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 Third Edition

Ethics, Jurisprudence,
& Practice Management
in Dental Hygiene
Vickie J. Kimbrough-Walls, RDH, MBA
Charla J. Lautar, RDH, PhD

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Notice:
The authors and the publisher of this volume have taken care that the information and technical recommendations con-
tained herein are based on research and expert consultation and are accurate and compatible with the standards gener-
ally accepted at the time of publication. Nevertheless, as new information becomes available, changes in clinical and
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Library of Congress Cataloging-in-Publication Data

Kimbrough-Walls, Vickie J.
Ethics, jurisprudence & practice management in dental hygiene / Vickie
J. Kimbrough-Walls, Charla J. Lautar.—3rd ed.
p. ; cm.
Other title: Ethics, jurisprudence, and practice management in dental hygiene
Includes bibliographical references and index.
ISBN-13: 978-0-13-139492-6
ISBN-10: 0-13-139492-4
1. Dental hygiene—Practice. 2. Dental ethics. 3. Dental
jurisprudence. I. Lautar, Charla J., 1949- II. Title. III. Title:
Ethics, jurisprudence, and practice management in dental hygiene.
[DNLM: 1. Practice Management, Dental—organization & administration.
2. Dental Hygienists. 3. Ethics, Dental. 4. Legislation, Dental. WU 77]
RK60.5.K563 2012
174’.96176—dc22 2010037346

10 9 8 7 6 5 4 3

ISBN-10: 0-13-139492-4
ISBN-13: 978-0-13-139492-6
 CONTENTS

Preface xi
Acknowledgments xv
Reviewers xvii

Chapter 1 Introduction to Moral Philosophy and Moral Reasoning 1

Objectives 1
Key Terms 1
Introduction 1
Case Study 2
Ethical Theories: Duties and Consequences 2
Ethics 2
Normative Ethics 2
Ethical Theories: A Survey of Moral Theories 3
Utilitarianism 3
Kantian Ethics 6
Virtue Ethics 7
Social Philosophy 8
Utilitarianism and Justice 8
Liberalism and Rights 9
Three Facts about Rights 9
Rawls’s Theory of Justice 11
Applying Rawls’s Theory to Health Care Problems 13
Summary 14
Critical Thinking 14

Chapter 2 Core Values and Additional Ethical Principles 16

Objectives 16
Key Terms 16
Introduction 16
Case Study 17
Core Values 17
Autonomy 18
Confidentiality 19
Health Insurance Portability and Accountability Act 20
Societal Trust 23
Nonmaleficence 24
Beneficence 24
iii
iv Contents

Justice 25
Veracity 25
Additional Ethical Principles 26
Fidelity 26
Parentalism/Paternalism 26
Utility 27
Summary 29
Critical Thinking 29

Chapter 3 Informed Consent 30

Objectives 30
Key Terms 30
Introduction 30
Case Study 30
Historical Background 31
Giving Information 31
Giving Consent 32
Rights and Duties Involved in Informed Consent 32
Evolution of the Concept of Informed Consent 33
Types of Consent 33
Harm-avoidance Model 34
Examples 34
Autonomy-enhancing Model 35
Exceptions to the Rule 35
The Ideal Context 38
Disclosure in the Office: Practical Hints 39
Informed Consent and Research 42
Use of Photos and Other Recording Devices 43
Disclosure by Infected Health Care Providers 44
Patients’ Bill of Rights 46
Summary 47
Critical Thinking 47

Chapter 4 Decision Making 49

Objectives 49
Key Terms 49
Introduction 49
Case Study 50
Ethical Dilemma 50
Examples 52
 Contents v

Solving Ethical Problems 53

Kohlberg’s Model 53
Rest’s Model 54
Decision-Making Process 55
Applying Decision-Making Steps 57
Identify the Problem 57
Gather the Facts 57
List the Alternatives 58
Select the Course of Action 59
Act on the Decision 59
Evaluate the Action 60
Summary 61
Critical Thinking 61

Chapter 5 Jurisprudence 62
Objectives 62
Key Terms 62
Introduction 63
Case Study 63
Criminal Law 63
Insurance Fraud 64
Civil Law 65
Tort Law 66
Professional Negligence and Malpractice 66
Assault and Battery 69
Defamation 69
Contract Law 70
Abandonment 72
Risk Management 73
Case Law 75
Licensure 75
Educational Requirements 75
Written Board Exams 76
Practical Board Exams 76
Other Requirements for Licensure 77
Credentialing 78
Certification 78
Practice Act 78
Protection 79
vi Contents

Regulation 79
Scope of Practice 81
Supervision 81
Forensic Dentistry 84
Summary 85
Critical Thinking 85

Chapter 6 Social Issues 86

Objectives 86
Key Terms 86
Introduction 86
Case Study 87
Workplace Legislation 87
Affirmative Action 87
Pregnancy Discrimination Act 88
Family and Medical Leave Act 88
Americans with Disabilities Act 89
Age Discrimination in Employment Act 90
Sexual Harassment 90
Occupational Safety and Health Act 91
Reporting Domestic Violence 92
Child Abuse 93
Spouse Abuse 95
Elderly Abuse 96
Access to Care 97
Disparities 97
Financial Barriers 99
Managed Care 100
Government Assistance 101
Geographical and Organizational Barriers 102
Sociological and Cultural Barriers 104
Justice 106
Advocacy 107
Summary 109
Critical Thinking 109

Chapter 7 Aspects of Practice Management 110

Objectives 110
Key Terms 110
Introduction 110
Case Study 111
 Contents vii

Management Consultants 111

Consumer-Influenced Changes 111
The Focus for Consulting Firms 112
Customize Business Systems 112
Business and Dental Hygiene 113
Employer Management Styles 113
The Team Concept 114
Team Communication 114
Defining Staff Roles 115
Cross Training 116
Staff Meeting Benefits 116
Meeting Activities 116
Expectations and Public Relations 117
Employers’ Expectations 117
Interpersonal Skills 118
Communicate Your Education 119
Your Expectations 119
Staff Expectations 120
Patient Expectations 120
Marketing and the Dental Practice 121
Using Expertise to Market the
Practice 121
Successful Marketing 122
Using Advertising 122
Marketing the Patient’s Health
Care 123
Marketing the Practice 123
Marketing Yourself 124
Marketing Strategies 124
Marketing and Profit Centers 125
Profit Center and Patient Compliance 125
Profit Center Options 125
Other Practice Considerations 126
Summary 127
Critical Thinking 127

Chapter 8 The Business of Dental Hygiene 129

Objectives 129
Key Terms 129
viii Preface

Introduction 129
Case Study 130
Dental Hygiene Assessment 130
Thorough Patient Assessment 131
Building and Perfecting Skills 131
Preventative Home Care 132
Maximizing Skills 132
Developing Leadership Qualities 133
The Business of Dental Hygiene 135
Overhead Cost 135
Creating Daily Schedules 136
Dental Insurance and Hygiene Services 137
Common Insurance Plans 138
Insurance Billing Procedures 139
Insurance Codes 139
Excluded Treatments 139
Continuing Care and Recare Systems 141
Continuing Care Systems 141
Continuing Care Objectives 142
Time Management 143
Working with Other Dental Hygienists 144
Working as a Public Health Dental Hygienist 144
Career Alternatives 145
Six Roles of the Dental Hygienist 145
Lifelong Learning 146
Summary 146
Critical Thinking 147

Chapter 9 Alternate Practice Models: Future Trends

for Oral Health Care 148
Objectives 148
Key Terms 148
Introduction 148
Case Study 149
Overview of Alternate Practice in the United States 149
Alternate Practice Models 152
International Models for the Dental Therapist 152
Dental Therapists in the United States 154
Minnesota—Advanced Dental Therapist 154
 Contents ix

Dental Therapist 155

Alaska—Dental Health Aide Therapists 155
Current Alternative Practice Models in the
United States 157
California 157
Colorado—Unsupervised Practice 161
Maine—Unsupervised Practice 161
New Mexico—Collaborative Practice 162
Summary 162
Critical Thinking 163

