Legal & EthicsPractice MattersUncategorizedWorkplace Management

Quantum ethics: Coming to grips with the dark side


Most studies analyze ethical decisions as if they occur in a vacuum. Yet all decisions are made in a context that has a profound impact on both the decision maker and the decision. It’s this web of realities, human and otherwise, that constitutes the field of quantum ethics. Ethics is a discipline in which one applies certain principles so as to determine the right thing to do in a given situation. Principles are guidelines derived from philosophical perspectives (utilitarian, rights-based, duty-based, etc.). Right choices are those that conform to the ethical norms or principles, and others can know whether or not one has made a right choice (often based on their perception of human rights). Human rights are just claims to the fulfillment of fundamental, universal human needs. On the other hand, morality is the degree of congruence between what one perceives as right and one’s actual behavior; it is intensely personal, and others cannot know whether one acted morally.

Although studying ethical decision making helps determine what’s right, it doesn’t explain why people choose to do wrong, to act entirely contrary to their own principles. One could claim people are ignorant (of the consequences), clueless (don’t know the ethical import of their decisions), or evil (want to harm others). Unquestionably, people often don’t think through their decisions, and some unethical behaviors are so ingrained people simply accept them as normal. People also become incrementally habituated to certain behaviors, so even though they once thought them wrong, they no longer do.

And some people just don’t think at all: Think of how many times has one heard “Never shake a baby”—yet babies still die from shaken-baby syndrome. Others think a principle is good but doesn’t apply to them; people still drink and drive in the belief they can hold their liquor—yet they injure and kill thousands yearly.

Understanding our “dark” side

Cognition is conditioned by habit, reinforced by peer pressure, swayed by self-interest, and obscured by delusion. Even anxiety may blind one internally to the implications of decisions. Externally, the context within which a decision is made may limit one’s ability to see its ethical dimensions. For example, aspects of everyday work life—rewards, compliance systems, various pressures—contribute to ethical fading, a process that obscures the ethical dimensions of a decision. Thus, we classify something as something else—a clinical decision or a business decision—rather than an ethical decision, which increases the likelihood of unethical behavior.

Where conflict exists between professional codes and standards and institutional expectations of productivity, or between patient load and overtime, nurses may experience cognitive dissonance as their choices reflect one or the other, but not both.

Moreover, the impact of health care’s pervasive team mentality is significant: All people need to feel connected and a reciprocal need not to feel separated. These powerful needs are intensified by the techniques used to form effective teams. So team members may experience:

  • action anxiety—intense anxiety created when team members diverge from group norms
  • negative fantasies, in which team members imagine that contravening prevailing norms will have terrible consequences
  • failure to assess the real risk of negative fantasies so that a potential risk becomes a probable outcome.
  • justification of hopelessness (“I can’t do anything about it”).

Toward resolution

Laura Nash describes two kinds of problems—acute dilemmas and acute rationalizations. An acute dilemma arises when a person doesn’t know what’s right. An acute rationalization arises when a person knows what’s right but doesn’t want to do it. What’s the difference? When you start making excuses for your decisions (before or after the fact), it’s because you’re rationalizing. Yet, honestly facing the fact that you chose to do something you believe to be wrong and that you’re responsible for the hurt that follows will improve future decision making. Finally, make the implicit explicit. Communicating—not just a decision, but also its rationale—to others clearly and openly reduces unethical behavior dramatically.

Nurses, whose decisions affect other peoples’ lives, have an ethical duty to address the web of relationships, expectations—and their own egocentrism—that influences them, lest their decisions cause harm.

Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today

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  • Sorry to come late to t he discussion, but I strongly reccommend that people read “The Lucifer Effect” — which is most instructive, especially about the affect immoral systems have on individual decision-making!

  • JoRN has added enormously to this discussion, as has Marilyn and theother commentators. I think another potential clash in perspective occurs between the clinican and the manager as the former tends to focus on a particular patient(or small group of patients) while the latter focuses on the larger population of patients, especially when we’re dealing with distribution of resources…

  • An example of conflict between perspectives is arguing that individual rights always trump duty, so that “rights” claims by one group over-rule “conscience” obligations of another group. This is common in conflicts over justice, especially concerning sexual, reproductive, and life issues, like marriage, abortion, war, and end-of-life. Being aware and respectful of others’ philosophical frameworks on such issues can lead to better solutions, rather than one group running roughshod over another.

  • Thanks you for the reminder that ethical decisions rely on philosophical perspectives. It would reduce conflict and increase understanding if we all recognized these philosophical frameworks may conflict, which often results in our ethical conversations becoming “ships passing in the night”. Being willing to recognize different perspectives, such as rights versus utilitarian versus duty, depends on true listening, going beyond words or rhetoric, understanding assumptions on each side as well.

  • The powerful don’t do the dirty work themselves. Systems create hierarchies of dominance with influence and communication going down the line. The power residing in systems starts its ability to create mechanisms that translate ideology into operating procedures. In other words, situational conditions are created and shaped by systems of power. Systems, not just dispositions and situations, must be taken into account when trying to understand why good people do bad things.

  • In general, it is safe to say that there are some things that are objectively right or wrong. This column deals with the moral dimension of ethical decision-making. That is, it deals with the pressures and problems encountered by the decision-maker. It deals with guilt and innocence and shades of grey. It offers an explanation, rather than excuse for why people choose to do something they think it wrong – & then try to justify it…

    November 22, 2011 1:14 am

    Interesting, yes…but all thes things do not make that which is wrong, right!!

  • This article was very thought provoking and explained a difficult topic in a concise and relatable nature. Very well done Dr. Curtain.

  • This is one of the most interesting and insightful things I’ve ever read about ‘ethics.’

  • Do all these outside infulences and pressures justify a decision? Do they make something right or wrong? If I am afraid of losing my job, does this make it right to endanger patient safety?

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