Intro to Clinical Ethics

Having just completed the first week of classes for the fall semester, I can now say the PhD is officially underway. I really enjoyed my first week of my program, but it was the first week of teaching that really pumped me up.

I am teaching intro to clinical ethics to about 30 pre-med, nursing, and other health science majors. Of course, I began the semester with a broad look at ethical theory and Metaethics, or the nature of morality. I am always surprised by the discussions that accompany this material.

When asked "what shapes our ethics/morals/", students usually give 3 possible answers:

1. Religion
2. Culture
3. Intuitions/feelings

The problem with answer 1 is simple: what about the atheists/non-religious/secularists of the world? Many of them seem to have *roughly* the same morals as everyone else--how does that work?

The problem with 3 is also simple: if morality is ultimately subjective, then every person is infallible with regards to moral judgments, which is absurd. Furthermore, we generally agree that some actions just have to be wrong/right, regardless of how one feels about them.

Similarly, answering "culture" is problematic for the same reasons answering "intuition/feeling" is (just on a different scale). Or just think about the morality of certain cultures, like Nazi Germany or the Slave-owning Southern US, and it is clear why culture cannot be the ultimate source of morality.

Then where does that leave us?

I think Aristotle says it best: "For all things that have a function or activity, the good and the well is thought to reside in the function" (Nicomachean Ethics. BK 1. ch. 7). The argument goes like this:

• In order to know what is "good" for some thing,
• one must first identify what the function, or purpose of the thing is.
• Then, we can distinguish between:
• a thing that does not function as it should,
• a thing that functions adequately,
• and a thing that functions well.
• Likewise, once the human function is uncovered, then we can know how to live well.

The idea is so simple, yet incredibly insightful. In order to establish an objective source of morality, we first have to contemplate what it means to be a human being. Once the essence of being a human being is uncovered, then activities, actions, pursuits, etc. that facilitate the performance of the human function are intrinsically good. These actions that help us live well are called virtues. Furthermore, the source of morality (understood as that which formally causes actions to be "good" or "bad" with respect to other actions) is, in a sense, human nature since actions are good or bad given the kind of being we are.

Much more on this to come.

Chris

Functions and Tendencies

As I prepare to teach intro to clinical ethics this fall, I find the need to incorporate more philosophy (esp. metaphysics) into the course. I think I can squeeze in a discussion of natures, or essences, by way of this clip from my MA thesis:

(1)   Every agent acts for some end.

a.       Substances that lack agency also “act” for some end as they bring about effects.

(2)   When an agent can act for a range of ends, there is no reason that the agent should pick one end over another.

a.       In substances that lack agency, while the substance does not have the ability to “pick” one end over anther, it is possible that any number of ends could be sought—and there is no reason one end ought to be preferable to another.

(3)   In our experience, substances have characteristic functions and bring about characteristic ends.

(4)   As efficient causality refers to the capacity to bring about some effect, so final causality refers to the determination that is made to bring about certain effects instead of others

a.      In substances that lack agency, this determination to bring about certain effects is built into their very nature.

(5)   The internal directedness of a substance to its characteristic ends is an expression of its essence/nature in the context of efficient causality.

a.       In other words, since the essence makes a substance to be a certain kind of thing, the characteristic effects that a substance brings about originate from its essence.

Now, you might ask why this is relevant to an intro course in clinical ethics. I think that thinking about "characteristic functions" and "natural tendencies" is an easy bridge into a deeper discussion of what those concepts actually mean. And "function" and "tendency" are a large part of medical science--practically all of biology utilizes this terminology without much consideration of what makes a function a function, or a tendency a tendency.

When a doctor tells you that your heart is not working properly, he must have a reference for what a properly-working heart looks like. Likewise, when a doctor prescribes a certain medication, he knows what the medicine tends to do for patients. Furthermore, the pharmacist knows about the tendencies of the ingredients of a certain drug, and he knows how those ingredients function together.

Now, there are basically two approaches one can take at this point: either we can know something about the nature/essence of those drug ingredients, or the heart itself, or we cannot know the nature/essence of things in themselves. David Hume, and many scientists today, take the latter approach, while Aristotle, Aquinas, and others take the former. Obviously, I opt for the former approach. Here is why.

IF we are a Humean, then hearts tend to pump blood. That is all. Every heart we have come across does, in fact, pump blood, but we don't know what a heart really is. Hearts simply pump blood in our experience.

