Saturday, January 23, 2010

Ethics-on-the-Fly

First off, a question from me: Why should the term "medical ethics" be designated as an oxymoron? This can be answered from almost any point of view in a similar fashion; scientific, religious, political, practical, etc.

Secondly, my thanks to Dennis The Hall for obtaining the article, "A Lecture on Ethics," by Ludwig Wittgenstein. It contains the quote to which I referred earlier, "I can only describe my feelings by the metaphor, that, if a man write a book on Ethics which really was a book on Ethics, this book would, with an explosion, destroy all the other books in the world. Our words used as we use them in science, are vessels capable only of containing conveying meaning and sense, natural meaning and sense. Ethics, it is anything, is supernatural and our words will only express facts; as a teacup will only hold a couple of water and if I were to pour a gallon over it................."

Of Course There Is Such a Book. The combustion mentioned above is really somewhat of a slow burn, similar to the combustion that is taking place in your body and mind as we speak. We speak of a controlled burn in the science of forestry but as one can see, such a thing can get totally out of control. There is also Entropy to consider which makes the above all the more difficult to comprehend from a purely scientific point of view. The additional problem is that pure science does not exist either. The more I think about it, whether as a scientist or as one interested in metaphysics, the more I see that we are up against the famous failure of "The Critique of Pure Reason." The French Revolution of course attempted to create a new a new goddess out of a mental construct called Reason and the results were quite unreasonable!

I would further contend that what we have today is not Science as such but "science -- so -- called." It is commonly recognized among relatively reasonable scientists that, outside of technology, science is culturally determined. (Now but I think of it, the development of technology is largely culture driven as well --my father, a World War II veteran, is fond of pointing out how much technology has been developed as a spinoff of devices invented to waste people.) Of course this is precisely the critique of postmodernists as well as a number of feminists. As I have said previously, "science proves".... very little. To reason by induction is logically speaking very difficult in the first place and extremely restrictive. Science generally advances by deduction, a much easier process, but inherently much less certain than proof by induction. The scientific method or what I would call bench science is restricted to repeatable phenomenon that can be controlled. Historical deduction is outside the realm of science just as much as Ethics, as Wittgenstein mentions.

(Incidentally, Wittgenstein was initially mentored by Bertrand Russell but quickly outgrew Russell's rather contracted universe. Dr. Russell acknowledged that Wittgenstein's abilities in mathematics etc. far outstripped his own. Wikipedia has an intriguing summary of Wittgenstein's career. I also note that T.S. Eliot was a good personal friend of Dr. Russell and they had an rather revealing correspondence in the early years of Eliot's literary career. They also parted ways I would hope to say on good terms but apparently Dr. Russell was unable to pass on his beliefs to either Wittgenstein or T.S. Eliot, a fact that I find quite fascinating to me from both scientific and literary points of view. ( I have copies of this correspondence if anyone is interested.)

I heard the Editor of the Journal of the American Medical Association speak a few years back and she confessed that 15% of medical research is not just flawed but deliberately deceptive, to speak kindly about it. She also stated that this was probably just the tip of the iceberg and that even with peer review it was impossible to detect much of the deception unless one had access to the original data which, as we have heard recently, is often destroyed or altered to fit the conclusion already chosen before the study even began. The whole study would have to be repeated by different people who do not have a vested interest in making a name for themselves or fulfilling their vaulting ambitions. Not to mention the money and grants. She also acknowledged that she wasn't sure that medical ethics hadn't hit lows never previously seen in science.

The ethics and science that we generally use -- largely without thinking about them in any depth -- are part of a large and growing subculture which has an priori commitment to naturalism. Ironically this also rules out free will and puts sheer political power in its place. The Hippocratic oath is a particular example. The original Hippocratic oath had specific content. The current replacement in the AMA statements of mission/purpose etc. is so vague as to be completely useless in any practical sense. And no one uses it except possibly when the AMA is being attacked as being unethical and they certainly have been caught doing that on a number of occasions.
I think it is quite interesting that those who abhor violence and war often subscribe to the same commitment noted above but that assumption also does not mandate anything even remotely akin to pacifism. I like Walt Kelly's and Walker Percy's approach to the difficult problem of war and peace. I also do hope that everyone has read The War Prayer, by Mark Twain. I particularly liked the introduction in which Mr. Twain confesses that he has told the whole truth in this poem and he would not allow it to be published until after his death. He was apparently afraid of the backlash in spite of his established reputation and fame. I am hoping for some feedback on this.

One final question: which book did Mark Twain consider his best? Any ideas why? Any ideas why one never hears about it?

4 comments:

  1. "I like Joan of Arc best of all my books; and it is the best; I know it perfectly well. And besides, it furnished me seven times the pleasure afforded me by any of the others; twelve years of preparation, and two years of writing. The others needed no preparation and got none." He also said: “Taking into account, as I have suggested before, all the circumstances—her origin, youth, sex, illiteracy, early environment, and the obstructing conditions under which she exploited her high gifts and made her conquests in the field and before the courts that tried her for her life, —she is easily and by far the most extraordinary person the human race has ever produced".

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  2. I read this in an essay by Wendell Berry from his latest publication and thought it might be a good place to mention it with your thoughts on medical ethics.

    “An idea of health that does not generously and gracefully accommodate the fact of death is obviously incomplete. The crudest manifestation of modern medicine is its routine, stubborn, and finally cruel resistance to death. This comes of the refusal to accept death not only as part of health, which it demonstrably is, but also as a great mystery both in itself and as a part of the mystery that surrounds us all our lives. The medical industry’s resistance is only sometimes an instance of scientific heroism; sometimes it is the fear of what we don’t know anything about. Science can teach us and help us to resist death, but it can’t teach us to prepare for death or die well.”

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  3. Thankew Please see the short story "Fidelity" for a dramatic storytelling version of the medical model vs death theme. This is in the anthology, "That Distant Land"--not a bad story in the bunch; or as that advert for Mule Hide Roofing once proclaimed, "Not a kick in a million feet" Not sure what that means but I got the message at Dixon Home Lumber Co.where my Dad usta work shovelling coal out of a railroad car. Not cool! Death Valley Hot!!!

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  4. From "Fidelity", a good read.

    "If we are living in the future then surely we're living in the past, too, and the dead and the unborn are living right here in our midst. Wouldn't you say so."

    "And you are here not to tell us that a person who is sick and unconscious, or even a person who is conscious and well is ultimately the property of the medical industry and government. Aren't you?"

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