Tuesday, January 14, 2014

Health and Tradition

It's no secret that I do not have a high opinion of bioethics as a field. Indeed, I think that it is, of all philosophical fields one is likely to come across, consistently the most embarrassing -- much of the work is low quality and, while I try to be charitable, it is difficult to avoid the conclusion that an absurd proportion of bioethicists would have difficulty reasoning their way out of a refrigerator box. Udo Schuklenk, who teaches philosophy at Queen's and is an editor for Bioethics is out to prove my opinion right.

It's an attack on the tradition of the Hippocratic Oath, and it's a sign of the awfulness of the argument that he can't even be bothered to get it right. He says, for instance, that the Oath involves a promise "not to participate in what we would describe today as surgery", which is misleading at best. The corresponding clause in the Oath is to leave surgery to surgeons ("I will leave this operation to be performed by practitioners, specialists in this art" -- and even then, the Greek can't be made to cover any and all operations that we would call surgery). Even just looking up the text of the Oath would have prevented him from making such an obviously stupid mistake, if he can't be bothered to know what it is in the first place. And anybody who thinks this is a "silly promise" shouldn't be allowed anywhere near medical ethics, because non-specialists engaging in surgical operations they have no qualifications for has been one of the endlessly recurring problems in the history of medical ethics. You can find it all over the place in history, sometimes in places you wouldn't expect. For instance, one of the background points in Flaubert's Madame Bovary is that Charles Bovary is a low-level medical practitioner -- he isn't qualified for more than the basics. But in order to make a name for himself he practices surgery -- and, of course, flubs it. Flaubert isn't just making this sort of thing up out of thin air; this sort of thing happened, disturbingly often. It's why we have medical licensing and surgical certifications. Yes, the Oath identifies the problem in the terms it would have been known to Greeks in the fifth century BC or thereabouts, but precisely in doing so it shows that it is a constant problem, one that medical professionals need always to be vigilant about.

It's not really surprising that Schuklenk wouldn't grasp this very basic point, I suppose, because it is clear from Schuklenk's op-ed that on his conception of medicine, medicine is amnesiac and does not learn from its ethical history. It has no memory. Of course, Schuklenk attacks this ethical memory in the profession by calling it 'tradition'; this allows him to call into play a lot of bad, amateurish, undergraduate informal logic:

The point I am making here is that arguments from tradition have zero substance as arguments. They are non-arguments. Each time someone tells you that you should do a certain thing because of tradition, it’s best to tell them to go away and get a life. They merely describe what we have always done or what we have done over extensive periods of our history. If that was sufficient, we could justify slavery. After all, if we bought and sold other people for such a long time, surely it’s a tradition of sorts. The fact that there was such a tradition doesn’t provide us with any moral guidance with regard to what we should do in the future.

And to say that this argument is bad, amateurish, and undergraduate is not really fair to many amateur undergraduate bad reasoners. It's false to say that traditions "have zero substance as arguments" for the same reason it is false to say that memory has zero substance as argument: 'tradition' is nothing other than the word of handing down what has been learned, or what people think they have learned. To say that an argument from tradition is a "non-argument" is to say that nobody has ever learned anything through actual practice -- like, for instance, that important tradition of pointing out that surgery is best left to surgeons. This is something that sums up a long experience, across many generations. Over and over again certain temptations arise for doctors; the ethical advice has come down from ancient times, and survived the journey, that surgery should be left to surgeons, and that is just what the tradition is. But even that aside, look at the nonsense of the rest of the argument, in which Schuklenk attempts to justify "arguments from tradition have zero substance as arguments" by arguing that they are not intrinsically sufficient for justification -- that is to say, he thinks that from mere appeal to tradition does not necessarily justify, which is what the slavery case would show, he can derive tradition doesn't provide us with any moral guidance with regard to what we should do in the future and arguments from tradition are non-arguments. But what serious ethicist thinks that no ethical arguments provide moral guidance unless the bare appeal to them is sufficient to determine right or wrong?

