By: Mohamed Sesay,
on 10/4/2015
This October, the OUP Philosophy team are highlighting German social and political theorist Karl Heinrich Marx (5 May 1818 – 14 March 1883) as their Philosopher of the Month. Known as the founder of revolutionary communism, Marx is credited as one of the most influential thinkers for his theoretical framework, widely known as Marxism.
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By: Alex Guyver,
on 3/22/2015
Morality is a funny thing. On the one hand, it stands as a normative boundary – a barrier between us and the evils that threaten our lives and humanity. It protects us from the darkness, both outside and within ourselves. And it structures and guides our conception of what it is to be good (decent, honorable, honest, compassionate) and to live well.
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By: Mohamed Sesay,
on 10/12/2014
Since its advent in the early 1970s, bioethics has exploded, with practitioners’ thinking expressed not only in still-expanding scholarly venues but also in the gamut of popular media. Not surprisingly, bioethicists’ disputes are often linked with technological advances of relatively recent vintage, including organ transplantation and artificial-reproductive measures like preimplantation genetic diagnosis and prenatal genetic testing. It’s therefore tempting to figure that the only pertinent reflective sources are recent as well, extending back — glancingly at most — to Immanuel Kant’s groundbreaking 18th-century reflections on autonomy. Surely Plato, who perforce could not have tackled such issues, has nothing at all to contribute to current debates.
This view is false — and dangerously so — because it deprives us of avenues and impetuses of reflection that are distinctive and could help us negotiate present quandaries. First, key topics in contemporary bioethics are richly addressed in Greek thought both within Plato’s corpus and through his critical engagement with Hippocratic medicine. This is so regarding the nature of the doctor-patient tie, medical professionalism, and medicine’s societal embedment, whose construction ineluctably concerns us all individually and as citizens irrespective of profession.
Second, the most pressing bioethical topics — whatever their identity — ultimately grip us not on technological grounds but instead for their bearing on human flourishing (in Greek, eudaimonia). Surprisingly, this foundational plane is often not singled out in bioethical discussions, which regularly tend toward circumscription. The fundamental grip obtains either way, but its neglect as a conscious focus harms our prospects for existing in a way that is most thoughtful, accountable, and holistic. Again a look at Plato can help, for his handling of all salient topics shows fruitfully expansive contextualization.
Regarding the doctor-patient tie, attempts to circumvent Scylla and Charybdis — extremes of paternalism and autonomy, both oppositional modes — are garnering significant bioethical attention. Dismayingly given the stakes, prominent attempts to reconceive the tie fail because they veer into paternalism, allegedly supplanted by autonomy’s growing preeminence in recent decades. If tweaking and reconfiguration of existing templates are insufficient, what sources not yet plumbed might offer fresh reference points for bioethical conversation?
Prima facie, invoking Plato, staunch proponent of top-down autocracy in the Republic, looks misguided. In fact, however, the trajectory of his thought — Republic to Laws via the Statesman — provides a rare look at how this profound ancient philosopher came at once to recognize core human fallibility and to stare firmly at its implications without capitulating to pessimism about human aptitudes generally. Captivated no longer by the extravagant gifts of a few — philosophers of Kallipolis, the Republic’s ideal city — Plato comes to appreciate for the first time the intellectual and ethical aptitudes of ordinary citizens and nonphilosophical professionals.
Human motivation occupies Plato in the Laws, his final dialogue. His unprecedented handling of it there and philosophical trajectory on the topic warrant our consideration. While the Republic shows Plato’s unvarnished confidence in philosophers to rule — indeed, even one would suffice (502b, 540d) — the Laws insists that human nature as such entails that no one could govern without succumbing to arrogance and injustice (713c). Even one with “adequate” theoretical understanding could not properly restrain himself should he come to be in charge: far from reliably promoting communal welfare as his paramount concern, he would be distracted by and cater to his own yearnings (875b). “Adequate” understanding is what we have at best, but only “genuine” apprehension — that of philosophers in the Republic, seen in the Laws as purely wishful — would assure incorruptibility.
The Laws’ collaborative model of the optimal doctor-patient tie in Magnesia, that dialogue’s ideal city, is one striking outcome of Plato’s recognition that even the best among us are fallible in both insight and character. Shared human aptitudes enable reciprocal exchanges of logoi (rational accounts), with patients’ contributing as equal, even superior, partners concerning eudaimonia. This doctor-patient tie is firmly rooted in society at large, which means for Plato that there is close and unveiled continuity between medicine and human existence generally in values’ application. From a contemporary standpoint, the Laws suggests a fresh approach — one that Plato himself arrived at only by pressing past the Republic’s attachment to philosophers’ profound intellectual and values-edge, whose bioethical counterpart is a persistent investment in the same regarding physicians.
