It is an honor to be here among this August group, just to have a conversation, as Dr. Warren just put it, talking back, listening, and engaging. This is an exciting moment for me because I have never done anything like this before. Therefore, if I slip up, trip up, fall over myself, I appreciate your forgiveness. I have the wonderful honor of working with a group of students at Tuskegee University, the Bio-Ethics Honors students and Dr. Warren just asked them to stand so I would not embarrass them any further. But they are here today, and I want them to know that I thank them and appreciate you for your presence at this very moment. Also, I want to thank Dr. Rueben Warren because he invited me a year and a half ago to be his partner at the National Center for Bioethics in Research and Healthcare at Tuskegee University. It has been an amazing ride so far.
We are about to have a conversation about ethics. Given today’s context, the content of our material is about how to understand ethics and issues for children and youth. I also want to give some attention to the overall broader category of what ethics is and what it entails. Many of us have a kind of pedestrian view of ethics; we roll with the punches. But ethics is not easy. Trying to do the kind of work we do daily, trying to figure out (not just as Dr. Warren said a moment ago) that something is right or wrong, but why is it right or why is it wrong? That last inquiry can be extremely tedious. So, I’m going to take us through a session as quickly as I can, and as explanatory as I can, because I want all the older people in the room—given last year’s conversation about elders—to eavesdrop on this conversation. This presentation is for the young people. I needed a metaphor that would work for young people, so I came up with: “Theme Parks, Rap and Moral Dilemmas: Ethics and The Least of These.”
Several years ago, I decided to take my first rollercoaster ride. My family and I went to Space Mountain in Disney World. Ladies and gentlemen, I do not understand how these people make money scaring the life out of people! We actually pay for this foolishness. The idea of riding a rollercoaster, paying to be scared makes no sense to me. This was my first rollercoaster ride; and it was also my last rollercoaster ride.
Last year, my brother and his children took my youngest son Jonathan to Six Flags Atlanta and they invited me to come. But why would I want to do this? It made no sense to me. When we saw Space Mountain, I thought it was a haunted house. I began hearing a loud sound as we ascended the staircase. It sounded a whole lot like a tornado in the building, but we kept climbing. The noise did not sound like fun. Hearing people scream did not sound healthy. But we continued to climb until we got to the top. The attendants herded us like cattle into short lines with dividing railings, then they placed me into something that looked very much like a coffin. They buckled and strapped me in (This should have been an indication that I should leave). I asked my son, “David, you know, we are Hodges. We are proud Virgin Islanders. We don’t need to do this.” He said, “Daddy, I want to do it.” I said, “We don’t have to.” He said, well, daddy, this looks like fun.” “No, it does not, son. We could walk down these stairs the same way we came up and we will do it with our heads held high.” He said, “No.” I said, “Alright, you sit in front and I will sit behind you and I will hold you.” So, I held him. He said, “Daddy, you’re holding me too tight.” I said, “Hush, son, just accept daddy’s love right here.” If you have ever been to Space Mountain, the ride takes off in this casket device. People talk about near death experiences. They will talk about going through a kind of corridor of light, a tunnel of light. That is what it takes you through. As we go through the tunnel of light, we heard a very loud clack, clack, clack, clack. That clack, clack, clack noise is very ominous. I am certain that the point was to terrify us more.
As we were going through clack, clack, clack, clack, clack, clack, I am holding him tightly, then it starts going up—this is the scariest thing in the world. Not so much because of the ascension, but because you know there will be a descension. When it got to the top, it paused, just to terrify us even more. And then it took off. Now, the idea is, I guess, you are supposed to hold on as tightly as you can and enjoy the ride. But how can you enjoy the ride when you are yelling the entire time? And then it gave a short break and did it again. Now, we got to the very end and this cute little girl, she was very nice, came to me and said, “Sir, let me help you out.” I said, “Go get some help.” She said, “No, I could do it.” I said, “Look, go get some big people to lift me out of this thing.” She said, “No,” and I said, “Please, go get some big people.” So, she got some big people. They lifted me up, my little feet dangled as they took me, sat me down next to a booth, which looked like Lucy’s psychology booth from Charlie Brown. What they did not tell me – and they never asked for permission—they had taken pictures of me, screaming, my eyes and my mouth wide. A little boy pointed and said, “Hey, look at the big guy” and pointed and laughed. And I am like, “What’s he laughing about?” And that is when I saw he was laughing at me. Why was he laughing at me? Because I looked the part of a sick person. Why? Because this is what rollercoasters do to you. This is what theme parks do to you. So now I stick to what I can handle. When I go to Disney World, I go to It is a Small World After All. Here is the thing: I would get on that ride 15 times and it never stresses me.
