The American Philosophical Association is undergoing a rancourous debate about a proposal to prevent various Protestant universites from advertising in the APA's paper, 'Jobs for Philosophers'. The argument is that since these universities ask their staff to live in accord with Christian norms, which exclude sex outside marriage, they discriminate against homosexuals. This kind of argument is becoming common.
A very helpful response has been put together by Mark Murphy, a Catholic philosopher at Georgetown University. It is interesting to note the leading role taken by Catholics to defend the right of institutions to follow a practice that no Catholic institution, as far as I know, would dream of adopting. These Protestant colleges, moreover, would as cheerfully have excluded Catholics as homosexuals a generation ago. But that, as they say, is not the point.
Dr Murphy's letter can be seen in full here; here's an interesting extract on the nature of discrimination.
First, there are reasons to believe that these institutions are not engaging in discrimination based on sexual orientation. The policy lacks a definition of discrimination. We suggest that it is plausible that satisfaction of any of the following conditions is sufficient to constitute discrimination, but satisfaction of at least one of them is necessary: (a) intentional targeting for burdening of the protected class; (b) burdening that is motivated by animus against the protected class; (c) burdening of the protected class that is disproportionate and not adequately justified. But none of these is satisfied in the case of the sexual conduct requirements at these Christian colleges. (If there is an alternative understanding of 'discrimination' not here considered under which these schools do discriminate, we ask that the defenders of the original petition bring it forward and defend its acceptability.)
(a) Those with a particular sexual orientation are not targeted. Employment is conditioned on one’s willingness to refrain from sexual conduct outside of traditional marriage; it is compatible with the satisfaction of this condition that one be of any sexual orientation, and no particular sexual orientation would be sufficient to meet the condition.
(b) There is no institutional animus toward those who are homosexually oriented; or, to put it more guardedly, no evidence at all of institutional animus toward those homosexually oriented has been brought forward. The norms of sexual conduct of the institutions in question are broad, reaching to various sorts of sexual conduct, both homosexual and heterosexual, and appear to be generally enforced as written. (If defenders of the original petition have evidence that these institutions' policies are being enforced in a way that provides evidence of institutional animus, we urge that they put it forward.)
(c) What will generate most contention is whether there is unjustified disproportionate burdening. Defenders of these schools’ policies will note that adherence to their policies on sexual conduct is justified by the job description, which is to contribute to the living of a Christian life in a specific sort of educational community. This way of life does in fact place different burdens on people; no doubt those who are homosexually oriented are burdened in a way that those heterosexually oriented are not. But we think that it is important that in the context of US discrimination law, and even in the context of the APA’s own norms, there is some deference given to the religious character of the institution — that these are schools that adopt the requirements for the conduct of their communal life from what they take to be divine revelation, and it is explicitly allowed by the APA policy for schools to make adherence to the faith statements of these schools, statements that include moral claims about the ordering of individual lives and communities, a condition of employment. When we add to this the fact that one's adherence to a certain faith affects what one counts as a 'burden' and what personal and social meaning those burdens have, it is, at best, an extraordinarily contentious claim to hold that these schools discriminate in the sense of placing a disproportionate burden without adequate justification. To put it another way: for the APA to defend the claim that there is unjustifiable burdening, the APA will have to endorse officially a certain disputed view on the ethics of marriage and human sexuality, and commit itself to the falsity of any view, secular or religious, that disagrees.
Saturday, April 11, 2009
The Pope on AIDS and condoms
My attention has been drawn to a very interesting article on Alligator online by Michael Webb, which goes into some detail about the research on the effectiveness of condoms. The Pope's claim that condoms 'make things worse' with the AIDS epidemic in Africa has overwhelming plausibility to those who have watched the failure of contraception to reduce so-called 'unwanted pregnancies', and, for that matter, ordinary sexually-transmitted diseases, in the West. If fire-hosing condoms at people doesn't reduce pregancies, it is not going to work with AIDS either. In fact we actually see an increase of pregnancies, and abortions, where contraceptives have been pushed at people; a similarly tragic consequence, one may infer, is likely to happen with AIDS. The fact that the advocates of condoms refuse to accept that this is happening, and insist the situation would be even worse without the condoms, just shows the blind attachment to ideology when you face ostracism and redundancy for dissent.
Why condoms might be counterproductive as preventers of pregnancies and AIDS is, intuitively, that promoting contraception promotes a culture of promiscuity, and the culture of promiscuity is actually not very friendly to putting those rubber things on just at the moment life is getting interesting. Webb, however, uncovers some very interesting research which not only supports the casual empiricism against condoms but gives a slightly different (though not conflicting) explanation, that of 'risk compensation'. When you make an activity safer, people performing the activity will take more risks with it: see 'The Pope was right' on the Cornell Society.
Everything we do is based on an assessment of benefit and risk. We have a certain appetite for risk (as they say in finance), and if something becomes safer, we'll tend to go for the extra benefits associated with taking on another slice of risk. This is really not controversial; the only question, in making things safer in any given situation, is whether the risk compensation will end up making the situation worse over all. It will depend on how much safer people are made to feel, and what the opportunities for greater risk-taking might be.
