What are the differences between morals and ethics? Do both really play a role in healthcare, or should healthcare focus on one but not the other?
Knowing and owning the differences between morals and ethics and having optimal clarity on the wishes of patients and families can prevent ambiguity when the mammoth concepts of morality and ethics collide.
Understanding the Differences Between Morality and Ethics
The concepts of morality and ethics can get fuzzy sometimes. Both pertain to frameworks that support ideas of right and wrong—and that is where, more or less, the two part ways.
The NASBA Center for Public Trust is a nonprofit organization whose mission is to “develop, empower, and promote ethical leaders.” In a post titled “Ethics versus Morals: A Comparison” NASDA said, “Ethics refer to rules provided by an external source, such as a code of conduct in the workplace.” However, it adds, “Morals refer to an individual’s principles regarding right and wrong.”
Ethics are rules and guidelines established by industries, institutions, and businesses and tend to be entrenched, whereas morals are personal to each of us and can change over time. Ethics are ingrained in fields such as education, healthcare, law, and finance, with people working in these fields expected to abide by those ethics.
Morals are personal codes of conduct. They are instilled beginning in childhood but are influenced by life experience, making them prone to change. People can make personal choices based on their morals within the confines of the law. Acts stemming from ethics and morals must not break the law.
Ethics, Morals, and Now, Law?
It makes sense that distinguishing between morals and ethics is essential in healthcare, but now we’re expected to be lawyers? Not really.
A handy visualization for keeping things straight is picturing a judge perched high behind their bench, pounding a gavel to remind us that the law supersedes all. From there, it’s not hard to remember that ethics, because they guide the conduct of vast numbers of industries and institutions, come next and that morals, because they pertain to individuals and are subject to change, follow ethics.
Examples of Healthcare’s Moral Versus Ethical Head-Butting
Healthcare is a complicated arena in which to separate morals and ethics. Conflicts between the two can occur in patient care, insurance coverage, finance and accounting, medical research, and other functions.
For physicians and nurses, quandaries include whether to deny medical care to a non-paying patient, the temptation to overstate a patient’s condition to help them obtain insurance coverage, and the performance of medical procedures inconsistent with their personal beliefs.
Mirror image conflicts can occur on the insurance side when workers determine authorization for coverage but suspect that the seriousness of a patient’s condition has been exaggerated. And similar to nurses and physicians, insurance workers can find themselves approving procedures that oppose their moral compass.
What about decisions made in the heat of the moment? Imagine a patient undergoing surgery. A Do Not Resuscitate (DNR) order is in place. Suddenly, the patient’s heart stops due to blood loss, something easily remedied with a blood transfusion. Complicating matters is that the blood loss is due to human error. What happens to the DNR now? Should the physician assume that the patient would choose resuscitation under such circumstances? Is the surgeon justified in overriding the DNR?
Can We Blame Hippocrates for All This Confusion?
Hippocrates was a physician in ancient Greece and is said to have been the first epidemiologist. He is famously associated with the Hippocratic Oath and the proclamation to physicians to “First, do no harm.” But according to this post from the Harvard Health Blog, “First, do no harm” comes from another work by Hippocrates titled “Of the Epidemics.” Assuming that’s true, “First, do no harm” is not part of the Hippocratic Oath.
And then it gets confusing.
According to the Harvard post, some medical schools ask that their graduates commit to the Hippocratic Oath, but some do not. Some schools embrace a different oath (or pledge), and some don’t use them at all. The Harvard post concedes that similar language is used by the Hippocratic Oath and “Of the Epidemics,” but it all boils down to this: “First do no harm” is not the universal guiding principle among physicians that many think it is.
Again, if we assume the Harvard post’s assertions are correct, we must accept that not every physician takes the Hippocratic Oath and that some take no oath at all. This means edicts such as “First, do no harm” are not necessarily consistent across institutions and not uniformly embraced by physicians. Other guidelines might be followed and not in the form of a sworn oath.
A full understanding of the healthcare ethics playbook you are expected to follow, whether for finance, care provision, research, or something else, is a must for healthcare professionals everywhere. Ensuring all teammates are on the same page of that playbook can prevent major mishaps.
What Should You Do Now?
What is achievable in healthcare and science is ever-evolving, especially around issues like fertility and end-of-life. With those evolutions, the voices of patients, institutional leaders, advocates, lawmakers, and others ebb and flow, rise and fall, and overtake one another by turns.
Everyone working in healthcare must understand the ethics they are expected to uphold. As individuals, we must regularly ask ourselves what to do if personal morals conflict with institutional ethics.