Ethics and Evidence – a year on

Response to Ethics and evidence, by Donal O’Mathuna and Ethics and Evidence – Reply from Hugo Slim

Both Donal and Hugo agree there are at least three interesting ways in which evidence and ethics are linked. The first has to do with interventions designed to change something in the world: if we intend to make changes for the better we are under an obligation to acquire and use the best evidence we can when trying to do so. The consequences of our actions are our primary focus and evidence helps us bring about the consequences we desire. The second is the ethics of acquiring evidence: we are under an obligation to proceed in a way that is respectful of the interests of the subjects of our research – a duty rooted in the requirement to show respect for persons as ends in themselves and not treat them as grist to the mill of our research. I agree with both of these but I want to explore some of the issues raised by the third: the question of motivation.

Donal and Hugo refer to psychological states that issue, or fail to issue, in humanitarian responses. As a first step, both seem to agree that, as humanitarian actors, we need to be honest about our motivations. This is where evidence comes in: if your motivations are linked to fantasies of heroism and rescue, they may not survive in the crucible of humanitarian missions – something more modest and reality-oriented might be preferable. But the human psyche is a curious place, and our use of evidence here is unlikely to be straightforwardly deductive. No doubt many people first engage in humanitarian action fuelled, in some part, by such fantasies, but experience has a way of chastening us. We are in tricky territory but maybe we need to talk as much about reasons as evidence. Something important is lost if we try and reduce the reasons why we do what we do to the question of evidence.

And what of those people (probably most of us) who are, as Donal says, more likely to spend their spare cash on a good night out than donating to a reputable charity? As a standalone piece of evidence about human motivation and the possibility of humanitarian engagement, it doesn’t take us far. The more challenging question, in these hyper-individualistic times, is how we can build the kinds of fellow-feeling that are likely to predispose people to altruistic donation?

Hugo rightly points to the truth that ethics does not stop when evidence runs out. He writes of how, in the face of radically imperfect information, phronesis or practical wisdom is required.

But if there is a danger in this approach, it is of bringing evidence and ethics too close. Ethics tends to address itself to questions of what we should or ought to do; evidence, and the scientific frameworks which deploy it, focus more on the realm of what we can do. We must not conflate them. As Hugo suggests, there may be times when we have to act despite the evidence – or to make choices where the evidence is silent. A decision to focus humanitarian attention on the most vulnerable or hard to reach will never be a decision based on evidence alone. It is an irreducibly normative decision, predicated on the belief that the neediest have the largest moral claims on us. Evidence might point us to where the neediest are. We will also require as much evidence about their needs as possible, and use the available evidence to shape our response. Evidence will also guide our decisions about what might, and might not, be effective for these groups. But the prior decision, like the mainspring of humanitarian engagement itself, is irreducibly moral.

Dr Julian Sheather (PhD) is special adviser in ethics and human rights to the British Medical Association and an ethics adviser to Médecins Sans Frontières. His particular interests lie in health and human rights, medical ethics in times of conflict, humanitarian ethics, public health ethics and mental health and mental capacity. He is the BMA’s policy lead on resource allocation and NHS change. He is a co-author of Medical Ethics Today, the BMA’s handbook on medical ethics and medical law, Assessment of Mental Capacity (with the Law Society) and is a regular contributor to the British Medical Journal and The Journal of Medical Ethics. He sits on the British Medical Journal’s ethics committee and the Institute of Medical Ethics. He lectures widely both nationally and internationally on a range of topics in medical ethics.