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Problems of ethics and of professional ethics

Professor Kuguradi graduated from the Department of Philosophy, Istanbul University in 1959. Appointed Assistant Professor there between 1959-1961, she then moved to Ataturk University, Erzurum until 1969 and to Hacettepe University in 1969 where she remained until 2005. First appointed as lecturer in the Education Department, she became Founder and Head of the Department of Philosophy, and later Founder Director of the Centre for Research and Application ofthe Philosophy of Human Rights. She has also held a UNESCO Chair of Philosophy since 1998. Recently she moved to Maltepe University, Istanbul. Amongst many honours, she received the Council of Secular Humanism's Planetary Humanist Philosopher's Award in 2005. She has served on many Committees, notably the International Federation of Philosophical Societies (president between 1998-2003). Professor Ioanna Kuguradi Ioanna Kuguradi Hacettepe University, Ankara, Turkey Correspondence: e-mail: ioanna@fisp.org.tr

Abstract
Conceptual confusions have a negative impact on our thinking and are among the main obstacles that prevent us from finding ethically sound solutions for the problems we face and so to overcome artificially created dilemmas. In this paper, first I shall show the differences among kinds of so-called 'ethical problems'; then I shall try to clarify the term 'ethics'. On the ground of these distinctions and clarifications, I shall attempt to exemplify how we can deal with the different kinds of ethical problems related to the issue of this conference in an epistemically and ethically sound way, beyond the alternatives created by the confrontation of different norms on the same issues, stemming from different, not rarely incompatible, world views and anthropological conceptions, i.e. stemming from the differences between cultures. Keywords: assisted human conception, meanings of ethics, medical ethics, moral philosophy

Introduction
The questions and problems of ethics as a philosophical discipline - or of moral philosophy, as Anglo-American circles call this same discipline - , although they are related to our decisions and actions in our relations with other persons and with ourselves, are different in kind from the ethical questions and problems we are faced with in everyday life. Their ontological and epistemological specificities are different: consequently these two kinds of questions and problems should not be confused, although it is usually done. For example, the question 'what is the right action?' and the question 'what is right to do now, in this situation?' do not ask about the same thing. The answer to the former would be the 'definition' of 'right action'; while an answer to the latter could be given only by one's finding out what he should or can do in that given-unique situation in which he has to act. For example, he could say 'I have to resign from this post' and do so. In the first case we are dealing with knowledge, in the second with action. Yet, the questions raised ethics and various other to neither of these kinds ask what is right to do now in bioethics, medical professional ethics belong of questions. They usually in such and such cases in general, e.g. 'shall cloning of organs be permitted or not?' As can be easily seen, the ethical questions raised in everyday life are: (i) questions concerning a given person's evaluation of a given, real situation, action, person ete.; (ii) questions concerning the attitude that a given person - you or me - has to take, or the actions that one has to perform in a given, real situation. The questions raised in professional ethics on the other hand, concern what one should or should not do in general, while exercising the given profession; they are questions concerning ethical and legal norms. Their answers, if given, appear as international declarations and professional codes. If they are not given, they are left to the decision of the states.

The meaning of the term 'ethics' in bioethical debates

Let me now try to distinguish among the meanings that the term 'ethics' is ascribed in the present debates, and, of course, the objects it is made to denote. These distinctions help us to avoid naming two different things with the same name - which is one of the main causes of confusions and dilemmas we are faced with.

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Problems of ethics and of professional ethics - / Kuguradi

avoid naming two different things with the same name - which is one of the main causes of confusions and dilemmas we are faced with.

