Genetics and the Alterable Course Toward Fascism

R. Horton

Genetics and the Alterable Course Toward Fascism

Given that theories of heritability arose before eugenic plans and that those eugenics plans preceded fascism, it is easy to understand why some would infer that hereditary thinking in Western cultural settings may have caused both the eugenics programs and the fascist movements that followed. On the face of it, of course, this is a clear example of the post hoc ergo propter hoc fallacy. On the other hand, it is possible that beneath the surface is a clear causal link between hereditary theory and fascism, but it is equally possible to imagine a different course of events unfolding given only slight changes in the historical record or in human nature. In one sense, all events are caused by those that precede them, or so the determinist will claim. If this is true, then the path of history is unalterable regardless of the subject at hand. For the purposes of this essay, though, I will assume that humans have free will and that cultures have differing goals and values. I will also assume that the motives of at least some early geneticists were devoid of the values of later fascists in Germany and elsewhere. Given that most people familiar with western science accept the heritability of personality and other traits as scientific fact, I will also question whether science must be concerned with the possible applications of its theories, even when they seem almost certain to be correct.

The work of Mendel, in particular, seems to fly the flag of Objective Truth. Scientists still accept the basic laws of genetics discovered by Mendel, and most would say these truths are separate from any social programs or ideological agendas they may be used to support. Mendel’s laws are more easily verified and categorized than Darwin’s, but it was Darwin who originally captured the public imagination in the nineteenth century, with the importance of Mendelian genetics being asserted decades after their original publication. Both Darwin and Mendel were “scientific” in the sense that they collected data based on observation and recorded it with care, even if Mendel’s data now seem to be a bit more consistent than nature itself (meaning that some have suggested Mendel manipulated the data to fit his theory with greater exactness than one would expect). To state that someone’s methods are “scientific,” though, is to say almost nothing. Many methods of doing science have been employed over the years, and no Scientific Method has presented itself. The best science, it is claimed, is science that is based on mathematical models, makes predictions, is simple, can be observed repeatedly, is instrumental in producing results, or is accepted by a community of scientists.

Various theories of genetics, evolution, and social degeneration all could be classified as “scientific” by one of the methods mentioned above. What scientific method does not yield, however, is Truth (or, even, truth). One need only look to the constant modifications to scientific theory to see that the truth of science is ever changing. One must not be skeptical only of science practiced by those with a social agenda. One must be skeptical of all scientific truth. That many scientists practicing in genetics, eugenics, sociology, anthropology, and psychology did have a social agenda is not evidence in itself of bad science, though it may be evidence of bad social agendas. On the other hand, scientist such as Mendel did not appear to have an obvious social agenda, and it seems unreasonable to expect a scientist doing research in good faith to predict the abuses of his discoveries. If Foucault is correct in asserting that the nineteenth century gave rise to the study of Man, then we would expect the nineteenth century to produce a plethora of work in the so-called social sciences. Indeed, Foucault listed sciences such as economics, anthropology, and sociology as examples of fields of study that arose as men turned to study Man. Physicists and chemists and other “hard” scientists would be likely to question Foucault’s concept of science and deride the social sciences as rife with unsupportable assertions. On the other hand, Foucault’s claim that humans turned to the study of Man as subject in the nineteenth century is noteworthy.

The scientists in the new fields were not unaware that their work may be seen as unscientific, and they made every effort to produce claims objectively verifiable by relying on the universal under girding of objective science: mathematics or, at the least, quantification. These scientists observed, counted, and recorded with fervor in an effort to gain acceptance for their theories. They were in luck, in a sense, as many in society were eager for their “discoveries.” Social reformers of the nineteenth century were no different from social reformers of the twenty-first century in one respect: they felt they had given their claims credibility when they could begin their arguments with the words “studies show.” When looking for the cause (or someone to blame) for social ills, it gives great force to one’s arguments to claim scientific proof . Errors are made in all branches of science, but the social sciences are particularly vulnerable to abuses for social ends.

If fascism is defined broadly as an attempt to improve society through the elimination of undesirable elements, then many of the social sciences were born of the effort to identify and eliminate causes of social ills. For some, social ills were caused by poverty and injustice, and such individuals advocated the elimination of slavery, oppression of women, exploitation of children, and abuse of animals. For others, the ills of society stemmed from the existence of dangerous persons, and those who believed dangerous persons caused such problems advocated more government intervention to imprison or even destroy those found to be defective. It is the latter mode of thinking that leads to to the sort of autocratic and despotic fascism that most of us imagine when we hear the word “Fascism.” Hereditarianism was certainly incorporated into the arguments of fascists, but it was also used by social reformers seeking more humane treatment of prisoners, the mentally ill, and the poor. The anarchist, socialist, liberal democrat, communist, and fascist may all agree that certain personality traits are inherited. One person will see it as a reason to show compassion to individuals while another will see it as a reason to eliminate such individuals or declare them to be less than human. If hereditarianism leads inevitably to fascism, it reveals not a feature of the theory but a feature of human beings. In the struggle between acceptance and blame, acceptance seems always to lose. Before we give up in despair, however, we should remember that social reformers of a more benevolent nature have continued to use genetic research in an effort to ease suffering while recognizing the value of diverse individuals. Over the last 150 years, acceptance of the mentally ill and the disabled has increased dramatically. In addition, genetic research has helped identify the causes of some disorders and helped us cope or even find superior treatments in some cases.

Before the eugenics movement gained momentum, Hervey Backus Wilbur, Samuel Gridley Howe, and Dorothea Dix were all advocates for improved treatment of those with mental disabilities. Before eugenics the attitudes were quite different, but similar arguments were used for quite different ends. Nicole Hahn Rafter says:

Supporters of idiot education drew on two rhetorical strategies that, Joel Best has shown, are utilized frequently during campaigns to identify social problems: they argued that it would be immoral to further ignore members of this class (what Best calls ‘the rhetoric of rectitude’) and that it was socially beneficial to help them (Best’s ‘rhetoric of rationality’). Eugenic criminologists later used the same strategies to define the retarded as deviant and socially dangerous.[1]

Wilbur and his contemporaries intended to use their facilities to reduce deviance and improve the lives of the disabled. They shared the view of eugenicists that reducing deviance was a social good, but felt it could be achieved through humane treatment and education. Dix was particularly strident in her advocacy of reform for poor houses. She complained of country institutions that isolated inmates in “close, unventilated rooms; narrow dark cells; cheerless dungeons, cold and damp.”[2] It is quite conceivable that later hereditarians could have followed the compassionate lead of Wilbur, Howe, and Dix in seeking improved care and education of the disabled, rather than their elimination.

