Adam Blatner, M.D.

Revised, January, 2006:

This paper presents over 30 significant ethical issues that remain unresolved and invite more discussion by the general public. Social policy regarding these issues shouldn't be decided by special interest groups and lobbyists. The list below is meant to be evocative rather than comprehensive. (I hope it stimulates you to think of some issues I haven't listed. Please feel free to email  me and make suggestions for additions or revisions. Perhaps we'll add them to the list.)
The answers to the issues listed below aren't easily deduced from any type of philosophy that I know of–maybe a few, but not all. To assume that a grand unified philosophical theory can address all these issues adequately may be a form of reductionistic thinking. Some of the easier problems (in my mind) involve the more individual issues.

One application of these issues is as a way to assess the effectiveness of a philosophical system or theory of consciousness-raising. Can the ideas advocated in that system guide or help us in  addressing the the problems posed?

Ethics involves the sphere of interpersonal, group, and community politics at the level of values–not just what can be achieved or how to achieve it, but more what should be sought, in the realm of social harmony and fairness. It is the complexity of the other side of individualism– other than taking care of oneself, what do we want our collective to do or refrain from doing? Ethics looks at our proper relations, our duties to each other, indvidually and collectively.

In the past, ethics–and a good deal of civil law, in addition–was mixed with the requirements of religious ritual and the establishment of the details of the priestly caste. There was no other law back then, around the time of Moses, at least for the wandering Israelites, and when the alleged basic rules were laid down in the Torah, the first five books of the Bible. In most other countries, the law wasn't codified, and although there were traditions, the king was the boss and he could be pretty capricious. (The code of Hammurabi, around 1700 BC in the area near Babylon, was a bit of an exception, as far as we know.)

It took a while to establish a civil government with some semblance of consistent law, and the revisions of the code re-established this effort. Such efforts also were in reaction to the growing problems of trade, the establishments of small sub-cultural communities within larger communities, and inter-cultural mixing, which then required laws that applied to all sub-cultures within a greater empire. (Before that, each minority or mini-nation or tribe was allowed to apply its own traditional rules of justice–as long as they paid their taxes, sent their military levies, and didn't make trouble, they were left pretty much alone.)

The ascendency of the Church in the West and of a theocratic legal system in the Islamic Empires tended to re-establish a more theocratic process, but once again this has broken down in most countries of the West and many in the Middle East, so that civil questions are distinguished from religious ones. This preamble is being presented because there's still a sense that our ethical rules are if not explicitly described in the Bible, they are implicit there, and can be applied to all modern issues.

The Jews actually tried to do this, and the Talmudic tradition was a result, an interpretative tradition that laid the groundwork for some of the later traditions of rational argumentation found in our judicial systems. But the problem is this: New circumstances and technologies really create new problems. Should we rationally tie our ethics to these traditional sources and precedents, especially when they arose out of cultures that may be becoming minority cultures in our present society? (i.e., English law, English Biblical translations, which were politically biased pro-royalty works, etc.)

Beginning perhaps with the Magna Carta and flowering in the 18th century, the idea of "rights" emerged. The problem is that these were perceived as existing a priori, 0ut there, so to speak, objectively. Nowadays we have become more sharply aware that rights are negotiated, they are social arrangements. As increasing groups of peoples--including, lately, the "unborn," and now, even animals, are viewed as having "rights," ethics has expanded to explore who should have which rights? Is health care a "right," and if so, are we obligated to collectively offer it, or should it be something people have to purchase (at some significant expense) from privately-owned corporations?

Thus, we are charged with a goodly number of "hot potatoes," sticky and pressing ethical problems, social issues, that are more often than not avoided, at least as topics of ongoing rational social discussion. There are positions taken, of course, and challenges to these positions, but, alas, rarely is there really rational discourse. So it is worth while to stand back and consider what these issues are in contemporary culture.  The following are presented in no particular order–I haven't been able to think of a way of classifying them or attributing any sort of rank or hierarchy. The numbering, then, is just for the convenience of referring to them later in the paper.

