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Medicine depends on axiology

I got thinking about Jake's post below concerning "is" and "ought," science, and language while cooking pork chops last night. (The pork chops have nothing to do with this post. They're thrown in only to show that this really was just generated by random thoughts while going about one's day and that this post is not in any way disagreeing with the post that I happened to be thinking about at the beginning of my musings.) It got me thinking about how to distinguish "is" and "ought" statements, and I came back to a hobby horse which I have so far not ridden much here at W4.

The practice of medicine depends essentially upon believing propositions which fall right at the intersection of "is" and "ought." Consider the following:

--Cutting off Jennifer's leg would be detrimental to her health.
--Anti-oxidant vitamins are good for you.
--John's spleen is healthy.

A doctor's practice could depend at various times upon believing and telling people all of these. Are they "is" or "ought" statements?

On the face of it, it might appear that they are merely "is" statements. After all, we know what Jennifer's health involves--her body's continued proper functioning, for example. And, if her leg has no infection, no tumors, no severe pain, if her leg is functioning neurologically so that she is able to feel it and walk on it, then why would cutting it off be anything but detrimental to her health? It is a healthy, functioning leg, so cutting it off would only decrease her physical function.

The sense in which anti-oxidants are good for you can, it seems, be defined and defended scientifically in terms of increasing human physical good function and well-being, preventing cancer, etc.

John's spleen is healthy if it is performing such-and-such functions well, and that can be scientifically determined.

But I would contend that each of these statements has implicit axiological content. For example, the statement that it would be detrimental to Jennifer's health to cut off her functioning, non-infected, etc. leg implies that it is better if Jennifer's body is working in a particular way than if her body loses some of those abilities. Jennifer herself might just decide that she prefers not to have that leg around, even though it isn't painful, infected, unusable, etc. Naturally, we might well regard that as a mental pathology in itself, but again, that is a judgement of "ought" rather than a mere observation of physical fact. If "health" is not understood in a normative sense, then there is no more reason to leave Jennifer's leg on than to cut it off, especially if that is what she happens to want. Or alternatively, if we radically change the normative use of "health" so that it means, "Doing what Jennifer really, really wants," then it becomes positively unhealthy to leave the leg on if Jennifer wants it off, even if there is nothing wrong (there's a normative word again) with the leg.

What about the statement about anti-oxidant vitamins? Well, what if someone happens to think that it's better to get cancer than not to get cancer? Sure, we'd think he's crazy, but he would presumably reject the statement that anti-oxidants are good for you.

As far as John's spleen is concerned, again, the word "healthy" seems to imply that there is something good or valuable about his spleen's behavior. Certainly that is how a doctor will treat the matter. A doctor will decide whether or not to remove a spleen based on whether or not it is performing such-and-such biological functions. A doctor who removes a healthy spleen for practice while he is carrying out some unrelated surgery would be committing malpractice.

I have always found this fact very interesting to consider. Culture-watching readers will immediately think of all sorts of applications. The most obvious application of the point is to "identity based" medicine (I use the word "medicine" advisedly) in which doctors lend themselves to the mental pathologies of their patients in wanting their bodies mutilated and harmed. This even extends to cutting off healthy limbs.

It comes up surprisingly often in debates over abortion as well. If a patient comes into a doctor's office and says that he is distressed because he can't bark like a dog and wants this "problem" treated, the doctor will rightly conclude that he has a mental problem rather than a physical problem. His mental problem is that he doesn't understand what species he is, that he is out of touch with reality, and that he thinks he should have abilities that are not "supposed" to be human abilities at all. But if a person comes into the office or is brought in because he cannot see, this will be treated as a bona fide medical problem which should be addressed medically if possible.

This implies that human beings are a certain kind of entity and that particular abilities are proper to human beings. A human being who has no vision is either undeveloped or is suffering privation. An unborn child who cannot yet see (or speak, or experience self-consciousness) is not therefore something other than a member of the human species, because we are still able to recognize that those abilities are proper to that individual because of the type of creature he is and that they will either develop eventually or that it will be a tragedy if they do not develop.

The integral connection between medicine and both teleology and axiology arises also at the end of life, where doctors are asked to behave as mere technicians and administer lethal injections. Why does that seem contrary to the practice of medicine? Obviously, it seems contrary to medical practice because medical practice has always been defined in terms of helping the body to function better, to function as it should, but a lethal injection stops all body functioning. In other words, it kills.

I believe that the fact that medicine depends upon axiology is crucial to human civilization. It is a resource that we should freely draw upon in our debates over social issues with leftists. It is also, alas, a resource that is fast disappearing. So use these concepts, and strengthen them in the minds of others, while you can.

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