Futurisms: Critiquing the project to reengineer humanity

Friday, February 10, 2012

Against Medical Ethics?

[Note: I am very belatedly posting two final entries about the Alasdair MacIntyre conference, which I attended and blogged this past July.]

The talk I was perhaps most looking forward to at the Alasdair MacIntyre conference was the provocatively titled “Against Medical Ethics” by Daniel Sportiello of Notre Dame University.

Sportiello spends the better part of his talk essentially giving a summary of MacIntyre’s argument in After Virtue.* What happens in philosophy courses, Sportiello contends, is that instructors “objectively” present students with all alternate sides of an argument, believing and acting as if, because all sides have been presented, the students will use reason to pick the best one. Because this procedure, as MacIntyre shows, is so clearly based on a moral fiction, Sportiello contends (and this is where the talk starts to get interesting, to put it mildly) that by teaching students medical ethics we are teaching them not how to ascertain which arguments are the most right and good, but only how to manipulate each other. (It’s not clear to me why he is singling out medical ethics here, except that it is among the most consequential of philosophical studies.)

* The argument, in short, is that modern philosophical debates use fragmented principles that have been divorced from their original, fully articulated forms, and from the embodied social contexts in which they could find their meaning. Modern philosophical discourse, then, is disordered; it cannot provide sufficient reason to adhere to any one side of an argument, yet it purports to provide such impersonal, objective reasons. Consequently, whatever force of argument does exist, rather than a function of reason, is a function of the Nietzschean individual’s will to power in bringing another to adhere to his own interests. (Although MacIntyre differs sharply from Nietzsche in arguing that this state of inquiry is a contingent feature of modern philosophy, not the nature of philosophy as such.)

(Speaking of divorcing arguments from their full context, this is really an inadequately truncated version of MacIntyre’s. Wikipedia’s synopsis is decent and pretty short, while any serious student of philosophy or moral inquiry should read the full book itself.)

Sportiello offers an example of a student who is raised to believe that murder is wrong. The student then goes to a bioethics course in college, where he is challenged to present rational arguments for murder’s wrongness. He is presented also with potential alternatives to this view, and is given each side of the argument from a neutral standpoint so that he may “objectively” decide between them. But here a seed of doubt is introduced, and in a later moment in his life, with his certitude wavered, he might find himself with a justification for committing the act of murder.

This may be an extreme or fantastical example, but Sportiello applies the same example to the abortion question. He asks us to suppose, first, that the pro-life side is right, and to imagine a student raised to believe it is right, who is then poisoned with “neutral arguments” for both sides. Then he asks us to suppose likewise that the pro-choice side is right, and to imagine a student raised to believe it is right, who is similarly wavered from his belief. In either case — whichever side is right — should we not greet with moral horror the student who is drawn away from what is true and right (whatever we take that to be), just as we would the student taught to doubt the wrongness of murder?

Therefore, Sportiello concludes, we should not teach students bioethics. Rather, we should teach them After Virtue, and when it comes to specific issues, instead of neutrally presenting all sides of an argument, we should reject the frameworks in which these arguments are commonly presented, and instead present the view that is true, and explain why it is true, and offer resources for combating the false arguments.

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This talk reveals what is perhaps the most dangerous impulse lurking beneath the MacIntyrean argument if it is not correctly understood: the one that is opposed to the Socratic method, and to the broader defenses of freedom and inquiry provided by liberal democratic states. I think the dangers are so obvious as to not be worth elucidating at length here — except to note that the genie is already out of the bottle: the ethical debates Sportiello is really interested in (such as abortion) are already underway in our society. And they remain unsettled just because, unlike on the question of murder, there are actual rival sides, and neither has yet offered arguments sufficient to convince every rational person.

This means that implementing the solution Sportiello prescribes would not be an act of philosophical restoration, but rather would be an entrenchment of the exercise of the will that Nietzsche and MacIntyre agree characterizes so much modern philosophical debate. More practically, attempting to eliminate pluralism and to force in its place the certitude Sportiello seeks would require either abandoning society for enclaves and sects, or moving away from our liberal attitudes about differing ways of life, and away from our tolerant attitudes toward free inquiry.

