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I frequently hear physician's voice the following argument with respect to

I frequently hear physician's voice the following argument with respect to sexual disorders and anxiety/depression, and I wonder of its validity: If there's a chemical treatment (e.g. pharmaceuticals) and it's successful, then the problem is physiological, not psychological. The argument appears invalid to me, because it seems to assume too large of a rift between one's psychology and one's brain. More exactly, if a chemical treatment works, and if one's psychology (i.e. thought-patterns and emotions) can have an effect on one's brain chemistry (and vice versa), then couldn't the problem still have a psychological source? It seems as if these physicians view psychology as having a basis in a something (a soul perhaps) that is causally independent of the brain. But that seems like an odd view for a Western physician to hold. I'd greatly appreciate any thoughts on this.

I agree that this reasoning seems strange. However, here's one possible justification for it. Any cause can be described in a large number of different ways. For example, a brick thrown at a window can be described as: (i) a brick thrown at a window, or (ii) the movement of a bunch of molecules through space.

Which way we choose to describe a cause depends on our interests in the case. If we are interested in atomic physics, we may prefer description (ii); if we are interested in the movement of bricks in the area, we may choose description (i).

Suppose that in medicine our interests are primarily to explain and treat disorders. For some disorders, it may be easier to explain and treat them by describing their causes in purely psychological language. For other disorders, it may be easier to explain and treat them by describing their causes in purely physiological language. There may also be difficult mixed cases, as you mention, in which the best strategy is to describe the causes in a mixed psychological and physiological language.

However, none of these three options commits one to the view that you mention: that there is a soul that is causally separate from the brain. A physician could say that it is just the same thing (the brain) that is being described in different language in each of the three cases, in much the same way as the case of the brick.

It's plausible that medical advances will mean that, probably at a huge cost, we

It's plausible that medical advances will mean that, probably at a huge cost, we will be able to extend our lives a lot longer than people used to expect to live. I'm thinking something like 500 years or so of quality life. Presumably limited resources and things would mean that less children would be born, or that most people on earth would be stuck with poor and shorter lives. Would it be wrong to make use of such an opportunity?

If the very expensive life extension you envisage is available to all, one might defend it as a permissible collective choice. Of course, there would be fewer births, and fewer deaths, each year -- perhaps just 20 million annually instead of 125 million on the assumption of a steady human population of 10 billion. (Currently, there are about 131 million births and 57 million deaths each year.) Such scarcity of children would change our social world considerably. But I do not see how it would be wrong for humankind to move in this direction.

Serious moral problems arise when we envisage the (more likely) possibility that such expensive life extension would be available only to a minority while its great cost would contribute to most people on earth leading short and miserable lives. To a large extent, this sort of dramatic inequality in health and life expectancy is already a reality today. About one fifth of all human lives are cut short by poverty-related causes before the age of 5. One important causal factor here is that pharmaceutical research is incentivized by offering inventor firms monopoly pricing powers as a reward. The foreseeable result of such a scheme is that new medicines are priced out of reach of poor populations and that pharmaceutical companies ignore the special health problems of the poor populations.

Both problems would be solved if research and development of any new medicine were rewarded, out of public funds pooled globally, in proportion to its health impact which, in the context of your question, might be defined in terms of healthy years of life. Under such a scheme, the intellectual achievement embedded in medicines would be freely available as a public good, and competing pharmaceutical manufacturers would drive the prices of medicines down to near their marginal cost of production.

If pharmaceutical inventor firms were incentivized in this way, they would concentrate their efforts on the most cost-effective health improvements. Given that it is much cheaper to secure additional years of life to children and young adults among the global poor than to prolong the lives of people in their 80's and 90's, pharmaceutical companies would give priority to the former task. These efforts would cause the average human life expectancy to increase sharply and inequalities in life expectancy to drop dramatically. As the cheaper life-extension opportunities get exhausted, pharmaceutical inventor firms would then gradually be drawn toward developing medicines that would prolong life beyond the 90's. Humankind would progress toward your 500-year milestone -- together.

It is often claimed that certain actions - usually in the field of medical and

It is often claimed that certain actions - usually in the field of medical and biological science - amount to 'playing God' insofar as the foundations of life are manipulated and synthesized artifically. However, isn't this merely a rhetorical claim given the impossibility of humans acting as gods? Also, what strength does such the 'playing God' claim have against the irrefutable claim that all knowledge demands risk, and an initial ignorance to provide the impetus for the research?