In 1925, Judge Harry Olson delivered an address on crime and heredity. Judge Olson’s address was highly acclaimed and included an impassioned plea for eugenics. Olson argues that crime is a product of heredity and, in effect, that criminals are not able to choose differently. His argument calls for compassion but also a deprivation of freedom for criminals. Rather than harsh punishment, however, he calls for farm colonies to provide segregation for delinquents. For his time, he was calling for a relatively humane treatment of such individuals. He says of the inmate on such a farm, “The need of the individual defective is likewise met, for he is given an opportunity to live to the limit of his powers, whatever their limit may be in each individual case. He will have all his worries and troubles removed, existence will no longer be anguish and agony for him, but a sensible balancing of work and play.”[3] Olson’s argument is a strange mélange of compassion and indifference, but it is not far from the approach taken today, even if the terms we use are different. Today, individuals who are severely disabled are often cared for in residential care facilities, and reproduction, when it happens, is seen as a great tragedy. It is seen as a tragedy because it is usually the result of rape committed by a staff member as residents are still not permitted sexual or reproductive freedom. Facilities today will also claim to be providing the most compassionate care possible.

Geneticists and hereditarians made every attempt to be positivistic in their claims, reporting only what could be observed, measured, counted, or deduced. From craniometry to psychometrics, the inferiority of certain races, genders, nationalities, and even families was confirmed again and again. In retrospect, it is easy to see that positivism was a cloak for prejudice, but many saw this as a way of ascertaining truth with a high degree of certainty, just as many do now.

The positivism taken by the social scientists was not what it could have been. Karl Popper claimed in 1919 that he was dubious about the claims of three specific kinds of science: Marxist theory, psychoanalysis, and individual psychology. He claimed that in order for a scientific theory to be an actual scientific theory it had to make certain kinds of claims. The riskier the claims, the more scientific the theory. The theory should, according to Popper, make a prediction and make a claim that could possibly be shown to be false. Most theories in the social sciences (psychometrics, for example) fail to make predictions or falsifiable claims. For Popper, no scientific theory is ever proven to be true. Tests of the theory can only prove it false or fail to prove it false. Theories that pass all tests are only theories that have not yet been proven false. Such theories may have instrumental value, but no one should ever be brazen enough to speak of scientific fact. In contrast, theories such as those in the social sciences posit a hypothesis and then researchers seek confirmation through observation. Popper calls this process pseudo-science.[4] Most of the sciences Foucault describes as the science of Man are pseudoscience by Popper’s reckoning. Popper was also a strong critic of totalitarian governments and the author The Open Society and Its Enemies. He was opposed to the theories of Marx, Hegel, and Plato.

In opposition to Popper, Thomas Kuhn argues that science is the product of social interaction of communities of scientists. Kuhn argues that normal science proceeds according to past achievements and evidence that is accepted by most scientists in the field. When evidence that a theory needs modification, the community must accept a paradigm shift that results in a scientific revolution. For Kuhn, scientific revolution occurs when scientists encounter unexpected anomalies that create a crisis within the community.[5] An example he does not give might involve craniometry; when it was discovered that extremely intelligent people sometimes had smaller skulls than the unintelligent, craniometrists were faced with a crisis and were forced to shift to a new paradigm such as intelligence testing. Although Kuhn gives the discovery of oxygen as an example, his theory seems particularly applicable to the social sciences, which Popper would deem pseudoscience in the first place.

It is impossible to say whether the outcome would have been different if the science practiced by many hereditarians had been more reliable and accurate, but I am skeptical of any improved results. Fascists are just biased individuals who are likely to seek the science that suits their aims rather than survey a wide array of data. In other words, fascists had a social agenda and sought any possible support for their agenda; they did not base their agenda after becoming familiar with scientific theories of their time. Of course, seeking alternative scientific views would have proven difficult as objections to the conclusions of hereditarians were few. Some did question the results they were finding, but most forged ahead emboldened by the authority of science.

Even when scientists were careful to articulate the limits of their research, as Binet did with intelligence testing, their theories were used to support and reinforce prejudices and biases. While Binet sought to help all children learn to their fullest potential, his test was eventually used to deny education to children who were not fully adapted to the educational settings in which they found themselves.

Centuries before Darwin, Galton, or Mendel, Plato’s Republic provided a model for a possible meritocracy and eugenic society. Plato advocated rule by the fittest (meaning those with the greatest intellectual powers) members of society and also a selective breeding program to produce more rulers. In this breeding program, pairs would be matched according to their native intelligence, which would be determined by elder rulers. Plato did not see a need to extinguish all of the less intelligent members of society as they, driven by their bodily appetites, would become motivated workers struggling daily to produce goods in order to earn enough to satisfy their baser desires. Those unable to achieve this level of productivity independently would be slaves. Plato assumed that intellectual ability was the product of good parentage, and he was certain that both parents played a role in producing the best possible offspring.

In the nineteenth century, Hegel proposed another view of political philosophy without reference to eugenics. In fact, Hegel said that individuals are powerless to effect change in society. On the contrary, history makes progress toward what he called freedom through the rational movement of the Absolute Spirit. The movement of the Absolute Spirit is rational but can only be understood by humans when it is too late to change it. He famously claimed the “Owl of Minerva” flies only at dusk. Historical progress proceeded, in Hegel’s mind, at the “slaughter bench of history.” Through progress, one nation would overthrow another nation and bring synthesis of the two. The eventual result of such progress would be that all individuals would share a single will that would be in accord with the Absolute Spirit, which is embodied in the State. Any struggle against the State would be a struggle against the Absolute Spirit and would therefore be immoral. Absolute freedom, in Hegel’s mind, would be a state where no individual would have any desire to behave in a way contrary to the national will. As the most popular intellectual in Germany and perhaps all of Europe, Hegel’s philosophy had a profound influence on his generation and the generations that followed. Though Hegel claimed the Absolute Spirit acted according to Reason in a manner that was unalterable, he also said that the actions of the Absolute Spirit would be driven by world-historical individuals. For his time, he noted that Napoleon was such an individual. It is easy to imagine Hegel also identifying Mussolini, Hitler, and Stalin as such individuals as well. While fascist propagandists and defenders may have used genetic research to bolster their movements, the drive toward fascism existed independently of genetics and eugenics.

Hegels most famous student and disciple, Karl Marx, altered his teacher’s theory in significant ways, but many of the elements remained the same. The Absolute Spirit, in Marx’s view (based on the philosophy of Feuerbach) was actually the spirit of Man. Also, although the actions of the Absolute Spirit are inevitable, Marx advocated direct action to effectuate change in society. Rather than one nation overthrowing another nation, Marx claimed that capitalism must be overthrown by communism. I would aver that Marx’s vision of communism has much in common with fascism and had nothing to do with eugenics.