People in countries afflicted by AIDS are still willing to engage in promiscuous sex: hence AIDS continues to spread. Whatever the (perceived) risk they are running is, that is a level of risk they are happy to live with. If you give them condoms and they wear them 50% of the time, thinking that makes them 50% safer, they would rationally double their number of partners to get back up to the old level of risk. The reward of doing this, of course, is fantastic: twice as many partners! There may, of course, be other factors.
So much for the principle. But this is exactly what many researchers have found. Over to Michael Webb:
Webb points out that the studies making this point are fairly limited in number: no surprise there, since this is not a conclusion the AIDS industry wants to hear. He also points out that there is agreement accross the debate that IF condoms were used 'consistently and correctly', and IF behaviour didn't change, then condoms would help with AIDS: true, but irrelevant.
More interstingly, Webb makes the odd conclusion that 'the Pope should not make claims that can be interpreted as being scientific.' This is odd because he adds that the Pope's remarks were interpreted as making a claim not supported by the evidence. But the body of Webb's article has shown that it is perfectly scientifically respectable to hold that view; it may not be the view of the WHO but there is plenty of evidence for it, and the WHO is not infallible.
A deeper reason for Webb's criticism of the Pope, however, is that the Pope's position is, or ought to be, really a matter of moral teaching: against promiscuity, and against contraception. Webb seems to think that if this was made clearer, criticism of the Pope would have less traction.
It is true that the Pope's position is driven by moral concerns, and the moral teaching of the Church. But it is because voicing this moral teaching has been condemned as tantamount to mass murder - as Jon Snow gently put it, the Pope is responsible for 'millions of deaths' - that it become necessary to look into the claims being made about the effectiveness of condoms.
Catholic reseachers and all people of good will can and must refute the lies which are used to justify crimes. The Nazi genocide was unjustifiable, but people were persuaded to go along with it on the basis of grotesque lies about the Jews. The Church has had to contend with 'black legends' in every age; the work of the Bollandists on Church history is an example of her response. It is true that even if they were successful, condoms would not be justified, but the Pope in concerned to influence opinion and policy, and the lies must be opposed.
The idea that Catholics should leave the 'facts' in the hands of their opponents to distort at will only has to be stated to be rejected.
Why condoms might be counterproductive as preventers of pregnancies and AIDS is, intuitively, that promoting contraception promotes a culture of promiscuity, and the culture of promiscuity is actually not very friendly to putting those rubber things on just at the moment life is getting interesting. Webb, however, uncovers some very interesting research which not only supports the casual empiricism against condoms but gives a slightly different (though not conflicting) explanation, that of 'risk compensation'. When you make an activity safer, people performing the activity will take more risks with it: see 'The Pope was right' on the Cornell Society.
Everything we do is based on an assessment of benefit and risk. We have a certain appetite for risk (as they say in finance), and if something becomes safer, we'll tend to go for the extra benefits associated with taking on another slice of risk. This is really not controversial; the only question, in making things safer in any given situation, is whether the risk compensation will end up making the situation worse over all. It will depend on how much safer people are made to feel, and what the opportunities for greater risk-taking might be.
People in countries afflicted by AIDS are still willing to engage in promiscuous sex: hence AIDS continues to spread. Whatever the (perceived) risk they are running is, that is a level of risk they are happy to live with. If you give them condoms and they wear them 50% of the time, thinking that makes them 50% safer, they would rationally double their number of partners to get back up to the old level of risk. The reward of doing this, of course, is fantastic: twice as many partners! There may, of course, be other factors.
So much for the principle. But this is exactly what many researchers have found. Over to Michael Webb:
Dr Edward Green, Director of the AIDS Prevention Research Project at Harvard. “The best evidence we have”, he says, “supports the Pope’s comments. There is a consistent association shown by our best studies between greater availability and use of condoms and higher (not lower) HIV infection rates.” He told me:
In epidemics that are population wide, where most HIV is found in the general population, for whatever reason we can't get people to use condoms consistently, and when they use them at all, that seems to have the effect of disinhibiting people's behaviours so they end up taking greater sexual risks and cancelling whatever risk reduction they have gotten from the technology they're using.
Webb points out that the studies making this point are fairly limited in number: no surprise there, since this is not a conclusion the AIDS industry wants to hear. He also points out that there is agreement accross the debate that IF condoms were used 'consistently and correctly', and IF behaviour didn't change, then condoms would help with AIDS: true, but irrelevant.
More interstingly, Webb makes the odd conclusion that 'the Pope should not make claims that can be interpreted as being scientific.' This is odd because he adds that the Pope's remarks were interpreted as making a claim not supported by the evidence. But the body of Webb's article has shown that it is perfectly scientifically respectable to hold that view; it may not be the view of the WHO but there is plenty of evidence for it, and the WHO is not infallible.
A deeper reason for Webb's criticism of the Pope, however, is that the Pope's position is, or ought to be, really a matter of moral teaching: against promiscuity, and against contraception. Webb seems to think that if this was made clearer, criticism of the Pope would have less traction.
It is true that the Pope's position is driven by moral concerns, and the moral teaching of the Church. But it is because voicing this moral teaching has been condemned as tantamount to mass murder - as Jon Snow gently put it, the Pope is responsible for 'millions of deaths' - that it become necessary to look into the claims being made about the effectiveness of condoms.
