In the 1990’s I was a special student at Harvard Divinity School. My interest was moral philosophy, sparked by the kind of situations I encountered in my therapy practice. There were occasions, custody issues, for example, where I was asked for opinions or recommendations. Rarely were cases clear cut. Children and their parents experienced painful gains or losses no matter what I proposed. I thought it impossible to be in my position without acknowledging the “blood on my hands.” What I owed was a thoughtful process and an open ear and heart to all parties.
Browsing in the old Harvard Bookstore on Mass. Ave. in those halcyon pre-Amazon days, I also discovered Martha Nussbaum’s brilliant and profound,”The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy.” She explored the suffering often associated with being forced to choose between two goods with negative consequences to befall the unchosen– think “Sophie’s Choice” or Patrick’s dilemma regarding custody of Amanda (played by granddaughter Madeline O’Brien!) at the end of “Gone, Baby, Gone” for contemporary illustrations–and raised questions of whether one could be called a good person if harm was the unavoidable outcome of well intentioned acts.
This week the many rave reviews by emotionally shaken writers of Kenneth Lonergan’s Sundance critics prize winning film, “Manchester by the Sea”, (in which my grandson Ben appears in a small, but significant part) reminded me once again of the many ethical issues that I think are relevant to those of us who live with chronic illness.
Often we and our families find ourselves in situations that call for us to exercise what I would call moral intelligence. Among the many reasons are the increasingly complex judgements we are called upon to make where the outcomes have mixed outcomes and we approach with marked ambivalence. This is often the case particularly where the distribution of resources and care giving is concerned.
To what extent can the members of our family be asked to sacrifice their interests for our sake? What if we and our families do not share the same values? To what degree do the claims of the obviously suffering person deserve more consideration than the claims of others? How often do the lengthy and intrusive assessment and search for the best and most rational solution create more unnecessary pain?
Formerly, for example, custody decisions were to be made in the best interest of the child. After many years, people realized the time, money, and effort involved in deciding. inflicted unnecessary pain upon child and family. The standard now is less “best” and more likely “reasonably good.”
How often do we admit that there is no perfectly good, wise, or just solution to many medical quandaries Is it any wonder that the deep feelings that surround our own experiences of life get stirred up and hurled into these whirlpools of emotion? In circumstances where we must decide between incommensurable goods, that is those things which cannot truly be compared–autonomy vs. safety in assisted living and nursing homes as examined in “Being Mortal.”
Maybe the best we can do when we face adversity and the hard judgments that may be required by ill fortune are to know to whom to turn to examine the perplexing questions? For many people in our culture, where religion and ritual once served as supports, alas, there is no longer “the sacred canopy”, as Peter Berger wrote referring to people in traditional cultures. We must find family members, devoted friends, trusted professionals to affirm and witness with compassion our afflictions and to help us and those for whom we care and care find meaning, comfort, and compassion. It is never too early to know or to ask.