The theories of Darwin, Mendel, Galton, and others were certainly used by fascists to justify some of their actions. The theories of eugenics also helped motivate people with the best of intentions to advocate actions that were cruel and hopelessly flawed. This is in part due to strong biases that were reinforced by inaccurate claims of scientists. Theories of genetics and evolution are not value-free, but they also do not lead to any inevitable conclusions. Where one person sees genetic theory as a means to improve the lives of individuals, another will see genetics as a way of identifying scapegoats. Skepticism of scientific claims of inferiority (or of anything else, really) and a bit of humility would go a long way toward inoculating society from the excesses and cruelty of both fascists and eugenicists. Those who are too certain of their claims are prone to irremediable, rash, and dangerous action.

[1] Nicole Hahn Rafter, Creating Born Criminals. (Chicago: University of Illinois Press), 25.

[2] Dorothea Dix, qtd. in Rafter, 25.

[3] Harry Olson, Research Studies of Crime as Related to Heredity (Chicaco: Municipal Court of Chicago, 1925) 28.

[4] Karl Popper, “Science: Conjectures and Refutations” in G. Lee Bowie, Meredith W. Michaels, and Robert C. Solomon, eds. Twenty Questions (Belmont: Thomson-Wadsworth, 2005), 98 – 106.

[5] Thomas Kuhn, The Structure of Scientific Revolution (Chicago: University of Chicago Press, 1972).

Can we talk?

R. Horton

In recent months (perhaps years, now), it seems the religious and irreligious are divided more severely than ever. In response to demands that intelligent design be taught in schools or that evolution not be taught, writers such as Sam Harris, Daniel Dennett, and Richard Dawkins have taken religious thinkers and writers to task, attacking religious thought with unbridled enthusiasm. Their writings serve more as a rallying cry than as discourse and, as such, probably exaggerate the true gap between believers and non-believers in our society. Some of the religious seem equally enamored of raising arms against the other side. The Terri Schaivo “debate” quickly devolved into nothing more than grandstanding, posturing, and provocation for combat. With no background knowledge of our society, one would think pluralism had only happened moments ago and that any kind of discourse between the two sides (indeed, there are far more than two sides, but such nuance is invisible at the moment) is impossible. A little reflection, however, will remind us that the United States, while not quite the rich and diverse mosaic some dream it has been, is a country that has managed discussion between divergent groups in the past. The founders of our country were both religious and secular. Although a fair amount of strife resulted, discussion and compromise were always seen as real possibilities. It is possible that a way forward still exists.

