Quality Assurance Auditors: How to Survive Between a Rock and a Hard Place

2. Roots of pure deduction in principlism

Another critique of the "principalism patient" would be in the area of methodology -- or what is known in philosophy as epistemology. Epistemology is concerned with how we come to know reality. It is also concerned with the justification of the starting points of knowledge (starting from a concept or hypothesis in the mind [Fig. 4]; or from our actual experience of a material thing which is outside the mind [Fig. 5]. It is also concerned with the criteria for determining the truth or falsity of the concepts about reality arrived at by the human knower. Without going into detail here, the starting point of most early bioethics theorizing was "in the mind", so to speak, rather than outside the mind in the objective world which we can experience and observe, and to which we can check back to determine the truth or falsity of our concepts. That is, Kant's or Mill's theories were taken -in parts or in wholes -- and simply posited as both theorectically and objectively viable, with very little rigorous analysis or justification on a deeper metaphysical, epistemological or anthropological level. Given that these philosophers were either rationalists or empiricists, their theories came complete with several of the systematic metaphysical and anthropological problems and presuppositions already noted. Yet such presuppositions were not identified, acknowledged or dealt with.

In hind-sight this present situation was predictable. In one popular bioethics text book the authors, when confronted with making a decision about the use of incompetent human subjects in research, concluded: "These problems cannot be resolved without an integrated theory of the nature and moral relevance of categories such as human being, person, animal, mammal and the like. Unfortunately, this immense task is more than we can undertake in the present volume." (Beauchamp and Childress 1989, p. 163)! Needless to say, this "immense" task was never undertaken.

If you're going to reinvent the wheel, why try to rebuild it using only two "spokes" -- which are then actually collapsed into one spoke? Furthermore, it would seem far more reasonable to start one's theorizing with an objectively based theory drawn from actual experiences and observed phenomena. Without going into detail, such a general framework for theorizing had been developed by, e.g., Aristotle -- who defined a "human being" as noted: one substance, composite of body and several human powers. At least no mind/body split -- and interaction is both possible and explainable.

Thus from the beginning the selection of basically only Kant's (a rationalist) and Mill's (an empiricist) definitions of a "human being" actually precluded a realistic and correct definition of a "human being" or formulation of "autonomy". Rather than define a "human being" in his or her real human wholeness, human beings were "split", equated only with a part of a human being, i.e., only the active reason, or "rational attributes", or only with physical sentience. Thus some human beings are not necessarily persons. If they are, they are only equated with pure, absolute autonomous choices and autonomous actions -- split off from the rest of their own composite powers and body, as well as from any real relatedness with the rest of society and our environment. The rest of the human being, as well as the rest of non-autonomous humanity is by definition left out of ethical or bioethical -- and often even legal -- consideration in any real sense (Shamoo and Irving 1993B).

D. A realistic, objectively based ethics for professional integrity and decision-making

A realistic ethical theory requires a careful consideration of epistemological presuppositions -especially an evaluation of the starting points of definitions, and whether or not those definitions really match reality. It also requires a careful consideration of the anthropological presuppositions from which an ethics must necessarily be derived -- especially how it defines a "human being". Also dependent on that definition is a realistic understanding of the role that character or integrity plays in any professional decision making process (Irving and Shamoo 1993). The character and integrity of human actions flow necessarily from the character and integrity of the human actor.

1. Professional character and integrity

If a "human being" is defined objectively as one whole unfractured composite of powers and body, this will lead to the definition of a realistic "ethics", based on the real human needs and goals of real human beings. Roughly -- something is ethical if it leads to real human happiness (or flourishing), consisting of many human goods (e.g., food, shelter, clothing, education -- even leisure) (Finnis 1982). These human goods, objectively determined, are the natural human goals. For example, because of the nature of cocaine and because of the nature of a human being, we know empirically that cocaine will destroy a human being on every level, and therefore it is wrong to use it. If an action leads to these real human goals then it is an ethically right action. If an action does not lead to these real human goals then it is an ethically wrong action (Aristotle, "Ethica Nichomachean", in McKeon 1941, p. 935; Bourke 1951).

Obviously human actions do not just happen in a vacuum. They are the products of many interacting causes. Considerations of the causes of our actions involve not just the real nature of a human being, nor his or her real ends or goals. It also involves a consideration of the quality of the actor and his/her actions themselves. Thus the virtues, which condition human actions, were historically understood as playing an important role in ethical behavior or conduct.

What are virtues? Well, I would tend to agree with Meilander's more comprehensive understanding of that term. For him, the moral virtues are not simply dispositions or "habits" which help us realize the fullest potentialities of our nature (or flourishing). Nor are they simply particular techniques or skills. They are also traits of character which suit us for life and shape our vision of life. They help to determine not only who we are but what world we see (Meilander 1984, p. 11).