This doesn’t mean Sportiello isn’t on to something in his practical application of MacIntyre’s theory. There is something wrong, even dangerous, with that style of moral inquiry, so commonly found in ethics courses, that simply presents rival arguments on particular issues from a disinterested, ahistorical standpoint and asks students to decide.

But on the questions over which there is real dispute, telling (or “teaching”) students that one side is obviously right is not the only alternative. The better alternative is to offer students the resources to understand to the greatest degree possible each rival argument. But this crucially must involve not taking a disinterested, neutral standpoint, but rather following the Socratic method, and learning how each ethical viewpoint understands and attempts to answer the criticisms of the other. And, as MacIntyre so well shows, teaching rival ethical perspectives involves learning not only differing philosophies, but the distinct historical and social contexts from which these perspectives derive, and within which they are fully embodied. Any adequately articulated ethical perspective, after all, consists not just of a set of principles or propositions, but a way of being and living. Teaching this fuller form of philosophy and ethics is not a small task, but it is possible.

The preceding is my interpretation of what MacIntyre’s theories imply about the proper approach to conducting moral inquiry. But it is clear from this talk that MacIntyre has not adequately taken pains to emphasize how his approach actually requires a liberal society and a liberal methodology, even if it rejects liberalism as an account of morality itself. And it’s remarkable what a fine line there is in the takeaway from his argument between these two radically different conclusions about how we should regard liberalism.

(I should note that the conference audience last July also pounced on Sportiello and made many of these points. And he said he had not meant his talk the way we were taking it and was worried it might come across this way — though I still wasn’t clear after this on what he might have meant instead. So one should not necessarily take this post as a completely fair representation of and response to Sportiello’s argument — although he did publish a version of it as a column in the Notre Dame Observer a month later, and it appears consistent with my description here. [NOTE: See the end of this post for an exchange between myself and Mr. Sportiello about his talk.] Regardless, one could easily take MacIntyre’s work to the conclusions described here, and so it is crucial to respond to them.)

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As a postscript to MacIntyre’s account of moral inquiry, I would also contend that coming to the best conclusion in a moral debate requires not only understanding but sympathizing with each side of an argument. This is crucial to inhabiting rival views, to understanding why someone might not only rationally believe them but reasonably live according to them. The act of sympathy can become a rational basis for rejecting a viewpoint — and it ought to be considered a much better basis than one of lacking understanding, of bafflement.

It strikes me that this account tends already to support a skeptical view of the reflexively progressive impulse toward bioethics and biotechnology — the impulse that culminates in transhumanism. For (at the risk of overgeneralizing) it seems that transhumanists tend to meet their critics with bafflement. Transhumanists regard their rivals’ viewpoints as fundamentally irrational and superstitious, and their approach is more often to dismiss those arguments as such than to provide criticism based on a deep understanding of their rivals. By contrast, I think critics pretty well understand and sympathize with, and have offered coherent and charitable accounts of, the impulses and reasons motivating transhumanism.

Actually, it is closer to the truth to say that transhumanists and their critics fundamentally value different, and basically opposed, sets of goods. But transhumanists seem to reject their rival goods out of incomprehension — whereas the critics of transhumanism reject transhumanism because they understand all too well what it wants.

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ADDENDUM: Before publishing this post, I sent it to Mr. Sportiello to give him an opportunity to correct or clarify my account of his talk. The below is excerpted from our e-mail exchange.

Daniel Sportiello: I have now given my paper several times — and been misinterpreted several times: my audience at Providence, of which you were a member, took me to be a reactionary, for example, while my audience at Notre Dame took me to be a nihilist. No doubt these misinterpretations are my fault: I find, in the words of the poet, that it is impossible to say just what I mean. Nonetheless, let me try to articulate my thesis as clearly as brevity allows.

First, to repeat, I advocate teaching courses on After Virtue instead of courses on applied ethics — though any course on After Virtue must begin with a course on applied ethics in miniature. But we should teach them these common arguments only in order to immediately reveal their shallowness — the extent, that is, to which they depend upon premises that are without justification — and the culture of manipulation that results from that shallowness.