If values-spheres aren’t discrete, it’s unsurprising that medicine’s quest to demarcate medical from non-medical values, which extends back to the American Medical Association’s original Code of Medical Ethics (1847), has been combined with an inability to make it stick. In addition, a tension between the medical profession’s healing mission and associated virtues, on the one side, and other goods, particularly remuneration, on the other, is present already in that code. This conflict is now more overt, with rampancy foreseeable in financial incentives’ express provision to intensify or reduce care and to improve doctors’ behavior without concern for whether relevant qualities (e.g., self-restraint, courage) belong to practitioners themselves.
“As Plato rightly reminds us, professional and other endeavors transpire and gain their traction from their socio-political milieu”
Though medicine’s greater pecuniary occupation is far from an isolated event, the human import of it is great. Remuneration’s increasing use to shape doctors’ behavior is harmful not just because it sends the flawed message that health and remuneration are commensurable but for what it reveals more generally about our priorities. Plato’s nuanced account of goods (agatha), which does not orbit tangible items but covers whatever may be spoken of as good, may be helpful here, particularly its addressing of where and why goods are — or aren’t — cross-categorically translatable.
Furthermore, if Plato is right that certain appetites, including that for financial gain, are by nature insatiable — as weakly susceptible to real fulfillment as the odds of filling a sieve or leaky jar are dim (Gorgias 493a-494a) — then even as we hope to make doctors more virtuous via pecuniary incentives, we may actually be promoting vice. Engagement with Plato supports our retreat from calibrated remuneration and greater devotion to sources of inspiration that occupy the same plane of good as the features of doctors we want to promote. If the goods at issue aren’t commensurable, then the core reward for right conduct and attitudes by doctors shouldn’t be monetary but something more in keeping with the tier of good reflected thereby, such as appreciative expressions visible to the community (a Platonic example is seats of honor at athletic games, Laws 881b). Of course, this directional shift shouldn’t be sprung on doctors and medical students in a vacuum. Instead, human values-education (paideia) must be devotedly and thoughtfully instilled in educational curricula from primary school on up. From this vantage point, Plato’s vision of paideia as a lifelong endeavor is worth a fresh look.
As Plato rightly reminds us, professional and other endeavors transpire and gain their traction from their socio-political milieu: we belong first to human communities, with professions’ meaning and broader purposes rooted in that milieu. The guiding values and priorities of this human setting must be transparent and vigorously discussed by professionals and non-professionals alike, whose ability to weigh in is, as the Laws suggests, far more substantive than intra-professional standpoints usually acknowledge. This same line of thought, combined with Plato’s account of universal human fallibility, bears on the matter of medicine’s continued self-policing.
Linda Emanuel claims that “professional associations — whether national, state or county, specialty, licensing, or accrediting — are the natural parties to articulate tangible standards for professional accountability. Almost by definition, there are no other entities that have such ability and extensive responsibility to be the guardians of health care values — for the medical profession and for society” (53-54). Further, accountability “procedures” may include “a moral disposition, with only an internal conscience for monitoring accountability” (54). On grounds above all of our fallibility, which is strongly operative both with and absent malice, the Laws foregrounds reciprocal oversight of all, including high officials, not just from within but across professional and sociopolitical roles; crucially, no one venue is the arbiter in all cases. Whatever the number of intra-medical umbrellas that house the profession’s oversight, transparency operates within circumscribed bounds at most, and medicine remains the source of the very standards to which practitioners — and “good” patients — will be held. Moreover, endorsing moral self-oversight here without undergirding pedagogical and aspirational structures is less likely to be effective than to hold constant or even amplify countervailing motivations.
As can be only briefly suggested here, not only the themes but also their intertwining makes further bioethical consideration of Plato vastly promising. I’m not proposing our endorsement of Plato’s account as such. Rather, some positions themselves, alongside the rich expansiveness and trajectory of his explorations, are two of Plato’s greatest legacies to us — both of which, however, have been largely untapped to date. Not only does reflection on Plato stand to enrich current bioethical debates regarding the doctor-patient tie, medical professionalism, and medicine’s societal embedment, it offers a fresh orientation to pressing debates on other bioethical topics, prominent among them high-stakes discord over the technologically-spurred project of radical human “enhancement.”