Theme parks all around this country make a lot of money. You must pick and choose which one you want to terrify you the most. This is what ethics is about. It is a matter of picking and choosing which one of the various theories you want to terrify you the least or you want to use the most. Ethics is a subset of philosophy. There are six major areas of philosophy. One is epistemology, which is the nature of knowledge. Then there’s logic, which is about identifying valid arguments. Metaphysics is about what is real: Do I exist? Am I here now? Are you here now? How do I know I am here? When does time end? When does time begin? Is there such a thing as time? Metaphysical questions take us into conversations about God—like, is there a God? Then there’s aesthetics/esthetics, which is about beauty and the nature of beauty and so on. Finally, we have ethical theories and ideas. Dr. Martin Luther King, Jr. said, “the time is always right to do what is right.” The word “right” is ambiguous. The time is always right to do what is right, but can we always know what is right? Sometimes, as Dr. Warren said a little while ago, we may not always know the right answers. He kind of stole my thunder. In the cases in which we do not know, he said, go with what is visceral. Go with your gut. But if you have a bad gut and you know you have a bad gut, do not trust your gut, because there are bad gut people—I will talk about them in a moment.
In other words, when we are dealing with ethical theory, the question is what should we do? What ought we do? Given what we see, and given what we use our minds to reason and to understand, what should we do? It is really a wrestle. It is a wrestle trying to figure out and identify the precise kinds of conversations we need to have, because it is about judgments. Ethics is about doing our best to do what we ought to do, which is quite different from the sciences.
The sciences are descriptive. They are describing things as they are in the natural world or society. But ethics is generally prescriptive. The ethicist is saying, “These are the kinds of things that we ought to do if we’re going to function in a good environment—in a good society.” Years ago, a fellow by the name of Charles Darwin—I am sure you have heard of Mr. Darwin. His theory is called Social Darwinism, “we’re better off being kinder—more altruistic to each other.” To use the language of President George H. W. Bush, we need to be “a kinder gentler nation.” Charles Darwin defends the idea that we evolve better as a species when we are altruistic. One of the most beautiful things about this world is if your car breaks down on the highway, you need simply to wait, and somebody will stop to help you. Or if you have a been harmed, typically somebody is going to help because the world is better off with people who help others versus people who do not. There are areas of emphases in our moral judgment, and I will emphasize these in each moral theory.
Acts, rules and maxim, consequences, character, caring relationships. We use these terms in our everyday language; and they speak to a kind of moral theory. Motives, acts, consequences. Motives and character are incredibly important in virtue ethics. Acts and rules are major in deontological ethics. Consequences is definitive in utilitarianism. Look at these words. These are the kinds of words or terms that we, if these are our motivations or inclinations, ought to develop and see where they lead us, in terms of developing a constructive view of what ethics is. So, to answer the question about goodness and rightness and what makes for good and what makes for right gives us several different theme parks of ethical theories. This is the kind of stuff that could drive you crazy. Because when you look at them, it seems a lot like ethical relativism, “I do what I want to do” or it seems like cultural relativism. “I do what my culture says I ought to do.” Then there is the Divine Command Theory. What does God have to say about what is right and what is wrong? Is something right or wrong because God says so?