Contemporary Ethical Issues

1. Welfare and charity. Welfare is organized charity, funneled through the collective, the government. But it raises many issues. How should we help others who are less fortunate? Can we differentiate between the "deserving poor" and the "undeserving" poor?   Here are some associated questions.

   A. How responsible can people be? To what extent can we require that people "pull themselves up by their own bootstraps." If a college student is raised in a neighborhood where study is not fashionable, and they didn't study, to what extent are we obligated to provide "remedial" training in college?

   B. What if some folks are disabled, to what extent are we obligated–or would we choose to be obligated if we were fully enlightened–to help these people. The "how much" issue is tricky, because new technologies make increasing levels of aid exponentially more expensive.

  C. What if a teenager has been raised in an area that is judged to be significantly culturally, economically, or technically "behind"–to what degree should we choose to compassionately support these people?  Again, the themes would be remedial education.

   D. What about those whose disabilities make them mentally unable to do more than fairly simple and routine tasks? In our culture, merit is associated with intelligence. What levels of subsidy should be given?  What about the in-between categories, which represents an expanding sector of the population: Folks not that smart, not smart enough to get "good" jobs, but smart enough to live independently and have full and dramatic lives.

  E. What about people who say they can't work? They're too burdened with kids–how much should this role of mothering be challenged? (This of course is a lively socio-political issue in the legal system right now.)

  F. Regarding the broader topic of welfare: General issues of responsibility are raised. When is helping someone really helping them, and when is it rescuing them and enabling their own self-defeating behavioral patterns. Can beggars be choosers? Are any "rights" implicitly forefeited by someone who receives charity? (This varies in different cultures!)

For example, if offered work, is the person who is given welfare obligated to accept that job, even if they don't like that work? What if the decision as to a job being not acceptable is viewed as trivial or unworthy by others?

  G. What then are people entitled to as a basic support of society? Can these entitlements be negotiated?

  H. Do we have special obligations to veterans, the elderly, children, women, any minorities, any types of disability or "differently-abled" people?

  I. When does support for certain occupational groups, tariffs for workers in certain industries, subsidies for certain farmers, – when are these matters of social -ethical policy and when are they merely matters of community economic self-interest.

   (1) Do we owe people jobs? To what extent do we collectively need to extend ourselves to sustain lines of work that are economically uncompetitive?
  (2) As tobacco is becoming viewed as less of a socially beneficial substance, what obligations do we have to tobacco farmers?

  J. What about our obligations to help people in other countries? There's national and international charity, but is Government aid an ethical obligation?

    (1) What about "strings attached"? Can we demand political, human rights, ethical governmental policy, enforcement of human rights, etc. before we give aid?
   (2). What rights do we have on criticizing the ethics and priorities of peoples in other cultures?

  K. Should those who have been "dis-advantaged" because of past injustices, colonialist policies, slavery, etc., be given reparations?--or their descendents given reparations?  What kinds?

2. Addictive Substances–Alcohol, drugs, tobacco...

   A. Should we consider addiction a "disease"? What does that mean in terms of the role of the alcoholic or other drug abuser?

       (1) Should we collectively pay for drug treatment?
       (2) If they enter rehab and relapse, should they be taken back? How many times?
       (3) How much should addiction be considered a mitigating circumstance from some associated misbehavior or crime?

3. Abortion: Should abortion be allowed? Is this a religious or a legal issue?
   A. What about if the life of the mother is endangered?
   B. What if the fetus is found to be anencephalic –no functioning brain–
              Or if it has some other either catastrophic congenital defect?
                   Is Down's Syndrome–moderate retardation–grounds for an abortion?
   C. How late can an abortion be performed? 3 months? 5 months? 7 months?
   D. How early can an abortion be performed?
          Is the "morning-after pill?" an abortion? (I.e. before the embryo has implanted into the uterus)
    E. Should the community regulate contraception or is this for the individual to decide?

4. Suicide: How should the community relate to the problem of suicide? Should there be any legal constraints at all?

  A. Might it be allowed only to stop the suffering of the terminally ill?

  B. What about people whose illnesses deprive life of its meaning–not terminal, but severely handicapped, or dying over years, but not immediately terminal. Should they be allowed to kill themselves?

