Heuristics are for humans
Wherein we discuss heuristics vs. algorithms and the 5 Ds of bioethics case analysis
This is what the AI image algorithm spit out when I mentioned “heuristic” Bing is creepy.
In chapter two of Practical Bioethics, I introduce a heuristic tool to analyze case studies. A heuristic is different from an algorithm. Algorithms produce predicable and consistent results. Heuristics are more human. They are rough and ready procedures that produce results that are aren’t as predictable or nearly as consistent.
Heuristics are human. They aren’t perfect, but they give us a process for doing rough assessments. Jeremy Bentham, the Utilitarian philosopher and Weekend at Bernie’s impersonator, wanted an ethics that was like an algorithm I think. Ethics was essentially an arithmetic problem. Add up pleasure, subtract pain for each option. Pick the most optimific.
Bentham both throwing and wearing shade
I kind of see J.S. Mill as pulling Utilitarianism back to a heuristic. We should make a study of the past to see which principles lead to overall well-being but the results would not be algorithmic.
You know who understood this? Aristotle. I am fond of W.D. Ross’s translation of the Aristotle’s Nicomachean Ethics :
We must be content, then, in speaking of such subjects and with such premisses to indicate the truth roughly and in outline, and in speaking about things which are only for the most part true and with premisses of the same kind to reach conclusions that are no better. (NE 1.3)
I think Aristotle would have liked the word “heuristic” Don’t you?
The heuristic I introduce in Practical Bioethics, I call the five Ds. Describe, Dilemma, Discern, Decide, Defend. Notice they are verbs (except for “Dilemma” which I couldn’t make a verb and I tried. Oh how I tried). Describe the relevant ethical details. Articulate the dilemma. Discern the principles. Decide the course of action and Defend your decision against objections.
If you do a search for ethical decision making heuristics, you will find that no matter the field (accounting, business, medicine, etc) the elements of ethical analysis are largely the same.
The exception might be the “Dilemma” phase. We talked about dilemmas in “Damned if you Do, Damned if you Don’t”. So refer there to see how I define dilemmas. I mentioned in that post that I am a bit insistent that my students be able to articulate the dilemma. After all, if there is a clear option with less ethical costs than the alternatives, then there is a clear moral reason to chose that option.
Actual clinical ethics consults are almost never that clear cut. Else they wouldn’t be referred to an ethics committee. Real cases are messy with facts. That’s why you have to isolate the ethically relevant facts in the describe phase. This helps you articulate why this case is a dilemma. If we do x we violate this value but if we don’t do x we violate this value.
It gets even messier when start comparing this case to other cases and time-honored principles in the discern phase.
[As an aside, pre-med students and nursing students especially get frustrated about the time I introduce the discern phase. Understandable because their worlds outside of my class are full of titrations, measurements, and you guessed it: algorithms. Evidence based medicine is practically a mantra these days. We are all down with EBM right? It takes some time for them to realize that ethics is more heuristic than algorithm]
The decide phase is also one that students have to get used to. I am fond of saying tongue-in-cheek “Get the fence post out of your butt. You have to come down on one side or the other.” This gets across to students that you do all this work and then waffle by saying “Well, there are good arguments on all sides and who’s to say?” It may be true there are good arguments on all sides but this is a dilemma. Doing nothing is choosing.
The defend phase can also be a challenge. Students are not skilled at answering objections to their claims, let alone coming up with those objections themselves! Putting yourself in the shoes of another stakeholder is sometimes an art that comes from practice.
I agree that it is necessary to provide students with a protocol and a framework for thinking through an ethical dilemma. My problem is not algorithmic thinking, but just emotional reactions. Students will just state their opinion, and then say everyone's opinion counts. I'm not confident they are learning anything in the class. I was asking them to use a specification model I found in Beauchamp and Childress, in which they have to state the principle they are invoking, like autonomy or beneficence, and then specifying this principle into first rules and then judgments.