Let us take a moment to talk about these theme park of ideas. I went to Universal Studios Orlando to ride the Incredible Hulk. Some genius sat down and said, “I’m going to make a ride that’s going to make people very unhappy.” When you look at the faces of the riders, about two or three of them look like they are excited, but many appear unhappy. Ethical theories are like a theme park. There are a whole lot of them, and you must figure out which one of these ethical rides you want to take. It is sort of like rap music for those of you who like rap. Against public opinion, often non-Black adults, all rap isn’t distasteful, vulgar or misogynistic; I like Tupac, for example, but not all of Tupac’s lyrics (incidentally, I can’t imagine liking all the lyrics of anyone I support musically). When Tupac is rapping about Changes, I am into Tupac. When he is rapping about Dear Momma, I am into Tupac. When he is rapping about some other stuff he says – No! Tupac, you are a little off center. I am not into that. You must find conversations or genres that will work for you ethically and morally.
There are two sides to this conversation. One is ethics. Ethics is derived from the word ethos, which is simply about character. What is my character? For example, when a doctor says, “I am qualified to tell you that the course of treatment will likely generate the best results,” then that doctor is speaking from a kind of ethos. In other words, he is saying that I am in position -- my credibility’s in position to share something with you. My character is in position. The words ethical or ethics or ethos, are terms that were defined by the ancient Greeks. As a matter of fact, in the ancient world, the only kind of ethics they really employed was something we will discuss called virtue ethics.
Then there’s morals. Morals differ from ethics. And do not stress yourself with this. This is a fun talk right now. But morals differ from ethics and that ethics are more philosophical or tends to be more philosophical and morals tend to be more personal. I derive from my morals and customs and values and so on. So, it tends to be more personal. But then it is against all corruptive when you start talking -- in 1958, we started talking about moral philosophy. Right? So now we do not really have to hold on to those kinds of descriptive anymore. But one of the things that we need to understand is that ethics is part of what it means to be human, what it means to develop as a human personality. What should I do? What is mankind? And additive theory must consider human nature and human behavior. In other words, ladies, and gentlemen, it does not make sense to talk about ethics if we cannot do it. You know? We are, as human beings, we have certain constraints. There are some things that we cannot do. There are some places our mind cannot go. And then there’s places that a mind absolutely will go. For example, I do not have the time to tell you about when I gave a kidney to a student. I do not have the time to talk about that. A student needed a kidney. I gave a kidney. Student called me, years later and said -- every year, give me a card. It says, “Thank you, Dr. Hodge, for giving me another opportunity at life.” Then a few years later he sent me a card that says -- with a little picture, he had a son and he named his son David and on the back of the picture, it says, “Thank you, Uncle David. Without you, I couldn’t be here.” That is called supererogatory, that is when you go over and above the call of duty, when you do more than is morally expected of you. Now, if I told you I gave a kidney to my son, Jonathan, you would say, “And that is what you’re supposed to do.”
Until you give a kidney to a student. Look at you. You look all teary-eyed. You look like, “Oh my God, wow. That’s such a nice thing.” Well, here is the problem. I really did not give a kidney to a student. Right? That did not happen, but it is a good story, right? Which leads to some of the problems in ethics, because how do we know when something is true or false? Because when I just told that story, it sounded true, didn’t it? As a matter of fact, as I am up here talking about it,
I started believing it. Dr. Liburd, she was looking at me like, “Oh, David, I love you.” And when I said it was false, she looked away from me. She is no longer my friend. She is saying, “You are giving a lecture on ethical and you’re unethical yourself.” Ladies and gentlemen, we are constrained in certain ways, such that we would say that some things make sense to us and other things do not. It is part of how we develop, how we have embedded codes to behave in a certain way. Part of that development is our conscience because conscience guides our moral lives. Our conscience dictates what we should and should not do. And sometimes, if you could do something bad and it does not bother you, what do people say? You have no conscience.
