The Most Important Ethical Challenge of Our Time: Remaining in Conversation

“Functioning as our better selves leads to better outcomes for patients and everyone.”

Tarris (Terry) Rosell, PhD, DMin, HEC-C

Published June 2026

It seems increasingly that our culture expects immediate certainty. That presents problems when it comes to healthcare.

Healthcare has always confronted us with difficult questions: Life and death. Autonomy and authority. Suffering and dignity. What we owe one another. These are not easy questions, and they rarely have easy answers.

Society encourages us to take a position, defend it vigorously, and view disagreement with suspicion. We live in a time of “great, big, beautiful” immediate reactions rather than humility, patience, and thoughtful analysis. Complex issues that are best approached with these virtues are often reduced to competing slogans, and conversations that might otherwise foster understanding become exercises in persuasion and, increasingly, bullying and vitriol. In this environment, the space for genuine ethical reflection can feel increasingly rare.

Transgender health illustrates the problem.

Recent debates about transgender healthcare illustrate the problem. For the sake of narrative transparency, I support the dignity, humanity, and wellbeing of transgender individuals. Like all patients, transgender people deserve compassion, respect, privacy, and access to quality healthcare.

Questions about gender-affirming care, patient privacy, government oversight, professional responsibility, and patient autonomy have become deeply contested in both healthcare and public life.

A recent CNN article described ongoing legal battles over efforts by federal investigators to obtain detailed medical records of transgender patients, including identifying information and treatment histories. Several courts have questioned whether such requests are appropriately tailored to the government’s stated investigative goals, while patients and families have expressed concerns about privacy and trust.

And honestly, who can blame them? No matter what you believe politically, if RFK Jr. showed up at your door asking for private medical information about your child, I suspect most of us would have a fairly quick answer – and it probably wouldn’t be “Come on in.”

At its heart, this controversy raises questions about patient autonomy, one of the four core principles of bioethics. We often talk about autonomy as the right of individuals to make decisions about their own lives and healthcare. What we discuss less often is what autonomy requires from the rest of us.

Respecting autonomy demands humility.

Autonomy requires acknowledging that other people may understand their own experiences, values, goals, and identities better than we do. It requires recognizing that we are not entitled to make every deeply personal decision for another person simply because we disagree with it. Respecting autonomy does not require agreement. It requires restraint. It asks us to accept that in a free and diverse society, thoughtful people will sometimes make choices we would not make ourselves.

Perhaps that is one reason autonomy can be so challenging. It asks us to relinquish the comforting belief that our own conclusions should govern the lives of others. As the saying goes, my right to swing my fist ends where another person’s face begins. Autonomy reminds us of the inverse: our desire to direct another person’s life ends where their right to direct it begins.

Of course, people approach these issues from different perspectives. Some strongly support access to gender-affirming care. Others have questions about specific treatments, evidence, or policy approaches. Still others are trying to understand a subject that may be unfamiliar to them. The fact that disagreement exists should not surprise us. In fact, disagreement is often where ethical reflection begins.

Bioethics creates space to remain in conversation.

Ethical discourse requires something that can feel increasingly difficult to find: the ability to remain in conversation with one another, even when we disagree.

Bioethics was built on this premise. Ethics committees bring together physicians, nurses, social workers, chaplains, attorneys, patients, and community members not because they share identical beliefs, but because they do not. The goal is not to eliminate disagreement. The goal is to create a space where disagreement can be thoughtfully and respectfully explored.

This requires psychological safety and humility that feels increasingly fragile in contemporary discourse. Many people hesitate to ask questions because they fear being judged. Others are reluctant to express uncertainty because they worry that uncertainty will be mistaken for hostility. Too often, we assume that disagreement signals bad intentions rather than a sincere effort to understand a complex issue.

When that happens, everyone loses.

Listen. Question. Learn. Accept. 

Ethical discourse does not require abandoning our values. We can affirm the dignity of transgender individuals while also encouraging thoughtful conversation about healthcare policy. We can support vulnerable populations while recognizing that people may approach difficult questions from different backgrounds and experiences. We can reject cruelty and discrimination while still making room for honest inquiry.

Creating space for conversation may be one of the most important ethical challenges of our time. Not simply determining what is right but providing opportunities for people to wrestle with difficult questions together safely. Ethical reflection requires humility and the recognition that complex issues deserve careful consideration while recognizing that none of us possess perfect understanding.

Humility reminds us that our role is not to control one another, but to listen, question, learn, and accept the autonomy of others. To understand that another person’s path may differ from our own. In a world that increasingly rewards outrage and certainty, perhaps one of the most radical ethical acts is simply remaining in conversation.

Source

Trans youth and their parents fight back against efforts to get their detailed medical records | CNN Politics

Mr. Mattis is a 43-year-old man with a history of diabetes. He has struggled to consistently manage his condition, which has contributed to a significant decline in his health. Two weeks ago, he was admitted to the hospital after suffering a heart attack.

As a complication of his diabetes, Mr. Mattis has developed severe diabetic ulcers on his left foot and leg. The condition has progressed to the point that the medical team is recommending an above-the-knee amputation.

Mr. Mattis retains decision-making capacity and has repeatedly stated that he does not want his leg amputated. When asked to explain his decision, he does not provide a detailed rationale but remains consistent in his refusal. The medical team has explained that, without amputation, his condition will continue to deteriorate and will likely result in his death. In response, Mr. Mattis calmly states that he understands the consequences but still does not want the surgery.