Chapter 10 Seeking the Dental Hygiene Position 164

Objectives 164
Key Terms 164
Introduction 164
Case Study 165
Beginning the Search 165
Keeping Options Open 166
Working as a Temporary 166
Employment Resources 167
Preparing for Interviews 167
Interview Skills 167
The Employer’s Interview 169
Common Interview Questions 169
Your Interview 170
The Working Interview 171
Interviews and Personality Tests 172
Attire 172
Leadership versus Management: Qualities and
Opportunities 174
Résumés 174
Perfecting Your Resume 175
The Cover Letter 176
Post-Interview Acknowledgments 178
Beginning the New Job 179
Compensation 179
Benefits 181
Major Benefit Components 181
Negotiating 182
x Contents

Other Negotiating Considerations 182

Employment Contracts 184
Policy Manuals 184
Employee Evaluations 184
Summary 185
Critical Thinking 186

Chapter 11 Planning for the Future and Career Longevity 187

Objectives 187
Key Terms 187
Introduction 187
Case Study 188
The Basics of Investing 188
Investment Vehicles 189
Earned Interest 191
Investment Brokers 191
Spend Money Wisely 191
Insurance Coverage for Dental Hygienists 192
Liability Coverage 192
Disability Coverage Disability 192
Life Insurance Coverage 193
Term or Whole-Life Policies 193
Professional Membership 194
Patient Perspective 194
Self-Care 194
Cumulative Trauma Disorders 194
Dental Operatories 196
Healthy Lifestyle 196
Therapeutic Considerations 196
Summary 197
Critical Thinking 198

Appendix A Internet Resources 199

Glossary 201
Works Cited 205
Index 213
 PREFACE

The practice of dental hygiene continues to evolve in both scope of duties and changes in legis-
lation. New workforce models are currently being offered for those interested in alternative set-
tings and flexibility for providing oral health care to those with limited or no access to a dental
office. Additionally, more health care providers are being sought in the profession of forensics in
the event of catastrophes.
The information and examples in this book are designed to orient dental hygiene students
to clinical practice and its many applications in an office setting. Although dental practices and
dental hygiene procedures can be generalized, each office will be unique in its daily operations
and policies. As public health is woven through the various roles of the dental hygienist, this
book contains limited discussions regarding public health issues; however, it is not intended to
replace the community health textbook you are presently using.

ORGANIZATION OF THE TEXT

Ethics, Jurisprudence, & Practice Management in Dental Hygiene is organized into 11 chapters
and divided into two major sections: ethics and jurisprudence, and practice management as it
applies to the dental hygienist as an employee and potential independent practitioner. The first
two chapters introduce codes of ethics and discuss ethical principles, moral values, and how each
influences society, individual, and the profession. Chapters 3 and 4 present informed consent and
decision making as they relate to patients and the practioner, and Chapters 5 and 6 discuss legal
information and social issues where the dental hygienist should be knowledgable, and as they
may be applied to patient care.
The second half of the text will cover practice management. Chapters 7 and 8 introduce
you to the dental practice and how it must operate as a small business. Chapter 9 is new and
presents current information on workforce models such as the dental therapist and the regis-
tered dental hygienist in alternative practice. Chapters 10 and 11 provide information on inter-
viewing, seeking your first dental hygiene position, and planning for a long-term career in
your new profession.
At the end of the book are listed references, key terms in a glossary, and Internet resources.
Throughout the book are boxes that highlight and condense information that was previously dis-
cussed. Follow-ups and critical-thinking questions integrate the chapter’s content with the chap-
ter’s case study.

Chapter Format
Each chapter is consistent in its presentation of information and includes the following:
Objectives are statements designed to inform the student about the overall knowledge
gained from chapter information.
Key Terms are listed at the beginning of each chapter and you will find them bolded and
italicized in the text as you read through the chapter. They emphasize important concepts
or major points of chapter content. These terms are also found at the end of the book in the
glossary.
xi
xii Preface

Case Studies The case studies present short scenarios that introduce and highlight chapter
content. Some include a task or ask you to consider applying the chapter to the case in
order to better understand how it applies to you as a dental hygiene professional.
Critical Thinking questions are found at the end of each chapter. These questions help
you to insure your knowledge of the chapter content is correct, and some can be used for
classroom discussion.

SPECIAL FEATURES
This third edition includes information regarding the practice of dental hygiene in Canada
and internationally. Canadian dental hygienists are similar to American dental hygienists in
many ways but differ in that the majority of them practice under self-regulation. In this global
economy and transient society, it is important to be prepared for the opportunities of one’s
profession.
Also new to this edition is information on the new workforce models being offered and
developed in the United States such as dental therapists, the registered dental hygienist in alter-
native practice, collaborative practice, and most recently, unsupervised practice in Maine.
Aspects of practice management have expanded to include production goal setting, more busi-
ness planning for dental hygiene, and identifying characteristics for leadership skills. You will
find additional case studies located on MyHealthProfessionsKit along with many more resources
designed to prepare you for entering the dental hygiene profession.

TEACHING AND LEARNING PACKAGE

Ethics, Jurisprudence, & Practice Management in Dental Hygiene has been written with the stu-
dent in mind. Each chapter provides background information so that students without previous
dental experience can better relate to topics in the text and apply them to clinical experiences
they may have had during their dental hygiene education. The content provided in the text will
enhance the development of professionalism students learn as they interact with peers and
patients through a broad spectrum of topics for discussion and application to real situations.

For the Student

As a student, you will find the case studies in each chapter essential to better comprehension of
the chapter content and how it applies to the practice of dental hygiene upon graduation. The
MyHealthProfessionsKit includes more case studies related to ethical decision making along
with Internet resources and business plan templates that may be required for assignments. For
additional information please go to www.myhealthprofessionskit.com.

For the Instructor

Ethics, Jurisprudence, & Practice Management in Dental Hygiene now includes updated infor-
mation on the new workforce models for oral health care professionals: dental therapists,
advanced dental therapists, the Alaskan model (DHAT), and more. Additionally, new case stud-
ies are found in this edition and the previous case studies can be found on the
MyHealthProfessionsKit website. This third edition has updated PowerPoint presentations that
can be enhanced to customize your own lecture style and content, along with test bank questions
 Preface xiii

to include on quizzes or tests. There is also a teaching tip component that offers suggestions
for classroom activities and assignments. For additional information, please go to www.
myhealthprofessionskit.com.

STUDY TIPS FOR STUDENTS

Many dental hygiene students use multiple methods for learning course content. The use of tech-
nology provides unlimited resources for gathering data and more examples to enhance student
learning. The MyHealthProfessionsKit website provided for you with this text is one more way
technology may assist in your overall understanding of the material and how it applies to the den-
tal hygienist.
As you read and participate in the critical-thinking exercises, keep in mind that experiences
will be unique. In this new millennium, the art and science of dental hygiene continue to progress
and evolve. Consider the following as they apply to the content of each chapter:
✓ Supervision laws have been relaxed that allow for increase access to care and help elimi-
nate disparities among diverse and underserved population groups.
✓ Strategies are being developed to increase cultural competencies and multidisciplinary
collaboration as well as to increase the number of minorities in the oral health workforce.
✓ Dental hygienists are using more of their skills as oral health is becoming an important
entity of general health.
✓ Dental hygienists are becoming more responsible for the regulation of their profession.
As a student, actively discuss dental situations you have previously experienced in your
dental hygiene education. On becoming a registered or licensed dental hygienist, you are encour-
aged to actively participate in furthering the development of patient education and dental hygiene
research as well as your own education. Reach out to communities that are not able to access
dental care in a traditional setting and continually stay abreast of the link between periodontal
disease and total body health, as patients see the dental hygienist as the oral health care special-
ist. The knowledge and relationships that build from networking with other professionals will be
invaluable.
We hope that you find personal and professional satisfaction in your dental hygiene career
and as a member of the dental hygiene profession. As dental hygienists move outside the isolated
private dental office and globalism facilitates the exchange of information and culture, embrace
dental hygiene wherever your future may be.
This page intentionally left blank
 ACKNOWLEDGMENTS