Catholic reseachers and all people of good will can and must refute the lies which are used to justify crimes. The Nazi genocide was unjustifiable, but people were persuaded to go along with it on the basis of grotesque lies about the Jews. The Church has had to contend with 'black legends' in every age; the work of the Bollandists on Church history is an example of her response. It is true that even if they were successful, condoms would not be justified, but the Pope in concerned to influence opinion and policy, and the lies must be opposed.
The idea that Catholics should leave the 'facts' in the hands of their opponents to distort at will only has to be stated to be rejected.
Monday, January 19, 2009
Licit cooperation with evil
Here it is, in Poland (hat-tip to the Hermeneutic of Continuity).
The window can be opened from the outside. A person with a baby the parents are unable or unwilling to care for can pop the baby in and make themselves scarce. The baby will be scooped up by nuns on the other side and looked after. This is a modern version of a long-standing practice; in former times convents would sometimes have a wheel set horizontally into the wall like a dumb waiter: put the baby on the wheel, turn it so it goes inside, the baby is cared for and the parent or whoever remains anonymous.
Is it cooperation with evil? Of course: it is an extremely grave sin for a parent to abandon a child, even when the child's prospects are not too bad. The existence of these windows facilitates this abandonment, by ensuring that there will be no legal sanction against the abandoning parent. (Neglect and of course killing of children is illegal: normally abandonment would be at least neglect and probably killing.)
Furthermore, not only are these windows providing a specific mechanism for a person who wishes to commit this sin, but by making the sin easier and eliminating the legal risk they will certainly be making it more common, if only fractionally.
It is not wrong, however, to provide the window. The nuns' intention is conditional: that a person seriously considering abortion, infanticide or abandonment use the window instead, and perform a less serious sin with far less bad consequences for the baby. They do not intend that anyone abandon a child, any more than a person providing fire-extinguishers intends there to be a fire in which they might be used. Given that the provision of the window is a merely material, not formal (intended) cooperation with evil, it can be justified by reference to its consquences, including the possible scandal it might cause. Since the motivation of the nuns is clear enough, there is not likely to be scandal; nor does it seem likely that the existence of the windows will increase the number of times people abandon (or murder) their infants to the point where the scheme becomes the cause of greater harms than of good.
In this way it is a far clearer example of licit cooperation with evil than other putative examples, such as needle-exchange schemes for drug addicts, the provision of drugs themselves to adicts, or the distribution of condoms.
The window can be opened from the outside. A person with a baby the parents are unable or unwilling to care for can pop the baby in and make themselves scarce. The baby will be scooped up by nuns on the other side and looked after. This is a modern version of a long-standing practice; in former times convents would sometimes have a wheel set horizontally into the wall like a dumb waiter: put the baby on the wheel, turn it so it goes inside, the baby is cared for and the parent or whoever remains anonymous.Is it cooperation with evil? Of course: it is an extremely grave sin for a parent to abandon a child, even when the child's prospects are not too bad. The existence of these windows facilitates this abandonment, by ensuring that there will be no legal sanction against the abandoning parent. (Neglect and of course killing of children is illegal: normally abandonment would be at least neglect and probably killing.)
Furthermore, not only are these windows providing a specific mechanism for a person who wishes to commit this sin, but by making the sin easier and eliminating the legal risk they will certainly be making it more common, if only fractionally.
It is not wrong, however, to provide the window. The nuns' intention is conditional: that a person seriously considering abortion, infanticide or abandonment use the window instead, and perform a less serious sin with far less bad consequences for the baby. They do not intend that anyone abandon a child, any more than a person providing fire-extinguishers intends there to be a fire in which they might be used. Given that the provision of the window is a merely material, not formal (intended) cooperation with evil, it can be justified by reference to its consquences, including the possible scandal it might cause. Since the motivation of the nuns is clear enough, there is not likely to be scandal; nor does it seem likely that the existence of the windows will increase the number of times people abandon (or murder) their infants to the point where the scheme becomes the cause of greater harms than of good.
In this way it is a far clearer example of licit cooperation with evil than other putative examples, such as needle-exchange schemes for drug addicts, the provision of drugs themselves to adicts, or the distribution of condoms.
Tuesday, August 05, 2008
Humanae Vitae
Letter published in the Catholic Herald, Julty 25th 2008.
Sir,
I enjoyed Quentin de la Bedoyere’s interview with Professor John Marshall (Features, 18th July), a member of the commission which vainly recommended to Pope Paul VI that he change the Church’s teaching on contraception. Particularly amusing was the suggestion that the faithful have not ‘received’ this teaching, as if Christ should, when faced by a rejection of his teaching by many of his followers (John 6.66), have reconsidered it, or as if St Paul, anticipating an audience who ‘would not endure sound doctrine’ (2 Timothy 4.3), would recommend giving them unsound doctrine instead. It is one of the most remarkable works of providence in modern times that Paul VI was able to overcome the pressure from this commission, and other sources, to exercise faithfully his role, which was that of a teacher, not a weathervane.