We should next teach them what men like Kant and Hume actually wrote — the grounding of autonomy in the normativity of theoretical and practical reason and the complementary role of sympathy and self-love in any explanation of the rise of civil society, respectively — before teaching them what really matters in all of this: an understanding of embodied rationality, deeply informed both by the practices of everyday life and by history, that would serve as the core of a tradition of rational inquiry that could be shown to be rationally superior to its rivals — who should be included, not excluded, from this conversation.

Ari N. Schulman: It’s important to point out the philosophical errors of common ethical debates. But the issues people discuss in medical ethics courses are there because they are of such pressing significance. So it seems you have to advance some positive argument about bioethical issues, even absent a revolution in philosophy or culture. People are going to have to contend with these issues — if not in an ethics course, then elsewhere.

So once you’ve taught students After Virtue, just how are you going to present them with those purportedly shallow arguments in favor of, say, abortion or euthanasia? Because the big problem with your talk as presented is that it sounds like you’re saying that you wouldn’t present them with those arguments at all — yet the arguments need a full and clear airing, whether to defend or refute them. The other problem is that if you’re truly following After Virtue, then you have to believe that you shouldn’t be teaching the common arguments against those practices, either — or rather, as you say in your talk, you have to present all of the common arguments about these practices as equally unjustified and manipulative. So you seem both to be saying that you shouldn’t teach any of the common arguments on these issues, and yet also that you should present only the right one. These two positions are of course hugely problematic on their own, but are also quite opposed to each other. So how then do you go about presenting and responding to these contemporary arguments about bioethical issues?

Daniel Sportiello: The version of my paper that you heard ended in a way that was intended to be punchy but succeeded only in being obscure. This obscurity is, it seems to me, reflected in your interpretation of my position, expressed in the paradoxical conclusion that “you shouldn’t teach any of the common arguments on these issues, and yet also that you should present only the right [arguments].” I admit this is contradictory — or would be, if “arguments” were taken in the same sense in both conjuncts. However, I do not mean for it to be so taken.

When “arguments” is taken in one sense, I affirm the first conjunct: one should not teach any of the common arguments, for or against, in applied ethics. This is because I, with MacIntyre, take these arguments to rest on incommensurable premises, each of which is shared only by a minority of those in our society; therefore, to teach any of the common arguments, for or against, would be to induct students into a practice of manipulation and to introduce unanswerable doubt into their hearts regarding matters of life and death. You are quite right, in other words, to think that my paper forbids teaching, for example, either the common argument for socialized medicine (citing utility) or the common argument against it (citing autonomy). And this applies to all of the arguments in applied ethics that are taken seriously within our emotivist culture: they should be presented only in order to show that they, and the whole practice of argumentation in which they find their home, are unsound.

When “arguments” is taken in the other sense, I affirm the second conjunct: one should teach the right arguments in applied ethics. But by “one should teach the right arguments,” I mean that one should build a whole new culture — one based not in manipulation and shallow arguments but rather upon the very deepest understanding of human practices, human nature, and human history. When you say, then, that I “have to advance some positive argument about bioethical issues, even absent a revolution in philosophy or culture,” I agree entirely: a revolution in philosophy and culture is exactly what I seek.

I know those who would put the point in this vocabulary: one should work to overthrow the Culture of Death and institute in its place the Culture of Life. Whatever one calls such a culture — one defined by its rejection of manipulation — one thing is quite clear: no one will be in doubt about the morality of issues like abortion, euthanasia, and capital punishment. Sound arguments against them would be fairly trivial deductions from a comprehensive view of our relation to the world and to ourselves — a comprehensive view, that is, of the point of human life. Indeed, it might be more accurate to say that questions regarding abortion, euthanasia, and capital punishment — if questioning implies honest perplexity about something — would not even arise. This could even be a litmus test for such a culture: it would not only answer such questions but, indeed, stop asking them altogether.

I hope that my tone comes across as one of goodwill rather than hostility: for what it is worth, I have come almost to regret ever giving this paper — one born less of any desire to make a bold claim than of my frustrations with teaching intelligent, eager students the sophistries of medical ethics. I never meant for it to sow the confusion that it did. For I take it that my position is not otherwise than that of a fairly orthodox MacIntyrean: the danger was not, in the words of the poet, that I would be refuted, but that I would not be understood.

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