One can interpret this in two ways: firstly, can morality continue to exist in a society that treats it as an “add-on”, rather than a set of principles which should (in some sense or other) ‘dictate’ our actions and, secondly, is it possible to negotiate one’s way through a morality (moralities?) whose principle concern seems to be economic? Put another way, are economics and morality such different kinds of ‘thing’ that they are mutually exclusive?
A primary consideration here is how, before we get to the varieties of competing metaethical theories, we define morality per se. Is ‘morality’ something that I can have in and of myself or, as I will argue, is morality (similarly to, for example, language) necessarily a shared concept, that is, a concept which makes no sense without the inclusion of other human persons?
Think about the Aristotelian concept of morality compared to the post-Cartesian concept. Prior to Descartes, morality is performative: one reveals one’s moral standing through action. What you say is as nothing when compared to what you do. One expresses one’s morality in the ways in which one behaves in the world, how one treats others. Aristotle identifies a set of performative ‘virtues’ that are manifested in the world. Without manifesting these, one cannot be identified as moral/virtuous because, on the Aristotelian model, a virtuous person is one that we are encouraged to imitate – a central idea to his theory. One imitates the virtuous person consciously, until such time as this imitative behaviour becomes unconscious. At this point, you too are virtuous.
However, with the advent of Cartesian dualism in the eighteenth century, thus, the split between body and mind, Cogito ergo sum (I think, therefore, I am), morality becomes a very different kind of thing. Once the idea that the human person consists primarily in a “thinking thing” takes hold, we embark on what still holds today: morality is expressed as thought, as a disposition – but a disposition that is not necessarily acted upon. One can “morally approved of/support” X, Y and Z, but in thought alone. There does not, apparently, need to be any accompanying action in which one manifests one’s dispositions. Agency then consists in agreeing that X is good, or saying that one approves of Y but the performative aspect has become secondary to the thought. Thus, the news item on genocide in Gaza can be classed as ‘upsetting’ and the Israelis condemned, but without any accompanying action. The news media itself (in general) plays into this by focusing on items that enable condemnatory inaction. It contributes to the idea that “this is just the way the world is; there’s nothing I can do”.
In addition, our “moral thinking” has been altered by the focus on individualism. Not only are we encouraged to feel powerless in the face of events that are represented as having the same tenor as “natural disasters”, individualism causes us to see such events as “not my business because X does not directly affect me”. Thus, in Ireland, we watch, and are entertained by, events in Gaza, Yemen, Sudan and Ukraine. What we might call “the moral reaction” only appears when people from these places flee and arrive here. Then we see “the blame game” begin: they (these ‘others’ who are not like us, although it’s more palatable if they’re ‘white’) are responsible for the housing shortage, they’re taking ‘our’ jobs, they’re claiming benefits and so on. Nor are these claims confined to far-right parties; mainstream politicians will utilise these ‘sentiments’ to show that they are “in touch” with the “real Irish”.
Who exactly are the “real Irish”? Do they possess some distinguishing characteristic that means they are more ‘worthy’ of moral consideration that those who are classed variously as ‘immigrants’, ‘refugees’ and “asylum seekers”? Or is this some entirely invented category of ‘nationalism’ that owes more to late nineteenth/early twentieth century nostrums of racial superiority? A throwback to the (ridiculous) idea of racial ‘purity’?
What we see here is a thought-performative morality: “Oh, I know it’s terrible in those countries but…”. We also see the bifurcation of morality: it no longer the case that “X applies to all human persons, but that “X applies to human persons, if and only if, they possess certain characteristics”. What recognition of this does, is lead back to the central question: can morality be said to exist if it does not apply to all human persons equally?