My concern with this sort of explication of "virtue theory", on the other hand, is that there is often a lack of the more fundamental antropological grounding needed for a full virtue theory. This is apparent when most courses and books on "virtue theory" concern themselves only with what are known as the moral virtues (virtues of the desiring or appetitive powers). They seem unaware of or disinterested in the intellectual virtues on which the exercising of the moral virtues greatly depend. This could be symptomatic again of a mind/body split -with a preoccupation here with the virtues of the "appetites" only. All of the virtues of all of the parts or functions of a human being influence and shape what we know as personal "character" or "integrity". Consider for a moment just some of the kinds of virtues which historically have been acknowledged to play such an important role in the development of "character" and integrity (Fagothey 1963; Oesterle 1984; Meilander 1984):

The intellectual virtues (influencing both the speculative and practical intellect) are understood as good habits of the intellect [Table 3]. The speculative intellect is influenced by the virtues of understanding, science and wisdom. Understanding is the virtue or habit of knowing first principles, e.g., the knowledge of primary self-evident truths that lie at the root of all knowledge (such as the famous principle of non-contradiction). These first principles are not somehow platonically or "mystically" intuited, but rather are inductively discovered, as Aristotle has insisted (Aristotle, "Analytica Posteriori", in McKeon 1941, p. 136, 184-186). Science is the virtue of drawing correct conclusions by demonstrations from those first principles. It includes the habitual knowledge of the particular sciences. Wisdom is the habit of being able to know things in their highest causes, to order all principles and conclusions into one vast body of truth.

The practical intellect is influenced by the virtues of art and prudence. Art is the virtue or habit of knowing how to make things, how to produce some external object well. It includes the mechanical, the liberal, and the fine arts. Prudence is the virtue of knowing how to do things well, how to direct activity that does not result in tangible external products, but rather in how to live a good human life.

The cardinal or moral virtues are good habits of the appetitive or desiring part of a human being, directing the activity of the will and governing the passions of the sense-appetites. The term "cardinal" has no religious connotations. Rather it is derived from the ancient Greek term "cardo", or hinge. That is, all of the other moral virtues, as even the pagans Plato and Aristotle acknowledged, "hinge" on or depend on these four virtues of prudence, temperance, fortitude and justice. Prudence, the only one of the virtues which is both an intellectual and a moral virtue, is the habit of choosing the right means toward worthy ends. Temperance is the habit of regulating the appetite in the use of sensible pleasure. Fortitude enables us to face danger and work without flinching. And justice inclines us to give to each one his own proper due.

Historically some also included the theological virtues, or good habits ordering us to supernatural happiness. Thus the virtue of faith is the habit of the intellect to believe certain supernatural principles which are not accessible to human reason. Hope is the habit of the will to be directed toward our supernatural end, an end to be intended, and an end which is possible. And charity is the habit of the will to be transformed into that end, as in a spiritual union.

2. Moral professional decision making

Using this objective framework and definitions of a "human being", "human goals" and "human character", a moral decision-making process was established. This process integrates the intellectual and physical functioning of a human being on an ethical level (Irving and Shamoo 1993). Briefly:

The starting point of the decision making process must be objectively correct intellectual information about the real world and our real human goals [Table 4]. Roughly, as Aristotle put it, a small error in the beginning leads to a multitude of errors in the end (Aristotle, "De Coelo", in McKeon 1941, p. 404). Obviously if the decision making process starts off with objectively incorrect intellectual information, then the entire moral decision making process will be incorrect, leading to incorrect and sometimes unethical decisions and conclusions. One of the most important virtues used in this process is the intellectual virtue of "science". Next the ethical means or actions to reach an ethical goal are deliberated about. Judgments are made. For example, will these means or actions bring me closer or farther from my real and true goal? Do I allow personal interests or external pressures to influence my decisions? Would this decision really be harmful to myself or harmful and unjust to others who depend on my professional knowledge and judgment? Then a particular action is prudently chosen or decided upon as a means of achieving that goal. And finally, the chosen action is actually executed or performed under specific circumstances. Sometimes execution of the chosen ethical action requires great fortitude on the part of the human decision maker.

Further refinements to this decision making process included considerations of circumstances, the intention of the person acting, or the accountability and responsibility for one's own actions (McInerny 1982). Of paramount importance in this process was the character or integrity of the decision-maker, and the implications which one's character had for the ethical quality of one's actions. As Aristotle noted, only a good thinking person can act good; and only a good acting person can think well (Aristotle, "Ethica Nichomachean", in McKeon 1941, p. 1035). So the decision making process is actually circular (Irving and Shamoo 1993). If the thinker develops bad moral habits by acting immorally, these bad habits can in turn prejudice the thinker to use incorrect intellectual information as the false starting point of his or her deliberations. This can lead to theoretically as well as morally incorrect decisions and conclusions. These, in turn, are assumed to be correct, and therefore used as the false starting point in the decision making processes of other decision makers who depend on these thinkers -- e.g., research and development institutions, regulatory bodies, local, state and congressional law makers, the media, etc. (Irving and Shamoo 1993).

E. The survival of "the most morally fit"

Whether politically correct or not, virtuous people with personal integrity are required for a society not only to flourish but also to survive. Immorality destroys an individual and a society from within -- especially if these individuals' professional judgments, decisions and actions have a major impact on the "social good". Perhaps the Darwinian "survival of the most physically fit" (Irving, 1992) should be rethought from the perspective of the "mind/body" split. Perhaps our society should also consider the "survival of the most morally fit"! At least that is something to think about.