To my sons, Kris, Lenny, and Rik—you continue to become my best friends and appreciate my
pursuits in higher education, my mom Joanne, for her continuous pride in my achievements, and
my, husband Mick—thank you for understanding my responsibilities and being patient as I jug-
gle all these balls in the air.
I appreciate the many educators I have been in contact with during my career and respect
the collaborative efforts to advance dental hygiene in all aspects of its potential. Special thanks to
my fellow faculty at Truckee Meadows Community College for having open minds and the will-
ingness to try new ideas that contribute to our positive learning environment and continued
achievements.
Vickie J. Kimbrough-Walls, RDH, MBA

Thank you to Dr. Mohamed Elsamahi for his support and advice throughout the writing of the
third edition. I would also like to thank those individuals and fellow dental hygienists who con-
tributed case studies for this text and previous editions, including the Instructor’s Manual, which
are now on the website MyHealthProfessionsKit. In particular, I would like to recognize Teri
McSherry for her case study in chapter four and to thank fellow dental hygiene educators Debbie
Boyke and Judi Thomas for their prewriting encouragement with this edition.
Charla J. Lautar, RDH, PhD

xv
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 REVIEWERS

Third Edition Reviewers Robin B. Matloff, RDH, BSDH, JD

Marsha Bower, RDH, CDA, MA Mount Ida College
Monroe Community College Newton, Massachusetts
Rochester, New York
Shelly A. Purtell, RDH, MA
Amy E. Cooper, RDH, BA Broome Community College
Tarrant County College Binghamton, New York
Hurst, Texas
Salim Rayman, RDH, BS, MPA
Renee Cornett, RDH, MBA Hostos Community College
Austin Community College Bronx, New York
Austin, Texas
Maribeth Stitt, RDH, MEd
Laura Cunningham, MEd Lone Star College—Kingwood
University of Oklahoma Kingwood, Texas
Oklahoma City, Oklahoma
Sharon Struminger, RDH, MPS, MA
Ann Curtis, RD, RDH, MS, CAS Farmingdale State College
University of Maine at Augusta Farmingdale, New York
Bangor, Maine
Rebecca G. Tabor, RDH, MEd
Jacquelyn L. Fried, RDH, MS Western Kentucky University
University of Maryland Dental School Bowling Green, Kentucky
Baltimore, Maryland

Tracy Gift RDH, MS

Mohave Community College
Bullhead City, Arizona

xvii
xviii Reviewers

Previous Edition Reviewers David C. Reff, DDS

Doni L Bird, RDH, MS Apollo College
Santa Rosa Junior College Boise, Idaho
Santa Rosa, California
Bonnie Tollinger, CDA
Ann Brunick, RDH, MS Boise State University
University of South Dakota Boise, Idaho
Vermillion, South Dakota
W. Gail Barnes, RDH, PhD
Geraldine Hernandez, RDH Massachusetts College of Pharmacy
Miami Dade College and Health Sciences
Miami, Florida Boston, Massachusetts

Sandra Horne, RDH, MHSA Chris French Beatty, RDH, PhD

University of Mississippi Medical Center Texas Woman’s University
Jackson, Mississippi Denton, Texas

Jacquelyn W. Johnson, RDH, MS Donna J. Stach, RDH, MEd

Tarrant County College—Northeast University of Colorado
Hurst, Texas Denver, Colorado

Bernice A. Mills, RDH, MS Barbara Paige, RDH, EdD

University of New England Cabrillo College
Portland, Maine Aptos, California

Nichole Oocumma, RDH, MA, CHES Angelina E. Riccelli, RDH, MS

Stark State College University of Pittsburgh
North Canton, Ohio Pittsburgh, Pennsylvania

Carolyn Ray, RDH, MEd

Texas Woman’s University
Denton, Texas
 CHAPTER 1

Introduction to
Moral Philosophy
and Moral Reasoning

OBJECTIVES
After reading the material in this chapter, you will be able to
■ Define the term ethics.

■ Define the terms deontology (deontological approach) and teleology (teleological approach).

■ Distinguish between the ethical theory of utilitarianism and Kant’s ethical theory.

■ Compare rule utilitarianism with act utilitarianism.

■ Contrast a right with a duty and a right with a privilege.

■ Discuss the role of social justice in determining ethical behavior.

KEY TERMS
Act utilitarian Ethics Rights
Consequentialist theory Normative ethics Rule utilitarian
Deontology Prima facie Teleology
Duty Privilege Virtue ethics

INTRODUCTION
Throughout our personal and professional lives, we make judgments and behave according to
moral principles. These actions may be perceived as right or wrong based on their consequences,
an individual’s duties, and virtues or character traits. These perceptions have a profound effect on
our view, as health care providers and as ordinary citizens, of access to health care and other
social justice issues. This chapter serves as a knowledge foundation for decision making and
actions in dental hygiene practice.

1
2 Chapter 1 • Introduction to Moral Philosophy and Moral Reasoning

Case Study
After a conversation with your supervising employer dentist about universal health care, you
tell her that covering every individual should be the aim. She argues against this proposition
because this kind of health care coverage will lower the incomes of dentists and the entire
office staff working with them.
As you read this chapter, consider the following: Which ethical theory has guided you
position?

ETHICAL THEORIES: DUTIES AND CONSEQUENCES

In health care and elsewhere, ethical behavior is the result of perceiving an action as either right
or wrong. This perception is based on norms, duties, consequences, and character traits.

Ethics
The discipline of ethics consists of thoughts and ideas about morality. Ethics (or moral thinking)
is concerned with studying human behavior, particularly toward other human beings, and the
principles that can regulate it. Most ethical thinkers are philosophers, and philosophy differs
from social sciences in its tendency to suggest or recommend standards, or norms, of behavior.
For example, a sociologist may study the phenomenon of aggression, focusing on the causes of
aggression and how some members of society become aggressive under certain circumstances.
Similarly, a psychologist may explain why some people fail to develop normal empathic atti-
tudes to others and become indifferent and insensitive to human suffering. A philosopher, on the
other hand, would deal with aggression and insensitivity to suffering as violations of several
moral values and would propose arguments to support the importance of peaceful and mutually
respectful attitudes to human life and to other people.

Normative Ethics
The difference is that science, whether social or physical, is mainly descriptive, while moral
philosophy is mainly normative. Science analyzes phenomena in depth and explains them. It
may also predict future events on the basis of present observations. Ethical philosophy goes
beyond studying phenomena at a descriptive level and proceeds to recommend desirable atti-
tudes. Because desirable attitudes are commonly called norms, ethical thinking that purports to
guide human behavior is called normative ethics.
Traditionally, the ethical studies that explore the nature of moral judgments and the struc-
ture of moral concepts are called metaethics. Metaethical studies investigate, for example, the
meaning or the significance of what is right or wrong (good or evil) and whether moral judg-
ments are objective or subjective (Honderich, 1995, p. 555). Normative ethics is the branch of
metaethics that is concerned with moral recommendations about which acts are right and which
are wrong. The study of normative ethics that is relevant to health care ethics can be divided into
two major groups of theories: deontology and teleology. Virtue ethics is also an important nor-
mative position and will be discussed later in another section of this chapter.