  C. What about those who can't do it themselves? Should assisted suicide be allowed?

  D. What about those who can't even decide? Should euthanasia be allowed in any circumstances?

     (1) What about those who have failed to leave an advanced directive: If they are left in a vegetative state after an accident, stroke, etc., when is it okay to "pull the plug?"
    (2). Should a consideration of the legal device of advanced directives be made a compulsory unit–you don't have to sign it, but you do have to discuss why you won't–for people at age 80? 60? 30?  In college?

5. Parenthood: Is there a "right" to parenthood? Should we support anyone who wants to be a parent in this activity?  What if they are thought to be "unfit"? What makes a person "unfit" as a parent? (This is related to the next topic of abuse.)  How much attention does a child really need? How nice must the housing be? The neighborhood? What if a parent cannot protect a child from the bullying of other children?

  A. Under what circumstances, if a parent has "lost" the right to parent for a while, should that right be re-instated?  When should it not be?

  B. What about conditions for adopting babies?

    (1) Is it okay for gay or lesbian partners to adopt a child?
    (2) What about adopting a child of a different race? Or religion?
    (3) If the child is in permanent foster care because the parent has lost rights, can that parent nevertheless protest against the parents who would adopt that child on the basis of religion or some other ethnic criterion?

6. Animal Rights What rights should animals have? Our sensitivity to other peoples, minorities, etc. continue to expand. We're less tolerant of rank cruelty. What about intermediate conditions, excessive constraints in raising livestock, for instance? Animal laboratory testing?
    A. Supervision and regulation of animal farms, e.g., dog-raising kennels.

7. Heroic Medicine: How "sacred" is life itself? How heroic are we obligated to be in near-terminal conditions?
    A. How much money should be spent to attempt to keep alive a 2 month-premature infant? A 3-month premature infant? The limits of viability gradually are pushed down along with an exponential increase in cost and resources. Just because science can do something, it raises the question whether it should be done.

    B. Should we begin to consider rationing health care for the very old, those with senility? Again, a disproportionate amount of money is being spent for near-heroic procedures for those whose prognosis is guarded.

   C. What about liver transplants for alcoholics, drug abusers with Hepatitis C, etc?

         Expensive AIDS treatment for those whose lives were reckless?
         Lung transplants or other heroic treatments for inveterate smokers?
         Rehab, surgery, etc. for victims of reckless driving and motorcycling without helmets?
    Or should health care attempt to be blind and non-judgmental as to the source of illness      (All this is related to item 1-B and 4-C.)

  D. Should we differentiate between mild and severe disability in considering the allocation of costs of help?  Differences between prognosis–how likely that help will yield substantial changes in function?

  E.  Do we need to re-negotiate our standards in times of significant economic constraints, recession, economic depression?

8. Safety Standards: What standards of safety do we wish to set? Is there a "right" to be protected even from our own foolishness?
   A. Should government get out of the business of telling people what substances they can or can not put into their bodies?  (A strict "libertarian" stance.)
    (1) Is there a moral difference between "legalization" and "de-criminalization"?
    (2) Are there ethical or philosophical issues in drawing distinctions among the harm potential of alcohol, tobacco (in different forms), cocaine, amphetamines, caffeine, marijuana, LSD, heroin, other opiates (e.g. Oxycontin), sedatives, ecstasy (MDMA), etc.?
    (3) What about the whole field of restricting drugs or medicines to "doctor's" prescriptions?
           (a) what are the economic advantages of making all drugs over-the-counter?

  B. How much should we regulate different types of foods and drugs? Should many of the alternative and herbal medicines that slip through the technical net of FDA requirements be brought under that process?  Or should we return to a "buyer beware" type of ethos?

  C. What about liability for accidents? Are some lawsuits becoming excessively lenient towards people doing dumb things, like getting drunk and laying down on the railroad tracks?

  D. How much "purity" can we afford in air pollution, ground pollution, water pollution, or food pollution standards? (There are some carcinogens in foods naturally that are present in far greater concentration than some so-called carcinogens from other "artificial" sources, but these latter must be reduced to almost impossibly low levels.

