MARGARET SOMERVILLE: THE INTEGRATIVE POWER OF WHY @Arts & Opinion

Margaret Somerville is Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia. Until recently, she was Samuel Gale Professor of Law, Professor in the Faculty of Medicine, and Founding Director of the Centre for Medicine, Ethics and Law at McGill University, Montreal. Her most recent book is Bird on an Ethics Wire: Battles about Values in the Culture Wars. This article originally appeared in Commentt (www.cardus.ca.com).

I have been writing about the role of amazement, wonder, and awe in our lives and how these experiences might be connected with finding meaning. To find meaning we need to feel that our lives have a purpose, that we have what concentration camp survivor Viktor Frankl called a “why” to live. So, as I prepared this article, I mused on whether the presence or absence of experiences of amazement, wonder, and awe might in some way also be connected with the presence or absence of “integrity.”

If experiences of amazement, wonder, and awe can help us to find meaning, that is, to feel that our lives have a purpose or an ultimate “why,” might those experiences, along with our finding meaning, also be connected with the generation of integrity or integration, especially moral integrity?

I believe there is a thread linking our experiences of amazement, wonder, and awe; our finding of meaning; and whether we have integrity. The meaning or purpose we find in our lives can be described as the integrating power of the “why.” I propose that giving people a why is necessary if they are going to live integrated lives, which in turn is the necessary condition of their having integrity. Let’s explore this claim.

First, let’s look at what the word “integrity” means. When in doubt start from the dictionary definition. I found that there are two senses of “living with integrity,” and I want to consider how wonder, amazement, and awe conjoins them. Here’s the definition of “integrity”:
Integrity (noun):

This definition captures the two ways in which integrity can be viewed. In the first sense, “ethics” is a synonym for “integrity,” and this definition of “integrity” is also an excellent definition of “ethics.” It describes the characteristics of a person with integrity, which also describe an ethical person or group of people, organization, institution, or society.

The second definition defines integrity in the sense of an entity being integrated as a whole in contrast to its being disintegrated. What interests me is the relation between the two definitions: that integrity in the sense of integration, especially moral integration or consistency, might be required in some circumstances to promote and realize integrity or ethics in the first sense.

It’s not easy to delineate what constitutes personal integrity, at least precisely. It could be one of those entities that we know is present, or indeed absent, but it’s difficult to articulate exact, comprehensive criteria that could be universally and consistently applied to determine a person’s integrity. Perhaps we intuitively judge integrity on the basis of how a person acts toward others. And maybe we can only judge it in others, not ourselves.

The people whom we regard as having integrity are those we cannot imagine acting contrary to their conscience, even at great expense to themselves not to do so. Maybe we can judge it in ourselves on the basis of whether we follow our own conscience. Might the test of integrity be that we do not see conscience as a commodity? For those with integrity, conscience is never for sale, no matter how high the reward offered or serious the harm to oneself avoided.

Or perhaps we could think about integrity in terms of healing and, its opposite, disintegration, whether that disintegration is physical, mental, or spiritual in nature.

“Healing” is also a challenging term to define. For instance, Balfour Mount and Michael Kearney, my former colleagues in the Faculty of Medicine at McGill University, defined healing as “a relational process involving movement towards an experience of integrity and wholeness.” It has been operationally defined by Thomas Egnew as “the personal experience of the transcendence of suffering.”

In a paper that my colleague Donald Boudreau and I wrote for the British Medical Bulletin, we proposed that euthanasia is not medical treatment, because it contravenes the healing mandate of medicine. We argued “that healing does not require biological integrity. Although it may seem counter-intuitive at first glance, it has been pointed out that if a sick person is able to construct new meaning and is able to achieve a greater sense of wholeness, that individual may ‘die healed.’” So healing the person, as compared with their body, requires recovering a sense of “wholeness” or integrity.

And not only individuals need to be healed. Families, communities, organizations, institutions, societies, and our world also need healing.

In short, healing involves reintegration in a situation that threatens disintegration, whether physical, mental, or spiritual in nature. Reintegration promises restoration of integrity in one or more of these regards; disintegration, loss of integrity in one or more of these regards.

Whether a person has found meaning in their lives—that is, has found a unifying purpose that informs their actions—can be especially influential in decision-making in situations in which the person’s integrity is challenged. In A Doctor’s War, Rowley Richards, an Australian medical doctor who was a prisoner of war in World War II, speaks of maintaining one’s integrity in making decisions in horrible circumstances:

As far as I could see, what distinguished one human from another in captivity was his ability to make very different decisions: to accept his fate or make active judgements about the life he chose to lead, regardless of his circumstances. A prisoner of war might be treated like an animal, but he still holds the power to choose to not become one, or act like one. Equally, a guard might be ordered to act like an animal, but he still held the power to choose not to become one, or at least one not so vicious. The life of a human is always filled with decisions. The ultimate challenge for us as prisoners of war and individuals, was to search for the right kind of answers that might lead us home—with our integrity still intact.