DEONTOLOGY The first normative ethical theory is deontology. Advocates of deontological

ethics emphasize duties. For them, performing moral duties is not a matter of deliberation or
 Chapter 1 • Introduction to Moral Philosophy and Moral Reasoning 3

negotiation. A duty is an obligation, an act that has to be done or ought to be done regardless of
its consequences. In that way, deontological ethics shares with religions the concept of absolute
obligation. A deontologist, for example, would expect people to tell the truth no matter what hap-
pens as a result. This is similar to the attitude of a religious person who never lies because lying
is against the Ten Commandments. Ethical duties are derived from ethical principles and con-
cepts. Some of these duties (e.g., truthfulness) are adopted by health care professions and stated
in codes of professional ethics. Other duties (e.g., respect for private property) are incorporated
into the legal system, while others (e.g., respect for personal privacy and helping the poor or eld-
erly) are incorporated into social traditions and customs (Weinstein, 1993, p. 84). Purtilo (1999)
defines three basic duties: absolute, prima facie, and conditional (p. 60). An absolute duty is
binding under all circumstances. For example, the duty not to kill an innocent person is absolute
because we know of no situation in which such killing would be permissible. It is important to
notice here (or in that respect) that having to defend oneself against a non-innocent aggressor,
which may result in killing in self-defense, is not a violation of deontology.
Prima facie duties differ in that they are determined by the present situation. The term
prima facie means “at first glance,” and a prima facie duty is a duty that is made obvious by the
circumstances surrounding it. In dentistry, a scenario to illustrate this is treating the patient who
is in pain before treating the patient who has come for a routine scheduled appointment. Treating
the patient in pain seems to be the right decision even though it may upset the scheduled patient
because of unexpected waiting.
A conditional duty is a commitment that comes into being after certain conditions are met.
For instance, our society has a duty to support unemployed persons only after they try to learn
new skills that may enable them to find jobs, or after it becomes obvious that they have no chance
to find employment. Similarly, we have a duty to support medical research only after ensuring
that it is well designed, feasible, and concerned with major health problems rather than with aca-
demic curiosities. Duties are further discussed in this chapter and in Chapter 2.

TELEOLOGY Thus far, we have discussed the deontological group of theories. Let us examine
the second group of normative theories, which is called teleological theories. The term teleology
is derived from the Greek word for “end,” or “goal.” A teleologist will consider the consequences
of telling the truth versus the consequences of lying and may find that lying is morally justified
in a specific circumstance. This position, which is also called consequentialism, is based on the
notion that what matters for morality is the result, or consequence, of an action. Telling a “little
white lie” that will do more good than telling the truth counts, for teleologists, as a good action.
For example, a teleologist would say that lying to a known killer about the hiding place of his
potential victim is morally good. So the difference between deontologists and teleologists is that
the former are concerned with the principle behind an action, while the latter are concerned with
the results of an action.

ETHICAL THEORIES: A SURVEY OF MORAL THEORIES

In this section, three ethical theories will be discussed: utilitarianism, Kantian ethics, and virtue
ethics. These theories provide a background or rationale for making moral judgments.

Utilitarianism
UTILITY AND CONSEQUENCES The first utilitarians were the British philosophers Jeremy
Bentham and John Stuart Mill, who lived in the nineteenth century. They argued that the aim of
4 Chapter 1 • Introduction to Moral Philosophy and Moral Reasoning

morality is attaining the greatest amount of utility for human beings and identified utility (or use-
fulness) with happiness. Their theory, which became popular during much of the twentieth cen-
tury in Britain and North America, is a consequentialist theory. Consequentialist (teleological)
theories are based on the results of actions rather than on the nature of actions. For instance, if
telling a lie can lead to saving an innocent life in a particular situation, it is morally good to tell a
lie in that situation. That is, an action is morally right if it leads to desirable results and is wrong
if it leads to undesirable results. Utilitarianism defines the “good consequence,” or “desirable
result,” as the maximal happiness in the world (i.e., happiness for most people). According to
utilitarianism, suffering is the ultimate evil and happiness the ultimate good, and the role of
morality is to guide us to eliminate suffering and maximize happiness.

HAPPINESS Utilitarianism does not recommend that every person pursue only what promotes
his or her happiness. Instead, it recommends that all persons act in a way that leads to the least
misery and the most happiness (including personal happiness) in the world. The utility principle
recommends that we seek the “general” or “total” happiness in society rather than our own per-
sonal happiness. However, utilitarians do not ask us to ignore our own happiness but rather to view
it as a part of total happiness. In that respect, utilitarianism adopts the principle of beneficence,
which is discussed in Chapter 2. The beneficence principle requires one to do what is good for
others without expecting a reward for doing so. Box 1-1 gives an example of utilitarianism.

BOX 1-1
Example

To understand utilitarianism, consider this example. A healthy man knows that his neighbor’s daugh-
ter needs a kidney transplant to survive after a disease has destroyed both her kidneys. He volunteers
to have his tissues tested for compatibility with the girl’s tissues, and the result turns out to be posi-
tive. If he donates his kidney to save the girl’s life, he exposes himself to a major surgical operation.
He also knows that if he lives with only one kidney, there is a small chance of having a disease in that
kidney in the future that may be severe enough to kill him. Donating his kidney would cost him at
least some peace of mind. Should he accept this price (i.e., some anxiety about future health) and
give the girl one of his kidneys? Utilitarians would encourage him to do so as long as he is unlikely to
be significantly harmed. By saving her life, he makes her and her family and friends happy. He also
makes people who advocate benevolent actions happy by giving a good example of benevolent
behavior that may inspire others. The outcome of his action, then, would be more happiness in the
world, and this agrees with the utility principle.
But utilitarians would not encourage a person who is likely to be harmed by a surgical opera-
tion to donate his kidney. As soon as the girl and her family realize that the benevolent man has
exposed himself to a great danger, they would feel sorry rather than happy and thankful. At the same
time, the man’s own family and friends would be unhappy if he is harmed. In the end, his action
would not add to the total happiness in the world and is therefore unethical on utilitarian grounds.
So utilitarianism does not expect from any individual sacrifices that would not maximize happiness
and minimize suffering for the greatest number of people.
 Chapter 1 • Introduction to Moral Philosophy and Moral Reasoning 5

When utilitarians discuss happiness, they do not mean any form of happiness. Happiness can
be shallow, short lasting, significant, long lasting, hedonic (in the form of pleasurable feeling), or
intellectual (e.g., enjoying an artwork). Short-term happiness is not the aim of utilitarianism. No
utilitarian, for example, would encourage a student fond of sports to abandon school to satisfy the
passion for sports or an art lover with limited resources to spend most of her income collecting
paintings. It is also important to recognize that utilitarianism does not construe happiness merely as
pleasure. Satisfaction in general, whether it derives from meeting one’s basic needs, reading inter-
esting novels, or helping the poor, would count as happiness for utilitarians. Another important
point is that utilitarians regard reducing suffering (or decreasing unhappiness) equivalent to
increasing happiness in the world. A dental hygienist who donates time to a public aid clinic think-
ing that the consequences will bring happiness to others is guided by the utility principle. If the den-
tal hygienist who donates time to the public aid clinic instead of working for a salary is not able to
provide for his or her children, then he or she is not following the utilitarian principle.

CATEGORIES OF UTILITARIANISM There are two versions of utilitarianism: act utilitarianism

and rule utilitarianism.
• An act utilitarian is concerned with individual acts. This person would assert that acting
in a certain way (e.g., keeping promises) promotes general happiness, and for that reason,
it is a good action.
• A rule utilitarian, on the other hand, is concerned more with the rule from which an
action is derived. He or she would assert that the goodness of an action depends on whether
it is justified by a rule that, if followed, can maximize happiness in the world.
There seems to be no substantial difference between the two positions. However, in some
situations, rule utilitarianism can avoid problems that act utilitarianism cannot. As dental hygien-
ists, we know that polishing teeth can damage tooth structure (Wilkins, 2009). Many patients feel
that they have not received complete treatment unless the teeth are polished even though they are
told about the disadvantages of polishing (patient may not have stains, polishing is contraindi-
cated, no therapeutic reason). In order to provide happiness to the patient, the dental hygienist
gives the illusion of polishing by sweeping the rubber cup over the surfaces of the teeth with
minimal or no pressure. The patient feels the act of polishing and tastes the polishing agent.
It is difficult to describe a deceptive act as morally good, yet a rule utilitarian would not
agree that the dental hygienist’s action was good because adopting the rule that deceiving people
in order to please them would not maximize happiness. Rational people would feel unhappy and
even angry if they knew that they were deceived in order to be pleased. It would be wrong to sug-
gest to a patient that a procedure was done when in fact it was not.

RELEVANCY OF UTILITARIANISM Is utilitarianism relevant to health care ethics? Yes, because

this theory is concerned with reducing suffering, which is one of the main duties of health care
providers. Moreover, utilitarianism contributes significantly to the discussion of the problem of
fair distribution of health care resources.