This is a really unsatisfying answer. However, the Humean will look to the history of science and point out all the failures and misunderstandings up to this point, and he will say we cannot know, for certain, that we are right about hearts pumping blood.

Now, the Humean has a point about human history--we tend to discover that our ancestors were wrong about things (see flat-earthers). But is this really the alternative?

I think not. Aristotle and Aquinas (A-T) argue that all substances have natures, or essences, which make them to be what they are. These essences are formally responsible for the properties, characteristics, tendencies, powers, etc. of a given substance. When we say that a heart pumps blood, we mean that, given our empirical observations (and historical record of observations), it is in the nature of hearts to pump blood. The heart itself is perfectly suited and designed to pump blood, and it does not have a function outside of a chest.

Where this train of thought gets really interesting is when we think about hearts at the molecular level/microscopic level. All organisms and all parts of individual organisms start to look strikingly similar--so why do the macroscopic organs, and individual organisms, have such diversity when the base layer is either the same or very close to the same? Because macroscopic organisms, or individual substances, are ontologically independent. Parts of organs and even the organs themselves are identifiable (and parts of large organs are even bigger than certain individual organisms) insofar as they are part of the whole organism. Aquinas famously said that a severed hand is only a hand in name.

Now this small tangent into metaphysics is important for doctors, nurses, etc. because we use terms like "tendency" and "function" quite often. Once we reject the Humean approach to causality, then we must accept the fact that every organ has a characteristic function, a function that is natural to it. This is the basis of natural law ethics. And this is incredibly important for discussions in reproductive/sexual ethics.

More on this later.

Chris

Plan for Summer

I recently visited the Health Care Ethics dept at SLU and I am now very excited to start in the fall. But before that, I have some work to do. This summer I will be studying medical terminology. This makes perfect sense; all the literature I will be reading makes use of the legion of medical terms, procedures, and diagrams so I might as well know them too.

While medical terminology will take up a big portion of my summer, I have a few more interesting books lined up. I just started After Virtue by MacIntyre, which, I admit, is completely overdue. This is a book I should have read years ago--but I am just getting to it now. Next, I will be reading a few bioethics books: Aquinas and Bioethics by Craig Payne and Principles of Biomedical Ethics by Beauchamp and Childress. The Principles book is practically the Bible of bioethics, so I imagine I will be getting many miles out of it.

Aside from this, I also need to start thinking about the course I will be teaching in the fall. I will have one section of Intro to Clinical Ethics this fall, and two sections starting in the spring. This course has a basic syllabus for uniformity, but I do get to add some additional readings/assignments to make it my own. I have been reading some really interesting articles by David Oderberg that I might incorporate. He has a great one on the metaphysical status of the embryo, which is the fundamental question that must be addressed before we can talk about ethics.

One of the most interesting/frustrating things I have noticed in applied ethics (environmental specifically), is that no one wants to talk about metaphysics. They assume we can know what "intrinsic value" and "moral worth" is without first understanding the thing itself. See, metaphysics is simply the investigation of things themselves, so virtually all other methods and sciences presuppose certain metaphysical commitments. I just want to make sure to incorporate those commitments into my discussion of bioethics.

In our everyday experiences, we all take certain things for granted. For instance, we take it for granted that the objects of our sense experience are actually real. However, this assumption entails certain metaphysical commitments, namely, realism. Another commitment most people utilize is that similar objects share at least some properties. While this may seem commonplace, there is a contingent of people, the nominalists, who do not think we can analyze objects in this way.

My point is that it makes more sense to start out with the metaphysical commitments and their implications in the realm of ethics. For Aristotelians and Thomists, this is clearly seen in discussions of the teleological nature of, say, sexual organs and processes.

Anyways, more on this to come.

Chris

Updates

Well....I guess keeping up a blog is not for everyone! I will do my best from here on out. As you can see, I have re-branded my blog from "Aquinas and the Summa" to "Metaphysics, Ethics, and Medics". Metaphysics is broadly the study of the structure of reality itself--questions about the nature of objects, properties, universals, etc. Ethics is the study of how to live the elusive "good life". And I chose "medics" to sound clever. But I really want to focus on metaphysical and ethical considerations/concerns/questions in the medical field. The reason for this change is simple: I am about to start a PhD in Health Care Ethics at Saint Louis University.