And here we can introduce a further ‘aspect’. Those who take the centre-, soft- or far-right position argue from what is represented as the “sensible position” of economics. Their morality is measured in terms of money. Let us formulate this so there is no mistake. This position is “I/We will behave morally if and only if economics agrees it makes sense to do so”. Therefore, morality is allowed to exist only when money says it can (to put it bluntly – which it needs to be). Take a macro example: Western countries’ Foreign and ‘Aid’ policies are both inextricably linked to obtaining preferential economic advantage – aid as imperialism, foreign policy as colonialism. A country which is seen to ‘threaten’ the economic interests of a “Western Power” will find themselves being undermined economically, and overthrown. Ethiopia and Chile for example – or any number of South America countries. Or Cuba. Or various countries in Africa. Or, if we go back to 1919-21, the Soviet Union (which is not to suggest for a moment that the West ever stopped trying to undermine the Soviet Union, merely that it became less blatant). Thus, morality is linked to economics and to obeying Western capitalist ideology, but ‘aid’ is represented in the Western media as morally neutral and beneficent. The general tenor is “Look at us helping out these poor, badly-governed, underdeveloped countries”, the irony being that the poverty and underdevelopment is a direct result of Western imperialism. As are the regimes that hold power (the former Soviet Union included).
One can take a smaller (micro?) example of morality as an add-on: the Irish Healthcare ‘system’. We have a public health service, funded from taxation. This service is designed to provide care to everyone. However, private medical insurance is rife because, in the public system, wait times are so long. Indeed, public patients die whilst waiting for treatment. What private health insurance enables is queue-jumping. If I can pay, then I can obtain treatment before you, regardless of the fact that your need is greater than mine. Thus, wealth transcends the position that you should be able to obtain treatment when you need it. Morality is conveniently side-stepped, forgotten in the relentless pursuit of profit.
Of course, there is also personal responsibility here. If people didn’t buy health insurance then the public health system would necessarily be improved, partly because public health spaces and equipment would not be used to ‘accommodate’ private patients at the expense of the poor. Treatment would be distributed on the basis of need. Therefore, one can argue that those who buy private insurance are acting immorally.
One can make precisely the same argument in regard to those who opt to use private education (the irony being that public taxation is used to pay the wages of teachers in private education; perhaps ‘outrage’ is a better word than ‘rony’ here). To those who would argue that “It’s my money, and I already pay taxes for the upkeep of public schools”, one can reply “You miss the point. You are trying to buy your child an advantage and supporting a system that guarantees and perpetuates inequality”. As with private health insurance, this is not a credible argument because it is tied to economic advantage. Unless there is a metaethical theory that incorporates inequality of persons in general, and inequality in wealth in particular – a theory that can justify how inequalities can result in fairness and justice for all – then these chosen actions are immoral.
I have no intention of considering each metaethical theory in turn, that would be too boring and serve no purpose. Instead, just consider a couple which seem to me to underlie our concept of “moral thinking”…until recently.
Firstly, Kant’s Categorical Imperative (CI). This is, to put it simply, a reworking of the Christian idea of “Do unto others as thou would have done unto you”. In other words, what Kant suggests is that when we make a moral decision we are not just making it in regard to ourselves, we are, in effect, saying “Anyone in position X, should behave in this way Y”. This applies, in regard to healthcare, in two ways: firstly, when I am able to obtain quick and appropriate treatment, I am in effect endorsing that everyone should be able to do this and, secondly, if I obtain this treatment using private health care, I am endorsing that everyone should be able to afford to do this. We can reduce these to a single ‘condition’: From each according to their means, to each according to their needs. Which formulation may seem rather familiar to those aware of socialism.
What Kant is definitely not advocating is that I, in virtue of my income, am better than these people, therefore, more ‘worthy’ of treatment than they are. Is there any set of conditions in which person X is more deserving of healthcare than person Y? No. In order to believe that this is the case, economics must be prioritised over morality, thus, Kant’s CI must be rewritten as “Anyone earning X amount, therefore, able to afford private healthcare, is more valuable than those who cannot afford said healthcare and are, therefore, more deserving of receiving healthcare first at the expense of those who do not earn X amount”. In Kant’s general schema then, this alters the primary consideration, that all human beings instead of being considered ends in themselves become, in some cases, means. The introduction of economics requires that the entire schema be rewritten to accommodate this. What is ‘this’? Institutionalised inequality.