Ethics as an unwritten system of actionguiding norms

'Ethics' sometimes denotes systems of norms - norms of evaluation, action, behaviour or conduct - valid in a given group at a given moment, which are expected to determine the evaluations, actions and conduct of individuals in their relations with other individuals in the given group. These are sets of widespread, living, unwritten conceptions concerning what is 'good' and 'bad' and what one should or should not do in general, prevailing at a given moment in a given group or culture. These norms, especially the norms of evaluation (the general 'value judgments') or the 'goods' and the 'bads' prevailing in a given group, are called 'values' - another confusion that has crucial implications for theory and for practice as well, e.g. it has led to the claim that 'science should be value-free'. Scientific research and its application should, of course, be free from cultural value judgments, but this does not mean that everything is permitted. Scientific research has to be based on ethical value knowledge. When we consider such existing systems of unwritten norms, we realize that they consist of epistemologically different kinds of norms - i.e. of norms deduced from premises of different epistemic specificities and by different kinds of reasoning - and consequently of norms which show axiological differences. Most of these cultural norms differ from a cultural group to the other and change with the time in the same group. The expression 'multicultural society', currently fashionable, aims to describe groups with different cultures, for example, different world views, ways of living and norms of evaluation and action, living in the same space. In other words, a multicultural society contains groups who impute different values to the same 'things', using different cultural value judgments, and consequently aet and react differently. Conflicting cultural norms are to be found behind so-called 'honour killings', the different attitudes to the termination of pregnancy and most of the artificial dilemmas we are made to face in bioethics and medical ethics, for example. They are due to different, often opposite, evaluations ofthe same 'things' made on the grounds of different or conflicting cultural norms. The term I use for these evaluations is 'value imputations' (Kuguradi, 1984). Professional codes and various declarations of international organizations are attempts to overcome such cultural, including religious, approaches and norms. Still such codes and declarations are approved by consensus, or better by compromise, mostly without sufficient scrutiny ofthe included and non-included norms.

agreed upon by the consensus of those involved and made valid by the appropriate procedures - still mostly without being evaluated philosophically. Typical examples of 'ethics' in this sense are all 'professional ethics', which are constituted of norms expected to determine the actions of everyone belonging to the profession. This is now the most widespread meaning of 'ethics'. Most ofthe norms in the Universal Declaration of Human Rights are this kind of basic norms. This is why the Declaration can be considered as an 'ethics' in this sense, though it is not called so. UNESCO's Universal Declaration on the Human Genome and Human Rights (1997) and the Guidelines for its Implementation (1999), the International Declaration on Human Genetic Data (2003), the Norms on Bioethics and Human Rights (2005), as well as similar documents of the EU, are attempts to develop general norms, to be used by everyone in the profession. In all these useful endeavours, it escapes attention that people can be forced to act according to norms, but they cannot be forced to act ethically. For the latter, everyone has to settle accounts with himself or herself. It also escapes attention that each case in reality is unique and has to be evaluated on its own account, provided that we wish to protect not the norms in themselves, as it often happens, but human beings and human dignity. It also escapes attention that the ethical problems faced during the exercise of medicine and related research are not different in kind from those faced in everyday life, but in order to solve them in an ethically sound way, professional knowledge is necessary. For this, education in philosophical ethics and training in evaluation beyond cultural norms is necessary.

Ethics as a philosophical discipline

'Ethics' is also used to denote the philosophical discipline which puts forth, or is expected to put forth, verifiable/ falsifiable knowledge. This philosophical discipline is usually, but not always, considered to be a 'normative' discipline, as a result of which we see various approaches to ethics, such as normative-deontological ethics, metaethics, and attempts to synthesize them. For the sake of clarity, I prefer to use the term 'ethics' only for the philosophical discipline whieh produces verifiablefalsifiable knowledge on the ethical human phenomenon. The sets of norms of the first kind, the sets of unwritten norms can be termed 'morals', and those of written norms 'codes of morality'. Under the two sub-headings below, I shall try to give you two examples: concerning how, I think, we can deal with disputed general issues in the light of ethical value knowledge.

Marrow transplants and Kant's practical imperative

It was many years ago. I was in the office of a friend, the first doctor in Turkey to carry out a marrow transplantation. He received a call from an Italian journalist, asking him his opinion about an ethical problem on which a fiery debate was going on in his county, related to the following event: There was a child, to whom marrow transplantation was

Ethics as a written code of norms as with medical ethics

Within other contexts the term 'ethics' is used in order to denote systems of written norms, or codes of norms, developed with given purposes. Such documents are constituted of norms deduced for the purpose or selected among existing norms.

