Saturday, February 17, 2007

Medical Ethics

I'm very glad that Alonzo Fyfe isn't a doctor: "If I were a doctor, I would not help my patients obtain treatment that I found to be morally objectionable."

Fyfe comments illustrate very clearly the danger of the fantasy of moral objectivism. A physician has an enormous amount of power over her patients. Allowing her to use that power to impose her own moral beliefs on her patients is very troubling.

Fyfe is correct, in a sense: If moral statements were indeed objective truths, then the ethical contract we currently expect from physicians, that they will treat us to our own benefit, and not theirs, is obviously absurd (similarly absurd would be the ethical contract that lawyers will represent their clients' interests, not their own). If moral statements were objective truths, then it would just as absurd to ask a physician to respect any of our moral beliefs as it would be to ask him to respect our beliefs about treatment contrary to good scientific practice.

Epistemic fuzziness cannot rescue us here. Just as the mean of the sample collected is always the best estimate of the population mean, our beliefs about the truth are always the best estimate we have of the actual truth. Even when a physician is wrong about what actually is the best treatment, she still has an obligation to treat us as according to her best understanding of scientific medicine. Likewise, if moral statements are actually true, a physician would be obliged to implement her moral beliefs as her best estimate of moral truth.

My previous physician was fairly upfront about being an evangelical Christian. It's not true of all evangelical Christians, but many do in fact consider atheism to be deeply and dangerously immoral. Should I thus not have trusted her to give me good medical advice according to my own well-being?

Of course, all of the above is predicated on moral statements really being objectively truth-apt. But they're not, of course--or at least no one has discovered any basis for knowing the specific objective truth of any moral statement. Objectivists such as Fyfe seem always to gloss over this little detail:
I know full well that there are theories that hold that moral statements have no truth value. I have no space in this posting to refute those theories.
They never have space, and they seem to phrase their assertion in terms of refuting subjectivism. This refutation typically consists of, "Everybody thinks that moral statements are objectively true, therefore the burden of proof is on the subjectivist to prove they're not." Of course, it's impossible to prove that there definitely isn't some unknown epistemic basis that could support moral objectivism. The objectivist thus is vindicated: We are entitled to consider our moral beliefs as the best estimate of objective truth even without any sort of epistemic basis to actually do so.

Fyfe will naturally object that he has an epistemic basis. I've been reading him for years, mostly on Internet Infidels: He's a very nice guy, always earnest and serious, but I'm frankly unimpressed with his "desire utilitarianism". I'll be taking a closer look at this philosophy in later posts.


  1. To put it simply, there is fact, and there is fiction.

    Any moral claim that is not an (objective) fact, is a fiction. And fiction has absolutely no place in medical diagnosis.

    Yet, if all moral claims are fiction, and has no place in medicine, then what does this say about the doctor's so called obligations with respect to his treatment of patients?

  2. There are also subjective facts: opinions, preferences, desires, etc. as well as moral beliefs. These are facts about human minds. They may reference objective facts, facts about the mind-independent world, but their full content is not objectively true, only subjectively true.

  3. I do not consider these to be "subjective facts" in any meaningful sense.

    Certainly, we have beliefs and desires. However, these are physical states like our height, blood pressure, or age. They do not reflect any type of reality outside of the objective reality that makes up the real world.

    Opinions Opinions are beliefs. A person can be of the opinion that the earth is less than 10,000 years old. That is his opinion. He happens to be wrong. Because this is his opinion, he will act as if this is true. However, reality is rather stubborn, and he is at risk of his beliefs about the world coming into painfully sharp conflict with how the world is.

    We have desires as well. I have a fondness for chocolate. That fondness for chocolate is nothing more or less than a disposition to make the proposition, "I am eating chocolate" true. I also have pulse, a blood pressure, and an age. My disposition to make or keep the chocolate-eating proposition true is 'subjective' in exactly the same way that my height, weight, age, pulse, and blood pressure are 'subjective'.

    Preferences are relationships among desires. If A will fulfill more and/or stronger desires that I have than B, then I prefer A to B. (I may believe or be of the opinion that I prefer A to B if what I believe of A will fulfill more and stronger desires than what I believe of B. But this opinion, like all opinions, can be mistaken. The question is whether A will, in fact, fulfill more and stronger desires than B).

    In order to discuss any of these entities, I do not need to say anything other than objectively true propositions. That which has no explanatory or predictive power we can cut from our ontology (by Occam's Razor). This "content" that is outside of objective truth is one such entity.

  4. I don't think you're doing anything here but muddying the distinction between subjective facts, facts about individual minds, and objective facts, mind-independent facts.

