There had never once been a public opinion poll done in El Salvador until Ignacio Martín-Baró, a Jesuit, set out as the only doctoral-level psychologist in the country to measure the opinion of the people in the 1980s. He knew this would be difficult. He had studied at the University of Chicago, and he was certain that he would need to practice very differently than how he had been trained. But he had still been unprepared for just how difficult it would be.
Much of Martín-Baró’s early conclusions were made on the fact that very few people would speak to him. Only 40% percent of the rich felt safe enough to speak their opinion. And the poor? Less than 20% of the poor would do the speak to him. Less than 20% would speak to him about their lives, what they thought of the government, or anything that could get back to someone who could hurt them.
In his case, silence stood for more than an inconvenience to answer a pollster. It stood for more than a passive distrust of someone collecting data. In his case, silence told a story of gripping fear, of generations of pain, of mothers mourning children slain by an oppressive and violent government.
Silence says a lot, and it’s important that researchers take that silence into account.
I do not present my essay from El Salvador, though, much less an El Salvador in the throes of civil war like my introduction remembers. Instead, I present my essay from the United States. Martín-Baró was attuned to the differences between the countries. He remarked to an American colleague once that, “In your country, it’s publish or perish. In mine, it’s publish and perish.” Indeed, Martín-Baró would later be killed, one of eight martyrs, in November of 1989.
I do not propose that he was mistaken. He was an American-trained researcher after all; he would know the dynamics between the countries. There is far more protection in the United States, particularly for the researchers today, than there was in Martín-Baró’s time and region. However, I do want to turn my gaze to those who cannot freely speak their mind in the United States, and posit that researchers can (and, I argue, should) take on their behalf, if they are to act in the heroic way that Martín-Baró did.
I will never forget the day my mother got diagnosed. I could swear that just yesterday I was thirteen years old waiting anxiously to be called in from the waiting room of some fancy New York State doctor’s office. I was young, but I had some idea of what was going on. I knew my parents and I were there because they were going through a divorce and fighting for custody of me. What I did not know was that we were about to endure a court-ordered psychiatric evaluation and that the results were going to change my life forever.
“Madeleine, your mom is very sick,” the psychiatrist attempted to explain to me. I did not understand. I did not know a sick person could look perfectly healthy. “It’s not a physical sickness, it’s in her head. She has a mental disorder called Paranoid Schizophrenia.” She went on using big words to explain how my mother’s brain “wasn’t like other people’s brains.” I sat there listening closely, hanging on every word the woman was saying to me. “She can’t help the choices that she makes, it’s not her fault that she is the way that she is. She needs help.” Every day since that day in the doctor’s office, that remark replays in my head over and over. “She can’t help the choices she makes.”
That is what gave me the most trouble. I sat around for years and years watching the choices that my mother was making, unable to intervene. If she cannot help the choices she makes, why could my dad or my mother’s other family not make the choices for her? Why could nobody make her take medication? I eventually learned that it was because my mother was sick, but “not sick enough.” The court ruled in favor of autonomy and said that my mother still had the right to make her own medical decisions. According to them she was functional and was not posing an immediate danger to herself or others. I understand autonomy. Autonomy is defined as “a principle in which a person should respect the rights of other individuals to freely determine their own choices and decisions” (Jonas). I understand how important free will and the ability to make choices about your own body are. It is hard for me, however, to understand how you can continue to honor a person’s right to make their own decisions, when every decision they make is only hurting them. It is hard to sit there, as a loved one, and not want to just make them take the medication they need to get better, or force them participate in that research study that just might help.
In certain situations, the moral or ethical decision is obvious, but more often than not, there are a number of complicating factors. Almost all decisions we make will affect more than just ourselves, forcing us to weigh our own morality against another’s autonomy. This is particularly true in the case of medical interventions for the sake of another’s health.
Anyone who has been a part of a long-distance friendship knows that there are very few things more exciting than the prospect of getting to see your friend in person for the first time since parting. That excitement is somewhat marred, however, when your friend has so drastically changed that you literally do not recognize them. The summer between my sophomore and junior years of high school, my family moved cross-country from Texas to Indiana, forcing me to leave my best friend behind. We of course kept in touch via text and phone calls, but between the time change and our equally busy schedules, we rarely if ever had the chance to video chat. Combine that with the fact that she is largely an abstainer from social media, and the result was that I hadn’t seen a picture of my friend in a year, at which point I was flying back to Texas to visit her and our other friends. When my plane landed, I grabbed my things and rushed down the escalator to baggage claim, not realizing that I had looked my friend in the face and kept on walking because I did not recognize her. She was about two-thirds the weight she had been when I left. We had discussed how she had started working out and had gone on a diet, but nonetheless, the extent of her weight loss scared me. Over the course of the trip, however, she seemed healthy and in better shape than she had ever been before, alleviating some of my fears.
