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Published onMar 27, 2020

This is about that sinking feeling that comes when you’ve done everything right, played by the rules, and yet know you’ve done something wrong. It attempts to understand the dilemma that occurs when you seek to do good but find your best intentions stymied. It isn’t about simple “moral intuitions” or making the best possible choice. Rather, it is about those situations in which moral intuitions do not serve because every alternative is bad.

Moral distress is a hot topic these days in moral philosophy and psychology. My work differs from that of most writers in those areas in several immediately obvious ways. First, I reject the assumption that moral stress, distress, and injury are limited largely to members of this or that particular profession. Rather, I argue they are a chronic and pervasive reality in modern Western society. Second, I refuse allegiance to one or another school of moral philosophy and remain constitutionally suspicious of theoretical propositions not grounded in the concrete realities of everyday life. Thus while I do discuss the insights of moral philosophers and ethicists, I build my argument from the ground up, on the experiential basis of normal folk in daily life.

Perhaps most significantly, this investigation relies on maps, which I present as cultural artifacts in which issues of ethics and morality are embedded. Professional cartographers and the works they produce provide an evidentiary backbone in this work not because mapmakers face unique problems but because they do not. The ethical dilemmas they confront, and the questions that maps may raise, are little different in kind from those I have heard from doctors, nurses, and social workers in medicine; graphic artists and reporters; demographers and statisticians; research librarians and others I have sometimes counseled and who, for this project, I have consulted.

The idea of “mapping morals” is an old one, born in the “moral statistics” developed in the nineteenth century to analyze public data in the early days of what we today call social science. Almost from the start, those statistics were mapped to present a comprehensible visual argument that focused reams of data bearing on social realities. The first great work in this field was André-Michel Guerry’s Essay on Moral Statistics (Essai sur la statistique morale de la France, 1833), in which maps distilled and then presented data on a variety of subjects of social concern: charity, illiteracy, illegitimacy, criminal activity, health, poverty, and so on. Maps of incidence in this or that place and at one or another scale powered the search to understand clinical and social phenomena in a manner that might promote specific and what in the day were enlightened responses to them.

I employ that conjunction of morals and social circumstance here in an attempt to image what we mean by ethics, morals, and their traces in our daily lives. As chapter 2 explains, I began with questions raised by professional mapmakers about moral and ethical issues arising in their daily work lives. I quickly realized that their concerns were not specific to mapping but offered general examples of a greater problem. Thus mapping became not the subject but the medium for ethical exploration.

It is in part the sheer ubiquity of the map that recommends it to this kind of study. Maps are everywhere, from the morning newspaper to the evening newscast, embedded in academic journals and lofty tomes on a bewildering range of subjects. Maps proliferate across the World Wide Web. And, as I hope to demonstrate, all come bundled with a series of assumptions and presumptions that make of them not simple, factual presentations but ones whose construction is ethically grounded. As Mary Midgley put it in another context, “Facts are not gathered in a vacuum, but to fill gaps in a world-picture which already exists.”1 Mapping pictures a preconceived world within which a set of facts is chosen, organized, analyzed, and then argued.

In the main, “historians and philosophers struggle sternly to conceal their own interests and personalities behind a screen of graphs and statistics, vainly hoping that this will make them look as impersonal as physicists.”2 Let me state without apology that this work draws on my personal experiences. It began with questions that I couldn’t answer at a meeting of cartographers in 2005. It continues with problems I considered but could not easily resolve. Chapter by chapter, it reviews subjects that have been the focus of my work for more than twenty years. It thus draws on my varying areas of expertise in ethics and bioethics, on the one hand, and on cartography, mapping, journalism and public health, on the other. Since I cannot pretend to Olympian objectivity, let me instead use this foreword to introduce myself, as well as the chapter-by-chapter program that resulted. There is nothing wrong with honest bias as long as it is clearly stated.

I am a US citizen by birth and a Canadian citizen by choice. My worldview, and that of this work, is therefore fundamentally North American. I make no general claims for the universality of its conclusions, although I believe that the materials presented, chapter by chapter, reflect more than a parochial perspective. Although I have studied, translated, and worked in other languages (Chinese, Spanish, and Japanese), English remains my primary working language. Thus the references at the back of the book are primarily to English-language works.

