Last week, the Health Advisory and Recovery Team (HART) published an article advocating the use of “ethical frameworks” to counteract disingenuous government behavioural science techniques. HART argues that deliberate use of fear tactics, shaming the non-compliant and covert ‘nudging’ are unethical and must be challenged by explicit ethical standards. As an example, they cite the “Seedhouse Grid… developed to promote ethical decision-making in health care”.
It is naturally pleasing to read that a tool I invented 35 years ago is still considered relevant, though the Ethical Grid (to give it its correct title) represents much more than a set of guidelines. The idea is simple. First, since labelling a decision ethical or unethical will always be controversial, the emphasis should be on the deliberative process rather than rules: the question is not “has ethical rule X been correctly applied” but “have we balanced sufficient factors as we work out what to do”? Second, rather than enshrine a set of objective principles, codes or pseudo-laws, the personal nature of ethical judgement should be embraced. Third, ethics is therefore best seen as a transparent form of critical thinking, always open to revision in the light of new evidence and argument.
The Ethical Grid looks like this:
Its layers represent four necessary aspects of competent social decision-making, whether done by individuals, groups or larger organisations, including government. They encompass practicalities (black), consequences or outcomes (green), duties or obligations (red) and purpose or rationale (blue). The choice of segments in each layer is not fixed, the concepts are possible rather than necessary – for example, ‘uphold rights’ might be preferred to ‘do most positive good’ and ‘most beneficial outcome for the most disadvantaged’ might replace the more general ‘particular group’.
In this example the blue boxes have a special role, summarising key components of working for health. But these too might be changed, for instance a Grid to support ethical journalism might offer ‘objectivity’, ‘balance’, ‘accuracy’ and ‘accountability’ in the blue layer.
There are several ways to apply the Grid to real-world decision making. Privately it can work as a prompt, ensuring that significant elements are not overlooked. Used in groups it is an evocative catalyst for creative conversation. Were it to have been used in the recent Archie Battersbee case, for example, the deliberative group might have involved the family, the Trust, experienced health care practitioners, legal experts and psychologists. The Grid could have been projected on a screen in a discussion room or implemented digitally. A proposal could have been put forward, say: “Life support will be discontinued after two weeks if there has been no improvement in Archie’s condition”, and participants invited to agree or disagree, referencing key segments.
Using the Grid is far from a check box exercise, nor is it intended to be applied by rote, rather it is meant as a flexible, exploratory approach to tough decision-making in which meanings and preferences are brought into the open. Possible meanings of each segment can be defined by the participants in the context of the issue at hand (and may be defined differently dependent on participants’ priorities); each participant can identify the most important segments in his or her opinion; and practical information (law, level of risk, availability of resources and so on) can also be clarified.
In order to judge who should enjoy the “most beneficial outcome”, ‘benefit’ must be defined and potential outcomes evaluated. Does “maximising benefit” mean ‘indefinite life’ for Archie and others in similarly tragic situations, or does it mean ‘a peaceful death’? If Archie is to be ‘respected equally’ with others, does this mean he should be supported to the same extent as patients with a better quality of life, or does it mean being treated similarly to others in this sort of situation? How certain is the evidence? What are the risks? Can we somehow accommodate ‘risk to individual existence’, ‘risk of devastating the family’, ‘risk of setting legal precedent’, ‘risk of unwisely using scarce resources’, ‘risk to religious beliefs in the sanctity of life’ and ‘risk to the Trust’s reputation’ in such a way that everyone involved can have their values acknowledged?
Any Grid analysis might head in many different directions, but using it will help ensure a comprehensive ethical investigation. Purposefully applied, the Grid inevitably brings values and disputes into sharper focus.
The result of using the Grid is al ways unpredictable. And it is this very uncertainty that is so vital and humbling. There are rarely if ever any right answers in ethical complexity. Open minds are essential, as any serious attempt to apply the Grid shows.
What if decision-makers had used the Grid or similar overt decision-making strategy in the U.K. in March 2020? It would have required insight, courage and humility in that febrile atmosphere, but it would have given ministers breathing space to contemplate alternatives to the ethically blind hysteria to which they so easily succumbed.
The Grid could have been used to make the case for lockdown, perhaps focusing on ‘risk’, ‘benefit for society’, ‘minimising harm’ and ‘serving needs first’. But this would have required a comprehensive rationale and a systematic ethical defence of any changes to civil liberties and established law – using the Grid demands a full and honest exploration of all its factors, in combination and in context. Sticking stubbornly to a bizarrely purist version of ‘following the science’ would not have been an option, nor would journalists who used it have found it quite so easy to denigrate protesters. We were after all simply asking for a little common-sense.