Apparently Schuklenk, who seems not to grasp the elementary idea that arguments can be provisional, defeasible, probable, presumptive, and the like. The room for parody-by-parity reaches hilarious heights here. The fact that you remember something is not in and of itself a guarantee that things will happen again. Yes, this is a commonplace. Therefore a Schuklenkaster will conclude, "arguments from memory have zero substance as arguments, they are non-arguments, they don't provide any guidance with regard to what we should do in the future". No, that does not follow. But the structure of the argument is the same: this kind of argument has sometimes led astray; therefore it is of no use at all. And it is an illicit jump in reasoning that would get a corrective comment in the margin if it were found in an Intro Phil essay; to have someone at a philosophy department actually bandying this about in public is an embarrassment to the profession.

Ah, but you might say, it's only an op-ed, with limited space! Then why does he elsewhere waste the reader's time with useless rhetorical blither-blather rather than doing justice to the question at hand? Schuklenk is clearly trying to make it easy for himself by picking on the Hippocratic Oath --which is, it should be pointed out, often delivered in forms the modify it for precisely some of the reasons Schuklenk has problems with it. Let's take something along the same lines, like the Declaration of Geneva:

At the time of being admitted as a member of the medical profession:

I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practice my profession with conscience and dignity;
The health [originally: health and life] of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers [originally: brothers];
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life [originally: the utmost respect for human life from the time of conception];
I will not use my medical knowledge to violate human rights and civil liberties [originally: the laws of humanity], even under threat;
I make these promises solemnly, freely and upon my honour.

It's obviously indebted to the Hippocratic Oath, but was formulated in 1948 in light of World War II and Nazi medical experimentation. It has many of the occasions of griping that led Schuklenk to rant against the Oath, but since it's a twentieth-century summation of basic medical ethics, not considering it conveniently lets Schuklenk get away with a lot of irrelevant potshots about Pythagorean cults and the like that contribute nothing to the essential argument. (It's actually quite controversial how the Oath is related to Pythagorean brotherhoods, incidentally, with some arguing that it is fundamentally Pythagorean in origin, and others arguing that any Pythagorean influence is very limited; but there's no need to break Schuklenk's head with accuracies when he's clearly having fun with mere rhetoric, which, apparently, he regards as having more substance as argument than tradition arising from actual practice.) It was adopted by the World Medical Association; and it was formulated with the intent to express the practical ethical experience of medical professionals, distilling the basic default principles preventing egregious medical malpractice and malfeasance, which the world had all too clearly seen. It took two years of arguing and comparing to draft. And, more than this, it was put forward to summarize the tradition -- for that is what it is, a tradition -- that medicine should be humanitarian. It's this that Schuklenk is attacking, just as much as the Hippocratic Oath; this, and things like the Declaration of Helsinki and the Nuremberg Code, for research ethics, which also distill what professionals think they have learned in dealing with the ethical temptations of their profession, and which are also carried forward as traditions -- the 'common property of humanity', as the Declaration of Helsinki is often called.

And we see through it all the very problem with bioethics these days: people whose primary ethical work is mostly theoretical and speculative, and in the long run likely to be of very little practical relevance outside (perhaps!) a handful of cases, sniping at summations of ethical experience that are taken by many actual practitioners (e.g., here) to have ongoing practical relevance -- yes, even if the details have changed a bit -- with arguments so bad that they should make real philosophers blush. It's frankly a bit sickening.

The Strong Incredible Sanities of the Sun

A Ballade of Ephemeral Controversy
by G. K. Chesterton


I am not as that Poet that arrives,
Nor shall I pluck the Laurel that persists
Through all perverted Ages and revives;
Enough for me, that if with feet and fists
I fought these pharisaic atheists,
I need not crawl and seek when all is done
My motley pennon trampled in the lists
It will not matter when the fight is won.

If scratch of mine amid a war of knives
Has caused one moment's pain to pessimists,
Poisoned one hour in Social Workers' lives,
I count such comforts more than amethysts
But less than claret, and at after trysts
We'll meet and drink such claret by the tun
Till you and I and all of us (What? Hists!).
It will not matter when the fight is won.

When men again want women for their wives
And even woman owns that she exists,
When people ask for houses and not hives
When we have climbed the tortured ivy's twists
To where like statues stand above the mists
The strong incredible sanities of the sun,
This dazed and overdriven bard desists.
It will not matter when the fight is won.

Envoi

Prince, let me place these handcuffs on your wrists
While common Christian people get some fun,
Then go and join your damned Thesophists.
It will not matter when the fight is won.

Yesterday started the term, but today's my first day of classes. Since I have three classes, two office hours, and two different campuses today, it will be a looong day. But it will be, overall, a much easier term than Fall was.