9. Environmentalism. What obligations do we have to the environment?
   A. To what extent must we go to preserve species of animals or plants?

   B. How much intervention in foreign affairs is ethical in the service of "saving" forests, whales, various other ecological systems?

10. Governmental Corruption: Should corruption in politics be dealt with more severely? What kinds of ethical standards are appropriate for those in greater power, in government or business?

11. Rehabilitation of Criminals: What kinds of efforts should we make to rehabilitate prisoners?
   A. Is there an obligation to differentiate between violent and nonviolent crimes?

   B. Regarding "cruel and unusual punishments," what rights should prisoners have?

      (1) should there be protection against homosexual rape?
      (2) to what degree should criminals be supported in the right to appeal?
             (What if they are in fact innocent?)

  C. Is there a moral justification for capital punishment, also known as institutional murder?

     (1) What degrees of defense and protection should there be to make sure the innocent are not executed?
      (2) Would some punishments, such as flogging, be less destructive and expensive in the long run and more deterrent?

   D. What kinds of moral obligations do we have not to release people on parole who have shown themselves to be fully rehabilitated? Or to release people who have not shown a continuing threat to society?

      (1) How many chances should people be given for various problematic behaviors?
   E. What about obligations for restitution to the victims of crime?

12. Supporting Businesses: Do people have an obligation to collectively ensure that others be supported if the economy shifts?

     (A) What if people who go bankrupt have been foolish or high-handed, fraudulent or ethically lax, even though they've been legally just within the law. Should distinctions be drawn as to degrees of "fault"? (After all, they are in effect getting debt relief from hundreds or thousands of people, many of whom may not be able to afford that loss!)

    (B) What about farmers who move into a region with marginal resources for supporting those farms, or others who set up a business in an area with already too much competition. How much unemployment should be given?

    (C) What about workman's compensation? Are there limits? (See questions about tort reform)

13. Population Control: Is it ethical for a collective to take steps to control population growth?
       A. China's policies regarding having second children.

       B. Pushing contraception even to people who don't believe in it religiously.

       C. Do some religious groups–not just the Roman Catholics–who refuse to consider any artificial contraception approaches–need to be pressured to re-consider their policies? (It's hardly even spoken about anymore in this culture of tolerance.)

14. Is medical care a "right"? What is the moral problem of demanding medical care for all? What would the cost be?
     (A). What kinds of mental health care, psychotherapy, is appropriate for coverage by the collective, and what kinds are not appropriate?
      (B) What about substance abuse treatment?

15. Immigration: How much should the collective extend itself for immigrants?
      A. Should we have bilingual education?
      B. What levels of immigration should the better-off countries permit, and what restrictions are permissible?

16. Support for the Gifted: What obligations should the collective take on to foster talent, the gifted?

17. Homosexuality: What should be the status of gays and lesbians? Are they immoral?
     A. Parenting rights: See...

     B. Should their economic considerations, rights of inheritance, right to be named closest of kin, etc., be respected?

     C. Should tolerance of homosexuals be taught in school along with teaching other types of cultural diversity?

     D. What about bisexuals, trans-gendered folks, etc.?

18. Affirmative action: Should extra weight be given anyone because of that person's belonging to a group that has been considered "disadvantaged." Should there be any communal or governmental policies that "level the playing field"?

19. Freedom of speech: What are its proper boundaries? Should it extend to include pornography? To what degree? Now that the internet is available, what kinds of censorship is permissible?

20. Smokers' rights: Should we recognize such a concept?  What about non-smokers' rights?

21. Gambling: Should there be any restriction of gambling? Is it a form of freedom, or an invitation to addiction?

22. Prostitution: What about legalizing or regulating prostitution? Is it always a degradation of women, a form of subtle oppression? What if some women who claim to enjoy this way of making a lot of money are not deceiving themselves?
     A. If it isn't a problem for consenting partners, is it a moral or ethical issue?

23. Privacy Rights: Are the rights to privacy diminished by the demand for drug testing for various schools, jobs, etc.?
      A. Should the type of employment have to justify its reason for demanding drug testing? Why couldn't a person use drugs on their days off?
      B. What about medical privacy in a world of managed care?