When asked who would be an authority on matters of morality, most members of the public, in the United States at least, would first mention members of the clergy. More sophisticated individuals might know to mention theologians specifically. Few people would think to mention philosophers, especially not secular or, worse, atheistic philosophers. In The Elements of Moral Philosophy, James Rachels says:
“It is not unusual for priests and ministers to be treated as moral experts. Most hospitals, for example, have ethics committees, and these committees usually include three types of members: healthcare professionals to advise about technical matters, lawyers to handle legal issues, and religious representatives to address moral questions.”
So, most people in the U.S. believe morality and religion are inseparable. Rachels refers to Plato’s Euthyphro to question whether God’s morality is arbitrary or rational. If actions or values are good only because God commanded them, then morality is arbitrary, or so the argument goes. If God commanded actions and values because they are good, then God’s morality is rational. Rachels quotes Gottfried Leibniz saying that the latter must be true. He says, “For why praise him for what he has done if he would be equally praiseworthy in doing exactly the contrary.” If God’s actions are rational and not arbitrary, then any rational person should have an equal ability to examine moral questions on the basis of reasoned argument. Rachels’ argument is that atheists and secularists should be included in moral discourse.
It is surprising, then, to find that the theologians Rachels felt have an undeserved place of privilege in moral discourse should complain that they have been left out of moral discussions, particularly with regard to bioethics. Courtney Campbell writes, “One unfortunate aspect of civic bioethics . . . is its incivility, including incivility toward religiously grounded opinions.” He also warns that religious bioethicists cannot retreat to the academy as, “the academy exhibits its own forms of intolerance toward religious expression.” Rachels and Campbell appear to be living in two different worlds, one hostile toward the secular and one hostile toward the religious. Authors on both sides declare that they must fight to be included in the discussion and be heard over the tyrannical forces of the opposing side.
Certainly, each side is correct in at least a surface view of discourse in the United States. Most people in the United States are religious, and their religious values are reflected in the public sphere. Some religious groups have shown clear forms of intolerance for opposing views. On the other hand, many professional philosophers are secular or atheistic, and a condescending attitude toward religion is perceptible to even beginning students in philosophy. Philosophers are a small minority, indeed, but their voices are disproportionately loud in the debates over bioethics, at least in part because they have made some provocative claims. How is a religious person to speak to a philosopher who claims it is permissible to kill babies and disabled adults but not animals? The fact that such a question is even asked must be enough to make some religious writers feel dialogue is hopeless.
James Gustafson describes three styles of religious discussion in medical ethics. The first is based on autonomy of religious views; most people would generally associate this view with an assertion of religious authority. When asserting authority, one is likely only to sway those of the same faith who feel compelled to follow the authority of its leaders. This is, of course, an important part of the moral work of many theologians, but it does not engage the wider community. The second style stresses continuity with the wider community. This style seeks to make religious positions intelligible both to those within and beyond a specific religious community. For example, a Catholic theologian may publish and article or give a speech intending to make the Catholic position on social welfare or just war comprehensible to non-Catholics. In doing so, some non-Catholics may come to agree and join with Catholics in support of or opposition to public policies. The final style is interaction, which is the only style in which the religious interlocutor is open to revising his or her original position. The interactive style is not for every writer or every occasion, but Gustafson notes that it is possible and can provide a space where the religious and the secular can converse about matters of medical morality.
J. Bryan Hehir discusses the role of the “public church.” In examining the proper role of Catholic bioethics, he notes that the Catholic Church “defines civil society as both an audience for its teaching and an object of its pastoral care.” From this prospective, theologians and others are obligated to engage the wider, pluralistic public on important matters of morality. He says that religious writers must be prepared to contend with a pluralistic society, a secular state, and a liberal philosophy of law. He notes the success of Martin Luther King in addressing the public on moral matters using rational argument that was not free from religious significance. However, biomedical issues seem especially intractable, particularly with regard to issues related to sanctity of life (e.g., abortion, suicide, euthanasia).
Given the steadfast opinions of individuals on both sides of the abortion debate, many have advised Catholic writers to focus attention on the ecclesial community. Hehir finds this dissatisfying as he advocates a public church, not a church that restricts its reach to its own enclave. He says, with some apparent pride, “The strategy may ultimately fail, but the failure will be that of a public church, rather than a decision by a once-public church to retreat within a purely ecclesial definition of its role.” The question is not whether the church succeeds or fails but whether it fulfills its duty to society as an object of pastoral care.
Hehir moves to another issue that may seem to be less of a problem for discussion between the church and the secular public: public access to health care. While religious language may be used to discuss health care, the general public can certainly understand the positions of the church, and the issues are not nearly so intractable as discussions of abortion, for example. On the surface, it seems that the church would be obligated to support efforts at providing heath care to all, but Hehir sees a problem. Many proposals for public access to health care include provisions for publicly funded abortions. He suggests that multiple strategies could be adopted but not in his short essay. Fortunately, Andrew Lustig expands on the discussion of health care rationing and reform, but the problem remains frustrating. Lustig recalls Christian teaching that demands universalizing love and care for one another, which would seem to require support for public access to health care, perhaps even globally. Nonetheless, he notes that U.S. bishops oppose any health care package that includes abortion. He calls for religious writers and others to invite their religious values to drive arguments expressed in non-parochial, or public, terms. He sees a possibility that religious values will “work their leaven upon the world” indirectly. How is a secularist to respond?
Two secular philosophers, Peter Singer and Peter Unger, have devoted much of their attention to the ethical use of the world’s resources. Both are motivated by a value shared by all Christian writer’s I am aware of: a value of preserving the lives of those who wish to live. Admittedly, some Christian writers would want to preserve lives in cases where someone might want to die, but it is possible to bracket that concern while discussing our individual obligation to others who do want to live. Singer and Unger both argue that taking care of the world’s most vulnerable people is an individual responsibility for everyone. While they both eschew religious language, others have pointed out that only Jesus seemed to have an ethic as demanding as Utilitarianism, requiring all in affluence to give to any who need assistance. Singer and Unger are both Utilitarians (a frequent straw man for non-Utilitarian ethicists) and argue that the interests of all must be considered equally (for Singer, the interest of animals must also be part of the calculus).
On the point of health care in particular, Singer questions the claim of Christians to value all lives equally. He challenges the notion, saying that to value all lives equally would mean spending as much money to save the lives of the world’s desperately poor as we spend saving premature infants and those in the last stages of life. Many of Singer’s positions are anathema to Christian thought and tradition, but on this point common ground seems possible. While not responding specifically to Singer and Unger, Edward Langerak gives an example of a kind of language that is distinctively religious yet still capable of engaging secular philosophers. He notes that religious covenant requires individuals to love their neighbors. He acknowledges that “the problem has usually been that people’s sense of obligation is too minimal for covenantal flourishing.” He quickly adds, “But some special covenants seem especially prone to encourage a ‘savior’ mentality in which persons lose themselves in a bottomless pit of others’ needs.” His language is decidedly religious, but it echoes secular arguments against the Utilitarian calculus. Both the Utilitarian and covenantal ethicist can “bury the self in the bottomless needs of others.”
James B. Tubbs grapples with the question of obligation to strangers. Tubbs exclaims, “Yet Jesus goes beyond the claim that needy strangers should be regarded in the manner in which God regards them. He suggests, in fact, that the needy stranger be regarded as the Son of Man himself!” Tubbs emphasizes this point further by admonishing that the encounter with the stranger should be seen as an encounter with the divine. He then moves to an examination of what it means to be a neighbor. He declares that our moral life is dependent on relationships with others, but he leaves off the discussion of what this relationship demands of us. It would not be difficult for the Utilitarian to agree that strangers shape our moral lives, but it seems more difficult for Utilitarians to turn away from what our relationships demand of us. In any case, it is not religious language or hostility to religious thought that prevents Utilitarians and religious writers from becoming interlocutors. One has no difficulty imagining a discourse on our obligations to strangers between the secular and the sectarian. A certain degree of consistency is of value in any moral tradition.
I have focused so far on obligations to strangers as it seems to me to be the most pressing medical issue for everyone. More than four million people die each year from starvation. Millions more die from treatable or preventable diseases. While academic bioethicists grapple with deep quandaries regarding patients and the role of the doctor at the bedside, most of the world would be improved greatly by having the luxury of becoming a patient rather than another statistic. War and its always-attendant famine kills far more people than withdrawal of treatment from impaired newborns or cessation of treatment for the cognitively impaired. This is not to dismiss the importance of discussions over transplantation and other hard questions, but the easy questions may be a good place for secular and sectarian interlocutors to begin a discussion. An infinitesimally small number of people discussing bioethics and medical humanities would claim that the loss of life is insignificant. Whether the author values life because it is a gift from God or because it is something individuals have developed an interest in maintaining, life is something to be preserved, at least in the cases where the living person values his or her life. Given the almost universal agreement with this statement, it seems that philosophers, theologians, and bioethicists of every stripe could work together not on whether life should be preserved but on how public policy can be shaped to help those who need medical care and cannot procure it. It has perhaps been avoided too often because the task is more daunting than deciding at what moment a dying person becomes a corpse with organs suitable for donation. Nonetheless, if we are to encounter strangers as our neighbors, we must gird ourselves for the struggle and prepare for a significant shift in how we view our fellow sufferers in the world.
If a discussion of helping the world’s neediest individuals seems possible among people of many faiths and philosophical dispositions, Leigh Turner’s example of blood transfusions will have us despair that no discussion is possible in other areas. To be sure, people from many backgrounds would agree that blood transfusions are often required to prolong lives. Many would see providing transfusions to be an obligation of the highest order. Turner points out that none of this rhetoric or consensus of most bioethicists will be of interest to Jehovah’s Witnesses. Turner warns, “Principlist and case-based approaches to moral deliberation typically exaggerate notions of common morality.” The point deserves consideration. It is naïve for any bioethicist to assume that any argument, no matter how well reasoned, will be accepted by all. Turner accuses bioethicists of ignoring the elephant in the room, but this conclusion may be rash. It could be that bioethicists, aware of the elephant in the room, persevere in the hope of lighting one candle rather than cursing the darkness.
It is no question that philosophers and theologians often talk past one another. Many religious concepts cannot be put into a language common enough for the secular and the sectarian. This should not mean, however, that the conversation should not begin. The “public church” should make its beliefs as clear as possible to even an unreceptive audience. The public intellectual should do the same. Resistance should come from all who have the strength of their convictions regardless of whether those convictions come from religious moral traditions or reasoned argument and reflection. Speaking one’s conviction publicly and arguing for it is itself a moral act. Tolerance and respect for diversity do not require us to stifle our voices. They require us to accept that other individuals have the same right and obligation we have to express their deeply held convictions and beliefs.
Public policy, on the other hand, must reflect the greatest respect for individual beliefs and convictions that cause no harm to others. To be sure, it is not easy to decide what beliefs cause harm to others. The case of blood transfusions from the Jehovah’s Witnesses’ point of view is a reminder that sometimes harm seems quite different when seen from different vantages. I personally am concerned about harm done to animals. I realize that most do not consider harm to animals to be harm at all. I join the relatively small group of individuals, mostly but not exclusively secular philosophers, in explaining why much of the harm to animals seems not only cruel but unnecessary. I have learned that the stronger claim that animals should not be harmed or used in research is almost universally rejected, but many people of various faiths and backgrounds accept that cruelty is an evil. Deontologists and virtue ethicists both reject cruelty to animals as a bad habit that could lead to cruelty to humans. Thus, Kant and Aquinas both reject direct obligations to animals but see humane treatment of animals as an indirect obligation to humans. Those with sufficient openness have been able to discuss this subject with respect and results. Globally, a shift toward more humane farming is underway even as factory farming continues to be the most profitable means of producing food.
We can and must engage one another in discourse with respect, tolerance, and courage. The debate will not always produce an answer that is accepted by all, but the lack of debate will always produce frustration and power struggles. Bioethicists are in a position to model such discourse for the larger society. This will require leaving the enclaves of institutions and entering the public sphere in a more visible manner. We must take care to live by the principles we espouse. Peter Singer has been criticized for donating only 20 percent of his salary. He admits he could do more but also points out that it would not be necessary if everyone living in affluence would give only one percent of her or his income. We have achieved nothing near this level of giving, but aid organizations did see a spike in donations after Singer’s essay on world poverty appeared in the New York Times. It is certain that atheist Singer managed to engage the religious with his argument. Discourse can have positive results.
Ronald Carson writes, “In covenant, one receives others as one receives a gift—in trust—and one passes the gift on in response to need, with due regard for the recipient, and without calculation.” Our fellow ethicists are in need of respectful interlocutors just as our fellow humans are in need of medical assistance. As bioethicists, medical humanists, and responsible human beings, we can help provide insight, assistance, and advocacy. We can join and be fully engaged in a moral community. This is the task at hand.