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Problems of ethics and of professional ethics - / Kuguradi

could pass to the marrow of the ill child. But the 'ethical authorities' in his country, to use the journalist's expression, claimed that this solution was 'unethical', because the second child would be treated as means. Whoever has read Kant's books on ethics. Critique of Practical Reason and his Metaphysical Foundation of Morals, will recognize that those 'ethical authorities' assumed that they were basing their objection on Kant's 'practical imperative', which says: 'so act as to treat humanity in your own person, as well as in the person of any other in every case also as an end, never as means only' (Kant, 1956). These ethical authorities had not probably paid sufficient attention to the word 'only' that Kant, to my mind very wisely, added to this criterion of 'good will' and consequently of ethically sound action, and they probably didn't know that giving marrow does not do any harm to the health of a healthy donor. Thus they applied to the decision of these parents a misinterpretation of Kant's 'practical imperative'. I don't know whether these parents got a second child and what was the fate of the ill child, i.e. I don't know what was the pragmatic result of this decision. But I do know - due to my research in philosophical ethics - that this Kantian criterion for the quality of the will and consequently of action is an insurmountable criterion for one of the points which make a decision or an action ethically sound.

are thousands of children without a parent, who can be adopted by those who wish to have children.

Conclusion
For all these reasons, I wish to close by suggesting that before we start discussing such issues, most of which depend on an individual's decision, training in philosophical ethics is necessary. Knowledge of norms is not sufficient for ethically sound action in any given situation. Because the subjective conditions of ethically sound decisions and actions are settling accounts with ourselves in the light of ethical value knowledge, while its objective conditions are, besides this knowledge, detailed knowledge of the situation in which we have to act and professional knowledge. Norms of morality can play only a limited role, in cases that we don't possess sufficient knowledge of the situation. In such cases the role of norms is to increase the probability, but only the probability, of ethically sound action.

References
Kant I 1956 Grundlegung zur Metaphysik der Sitten, Kant Werke in zwolf Banden VII, Theorie-Werkausgabe, Suhrkamp. Ku9uradi I 1984 From Revolt to Philosophy. In: Mercier A, Svilar M (eds) Philosophes Critiques d'ettx-ttietnes/Philosophers on Their Own WorldPhilosophische Selhstbetrachtungen 11. Peter Lang, Bern. pp. 109-119.

Human life and human rights

Another strongly debated issue is the 'beginning of human life'. According to different acceptances concerning this beginning, research (e.g. stem cell research) and various practices (e.g. tennination of pregnancy for different reasons) are permitted or prohibited as violations of the right to life. I think here the crucial question is not the beginning of life - which is obvious- but whether the embryo, whose life is dependent on the bearing mother, can be considered a human being. Some consider it a human being and some others do not. Objectively seen, it is a potential human being. Aware that all human rights problems are also ethical problems, but not vice versa, I can say that here we are faced with a mother's ethical problem, to be decided by the mother, based on medical and ethical knowledge. When a mother decides to terminate pregnancy for any reason, she decides about a treatment of her own body, but when she decides not to terminate the pregnancy in spite of all other (philosophical and physical) problems that might be involved, she decides for the future independent existence of a human being, sometimes of a human being who cannot physically exist independently. I think that the decision to terminate or not terminate pregnancy is an ethical right of the mother, who can use it under the influence of cultural-religious value judgments or for other reasons, including for the sake of the future human being, which might necessitate termination of pregnancy. Concerning assisted reproduction I wish to say that I have no serious ethical objections, if it does not cause great risks for the health of the mother, but that I find it unnecessary, when there

Received 10 July 2006; refereed 21 November 2006; accepted 8 December 2006.

Ethics, Law and Moral Philosophy of Reproductive Biomedicine. Vol. 2, No. I, February 2007