My mother used to tell my brother, not me, my brother and mom, if you are watching now, not me. She used to tell my brother, when he eats too much food or he ate more than his share, “Boy, you are not going to conscience it up.” You do not have any conscience. In other words, you do not know when to stop. Dr. Warren’s word, it is a kind of gut thing. We all should have a conscience. And such that a person does not have a conscience, then we must raise questions about whether they can be moral, whether they can be ethical. So, I am not going to go through this long dissertation but suffice to say that our conscience governs our critical thinking. It governs our rational capacity. It puts parameters on our emotions and how we should feel about certain things. Immanuel Kant, the great philosopher, says, “The good will is good in itself.” And he went on to say that “We should be governed by this good will.”
He said, “Two things excite me. The starry skies above and the moral law within.” Because it seems to be something that we could always look -- when we see something that is universally wrong, we admit it. We say, hey, it is universally wrong to harm children. It is universally wrong to hurt anybody, but for some reason, it seems even more wrong to harm “innocent” and “vulnerable” children. We were driving in today and we heard about an athlete, a football player I think, and they recorded how he talked about punching his three-year-old. That shut me down because it is wrong -- the moral law would end. It governs us. It governs us rationally, even if you are an atheist or have no God concern, you are still governed by reason or sentiments. So, no one is without excuse. In our modern world, ethics is about the philosophy of right or wrong.
Morals is about my personal views of right and wrong; ethics is more philosophical.
Ethical relativism argues that people can never be mistaken about what is morally right or wrong because there is no objective or universal moral statements of truth. Instead, there are only opinions. In other words, it would have been so easy had morality been written in the clouds, “These things are wrong,” so anytime there is an issue, we just look to the clouds and say, “Hey, that is wrong.” But we do not have that, says the ethical relativist. But somehow, on the inside, we feel like we do have something of that sort. Ethical subjectivist would argue, “No, I do want to do what is right. What is right is what I say is right.” Opinions express what a person believes. It does not have to be backed up by reason or facts. An ethical subjectivist does whatever he or she wants to do. They interpret life to their taste. A danger for the subjectivist is that the only requirement is that they do what they believe is right. If they believe that giving money to the poor is right, then it is right. But if they believe discriminatory practices are right, they are right. If they believe that it is right to discriminate against Jews, Blacks, women, gays, lesbians or whomever, then it is right. So ethical subjectivism has its good parts, but it also has its danger.
Cultural relativism also has its good (theme park) points. What is right for you and what is wrong for you is defined by your culture. And what if you do not believe in God or if you believe in God, which one? Are we talking about Jehovah, Allah or are we talking to something more eastern, like Buddhism, Jainism, or Syncretism? How are we supposed to understand God?
Perhaps we should just make ethics be a part of our ego. Egoism argues that I do what is in my best interest. I am not going to go through ethical egoism here, because it is just too much fun stuff, but the major part that I wanted to start closing my talk on ethics by looking at three theories. First, deontology. Where there’s bioethics or public health ethics, there has to be a theory that undergirds that ethical theory. Once you have a buy-in on the theory, then you can have conversation partners. If we are going to talk about, say, bioethics, then we must have a theory -- one of those many theories I talked about -- that undergirds it. And once we develop the principles or understand how that undergirding theory works, then we will know how it will function in the operating theory that you want to use, sort of like software and hardware. If you have the correct software, it can run; we can do some major work on a computer hardware, system. But if we do not have a software that is going to fit, it may not fit accurately. It may not take you to where you want to go. So undergirding bioethics is typically what we mentioned earlier: deontology. Obligations and duty govern. This means that bioethics has a tremendous regard for respect of persons, benevolence, and justice.
On the other hand, another moral theory is utilitarianism, which argues that what is right or wrong is based upon what the consequences. In other words, imagine this situation. What if you are in a scenario where you must kill one person to save 50 lives? What would you do? What should you do? Utilitarianism, i.e., the greatest good is what brings about the greatest happiness for the most people. Public health ethics is typically grounded in utilitarianism, because essentially this is what public health is all about: it is about population. It is about social ethics and social regard. We have situations where we have scarce resources. But we must do the best with the resources we have to reach the most people we can. Thus, utilitarianism governs. I stole those words from Dr. Drue Barrett. This is what public health ethics is, is identifying and clarifying ethical dilemmas.