24. AIDS & Venereal Disease: Now that one venereal disease is both deadly and un-treatable, should our policies and ethics about "free sex" be changed?
       A. Is there any place for governmental intrusion or laws, say, to make sure that all people who test positive can be interviewed and their contacts also notified?
           (1) Is it a moral obligation to inform contacts.
                    What about for herpes or other venereal disease?

25. Tort Reform: Now that liability insurance is beginning to cripple health care delivery and interfere with other industries, we need to look at the fairness issues involved in civil liability suits and "tort reform." Should there be limitations, caps? Is there any way to suppress "nuisance" litigation without also limiting the rights of people who are disadvantaged?

26. Exclusive "Clubs": When are free organizations, clubs, fraternities, etc., against the common interest, unduly privileging certain groups, enabling of prejudice, etc?
    A. Are there any contexts where limiting participation by members of the opposite sex is appropriate?
    B. Should schools with co-ed dorms also make sure they have non-co-ed dorms for those who don't want to be exposed to the pressures on modesty in co-ed living?

27. Age Limits: What should be the proper age limits for driving, drinking, smoking, voting, going into the military, getting married without a parent's consent, having an abortion without a parent's consent, and other age-limitations.
        A. Should there be any routine age limitations on the older age side? For which roles or skills?

28. Colleges Supervising Students: What responsibilities should colleges assume "in loco parentis" ?

29. Grade Inflation: What is the obligation of the teacher, administrators, and general society (parents, media)  to fight against pressures for grade inflation?
       A. Are there circumstances in which a child who has failed to perform should be flunked, retained, not passed along? When?
       B. Should kids be passed in the service of self-esteem? Other reasons?
       C. At what ages should these policies be looser or tighter?
      D. Is expulsion ever justified? Where should the child go?
               What responsibility does the community school system take for severely obstreperous kids?
       E. What pressures are appropriate to demand psychological evaluation of not only a child, but also of the family? Is this intruding on the freedom of parents to raise their kids as strictly or permissively as they wish?
       F. When is discipline abuse?

30. Language Dialect and Accent: Is it all right to discriminate among people because of dialect, when that mode of speech may not be understood by a significant portion of the community?
     A. Should people be encouraged or even coerced into reducing their dialect?
     B. Or should dialects be granted equal status?
           What about jobs or roles in which being understood clearly is an important role component, such as in offering tech support by phone, or other service-related dealing-with-people roles?

31. Privacy: What are the appropriate limits of privacy?  Is it unethical to break a confidence if the behavior that is known involves something really destructive to the person or others–e.g., suicide or murder?
       A. What about self-mutilation, cutting; or driving while intoxicated?
      B. Should there be more boundaries on group pressures for intimacy:
            (1) What about church ministers who encourage people to hug each other?
            (2) In groups, being encouraged to disclose more about one's life than is comfortable. (This could apply to this class, too– so check it out.)
       C. Recent moves toward a standard or pooled electronic health records opens them to hackers and insurance administrators who then can use this information to deny health care coverage to the people.  Claims that these records can be made secure are of dubious validity, even if they are naively sincere.

32. International Obligations: Are wealthier nations obliged to help other nations or governments, not just with humanitarian aid, but with military aid, or even more, are we obliged to intervene if those governments institute or enable or condone massive human rights abuses?
     A. What if the governments collapse in civil war? Or become chaotic and ineffective? Or allow or encourage genocide ("ethnic cleansing")?
            (Some have advocated a return to colonialism as being more ethical and benign than our self-righteous claims to non-interference in the service of promoting democracy)

33. Degrees of Wealth: Should a distinction be made between those who earn moderately more than the average and those whose income is hundreds or thousands of times greater than those who earn a minimum wage? Should there be a steeply graduated income tax or inheritance tax so as to reduce this discrepancy?

    A. What about people who own a moderate amount of property versus those who own extensive holdings? Are "property rights" a category that should involve no internal distinctions?


Isbister, J. (2001). Capitalism & Justice: Envisioning social and economic fairness. Bloomfield, CT: Kumarian.

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