You are right that saying that someone is 'playing God' is merely a rhetorical claim made by those who oppose the kind of actions that the person is doing are contemplating doing. Since, "given the impossibility of humans acting as gods," as you say, it is a way of saying that you should not do the action because it is inappropriate for a mere human to act in a way that is appropriate only for a god. Insofar as the claim has any force, and it does not have much, it is a warning about making fundamental changes without very carefully considering all of the consequences, long term as well as short term, of making these changes. Many actions have massive unintended consequences, especially those that involve changing how we deal with life and death matters.

'Nature' is commonly understood as, among other things, standing in contrast to

'Nature' is commonly understood as, among other things, standing in contrast to the 'man-made'. However, can these two ideas be kept separate? Surely everything 'man-made' cannot occur contrary to the fundamental structure of the universe and does not oppose it, but rather occurs within it and perhaps even as a factor of the natural constitution of humankind? Or to put it more simply: surely there is nothing 'unnatural' about (for example) a parent deciding upon the genetic make-up of their as yet unborn child, despite this being to many peoples' distaste.

'Nature' is a difficult concept, with a long and varied history. Thus, whenever someone comes up with an argument that something is ‘natural’ or ‘un-natural’, the first question that should be asked is ‘what do they mean by ‘nature’, and how can this concept of nature be justified?’

Broadly speaking (very broadly) there are two conceptions. First, nature as ‘of this world’, and thus as opposed to ‘supernatural’ (for example, pertaining to God). Under this conception, human activity would generally count as natural, along with rat-behaviour, tulip-behaviour, and granite-behaviour. However, if we take away the possibility of the supernatural (if we argue that, at least for these purposes, we can discount the realm of the divine), then natural is everything, and thus doesn’t really have much meaning at all. Second, nature is the world insofar as human beings do not interfere; as opposed to, say, ‘culture’. It is this second meaning that would be in use in the kind of argument about genetic choice that you cite. What does this distinction mean? One way of understanding it, which is to be found in Aristotle and Kant among others, is that the human domain consists of activity organised by conceptions of purpose. So, both a dog and a human can chase a ball, but in the case of the latter there is (or might be) a conscious purpose (to stop the ball rolling over the boundary for four points, in cricket, for example). But then the question is, can this nature/ culture distinction really be maintained? Can we really show that a dog has no purposeful conceptions; can we really be sure that all human action does?

Anyway, these are some of the issues. My basic point is that talking about ‘nature’ says and proves nothing until the above issues are at least provisionally resolved.

Can cardiac rescusitation of an individual with an inoperable brain tumor be

Can cardiac rescusitation of an individual with an inoperable brain tumor be justified? Who benefits? Glen.

Hey Glen,

An interesting question, indeed. It reminds me, too, about why medical care is provided to people who've been sentenced to death.

Look at it this way, though, all of us are going to die at some point. You might say that those with inoperable brain tumors just have a clearer picture than most about when and how they'll die. Knowing when and how one's going to die doesn't seem to be a good reason to deny that person medical care.

And notice that even for those with inoperable tumors the picture isn't perfectly clear:

Probability not necessity: Typically, people face some probability of death from the tumor, not certainty. Even one tenth of a percent chance of recovery is a chance and therefore a reason to administer rescusitation.

Time: even if it were certain, a tumor takes time to kill. That time to live is likely to provide grounds for rescusitation. One of my uncles died of a brain tumor. While it was killing him he spent his time visiting family and friends, getting his financial and legal affairs in order, making plans for the care of his spouse and child, attending religious services, listening to music, reading, travelling, etc. Had he suffered a cardiac arrest during that period and been refused rescusitation, many of those goods would have been made impossible. Now, if administering rescusitation were to exact an enormous social cost and prohibit those without tumors from realizing some important goods and if death from the tumor were almost certainly imminent, then there might be grounds for refusing the rescusitation. But the costs of rescusitation are relatively low, and so this scarcity objection doesn't work.

Autonomy: Deciding how to greet one's demise is a terribly important element of human self-determination. It seems meaningful to assist those who wish, as it were, to go down fighting.

