved though these simple actions? How many fewer people are harmed?
With the Hippocrates Principle as our guideline, a better world awaits.