This observation, in turn, again brings to mind Frankl’s insight that when you have a “why” to live you can find a “how.” Frankl wrote, “Any attempt to restore a man’s inner strength . . . has first to succeed in showing him some future goal. Nietzsche’s words, ‘He who has a why to live for can bear with almost any how,’ . . . Whenever there was an opportunity for it, one had to give them [the concentration camp victims] a why—an aim—for their lives, in order to strengthen them to bear the terrible how of their existence.”

In other words, having a “why” to live is necessary to prevent us from “falling to pieces,” that is, disintegrating.

Does this perhaps offer an explanation for the loss of integrity in our societies? Have we lost a “why” to live? Is this loss of purpose and meaning the source of our disintegration?

Perhaps, without a purpose, we can no longer know what a “coherent” life is, which makes it very difficult, if not impossible, to find integrity. One can’t find something that one does not recognize. It’s even more difficult than finding a needle in a haystack—at least we know what the needle looks like.

The forces of modernity that often fragment and compartmentalize our lives include loss of religion; loss of experiences of transcendence; broken families and loneliness; the predominance of a ubiquitous philosophical base of moral relativism, which makes it harder to find integrity, as there is no solid foundation for our values and decisions, no givens; radical individualism at the expense of the “common good”; a failure of courage and fear of speaking out against ethical wrongdoing; feeling powerless to protest “post-truth” developments (for instance, we know politicians are lying but we expect that they will and we are powerless to change it); and loss of respect for and trust in authority.

Some, perhaps many, of these losses occur for good reason. Take, for instance, just the last one, loss of respect for and trust in authority, especially on the part of young people. Two anecdotes allow us to easily understand that loss, indeed that it is inevitable.

It’s been reported that police in Sydney, Australia, have been fulfilling the quota of RBTs (Random Breath Testing for alcohol) they are required to administer by taking the test themselves and including those results in their reports. There are also reports of ambulance workers who are addicted to opioid narcotics, using the injectable Fentanyl in the ambulance supplies and substituting it with ampoules of normal saline or water. Apart from other wrongs, this could cost some people needing emergency care their lives.

While profoundly distressing to recognize, it’s also possible that a person, family, community, or even a society can lose their physical, mental, or spiritual integrity as a result of the acts of others undertaken with an intention to achieve just that. Situations in which this can happen include torture and the appalling, dehumanizing ways in which, for example, asylum seekers and refugees, aboriginal communities, homeless people, people with disabilities, or old and fragile people are often treated. We are disintegrated because others have torn us apart.

How can we counteract these losses of integrity and promote integration, particularly in a world where we don’t agree on the “why”? We might consider some lessons from bioethics, not least because implementing ethics promotes integrity and vice versa.

Medical and scientific ethics burst into public consciousness in the 1970s with the first heart transplant and the first IVF baby. We were astonished and asked, “Are these developments ethical?” Up to that time we almost always assumed that we could trust physicians and scientists, because they were ethical and should decide what should and should not be done. Questioning the ethics of the use of the powerful new technoscience, such as genetic and reproductive technologies, led to public discussion of ethics, and this spread to questioning the ethics of other institutions, organizations, and professions, including politicians and governmental bodies.

In trying to ensure that scientific research was ethical, we learned valuable lessons with wider application. First, ethics must be embedded in science from its inception and not be seen either as a hurdle that is jumped at the beginning of the research and can then be forgotten, or as simply an add-on after the research is completed. In short, ensuring ethics and the integrity of scientists and scientific research is an ongoing process, not an event.

What we choose to research, who funds it, who undertakes it, who benefits from it, who is put at risk or harmed, for what purposes it is used, and so on all raise ethical issues that must be addressed. We could no longer accept the old argument that the search for knowledge through scientific research is value neutral and ethics is only needed when the technology that research engenders is used.

So ethics must be embedded in our science from its inception through a comprehensive and coherent system. The same requirement is true for our political systems, our armed forces, our legal system, our financial institutions, our commercial and business enterprises, our governments, and so on.