Case Study Follow-up #1

In the chapter’s case study, the dental hygienist is taking the position of a utilitarian or
using the utilitarianism ethical theory to defend universal health care. The dental hygienist
perceives that universal health care will bring happiness to most people.
6 Chapter 1 • Introduction to Moral Philosophy and Moral Reasoning

Kantian Ethics
MORALLY RIGHT ACT OR A DUTY According to Immanuel Kant, the eighteenth-century
German philosopher, certain acts are morally right because they are intrinsically right regardless
of their consequences or results. Consequences, he asserts, should not matter when the moral
value of an action is assessed. Kant even argues that consequences are relevant to practical mat-
ters, not to ethics. In the practical realm, one has to ask will this action can lead to good results and
act accordingly. For example, a student may decide to study engineering because engineers have
good careers. Such a decision is based on consequential (teleological) considerations: studying
engineering qualifies one to enter a stable and rewarding career. When that student decided to be
an engineer to enjoy the benefits that result from this decision, he or she was making a consequen-
tialist but purely practical decision. But the situation is different in the moral realm.
In the moral field, there are acts that must be done whether or not they lead to desirable or
undesirable results. Therefore, these acts are moral duties, Kant asserts. These acts lose moral
worth when they are done to attain an aim. For example, if you do not tell lies because you want
to impress people and get their support or votes, you are either acting practically (from practical
motives) or immorally (by trying to exploit ethical principles for material gain). However, if you
do not tell lies because you believe that lying is morally wrong, you are acting morally. In other
words, you are performing a moral duty. Because Kant’s ethics is concerned with duties and
reduces moral principles to duties, it was called deontological (from the Greek deon, meaning
“obligation”).

MORAL PRINCIPLES Kant opposed deriving moral principles from accidental events and con-
tingencies because that could lead to formulating contradictory principles. Suppose that a free-
dom fighter in Poland during World War II gave the Nazi officers who were interrogating him
false information about the identities of his partners. By doing that, he saved their lives and
served a good cause. But can we derive from that circumstance a principle that justifies telling
lies when it is convenient to do so? Kant’s answer is an unequivocal no. For him, ethical princi-
ples cannot be subjected to negotiation, nor should they be modified to adapt to new situations
when it appears useful to modify them. It is wrong, he believes, to modify one’s commitment to
truth telling in light of the present circumstances. Moral principles, Kant insists, should be based
on solid foundations then followed with total disregard for the context. If we believe that truth
telling is good, we must always tell the truth even if that leads to great harm in a particular con-
text. Thus, the Polish freedom fighter did not act according to sound moral principles when he
lied to the Nazis, in Kant’s opinion.
Kant acknowledged that it is sometimes harmful to follow moral principles faithfully. He
knew very well that, at least in exceptional cases, we might do better by violating moral princi-
ples. But he argued that repeated violations could send a harmful message to people. Violations
(or variations) may suggest that one is encouraged to violate moral principles when it seems use-
ful to do so. Kant believed interpreting moral principles in a relative way permits us to lie today
and then tell the truth tomorrow and opens the door for moral confusion and chaos.
Consequently, moral principles should be absolute (unmodifiable). So the main issue in Kantian
ethics is that there are categorical (absolute) imperatives (duties) that are inescapable. They can
be inferred by reason and should be generalized.

MORAL DUTY Kant’s contention that duties are categorical is disputable. However, his view
that we must treat all people as ends in themselves, not as means, is widely respected. How does
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Beethoven entitled the next movement ‘a devout song of praise,
offered by a convalescent to God, in the Lydian mode.’ It probably
owes its origin to the fact that Beethoven was taken seriously ill while
at work on this and the B-flat major quartet. It seems likely that
before this illness he had other plans for the quartet, and that the
Danza tedesca before mentioned was to find a place in it.

The movement is long in performance but relatively simple in

structure. The chorale melody, simply harmonized, is preceded by a
short, preludizing phrase; and its strophes are set apart from each
other by short interludes in the same manner. After the chorale has
been once given, there is an episode in D major (Neue Kraft fühlend)
of blissful, gently animated character. The chorale is then repeated,
the melody an octave higher than before, the interludes and the
accompaniment complicated by syncopations. Once again the D
major episode, highly elaborated. Following this, the chorale is
introduced once more; but the introductory phrase is greatly
lengthened and developed, and there are suggested entrances of
the theme in all the instruments; nor does the complete theme make
itself heard, but only the first phrase of it seems ultimately to soar
aloft, in yet a higher register than before. So that this last section
may be taken as a coda, or as an apotheosis.

The short march which follows calls for no comment. The final
allegro is introduced by recitative passages for the first violin, gaining
in passion, culminating in a dramatic run over the diminished
seventh chord which bears some resemblance to the opening of the
allegro of the first movement. There is a passing sigh before the last
movement begins, Allegro appassionato.

Compared with the quartet in A minor, that in B-flat major is simple. It

is more in the nature of a suite than in that of a sonata, though the
first movement presents beneath an apparently irregular outline the
basis of the classical sonata-form. At first glance the frequent
changes of not only key signature but time signature as well are
confusing. The key signatures are now two flats, six flats, two sharps
and one sharp; and at the beginning, the middle and the end of the
movement the time is now triple, now duple, now slow, now fast.

The slow measures are related to the introduction, which here as in

other works of Beethoven is recalled at times in the main body of the
movement. The allegro makes a false start, in which the main
outlines of the first theme are suggested. From the second start,
however, the movement follows a relatively normal course. The first
theme is compound. On the one hand, there are rapid groups of
sixteenths, which play an important part in the whole movement; on
the other, a rhythmical motive, rather than a theme, first announced
by the second violin, which is the motto of the piece. The second
theme is first presented in G-flat major by the second violin and
immediately taken up by the first. At the beginning of the
development section and again in the coda use is made of the
motive of the introduction.

The second movement, a Presto in B-flat minor in alla breve time,

with a Trio in 6/4 time, is short and in the manner of a folk-song or
dance. It has no inner relation with the first movement; but it may be
said to breathe something of its spirit into the following andante (D-
flat major, common time). The kernel of the melody of this movement
may be found in the first measure, given by viola and 'cello; and this
kernel was sown, so to speak, by the previous movement. The viola
develops it in the second measure and the phrase is immediately
after taken up by the first violin.

For the fourth movement there is a rapid German waltz—Alla danza

tedesca—in G major. The fifth is a simple cavatina. Karl Holz, one of
the members of the Schuppanzigh quartet, has reported that
Beethoven could not read over the score of this short movement
without tears in his eyes. As the sixth movement there is the fugue,
published as opus 133, with a new dedication to Archduke Rudolph,
which was, as we have said, written for this quartet, and one of the
themes of which seems related to the chromatic motives of the A
minor quartet, on the one hand, and of the C-sharp minor quartet, on
the other; or there is the brilliant rondo with which Beethoven
replaced it at the behest of the publishers, and which is the last of
Beethoven’s compositions.

The fourth of the last quartets, in C-sharp minor, is dedicated to Field

Marshal Baron von Sutterheim, who interested himself deeply in the
affairs of Beethoven’s family. It is in some respects the most elusive,
in others the most unusual of all. Its various movements are
designated by numbers; yet two of them are so short that they need
not be regarded as separate movements, but only as transitional or
introductory sections. These are the third and the sixth. Furthermore,
a definite pause is justifiable only between the fourth and fifth. Thus,
in spite of the numbers, the work is closely blended into a whole, of
which the separate parts are not only æsthetically united, but
thematically complementary.

The first movement is a slow fugue, on a chromatic motive that

makes us once again remember that Beethoven was working on this
and the two preceding quartets at the same time. The fugue unfolds
itself with greatest smoothness and seeming simplicity. The texture
of the music is extremely close until near the end, where wide skips
appear in the various parts, like the movement of a more vigorous
life soon to break free in subsequent sections from such strict
restraint of form. One will find a perfect skill in technical details, such
as the diminution of the theme which appears in the first violin at the
change of signature, and the augmentation in the 'cello part in the
stretto not far before the end.