Two well-known and closely related arguments are relevant here. First, the unitive value of the sexual act in marriage is dependent upon its procreative potential, since it is in becoming, or being open to becoming, a single procreative principle, that the couple is drawn together. Second, sexual self-giving in marriage is incomplete when procreation is artificially excluded, since in that case one or both the partners is holding something fundamental back: he or she is not giving him or herself wholly, but excluding his or her fertility.
These arguments, which are at least implicit in Humanae Vitae sections 8 and 9, have been set out with great clarity since then, notably in the work of Karol Wojtyla, both before and after his election as Pope John-Paul II. Far from it being the case, as Professor Marshall affects to think, that there are no Natural Law arguments for the Humanae Vitae position, I am not aware of any other arguments, compatible with artificial contraception, which explain the unitive role of the marital act.
Yours,
Joseph Shaw
Sir,
I enjoyed Quentin de la Bedoyere’s interview with Professor John Marshall (Features, 18th July), a member of the commission which vainly recommended to Pope Paul VI that he change the Church’s teaching on contraception. Particularly amusing was the suggestion that the faithful have not ‘received’ this teaching, as if Christ should, when faced by a rejection of his teaching by many of his followers (John 6.66), have reconsidered it, or as if St Paul, anticipating an audience who ‘would not endure sound doctrine’ (2 Timothy 4.3), would recommend giving them unsound doctrine instead. It is one of the most remarkable works of providence in modern times that Paul VI was able to overcome the pressure from this commission, and other sources, to exercise faithfully his role, which was that of a teacher, not a weathervane.
Two well-known and closely related arguments are relevant here. First, the unitive value of the sexual act in marriage is dependent upon its procreative potential, since it is in becoming, or being open to becoming, a single procreative principle, that the couple is drawn together. Second, sexual self-giving in marriage is incomplete when procreation is artificially excluded, since in that case one or both the partners is holding something fundamental back: he or she is not giving him or herself wholly, but excluding his or her fertility.
These arguments, which are at least implicit in Humanae Vitae sections 8 and 9, have been set out with great clarity since then, notably in the work of Karol Wojtyla, both before and after his election as Pope John-Paul II. Far from it being the case, as Professor Marshall affects to think, that there are no Natural Law arguments for the Humanae Vitae position, I am not aware of any other arguments, compatible with artificial contraception, which explain the unitive role of the marital act.
Yours,
Joseph Shaw
Wednesday, January 30, 2008
CFFC attack on conscientious objection
Catholic For a Free Choice campaigns for abortion; it has been condemned by the US Catholic Bishops' Conference; see the information here. It is currently seeking to undermine the role of 'conscience clauses', clauses in laws or contracts of employment which allow anyone with an objection to abortion to refrain from cooperating in it. They make an extended argument in their pamphlet 'In Good Conscience: Respecting the Beliefs of Health-Care Providers and the Needs of Patients', available here.
The argument can be summarised as follows:
1. Conscience is sacred.
2. When a doctor/nurse/pharmacist declines to hand over pills/perform an operation which a patient desires (presumably in good conscience), the patient's conscience is 'negated' (p12). There ought to be 'deference to the conscience of others' (p9).
3. Doubt is cast on the possibility that the medical employee is himself acting in good conscience, by suggesting that in refusing to hand over abortifacients or perform abortions they are merely following the orders of their Catholic hospital or of the Catholic hierarchy (p.10).
4. Even if the conflict between the patient and the medic can be seen as a conflict between two consciences, the way to resolve the matter is for a Catholic (or any other) hospital to 'serve as a facilitator of all consciences': i.e. to let the conscience-afflicted medic to step aside from the case and replace him with a more flexible colleague. Presumably the original medic's cooperation here will be required (p.13).
From a Catholic point of view (the document is at pains to present itself as based on Catholic principles), this argument is bizarre.
On (2): conscience relates to the agent's actions, or to what they ask or agree to have done to them. If a woman (sincerely, conscientiously) wanting an abortion is refused one by a Catholic doctor, this is not parallel to the situation of a (sincere, conscientious) doctor whose employer seeks to overcome his reluctance to perform abortions by threats. In the latter case, an attempt is being made to get a person to act against his conscience; in the former case, one free agent is declining to cooperate in the proposed action of another free agent.
CFFC's refusal to see the doctor as a free agent in this situation is puzzling. The suggestion seems to be that since the doctor has the knowledge and the equipment necessary for an abortion, he is under an obligation to perform one to anyone who asks. But no doctor is under an obligation to give patients the treatment they ask for: it is the doctor's role to determine what treatment is appropriate; the role of the patient's conscience is to refuse to submit to treatments the patient thinks are wrong. The patient may be deluded or obsessive about his medical interests; in the case of abortion, the conscientious Catholic doctor will not conclude that abortion is in the interests of either the mother or her unborn baby.
On the one hand CFFC wants to say that abortion is simply part of normal medical treatment; but on the other hand, they are claiming that it has a special status in which the patient, uniquely, takes the initiative and the doctor is a mere technician who must obey or risk violating a right. But the mere fact that abortion is legal under certain circumstances does not mean that anyone has a 'right' to it.
