Mednotes

L7 Ethics Ethics and te ao Māori

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tagsethics, lecture
aliasesL7 Ethics Ethics and te ao Māori

10 min read

Overview

This lecture argues that ethical reasoning is never culture-neutral: values and the rules built on them come from shared “forms of life”, so a purely rational, principle-based approach to ethics (as in the “four principles” of biomedical ethics) presupposes a common set of values and language that cultures do not automatically share. It then applies this to Te Ao Māori, contrasting tikanga-based values with the “four principles” framework and working through a Covid-19 vaccination case to show how a value difference between Māori and non-Māori perspectives on age and vaccination priority has real ethical and policy consequences.

Ethics depends on shared values and language

  • Ethics is an attempt to answer questions about what we should do; difficult ethical questions often arise in medicine.
  • We answer ethical questions with reasons; reasons carry normative weight according to the values they refer to.
  • Values come from many, intersecting sources: family, upbringing, society, identity, religion, past decisions, medical school, “nature”, intuitions, and culture.
  • The assumption that continued ethical discussion will converge on an answer everyone agrees with presupposes three things, any of which may fail:
    1. A common set of values to refer to.
    2. A common language through which to understand values.
    3. Participants equally able to express their values.
  • Cultural difference is a major reason these presumptions can fail; this links to cultural safety.

Moral philosophy has often ignored culture

  • A long tradition in moral philosophy (associated with figures such as Descartes, Kant and John Stuart Mill) presumes ethical questions can be answered through rational analysis alone.
  • This tradition connects to the “four principles” approach of Beauchamp and Childress (Principles of Biomedical Ethics): non-maleficence, beneficence, autonomy and justice, which they claim are “not relative to cultures, groups or individuals” and so should be equally compelling regardless of a person’s culture.
  • The lecture states this claim is not true.

Where values actually come from

  • Values are grounded in practices or ways of living, i.e. culture. Ludwig Wittgenstein called these “forms of life”; participating in a form of life means absorbing a set of commitments and norms.
  • Ethical rules are fundamentally based on ways of living, not the other way around. Medicine is itself a practice, so this applies to medicine too.
  • Example: a STOP sign is only a “reason” to stop for someone who already participates in the practice of road rules. Trying to justify the sign by appeal to further rules only pushes the question back further (what are those further rules based on?). The real justification is the practice itself: if people don’t obey road rules, the whole practice of driving on the road ceases to work.
  • Key points about ethics:
    • Any justification of an ethical claim ultimately rests on some concept of how life is actually lived (“how we do things around here”).
    • Someone with no comprehension of a way of life will not understand a rule grounded in it.
    • This does not mean forms of life unfamiliar to us (other cultures) can never be understood — it means we must take time to learn about a way of life before engaging in ethical discussion about it.
    • Cultures can and do change, but a culture should not be expected to change simply because of a “good argument”.

Tikanga and Te Ao Māori ethics

  • Quotation (Te Puni Kokiri, 1994): “Ethics is about values, and ethical behaviour reflects values held by people at large. For Māori, ethics is about tikanga – for tikanga reflects our values, our beliefs and the way we view the world.”
  • Contrast drawn between “supposedly universal” European ethical principles and Māori concepts:
    • The “Big Four”: beneficence, non-maleficence, justice, autonomy — the lecture stresses that interpretation of these principles is culturally shaped.
    • Māori concepts named: Manaakitanga, Kaitiakitanga, Utu and Mana; also Rangatiratanga and Mana Motuhake.
  • Tikanga has evolved and is still evolving.
  • A rhetorical device (a taniwha image) is used to parallel the earlier STOP-sign example, illustrating that meaning depends on the cultural framework of the viewer. [flag: the slide poses “what does a taniwha represent?” as a rhetorical question without an explicit on-slide answer; meaning was to be inferred from lecture delivery, not stated on the slide]
  • A poll slide (“Dogs are friends, not food”) was used to illustrate cultural relativity in norms about animals (e.g. dogs as pets vs. food across cultures). [flag: the poll question itself is not given on the slide, only the title statement and an icon]