The question is: How best to achieve that embedding? The “ethical tone” of an institution is set by a very small number of its leaders: if they are ethical, the institution and its employees are likely to be ethical; but if they are unethical, the opposite is likely to be true. As few as five people at the top of an institution with around one thousand employees can set its “ethical tone.”

Young people who have been taught ethics can also bring ethics into an institution. My anecdotal experience is that medical students who have studied ethics and respectfully challenge their superiors’ views on ethics can cause the latter to question those views and the conduct to which they give rise and to seek ethics education for themselves. The most resistant group is made up of those in the middle who have bought into the ethics of the old medical system but have not yet reached leadership positions. In short, a high ethical tone in an institution is set by both ethical leadership from people at the top and ethical pressure from those at the bottom.

But ethics goes beyond our public and professional lives and needs to be embedded in all aspects of our lives, including our private lives. As James Smith writes, “one of the dangerous compartmentalizations of late modern life is to imagine that ‘ethics’ is something that can be restricted to some sphere or compartment, letting other facets of our lives be governed by self-interest or profit or self-actualization or what have you. In other words, by sequestering the ethical, we give ourselves permission to be amoral—‘beyond good and evil,’ as it were—in vast swaths of contemporary existence.”

The most intimate form of integrity is articulated in Polonius’s advice to his son in Shakespeare’s play Hamlet: “This above all: to thine own self be true, / And it must follow, as the night the day, / Thou canst not then be false to any man.” It’s easy to be true to oneself—to be a coherent whole, to have integrity—when others agree with the values we espouse; but when they disagree, being true to oneself and one’s values requires courage. Personal moral integrity is linked with courage, and maintaining it may require courage.

Moral integrity requires a consistency of moral behaviour. In contrast, psychologists speak of superego lacunae—I would call them moral lacunae: A person who in general has integrity and is ethical can regard some acts, such as petty theft from an employer, as not contravening ethics. These ethical lacunae are like the holes in a Swiss cheese and can result from insensitivity, dulled moral intuitions, or denial of wrongdoing; and loss of ethical sensitivity in relation to them is reinforced by habitual behaviour. As with the cheese, when the holes become too large or there are too many of them, the structure of the cheese or moral system becomes fragile and can collapse.

Whom we see as harmed by such acts can affect whether we regard them as ethical wrongdoing. Most of us are likely to see stealing from an immigrant shopkeeper in a small corner store struggling to support his family and whom we know personally as wrong. In contrast, we might not see stealing the same item from a large department store in the same way, unless the impact of our wrongdoing becomes personalized, as when we learn that a young woman student employee had to compensate the store for the stolen merchandise.

Individuals, institutions, governments, and societies can all have moral lacunae. When they exist at all levels, the probability of unethical conduct and loss of integrity, in both senses of that word, is exponentially increased. The challenge is how to plug or repair these holes in our individual and shared moral fabric.

The suggestions in this section are by no means meant to be a comprehensive list of ways in which we might make integrity and ethical conduct more likely, but I hope that they might contribute to achieving that goal.

First, even though we disagree on the ethics that should govern many issues, we need to create some situations where we can experience belonging to the same moral community. For example, whether we are pro- or anti-euthanasia we all agree that we must relieve terminally ill people’s pain and suffering. Where we disagree is as to the interventions we may or must not undertake to achieve that goal.

Experiencing belonging to the same moral community is likely to help us to find more agreement than would otherwise be possible. Starting from disagreement and often not moving beyond that also reinforces polarization. On the contrary, starting from where we agree and moving to where we disagree allows us to recognize that we all want to be ethical; we just disagree about what that requires.

As explained previously, integrity and ethics are related to the search for meaning in our lives. To seek meaning is of the essence of being human—indeed, the feature that distinguishes us from other living conscious beings. Questions that arise include: Is loss of meaning the basic issue and problem causing loss-of-integrity postmodern ills such as corruption? Or is our mistake that we are seeking meaning in entities, such as great financial wealth, that cannot provide it? Can you have integrity or find meaning when you believe there is no such entity as absolute truth, that is, that all humans have within them a deep innate sense of right and wrong? Does being a moral relativist (there are no absolute truths) or a conservative (there are absolute truths) affect the person’s integrity? Are finding meaning and having integrity linked to the experience of transcendence?

Transcendence is the experience of feeling that we belong to something larger than ourselves and that what we do matters to more people than just us, including future generations of humans. We must not leave them a world in which no reasonable person would want to live.

A central component of transcendence is what I call the human spirit, “the intangible, immeasurable, ineffable reality to which all of us need to have access to find meaning in life and to make life worth living—a deeply intuitive sense of relatedness or connectedness to all life, especially to other people, to the world, the universe and the cosmos in which we live; the metaphysical—but not necessarily supernatural—reality which we need to experience to live fully human lives.”