When doctor’s hate informed patients

R. Horton1 Comment

A doctor, Scott Haig, published an essay in time magazine titled “When the Patient is a Googler” on November 8. The doctor describes a prospective patient who is “well spoken and in good shape, an attractive woman in her mid-40s.” He then says that she “launched into me with a barrage of excrutiatingly well-informed questions.”

In the course of the essay, Dr. Haig describes Susan’s child as a “little monster” and her as a “brainsucker.” He says patients like Susan are full of “half-baked ideas” and are suspicious and distrustful. He also says that patients like Susan are full of “misused, mispronounced words and half-baked ideas” (what happened to her being “well spoken” and informed?) He knew these things about patients like Susan not because of anything she said (she was well spoken, after all) but because “a seasoned doc gets good at sizing up what kind of patient he’s got.” He decides not to treat Susan but to refer her to another doctor. When he declined to treat her, he says she was “disappointed and annoyed,” but she already had an appointment with the doctor he planned to suggest.

It is obvious to anyone but the doctor that she was vetting prospective doctors just as he was vetting prospective patients. It may be that knowledgeable patients get good at sizing up what kind of doctor they have. Based on the essay, her questions were a good way to ferret out a megalomaniacal doctor who could not handle a patient who may know a little too much. He asks whether such patients exist in countries where doctors are in short supply. It is possible that Susan is a selfish prig who wants everything in life on her own terms.

It does not appear, however, that Dr. Haig is one of those doctors who travels to a war-torn country to give his services to those who need them most. Nor does it appear that Dr. Haig has any humility in the face of patients who may know more about their own pain than he. Susan isn’t the only patient Dr. Haig doesn’t like, you see. He describes others as “non-compliant Bozos.” This is a doctor who gives orders and expects them to be followed.

Paternalism, indeed, is not dead.

The Value of Simplicity

R. Horton1 Comment

Many political, social, and religious movements advocate simple living as a way of reducing demand for financial resources, increasing spiritual awareness, and placing fewer demands on environmental resources. For some, simplicity is a matter of interior design or architecture that emphasizes a lack of clutter and distraction. For examples, consider some Buddhist monasteries and temples, and meeting houses of the Religious Society of Friends. Architects design buildings to help people focus on their own thoughts and revelations while meditating or praying. Some practitioners will extend simplicity of design to clothing, gardens, and other spaces. In some ways, this first concern focuses on the benefits to the individual, especially with regard to spiritual growth. The spiritual growth of the individual should then provide benefits for others or for the universe as a whole, or so some believe.

Another argument for simple living focuses primarily on what is good for others. By living simply, we can leave more resources for current inhabitants of the world, including animals, and for future generations. Our commitment to simplicity also takes us out of competition with our neighbors. We no longer struggle to have the best clothes, homes, or cars. If everyone practiced this type of simplicity, it is argued, we could feed the world’s hungry and provide medical care for the world’s sick. People as diverse as Buddha, Jesus, and philosopher Peter Singer have argued for simplicity as a moral imperative.

These two arguments for simplicity cannot be separated. The spiritual growth or enlightenment of the individual should benefit others and be aimed, ultimately, at relieving suffering and providing comfort. The benefit of meditation and prayer is not to be a sense of calm or relaxation. The goal is to be a better person, not to feel better. I should perhaps qualify this last sentence and say that I believe the goal of meditation and prayer should be to become a better person rather than a more relaxed person. A feeling of calm can help one see reality with greater clarity, but calm in itself is not the end goal of meditation. Right thought is necessary to produce right action, and right action is driven by compassion for all that suffer, which is to say all that live.

The Religious Society of Friends (Quakers) has a long and rich tradition of simplicity (known as the “Testimony of Simplicity”). From the inception of the tradition, Friends met in unadorned buildings, wore plain clothing, and waited in silence to be inspired by the “light within.” The benefits of simplicity were described in the 17th century by Quaker William Penn:

“Personal pride does not end with noble blood. It leads people to a fond value of their persons, especially if they have any pretense to shape or beauty. Some are so taken with themselves it would seem that nothing else deserved their attention. Their folly would diminish if they could spare but half the time to think of God, that they spend in washing, perfuming, painting and dressing their bodies. In these things they are precise and very artificial and spare no cost. But what aggravates the evil is that the pride of one might comfortably supply the needs of ten. Gross impiety it is that a nation’s pride should be maintained in the face of its poor. ”

It was important to Penn that the money saved on adornments could be used to help those in need. Recently, pride has come to be seen as a virtue, but William Penn obviously considered pride to be a sin that encumbered any attempt to achieve justice or moral goodness.

Another Quaker, Richard Gregg, was equally clear on the value of simplicity in 1936. He said:

To give a concrete instance of what I mean by unity and disunity, it would be consistent with a real awareness of human unity if I should invite into my house for a meal and a night’s lodging a starving man who has knocked at my door. But if my rugs are so fine that I am afraid his dirty shoes may ruin them, I hesitate. If I have many valuable objects of art or much fine silverware, I also hesitate for fear he may pocket some of them or tell men who may later steal them from the house. If my furniture and hangings bespeak great wealth I mistrust him lest he hold me up; or perhaps if I am less suspicious and more courageous and more sensitively imaginative, I fear lest the contrast between his poverty and my abundance will make him secretly envious, or resentful, or bitter, or make him feel ill at ease. Or perhaps he is so very dirty that I fear he has vermin, and I am revolted by that thought and am so far from him humanly that I do not know how to deal with him humanely. In this case it is clear that my lack of simplicity acts as a barrier between him and me. The prolonged lack of simplicity of our whole society has increased the distance between his thoughts, feelings and ways, and mine, and so adds to the social barrier. That troubles me.