On 3. There is no reason to suppose that Catholic medics who pay attention to the Church's teaching are not thinking for themselves. In a society where abortion is commonplace and socially acceptable, anyone who is reflective enough to accept the Church's arguments, based on Natural Law, against abortion is taking a courageous stand against the current. The role of Church teaching in clarifying our thinking on moral matters is part of the development of the 'formed conscience', a phrase absent from CFFC's discussion. This is obviously what Church teaching is for: what else is it for? On the other hand, the conscience of women who ask for abortions may well be distorted by the refusal of secular society to think the issue through, and above all by pressure from family and friends. This is not a good example of a conscientious decision.
On 4. First, a medic who, faced with a request for abortion, calls in a colleague to carry it out, is cooperating with abortion. If abortion is wrong, then this is wrong. If a hospital asks him to do this, it is asking him to act against his conscience.
Second, hospitals exist to further the health of their patients. If a hospital chooses to reject that role, and become places where women can dispose of unwanted members of their families, they are not being 'neutral' about anything, but evil. Such a hospital clearly could not call itself 'Catholic'.
In summary: it is never right for any doctor to give any patient treatment which the doctor thinks will harm the patient (unless a medical intervention is necessary to help for example an unborn baby), however sincere the patient might be in asking for it. It is also wrong for any doctor to arrange for such treatment to be given to the patient by another doctor. Equally, it would be wrong for any doctor to give a patient treatment which the patient refuses to consent to. To override the doctor's judgment or the patient's consent by coercing them to act or be treated against their wishes is to violate their autonomy and freedom of conscience. This has got nothing to do with religious belief; these are principles of Natural Law which protect the consciences of everyone.
The argument can be summarised as follows:
1. Conscience is sacred.
2. When a doctor/nurse/pharmacist declines to hand over pills/perform an operation which a patient desires (presumably in good conscience), the patient's conscience is 'negated' (p12). There ought to be 'deference to the conscience of others' (p9).
3. Doubt is cast on the possibility that the medical employee is himself acting in good conscience, by suggesting that in refusing to hand over abortifacients or perform abortions they are merely following the orders of their Catholic hospital or of the Catholic hierarchy (p.10).
4. Even if the conflict between the patient and the medic can be seen as a conflict between two consciences, the way to resolve the matter is for a Catholic (or any other) hospital to 'serve as a facilitator of all consciences': i.e. to let the conscience-afflicted medic to step aside from the case and replace him with a more flexible colleague. Presumably the original medic's cooperation here will be required (p.13).
From a Catholic point of view (the document is at pains to present itself as based on Catholic principles), this argument is bizarre.
On (2): conscience relates to the agent's actions, or to what they ask or agree to have done to them. If a woman (sincerely, conscientiously) wanting an abortion is refused one by a Catholic doctor, this is not parallel to the situation of a (sincere, conscientious) doctor whose employer seeks to overcome his reluctance to perform abortions by threats. In the latter case, an attempt is being made to get a person to act against his conscience; in the former case, one free agent is declining to cooperate in the proposed action of another free agent.
CFFC's refusal to see the doctor as a free agent in this situation is puzzling. The suggestion seems to be that since the doctor has the knowledge and the equipment necessary for an abortion, he is under an obligation to perform one to anyone who asks. But no doctor is under an obligation to give patients the treatment they ask for: it is the doctor's role to determine what treatment is appropriate; the role of the patient's conscience is to refuse to submit to treatments the patient thinks are wrong. The patient may be deluded or obsessive about his medical interests; in the case of abortion, the conscientious Catholic doctor will not conclude that abortion is in the interests of either the mother or her unborn baby.
On the one hand CFFC wants to say that abortion is simply part of normal medical treatment; but on the other hand, they are claiming that it has a special status in which the patient, uniquely, takes the initiative and the doctor is a mere technician who must obey or risk violating a right. But the mere fact that abortion is legal under certain circumstances does not mean that anyone has a 'right' to it.
On 3. There is no reason to suppose that Catholic medics who pay attention to the Church's teaching are not thinking for themselves. In a society where abortion is commonplace and socially acceptable, anyone who is reflective enough to accept the Church's arguments, based on Natural Law, against abortion is taking a courageous stand against the current. The role of Church teaching in clarifying our thinking on moral matters is part of the development of the 'formed conscience', a phrase absent from CFFC's discussion. This is obviously what Church teaching is for: what else is it for? On the other hand, the conscience of women who ask for abortions may well be distorted by the refusal of secular society to think the issue through, and above all by pressure from family and friends. This is not a good example of a conscientious decision.
On 4. First, a medic who, faced with a request for abortion, calls in a colleague to carry it out, is cooperating with abortion. If abortion is wrong, then this is wrong. If a hospital asks him to do this, it is asking him to act against his conscience.
Second, hospitals exist to further the health of their patients. If a hospital chooses to reject that role, and become places where women can dispose of unwanted members of their families, they are not being 'neutral' about anything, but evil. Such a hospital clearly could not call itself 'Catholic'.
In summary: it is never right for any doctor to give any patient treatment which the doctor thinks will harm the patient (unless a medical intervention is necessary to help for example an unborn baby), however sincere the patient might be in asking for it. It is also wrong for any doctor to arrange for such treatment to be given to the patient by another doctor. Equally, it would be wrong for any doctor to give a patient treatment which the patient refuses to consent to. To override the doctor's judgment or the patient's consent by coercing them to act or be treated against their wishes is to violate their autonomy and freedom of conscience. This has got nothing to do with religious belief; these are principles of Natural Law which protect the consciences of everyone.