The fugue ends on a C-sharp unison, following a chord of C-sharp

major in seven parts. Then, as if this single C-sharp bore within itself
a secret harmonic significance, i.e., as the leading note in the scale
of D major, the whole fabric slips up half a tone in the opening notes
of the following movement, allegro molto vivace, D major—in 6/8
time. One cannot but feel the relationship between the delicate
convolutions of this new theme and the fugue theme. The whole
second movement hardly moves away from the motives of the
opening measures. A sort of complement to them may be found in
the successions of fourths which begin to rise up in the twenty-fifth
measure; and much farther on a sequence of chords beginning in F-
sharp major suggests some variety. But on the whole the movement
plays upon one theme, which recurs at intervals as in a rondo, but
after episodes that offer only in the main an harmonic contrast.

The third movement, allegro moderato, in common time, is a

recitative, begun in F minor and leading to a half-cadence in the
dominant seventh harmonies of A major, in which key the following
movement opens. We have here an andante and seven variations,
variations so involved and recondite that, though they may be clearly
perceived in the score, they will strike the unfamiliar ear as aimless
and inexplicable music.

The theme itself is in the form of a dialogue between first and second
violins. It merges into the first variation without perceptible break in
the music. Here the theme is carried by the second violin, the first
filling the pauses with a descending figure. This clause of the theme
is then repeated by the viola, the 'cello taking the rôle of the first
violin. The second clause of the theme is similarly treated.

The remaining six variations are clearly set apart from each other by
changes in the time signature. There is a variation marked piu
mosso, really alla breve, which is a dialogue between first violin and
'cello, accompanied at first monotonously by the other two
instruments, later with more variety and animation. The next is an
andante moderato e lusinghiero, in which the theme is arranged as a
canon at the second, first between the two lower instruments, later
between the two higher. This leads to an adagio in 6/8 time, in which
the theme is broken up into passage work. The next and fifth
variation (allegretto, 2/4) is the most hidden of all. The notes of the
theme are separated and scattered here and there among the four
parts. But the sixth, an adagio in 9/4 time, is simpler. The seventh,
and last, is a sort of epilogue, a series of different statements of the
theme, at first hidden in triplet runs; then emerging after a long trill, in
its simplest form, in the key of C major; then in A major with an
elaborated accompaniment; in F major, simple again; and finally
brilliantly in A major.
The following Presto in E major, alla breve, is very long, but is none
the less symmetrical and regular in structure. It is in effect a scherzo
and trio. The scherzo is in the conventional two sections, both of
which are built upon the same subject. The second section is broken
by four measures (molto poco adagio!); and there is a false start of
the theme, following these, in G-sharp minor, suddenly broken by a
hold. This recalls the effect of the very opening of the movement, a
single measure, forte, by the 'cello, as if the instrument were starting
off boldly with the principal subject. But a full measure of silence
follows, giving the impression that the 'cello had been too precipitate.

The Trio section offers at first no change of key; but a new theme is
brought forward. Later the key changes to A major, and the rhythm is
broadened. A series of isolated pizzicato notes in the various
instruments prepares the return of the Scherzo (without repeats).
The Trio follows again; and there is a coda, growing more rapid, after
the Scherzo has been repeated for the second time.

A short adagio, beginning in G-sharp minor, forms the sixth

movement, modulating to the dominant seventh in C-sharp minor.
The last movement is in sonata form. There are clearly a first theme
and a second theme, arranged according to rule. But the coda is
very long; and, even more important, not only the first and second
themes, but secondary themes and motives are all vaguely or
definitely related to the themes of the earlier movements. The first
theme, for all its somewhat barbaric character, is akin to the theme of
the first allegro in D major. In the episodes which follow, the notes of
the first violin and of the 'cello, in contrary motion, give a distinct
impression of the opening fugue theme. The second theme itself—in
E major—brings back a breath of the Trio, and Dr. Riemann finds in
the accompaniment suggestions of the fourth variation. Only a
detailed analysis could reveal the elaborate and intricate polyphony
which is in every measure in the process of weaving.

After the C-sharp minor quartet, the last quartet—in F major, opus
135—appears outwardly simple. It shares with the first of the series
simplicity and regularity of form; and is, like the quartet in E-flat
major, calm and outspoken, rather than disturbed, gloomy, or
mysterious. It is the shortest of all the last quartets.

The first movement is in perfect sonata form. The first theme (viola)
has a gently questioning sound, which one may imagine mocked by
the first violin. The second theme, in C major, is light, almost in the
manner of Haydn. The movement builds itself logically out of the
opposition of these two motives, the one a little touched with
sadness and doubt, the other confidently gay. The Scherzo which
follows needs no analysis. Two themes, not very different in
character, are at the basis. The second is presented successively in
F, G, and A, climbing thus ever higher. The climax at which it arrives
is noteworthy. The first violin is almost acrobatic in the expression of
wild humor, over an accompaniment which for fifty measures
consists of the unvaried repetition of a single figure by the other
three instruments in unison. Following this fantastical scherzo there
is a short slow movement in D-flat major full of profound but not
tragic sentiment. The short theme, flowing and restrained, undergoes
four variations; the second in C-sharp minor, rather agitated in
character; the third in the tonic key, giving the melody to the 'cello;
and the fourth disguising the theme in short phrases (first violin). To
the last movement Beethoven gave the title, Der schwer gefasste
Entschluss. Two motives which occur in it are considered, the one as
a question: Muss es sein? the other as the answer: Es muss sein.
The former is heard only in the introduction, and in the measures
before the third section of the movement. The latter is the chief
theme. Whether or not these phrases are related to external
circumstances in Beethoven’s life, the proper interpretation of them
is essentially psychological. The question represents doubt and
distrust of self. The answer to such misgivings is one of deeds, not
words, of strong-willed determination and vigorous action. Of such
the final movement of the last quartet is expressive. Such seems the
decision which Beethoven put into terms of music.
 FOOTNOTES:
[70] The famous Schuppanzigh quartet met every Friday morning at the house of
Prince Lichnowsky. Ignaz Schuppanzigh (b. 1776) was leader. Lichnowsky himself
frequently played the second violin. Franz Weiss (b. 1788), the youngest member,
hardly more than a boy, played the viola. Later he became the most famous of the
viola players in Vienna. The 'cellist was Nikolaus Kraft (born 1778).

[71] Förster (1748-1823) forms an important link between Haydn and Beethoven.

[72] 2d edition, Berlin, 1913, pp. 482, et seq.

[73] Beethoven’s Streichquartette.

[74] Only Schuppanzigh himself, and Weiss, the violist, remained of the original
four who first played Beethoven’s quartets opus 18 at the palace of Prince
Lichnowsky. The second violinist was now Karl Holz, and the 'cellist Joseph Linke.
 CHAPTER XVII
THE STRING ENSEMBLE SINCE
BEETHOVEN
The general trend of development: Spohr, Cherubini, Schubert—
Mendelssohn, Schumann and Brahms, etc.—New developments:
César Franck, d’Indy, Chausson—The characteristics of the
Russian schools: Tschaikowsky, Borodine, Glazounoff and others
—Other national types: Grieg, Smetana, Dvořák—The three great
quartets since Schubert and what they represent; modern
quartets and the new quartet style: Debussy, Ravel, Schönberg—
Conclusion.

I
There is little history of the string quartet to record after the death of
Beethoven in 1827. It has undergone little or no change or
development in technique until nearly the present day. The last
quartets of Beethoven taxed the powers of the combined four
instruments to the uttermost. Such changes of form as are to be
noted in recent quartets are the adaptation of new ideas already and
first put to test in music for pianoforte, orchestra, or stage. The
growth of so-called modern systems of harmony affect the string
quartet, but did not originate in it. A tendency towards richer or fuller
scoring, towards continued use of pizzicato or other special effects,
and a few touches of new virtuosity here and there, reflect the
general interest of the century in the orchestra and its possibilities of
tone-coloring. But it is in the main true that after a study of the last
quartets of Beethoven few subsequent quartets present new
difficulties; and that, excepting only a few, the many with which we
shall have to do are the expressions of the genius of various
musicians, most of whom were more successful in other forms, or
whose qualities have been made elsewhere and otherwise more
familiar.