I have served for several decades as a gerontologist and as a medical ethicist specializing in chronic and palliative care. In those roles, I have struggled with the ethical conflicts and moral dilemmas expressed by patients who find the world they knew disappearing and, separately, the doctors, nurses, and social workers professionally enjoined to attend to those patients’ needs. I have listened as some described how the vocational hopes they once entertained had been dimmed if not wholly extinguished by the realities of professional regulations and strictures.

The book’s organization is more circular than linear in its attempt to bridge experience and theory, ethics, morals, and their practice. That is, as the book advances, it sometimes circles back to ideas earlier introduced. Chapter 1 reviews the idea of moral stress, distress, and injury as historical subjects and philosophical concerns. It briefly reviews that voluminous literature and places it firmly within a context of lived experience. The general theoretical grounding will be critical to some, but certainly not all, readers. Readers suspicious of philosophy and theory are invited to begin their reading with chapter 2. They can return to the first chapter’s comments at need and at their leisure.

Chapters 2 through 4 are more ethnographic than philosophical, presenting what some might call a Foucauldian archaeology or at least anthropology. Chapter 2 describes the meeting of working cartographers where I was first challenged to transpose the broad strokes of ethical discourse into something relevant to the mundane working world of professional mapmakers. If the attendees had ever taken an undergraduate course in applied ethics or philosophy, the lessons half learned in those classes seemed, they said, to offer little guidance in their daily lives and their resulting dilemmas. The question for me was how to create a space—both figural and literal—in which they might better consider the ethical issues that seemed to them problematic.

Chapter 3 presents the program I developed to explore the unease those cartographers described and, by extension, that members of other trades and professions—graphic artists, journalists, and social scientists—similarly experience. The goal was to create a scenario that raised issues but did not dictate solutions. From the start, what I called “the Tobacco Problem” was fashioned in a manner permitting me to investigate the troubling questions raised by classroom students and working professionals participating in seminar settings. It was in the teaching that what began as a question of ethics became an exercise in moral anthropology.

Over time the context of questions about ethical problems and moral foundations expanded. This was, again, as much a reflection of my own history as it was of the lessons learned in the evolving project or the lectures I was asked to give. I spent many years as a daily journalist writing for newspapers, magazines, the Canadian Broadcasting Corporation, and a wire service. So it is no surprise that journalistic examples appear across these pages. Because public media are voracious consumers of maps (and charts, graphs, and tables), expanding from the map to its published context seemed logical and, in retrospect, perhaps inevitable. And, too, it was clear early on that journalists and mapmakers are in a similar ethical bind. Chapter 3 therefore expands its focus from the cartographic specific to mapped arguments in popular media and finally in scientific journals.

Chapter 4, “The Morals in the Map,” describes what happened when I took the problem of cartographic ethics into the classroom. In presenting audiences—undergraduate, graduate, and professional—with an ethical question for which there is no clear answer. I was able to draw from participants their views, encouraging them to perceive the manner in which ethics and their moral underpinnings informed their work. Their responses taught me a great deal about how issues of ethics and morals are perceived and then understood by average citizens. Those lessons prompted me to review things I had, in other contexts, considered earlier.

There the book stalled until Alexandria Enders, a geographer at the University of Montana, kindly sent me a map of governmentally defined poverty in US counties. What was this poverty, and why should I care about it? How did the map describe itself, and what was hiding in its presentation? In its facticity, I wondered, where were its ethics, and why was I not immediately outraged by the map’s bald statement that more than one in eight Americans, citizens of my birth country, were living in poverty? Answering those questions, or at least raising them, is the subject of chapter 5 and the beginning of the “evidentiary” section of this book.

Because poverty and public education are intimately related, chapter 6 focuses on poverty’s effects on the education of the US urban poor, and thus on society at large. At the University of British Columbia, my friend Ken Denike and I had explored and written about a seminal US court case that focused on the systemic links between education and poverty. Here that earlier work is reviewed and expanded as a way of locating the real effects (short- and long-term) of the poverty mapped in the previous chapter. The focus becomes not simply poverty, or the fact of poverty’s effect on student education, but also the moral violation that results.