We had a young man to lecture at last week’s Public Health Ethics Intensive at Tuskegee. He is my former student and now he is a licensed therapist. When I want to know about young people, I go to him because I have no idea. I had no idea, for example, that there was a drug problem in the suburbs. Before I heard about opioids and crystal meth, he was the one who told me, “Dr. Hodge, it’s coming and its coming fast.” Public health ethics and bioethics, operating without grounding, cannot do much.
Thus, the operative questions are, how do I ground public health ethics? How do I ground bioethics? I ground them in virtue and care ethics, and I have a good reason for doing this. As Captain Wilkins read the last sentence of my dossier, he said, my dissertation was on “Jesus and Virtue Ethics.” Jesus gave us something in virtual ethics that Aristotle did not. Jesus gave us notion of love and the notion of compassion. Jesus’ terms were less impactful in the rational Enlightenment, but the 18th century became very prominent with the words like “empathy” and, in the 20th century, “care.” Consequentially, I tend to ground my work in public health ethics, not in utilitarianism, and not in deontology (consequences and rules, respectively), but I ground it in what is closest to my faith tradition. Regardless of your faith, the cause of your beliefs, your tradition, there are some principles in religious tradition that are very similar to virtue and relational care ethics. For example, benevolence, and being kind.
Benevolence is doing good. It is not just being kind; it is the will and action of doing good. Empathy is having a certain kind of other-regarding feeling, but compassion is going beyond the feeling and demonstrating some action.
Thank you very much for indulging me for the last 40 minutes. And young people, this day is yours. Take this opportunity to say the things that you always wanted to say and felt you could not. And if it is deeply personal, there are enough trustworthy adults in this room to whom you can turn for compassion. You can trust those who are trustworthy. Thank you very much for indulging me with these words. Blessings upon you. Take care.
Question
I was interested in what you were saying about the greatest happiness for the most people and that concept. I work for Feeding America and the food banking world and programs that are intended to help people get enough food. And I find that a conundrum that we think about frequently is this concept of sort of scale versus specificity. So is it quantity, serving a lot of people and doing the best we can there versus knowing that, as we have these deeper programs or interventions, we can actually probably make a bigger difference, but it’s to a smaller number of people. So, I was just wondering if you had any sort of thoughts on that?
Dr. David Hodge
There you go. Thank you very much. I appreciate the question. The dilemma that that question motivates is precisely why I am not a utilitarian, though there’s some good work to be done in utilitarianism, medical actions like xenotransplantation are usually utilitarian arguments to demonstrate why we should have respect for animal lives and so on and so forth. I go with virtue ethics and care ethics because Aristotle said it this way. He said, “Find the virtuous person and follow them and then habituate their virtues.” In other words, we cannot be wrong when we are operating out of good motives and gracious character. So, your safeguard is that you know you have done your best. Where there’s quality or quantity, you know you can sleep well at night, because you did your best in each situation. But if we put it to a purely utilitarian situation, then you may fall into some other kinds of discriminatory behaviors. For example, if when we start talking about utilitarianism and start balancing the many versus the minority, then we would have a problem. The minority is typically a race, a gender, a religion, or a sexual orientation. Therefore, we must be cautious. If, on the other hand, you are operating out of a sense of character, then you are not constrained to operating by numbers but by what is the right thing to do. That is why I ground my ethical theory in virtue ethics over against the opposite.
Question (Dr. Dru Barrett)
It was, I think it was very -- your use of narrative and story really brought these concepts to life. And as you know, we are trying to look more at how we can use narrative ethics approaches, to better have people learn about ethics. And I think scientists often have a hard time with that, there. They just want to express the facts. They do not, it is more difficult, I think to sort of understand their approaches. So, I am wondering if you could talk some about like what you see -- you know, you are obviously an expert in telling, you know, bringing the stories to life and presenting a narrative. And I wonder if you have any tips for scientists and how they can do a better job in that area.