Monday, January 13, 2014

Full and Provisional

Prudent people, therefore, avoid many dangers by frequently employing in daily life assent which is both full and provisional. 1. On the one hand, assent when full, that is, finished and complete, does not leave the mind in suspense and disquiet as doubt naturally does; it produces a state of certainty, makes human actions possible, and gives rise to solid frankness and the resolution necessary for action in one’s undertakings. 2. On the other hand, because this assent is provisional in the sense explained, it avoids error (which would not be possible in the case of an absolute, immobile assent) and leaves the way open to progress in spirit by assisting quiet, wholesome communication between human beings. Effective union between many individuals is brought about by means of courtesy and tolerance in the midst of varying opinions.

Antonio Rosmini, Certainty,Part IV, section 1306

Malleus Arianorum

Today is the feast of St. Hilary of Poitiers, Doctor of the Church, Hammer of the Arians, Athanasius of the West, Most Greek of the Latin Fathers. From his book on the Trinity (1.2-3):

I believe that the mass of mankind have spurned from themselves and censured in others this acquiescence in a thoughtless, animal life, for no other reason than that nature herself has taught them that it is unworthy of humanity to hold themselves born only to gratify their greed and their sloth, and ushered into life for no high aim of glorious deed or fair accomplishment, and that this very life was granted without the power of progress towards immortality; a life, indeed, which then we should confidently assert did not deserve to be regarded as a gift of God, since, racked by pain and laden with trouble, it wastes itself upon itself from the blank mind of infancy to the wanderings of age. I believe that men, prompted by nature herself, have raised themselves through teaching and practice to the virtues which we name patience and temperance and forbearance, under the conviction that right living means right action and right thought, and that Immortal God has not given life only to end in death; for none can believe that the Giver of good has bestowed the pleasant sense of life in order that it may be overcast by the gloomy fear of dying.

And yet, though I could not tax with folly and uselessness this counsel of theirs to keep the soul free from blame, and evade by foresight or elude by skill or endure with patience the troubles of life, still I could not regard these men as guides competent to lead me to the good and happy Life. Their precepts were platitudes, on the mere level of human impulse; animal instinct could not fail to comprehend them, and he who understood but disobeyed would have fallen into an insanity baser than animal unreason. Moreover, my soul was eager not merely to do the things, neglect of which brings shame and suffering, but to know the God and Father Who had given this great gift, to Whom, it felt, it owed its whole self, Whose service was its true honour, on Whom all its hopes were fixed, in Whose lovingkindness, as in a safe home and haven, it could rest amid all the troubles of this anxious life. It was inflamed with a passionate desire to apprehend Him or to know Him.

St. Hilary was a highly educated Neoplatonist pagan who converted to Christianity; the above passage is part of his discussion of how he became Christian (the rest of the account is quite interesting). He was a married man and had a daughter -- we don't know her name, but traditionally she is called Saint Abra -- who converted with him. When the episcopacy of Poitiers came open, the people insisted that he be elected bishop despite being married. He immediately went about with a firm hand opposing Arianism, which got him into trouble with the imperial court and sentenced to exile in Phrygia.

His most famous work is the De Trinitate, which has the distinction of being the first serious defense and exposition in Latin of the theology of the First Council of Nicaea, which had occurred about three decades before. Hilary's theology is highly Alexandrian in flavor -- his major influences were Athanasius and Origen -- but he is quite innovative in some of the ways he approaches the topic. He wrote a number of other works while in exile, including a work attacking the Emperor Constantius as the Antichrist. This was perhaps a dangerous gambit, but Hilary ended up annoying the powers that be so much -- he kept insisting on public debates to prove the rightness of his cause -- that they sent him back to Poitiers to get rid of him. When there, he continued his opposition to Arianism, not always very successfully. He died about AD 367.

