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Book Review: Obedience to Authority

by Suleman
  1. What is Conscience, and What is its Position in the Ethics of Health Care?

In medical research, the lessons gained from the Nazi crimes against Jews have become the testing ground of conscience. The question is how such actions are performed by groups of people on a mass scale, without any provocation, who would not have accomplished such activities in the ordinary course. The death camps were operated by administrative personnel to exterminate the Jews systematically. The killing method was systematic, and they were not prepared to be savages by the force that did the unpleasant assignments; they were carrying out the duty placed on them. Their conscience was not, in ordinary parlance, different from any other German citizen. They realised that what they did was wrong at the time of committing the crime. How did they seal the emotional chamber of their hearts and indulge in unimaginable savagery, those people who were decent in the ordinary course of their disposition? The German civilians in charge of the death camps were regular, everyday people. Stanley Milgram (1983) writes, “Behind the unimaginable in a person who acts on his own, when carried out under orders, can be executed without hesitation” (p. xi). (p. xi). What is the root cause or genesis of their immoral behaviour towards a specific community?

Apart from the physical condition, when one is afflicted with health-related problems, an individual remains typically mentally weak and submissive. Stanley Milgram, the psychologist who created the Milgram experiment related to induced electrical shocks provided by the learners to a group of individuals under the experimenter’s command, investigated the moral question in health problems. This experiment confirmed that, although the act is against their conscience when people are ordered to do something by the people in power, most people will obey, fall in line, and execute the orders. The experiment with Milgram was replicated many days, and the findings were the same. People were able to place their conscience on the mortgage and carry out orders, no matter their meaning. Obedience is a virtue for such individuals, and the killing of conscience is not.

Book Review: Obedience to Authority

The fact that Milgram has been contradicted is pleasing to note. Also, the time variable is a factor. 2014 is not 1933 (the year Adolph Hitler took over Germany’s reins of power). The relentless propaganda unleashed by the top Nazi hierarchy that all Jews were evil incarnations was a powerful reason that killed the average German’s conscience and turned them against the Jews. A thick coat of negative thinking engulfed germans’ consciousness, and they were unable to transcend it when needed. In the subsequent experiment, the fact came to light that people were willing to act as per their conscience’s dictates and disobey the ill-founded orders. In health care, the role of conscience is highly essential. An individual in the healthcare system at any level does not deserve to be there if one does not follow the ethical norms in dealing with the patients under care. The best type of moral education needs to be given to the medical fraternity at all levels as conscience is an essential issue in this science. The harmonious blending of medical science and metaphysical principles is necessary for the healthcare environment. Conscience must represent the decision-making capacity of humankind to preserve the integrity and ethical wholeness.

  1. What is the Role of Authority in Health Care Ethics?

Each discipline has distinct parameters of ethics. In the healthcare system, it is linked to individual liberty. Any medical course consists of different levels of forums and authority. Medical technologies, modes of treatment have ethical implications in administering health care. Most of the hospitals have an established mechanism to decide ethical issues. At the terminating point of law, ethics enters. The moral conscience is the predecessor to the development of legal rules for social order.

A community is the individual’s ethical guardian, and the relationship between the patient and the treatment provider is no less than that of a guardian. The medical practitioner is the protector of the physical and psychological health of the individual placed under care. In the health care system, specific actions are spontaneous, they need to be taken on the spot without delay, and some steps are taken on command by the higher authority. Stanley Milgram (1983) argues, “For an act carried out under command is, psychologically, of a profoundly different character than action that is spontaneous” (p. xi). The operational level and necessity of the present-day health care system are much complicated and right, and ethics, lawyers and risk managers (who is generally an attorney) find a place. The presence of ethical issues goes in tandem with legal and risk management in the health care system. There are different levels of authorities, and at each class, the pressure of ethical decisions varies with the level of control they are allowed to exercise. For example, the attending doctor’s power is generally more than the authority of the nurse in charge of the patient. There is no fixed ethical solution to a moral dilemma, and it is situational and varies from patient to patient.

     In all cases, notwithstanding the long experience, a nurse should respect the authority and carry out the duties as per the instructions. They knew what they were doing was incorrect; the nurse is ethically right but legally wrong. In addition to protecting the patient’s interests, the concerned medical staff has to defend one’s claim also. In such circumstances respecting the instructions of the higher authorities is the best choice of professional ethics. Stanley Milgram (1983) argues, “The essence of obedience consists in the fact that a person comes to view himself as the instrument for carrying out another person’s wishes, and he therefore no longer regards himself as responsible for his actions” (p. xii). The critical issues like empirical knowledge and personal beliefs will have to be kept aside, and the ethical choice of the higher authorities need to be followed. But there are certain fundamental principles for which even the police will have to be questioned. For example, in telling the truth versus deception, it is better to stand by truth by keeping the long-term perspective in view. Stanley Milgram (1983) writes, “But humanists argue for the primacy of individual conscience….insisting that the moral judgments of the individual must override authority when the two conflict” (p.2). The role of authority in health care ethics is a delicate issue, and no cut and dry formula can be applied. The problem in dealing with the police when the doctor, nurse, and the patient have ethical conflicts. For example, how a nurse will view the case of a patient who wants to have an abortion, when according to her personal beliefs the person considers it as the murder and the doctor remains neutral or considers it from the profit angle, assuming that one has been offered a hefty sum for treating the patient? There is no final definition of authority in health care ethics. We are dealing with human beings whose inner world is known to the concerned person only, and it isn’t easy to make decisions based on feelings.

  1. Discuss Human Freedom in this Book

As we go through the contents of the first chapter of the book, the reader realizes how human freedom faced the gravest challenge in humankind’s known history. Referring to the Holocaust, Stanley Milgram (1983) writes, “These inhumane policies may have originated in the mind of a single person, but they could only have been carried out on a massive scale if a huge number of people obeyed orders” (p.1). Obedience! Sometimes what sins are committed in the name of compliance! One individual decided to terminate the freedom of millions of persons belonging to a particular community, and the release of that community was in peril. The men, when interviewed later, could not explain or give valid reasons for their heinous conduct. They had no ground and found it difficult to believe that their fall could be to that extent. The grave incidents are comparable to the road-rage, devoid of all reasoning. Stanley Milgram (1983) writes, “Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents of a terrible destructive process” (p.6). Their behaviour defied scientific explanation, and the momentary madness had its way. Why ordinary men became cold-blooded killers? They were not thoroughly convinced about the tasks allotted to them, nor were they happy about their responsibilities. When the operation was over, and when the men returned to the barracks, they were thoroughly shaken. The massacre brought to the surface the deep signs of unpleasantness about the tasks they performed under duress and compulsion.

When the killings became routine, the Nazis became desensitized, and many accepted killings as part of their duty. The unwillingness was a temporary phase. Many new methods were introduced to the annihilation program and peculiar procedures developed. Each Commander designed the best way suited to the situation, but no ambiguity was seen from the policy instructions that originated from the highest level. Hitler was clear about his objectives. Wipeout Jews, wherever an opportunity happened amidst the war-scenes. The soldiers had no option but to comply with their unit commander’s orders, and when the charges were stern and clear, no scope existed for personal choices. The soldier was worried about the consequences of disobedience of higher authorities’ orders that it may result in punishment for his family members.

  • Milgram, Stanley (1983). Obedience to Authority: The Experiment that Challenged Human  Nature. New York: Harper Perennial, 1983.

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