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