In the late 1980s, I spent a year at Ohio State University, studying transportation analytics with geographer Howard Gauthier. Chapter 7 draws on that experience in a case study of the means by which transit mapping (and thus planning) may hide the effect of travel barriers on persons who have mobility limits. Here was a way to build from my experiences as an arthritic with low vision to fashion a detailed study of the means by which people with physical or other differences are excluded from participation in our shared world. In this chapter, I focus on London’s famous transit system and its iconic map. In the gulf between my map of mobility-restricted opportunities and the “official” map of London transit, I found a wide gulf between the ethical promise of inclusion and the realities of systemic exclusion.

Chapter 8 takes as its focus the US graft organ transplant system that I first studied in the 1990s. Here was a perfect subject for issues of not simply mapping but also statistics, as well as the way in which the force of our moral declarations is diminished (and sometimes denied) in the name of utilitarian practicality. Like its predecessor, this chapter finds the traces of poverty’s effects in an area that, by law, is supposed to be egalitarian and noneconomic. Again, my earlier work was reviewed, revised, and extended with newly available data.

In the book’s final part, chapters 9 and 10 attempt to bring these individual case studies together, to map (if you will) a coherent argument across the various insights their predecessors advanced. Readers who are looking for an easy fix, a straightforward, uncomplicated ethical rule, or an inflexible moral standard will be disappointed. It is simply not that easy, not ever. There is no one thing that makes the “right” always crystal clear and the “good” blindingly obvious. It’s a messy world, as John Law says,3 one in which complexity rather than simplicity rules.4

But because it is messy does not mean it is incomprehensible. A close analysis of mapped arguments does provide a kind of nested hierarchy that is prescriptive, rejecting both the anarchy of individual eccentricities (“I believe … no matter what you think or say”) and the bludgeon of social imperatives (“You’ll believe what we tell you to accept … no matter what”). We can understand conflicts by attending to the ethical propositions they present, and to the sometimes conflicting moral declarations an ethical proposition may invoke. The result is an experiment in ethics that seeks to join a consequential consideration of thick realities to the overriding presence of thinly principled value declarations. It is not the answer but an answer, a beginning but hopefully not the last word in assessing the moral queasiness of modern professional and social realities.

If the effort is successful, those of us who have known moments of uncertainty and distress will at the least be able to identify the source of our moral queasiness. Once ethics in places are seen as real (again, I want to say “mapped”), we can look for the linkages that will identify their associations in a manner permitting not only a better understanding of our dilemmas but, perhaps, at least a partial resolution.

This is a book about ethics and morals as understood through maps and what they say. That said, it is also about the arguments we make and the rationales on which they are based in societies that promise but do not always deliver on their best ideals. In thinking about those things, it also is about the distance between truth as a simple thing and truth as something shifting, uncertain, and dependent on the experiences we have and the perspectives we accept in the societies where we live.

It is hard to talk about ethics and morality without thinking about truths, because our judgments about good and bad, right and wrong, are bound up in the assumption that truth is an objective thing. It isn’t. Instead the things we call truths are grounded in the values we hold as citizens, members of social groups, and professionals. That doesn’t mean all truth is relative and can thus be dismissed as a chimera. Rather, it is to say that the truths we proclaim evolve over time as our societies evolve and change. Think of them as tectonic plates that support the world while shifting, slowly, beneath its surface.

There are no simple solutions to the complex questions of ethics, no litmus test that firmly establishes moral verities. There is no road map that ensures you or I can live easily and conscience free in a society where what we believe is right is so often a question of what is practical. What I can offer, perhaps, is some insight into what makes ethics and morality difficult things. I can point out the alternatives we face as persons in society and the result of those alternatives for society at large. I can offer some direction to the dilemmas we face in a world composed of coworkers, family members, neighbors, fellow citizens, and species members with whom we share the world.

That’s not everything, of course. It may not even be much. But it’s a beginning.

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