Tuesday, December 05, 2006

What are people for?

Against conventional theodicies, and above all against a culture that has lost its way, where its answer to the question, "What are people for?" is, “For autonomy and control, for health and beauty, for performance and productivity,” Professor Young has lodged a considerable critique. Human beings, she says, are made for friendship, and human communities are made for hospitality. And it would seem to be the vocation of so-called disabled people to take this gospel to so-called indepedent, fit, and achieving folk.
- Kim Fabricus

The always thought-provoking Kim Fabricus recently posted this here. And it got me thinking, obviously. I've written on the idea of disability before, as it pertains to abortion, and I've commented on it at Truth or Vanity as it pertains to the passive euthanasia of children. And I realized that, beneath what I flatter myself is an eloquent veneer is really the clash of ideologies. And I have been allowing myself to be convinced of the essential utility of a Darwinist perspective as it relates to ethics. The veneer of rhetoric allowed me to ignore the essentials of what I was saying.

Darwinism may well explain some things as biology, but as a philosophy, it is pernicious. It may indeed be the best case for the existence of God that we are still here, since left to our own devices, we tend to extend survival of the fittest to an all consuming selfishness that will destroy us. I am leaving aside the question of biology for now, because my subject, medicine, is really the spiritual side of biology. And if Darwinism is carried to its logical conclusion, there is no spiritual side to anything, except in the abstract complexity equals spirit formulations of Ursula Goodenough and her ilk. (A good friend of mine pretends to buy into this, but I think deep down he doesn't believe it.) Medicine deals with biology, but the best physicians are at least partly, if not primarily concerned with what effect biology has on the person as a person, not as a collection of homeostatic reactions.

What I'm driving at is what I've written at the top of my sidebar: "Without faith, without poetry, without music, medicine is pointless, for why save a life which is not special, and why dedicate so much effort to a cosmic accident? It would be worse than pointless, it would be cruel." In considering that life, which is so much more than a cosmic accident, the question that titles this post arises: what are people for? And relying on Darwinism, we have no answers that allow us to simultaneously affirm our rarified convictions and disapprove of mass murder of weaker individuals. Unfortunately, Darwin and Bentham are behind most of medical ethical reasoning. It is simply not possible to consistently affirm an empiricist, evolutionary perspective and also affirm the existence of evil as anything more than an opinion.

It seems to me then, to effectively function in a medical environment without becoming jaded or cynical, one must have a strong perception of "what people are for" underlying every action. And though I have assumed that my Christianity undergirded my reasoning, it seems I have been allowing some degree of Darwinism as well. This is worked into our training surreptitiously, and probably not intentionally in most cases. Since doctors play god, they become used to making value judgments about life and death which may not properly be the sphere of their control.

The problem is that, in the big picture, we need Bentham in medicine. There are a finite amount of medical resources, and those resources must be rationed. The question of how best to do that occupies numerous graduate theses and pet theories around the world. And I'm not sure what the answer is. Some of my more detail-oriented professors have stated that medical policy is not the purview of the physician, and we instead ought to solely be advocates for our patients, working to the get the most effective treatment for them at all times. Others insist we need to be mindful of the costs of the procedures we order, and the lives we expend effort in saving, because of the need for rationing. While I do not want to address the macro-scale subject of rationing now, the consideration of life and advocacy properly belongs here.

My conviction is that yes, Prof. Young is right. Humans are created, at least partly, for friendship and hospitality, not for some naturally selected drive to reproduce and leave as many beautiful, strong, autonomous descendants behind as possible. But if we approach medicine from that latter perspective, we will be unable to maintain hope in the face of despair. After all, if your life and work are merely prolonging the inevitable for the sake of the unworthy, it would be impossible to fend off despondency. If Prof. Young's perspective is true, then every action within that life and work serves the purpose of your life and work, making every moment and gesture meaningful, and every life precious. I don't think this perspective is possible to maintain outside of faith. At the same time, advocacy for a patient does not, and cannot always mean working to extend the quantity of their life. A balanced perspective, and a thorough understanding of what makes life meaningful must root all medical decisions. And that understanding is impossible to achieve, in cases where the person's capabilities with life are different from your own, without a more inclusive perspective than Darwin gives us. More than simply inclusive, we need a perspective which recognizes the essentially spiritual nature of mankind, a nature which makes him above the animals, more than simple biology, and worth preserving despite disabilities.

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