In this case (as in others, John Rawls for example, who takes what exists and then “reasons backwards”), Kant’s is no longer a metaethical theory. It becomes a theory constructed to justify what exists ‘now’. In short, it must assimilate capitalism in order to justify inequality and injustice, and revisit definitions of ‘natural’, ‘ends’, ‘reason’ and ‘Being’.
In healthcare, deontology (doing one’s duty) is most famously related to Kant. However, when one attempts to act deontologically within our existent system, one has to ‘shrink’ one’s moral behaviour to one’s specific circumstances: I cannot justify doing my duty in general terms, therefore, I must try to apply doing my duty in the circumstances that I find myself in here and now. Thus, deontology becomes not a metathetical theory, but a theory (if one can call it that, which requires a consideration of the term ‘theory’) I use to try to justify my actions here and now. For example, if I work in private healthcare, I remain aware that this is not morally tenable. All I can do is grasp at “moral straws”, see morality as an “add-on” to my own economic well-being (which I prioritise over morality per se). By doing this, I am culpable in capitalism’s systemic immorality.
We can also examine consequentialism, a theory developed to go beyond Kant’s concept of doing one’s duty regardless of the consequences. The clue is obviously in the name. When considering one’s duty (according to a set of moral absolutes that Kant specifies), one moves beyond performing dutiful actions to consider the consequences of those actions. Take a standard example: if a dementia patient begins each day by getting dressed then awaiting the arrival of their partner who I know died long ago, do I each day tell that patient that their partner is dead? The answer is (to me anyway) no. To tell the patient that their partner is dead each day would inflict needless suffering, so one engages in what is called the Benevolent Lie. Truth-telling in this instance is neither beneficent nor is lying maleficent. This is, however, an example drawn from here and now circumstances in healthcare practice. What are we to make of other types of example drawn from healthcare? For example, why is this waiting list two years long? Why are patients in public hospitals waiting on trolleys for eight hours? These are consequential examples that have their basis in economic inequality. One can identify the consequences of immoral behaviour in both of these examples, but the reasons for these are beyond our control, insofar as others – whom we elect – are meant to act in the best interests of everyone.
Here we can cite another metaethical theory, Utilitarianism, summed up by the slogan, “The greatest good for the greatest number”. This, at face value, appears to suggest that having a health service which treats each citizen equally, regardless of their income, and provides prompt treatment is a moral imperative. However, once again, economics is overtly influential in this moral imperative, therefore, the imperative becomes immoral as income dictates treatment (N.B. When economics is introduced into Utilitarianism, the result can be brutal.)
Thus, in healthcare, we can (and necessarily do) reach the conclusion that economics is incompatible with metaethical theories of any sort. We could levy precisely the same charge at narrative ethics, care ethics or contractualism. We can, in fact, go further and argue that the incompatibility between morality (healthcare ethics in this specific case) and economics causes those who work in healthcare perpetual moral distress, in that it forces them to adjust their moral compass to accommodate the inequality and injustice that is a defining characteristic of the capitalist system. Healthcare professionals know what they should do yet must contrast this with what they can do constrained, as they are, by an economic system based on inequality.
This serves as one example of the ways in which the human person knows what it is moral and right to do, but engages in a series of compromises forced upon them by the capitalist system. Of course, this system attempts to present itself as ‘legitimate’, as ‘natural’, the way human persons are whilst eliding the fact that the environment in which the human person exists is the cause of these behaviours apparently being ‘natural’.
In this artificially-created environment, in which the focus is shifted from said environment to the individual as responsible for their own economic ‘situation’, morality is, indeed, thought-performative: a series of moral positions which are ‘expressed’ through social media by clicking ‘like’, ‘upset’ and ‘love’ emojis, without any expectation of change. Morality becomes simply a way of trying to live with oneself in a world that is structured by self-interest, greed and performative cruelty.