PROGRAMA DE RELACIONES COMUNITARIAS

Kant is considered as the most significant Western philosopher since Aristotle and the Greek tradition in philosophy ranging from Plato, Socrates and Epicurus. Kant is believed to be the founding father of the concept of autonomy, both in the European and the Anglo-American context. Beauchamp and Childress explain that respect for autonomy flows from KantÕs recognition that Òall persons have unconditional worth, each having the capacity to determine his or her own destiny. To violate a personÕs autonomy is to treat that person merely as a means, that is, in accordance with otherÕs goals without regard to that personÕs own goalsÓ.41 Indeed, Kant has inspired and still inspires many debates in health care and public health, perhaps also because of his views on duties, obligations and responsibility, concepts which are so prone in debates on freedom and communality in health care, public health and in society at large; some authors inspired by Kant will reappear in this chapter. KantÕs philosophy has been interpreted in terms of autonomy, self-determination, integrity and privacy amidst the other thinkers of liberalism such as John Stuart Mill and John Locke. This interpretation is a very narrow conception of the philosophy of Kant. Such a narrow conception fits the instrumentalization and rationalization in contemporary society and medicine, but is not adequate. The central problem Kant was working on was on bridging the moral choices of the individual and the community, the secular and faith based systems of right and good, and the persons in power in society Ð including professionals in health care and public health Ð and the citizens in the community at large.

The following case presented by Bernard Williams in his moral luck debate with Thomas Nagel, and further discussed by Donna Dickenson42 might help to introduce KantÕs philosophy:

A traveller into a South American market square, Jim, meets Captain Pedro who is about to execute twenty Indians. Pedro offers Jim a chance to save all the Indians but one, whom Jim must kill with his own hand. If Jim refuses, Pedro says that all the executions will proceed; if he assents, Pedro promises that the other nineteen Indians will go free.

Interestingly, Williams concludes, rather grudgingly, that the utilitarian prescription Ð that Jim should kill the Indian Ð is right in this case, but not for the conventional utilitarian reasons. Those who wants a more contemporary example may choose the example of the policeman and the terrorist and ask whether it is allowed to torture the terrorist in order to find out information about a bomb which certainly will take the lives of many innocent citizens. In any case, a Kantian could and would argue, as many interpreters of KantÕs philosophy have concluded, that Jim should not shoot one of the Indians to save the others.iv

iv

Kant discusses these issues in his essay: ÒOn a Supposed Right to Tell Lies from Benevolent MotivesÓ. (see in: Abbott T.K. (trans.) KantÕs Critique of Practical Reason and Other Works on the Theory of Ethics. London: Longmans, Green and Co.). In this essay Kant asks whether you should tell the truth to someone who comes to your door asking if someone who he says that he wants to murder is inside. Yes, says Kant, and up to now many philosophers, sympathetic to KantÕs philosophy, are struggling with this case, with the intent of Ôtrying to rescue

How should ethics deal with such a case? Kant gives two answers. His first answer is the categorical imperative expressed as follows: ÒAn action is morally right for a person in a certain situation if and only if, the personÕs reason for carrying out the action is a reason that he or she would be willing to have every person act on, in any similar situation.Ó

In this respect, two criteria are at stake:

1. The personÕs reasons for acting must be reasons that others can act upon, at least in principle (a principle has to be universal);

2. The personÕs reasons for acting must be the reason he or she would be willing to accept when applied to his or her self (a principle has to be reciprocal).

The fundamental tenet of KantÕs philosophy focuses on the interior features and not on the consequences of an individualÕs external actions. Moral right and wrong do have to be distinguished according to Kant not by what a person accomplishes as such, but by the reasons a person gives for what he tries to do. We can easily understand from the case above what Kant had in mind: the outcome of JimÕs action Ð either accepting or refuting the offer of Captain Pedro Ð is not less good (if considered as good) or not less wrong (if considered as

wrong), if Captain Pedro would shoot the Indians whatever way Jim decided.v

The second answer Kant gives is his tenet for Òtreating humanity as an endÓ, which can be expressed in the following principle: ÒAn action is morally right for a person if, and only if, in performing the action, the person does not use others merely as a means for advancing his or her own interest, but also both respects and develops their capacity to choose freely for themselves.Ó

Two criteria are involved here as well:

1. Respecting each personÕs freedom by treating others only as they have freely consented to be treated beforehand;

2. Developing each personÕs capacity to freely choose for him or herself the aims he or she will pursue.

Thus, we might discuss the case of Jim and Pedro in terms of whether JimÕs freedom was respected. No, Kant would say, not because Jim had no choice Ð he was given a choice Ð , but because PedroÕs offer included no moral choice set on KantÕs terms.vi

The crucial thing Kant is saying is that it is not good outcome but the intrinsic features of the action themselves which determine whether actions are morally right or wrong: a personal

v

This has been debated in philosophy under the label of the Ômoral luckÕ banner, which is only one of the aspects Kant worried about, he was much more interested in the Ôother side of the medalÕ, namely in those cases where the outcomes were good, but not due to external contingencies, but due to ÔinternalÕ dispositions, being a crook, a Samaritan, or whatever, but NOT following the duty of the moral law: the paradigmatic case here is all those in power who always claim that a certain policy is the right thing to do in terms of what is ÔgoodÕ to do (and not ÔrightÕ or ÔjustÕ).

vi

The issue, as discussed by Dickenson (see Moral Luck in Medical Ethics and Practical Politics. Hants: Gower Publishing Company Ltd, 1991, p. 5), is that Kant is concerned with the question that there is a Òquintessential form of value, moral value, which is ÔunconditionedÕ, that is free from external contingency; but other

contingencies have to be considered, such as Ôconstitutive luckÕ, that is, good fortune in having the ÔrightÕ or the most praiseworthy inclinations, abilities, or temperament (p. 5) Ð say Jim had the moral luck for doing the good thing because he was lucky enough for his character. Again, this passes thepoint Kant was trying to capture, i.e. to do good by doing right or just (in particular for those who are in power).

