Are ‘Medical Ethics’ Possible? – Dr Paul Tyson

Thoughts on the Science/Metaphysics/Theology/Ethics Matrix


from Luke’s Journal Dec 2018 | Vol 23 No 3

Francis Bacon
Francis Bacon

Modern health professionals devote their working lives to a deeply humanitarian and compassionate vocation.

At a practical level, a vision of the dignity of all people and a commitment to giving life-affirming aid to their bodily needs defines the health vocations. Applied ethics – intelligently serving one’s neighbour in the interests of their good – is integral to the practice of modern medicine. And obviously, medical science is one of the great wonders gifted to us from the scientific revolution. Yet the question of whether there can be a consistent theoretical science of medical ethics, whether complex questions of right and wrong in relation to life and death can be reasonably ‘solved’, whether there are effective medical technologies that should not be used, etc., is the question of whether medical ethics as a theoretical discipline is even possible. Because the relationship between theory and practice is unavoidable, questions about theory are not simply theoretical.

In this brief piece I wish to provocatively argue that medical ethics is not presently theoretically possible. This is why we can’t solve basic problems in medical ethics. Or, if we do solve them, they are solved in a pragmatic, morally solipsistic and majoritarian manner – such as the continuous ‘advance’ in the legalisation of abortion. There is something about how we understand the interactive matrix of knowledge, reality, transcendence, and goodness that makes medical ethics an intractable theoretical minefield. This, I contest, has a lot to do with the success and nature of modern science itself – the knowledge frame in which medical practice is deeply embedded.

Significantly, modern science is embedded in Christian theology from its outset. If you go back to Francis Bacon in the late 16th century, advancing the practical use of experimental knowledge for improving the lot of humanity was seen by him as an important theological duty. To Bacon, Man takes up the image of God by exercising sovereign power over nature, the realm of authority and control divinely given to us. We gain power over nature through knowledge.

“Modern medical knowledge… is today embedded in a scientific method that validly prides itself on being useful to humanity and yet invalidly thinks of itself as being a knowledge enterprise that is entirely distinct from theological beliefs and philosophical speculations.”

So scientific advance is, to Bacon, an eschatological mission bringing the dangerous and unpredictable forces of nature under our mastery. We lost this mastery at the Fall, but we can regain it by experimentally uncovering the operational secrets of nature and then bending her energies to our own interests. Through applied science we will no longer be the slave of pitiless and fickle natural necessities.

This eschatological doctrine secularised over time and became the idea of Progress in the 18th and 19th centuries. Indeed, with the rise of a strident materialist atheism from the mid 19th century, scientific advance itself became a realised eschatology without God or heaven in the minds of some increasingly influential Progressive voices. In our day, Richard Dawkins is in this proud Progressive tradition. History is a strange thing: thus does avant-garde 16th century eschatologically-defined science evolve into populist atheism.

Let us swing from theology to philosophy

Bacon and the famous Royal Society set of enterprising mathematico-experimental thinkers that followed him, had a strong dislike for metaphysics. Anything to do with the Aristotelian natural philosophy which had developed over the previous four-hundred years – still powerfully active in Cambridge and Oxford during the 17th century – was considered hopelessly mired in scholastic metaphysics and superstitious theology. To our early modern scientists, arcane medieval philosophy integrated with complex sacramental theology simply got in the way of doing experiments to see how nature actually worked.

English Protestantism created an easy escape from medieval Roman Catholic theology, and the re-discovery of ancient atomism provided a conveniently serviceable approach to reality that was compatible with the new mechanistic and pragmatic experimental knowledge. Any alternative to Aristotle was hungrily explored. Pyrrho, Democritus, Lucretius, Sextus Empiricus; these ancient sceptics, atomists, atheists and hedonists gained a deeply interested audience in the 17th and 18th centuries.

Treating nature as if reality is only composed of atoms, motion, and void, suited the new physics, and served the need to disregard every assigned magical or inherent meaning to nature that might interfere with experimental curiosity or exploitative enterprise.

