Before I begin, what do I mean by “ethic”? Ethics are, in the end, a study of moral justification of our actions (or inaction). Most simply put, ethics are a set of moral judgments that can influence and later dictate a person’s or a group’s behavior. This supports for an often overlooked but necessary link to “system thinking” to ethics. When I was chosen as a Visiting Scholar to the Hastings Center in 2010, this was the leap of faith that I wanted to make. Medical ethics (or bioethics) has often ascribed to the negotiation of needs and morality as a linear action with no feedbacks, such as doctor/patient (or any other personal coupling). I knew so many ethicists grappling with beneficence (acts of mercy) and autonomy (self-determination) from this angle. It is a legitimate angle to take. But how do we really grapple with our moral compass? We are social. We are embedded with people, situations and environments which all tug at our ethics. I wish to add to these ethical discussions by allowing the ‘dope’-ness (is that a word?) of systems to shed light on the messiness of ethical negotiation.

As we engage with our environment, “good” or “moral” compasses change, making such declarations temporally and situational bound rather than universal law or socially proclaimed policy. I call this ethical malleability, whereby a person may “change” his ethical stance to suit his present belief system (Battle-Fisher, 2010). As I wrote in my article published in the Online Journal of Health Ethics (2010), human agency and the ability (though not coercion) to change one’s mind can make even a con a probable yes in the future. The question central for me is good and morality based on social influence and personal proclivity to take a side. In the end, we are linked in networks that influence our stances.

Next, let’s touch on affirming ethics. Does the affirming of bioethics require relevance, novelty, or something else altogether? Susceptibility to the people most connected (those with power centrality in systems speak) may sway other people connected to them enough to influence a choice in ethical decisions. Does this counter the ideal of autonomy? I say no as this malleability (inevitable flip flops in ethical positions) serves as a reality check to often unobtainable true autonomy. While we remain social creatures, autonomy will be a striving toward a pinnacle of self-realization. We operate along that journey toward this heightened state of actualization; therefore we are ethically susceptible to malleability. Might an ethic be “innovative” with the ability to diffuse across a network? Could a person change his mind and reverse the “innovation” or is it just a new feedback loop into cycle of innovation with no consequence? For instance if a person has a high measure of trust “closure” (due to densely packed connections) plus a high level of “closeness” which makes it easier to find others to influence. Imagine the ability to influence ethics under this scenario. An ethic can be changed until it is acted upon. Even after it is acted upon, a person may regret that moral decision then revert back and have to deal with the collateral damage of that choice. An ethic is NOT the action but a necessary precondition to action. But we ultimately must pay for our actions so we indirectly pay for our ethical positions in the end. We pay socially as well as personally.

Have you ever been the lone voice of discordance within a network? What were the situations that you decided to bend to the will of the majority? I implore that the last thing that we should do is blame the person for changing an ethic. An ethic may never necessarily be displayed as a discernible action or even need to be articulated. Must an ethic be communicated to count? Is it something else when discussed (by morphing into a value or norm)? No. Yes. Add in the wrinkle of persuasion and you have a party on your hands. Granovetter (1978) presented a cool idea he called the threshold model of collective behavior. He seeks a decision as a binary (pro or con) based on a threshold of others’ participation. I understand that ethics are much more gray that I present here. But stay with me. Valente (1995) later wrote of the idea of “network thresholds” which should be measured in terms of exposure to “direct communication ties” (a a measure of degree) but not as a threshold measured for the whole social system. This threshold shows the point where a node will be convinced to adopt. Valente found that opinion leaders (the big Kahunas in the network that you dare not defy) have lower network thresholds. The most connected and powerful require the least convincing to innovate. However, these opinion leaders must influence more resistant nodes in the network, those later adopting, those that hold on to self-determination the longest.

As diffusion is a long-term proposition, is diffusion the best model for ethical deliberation? Someone can change an ethic so perhaps definition of adoption proportion may be less meaningful over the long term. I still see the idea of diffusion spread as important though any conclusions should be taken in light of this time-based restriction. The use of a long view network approach would be the go-to guy. We must discern the nature of the ethic first in order for this network approach to become meaningful. But social networks would be the natural step in more fully elucidate how ethics in a public really work.


Battle-Fisher, M. (Dec. 2010). Organ donation ethics: are donors autonomous within Collective
networks? [electronic version] OJHE Online Journal of Health Ethics. 6(2). Retrieved from

Granovetter, M. (1978) Threshold models of collective behavior. The American Journal of
Sociology. 83(6), 1420-43.

Valente, T.W. (1995). Network models of the diffusion of innovations. Cresskill, NJ:
Hampton Press.

The topic is more fully nuanced in my book, Applications of Systems Thinking to Health Policy and Public Health Ethics- Public Health and Private Illness, published by Springer.

Featured image courtesy of Library of Congress.

About The Author

Avatar photo
Adjunct Assistant Professor, Wright State University Boonshoft School of Medicine

Michele Battle-Fisher is an Adjunct Assistant Professor at the Wright State University Boonshoft School of Medicine and the author of Application of Systems Thinking to Health Policy and Public Health Ethics: Public Health and Private Illness (Springer), a 2016 Doody's Core Title. Ms. Battle-Fisher is a Health Systems/Complexity scholar and bioethicist. She has researched and taught in the medical and policy fields, ranging from public health, science and technology, bioethics, systems theory and its application to health. She was a speaker at TEDxDartmouth 2018 where she discussed the "Paradigm Shift" of Health Systems Science curriculum in health and clinical medicine. She was selected as a finalist in the 1st annual MIT Press “Pitchfest”, the “Shark Tank” of book publishing.