It is clear that Richard Gregg saw acquisition of “things” to be a problem. While forced poverty is not the goal of simplicity, detachment from items of material value is a goal of simplicity. Attachment to expensive housing, artwork, clothing, or other ornaments interferes with one’s ability to act morally. The money saved can be used to help the plight of those suffering in the world, and the lack of attachment to ornaments frees one from being “owned” by one’s own property. It also means that one does not need to live in debt or with obligations to others. It means one is not required to ask for gifts from others who may or may not be dishonorable. In this sense, simplicity is both a form of liberation and a method for helping to liberate others from poverty or extreme suffering. The teaching on simplicity by Friends is rather unambiguous.

A 2001 New York Times article describes how the Live Oak Friends Meeting in Houston, Texas came to build a $1.5 million meeting house based on the principles of simplicity. The article notes that the 100 members of the meeting raised $500,000 through internal efforts and the remaining $1 million came from donations from “individuals, corporations and foundations making contributions to a nonprofit corporation set up for the purpose of the project.” The article does not specify who the individuals, corporations, and foundations were or whether they were screened for social responsibility.

The meeting house was designed by architect Leslie Elkins, but the cost is due largely to the James Turrell “skyspace” integrated into the meeting house. Turrell is a Quaker artist who uses light as his medium. The skyspace is like an open-air atrium with a retractable roof. When the skyspace is open, there is simply an open square in the center of the ceiling. Anyone can look at a section of the sky at any time for no cost at all, of course. Turrell creates an aesthetic experience of light in the sky in the same way my favorite composer, John Cage (influenced by Taoism and not a Quaker), creates an aesthetic experience of silence for audiences. The value of the art, as Taoists would say, lies in what is not there.

At Turrell’s insistence, any trees that obstructed the view through the skyspace were cut down. Turrell’s art, and the skyspace, attract visitors from around the world. Visitors may view the skyspace for free but donations are accepted. At the insistence of the artist, photography is not allowed as the rights to any images of the skyspace are retained by James Turrell.

Due to the expense of repairs to the skyspace and the cost of the building, the members of the meeting are understandably concerned with protecting the investment in this work of art. When I say “understandably,” I mean to imply that Richard Gregg, for example, would understand.

The meeting house follows simplicity by design. Does it fulfill the testimony of simplicity as described by William Penn and Richard Gregg? Could $1.5 million be better spent? Does the skyspace serve a greater purpose of promoting social justice and environmental sustainability in the world? I think the questions are worth considering, even six years after the fact.

Randall Horton

I don’t know what I was thinking

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If nothing else is certain, we must know the contents of our own minds. Descartes was unable to doubt the existence of his mind, and it seems quite impossible for me to doubt the thoughts I am thinking right now. As I produce thoughts, I am aware of them, and it is impossible for me to escape them. My thoughts, formed by language, express the contents of my beliefs and desires precisely, because that is how I have intended to express them to myself. I can’t imagine I am deceiving myself or that I am an automaton. I am a thinking being immersed in my conscious life. If the language I use in thinking expresses my beliefs accurately and rationally, then this is what enables me to develop moral principles and behave in a morally responsible manner.

But what of our “unconscious” thoughts? Hume demonstrated that our belief in cause and effect seems to exist in a precognitive state. We don’t use language and reason to develop a belief in cause and effect—in at least some cases, language merely expresses what is built into us. Our moral reasoning, though, is based on careful consideration and tediously crafted arguments. Surely our language is not expressing a precognitive instinct or intuition. In Kinds of Minds, Dennett quotes Elizabeth Marshall Thomas saying, “For reasons known to dogs but not to us, many dog mothers won’t mate with their sons” (10). Dennett rightly questions why we should assume that dogs understand this behavior any better than humans understand it. It may just be an instinct, produced by evolution. If the dog had language, it might come up with an eloquent argument on why incest is wrong, but the argument would seem superfluous—just following the instinct works well enough.

By the same token, human moral arguments may do nothing more than express or at best buttress deeply held moral convictions instilled by evolution or experience. In a Discover magazine article titled “Whose Life Would You Save?” Carl Zimmer describes the work of Princeton postdoctoral researcher Joshua Green. Green uses MRI brain scans to study what parts of the brain are active when people ponder moral dilemmas. He poses various dilemmas familiar to undergraduate students of utilitarianism, the categorical imperative, or other popular moral theories.

He found that different dilemmas trigger different types of brain activity. He presented people with a number of dilemmas, but two of them illustrate his findings well enough. He used a thought experiment developed by Judith Jarvis Thompson and Phillipa Foote. Test subjects were asked to imagine themselves at the wheel of a trolley that will kill five people if left on course. If it is switched to another track, it will kill one person. Most people respond that they will switch to another track in order to save four more lives, apparently invoking utilitarian principles. In the next scenario, they are asked to imagine they can save five people only if they push one person onto the tracks to certain death. Far fewer people are willing to say they would push anyone onto the tracks, apparently invoking a categorical rule against killing innocent people. From a purely logical standpoint, the two questions should have consistent answers.

Greene found that some dilemmas seem to evoke snap judgments, which may be the product of thousands of years of evolution. He notes that in experiments by Sasrah Brosnan and Frans de Waal capuchin monkeys who were given a cucumber as a treat while other monkeys were given grapes would refuse to take the cucumbers and sometimes would throw the cucumbers at the researchers. Brosnan and De Waal concluded that the monkeys had a sense of fairness and the ability to make moral decisions without human reasoning. Humans may also make moral decisions without the benefit of reasoning. It appears evolution has created in us (at least in those who are morally developed) a strong aversion to deliberately killing innocent people. Evolution has not prepared us for other dilemmas such as whether to switch trolley tracks to reduce the total number of people killed in an accident. These dilemmas result in logical analysis and problem solving. Zimmer writes, “Impersonal moral decisions . . . triggered many of the same parts of the brain as nonmoral questions do (such as whether you should take the train or the bus to work)” (63). Moral dilemmas that require one to consider actions such as killing a baby trigger parts of the brain that Greene believes may produce the emotional instincts behind our moral judgments. This explains why most people appear to have inconsistent moral beliefs, behaving as a utilitarian in one instance and as a Kantian the next.