Headline image credit: Doctor Office 1. Photo by Subconsci Productions. CC BY-SA 2.0 via Flickr
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By: Raquel Fernandes,
on 9/16/2014
Imagine a possible world where you are having coffee with … Aristotle! You begin exchanging views on how you like the coffee; you examine its qualities – it is bitter, hot, aromatic, etc. It tastes to you this way or this other way. But how do you make these perceptual judgments? It might seem obvious to say that it is via the senses we are endowed with. Which senses though? How many senses are involved in coffee tasting? And how many senses do we have in all?
The question of how many senses we have is far from being of interest to philosophers only; perhaps surprisingly, it appears to be at the forefront of our thinking – so much so that it was even made the topic of an episode of the BBC comedy program QI. Yet, it is a question that is very difficult to answer. Neurologists, computer scientists and philosophers alike are divided on what the right answer might be. 5? 7? 22? Uncertainty prevails.
Even if the number of the senses is a question for future research to settle, it is in fact as old as rational thought. Aristotle raised it, argued about it, and even illuminated the problem, setting the stage for future generations to investigate it. Aristotle’s views are almost invariably the point of departure of current discussions, and get mentioned in what one might think unlikely places, such as the Harvard Medical School blog, the John Hopkins University Press blog, and QI. “Why did they teach me they are five?” says Alan Davies on the QI panel. “Because Aristotle said it,” replies Stephen Fry in an eye blink. (Probably) the senses are in fact more than the five Aristotle identified, but his views remain very much a point of departure in our thinking about this topic.
Aristotle thought the senses are five because there are five types of perceptible properties in the world to be experienced. This criterion for individuating the senses has had a very longstanding influence, in many domains including for example the visual arts.
Yet, something as ‘mundane’ as coffee tasting generates one of the most challenging philosophical questions, and not only for Aristotle. As you are enjoying your cup of coffee, you appreciate its flavor with your senses of taste and smell: this is one experience and not two, even if two senses are involved. So how do senses do this? For Aristotle, no sense can by itself enable the perceiver to receive input of more than one modality, precisely because uni-modal sensitivity is what according to Aristotle identifies uniquely each sense. On the other hand, it would be of no use to the perceiving subject to have two different types of perceptual input delivered by two different senses simultaneously, but as two distinct perceptual contents. If this were the case, the difficulty would remain unsolved. In which way would the subject make a perceptual judgment (e.g. about the flavor of the coffee), given that not one of the senses could operate outside its own special perceptual domain, but perceptual judgment presupposes discriminating, comparing, binding, etc. different types of perceptual input? One might think that perceptual judgments are made at the conceptual rather than perceptual level. Aristotle (and Plato) however would reject this explanation because they seek an account of animal perception that generalizes to all species and is not only applicable to human beings. In sum, for Aristotle to deliver a unified multimodal perceptual content the senses need to somehow cooperate and gain access in some way to each other’s special domain. But how do they do this?
A sixth sense? Is that the solution? Is this what Aristotle means when talking about the ‘common’ sense? There cannot be room for a sixth sense in Aristotle’s theory of perception, for as we have seen each sense is individuated by the special type of perceptible quality it is sensitive to, and of these types there are only five in the world. There is no sixth type of perceptible quality that the common sense would be sensitive to. (And even if there were a sixth sense so individuated, this would not solve the problem of delivering multimodal content to the perceiver, because the sixth sense would be sensitive only to its own special type of perceptibles). The way forward is then to investigate how modally different perceptual contents, each delivered by one sense, can be somehow unified, in such a way that my perceptual experience of coffee may be bitter and hot at once. But how can bitter and hot be unified?
Modeling (metaphysically) of how the senses cooperate to deliver to the perceiving subject unified but complex perceptual content is another breakthrough Aristotle made in his theory of perception. But it is much less known than his criterion for the senses’ individuation. In fact, Aristotle is often thought to have given an ad hoc and unsatisfactory solution to the problem of multimodal binding (of which tasting the coffee’s flavor is an instance), by postulating that there is a ‘common’ sense that somehow enables the subject to perform all the perceptual functions that the five sense singly cannot do. It is timely to take a departure form this received view which does not pay justice to Aristotle’s insights. Investigating Aristotle’s thoughts on complex perceptual content (often scattered among his various works, which adds to the interpretative challenge) reveals a much richer theory of perception that it is by and large thought he has.
If the number of the senses is a difficult question to address, how the senses combine their contents is an even harder one. Aristotle’s answer to it deserves at least as much attention as his views on the number of the senses currently receive in scholarly as well as ‘popular’ culture.
Headline image credit: Coffee. CC0 Public Domain via Pixabay
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