The medical team conducts an extended family meeting with Mr. Mattis and his two sons. During the meeting, the team explains that amputation is medically indicated and is believed to be in Mr. Mattis’s best interest. Despite these discussions, Mr. Mattis continues to refuse consent for the procedure.

At the conclusion of the meeting, Mr. Mattis’s sons speak privately with the attending physician and consulting surgeon. They state that if their father’s condition deteriorates to the point that he loses medical decision-making capacity, they would consent to the amputation on his behalf.

The attending physician and surgeon request an ethics consultation regarding how the team should proceed if Mr. Mattis later loses decision-making capacity and the question of amputation arises again.

In the United States, medical ethicists seek to balance the four principles of medical ethics: autonomy, beneficence, nonmaleficence, and justice. However, it is undeniable that the principle of respect for autonomy often takes precedence over the others.

Even, for example, when a medical team believes that a life-saving surgery would be in a patient’s best interest, healthcare providers are generally unable to proceed if a competent patient refuses to give consent. This suggests that autonomy frequently takes priority over beneficence and nonmaleficence.

Upholding Autonomy Requires Empathy

The principle of respect for autonomy also involves considerations that are less prominent within the other ethical principles. Beneficence and nonmaleficence require careful medical judgment and an understanding of the risks and benefits of treatment. Justice requires consideration of broader social systems and the individual’s place within them. Autonomy, by contrast, centers on the individual and requires healthcare providers to step outside their own professional judgment and defer to the judgment of another person. In this sense, empathy becomes a fundamental component of respecting autonomy.

According to Varelius, “Personal autonomy is, at minimum, self-rule that is free from both controlling interference by others and from limitations, such as inadequate understanding, that prevent meaningful choice. The autonomous individual acts freely in accordance with a self-chosen plan, analogous to the way an independent government manages its territories and sets its policies” (Varelius).

This definition holds that autonomous individuals are capable of thinking for themselves, establishing and acting upon their own priorities, and remaining free from controlling outside influences. To properly uphold the principle of autonomy, healthcare providers must be able to understand and appreciate the perspectives of their patients.

Empathy Requires the Patient’s Point of View

Empathy itself is a complex concept, but in simple terms, “The foundation of empathy has to be a willingness to listen to other people’s experiences and to believe they’re valid…you don’t have to deny your own experience to accept someone else’s” (Abramson).

This idea is central to both compassionate healthcare and medical ethics. The patient is the one who will experience the consequences of a decision. Quality of life should therefore be defined by the patient, and subjective experiences such as pain and suffering can only be fully understood through the patient’s perspective. One patient’s suffering may be another patient’s acceptable quality of life.

For this reason, when faced with challenging healthcare decisions, ethicists and healthcare providers should strive to understand the situation from the patient’s point of view. Unlike the other ethical principles, which rely heavily on the expertise and knowledge of healthcare professionals, the principle of autonomy places significant value on the judgment and understanding of the patient. As noted earlier, autonomy often occupies a privileged position within the American healthcare system. It could therefore be argued that empathy is not merely an important clinical skill but a foundational ethical requirement.

Empathy Affirms Human Dignity

The philosopher Immanuel Kant viewed autonomy as an expression of the unique value and dignity of every individual. In the Groundwork of the Metaphysics of Morals, he describes humanity as possessing “the idea of the will of every rational being as a will that legislates universal law” (Groundwork 4:432). This suggests that to truly value human dignity, we must respect each individual’s capacity for self-governance and moral decision-making. As Chidi Wolemonwu further argues, “autonomy is the underlying principle of all human dignity and it is a defining principle of all human nature. It is reason that makes autonomy possible” (Wolemonwu).

Human dignity and respect for human life are central commitments of medical ethics. Following Kant’s reasoning, respecting an individual’s autonomy may be one of the most authentic and necessary expressions of honoring that dignity. If autonomy depends, in part, upon our ability to understand and respect another person’s values and choices, then empathy becomes more than a virtue—it becomes a practical expression of respect for human dignity itself. In this way, empathy may be among the most profound ways that healthcare professionals affirm the worth and humanity of those they serve.

Sources 

Varkey B. Principles of Clinical Ethics and Their Application to Practice. Med Princ Pract. 2021;30(1):17-28. doi: 10.1159/000509119. Epub 2020 Jun 4. PMID: 32498071; PMCID: PMC7923912.

https://www.apa.org/monitor/2021/11/feature-cultivating-empathy

Wolemonwu VC. Richard Dean: The Value of Humanity in Kant’s Moral Theory : Clarendon Press, Oxford, 2006, pp. x + 267. Cloth, £28.12. Med Health Care Philos. 2020 Jun;23(2):221-226. doi: 10.1007/s11019-019-09926-2. PMID: 31571029; PMCID: PMC7260255.

Kant, I. (2020). Groundwork of the Metaphysic of Morals. In Immanuel Kant (pp. 17-98). Routledge.

Written By Ryan Pferdehirt, D.Bioethics, HEC-C, Vice President of Ethics Services, Rosemary Flanigan Chair & Cassie Shaffer Johnson, MA, Program Director of Ethics Services