Monday, November 26, 2007
Catholicism and Acupuncture
Fr Timothy Finnigan, Parish Priest of Blackfen and blogger, wrote on acupuncture and Catholicism in his regular column in the Catholic Herald, 16/11/07, concluding:
A Catholic ought to be sure that their therapist is not committed, in their therapy and advice, to promoting a world view that is incompatible with Christianity. If there is any doubt about this at all, it would be better to steer clear of acupuncture.
I wrote a reply which was published in full in the 23/11/07 edition, as follows:
Sir,
Fr Finigan is quite correct to point out that acupuncture is based on a medical 'model' related to Taoism, a philosophy incompatible with Catholic teaching. It should also be remembered that conventional Western medicine is based on a medical model which takes the philosophy of materialism for granted. This philosophical outlook is held by the great majority of researchers and practitioners, and has many implications for medical practice. Like Taoism, it is incompatible with Catholic teaching.
As well as being impractical, it would seem unnecessary for ordinary Catholic patients to worry about the metaphysical commitments of their doctors. All medical models are imperfect; treatments based on imperfect models can still have good results; prudence directs us to the doctors best at curing disease, not the ones best at philosophy or theology. The focus of moral attention, on the other hand, should be on whether a doctor is giving concrete advice lacking in the moral dimension, as when materialist doctors propose to treat the unborn or the dying without the respect due to human persons. It is far from clear that medical traditions based on Eastern philosophies such as Taoism are worse off, in this respect, than traditions based on home-grown absurdities such as materialism.
Indeed, not even a medical tradition rooted in Catholicism, such as the 'humours' theory used in Medieval and Early Modern Europe, is immune to manipulation by immoral doctors. Ben Johnson and Nicolo Macchiavelli both wrote plays lampooning doctors who recommended sex (if necessary, outside marriage) as an aid to health. The compatibility of the medical model with Church teaching at a metaphysical level does not guarantee the compatibility of a practioner's advice with the Church's teaching on a practical, moral, level.
Yours,
Joseph Shaw
A Catholic ought to be sure that their therapist is not committed, in their therapy and advice, to promoting a world view that is incompatible with Christianity. If there is any doubt about this at all, it would be better to steer clear of acupuncture.
I wrote a reply which was published in full in the 23/11/07 edition, as follows:
Sir,
Fr Finigan is quite correct to point out that acupuncture is based on a medical 'model' related to Taoism, a philosophy incompatible with Catholic teaching. It should also be remembered that conventional Western medicine is based on a medical model which takes the philosophy of materialism for granted. This philosophical outlook is held by the great majority of researchers and practitioners, and has many implications for medical practice. Like Taoism, it is incompatible with Catholic teaching.
As well as being impractical, it would seem unnecessary for ordinary Catholic patients to worry about the metaphysical commitments of their doctors. All medical models are imperfect; treatments based on imperfect models can still have good results; prudence directs us to the doctors best at curing disease, not the ones best at philosophy or theology. The focus of moral attention, on the other hand, should be on whether a doctor is giving concrete advice lacking in the moral dimension, as when materialist doctors propose to treat the unborn or the dying without the respect due to human persons. It is far from clear that medical traditions based on Eastern philosophies such as Taoism are worse off, in this respect, than traditions based on home-grown absurdities such as materialism.
Indeed, not even a medical tradition rooted in Catholicism, such as the 'humours' theory used in Medieval and Early Modern Europe, is immune to manipulation by immoral doctors. Ben Johnson and Nicolo Macchiavelli both wrote plays lampooning doctors who recommended sex (if necessary, outside marriage) as an aid to health. The compatibility of the medical model with Church teaching at a metaphysical level does not guarantee the compatibility of a practioner's advice with the Church's teaching on a practical, moral, level.
Yours,
Joseph Shaw
Friday, November 23, 2007
Genetic Enhancements: reply to Savalescu
My talk at the inaugaral meeting of the Wolfson Applied Philosophy Society, chaired by Dr Francine Baker. My paper responds in general terms to an article by Professor Julian Savalescu of the Oxford Uehiro Centre for Practical Ethics which can be read here (pdf).
Gene Therapy and Genetic Enhancement
For example, it is morally problematic when governments propose to sterilise or castrate or lobotomise mentally retarded or mentally ill or simply morally bad persons for social reasons. It is problematic when governments regard political dissidents as mentally ill, and confine them to insane asylums. It is problematic when a person suffering from ‘Body Integrity Disorder’ asks a surgeon to amputate his healthy limb. It is problematic in all these cases because medical treatment is being given to people other than with a view to their restoration to health, or to the prevention of disease.
To take the first of these examples, when governments sterilise the mentally disabled, this is usually condemned for two reasons. First, the patient is not in a position to consent. Second, the procedure is not in the medical interests of the patient—it is not aiming at their restoration to health. On the contrary, an aspect of the patient which is functioning normally, healthily, is subjected to a procedure designed to prevent it functioning healthily. Even if consent could make this kind of thing permissible, in this case consent is lacking.