Dr. David Hodge
That is a good question, tips for scientists. Part of the work that we do, often is to critique the work of the scientists to kind of hold them up to a standard and a level because, for example, back to the statement I just made on xenotransplantation, scientists given an opportunity, they are running very fast into taking animal organs and putting them into human beings. And just to speak slowly here, we need to ensure that we have empathy, and this is where relational ethics come into play. Right? Now, relational ethics and virtue ethics are not the same. Relational ethics came out of the feminist conversation, not the radical feminists, but the more relational feminists.
And their conversation is about getting to know people, being in conversation with people, to use your word, Dr. Barrett, to understand their narratives. The work that Dr. Warren and I do, in terms of the research in clinical trials, has to do with going into the community, getting to know the people. The good part of, say, xenotransplantation against transplanting animal organs into a human, is that there is a whole lot of benefits. There are a 110,000 people each year on the waiting list for a kidney or heart or other organ, but only 30,000 surgeries are being done based upon low availability. What if you can give someone a pig kidney, which would give her five more years of sustained life until a kidney become available?
There is some good here. However, you cannot just walk into a Muslim community and give somebody a pig kidney. There must be some conversation and that is where the narrative, the relationships come in. Now, the scientist is on a very purposeful trajectory. We must get it done by a certain time, right? They have these constraints. But the human beings with whom we are dealing move very slowly. Dr. Warren pointed out the notion -- the contract between trust and trustworthiness in the larger scheme. We do not have to go into those conversations, but we know what they are. But there are communities that justifiably do not trust scientists or medical clinicians. So, it takes more and more time. My endocrinologist goes into Seminole county, into the Seminole community in South Florida (where the Hard Rock Cafe is and the other casinos to offer free clinics). It is an extremely wealthy community. He tried to have a conversation, but the problem is they are saying, “Wait a minute, we don’t trust you.”
Now, the Trail of Tears occurred several years ago; nevertheless, “We still don’t trust you.” So relational care ethics, Dr. Barrett, will be extremely helpful in building conversation and community. One of the things I foster, in terms of the public health conversation, how do we define public can be quite misleading or misunderstood. Because public could be numerical, public, or political. But public can also be community. This is where I think public health ethics needs to be mostly -- that is, to understand that the people we’re dealing with, regardless of the science, and though the scientists are starting to understand, that the people we are dealing with are real people, with real stories and real tragedies. There must be a conversation, not a kind of patriarchal pushing of oneself into a person’s community.
Question (Dr. Leandris Liburd)
Dr. Hodge, thank you so much for your talk. I have a question. This is something that we are grappling with right now, in the Office of Minority Health. So, we have a series of definitions that define our work -- health disparities, health equity, health inequity, social determinates of health and there and others. And we are finding that the more we engage in this work, the more nuanced our understanding of it is, particularly from a standpoint of wanting to act. And so, in our definition of health equity, we talk about things that have three characteristics. They are avoidable, they are systematic, and they are unfair. And so, I am interested in how you think about what is fair, particularly in a cultural context of the U.S., of what I am going to just describe as rugged individualism.
Dr. David Hodge
Thank you, Dr. Liburd. In 1972, one of our great academics, John Rawls, wrote a book entitled A Theory of Justice. His major argument was one called justice as fairness. There is no fairness that is dissociated from justice. Part of the problem, going into these conversations, is that the word justice seems very abstract. As a matter of fact, relational ethicists have struggled about how to understand the word justice because they are relational. They are not abstract. Justice is not something in the sky somewhere. They are talking about what is right in front of us. So, John Rawls’ conception of justice as fairness is one that would work. The other part of my definition is the importance of reaching the least, the lost and the left out—to prioritize those who simply do not have access. The other people can hold their own. If we are not doing good acts for the least, the lost and the left out, then we are not being fair. And if we are purposefully blinding ourselves to the least, the lost and the left out, then there is something extremely egregious about what we call our ethical philosophy.