David Solomon 9-25-09

Dr. David Solomon, director of the center for ethics at the University of Notre Dame, came to Baylor and delivered a lecture on "The Moral Troubles of Medicine" which both enlightened and disturbed me.

Enlightened, because his analysis of contemporary medicine illuminated some roots of key ethical dilemmas we're facing today, such as "when does life begin and end?" and "what is the appropriate role of the doctor in a doctor-patient relationship?" Solomon pointed out that with the leaps and bounds medicine took in the 20th century, our association of health with the good life rocketed through the roof-- other values we thought necessary for the good life were "grabbed up" by medicine. Solomon, taking us back to the "old days," reminded us of the time when the kids who sat in the back of the class and use their pencils and paper as airborne weapons to launch at their fellow students used to be smacked with a paddle. Now we diagnose them with attention defecit and send them to the nurse for drugs. The anecdote is laughable, but all too true.

This week, Nietzsche seems to be following me around everywhere I go! Surely when he proposed health and sickness as new standards of value he did not intend to limit this to physical health. But when scientific breakthroughs offer medical solutions to human problems as basic as depression, behavioral issues, when we have labeled the alcoholic as "diseased," it's clear that health has trumped the other values on our "wanted" list. We've jumped at the chance to secure the good life for ourselves by means of surefire, empirically tested methods.

But this puts an enormous amount of pressure on doctors; the doctor-patient relationship is continually corroded by the lopsided moral dependency of the patient on the diagnoser. Doctors, Solomon says, have taken the place of religious figures in our personal lives; we expect them not only to prescribe us with the right meds but to tell us whether we should take them or not. (Hello, moral ought. Welcome to Hillcrest Medical Hospital. Dr. Jones will be taking care of you today.)

Doctors, in turn, are fleeing this weighty responsibility, one which they have in no way been trained to carry. Med school classes don't make sure every obstetrician reads Peter Singer on the status of a fetus before she graduates. My friend's mom's oncologist did not want to make the call on whether after two years of chemotherapy beating up her body and producing few desired results, she should try a new drug or accept that her time had come.

This affects liberal democracy (or perhaps liberal democracy affects it), argues Solomon, because we are committed to the "membership" property. All members of our society have unalienable rights to happiness and unquestionable dignity; so who's in and who's out? Once we start questioning who merits membership, we all feel threatened; if the elderly lady down the street is "useless" and a "burden" on society (utilitarians and consequentialists ike Peter Singer and Michael Tooley are actually claiming this, not a joke...), then at what age will I be like her and be thrown out of the club? The prestige of medicine, says Solomon, can lead us t other confusions of value. The strong man trumps the weak. The net product of a country of healthy citizens is greater than the net value of a country with large populations of elderly, indigents, babies...Nietzsche, meet capitalism.

Solomon argues that we need an arena for all members of the community to come together and have meaningful discussion on these basic ethical issues in place of lugging the sack of them into our doctors' offices and hospitals. What do we want? What do we need for human flourishing? Dr. Solomon suggests that the philosophy of psychology Anscombe called for to pave the way for a fresh look at ethics has been done in the last 50 years-- perhaps we are ready to start recovering moral philosophy.