Moral judgement in medical ethics

In an article published in the 2014, Daniel Sokol reflected about the concept of moral judgement, that in the context of medical ethics, tends to refer not to the product of deliberation but to ‘moral wisdom’ or ‘moral discernment’. We propose a summary of this interesting work.

In practice, how people exercise moral judgement is not entirely understood. Reason and emotion are two key ingredients in moral judgement, but how they interact is unclear. Recent work in cognitive neuroscience suggests that reasoning plays only a restricted, though significant, role. Greene and Haidt, two North American psychologists, claim that ‘automatic emotional processes tend to dominate’ and Greene et al. have demonstrated that brain areas linked to emotion were more active in personal moral dilemmas (keeping money found in a lost wallet) than in impersonal and non-moral dilemmas (choosing between taking the bus or the underground). These emotions influence moral judgement but are not necessarily determinative. They can, it seems, be overcome by reasons.

Although excessively strong emotions can distort moral judgement, so too can a deficit of emotions. Philosopher Nancy Sherman draws a link between emotion and moral blindness:

Moral situations don’t come pre-labelled. Emotions help us to label them under specific descriptions. Those who lack moral perception, who are obtuse about the moral dimensions of a situation, are often just those who have never cultivated their emotional repertoire.

Moral judgement, then, should not be divorced from our emotions. For sympathy, compassion, kindness and other emotions can play an important part in balancing conflicting moral principles or selecting our guiding values.

There is a degree of interpretation required in applying prima facie moral duties (duties that are binding unless they conflict with stronger duties). We must decide whether or not a particular duty applies in a situation (the duty to tell the truth to the patient) and, if so, what action should be taken to fulfil this duty without violating a stronger, countervailing duty (the duty to avoid great harm to the patient).

More recently, ‘moral particularists’ such as Dancy have attributed great importance to the idea of grasping the moral landscape by ‘discernment’.

Moral judgement, through informed, reasoned, context-sensitive, critical analysis, can resolve most moral conflicts, but it is not a moral panacea. Arguing against the arbitrariness of moral judgement, Larmore says:

In many cases judgment will be powerless to settle the conflict. We should realize not only that there are limits to theoretical understanding, but also that there are other kinds of understanding that are more appropriate for grasping the nature of moral judgment (his emphasis).

Beyond its rational aspects, there is something mysterious and deeply personal about moral judgement, akin to a moral ‘sixth sense’ acquired gradually throughout a person’s life. Aside from reflecting the reality of moral psychology, it encourages us to expand our emotional, cultural and intellectual horizons. Good moral judgement will reduce the likelihood of making wrong decisions, revealing apparent dilemmas as merely epistemic. Even the wisest of the wise will hesitate in the face of a moral dilemma, especially on that tempestuous sea that is the clinical environment.


Written by

Graduated in Literature at the University of Eastern Piedmont, he's now studying anthropological and ethnological science at the University of Milano-Bicocca. Journalist and writer, he collaborated with many local newspapers and in the 2015 he published his first book "Qui non arriva la pioggia". In the 2017 published "Il peccato armeno, ovvero la binarietà del male".

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