promise, a debt to another person, a relational feeling such as in a parent-child, brother-sister, or friendship relation or the fairness of distribution do carry their own intrinsic features. Friendship includes that one should not give up one friend in order to gain two other friends. PedroÕs action to shoot one Indian in order to rescue the others is not better or worse considering his state of mind, being a Samaritan (because of its nature of character or his Spartan education to fear nothing or his religious belief to do only good things). Kant vehemently opposes the other grand tradition in ethics, namely the consequential or utilitarian ethics, which says that the right action for a particular occasion is the one that produces greater utility than any other possible action. In the case described above the best action to do then is not that which produces the most utility for the person performing the action nor that action which produces the most utility for all persons affected by the action, including the person performing the action. That Kant opposes utilitarian philosophy is important for two reasons: one is that Kant is particularly focusing on the problem how an individualÕs and communityÕs moral life can be enriched intrinsically; the other that Kant builds his philosophy on the Aristotelian virtue ethics: KantÕs work is much more on moral character instead of rigid duties and obligations as many have interpreted Kant.

KantÕs central notion therefore is not autonomy as such, but human dignity, reason and responsibility. Kantian ethics directs the individual to associate with and speak out in the community, thus not focusing on a liberal, atomistic view of individuals, but on a social self that lives in and through the community. Reversely, Kant was very much interested in how communities could enrich themselves. The paradigmatic case here is the bonding of parents and children in order to let the children leave those social bonds and find their own yet new social bonds.

Most philosophers have interpreted KantÕs philosophy as a universalistic, deontological ethics. However, KantÕs philosophy is not strictly deontological as many have interpreted. KantÕs search for ethical principles is not a search for (universal) features of human beings. Rather is it a search for how ethical systems have to be constructed. It is not the state of mind

of Pedro which decides on the goodness of his actions (whatever way he would have decided: either to reject or to accept PedroÕs proposal). So it is not the internal disposition of the ethical agent per se which counts, it is the practice and the ethical fabric of this practice which is decisive. One way to clarify this is to look at the example of the police officer shouting at a skating girl: ÒThe ice over there is weakÓ.vii _{Who wants to understand what the police officer} is doing here has to focus on what the police officer is doing, namely warning! Crucial to the acting of the police officer are not intentions Ð the officer might be in a good mood, the skating girl is her daughter or the officer is driven by philanthropy, sense of duty, or stickling for regulations and discipline. Perhaps there were no intentions at all. Instead, the kernel here is the practice of warning: its style, conventions, rules, etc. The warning itself is considered by Kant as an action with moral worth, neither because the police officer has good intentions nor because the warning produces the wished for result by saving the girl. Whatever result and whatever accompanying dispositions of the officer in warning the skating girl, WARNING (in such circumstances) is by itself an ethically sound practice.

KantÕs philosophy is indeed universalistic in the sense that his universal principle of right, in conformity with his categorical imperative, says: ÒAny action is right if it can coexist with

vii

See for such a very apt analysis of ÔrulesÕ and ÔrationalitiesÕ of practices: De Vries G. Zeppelins Ð Over filosofie, technologie en cultuur [Zeppelins Ð About Philosophy, Technology, and Culture]. Amsterdam: Van Gennep 1999, p. 132.

everyoneÕs freedom in accordance with a universal law, or if on its maxim the freedom of choice of each can coexist with everyoneÕs freedom in accordance with a universal law.Ó But mostly, it is neglected that the second and most important aspect of this universalism, is in fact the reciprocal feature of the categorical imperative. If I am willing to claim that people should not eat fat because they show risky health behaviour, other people might ask for reasons why I show my own sort of risky behaviour, say being very ambitious and leading a stressful life. If someone argues that he or she does not want to live in a kind of world with people showing risky behaviour, other people can argue why they should live in a risk- averting world. Rights (and norms) are in KantÕs view relational affairs, but not only negatively. Property rights are relations between people, not only in the sense that other people are forbidden to trespass my home or that my home remains mine still when I am not at home, but they are also productive in social behaviour: I can invite people at my home, I can show hospitality, I can ask other people for having meetings to associate, and so on. Yet, most of our rights (and ethical norms), so Kant claims, are not strict and conclusive, but are mostly provisional. Kant is here quite modest, since he is dealing with the fundamental question who shall be judge of political right? In the absence of perfect divine judgment and of reliable judgment on the part of rulers, politicians, and public officials, Kant identifies the public sphere as the most important place to approximate perfect judgment on matters of right.

Thus, Kant is not a top-down but a bottom-up ethicist. His maxims or rules of conduct are Wittgensteinian sort of rules Òcontaining as much of the particulars of person and circumstance as the agent judges are necessary to describe and account for his proposed actionÓ.43 KantÕs ethical agents are not na•ve; they are embedded in life forms and practices. The man on the boat saving his wife knows that saving his wife matters to him, but saving her on a Tuesday is not relevant (but might be later on as a celebration day). This is the big difference with Rawls and Habermas. Saving as a practice has its own ethical fabric and is therefore not unconditional, e.g. by saving someone while throwing someone else overboard. In this way KantÕs moral philosophy is connected to his political philosophy. Any practice cannot be justified in terms of doing good (or preventing bad) only. The principles making up the ethical fabric of that practice have to be the right principles. Right in the sense that practices encourage citizen autonomy along with civil rights, rights of participation and the social basis of the use of these rights.

4.3.2 The first way: Doing good and the problem of instrumental