It should be noted that the fact that patient is not in a position to consent makes it all the more important to make sure medical treatment is medically required. This principle is clearly going to be applicable to embryos and young children subjected to genetic enhancement.
In certain cases consent can make a non-therapeutic procure permissible. Giving blood would be an example. But where a serious and permanent harm is done to the health of a patient, other than to restore the patient to health (as when a gangrenous limb is amputated), consent does not seem to be sufficient to make it permissible. This is the case with Body Integrity Disorder. Those who want limbs amputated just because they suffer from an unfortunate desire, are refused treatment by conscientious doctors, because the treatment would do nothing to restore them to health.
The patient believes that the treatment would make him happier. The medical establishment replies that this belief is itself part of a mental illness. The patient may insist that he is mentally fine, and the doctor should get on with it. We have a disagreement here, and it is important to note that both sides are obliged to appeal, not simply to the importance of satisfying preferences, but to an objective notion of health. Such disputes have raged about homosexuality: is it a medical condition, or, as the jargon has it, a way of being normal? A view has to be taken if we are to decide what treatment is appropriate or permissible.
What was wrong about the Soviet practice of confining dissidents to looney bins is that the dissidents were not truly mentally ill. The claim that they were, according to some strange Marxist-Leninist psychological theory, was simply implausible. Such claims have to be examined and debated, if they are to be used to justify medical treatment. Professor Savalescu apparently believes that we can talk about medical practice without talking about the concept of health, but he is wrong.
Savalescu draws on a series of examples which appear to make unclear the point I have tried to make clear. Food supplements to improve mental abilities, for example, and plastic surgery, do not seem to be attempts to restore health, but surely, he seems to be saying, they are not impermissible. In response, one may ask whether food supplements fall under the concept of medical treatment at all; there may be borderline cases here, of course. But insofar as we regard them as medical treatment, we can regard their function as properly medical, that is, as giving the patient a better state of health, of healthy functioning. There is no question at all, in such cases, of impairing function, of mutilation, which is the opposite of restoring health.
In the case of plastic surgery, what we have is a medical intervention which frequently does not seem to have the normal justification, of restoring health, unless having a large nose, or small breasts, is regarded as a disability, and not just a way of being normal. It may be that this is indeed how it is regarded by the patients, at least in conjunction with their own attitudes to their bodies. They may be wrong; they may be suffering from something parallel to Body Integrity Disorder. It may be better for the medical profession to offer counselling, rather than surgery, to perfectly healthy people seeking plastic surgery, as opposed to car crash or burns victims. On the other hand, it is clearly not such a serious matter as the examples I gave earlier, since there is normally no loss of function where plastic surgery is concerned. My aim here is not to settle the matter, but to point out that argument here is possible.
So, let us apply the principles I have been developing to the case of gene therapy. Gene therapy is a medical intervention; since it has permanent effects, which may be irreversible, it is a serious matter and demands serious justification. The justification it needs, like all medical intervention, is a medical justification, which is to say that it restores or preserves health. Thus, if a person had a genetic disorder which impaired life expectancy or function, and if this could be cured by gene therapy, whether this involved addition or subtraction or modification of genes, then it would seem, in principle, the therapy is justified. If a person had a gene for homosexuality—to use one of Savalescu’s examples—then intervention to remove that gene would be justified if, and only if, homosexuality is regarded as a disability, and not as a way of being normal. And so on with the other cases.
So it seems that gene therapy would not be justified in order to enhance intelligence or vital statistics, unless one were able to argue, and argue successfully, that without the therapy the person would be suffering from poor health, limited functioning, disability. Evidently such arguments would be successful in certain cases. Equally evidently, the demand for medical justification would prevent the kind of genetically enhanced utopia Savalescu seems to have in mind.
Part II
Let me now present in a different way the argument I have set out. It would be possible to imagine a medical profession that saw itself in an entirely technical light. Doctors would exist solely to do what patients asked them to do. They know how to bring about various effects on the human body, for good or ill, and they would do those things on request. Sometimes this would involve restoring health, and sometimes destroying it. Sometimes saving a diseased limb, sometimes cutting off a healthy one. This kind of medical profession would be the one ready to do Savalescu’s bidding. Perhaps the practice of plastic surgery has been leading the medical profession in this direction, but cases like Body Integrity Disorder show that we are not there yet.
What cases like Body Integrity Disorder show is that medicine is not merely a body of technical knowledge, like plumbing, but a value-laden enterprise. It is necessarily connected with the concept of health, which is a normative concept. Part of the understanding which doctors have to acquire is an understanding of what health is, which is part of an understanding of what is good for people, what is in their interests. Patients certainly have autonomy, notably the right to refuse treatment, but they rely on doctors not only for technical information, but for an evaluation of their options. If the medical profession became a purely technical matter, doctors would become mere technicians. That is not our image of doctors, nor theirs of themselves. It would be a degrading change. As things stand, doctors are answerable to their own professional evaluations; this means they must have the right to refuse to carry out inappropriate treatment.