“It is a significant feature of the history of the 17th century that taking Aristotle’s non-material, non-mechanistic categories out of our vision of reality got modern science into the air.”

In contrast, to Aristotle, intellective, qualitative and purposive realities are – with matter – primary features of nature. It is a significant feature of the history of the 17th century that taking Aristotle’s non-material, non-mechanistic categories out of our vision of reality got modern science into the air.

I should also point out that a theological innovation in the 16th century – the doctrine of natura pura – made it religiously safe to embrace ancient materialist atomism as a means of discounting intellective and qualitative realities as natural. The theological sensibilities that prevailed in the 17th century separated a supernatural realm discretely from the natural realm, such that one could be a good Christian and treat nature as a purely material entity. God was still highly significant within general thinking about nature in the early modern period, but in a specific role. God was becoming a distant lawmaker whose laws could be understood by mathematics as the unbreakable regularities of nature. God was no longer the Grounds of Being in which creation itself subsists, but God was a separate Supreme Being, in “heaven”, that other place which has no contact with purely natural nature.

Thus modernity makes it possible to be a good theist in religion at the same time as being a functional materialist in science. Within this discrete nature and discrete supernature trajectory, the Deist’s God – the cosmic and impersonal watchmaker who fashioned and wound nature up, and then withdrew from nature to heaven – grew in popularity from the 17th century.

Knowledge is power

I’m giving you this very brief history of the genesis of modern science for a few reasons. Firstly, we should remember that from the beginning modern science was theologically embedded. Secondly, modern science embraced ancient atomist metaphysical commitments that define nature as purely material. Thirdly, modern science is pragmatic from the start – ‘knowledge is power’. Modern medical knowledge arises out of this history and is today embedded in a scientific method that validly prides itself on being useful to humanity and yet invalidly thinks of itself as being a knowledge enterprise that is entirely distinct from theological beliefs and philosophical speculations.

This history creates the distinctive framework of ethical difficulties faced in modern medicine. A secularised eschatology and a materialist metaphysics are the theological and philosophical foundations of modern science. As science developed as the primary truth discourse of modernity, the Christian ethical foundations of Western culture became background to the sheer instrumental power of modern science. As a result, we now treat nature in a reductively materialist manner such that intellective, qualitative and transcendent categories are excluded from knowledge and practical reality. Our ethical framework has shifted strongly in a utilitarian direction – now only pleasure defines good and only pain defines bad. But what if the theology and metaphysics that underpin modern science are wrong?

Consider this shocking suggestion: when it comes to the metaphysical status of the intellective, the qualitative and the purposive, Aristotle is right. They really do exist, as part of nature. Let me push even further into ‘the Dark Side.’ Deism, where God is the Supreme Being, and the doctrine of natura pura, are deeply theologically problematic – indeed, obviously wrong – from the standpoint of New Testament-grounded Christian theology.

I am an academic who works in the ‘science and religion’ arena. There is a very fine institute that works in this arena, run by first-rate scientists who are also devout and largely evangelical Christians. Let us call one scientist working there, whom I have high respect for, Bill. The fact is, Bill is deeply suspicious of Christian theologians who step into his scientific field of expertise. Bill, when discussing one of our mutual friends – let us call him Neil – told me he could work with Neil, even though Neil had gone over to ‘the Dark Side.’ What he means by this is that even though Neil has a PhD in a science, Neil is no longer an active scientist because he also completed a PhD in theology, and now thinks about science through his theological lens.

This is a matter of genuine delicacy

If you are a good scientist, or a good applied practitioner of a modern science – such as a medical doctor – and a Christian, then having a theologian or a philosopher raise fundamental issues about modern science itself will likely fly like a lead balloon.

I appreciate the sort of concerns Bill has. What, after all, would a theologian (other than rare people like Neil) know about the present state of scientific knowledge? And then – as Bill sees it – Christian faith has a bad name among some serious scientists because seemingly ‘fruitcake’ doctrinally-driven rejections of well-demonstrated scientific truth – Bill has Young Earth Creationists in mind here – can be loudly advocated as essential to Christian faith. From Bill’s perspective, this makes things very hard for a sensible Christian appreciation of science to be put forward within the scientific community and to the broader educated public.

