Reiheld, Alison

PhilPapers

End-of-Life Conflict Resolution PoliciesErasure of the Past: How Failure to Remember Can Bea Morally Blameworthy ActAlison Reiheld, Michigan State UniversityWojtaseiwicz (2006) argues that procedurally fair policyefforts to avoid providing “futile” end-of-life treatmentnonetheless may unjustly place the disparate burdens ofsuch policies on those who have historically born the bur-dens of injustice. I do not contest Wojtaseiwicz’s reason-ing. However, I wish to investigate whether anything elsemorally blameworthy is occuring in this scenario. To thatend, let us bracket the matters of whether it is unjust orsimply unfortunate that the burdens of these policies havea disparate impact (Lindsay 2006) and whether failure toaccount for history leads to injustice. I contend that whenmoral agents fail to properly remember past injustices, theyerase those past injustices. Such erasures of the past canthemselves be morally blameworthy irrespective of whetherthey result in acts which are (rightly or wrongly) perceivedas morally blameworthy.Two points must be made in support of the contentionthat erasures of past injustices by failure to remember canbe morally blameworthy acts. We must see why voluntaryerasure of past injustice may be morally blameworthy. Wealso must see that failure to remember can be a voluntaryact because involuntary acts are not traditionally held to bemorally blameworthy or praiseworthy.Let us first consider how voluntary erasure of past injus-tice can be morally blameworthy. Margalit (2002) arguesthat we have a duty to remember important events. Heillustrates this with the example of a commanding officer(CO) who had forgotten the name of a soldier killed un-der his command in a friendly fire incident, a soldier hewas obligated to protect from such incidents. Asking thesoldier’s name stands in for asking whether the soldier him-self is remembered. Margalit suggests that if the CO hadbeen able to recall some definite description of the soldier,he would have done just as well. But he had forgotten itall. He remembered only the event of a soldier’s death inthe friendly fire incident (Margalit 2002, 18–20). Margalitmakes this a case of the obligation to remember becauseremembering itself is an obligation. The case of the soldierillustrates that there are two potential losses at a person’sdeath: the life and the memory of the life. To lose both is toerase the person from ever having existed. Yet the CO doesremember the wrong that was done: that some individualwho was a member of a certain group (soldiers under hiscommand) died in a friendly fire incident. I contend thatif the CO had not remembered the friendly fire incident,yet a third loss would have occurred: not just the life andthe memory of the life, but the memory of the relationshipbetween the CO and this individual and the violation ofthe trust between them that ultimately shaped the finalstructure of that relationship.The connection between the friendly fire incident andinjustices may be opaque, but in both cases something islost in the occurrence and in the failure to remember. Atthe time an injustice is committed, justice itself is lost,but also belief in ideals of justice, and the “good life” thatmight have been had by the victims of injustice. But itis yet another loss if we fail to remember the injustice,1for we then also lose our grasp on the nature of the actualethical relations between persons, namely one tainted bythe losses already incurred. As Margalit (2002, 8) notes,ethics and morality are about the relations between persons.To distort these relations from their actual nature withoutany good reason for doing so is to commit a wrong. Thisis what would have happened had the CO forgotten thefriendly fire incident altogether, and this is the characterof forgetting most past injustices. Such erasures of the pastlead us to believe that our relations with each other are otherthan they are—they give us false beliefs and false relations.Whereas such false beliefs and relations may impair ourability to conduct right action, the creation of these beliefsand relations through voluntary faulty remembering canitself be a wrong action because of the damage they do tothe ethical fabric of human interaction. Indeed, we mightborrow Wojtasiewicz’s (2006) phrasing and say that we havecompounded the damage from a past injustice by erasingit from memory.But is this erasure voluntary? Recall that it must bevoluntary if we are to hold moral agents morally blame-worthy for erasure of the past. Situations do seem to existin which ensure is not voluntary, at least not in all casesfor all parties—consider the notorious manufacturing ofhistory by Soviet ministers of education and the concomi-tant punishment of dissenters, the accidental destruction ofarchives that alone record past events, or the classic exam-ple of amnesia. On the part of some agents, these are invol-untary instances of failing to remember. However, in thecontext that concerns us, where professional organizations1. Nussbaum (2000) has placed injustice in the context of what iscommonly called the capability approach: justice demands that weperform those actions which allow people to exert those humancapabilities which make a fully human “good life” possible, andinjustice occurs when we prevent the exertion of those