Duane asked:

How is medicine a social construct?

============

I'll indicate a possible approach to this intriguing question. Imagine the following three scenarios:

*
You are a tram driver and your tram's brakes have broken. You steer your tram onto a siding and
squash one person, instead of doing nothing and squashing the five people tied to the track ahead of
you.

*
You arrive in a remote village to find the locals about to kill five people; custom dictates that if you kill
one of them, then they will let five people live. So you shoot a villager to save the lives of five others.

*
You are a doctor in a remote hospital and there are five terminally ill patients at death's door. A man
arrives with a minor cycling injury; you kill the cyclist, take out his organs and distribute them among
the five thus saving their lives.

It is incredibly hard to refute the analogy at work here; each case involves the same outcome — five
live instead of one. Prima facie, one might think that it is always morally better when few die for the
sake of the many. Yet (1) we approve of, (2) we understand at a stretch and (3) we find is
outrageously wrong. So it is a good philosophers question to wonder whether there is an unjustifiable
fragmentation of value at work here — that moral values issue from a different source in each case
despite the surface similarities of the cases.

Is this because some issues in morality (e.g. medical ethics) are 'social constructs'? Are some moral
values inaccessible from different cultural standpoints? The three cases above present a problem for
a systematic ethical solution in the following way.

In the medical case, we have the Hippocratic Oath — that it is a doctor's duty to preserve life. This is
why we object to case (3). This kind of medical conservatism is ingrained in our culture, one might
say. From a Utilitarian standpoint however, the sum of happiness would be greater if only one person
died, and an impartial ethical line like this might compel us to endorse case (3). (Bernard Williams has
argued that such a line also requires the agent to alienate himself from the values that make his life
worth living. Serious moral intuitions can be such personal commitments, one might think.)

Case (3) clashes with our moral intuitions so strongly however, that we think that (3) could never be
justified. Indeed there would be something dangerous about 'moral' philosophers if they advocated (3)
on moral grounds.

But now imagine that there is a similar oath for tram drivers (McGinty's Oath — named after a great
ethical tram driver of yore, as a former teacher of mine put it). According to the oath, it is a duty for
tram drivers not to run over one person when there are five people in the way, even if you could save
the five.

Now this analogy might seem a little tortuous, but it is very difficult to spell out the difference between
McGinty's Oath and the Hippocratic Oath without begging the question against the defender of the
Hippocratic doctrine. So here is a possible sense in which ethics in medicine is a social construct. We
think that our cyclist has a better case in appealing not to be killed than the man on the track (to put it
in Contractarian terms) because of the nature of medical duty; yet considered impartially, the factual/
normative moral grounds for this appeal are difficult to justify independently of a doctrine that is a part
of our culture.

If there is fragmentation of value at work here, which is a possible way of thinking about this important
and controversial issue, it might well be explained in terms of social constructs and customs. The
Hippocratic Oath would be one such custom (so too McGinty's Oath in another possible world) This
thankfully leaves some of our important moral intuitions untouched by implausibly impartial moral
systems.

Adam Gatward