So Bill reflexively takes any theological critique of modernity as an ignorant critique of modern science – as, if he cannot understand the critique, irrational post-modern mumbo jumbo, or as anti-science fundamentalism. So an enlightened affirmation of the compatibility of good science with good Christian faith is best done by respected scientists who are sensible modern Christians, but not theologians. Hence, Neil has been seduced by the ‘Dark Side.’

“If you are a good scientist, or a good applied practitioner of a modern science – such as a medical doctor – and a Christian, then having a theologian or a philosopher raise fundamental issues about modern science itself will likely fly like a lead balloon.”

Whilst I have genuine sympathy for Bill, and for Christian doctors who compassionately serve God in serving the medical needs of their patients within a largely utilitarian framework of medical ethics, I think there really are serious theological and philosophical problems with modern science, and hence with the very structure of medical ethics.

The scientific perspective only treats measurable and observable material phenomena as real. To this knowledge framework, value – as found in any qualitative and moral judgement – does not have any real existence as value, it only exists as a subjective belief or a social norm. So all ‘moral truths’ are subjective belief states, not knowledge, and they are real only as culturally relative and legally relative social norm constructions.

Now you personally may subjectively believe in intrinsic human dignity, and this may influence what you think about the nature and meaning of suffering, life, death and human dignity etc., and about what makes a good doctor. That is acceptable within the parameters of the prevailing moral and legal norms of our society, but these are not matters that science and objective truth can have any say on, and they cannot – as personal values – shape institutionally-endorsed substantive ethical commitments, or policies and procedures. For, if we accept atomistic materialism as a valid way of understanding nature, and if we accept the secular demarcation of subjective beliefs from objective facts, then ethics itself is simply the prevailing legally actionable norms. If this is so, then forget rigorous reasoning about qualitative truths – let’s just take a vote.

Photo of scientists in lab

If we want to think of the intellective – soul, mind, thought, reason – as a real feature of nature, if we want to think of value – beauty, truth, goodness – as a real feature of nature, and if we want to think that immanence is always ‘haunted’ by transcendence, then this is going to throw a serious spanner in the cogs of using modern science as our primary truth discourse.

Frankly, the greater instrumental power that science has delivered to us, the more addicted to mere power we have become. There are many things which – if we thought of moral qualities as in some sense, real features of nature, or as transcendently inflected realities – we should not have done with our science and technology. For example, the development of chemical, biological and nuclear weapons; the degradation of global climate balances as seen in the depletion of Arctic ice due to the astonishing rise of ‘dirty’ power in the age of modern technology; mass species extinctions; the rampant technologically-enabled exploitation of cheap natural resources and labour; ever growing (though ‘offshore’) global pollution. But the fact is, ethics itself is outside of the ‘realism’ that governs pragmatic power in the technological age. This is because of our modern materialist metaphysics, our amoral epistemology, and our residual, if secularised, theology of the divine right to human power over nature.

To conclude

I am writing this brief article for a Christian health professional’s journal. You are people I think will understand that, in reality, science, metaphysics, theology and ethics are mutually impacting aspects of the practice of medical care. If you run your own practice or work for a Christian health institution, you may have some room to move in how you integrate your Christian vocation to serve your neighbour, with the science, metaphysics, theology and ‘ethics’ that define the context of modern medicine. Many workplace contexts, however, will not give you much room to move. At a theoretical level, ethics grounded in the (blindingly obvious) reality of the intellective, the qualitative and the transcendent, will not be possible. This will impact how legal frameworks that define ethical responsibilities in the medical context are set up. May God give you courage and wisdom in these challenges!

Dr Paul Tyson
Dr Paul Tyson
Dr Paul Tyson is a Senior Research Fellow at the Institute for the Advanced Studies in Humanities at the University of Queensland. He has authored Faith’s Knowledge (2013), Returning to Reality (2014) and De-fragmenting Modernity (2017) and works across Sociology, Theology and Philosophy with a particular interest in ‘science and religion.’

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