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PM360 Ethics 360 Column September 2012

Copyright 2012 by David Perlman, Ph.D. All Rights Reserved.

In my last column, we explored the trap of the false dilemma and

alluded to some ways to beat it. In this column, I will tackle one such
way reframing the usual and customary method of phrasing ethical
questions such that we avoid the false dilemma and open up the moral
imagination. The technique is simple yet potentially transformative. I
teach it as a communication strategy to nursing and medical students
and even those in practice.
If we (wrongly) think of ethics as helping to discern between
whats right and wrong or even deciding between two rights, then we
get caught in the false dilemma. The easiest way to avoid it is to use
some clever reframing of the original question. But first, we need to
tackle how to spot an ethical question. Sometimes its obvious. Other
times, it isnt. Looking at the language used helps make it easier.
A hallmark of an ethical question is what we philosophers call
normativity meaning that the question asks us to make a judgment,
evaluation, or pronouncement about a state of affairs in the world. The
language of normativity is about whats permissible, whats
impermissible, whats required, and whats not. Words like should,
ought, must, might, and their opposites (i.e., add a "not")
immediately denote ethical questions.
While these signal words are important, how we phrase ethical
questions is equally so. Most times, especially when we need an
answer quickly, we tend to phrase ethical questions in a close-ended
fashion. In fact, we even begin such questions with the very words that
signal normativity. Should I do X or Y? Must I avoid A or B? The
reason why these questions are close-ended is because a yes or no
answer will provide reasons for acting upon the selected choice. And,
here you can see the obvious dilemma the way the question is asked
limits us to only two choices. Yet again, we are faced with the false
However, if we can slow our thinking processes down and
reframe our initial ethical question into an open-ended question, we
can fully engage our moral imagination and critical thinking skills.
Rather than a knee-jerk reaction or decision based upon a cursory
analysis of choices and their consequences, we can hypothesize
possible answers to our ethical question and use thought experiments
to imaginatively and critically test out what consequences the various
choices might bring, how the decisions will affect our selves and
others, what values might be at stake, and thus avoid the false

Open-ended questions contain interrogative words such as

how, to what extent, whether, what, and sometimes even
why. So, with the two examples above, reframing the question
Should I do X or Y? yields To what extent is X or Y a better choice?
or What reasons exist for why I should avoid either A or B? (This last
one is a double-word score!)
Rather than narrowing our thinking into yes or no, asking
questions in this open-ended way allows us to form a multitude of
options or justifications for choices. Sometimes, we can even think of
additional options that we hadnt entertained before and add them to
our decision-making processes. Then, we can weigh, judge, or consider
the options, what values they assume, and what consequences each
might bring about for ourselves and others, then make what
philosophers like to call a considered moral judgment.
Ill end with a powerful example to which we can all relate. The
next time you visit your health provider, see whether he or she uses
the open- or closed-ended question to conclude your interaction. When
pressed for time, which is a precious commodity when it comes to
health encounters, providers usually ask the close-ended question Do
you have any questions?. The usual and customary response,
especially if we have received a barrage of difficult to process
information, is to shake our heads no. If, however, the provider uses
the open-ended question What questions do you have? it requires
more than a yes or no answer from us. It requires us and gives us
permission to ask the questions that we all know we have but either
are too polite or afraid to ask. Most importantly, and this is the ethical
component, we feel heard and respected two of the most important
ethical values in our human interactions.
Next time, Ill discuss some of the myths of ethical decisionmaking and how reframed ethical questions that avoid the false
dilemma provide us with the richness that characterizes our moral