I have decided to change career paths slightly, although I still want to teach in the end. Health Care is a booming field, and by booming I mean booming with ethical issues. The rate at which medical technologies and procedures are growing is astonishing and they show no signs of slowing down. We need good, Catholic men and women to devote their time and effort to help educate not only the patients and their families, but also the doctors, nurses, and hospital staff.

The new format of this blog will be straight forward: I will post material from my classes I take and any interesting articles/books I come across. I also plan on picking the Summa up again so I will sprinkle in some posts here and there.

Anyway, I hope this blog survives the test of time!

-Chris

DMA, Natural Kinds, Possible Worlds, and Other Fun Stuff

Well it has been a few weeks since my last post and for that I am sorry. I will post about Aquinas today, but first, here is some stuff about my personal research.

I am currently taking a seminar on analytic metaphysics with Robert Garcia here at TAMU, and it is a great class. The main topic is properties, although God and universals has been all the rage of late. I am working on a paper in which I investigate one contemporary metaphysician's (DM Armstrong) treatment of natural kinds.

David Malet Armstrong, or DMA, claims to follow Aristotle on immanent universals--where universals exist in the things in which they are instantiated--while denying the existence of natural kinds. However, I find DMA to not follow Aristotle very much at all, other than ascribing to immanent universals.

DMA is a self-proclaimed naturalist who believes that science will give us (someday) the "fundamental book of physics" in which is laid out the primary divisions in nature. I think that DMA's view runs into issues when he has to deal with everyday examples in metaphysics.

If there are no natural kinds, then,  according to DMA, the "kinds" in nature merely supervene on the ontologically fundamental categories of being--namely properties and bare particulars. But then it seems like all we can say about the difference between a human being and a polar bear is that each "state-of-affairs" is alike insofar as it is the combination of a bare particular and properties, and therefore the properties alone differentiate us from the polar bear. Furthermore, a fetus or a mentally handicapped person both are human beings for an A-T (Aristotle and Thomas Aquinas) theorist; for DMA, if we differentiate based on properties then it seems like the fetus or the mentally handicapped person is not the same "kind" as the healthy human being since they lack many of the properties of the latter .

Property talk is often misguided in contemporary metaphysics. It is often assumed that any "thing" is a bundle of properties plus a bare particular; but for the Scholastic following Aristotle, a property is a proper accident flowing from the essence of a thing. 

Directly related to this discussion is that of possible worlds in metaphysics. This tradition traces back to the Rationalist Liebniz and is all the rage today. The basic idea is that when trying to decide what is possible for any given thing--say a dog--we ask ourselves if there is a possible world in which the dog has this different property. Now, it is obviously more complicated than that, but this is the basic point.

But, as Edward Feser and others have pointed out with great clarity, possible world talk gets things backwards. Possibility is logically related to what is actual--in order to discuss what might be possible for the dog, we have to know about dogs. Seems obvious, right?

For example, the possible worlds lover might say that it is not possible for a dog to write a book because in no possible world do dogs write books. On the flip side, one might argue that in fact it is possible that a dog write a book since there are infinitely many possible worlds and therefore there must be one in which a dog writes a book.

Think about this reasoning.

The first response presupposes an understanding of the essence or nature of dogs--and therefore possibility is grounded in the actual dog, meaning that, given the nature of a dog, certain things are possible. The second response is just wrong.

Possible worlds talk might be useful when discussing the intrinsic and extrinsic potentialities of a thing, but it is only useful when the thing in question is understood.

Possibility is not grounded by possible worlds, but rather it is grounded in the nature or essence of things, and therefore it is ultimately grounded by God, since He is the Creator of all things.

So as you can see, I like Feser, dislike possible worlds for the grounding of possibility, and I don't think that DMA is very Aristotelian. Cheers.

Univocally, Equivocally, Analogously?

In question 13 of the Summa, Aquinas discusses the names of God. I think that the most important aspect of this question is the discussion of the relationship between names of creatures and names of God--specifically whether or not we can apply the same name, in the same sense (equivocation), to God.

Per the usual, Aquinas begins article 5 of Question 13 with objections, one of which is:

"Faciamus hominem ad imaginem et similitudinem nostram, videtur quod aliquid univoce de Deo et creaturis vocatur.
Let us make man to our image and likeness (Gen. 1:26), it seems that something can be said of God and creatures univocally".