It may turn out that Hume was correct when he claimed, “Morality is determined by sentiment. It defines virtue to be whatever mental action or quality gives to a spectator the pleasing sentiment of approbation” (Rachels 63). His claim is that we evaluate actions based on how they make us feel, and then we construct a theory to explain our choices. If the theory does not match our sentiment, however, we modify the theory—our emotional response seems to be part of our overall architecture. The work of philosophers, then, has been to construct moral theories consistent with our emotions rather than to provide guidance for our actions.

Language gives us access to our conscious thought. Language permits us to be aware of our own existence and to feel relatively assured that other minds exist as well. It is through language that we make sense of ourselves and the world. We may be deceived, though, into thinking that thought is equivalent to conscious thought. Much of what goes on in our mind is unconscious. Without our awareness, our mind attends to dangers, weighs risks, compensates for expected events, and even makes moral judgments. Evolution has provided us with a body that works largely on an unconscious level. However, humans, and perhaps some nonhuman animals, have become aware of their own thoughts, and this awareness has led to an assumption of moral responsibility. This awareness should not be taken to prove that we are aware of the biological facts that guide our moral decisions.

Stephen Stich explores the development of moral theory in his 1993 paper titled, “Moral Philosophy and Mental Representation.” In the essay, Stich claims that while most moral theories are based on establishing necessary and sufficient conditions for right and wrong actions, humans do not make mental representations based on necessary and sufficient conditions. He says, “For if the mental representation of moral concepts is similar to the mental representation of other concepts that have been studied, then the tacitly known necessary and sufficient conditions that moral philosophers are seeking do not exist” (Moral 8). As an alternative, he suggests that moral philosophers should focus on developing theories that account for how moral principles are mentally represented. He writes:

These principles along with our beliefs about the circumstances of specific cases, should entail the intuitive judgments we would be inclined to make about the cases, at least in those instances where our judgments are clear, and there are no extraneous factors likely to be influencing them. There is, of course, no reason to suppose that the principles guiding our moral judgments are fully (or even partially) available to conscious introspection. To uncover them we must collect a wide range of intuitions about specific cases (real or hypothetical) and attempt to construct a system of principles that will entail them. (8)

On this view, moral theories represent beliefs that are not only unconscious but are unavailable to the conscious mind. In order to make a determination of the content of our own moral beliefs, then, we must examine our own moral decisions and infer the content of our beliefs. In this approach, we find that humans are deciphering their own beliefs in much the same manner the Brosnan and De Waal determine the moral beliefs of capuchin monkeys. Not only does language fail to give a full accounting of our belief states, but our conscious thoughts may be an impediment to determining our actual beliefs, so that we must consider prelinguistic or nonlinguistic cues to discover what we actually believe.

Suffering and Meaning

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In other posts I have pointed out that life is the source of all suffering. I can’t claim to be profound; this is the First Noble Truth of Siddhartha Gautama. I’m only convinced that he was correct. Some Christians, of course, also see life as a “vale of tears,” only to be survived in order to be rewarded with relief in the afterlife. Hinduism and Theosophy also see existence in the flesh as something to be endured rather than a gift in and of itself.

So, why do we cling so tightly to this gift or trial or punishment, depending on one’s beliefs? Evolutionary psychologists and biologists would most likely agree that clinging to life aids the survival of the species (or of the “selfish genes” as Richard Dawkins would say). Surely, this is correct, but it may not be the entire answer.

Very soon after we are born, we also begin to form attachments. We not only love our own lives, but we love the lives of others. Many people resist the temptation of suicide because they “could never do that” to their parents, children, spouses, or friends. Some give in to the temptation of suicide because they care for no one and feel no one cares for them. Or, in some cases, people come to believe that their death will bring more happiness to those they care about. In some cases, they are correct in this as well.

So, love makes life extremely valuable but also excruciating. Our obligation, then, is to recognize the sorrow that is life. Recognize that it is a common feature of human existence. Recognize that all suffering is our own and do our best to help each other through. In so doing, we may find joy, bliss, and comfort along the way.

We may, in the end, feel that it is all worth it.

Randall Horton

(Some have said the Buddhist view is pessimistic. I’m not sure whether most Buddhists would agree, but I know that Arthur Schopenhauer, who was greatly influenced by Buddhism, classified Buddhism as a pessimistic religion. He also based his moral and ethical writings on the principle ideas of Buddhism.)

The Value of Life

R. Horton

Many bioethicists accept the Judeo-Christian view that human life and human life only has great intrinsic value. As a corollary it is taken that anything thing that is both alive and human possesses a right to respect and continued life.

These assumptions are powerful and pervasive, but go against the intuition of many people. The assumption that human life has great value and is even sacred would lead one to assume that it is proper to create as much human life as possible, but only a few people actually believe this. The prevalence of contraception and encouragement of abstinence belies an underlying belief that perhaps not every human life is of great value simply because it is possible for it to exist.

Similarly, rights are not granted uniformly to all that are human and alive, although many pretend that they are. When consciousness ceases to exist or fails to begin in living human tissue, many people will regard this being as perhaps being worthy of dignified treatment, but the idea that it is of the same value of all other human life is not represented through everyday actions of most people.

Concern for the “right to die” is some circumstances also implies a rejection of the view that life is sacred in all cases.

Alternative views of the value of life can be useful in resolving the apparent contradiction between the actions many people take and their declared respect for life and individual rights.

Not all people see life as sacred and valuable. The first noble truth of Buddhism, for example, is that life is suffering. We seek continued existence as a result of desire, which intensifies our suffering. Life becomes valuable, then, because it fulfills a desire which is itself irrational. Other views see life as the inevitable consequence of physical laws or nature. The fact that humans exist and desire life is a brute fact that is morally significant only because of the suffering generated by the desire for life.

We may recognize that life is valuable for reasons that are not metaphysical. A pre-embryonic collection of cells may be of great moral significance to a certain man who is hoping, with a bit of desperation, to become a father and see his child before he succumbs to a life-threatening disease himself. For this man, these human cells are not morally significant because they are endowed with rights and dignity at their first creation. He is not concerned with the metaphysical status of the cells. He is concerned, instead, with their ontological status. They exist and he wants them to survive because he is interested in their continued existence. In this case, we may feel morally obliged to take great measures to ensure the survival of these cells because they mean so much to this hopeful father. We are concerned for this father and he is concerned for his progeny. The moral commitment arises from concrete human relationships.

For similar reasons, non-human life may become of great moral concern to us. Police officers who have worked with service animals for many years will often refer to a deceased animal as a “partner” and such animals sometimes receive funerals and memorials. Few would claim that service animals are accorded respect and value because of the sanctity of life.

In both the cases I’ve given above, it can be claimed that the duties accorded to life are indirect duties to the ones who care about the life. While that is true, the moral commitment could arise from a direct concern for a life. An individual may value her own life because she enjoys being alive and wants to continue her existence. Her own concern for her life makes her life something of value. Out of a concern to reduce her suffering at the thought that her life may not be preserved, medical professionals will devote themselves to preserving her life.