Here’s a parallel we in this room should understand. People engaged in academic study are not merely gaining a body of useful technical knowledge; that would not be academic study. We are engaged in an essentially value-laden enterprise, connected with truth and professional judgement. Academic conclusions should have academic justification, which is to say justification in terms of reasoned argument; they cannot be justified by their convenience or money-value. There is something appalling about the idea of an academic who deliberately falsifies his own conclusions, regardless of the reason. Normally we can rely on academics’ sense of their own dignity to prevent this. Academia would be pointless if we did all our studies but didn’t undertake a proper evaluation of the results. We are answerable to our own professional evaluation of the material we are working with. For a serious academic to argue for whatever conclusions those paying him preferred would be a kind of prostitution, and he would immediately cease to be viewed by others as a serious academic. For the whole of academia to go down that road would be the complete degradation of the profession. This is not a Utilitarian argument, but it is nevertheless a consideration Professor Savalescu, as an academic, would ignore at his peril.
Just as the work of academics is essentially value-laden, the central value being truth, or, if you prefer, the exercise of academic judgement, so the work of doctors is essentially value-laden, where the central value is health, or the medical good of the patient. The idea that this might be reducible to the patient’s own preferences would be news to the whole branch of medicine, psychology, whose stock in trade is the changing of patients’ preferences. I have not articulated what the concept of health amounts to; it is enough to point out that there is such a concept, and that it has this role.
Given that there is such a concept, and that doctors make use of it in their evaluations of what treatment is appropriate, it should be clear that it will never be permissible to make serious medical interventions to healthy people. It may be possible to make the strong stronger or the clever cleverer, but that is not what medicine is for. The fact that this would satisfy the preferences, or assumed preferences, of the patient is an insufficient justification; that does nothing to provide the medical justification which is needed for a medical intervention.
Part III
This conclusion may seem mysterious. Medicine is governed by certain values internal to itself which prevents it from being as useful to others as it might be. The same is true of academia: academics worthy of the name do not manipulate their conclusions to further even worthy goals of social policy. But this seems less mysterious. For an academic who honestly thought one thing, and said another in public, would be lying, and it is a familiar enough idea that there is a moral constraint against lying. What is the moral constraint at the basis of a doctor’s refusal to make medical interventions other than with a view to restoring health?
I would propose that the answer is that there is a moral constraint here, most familiarly known as a constraint against mutilation. I put it in this cautious way because the cases we have may not look at first glance like cases of mutilation; what I am suggesting is that, properly understood, the constraint behind the limits of medical practice, which is very clear in classic cases of mutilation, is sufficiently broad to cover the cases we are focusing on here. Accordingly I propose to use the word ‘mutiliation’ in a broad sense.
One easy way to express what is wrong with sterilising the mentally disabled is that it is a case of mutilation. The way I have been expressing it is that the medical intervention has no medical justification, which would be justification in terms of restoring the patient to health. My suggestion is that the two ways of putting it are equivalent; they are interdefinable. Medical interventions without medical justifications are mutilations. We may raise the scalpel against, or give potions and drugs to, our fellow human beings only with a view to the cure or prevention of disease of the patient. To do so otherwise is wrong; it is akin to assault, battery, and mutilation. I think the moral intuition here is clear enough; stipulatively, for convenience, I will call the forbidden action mutilation. So the next question will be: is it plausible to characterise genetic enhancement, when lacking a medical justification, as mutilation in my broad sense?
First of all, let me clarify the meaning of mutilation. Normally, mutilation leaves the victim worse off, but this need not be so. Cutting off a healthy limb for no good reason is obviously mutilation. Would it cease to be mutilation if victim was fulfilling the condition necessary to gain a vast sum of money, leaving him overall better off? Of course it would; we would then ask whether the mutilation was worth it, or was morally justified by it. Like the ugly sisters in the un-Disnified version of the Cinderalla story, who cut of parts of their feet in order to get them into the magic slipper, we can see that there is a moral problem with this. This is not the way we should treat our bodies.
Now consider prosthetic limbs. These have been getting better and better. It will not be long before a prosthetic leg will actually be better than the usual healthy natural leg; perhaps this is so already. Let us suppose it is indeed so. Would it be right for a person to allow either or both of his healthy natural legs to be removed, in order to be fitted with souped up prosthetic legs, as we might say, bionic legs? Again, our moral intuitions are against this. By all means, let the unfortunate souls who lose their legs on land mines or in any other way get the best prosthetic limbs money can buy; but it would not be right to cut off a healthy limb to enjoy the benefits of an artificial one.
Our genes are part of our bodies. This is perhaps something we have to learn; it is not obvious, just by looking at us, but it must be so. Given the moral constraint on mutilation, it follows that it would be wrong to remove parts of our DNA to replace them with others, artificial or borrowed, supposed to be preferable, without medical justification. The moral constraint against mutilation is the protection morality gives to our physical integrity; it is the moral implication of the value, the moral importance, of the human body. Too often ethics limits itself to the moral implications of the value of life, or pleasure, but few if any philosophers defend the view that these are the only things of moral importance. So just as the value of life has the implication that we may not kill, without certain limited kinds of justification, so the value of the body has the implication that we cannot invade or disarrange it, without certain limited kinds of justification. The violation of the constraints protecting life is murder; the violation of the constraints protecting the body is mutilation.
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