Rebellion: The existentialist Albert Camus argues, persuasively in my opnion, that perhaps the central way of rendering life meaningful is to rebel or struggle against death, to not accept with acquiescence the ultimately crushing and annihilating reality of human existence. A story I once heard about the French artist Monet (as I recall) seems to illustrate the sense of Camus's claim: It became at some point impossible for the aging artist to hold his paint brushes any longer. So, in defiance of his degeneration (and ultimately his death), Monet asked his assistant/daughter to take the brush and "tie it to my hand." Telling Monet that he would be dead soon anyway would have been to capitulate to meaningless annihilation and to rebuke his choice about how to face it. She took the time and effot to tie it to his hand, and in doing so she did the right thing.

Is it actually ethical for medical science to try to develop cures for all

Is it actually ethical for medical science to try to develop cures for all diseases? Isn't disease helping to keep our population in check? If our population grows too much and depletes our resources, wouldn't wars over resources be the greater harm incurred?

If humans continue to reproduce at current rates, there is good reason for thinking that population growth will eventually be (if it already isn't) harmful to the well-being of humans and non-humans (though not only because of possible resource wars--there may be other harms related to unchecked population growth besides these, e.g., increased suffering due to malnutrition, crowding, pollution, habitat destruction, etc.) However, there is little reason for thinking that stopping the curing (or preventing) of diseases by medical science is the only or the most morally attractive way of limiting population growth and avoiding problems due to such growth. Many humans already limit population growth quite safely and effectively through various methods of birth control. Improvements in education, increased access to birth control and family planning services, and changes in incentives for having large families, can provide more morally attractive ways to avoid harms due to population growth.

Can someone's quality of life ever be so bad that you are justified in taking

Can someone's quality of life ever be so bad that you are justified in taking care of them against their will in order to improve it? If so, how bad does it have to be?

It all depends on the mental competence of the other person. If he's not very competent (a child, perhaps, or mentally disabled), then we may interfere with him even to prevent minor harms. One should never interfere with the freedom of fully competent adults in order to improve their quality of life. Still, when a person's quality of life becomes very low, her mental competence may come into question. It is very hard to think rationally when one is in severe pain, for example. And in such cases it may be justified, then, to take care of someone against her own will. Here we still face the question of WHO is so justified. A good candidate is a family member who intimately knows the person and what she would wish if she were feeling better. A poor candidate is some stranger, driven perhaps by moral or religious values that the person does not share.

So, when a normally competent adult is in such bad shape that his capacity for decision-making is impaired, then others who know him well may interfere with his freedom in order to improve his quality of life in ways that (they sincerely believe) he would approve of were he fully competent.

If I own something that is essential for other people to live, like medicines,

If I own something that is essential for other people to live, like medicines, and I know that I have made it impossible for them to afford it, am I responsible for their death?

Yes you are. Your decision to deny others access to the life-savingdrug has led to their death. But how serious is your responsibilityfrom a moral point of view? That depends on the circumstances. Perhapsthe medicine was in short supply and you needed what you had for yourown survival or that of your family. In this case, I think you didnothing wrong. Or perhaps the medicine was in short supply and youchose to give it to those who could pay you the most. This way ofrationing your supply is not beyond moral criticism, but at least yourdrugs saved as many people as possible and so your conduct did notincrease the number of deaths beyond what was unavoidable.

Nowconsider drug companies in the real world. They patent their medicinesand then enjoy exclusive rights to sell them at monopoly prices, whichcan be 400 times higher than the marginal cost of production. There aregeneric producers in developing countries which produce much cheaperversions of the same drug for sale to the poor. But the largepharmaceutical companies and their governments, through treaties andlaw suits, are working very hard and quite successfully towardsuppressing the production and sale of generic versions of drugs stillunder patent. Millions are dying as a result.

The justificationoffered for such conduct is that inventor firms have a right to theirintellectual property in the invention of a new drug. If the right hereinvoked is the legal right, it won't settle the issue, which is whetherthe creation and enforcement of such legal rights is morallyjustifiable. Is there then a moral right to exclusive ownership ofintellectual property? Think about it: If you and your partner hadinvented the Tango, would it have been wrong for any of the rest of usto copy your dance without your permission? And, if you believe thereis such a moral veto right, do you think it would have the exact same20-year expiration date as is enshrined in patent law? Most defendersof patent rights would not make such extravagant claims. They wouldinstead appeal to the social utility of the patent system, whichencourages the development of new medicines. But this appeal runs afoulof the fact that the majority of humankind cannot afford drugs underpatent. By suppressing poor people's transactions with themanufacturers of cheap generic drugs, our governments andpharmaceutical companies are causing many of them to die for the sakeof gains (incentivizing drug development) that benefit only to the rich.