It is quite extraordinary that governments around the world were able to ignore the blindingly obvious fact that decisions of such massive import – locking down society, imposing sweeping laws preventing normal behaviours and coercing people to accept experimental interventions – are so abnormal that they require all-embracing ethical justification and should not be permitted in its absence.
HART is right to call for explicit ethical frameworks, but such declarations are a first step only. As we witnessed, even the most carefully crafted ethical pronouncements are shockingly vulnerable to the whim of ignorant news media and politicians, many of whom seem to have no knowledge of the history of medical ethics or the battle to establish universal human rights in the aftermath of brutal 20th century wars.
The act of deliberation and the freedom to reflect openly matters much more than any specific set of principles. Given the disastrous consequences of the absurd official response to Covid, we must somehow try to ensure that any future policymaking of such consequence must be subject to sustained and participatory ethical processing.
Dr. David Seedhouse is Honorary Professor of Deliberative Practice at Aston University and the creator of Our Decision Too, a free website of participatory democracy which welcomes new members.
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So many of societies problems are caused by the people highlighted here.
Odd that the pre-budget visit to Downing St by those Inner Circle of Hell debentures, Bill Gates and Larry Fink, aroused no concerns in our ever vigilant media about foreign or billionaire interference
Someone mentioned that on GB News last week, and the Leftist guest responded with, we have no right to know what they discussed and if you do, you are a conspiracy theorist. Funny how the Left is now in bed with the corporations.
Twas ever thus with Fascism as it is the difference from Communism.
This is the paragraph that really caught my eye:
‘Coban led a very full life, working as Labour-run Hackney’s Cabinet Member for the Environment and fronting the borough’s £61 million mission to tackle climate change.’
First of all what a very grand title, Hackney obviously sees itself as a mini state.
Beyond that here we have a single Labour council pouring tens of millions of pounds down the Net Zero fantasy drain (and I’m sure many Conservative and Lib Dem ones are being similarly profligate) at the same time as the Labour government complains about multi billion pound black holes in the country’s finances.
Perhaps they should join the dots…
“… a single Labour council …” As you say, they’re all at it. Our “climate emergency” was declared in October 2019, to a great fanfare and presentation of a grandiose statement of intent. Time to revisit that.
Tackling climate change is the biggest waste of human resources in the history of mankind. Never has so much been spent to achieve so little.
Indeed. A colossal iniquity.
Coban and the empty-inane wild eye look of a psychopath with the requisite moustache. A grifter, grafter, corrupt and moron. Which is why the fake news loves him.
Coban and Climate Con Fascism. He and his cult are only missing their black and grey uniforms and shiny boots.
I don’t really buy this whole “election interference” thing – people are free to make their minds up with the information available. That said, the left make sure that any “election interference” that might benefit the right is well publicised, while hiding “interference” in the opposite direction.
Labour made a huge and helpful contribution to the recent US elections. They made damn sure Trump and the GOP won the whole shooting match! Thank you, lefties!
I think Cackles deserves credit for most of that. She might well have been worse than Dementia Joe.
It is v difficult to stop the slush funds since they can target the family(ies) instead or just provide cheap penthouse accommodation.
As Farage found, they can even prosecute a staff member for exceeding the legal threshold but not dismiss the MP elected and hold another election.
So what has Gates been doing for years?
Is Keir-Ching! going to tell us what he and Gates were discussing when they met in No.10 a couple of weeks ago?
Or with Boris in 2019. At least Dominic Cummings has been spilling the beans about the fake democracy in a video interview.
An excellent piece of investigative journalism by Charlotte Gill.
Mete Coban is a Turkish Muslim from the chunk of Cyprus seized by Turkey, “Mete” being a variation of the Turkish Muslim name “Mehmet”, for “Mohammed”.
“Mete was encouraged to get into politics by his father when he was 14 “to give back to the community”, after his family moved over to the UK from Cyprus so his brother could get [FREE NHS] medical treatment.”
Strange way to “give back”, as if the Indigenous Brits have benefitted in the slightest…
On holiday in Cyprus the Cyprian Head Chef said he had recently had an operation done in London free gratis via the NHS.
As Tony Bliar is involved you just know it is, to say the least, suspicious.
Donald Trump, the Winston Churchill of our times, will stick climate change up Stamerheddons backside.
And what about all the Labour people sent to the States to help Harris..