From this biblical quote it is clear that human beings are made in the likeness of God, so how could a term not apply in the same way both to God and man? If we cannot use the same words between creature and Creator, then how can we know we are "made in His likeness"?

Aquinas argues that since univocation between certain creatures is impossible, then we cannot speak of God univocally. The distance between any two creatures is, by definition, smaller than the distance between God and His creatures. Now, distance in this sense is not literal, but rather in the order of dependence, a sort of metaphysical or ontological "distance". The relationship between Creator and creature is that of necessity to contingency; the relationship between any two creatures is a matter of only contingent beings. Therefore, if univocation is not possible between some creatures, then it is certainly not possible between God and His creation. Furthermore, even if univocation was possible between all creatures then it does not follow that univocation between God and creatures is possible.

This is all a bit heavy. It gets easier, I think.

Take the term "wise". When we say "that man is wise" we are pointing to some aspect of that man, distinct from the essence of the man, or even distinct from the powers or existence of that man. Now, when we say that "God is wise", we cannot mean this.

As earlier proven (Q.11), the essence of God is to exist, and He is ultimately simple by Nature. Therefore, we cannot possible "point" to something distinct from God's essence in the same way that we do when we call some person wise or well-mannered.

BUT....this cannot mean that we only speak of God equivocally, always the same word but never in the same sense, otherwise we cannot be said to ever say anything about God, and Aquinas clearly thinks that natural reason allows us to arrive at certain truths about God.

Therefore, we must use analogy.

Whereas equivocal terms are identical in form but diverse in meaning, and univocal terms are identical in form and meaning or idea, an analogous term is not identical in meaning, but neither is it diverse--it is, as Aquinas so aptly puts:

"sed nomen quod sic multipliciter dicitur, significat diversas proportiones ad aliquid unum 
but a term which is thus used in a multiple sense signifies various proportions to some one thing" (13.5).

This third way allows for us to speak of God in terms that we know.

Aquinas saves the day, again.

Whether God is One?

In question 11 of the Summa, Aquinas discusses the unity of God. I will focus on article 3: Whether God is One? (Ia.11.3).

As usual, Aquinas begins the article with objections to the notion of God being One: "One, as the principle number, cannot be predicated of God". Furthermore, it is said in Corinthians that "there are many gods and many lords"(1 Cor 8:5).

But, as I have come to expect, Aquinas does have an answer to this fundamental question of the number of God, whether He is one or many.

"Respondeo dicendum quod Deum esse unum, ex tribus demonstratur"  (I answer that it can be shown from these three sources that God is One).

1. From God's simplicity we know that God is One. Aquinas gives an example of Socrates being a man: being a man is predicated of both Socrates and many other men, but being Socrates is predicated of only one, namely Socrates. In this way it is clear that Socrates is a particular member of the human race. But in the case of God, He is His own nature, as shown in Ia.3.3, and therefore it is impossible that many gods could exist. 
2. By definition and as proved in Ia.4.2, within God is contained the perfection of being. Now, if many gods existed, they would necessarily differ from one another otherwise they would not be many. Furthermore, there would be things that would belong to one which did not belong to another; if a privation, one of them would not be perfect, and if a perfection, then one of them would be without it as they must differ from one another necessarily. Therefore, it is impossible that many gods exist and we know that God must be one.
3. The unity of the world necessitates one first cause of order. We see that everything that exists serves some purpose and creates some harmony. A diverse cause or beginning would lead to a diverse end, leading to discord and chaos. This is not what we see in the world. Therefore, we know that what was the first cause was one, since it is the sole necessary cause. In this way we know that God is One.

Aquinas has done it again. He has a knack for taking very loaded objections to the foundation of the Catholic Faith and dismissing them concisely and completely. One key to remember is that this question does not stand alone, but it rests on previously defined truths that all serve as an "arsenal" for future questions.

But this is the beauty of what Aquinas accomplished.

He was able to start from the most basic--yet also profound--truth of God's existence and then move to uncovering what we can know about God. 

On a personal note, I recently decided who I would be working with on my thesis project here at TAMU. Dr. Robert Garcia and I will be working on the topic of natural kinds in contemporary analytic metaphysics; I am hoping to show how the Scholastics (like Aquinas) had a better metaphysical picture, so to speak, than the contemporary heavyweights like D.M. Armstrong.

I should be blogging rather regularly now, Wednesdays and Sundays. Anyways, until next time...cheers.