    The task of moral objectivism is, in my mind, not to simply redefine the subjective in an objective way but to prove moral facts which I should believe because they are true independently of my beliefs, not because they are elaborate restatements of my existing beliefs.

    No one has to argue to me what my emotions, beliefs and desires are; they are simply facts which I know directly.

    If you don't want to use clear, simple language to describe uncontroversial facts which people obviously know, that's your prerogative, I suppose. But turgidity and obfuscation are no substitute for philosophical depth or intellectual rigor.

  5. Let me add this too, from my earlier post Meta-Ethical Subjective Relativism, part 1:

    Yes, to a scientific materialist such as myself, minds are abstract entities that can be reduced to complicated states of neurons and brain chemicals. Since neurons and brain chemicals are not minds, this would be objective sort of talk. So we can talk about people's minds in a subjective sense or their brains in an objective sense--no big deal... If one is going to be anal-retentive or annoyingly particular, one could call MESR an "objectivist" theory, since according to materialistic reductionism, properties of minds supervene more-or-less directly on objective neurological states. I strongly suspect this supervenience does in fact obtain, but even so it's a distinction without a difference.

    We can, as scientists and philosophers, deal with multiple levels of abstraction. All restatements of subjective beliefs in objective terms are merely distractions from the fundamental point that subjectivism entails dependence on particular kinds of facts, whether they are stated explicitly as properties of minds or indirectly as physical properties on which subjective properties directly supervene.

  6. Actually, I hold that the distinction was muddied long before I got here.

    Subjectivism is a theory that gains its attractiveness because it gives an agent permission to consider his or her own likes and dislikes as "moral truth." It is, for all practical purposes, a theory that says, "I like it that people do X; therefore, everybody has an obligation to do X."

    It does so by interpreting 'subjective' facts as special types of facts that make this type of inference legitimate.

    Subjectivists use this inference persistently. However, it is not valid.

    Moral facts are, indeed, facts about brain states and states of affairs in the world. However, they are not facts about the brain states of the agent (or of the assessor, in the case of assessor-subjectivism). They are facts about the states that exist, and the states of the agent are only a subset of the states that exist.

    The vast majority of the brain states that exist are, external to and quite independent of the brain states of the agent/assessor, making moral facts one of the facts that a person cannot acquire by focusing his attention inwards. He actually has to study the world 'out there' - a world that contains brain states other than his own.

    The idea that one can infer from one's own emotions what is morally right and wrong is naturally attractive. It effectively makes it impossible for the agent to make any type of moral mistake (since moral conclusions are drawn directly from what the agent finds appealing).

    Some will take these claims as merely expressing personal dislike over the practice of inferring moral conclusions from personal sentiment. Yet, the objection is more than that. The objection is that the inference is invalid - that moral claims and personal sentiment claims do not occupy the same logical space in public discourse. The subjectivist inference is invalid.

  7. I agree that the subjective/objective distinction was muddied long before you and I (or our great-grandparents) appeared on the scene. Well, then, it is all that much more important for us to clear it up.

    Subjectivism is... a theory that says, "I like it that people do X; therefore, everybody has an obligation to do X."

    Perhaps some views of subjectivism, but not all, and certainly not mine. Subjective facts are indeed "special" (as they are subjective), but the naive inference you describe is certainly not the only inference that can be drawn.

    My view of meta-ethical subjective relativism does indeed recognize all subjective facts, not just those held by some individual. On the other hand, there is a certain degree of asymmetry, especially in practice: my own states are--to some extent--privileged just because they are mine. There is both a causal privilege (only my own subjective facts are actual proximate causes of my own behavior) as well as some degree of moral privilege (which requires a more elaborate explanation and justification than I can provide here).

    The idea that one can infer from one's own emotions what is morally right and wrong is naturally attractive.

    Taken in the sense that I (charitably) think you intend, this is a bad inference of long-discredited theories. Meta-ethical subjective relativism rejects this sort of inference on first principles: A moral statement cannot ever have a truth-value without specific reference to subjective facts. Full stop. Even if that statement was somehow inferred from subjective states.

    The objection is that the inference is invalid - that moral claims and personal sentiment claims do not occupy the same logical space in public discourse.

    I think the sort of naive subjectivism you describe is incorrect for a far more principled reason: It permits obvious logical contradictions.

    The "logical space in public discourse", however, is not a matter of truth but of framing. As philosophers, we are no more obliged to uncritically accept frames of discussion than we are to accept illogical or unworkable definitions, however blessed by custom and tradition.

    Although not explicit, I'm getting a sense that there is also some degree of ambiguity creeping into our discussion on another level: the distinction between ethics and meta-ethics. I am, at present, focusing almost exclusively by title and content on the meta-ethical level: what ethical theories in general are about, and what they mean.


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