Sunday, January 12, 2014

Restored to Amity

Also for the feast of Baptism, from St. Hippolytus of Rome's discourse on the theophany:

Do you see, beloved, how many and how great blessings we would have lost, if the Lord had yielded to the exhortation of John, and declined baptism? For the heavens were shut before this; the region above was inaccessible. We would in that case descend to the lower parts, but we would not ascend to the upper. But was it only that the Lord was baptized? He also renewed the old man, and committed to him again the sceptre of adoption. For straightway "the heavens were opened to Him." A reconciliation took place of the visible with the invisible; the celestial orders were filled with joy; the diseases of earth were healed; secret things were made known; those at enmity were restored to amity. For you have heard the word of the evangelist, saying, "The heavens were opened to Him," on account of three wonders. For when Christ the Bridegroom was baptized, it was meet that the bridal-chamber of heaven should open its brilliant gates. And in like manner also, when the Holy Spirit descended in the form of a dove, and the Father's voice spread everywhere, it was meet that "the gates of heaven should be lifted up." "And, lo, the heavens were opened to Him; and a voice was heard, saying, This is my beloved Son, in whom I am well pleased."

St. Hippolytus has an interesting resume; in addition to being recognized as a very holy man, and being one of the most important theologians of the third century, and a martyr, he was also a schismatic antipope through two and perhaps three papal reigns. It is one of the charms of the calendar of saints that his feast-day is shared with Pope St. Pontian, one of his contemporaries. Both St. Pontian and St. Hippolytus were arrrested under Emperor Maximinus and sentenced to labor in the mines, which was only just technically short of an actual death sentence. And, indeed, both St. Pontian and St. Hippolytus died about 235; St. Pontian's successor (actually, the successor to his successor, because the intermediate pope, Anterus, did not last long, in the persecution, either), St. Fabian, arranged to have both their bodies buried, as full and true martyrs, in Rome.

Note-Taking

For whatever reason, I was thinking of The Stupids movie today as I was out for a walk. The Stupids, which starred Tom Arnold and Jessica Lundy, is one of those movies that everyone should see once, not because it isn't an extremely stupid movie, but because it manages to do a handful of scenes almost perfectly: the bush-man scene, The Lloyd, "This is the worst fire extinguisher I've ever seen", Christopher Lee as The Stupids' imagination of what the insidious Sender plotting to steal everyone's mail must look like. In other words, it's one of those movies that nobody really cares much about, but somehow or other parts of it tend to end up on lists of people's favorite scenes. One of the scenes that has always stuck in my mind occurs when the Stupid children, Buster and Petunia, find their father unexpectedly gone in the morning; they jump to the conclusion that he has been kidnapped and decide to set out and find him. They need to leave a note for their mother, though, so Petunia dictates it to Buster:

Petunia: Take this down. 'We have gone to the police....'
Buster [concentrating hard as he writes]: '...the police...
Petunia: 'Dad has been kidnapped....'
Buster [still concentrating as he writes]: '...kidnapped...'
Petunia: 'Don't worry, we'll be back soon. Signed, Your Children.'
Buster: [still concentrating as he writes] '...your children...'
[Camera on the note Buster has written: 'The police kidnapped your children'.]

Not to say that they are stupid, obviously, but I am very sure that this is exactly how my students often take notes. All this is a roundabout way of saying that I think I should do something about it. I don't quite know what, though. Any ideas?

The Victory of Justice

Today is the Feast of the Holy Baptism of Our Lord; from the readings, in two different translations:

Thus says the LORD:
Here is my servant whom I uphold,
my chosen one with whom I am pleased,
upon whom I have put my spirit;
he shall bring forth justice to the nations,
not crying out, not shouting,
not making his voice heard in the street.
a bruised reed he shall not break,
and a smoldering wick he shall not quench,
until he establishes justice on the earth;
the coastlands will wait for his teaching.

I, the LORD, have called you for the victory of justice,
I have grasped you by the hand;
I formed you, and set you
as a covenant of the people,
a light for the nations,
to open the eyes of the blind,
to bring out prisoners from confinement,
and from the dungeon, those who live in darkness.
[NAB]

Here is my servant, whom I uphold,
my chosen, in whom my soul delights;
I have put my spirit upon him;
he will bring forth justice to the nations.
He will not cry or lift up his voice,
or make it heard in the street;
a bruised reed he will not break,
and a dimly burning wick he will not quench;
he will faithfully bring forth justice.
He will not grow faint or be crushed
until he has established justice in the earth;
and the coastlands wait for his teaching.


I am the Lord, I have called you in righteousness,
I have taken you by the hand and kept you;
I have given you as a covenant to the people,
a light to the nations,
to open the eyes that are blind,
to bring out the prisoners from the dungeon,
from the prison those who sit in darkness.
[NRSV]