In such cases as outlined above, it is compassion, sympathy, empathy, or care that creates moral demands for the preservation of life. This view of the value of life will not appease the demanding vitalist, but it may be accepted by many people from different faiths and philosophical backgrounds. It helps us reconcile the strong drive to preserve and extend life with our belief that some people have a right to die, that some non-human life deserves extraordinary care and respect, and the view that some human cells are precious while others are less precious.

Language of Machines

R. Horton

Daniel Dennett argues that we can use language, through the “intentional stance,” to describe the beliefs of people, animals, or artifacts including a thermostat, a podium, or a tree (Brainchildren 327). It is easy to construct sentences to describe the beliefs of these objects (“The thermostat believes it is 70 degrees in this room”). If the thermostat is working properly and conditions are more or less normal, we should be able to predict the temperature based on the actions of the thermostat, or we should be able to predict the actions of the thermostat by knowing the temperature in the room. We recognize the possibility of error, however. As the thermostat may be broken, we are likely to say, “According to the thermostat, . . .” If the room does not feel warmer or cooler than the thermostat indicates, then we assume all is well. If we want to know the true nature of belief, being able to describe the beliefs of a thermostat is outrageously unsatisfying. Unless the thermostat is able to describe its own beliefs using language, we are loath to even suggest it has beliefs.

But given the capacity for human language, machines might appear to have beliefs and desires similar to human beliefs and desires. In fact, if a machine could use human language in a manner indistinguishable from human use, it is difficult to see how the consciousness of the machine could be denied with any certainty. Of course, the claim that such a machine is impossible goes back at least to Descartes, who wrote, “It is not conceivable that such a machine should produce different arrangements of words so as to give an appropriately meaningful answer to whatever is said in its presence, as the dullest of men can do” (CSM II 140). Surely Descartes did not imagine 21st century computer programs when he provided this early version of the Turing Test (in which a computer is held to be conscious if it can master human conversation), but so far his challenge has not been met.

In John Searle’s Chinese room argument, we are challenged to accept that even a computer that could pass the Turing Test would not prove the computer is conscious. Although he does not deny that machines could someday be conscious, a language program would not be proof of it (Searle 753-64). Our best reason for believing the machine is not conscious is that it is not similar enough to a human to be considered conscious by analogy. Even if we can’t deny beliefs and desires to a machine with certainty, we are equally ill equipped to accurately ascribe beliefs and desires to machines, or trees, or stones.

Language and Belief

R. Horton

Human language brings clarity and understanding to human thoughts and beliefs. In fact, many have argued that without language, humans have no capacity for thought or belief. Descartes expresses a firm conviction that language is necessary for any thought:

There has never been an animal so perfect as to use a sign to make other animals understand something which bore no relation to its passions; and there is no human being so imperfect as not to do so. . . . The reason animals do not speak as we do is not that they lack the organs but that they have no thoughts. It cannot be said that they speak to each other but we cannot understand them; for since dogs and some other animals express their passions to us, they would express their thoughts also if they had them. (CSMK 575)

While the idea that language is necessary for the emergence of belief has been accepted for centuries, philosophers and others have begun to use the term “belief” more permissively, making the assertion much less obvious. While to say a cow had beliefs may have once implied the cow ascribed to some creed or doctrine, the claim has a much more mundane connotation in contemporary philosophy. For example, using the language of belief/desire psychology, we might say that a group of cows and humans gathering under a cover after hearing a thunderclap share a common belief that it is about to rain.

We will also say they desire to stay out of the storm. Cows do not need the ability to express their beliefs to want to avoid a storm that appears to be imminent. In this case, it is easy to describe the cow’s behavior using the language of belief/desire psychology, but it is also easy to imagine that the humans under the cover are in a far different position than the cows; they understand their position, have plans and fears for the future, and have a sense of what it is right and wrong to do. We want to say the humans are conscious, and the cows are not. We know the humans are conscious because we assume them to be more or less like us, and we are conscious. Language expresses our thoughts and beliefs, and we assume that other humans use language and experience consciousness as we do.

Language does more than provide evidence of consciousness, though; it is the structure of consciousness. A sophisticated study of human language and behavior should produce a powerful and accurate psychological theory. If language sets humans apart from machines and animals, then language is quite likely the feature of human consciousness that produces moral agency and responsibility. If animals and machines are not capable of beliefs and thoughts, then humans are the only known creatures to have any concept of moral responsibility. However, if consciousness is not unique to humans, or if language is not the stuff that makes consciousness, then we may not be able to construct an adequate description of beliefs and desires, much less moral agency.

The Ethics of Medication

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Yesterday, I went to the doctor, and he prescribed medication for reflux disease. When I went to pick up my prescription, the cashier told me the pharmacy could not fill it until they received authorization from the doctor. I asked whether the doctor’s prescription was not authorization. It turns out, according to the pharmacist, that the insurance company will not pay for the medication without a written justification from the doctor.

Rather than needing doctor’s authorization, the insurance company was rejecting his authorization. So, I get no treatment for my reflux, which hardly seems fair, but the situation is exasperatingly complicated.

It could be that my doctor, under the influence of pharmaceutical reps, prescribed an expensive medication that is no more effective than cheaper alternatives. If so, it may be in the best interest of everyone, except the doctor and pharmaceutical company, to reject payment for an expensive medication that offers no additional benefits over other medications. Praise to the insurance company for holding the line on costs.

It may be that the doctor knows that the new and expensive medication is more effective and has fewer side effects than alternatives. He may have prescribed what he feels will promote my health and healing better than any other treatment available. In this case, all thanks go to my doctor, and the insurance company is really quite evil.

Or, it could be that the insurance company rejects any expensive treatment with the hope that patients will give up and find cheaper treatments or go without treatment. This, of course, might save money in the short run, although rejecting claims costs money in itself. Sometimes, rejecting a claim is more costly than simply paying it. the amount of staff time and resources tied up on this one prescription is enough to give one pause. The pharmacy says the insurance company won’t pay for the prescription, but I did not press them on how they know this. It is possible they simply consulted a list of preferred medications. It may be that they checked a computer database. Or, they may have actually made a phone call. Any of these options require employee time.

After determining that the drug was not a “preferred” drug, the pharmacy faxed a form to my doctor. If things go as planned, a member of the doctor’s staff will obtain a statement and signature from him before completing the form and faxing it back to the pharmacy. This is an inefficient system at best.

In this case, the patient, me, is going without treatment for reflux, which is causing real problems and can lead, if untreated, to serious problems such as esophageal cancer, which frequently terminates in death. So, who is to blame for the suffering of the patient? Greedy pharmaceutical companies? Doctors under the influence of greedy pharmaceutical companies? Greedy private insurance companies? Or pharmacists who raise problems when there is no problem? I really don’t know the answer.