A weekly round-up and other observations
A key ingredient of the ethical concept of informed consent is that it should be enabling; the process should be enabling in relation to possible choices. I spend a lot of time discussing this with my students. What is the nature of such a process? What kind of information? How best can it be given? Who is best placed to give information? The list of questions is long, but often we fail to consider them. Consent should be a supportive process, not a disengaged one. But also we often forget that information flow should be two ways; it is a dialogue. It isn't simply one expert giving information to the patient. Information given must be relevant to the patient and the decision they might make. It is contextual and patient specific. The patient brings a certain expertise too; they have duties, obligations, hopes, anxieties, commitments, families, friends, loved ones, needs, desires and experience; most important they have circumstances. We should listen as well as tell.
I try to apply this in all walks of life. I am reluctant to tell people how they should live their lives; I certainly don't like making judgements about them and predicating my engagement on those prejudices. I confess it is hard. I don't always succeed. Indeed I am haunted by the knowledge that I don't succeed. We all have them, prejudices. But justice can only be fair if we try to put them aside. Fairness means we should give an equal consideration of interest to others. We should try to be aware of our prejudices.
Prejudice comes often if not entirely from generalisation; from stereotype. It also comes from our own priorities and judgements and this is why I have been cautious about the so-called 'Olympic spirit'; it has the danger of setting up false criteria of 'success'. I am not at all sure what relevance a highly trained elite athlete crossing the line for a gold medal has for most people other than providing a feel good factor. I can't recall the number of times the Olympics and Paralympics brought tears to my eyes; the joy of witnessing someone whose hard work and dedication has brought them to such achievement. But it would be wrong to assume 1) that all it took was hard work and dedication and 2) that all could have similar achievements if only they would apply themselves. Circumstances again. But what is success and why are we so obsessed with it?
We reward certain types of success more than others. We tend to equate the accumulation of individual wealth with success. How much we admire the wealthy entrepreneur. Now I admit that is not so of you the reader of this post; or me for that matter, although just a little of me does, just a little. I am only being honest. When I meet someone who has set up a business and succeeded I say that is wonderful, well done, what an achievement. What I don't really like is the assumption that everyone could or should do so; that this is the only kind of success we should be concerned with. Of course it isn't, I hear you say; good then we agree. Oh dear where is all this leading? It leads me to the government and their assumptions in relation to unemployment and poverty; that they are somehow due to an inadequacy on the part of the individuals. How much we are hearing this expressed in the language chosen.
This attitudinal problem tends to afflict government more in times of economic crisis than any other. As unemployment rises and poverty grows then there is an increasing tendency for government to start blaming those affected. This government is no exception. They will 'treat' the patient, those suffering from 'welfare dependency' with a good dose of therapy; withdrawal of benefits. This will be beneficial 1) because we know best and 2) it will force them to take up employment and become 'better people' (Mr Ian Duncan-Smith's description). As 'doctor' to patient they are offering this with choice; either get a job or we will reduce your benefits. I have argued in another post why this approach is unethical because it stigmatises those on benefits as 'work-shy', 'scroungers' or 'welfare dependants'.
But Cameron knows that this stigma works politically. Voters tend to back 'crackdowns' on 'benefit cheats', 'benefit scroungers'. This is why the tax avoidance issue has become so toxic for him. To crackdown on 'benefit cheats' but to ignore wealthy 'tax dodgers' isn't going down too well.
But the government's approach is unethical in another way.
It is unethical because it fails to understand or take account of circumstances. It is unfair. It fails to listen to the lives of real people with duties, obligations, families, hopes, anxieties, experiences. It is not a dialogue. It is a 'we know best approach' and they will turn a deaf ear to the cries of pain it will produce; they will be blind to the hardship. It isn't that they don't care. It is that their policies are uncaring. They will argue they are being hard to be kind. As IDS puts it they will 'make people better'.
It was that phrase that made me think of my medical ethics!
Nor is it that there isn't a problem. There are many long term unemployed who would like to get back to work but who are in a financial trap; not only is it difficult to find work but it is difficult to find work that pays sufficiently to compensate for loss of benefits. It is also true that many people have experienced little outside a life on benefits. But you can't solve that problem simply by withdrawing benefit in the vain attempt to force people to take poorly paid jobs. We will simply be left with a lot of unemployed people whose families are worse off; driving them deeper into poverty isn't a solution. It will simply increase costs elsewhere in the welfare and health budgets.
If there is a time to apply such tactics it surely isn't during a recession. We are witnessing scenes we haven't seen in Britain since the 1930s as increasing numbers turn to food banks to feed their families. This is a disgrace. Withdrawing benefits should be coupled with polices that stimulate growth and create jobs and policies that enable people to work. Simply cutting welfare won't work. If we are going to use a stick then at least provide a reasonable carrot.