A recent respose to my presenting such a decision making system led a participant to complain: "This scheme won't work either. It would require all of us to be priests"! Well -- I'm not sure one has to be a priest in order to have character and integrity. In fact, I'm not so sure that all priests do have character and integrity! But it is worth noting that in virtually all of the descriptions of the various professions -- which were not written by priests -- the necessity for personal character and integrity are uppermost and well articulated. One does not need a Ph.D. in ethics to grasp why.

For example, one of the goals of accounting auditors [Table 5] is to "encourage public confidence in the integrity, objectivity and professionalism of its members". The Preamble of their Code of Ethics states that membership "assumes an obligation of self-discipline above and beyond the requirements of laws and regulations", and it calls for an "unswerving committment to honorable behavior, even at the sacrifice of personal advantage." In carrying out their professional responsibilities, members should "exercise sensitive professional and moral judgments in all their activities." Members "should perform all professional responsibilities with the highest sense of integrity"! Integrity is defined as "an element of character fundamental to professional recognition. It is the quality from which the public trust derives, and the benchmark against which a member must ultimately test all decisions"! And finally, Rule 201 states: "A member shall maintain objectivity and integrity, shall be free of conflicts of interest, and shall not knowingly misrepresent facts or subordinate his or her judgment to others" (Gorlin, 1991).

I could continue quoting from the accountant auditors Code of Ethics, as well as from those of all of the other professions. Clearly, when these codes were written, it was not presumed that the members of all of these professions were first required to be "priests", but simply persons of moral and intellectual character and integrity -- because the public trust and welfare depends on the ethical quality of their professional knowledge, decisions and actions! What is the suggested alternative? Should we rewrite these codes of ethics and require instead that members of all professions shall be "dishonest, fraudulent, crooked, devious, deceptive, ignorant, and lie, cheat and steal"? Who wants that kind of society or profession? Or will the present Codes of Ethics be rewritten eventually in terms of the present bioethics principles of autonomy, beneficence, and justice?

On the contrary and as Michael Davis points out: "A profession is organized on the assumption that members mean well and are basically honest ... Professional discipline is not an external imposition like the legal order, but, like honesty in a person of good character, a demand from within." (Davis 1990, p. 142). Professionalism amounts to more than the acquisition of a formal body of knowledge, or displayed experience, or accreditation. It also, by definition, involves living one's integrity in the exercise of that profession. In other words, the answer to the perennial question, "Who audits the auditor", must be, simply, the auditor! This character and integrity is also required, by definition, in order for the public or society to have any trust in the professional's professional judgments, decisions and activities. The alternative, as with scientists who produce inaccurate or fraudulent data, is even more governmental regulation in order to protect the public from serious harm -- this time, harm from untrustworthy auditors who have been entrusted by the public to monitor scientific and industrial fraud or incompetencies.

But the objection does throw an interesting light on our contemporary scene. If -- in order to survive in a "pluralistic" society -- no mention of character or virtue or integrity is allowed -- even allowed to be discussed -- my prognosis is we simply won't survive. People must be allowed to freely ask unpopular and sometimes penetrating and uncomfortable questions again, to recover what it means to be fully and wholly human again, to regain that natural basic sense of what is right and wrong again. Instead of deluding ourselves with sterile, objectively unrealistic, autistic and rationalistic views of personal, professional and social "maxims" -- accessible only through text books and seminars -- perhaps it would be more advantageous to draw a new sense of "wholeness" from the diverse richness of character, integrity and caring inherent in the vast majority of this country's diverse traditions and store of human wisdom. Inherent in them are those enduring qualities of character and integrity which can really lead us to know and to freely choose genuine human goals and goods -character traits which ultimately objectively benefit us as individuals, professions, and society as a whole -- and which without question are also essential for our survival.

F. Conclusions

Simply studying kinds of ethical theories (e.g., deontology, utilitarianism, natural law, or virtue theory, etc.) from a text book does not make one ethical. It does give us information -- if only sketchy and sometimes inaccurate information -- about what certain people think or have thought ethics is, and what ethical behavior should and should not be. Studying their opinions does, unquestionably, focus our attention on ethical behavior, and sensitizes us to important situations we might not otherwise have been sensitive to. And in general it does sometimes help us to think and reason more clearly about what is ethically right or wrong -- and why.

But no ethical or bioethical theory is perfect, irrefutable or beyond criticism. Our understanding of ethics is an on-going process -- both individually and historically. Nor should bioethics be imposed as a substitute for the criteria of rightness or wrongness of actions within completely different fields. Nor is it a substitute for knowing how to become a person of character and integrity. It is precisely these virtuous human traits which are the benchmarks of a true professional -- traits which in the end may be more important to both personal and social survival -- or to the survival of science, industry, regulatory bodies or QA auditors -- than all of the ethics and bioethics textbooks stacked end to end around the country. There is no substitute for personal and professional character and integrity. Our very survival depends on it.


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