Cut to two years later, when she was getting off the plane to visit me. Now she was down to probably about half her original weight and, looking at her, I could no longer deny that something was definitely wrong. Her eyes were sunken, her hair was thinning, all of her clothing was too big, and when I hugged her, it felt like I could feel every bone in her body.
This was about a year ago now and I still have not brought up the term “eating disorder” to her. Every time we speak I vacillate about whether or not to broach the topic with her. On the one hand, she is my close friend and if her health was at risk, I would want to intervene on her behalf. On the other hand, I know that I am not in a unique position to say something. She lives with a group of roommates who see her on a day-to-day basis, not to mention she has her parents and siblings who see her more than I do. I justify my silence with the assumption that if anything was seriously wrong someone else would have intervened. We have a mutual friend who previously suffered from an eating disorder and her parents were the ones to get through to her before either of us, or any of her other friends, could.
Perhaps my action, or lack-thereof, reflects some form of the bystander effect, which raises another question about morality. One of the common tenets of ethical decision-making is whether or not you are in a unique position to prevent something from happening. By this standard, any time someone in a more authoritative position can take action, some of the burden of responsibility is taken off of oneself. For instance, in the infamous case of Kitty Genovese, a group of bystanders either heard or saw various portions of both an attack on and the murder of Genovese and all but one neglected to call the police because they assumed someone else in the vicinity would. This kind of moral code can lead to a good deal of damage because this assumption is not always true. That being said, there are no grounds on which to enforce an all-encompassing moral code dictating that everyone should act when they observe something potentially harmful or dangerous.
When wrestling with my decision of whether or not to intervene in my friend’s health, I also consider the possible negative ramifications of speaking up. I worry that if I were to say something, she would find it offensive and that our friendship would suffer because of it or that she would alienate herself. When a seemingly moral choice also has negative ramifications, it is harder to come to a decision. If I knew for sure that she was suffering from some form of eating disorder and that my saying something would ultimately result in her getting better, then the ethical decision would be very clear and I would bring the topic up to her. However, issues of moral or ethical standing are hardly ever this clear cut.
Another issue to consider is the question of morality versus autonomy. My friend remains an autonomous individual in control of her life, so even if it were to prevent some harm, I don’t know that I would have the right to intervene in her life. The line between one’s own sense of ethics and morality and the autonomy of others must be drawn somewhere. Just because I deem an action that I would take to be moral does not mean that I have the right to then carry that action out, taking away someone else’s autonomy, deciding what’s best for another person who has a right to make that determination for him or herself .
The conversation about eating disorders in relation to morality and ethics also calls to the forefront the role of media in the prevalence of eating disorders in American society. There is no denying that eating disorders motivated by body image issues are at least somewhat caused by representations of women in media. Unrealistic body standards are largely derived from the proliferation of Photoshop in magazine images and advertisements. It seems that media personnel who create this content should have some degree of moral responsibility to represent realistic images to their consumers whose lives they are negatively affecting. Questions about morality and ethics in regard to the issue of eating disorders range from the smaller, personal scale to this large scale.
I am still struggling with whether or not I should speak up in my friend’s situation. I have not come to any conclusions as to what the proper moral action to take is. However, I have come to believe that there are no simple guidelines for making decisions. Moral and ethical decisions are more often than not very complicated as well as multi-layered.
One of the great miracles of modern medicine is the ability to save a dying patient through organ transplantation. However, there still remains a worldwide shortage of organs and an excess of disadvantaged individuals who believe their salvation is not to receive, but sell one.
Every day, regardless of what I do, I use forced labor.
No, I am not a plantation owner in the South during the Civil War, nor am I a current factory owner in Asia. Rather, I am a 21-year-old Fordham student from the Bronx. I grew up in a loving, middle-class family with happily married parents, a brother, and a cat. I do not fit the stereotype of someone who uses forced labor, but I assure you that I do.
Everyday we struggle to resolve how to treat those who wrong us or cause us pain. How do we punish those who steal from us? Who determines how we are fully compensated for the pain others inflict on us? We demand justice, or a system of fairness that safeguards our dignity as humans. Our personal morals feed into this system of fairness, often making justice a complex ethical issue.