Mustwe then, in order give the poor access to new medicines at competitivemarket prices, take away the incentive to develop new drugs? We mustindeed take away THIS incentive: monopoly pricing powers. But we canstill incentivize drug development in other ways, for example throughan arrangement under which governments would reward inventor firms inproportion to the health impact of their invention. Under such ascheme, we taxpayers would pay some money to drug companies for any newand effective medicines they invent. But we would also benefit throughlower prices for drugs and medical insurance, because any newlyinvented drug could immediately be produced by generic manufacturers,so that its price would be just slightly above its marginal cost ofproduction.

Because such alternative schemes for incentivizingthe development of new drugs are readily available, we are indeedmorally culpable for killing millions of people in the developing worldby making existing and effective life-saving medicines unaffordable tothem.

When is it time to get on the medical intervention train and when should you

When is it time to get on the medical intervention train and when should you leave well enough alone? As I have gotten older, and my friends have gotten older, every doctor visit feels like stepping on a train that will soon speed up so much you can't get off - so fast you can't even see the landscape outside the window anymore. Chronic medication, more tests...preventive examinations, just one more, just one more. I understand that these things prolong life, but how do you distinguish treatable medical conditions from normal aging? How do you go gently into that good night?

It seems to me that the answer to this question depends on the answerto at least four other questions: (1) Under what conditions does onecount as living a life that is worth living? (2) Would a given medicalintervention allow me to continue to live a life that is worth living?(3) What obligations do I have to others (and in particular, does mycontinuing to live allow me to meet certain obligations to others, ordoes my continuing to live put morally unacceptable burdens on others)?and (4) Would a given medical intervention allow me to meet my moralobligations? Of course, the answers to these questions, and the weight that one should give to the answers to these questions, are verydifficult to determine.

Suppose that I'm working on a medical treatment for a project with no known cure

Suppose that I'm working on a medical treatment for a project with no known cure or even treatment. My subjects report that they feel much better after receiving the treatment, but subsequent study shows that the treatment is, in fact, ineffective and all that I'm seeing is the placebo effect. Can I ethically tell them the truth and thereby make them feel worse subjectively? Would that violate the "do no harm" principle of medical ethics?

The injunction “Do no harm” is hard to follow unless one knows whatcounts as harm, and there is no clear consensus about this issue. Itdoes seem that by making a person feel worse, I am harming her. Feelingbad is in itself a bad thing, and it might also lead to other badthings. If I feel bad, then I may not be able to do other things that Iwould otherwise enjoy, things that I might believe have value inthemselves. At the same time, it seems that I could be harmed if I amprevented from learning the truth about my situation. If I have falsebeliefs, I might make choices that I would otherwise not make, choicesthat lead me to feeling worse than I would otherwise have felt. Could Ibe harmed by being led to believe something false about myself even ifthis false belief never leads to any decrease of good feelings or anyincrease in feelings of pain, dissatisfaction, or discontent? Let’simagine that I believe about myself that I am widely admired and deeplyloved by my friends and family and that this belief gives me deepfeelings of contentment and satisfaction. But let’s imagine also that Iam completely deluded: I am ridiculed behind my back and privatelydespised by my friends and family who are hoping to achieve a biginheritance from me. Let’s suppose further that their secret is safe,unless you tell me the truth. Would I be made better off by learningthe truth about myself?

But returning to your particularcase. Even if one has figured out what counts as genuine harm, it'soften a tricky matter in any particular situation to figure out whichcourse of action will cause the least harm. For example, whether agiven patient would be most benefitted were he to learn that his deathis imminent (so that he could make wise decisions about what to do withthe rest of his life), or whether he would be most benefitted by being"blissfully ignorant", will depend on the nature of the person and whatchoices he has. But in any case, most of us value knowing the truthabout our situation, and even if we know that we tend to screw up ourown lives and even if we believe that others could make betterdecisions forus, we still prefer to make informed decisions for ourselves. For allof thesereasons, it has seemed to many that physicians should always discloseto their patients information about their medical condition (including,it would seem, what effect a given drug is having on the patient'shealth).

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