Moral intuition and its cultural basis

  • Most ethical decisions are intuitive and dogmatic rather than the product of explicit rationalisation; this is both good and bad. It would be difficult to live daily life needing to rationalise every decision, and intuitive decisions are not always “less ethical” than rationalised ones.
  • Which ethical intuitions are perceived as valid is often linked to their cultural underpinnings.
  • Implications:
    • Many ethical norms and beliefs are difficult to explain, but difficulty of explanation does not correlate with the strength of those beliefs.
    • It matters who you demand ethical justification from.
    • It is tiring and stressful to have to justify ethical beliefs just so they are not discarded by health professionals.
    • We don’t need to understand why a patient’s or co-worker’s boundaries exist in order to respect those boundaries.

Case: Covid-19 vaccination priority and kaumātua

  • In 2021 the first priority group for Covid-19 vaccination was people over 65, since older people were more vulnerable — this was widely supported.
  • Māori die on average 7 years earlier than non-Māori and experience a wide range of illnesses earlier than non-Māori.
  • Māori health experts and public health experts argued for a younger vaccination priority age to protect kaumātua.
  • Arguments discussed:
    • Against: health resources should not be prioritised on the basis of ethnicity.
    • For: equity, addressing systemic and historic disadvantage and inequitable access.
    • Consideration specific to Te Ao Māori: kaumātua hold an important role within whānau, hapū and iwi.
  • Counterpoint raised: many tauiwi (non-Māori) also value older people — but two further examples were used to complicate this.
  • Examples of public commentary devaluing elderly lives during the pandemic:
    • A reported private summary of a UK Prime Minister’s senior aide’s approach as “herd immunity, protect the economy, and if that means some pensioners die, too bad” (denied by the government, quoted via Simon Mair, Research Fellow in Ecological Economics, University of Surrey, via BBC Future).
    • Texas Lt. Gov. Dan Patrick reportedly suggesting he and other seniors were willing to “take care of ourselves” rather than “sacrifice the country” economically (NBC News).
    • A cited Atlantic piece (“A Failure of Empathy Led to 200,000 Deaths. It Has Deep Roots.”) on a psychology explanation for apparent indifference to elderly deaths.
  • What this shows:
    • The claim is not that there is a consistent Māori/non-Māori difference in how older people are viewed generally — many Europeans agreed with the pandemic-era sentiments above, and many others strongly objected.
    • Nonetheless, this is presented as an ethical issue where the established Māori perspective sharply contrasts with that of some European New Zealanders — a basic value difference relevant to ethical discussion and policy setting, showing one group’s ethical assumptions may not be shared by others.
    • Looking at other ways of living often challenges us to examine our own values more carefully; what we accept as normal is not necessarily so, and this can prompt us to change how we think, speak or act.

Learning outcomes (stated, repeated at start and end of lecture)

  • Recognise how a shared understanding of ethical concepts presupposes some shared values and language.
  • Recognise how cultural factors may impact on how a person approaches ethical deliberation.
  • Begin to consider how a doctor and health system should respond to cultural differences when addressing ethical problems.
  • Discuss key ethical concepts within Te Ao Māori.

Self-test

  1. Explain why the lecture argues that continued ethical discussion does not necessarily lead everyone to agree, and list the three presumptions this idea relies on.
  2. According to Wittgenstein’s idea of “forms of life,” where do ethical rules ultimately come from, and what does this imply about the STOP-sign example?
  3. Describe the “four principles” approach of Beauchamp and Childress, and explain the lecture’s objection to their claim that these principles are “not relative to cultures, groups or individuals.”
  4. List the Māori concepts contrasted with the “Big Four” European ethical principles in the lecture.
  5. Explain why the lecture treats most ethical decisions as intuitive and dogmatic, and why this is not necessarily “less ethical.”
  6. Using the Covid-19 vaccination case, give one argument for and one argument against prioritising a younger vaccination age for Māori, and state the consideration specific to Te Ao Māori.
  7. What broader point about ethical assumptions does the lecture draw from contrasting Māori and some European New Zealanders’ views on elderly people’s lives during the pandemic?
  8. Predict what would happen, according to the practice-based account of ethics given in the lecture, if a culture were expected to change simply because someone presented a “good argument” against one of its practices.

Answers

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