Both experiencing transcendence and respecting the human spirit require us to connect with other people and to a reality larger than ourselves. If we believe that is important because it helps us to find meaning in life, then we are, at the least, more likely to act ethically and with integrity than might otherwise be the case.

We now realize that our physical ecosystem—our physical environment—can be irreversibly damaged by our conduct, unless we intentionally act to protect it. The same is true of what we can call our metaphysical ecosystem—the collection of shared values, attitudes, norms of behaviour, the stories we tell each other and buy into to create the glue that binds us together as a society, and so on—which we must also hold on trust for future generations. Acting with integrity and promoting this is a central requirement for honouring that trust.

While there is a place for analyzing and critiquing what we see as ethically wrong or at least regretful, that is, as lacking integrity, we must not be only negative and finger wagging. We need to propose a positive, aspirational ethical vision to replace that which we see as wrong. We need to present in a compelling and persuasive manner what we are for and the values that support that stance, not just, as so often happens among people with conservative values, decry the values and conduct that we are against. As explorer Ernest Shackleton said, “Optimism is true moral courage.”

Perhaps I could articulate my proposal for generating integrity and ethical conduct in a formula:
AWA - C = H + E
which translates as “amazement, wonder, and awe” minus “cynicism” equals “hope and ethics.” I call it the “wonder equation.”

We can experience amazement, wonder, and awe in both the ordinary and the extraordinary, whether in nature or at what 21st Century science reveals and the astonishing new powers it gives us, which no humans before us have ever had. Experiencing amazement, wonder, and awe is so important because it can enrich our lives, help us to find meaning, and change how we see the world. It can change the decisions we make, especially regarding values and ethics and how we live our lives. It can help us to act ethically and with integrity.

We seem to be the only species that can experience amazement, wonder, and awe; these capacities are uniquely human characteristics, the very essence of our humanness. Consequently, we have an enormous responsibility not to damage or destroy them or the opportunities to experience them. Rather, we must hold them on trust for future generations.

So, what do we owe to future generations? Above all, we must leave them a legacy of hope. In doing so, we will also create hope for ourselves, because hope is generated by a sense of connection to the future. Hope and integrity are related, because hope makes us more likely to ask ourselves what we owe to future generations and what that requires of us in terms of our acting with integrity.

Hope is the oxygen of the human spirit. Without it our spirit dies. With it we can overcome even seemingly insurmountable obstacles. Hope is to our human spirit as breath is to our bodies. Hope is not passive. Just as we make war and make peace—indeed “make love”—we need to intentionally make hope. Eliciting hope needs to be an intentional goal.

Striving to leave a legacy of hope can also help us to find meaning, because feeling that our lives will have meaning after we are no longer here—that we will have left a legacy—is an important element in finding meaning in the present.

The antithesis of hope is cynicism, which is lethal to the human spirit. Experiences of amazement, wonder, and awe are an antidote to cynicism and, thereby, a protector and even promoter of hope.

It merits repeating that experiencing amazement, wonder, and awe can influence how we live our lives, the decisions we make, what we view as ethical or unethical, and whether we can find meaning in life and will act with integrity.

If we marvel at the fact that the great diversity of all life, including among humans themselves, is coded by just four nucleotides and regard that fact as an unfathomable mystery, we are more likely to accept that we have a serious responsibility, for instance, to maintain and protect the integrity of nature and the natural, especially the essence of our humanness. In view of the incredible powers the new science provides, such as genetically designing future generations, recognizing this responsibility will be central to maintaining the integrity of ourselves and our world.

Science has told us that we come from stardust—every atom in our body is billions of years old. Pondering from whom or what our atoms might have come should fill us with amazement, wonder, and awe; and hope, through a deep sense of connection not only to the past but also to the future. We need an integrated past, present, and future, which a shared religion used to provide to most individuals and societies. That is no longer the case in secular, postmodern, multiracial, democratic Western democracies, where radical individualism and presentism (focusing on only what individuals want and only the present) are the norm.

We must, as our ancestors have done and ancient cultures continue to do, learn from collective human memory to inform the present. And we must engage our collective human imagination to view the future if we are to make wise ethical decisions on which to build a future in which individual, institutional, and societal integrity are the norm.

also by Margaret Somerville
Great Divide in Ethics Over Mystery of Human Life
Euthanasia: a Flight from Mystery
Treating Animals Other Than Humans
Do Apes Have Ethics?
Against Euthanasia

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