The Emperor's New Ethics
It is not that I oppose reflection or the thoughtful inclusion of cultural context. Most clinicians I know already approach their work with thoughtfulness and recognize that each patient brings a unique context worthy of consideration. But what I encountered during this session was not a pluralistic ethics framework. It was a carefully constructed worldview that strongly nudges moral reasoning toward alignment with current sociopolitical trends—while still presenting itself as universally valid.
The session included a privilege wheel, an exercise in which participants were asked to map themselves according to perceived social advantage or disadvantage. This was followed by familiar themes: implicit bias, identity awareness, structural mistrust, and an emphasis on historical harms. Cases were introduced—one involving a patient seeking pain medication, another about assisting with breast binding. At no point were we explicitly discouraged from raising other ethical considerations like non-maleficence or clinical scope, but neither were those principles foregrounded. When I brought up, for instance, that breast binding carries physical risks and that beneficence and non-maleficence must be considered alongside affirmation, the presenter agreed readily. But the point is—these principles would not have surfaced had they not been raised.
That is the deeper concern: this model does not explicitly prohibit dissenting perspectives, but it does not really invite them either. It flattens identity into assumed categories—abstracted from the individual—and then builds ethical decision-making on those abstractions, as though group membership reliably determines experience, risk, or moral insight. It creates a kind of ethical momentum where the default moral conclusion is one of affirmation, deference to identity, and alignment with a particular vision of social justice. When I asked whether the current Code of Ethics, interpreted through this model, leaves room for ethical pluralism, the response was gracious—but also indirect. "We really need to have that conversation in person," I was told.
I appreciate the invitation, and will take advantage of it... but to me, that says a lot. While this model encourages reflection and awareness, it also embeds a fixed narrative about power and bias that frames ethics as a function of identity and ideology.
It just goes too far - and that may actually deepen division, not resolve it. I am really concerned about this point.
Ethics should begin with moral principles, not positional assumptions. This framework is not always enforced through overt coercion, though elements of its language in the 2025 Code of Ethics are beginning to appear in enforceable standards.
It functions by social gravity—by shaping the assumptions and direction of our ethical conversations. It depends on professionals going along with ideological framing because the language is positive, the intentions are good, and because no one wants to be seen as lacking empathy - or worse. This presentation ends not with ethics, but with vocabulary. That’s the clearest sign it’s no longer about moral discernment—it’s about social conformity. And professions built on conformity don’t cultivate wisdom or discernment or unity - they manufacture compliance. Some people will even call it coercion.
Ethics should make room for principled disagreement - not just rely on assumed agreement and social signaling. It should start with the question of what is right, not with where someone ranks on the privilege wheel.
The emperor has new ethics. And while the language may be careful and well-meaning, some of us still sense that something essential is missing from the outfit.
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