capabilities.September/October 2006, Volume 6, Number 5 ajob 25The American Journal of Bioethicsand healthcare institutions strive to use fair process to for-mulate end-of-life policies, failing to remember is a whollyvoluntary act: no agency strives to prevent us from access-ing the past; no accident has destroyed our ability to doso. Communities have the power to set out to accuratelydescribe the past and present relations between their mem-bers, to deliberately seek out pertinent information. SouthAfrica’s Truth and Reconciliation Commission (Cape Town,South Africa) has illustrated this most profoundly. In thebioethical context, the canonical nature of discourse aboutthe Tuskegee syphilis studies also illustrates this. Thus, tofail to seek and attend to information necessary for accu-rately understanding ethical relations is a voluntary act.That professional organizations and healthcare institutionsdo or do not set out to recall and attend to relevant pastinjustices is therefore a choice for which they can be heldmorally blameworthy.Can we say that fair process is itself an attempt to takejust such account? One might be tempted to think so basedon the description of the procedure as offering “all involvedparties the opportunity to present and discuss their respec-tive positions” (Wojtasiewicz 2006, 8). One might charita-bly interpret this as including interpretations of relationsbetween involved parties, past and present. Alas, I do notthink such charity deserved, for the “fair process for con-sidering futility cases” as defined by the American MedicalAssociation (Chicago, IL) Council on Ethical and JudicialAffairs seeks only to give fair hearing to “discrepancies be-tween values and goals” of “involved parties” (AMA 1999).The council’s report also makes it clear that fair process isintended for use in individual cases for which there appearsto be irresolvable agreement about care that has been judgedby someone to be futile or not futile with respect to the ac-tual hospital policy. It is not intended for use in formation ofhospital policies on futility but for implementation thereof(AMA 1999, 940). More to my point, the steps involvedindicate that fair process does not consider background in-formation that would help construct an accurate picture ofpast and current relations between involved parties. Thesteps of fair process, should disagreement continue aftereach step, are to: 1) consider prior deliberation of values; 2)engage in joint decision making using outcomes data andvalue judgments; 3) involve consultant(s); 4) involve theethics committee; 5) attempt to transfer care within theinstitution; 6) transfer to another institution; and finally7) to cease futile intervention despite the protests of theparty who wishes to continue. It is indeed critical to con-sider values and goals and data and to seek the informedopinions of consultants and ethics committees. Yet, noneof these are necessarily acts of remembering. The proce-dure of fair process itself thus ignores the importance ofpast events, injustices or otherwise. Fair process may bea fair process, but fairness is not the only component ofethics. It is entirely possible to abide by fair process—indeed to be entirely fair—and still commit a morallyblameworthy act of erasing the past. Institutions and or-ganizations thus have obligations to augment the “fair pro-cess for considering futility cases” with relevant consider-ations, including deliberate attempts to remember eventswhich, if forgotten, might skew relations between involvedparties.I have argued that whether or not the policies Wojta-seiwicz (2006) describes result in injustice because theirburdens fall on those whom the past reveals to already havebeen overburdened, something else is awry when we fail toremember and attend to the past: the failure, itself. I do notmean to suggest that every healthcare organization needsits own sweepingly comprehensive truth and reconciliationcommission. I simply mean to suggest that backgroundingdecisions against an inaccurate picture of relations betweeninvolved parties can do morally blameworthy damage to theinvolved parties and their relations. With rare exception,we are obligated to be honest about how we are with eachother; part of that obligation is remembering how we havebeen with each other. REFERENCESAmerican Medical Association. 1999. Medical futility in end-of-life care: Report of the Council on Ethical and Judicial Affairs.Journal of the American Medical Association 281(10): 937–941.Lindsay, R. A. 2006. Why should we be concerned about dis-parate impact? American Journal of Bioethics 6(5): 23–24.Margalit, A. 2002. The ethics of memory. Cambridge, MA: Har-vard University Press.Nussbaum, M. 2000. Sex and social justice. New York, NY:Oxford University Press.Wojtasiewicz, M. E. 2006. Damage compounded: Disparities,distrust, and disparate impact in end-of-life conflict resolutionpolicies. American Journal of Bioethics 6(5): 8–12.Copyright c© Taylor & Francis Group, LLCDOI: 10.1080/1526516060085981326 ajob September/October 2006, Volume 6, Number 5

Erasure of the past: How failure to remember can be a morally blameworthy act

https://philpapers.org/archive/REIEOT.pdf

Erasure of the past: How failure to remember can be a morally blameworthy act

Abstract

Similar works

Full text

Available Versions

PhilPapers