Less perhaps than any other form will the string quartet endure by
the sole virtue of being well written for the instruments. Take, for
example, the thirty-four quartets of Ludwig Spohr. Spohr was during
the first half of the nineteenth century the most respected musician in
Germany. He was renowned as a leader, and composer quite as
much as he was world-famous as a virtuoso. He was especially
skillful as a leader in quartet playing. He was among the first to bring
out the Beethoven quartets, opus 18, in Germany. He was under a
special engagement for three years to the rich amateur Tost in
Vienna to furnish chamber compositions. No composer ever
understood better the peculiar qualities of the string instruments;
none was ever more ambitious and at the same time more serious.
Yet excluding the violin concertos and an occasional performance of
his opera Jessonda, his music is already lost in the past. Together
with operas, masses, and symphonies, the quartets, quintets, and
quartet concertos, are rapidly being forgotten. The reason is that
Spohr was more conscientious than inspired. He stood in fear of the
commonplace. His melodies and harmonies are deliberately
chromatic, not spontaneous. Yet shy as he was of
commonplaceness in melody and harmony, he was insensitive to a
more serious commonplaceness.

When we consider what subtle systems of rhythm the semi-civilized

races are masters of, we can but be astonished at the regularity of
our own systems. Only occasionally does a composer diverge from
the straight road of four-measure melody building. Yet is it not a little
subtlety even within this rigorous system that raises the great
composer above the commonplace? Certainly the ordinary in rhythm
most quickly wearies and disgusts the listener even if he is not
aware of it. Spohr’s rhythmical system was so little varied that
Wagner wrote of his opera Jessonda that it was 'alla Polacca’ almost
all the way through.

The thirty-five string quartets are fundamentally commonplace, for all

the chromaticism of their harmonies and melodies, and for all the
skillful treatment of the instruments. The double-quartets (four, in D
minor, E minor, E-flat major, and G minor) amount to compositions
for small string orchestra. There are, among the quartets, six so-
called ‘brilliant,’ which give to the first violin a solo rôle, and to the
other instruments merely accompaniment. It is hardly surprising that
the first violin is treated brilliantly in most of the quartets.

But the point is that Spohr’s quartets have not lived. In neatness of
form and in treatment of the instruments they do not fall below the
greatest. They are in these respects superior to those of Schumann
for example. The weakness of them is the weakness of the man’s
whole gift for composition; and they represent no change in the art of
writing string quartets.
Ludwig Spohr.
Another man whose quartets are theoretically as good as any is
Cherubini. Of the six, that in E-flat major, written in 1814, is still
occasionally heard.

On the other hand, Schubert, a man with less skill than either Spohr
or Cherubini, has written quartets which seem likely to prove
immortal. Fifteen are published in the complete Breitkopf and Härtel
edition of Schubert’s works. Of these the first eleven may be
considered preparatory to the last four. They show, however, what is
frequently ignored in considering the life and art of Schubert—an
unremitting effort on the part of the young composer to master the
principles of musical form.

The first of the great quartets, that in C minor—written in December,

1820—is but a fragment. Schubert completed but the first
movement. Why he neglected to add others remains unknown. But
the single movement is inspired throughout. The opening measures
give at once an example of the tremolo, of which Schubert made
great use in all his quartets. The general triplet rhythm is familiar in
all his later works. We have here the Schubert of the great songs, of
the B minor symphony, of the later pianoforte sonatas; warm,
intense, inspired.

Two quartets were written in 1824, that in A minor, published as opus

29, and that in D minor,[75] the best known of all his quartets. The A
minor is dedicated to Ignaz Schuppanzigh, with whom Schubert was
on friendly terms. The second movement of the quartet in D minor is
a series of variations on the song Der Tod und das Mädchen.

Finally there is the great quartet in G major, written in 1826, which

may be taken as representative throughout of the very best of
Schubert’s genius as it showed itself in the form. In it are to be found
all the qualities associated with Schubert especially. The opening
major triad, swelling to a powerful minor chord in eleven parts, and
the constant interchange of major and minor throughout the
movement; the tender second theme with its delicate folk-rhythm, its
unrestrained harmonies, its whispering softness in the variation after
the first statement; these could have been the work of Schubert
alone. Peculiar to Schubert’s treatment of the quartet are the
tremolo, and the general richness of scoring—the sixths for second
violin in the variation of the second theme, for example; the frequent
use of octaves and other double-stops, the eleven-voiced chord at
the beginning, and other such effects of fullness. There is little sign
of the polyphonic drawing which so distinguished the last quartets of
Beethoven. The quartet is made up of rich masses of sound that
glow warmly, and fade and brighten. The inner voices are used
measure after measure frankly to supply a richly vibrating harmony,
nothing more. And an occasional dialogue between two instruments
is all of polyphonic procedure one meets.

The beautiful andante in E minor begins with a melody for

violoncello, a true Schubertian melody, which is carried on for two
sections. Then a new spirit enters through hushed chords, and
breaks forth loudly in G minor. There follows a passage full of wild
passion. The agitated chords swell again and again to fortissimo. At
last they die away, only the monotonous F-sharp of the cello
suggests the throbbing of a despair not yet relieved. Over this the
first violin and the viola sing the opening melody. Later the hushed
tapping is given to other instruments and the cello takes up its
melody again. Once more the despair breaks wildly forth, and yet
again is hushed but not relieved. The sudden major in the ending
can not take from the movement its quality of unconsoled sadness.
The scherzo, in B minor, is built upon the constant imitation and play
of a single merry figure. The trio is in G major, one of those
seemingly naïve yet perfect movements such as Schubert alone
could write. There is only the swing of a waltz, only the melody that a
street gamin might carelessly whistle; but somewhere beneath it lies
genius. The interchange of phrases of the melody between the
different instruments, and the mellifluous counter-melodies, have
something the same sort of charm as the Scherzo of the symphony
in C major. The final movement is a rondo with a profusion of
themes. There are the familiar marks of Schubert: the triplet rhythm
(6/8), the shifting between major and minor; the full, harmonic style;
the naïve swing, the spontaneous and ever fresh melodies.

Schubert worked at the string quartet with special devotion.

Excepting the songs, his steady development toward perfect mastery
of his expression is nowhere better revealed than in the quartets.
Certainly the last two quartets are second only to the songs as proof
of his genius. There is that soft, whispering, quality in Schubert’s
music, for the expression of which the string quartet is a perfect
instrument. Much of Schubert is intimate, too, and happily suited to
the chamber. Less than any of the great composers did Schubert
make use of polyphonic skill. It is easy to say that he lacked it; but
what is hard to understand is how without it he could have
contributed to music some of its most precious possessions.

II
We may say that Schubert applied himself to the composition of
string quartets with a special devotion and ultimately with great
success; that certain qualities of his genius were suited to an
expression in this form. Mendelssohn applied himself to all branches
of music with equal facility and with evidently little preference. Most
of his chamber music for strings alone, however, belongs to the early
half of his successful career. This in the case of Mendelssohn does
not mean, as in the case of almost every other composer, that the
quartets may not be the expression of his fully-matured genius.
Mendelssohn never wrote anything better than the overture to
‘Midsummer Night’s Dream.’ This before he was twenty! But having
put his soul for once into a few quartets he passed on to other works.

There was a time when these quartets were considered a worthy

sequel to Beethoven’s. In the English translation of Lampadius’ ‘Life
of Mendelssohn’ occurs the sentence: ‘But in fact they [his works]
stand in need neither of approval nor defense: the most audacious
critic bows before the genius of their author; the power and weight of
public opinion would strike every calumniator dumb.’ And yet what
can now be said of Mendelssohn’s quartets save that they are
precise in form, elegant in detail?

There are six in all. The first, opus 12, is in E-flat major. The slow
introduction and the first allegro have all the well-known and now
often ridiculed marks of the ‘Songs Without Words’: short, regular
phrases; weak curves and feminine endings; commonplace
harmonies, monotonous repetitions, uninteresting accompaniment.
The second movement—a canzonetta—is interesting as
Mendelssohn could sometimes be in light pieces; but the andante
oozes honey again, and the final allegro is very long.

Is it unfair to dwell upon these wearisome deficiencies? Is there

anything substantially better in the last of the six, in the quartet in F
minor, opus 80? Here we have to do with one of the composer’s
agitated spells. There is a rough start and measures of tremolo for all
the instruments follow. This is the first theme, properly just eight
measures long and as thoroughly conventional as music well may
be. Then measures in recitative style, and again the first theme, and
its motives endlessly repeated. Suddenly the instruments in an
access of fury break into triplets; but this being calmed, the second
theme appears, as it should in A-flat major, a theme that positively
smirks.

But why attempt either analysis or description of works so patently

urbane? There is no meaning hidden in them; there is no richness of
sentiment; no harmonies out of new realms; no inspiration; nothing
really to study. Between the first two quartets mentioned and the last
in F minor there is a series of three (opus 44), one in D major, one in
E minor, and one in E-flat major. There is an ‘Andante, Scherzo,
Capriccio and Fugue’ for the four instruments, published as opus 81.

One turns to Schumann for a breath of more bracing air. Though

Schumann was first and foremost a composer for the pianoforte, and
though his quartets seem to be written in rather a pianoforte style,
yet there are flashes of inspiration in the music which must be
treasured, imperfect as the recording of them may be. There are
three quartets, composed in 1842 and dedicated to Mendelssohn. As
early as 1838 Schumann mentioned in letters to his sweetheart that
he had a string quartet in mind; but work in this direction was
seriously hindered by troubles with Wieck, which were growing daily
more acute. The second summer after his marriage, however, work
on the quartets was resumed; and the three were composed in the
short time of eight weeks, the last indeed apparently in five days (18-
22 July).

The first offers an harmonic innovation. The introduction is in A

minor, which is the principal key of the whole quartet; but the first
allegro is in F major. There is a Scherzo in A minor, with an
Intermezzo, not a Trio, in C major. In these first two movements the
habit of syncopation which gives much of his pianoforte music its
peculiar stamp is evident: in the first theme of the allegro; in the
measures which lead to the repetition of the first part; in the motive
of the Intermezzo, which is rhythmically similar to the first movement
and suggests some connection in Schumann’s mind. It is perhaps
the prevalence in all three quartets of the rhythmical devices which
we associate mostly with the pianoforte that raises a question of
propriety of style. The adagio is pure Schumann, in quality of melody
and accompaniment. Measures in the latter—noticeably the viola
figure which accompanies the first statement of the melody—look
upon the printed page like figures in a piano piece. Such figures are
not polyphonic. They are broken chords, the effect of which is
felicitous only on the pianoforte. The final presto suggests no little
the spirit of the first and last movements of the pianoforte quintet,
opus 44, which was composed in the following months. The whole
movement, except for a charming musette and a few following
measures of sustained chords just before the end, is built upon a
single figure.

The first movement of the next quartet (in F major) likewise suggests
the quintet. The style is smoothly imitative and compact; and the
theme beginning in the fifty-seventh measure casts a shadow before.
The Andante quasi Variazioni is most carefully wrought, and is rich in
sentiment. The Scherzo which follows—in C minor—is syncopated
throughout. The final allegro suggests the last movement of the B-
flat major symphony, the joyous Spring symphony written not long
before.

The last quartet (in A) may rank with the finest of his compositions.
Whether or not in theory the style is pianistic, the effect is rich and
sonorous. The syncopations are sometimes baffling, especially in the
last movement; but on the whole this quartet presents the essence of
Schumann’s genius in most ingratiating and appealing form. The
structure is free, reminding one in some ways of the D minor
symphony. But there is no rambling. The whole work is intense.
There is an economy of mood and of thematic material. One phrase
dominates the first movement; the Assai agitato is a series of terse
variations. There is a sustained Adagio in D major; and then a
vigorous finale in free rondo form, the chief theme of which is
undoubtedly related to the chief theme of the first movement.

It must be admitted that Schumann’s quartets are beautiful by

reason of their harmonies and melodies; that theirs is a fineness of
sentiment, not of style; that the luminous interweaving of separate
parts such as is found in the quartets of Haydn, Mozart, and
Beethoven, is not to be found in his. He follows rather Schubert, but
without Schubert’s instinct for instrumental color. So then one feels
that it happened that Schumann should seek expression thrice
through the medium of the string quartet; not that a certain quality of
inspiration within him demanded just that expression and none other.
His quartets represent neither a refinement nor an abstract of his
genius. They are of a piece with his pianoforte pieces and his songs;
as are likewise his symphonies. We admire and love all for the same
qualities.

Brahms, who for so many reasons we may think of as taking up

German music where Schumann left it, published only three string
quartets. That he had written many others which he had chosen to
discard before the two quartets, opus 51, were published in 1873, is
evident from the note to Dr. Billroth concerning a dedication.[76]
Several pianoforte quartets, and two sextets for two violins, two
violas and two violoncellos, opus 18 and opus 36, are closely related
to the string quartet. The sextets are especially noteworthy.

The first sextet, in B-flat major, has won more popular favor than
many other works by the same composer. The addition of two
instruments to the regular four brought with it the same sort of
problems which were mentioned in connection with Mozart’s
quintets: i.e., the avoidance of thickness in the scoring. The group of
six instruments is virtually a string orchestra; but the sextets of
Brahms are finely drawn, quite in the manner of a string quartet.
Especially in this first sextet have the various instruments a like
importance and independence.

The first theme of the first movement (cello) is wholly melodious. The
second theme, regularly brought forward in F major, is yet another
melody, and again is announced by the violoncello. A passage of
twenty-eight measures, over a pedal point on C, follows. This closes
the first section. The development is, as might be expected, full of
intricacies. The return of the first theme is brilliantly prepared,
beginning with announcing phrases in the low registers, swelling to a
powerful and complete statement in which the two violins join. The
second movement is a theme and variations in D minor. The theme
is shared alternately by first viola and first violin. The variations are
brilliant and daring, suggesting not a little the pianoforte variations on
a theme of Paganini’s. There is a Scherzo and Trio. The main motive
of the Scherzo serves as an accompaniment figure in the Trio; and
the Trio is noteworthy for being entirely fortissimo. The last
movement is a Rondo.

The second sextet, in G major, is outwardly less pleasing; and like

much of Brahms’ music is veiled from the casual or unfamiliar
listener.

The first movement (allegro non troppo) opens mysteriously with a

trill for first viola, which continues through the next thirty-two
measures. In the third the first violin announces, mezza voce, the
main theme of the movement; of which the chief characteristic is two
upward fifths (G—D—E-flat—B-flat). The second theme appears
after an unexpected modulation in D major, and is given to the first
violoncello. The striding fifths sound again in the closing measures of
the first section. The development begins with these fifths employed
as a canon, in contrary motion; and the same intervals play a
prominent part in the entire section. The recapitulation is regular. The
following Scherzo (Allegro non troppo, G minor) has a touch of
Slavic folk-music. There is a Trio section in G major. The slow
movement is, as in the earlier sextet, a theme and variations. The
last is in sonata form. The first theme may be divided into two wholly
contrasting sections, of which the second is melodiously arranged in
sixths. The second theme is given out regularly in D major by the
violoncello. There is a long coda, animato, which is practically a
repetition of much of the development section.

In these sextets and in the three quartets, written many years later,
we have the classical model faithfully reproduced. The separate
parts are handled with unfailing polyphonic skill; there is the special
refinement of expression which, hard to define, is unmistakable in a
work that is properly a string quartet.

Opus 51, No. 1, is in C minor. The first theme is given out at once by
the first violin; a theme characteristic of Brahms, of long phrases and
a certain swinging power. Within the broadly curving line there are
impatient breaks; and the effect of the whole is one of restlessness
and agitation. This is especially noticeable when, after a contrasting
section, the theme is repeated by viola and cello under an agitated
accompaniment, and leads to sharp accents. There is no little
resemblance between this theme and Brahms’ treatment of it, and
the theme of the first movement of the C minor symphony,
completed not long before. There is throughout this movement the
rhythm, like the sweep of angry waves, which tosses in the first
movement of the symphony; an agitation which the second theme
(B-flat major, first violin) cannot calm, which only momentarily—as
just after the second theme, here, and in the third section of the
movement—is subdued.