Technology is ambivalent. I can use a hammer to fasten a nail into a board, or to hurt someone. There's nothing essential about a hammer that prevents me from doing one or leads me to do another.
Medical technology is also ambivalent. There's nothing essential about the surgeon's scalpel that says we should only use it, say, to remove infected gallbladders and the like, and not use it to amputate the legs of someone with body integrity identity disorder. What guides our use of the scalpel - and every other piece of medical technology - is a confluence of societal judgments, professional judgments, individual (patient) values, and limits (e.g., money, logistics). If I've understood you correctly, you say that individual (patient) values should be primary among these considerations. You seem to stay within the bounds of the argument you made here: https://pubmed.ncbi.nlm.nih.gov/32611618/ by not arguing that this should be "the" goal of medicine, but are you taking a further step by saying this should be a primary consideration for clinical decision-making?
"Daniel Callahan lamented this cost when he described liberalism’s inability to answer deep, important, unavoidable questions in bioethics like what are the proper goals and uses of medicine, what are realistic expectations for our health, what do we want to make of ourselves as human beings, and what kind of lives ought we aspire to live. As Callahan wrote, 'Liberal individualism’s greatest weakness is what is often thought its greatest strength: eschewing a public pursuit of comprehensive ways of understanding the human good and its future.' This is a problem because
'The inescapable reality of the kinds of changes that biomedical progress introduce is that they affect our collective lives, our social and educational and political institutions, as well as those tacitly shared values that push our culture one way or another. As an individual, I need to make choices about how I will respond to those changes. But more important, we have to make political and social decisions about which choices will, and will not, be good for us as a community, and about the moral principles, rules, and virtues that ought to be superintend the introduction of new technologies into the societal mainstream.'
Talk like this can make any person living in the modern West a little squeamish. Specters of dictatorship haunt these ruminations. Callahan continued:
'The greatest fear of liberal individualism is authoritarianism. But that fear, reasonable enough, fails to take account of the fact the power of technology, and the profit to be made from it, can control and manipulate us even more effectively than authoritarianism. Moral dictators can be seen and overthrown, but technological repression steals up on us, visible but with an innocent countenance, and is just about impossible to overthrow, even as we see it doing its work on us. Liberal individualism makes this scenario more easily possible, and that is why it is not a tolerable guide to the sensible use of medical knowledge and technology.'
One need only look as far as Facebook, the electronic medical record, spiraling healthcare costs, and the loneliness “epidemic” to see that merely leaving people to their own devices hasn’t yielded a society of flourishing."
Yes, I think that patient values should be the primary consideration in clinical decision making, though that's just at the clinical level. As we discuss, there are other contexts where patient values won't work: funding, public health, paediatrics, decision making for unconscious people whose values are unknown. These are of low relevance for MAID though.
As a liberal, I believe that the good of the community is a function of the good of the individual members of the community. Communities don't have well-being; people do. But besides that, I don't see how I'm not engaging in the same pursuit you're advocating for. Since I have a paper on the goals of medicine, I can hardly be accused of being unable to answer that question, even if you don't like my view.
Perhaps the confusion is that liberalism is a political theory which is, almost by definition, opposed to answering so-called 'thick' questions about the good life. That's what ethics is for. As an ethicist, I have many thoughts about the good life. I can have strong views about these questions without thinking I'm justified in pushing those views on others. We as a society can talk about how we should live, but there's conceptual space between leaving people to their own devices and telling them whether they can access abortion, MAID, or any other medical technology.
Respectfully, Callahan's claim that technology "can control and manipulate us even more effectively than authoritarianism" is laughable, not just because authoritarians use technology as a means of control, but also because I can log off Facebook. I'm sorry to say that even authoritarian countries have EMRs! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932845/
"too much depth elsewhere" — broken link?
Should be fixed now!
Technology is ambivalent. I can use a hammer to fasten a nail into a board, or to hurt someone. There's nothing essential about a hammer that prevents me from doing one or leads me to do another.
Medical technology is also ambivalent. There's nothing essential about the surgeon's scalpel that says we should only use it, say, to remove infected gallbladders and the like, and not use it to amputate the legs of someone with body integrity identity disorder. What guides our use of the scalpel - and every other piece of medical technology - is a confluence of societal judgments, professional judgments, individual (patient) values, and limits (e.g., money, logistics). If I've understood you correctly, you say that individual (patient) values should be primary among these considerations. You seem to stay within the bounds of the argument you made here: https://pubmed.ncbi.nlm.nih.gov/32611618/ by not arguing that this should be "the" goal of medicine, but are you taking a further step by saying this should be a primary consideration for clinical decision-making?
The challenges of contending with technology's ambivalence are insidious. Relying on Dan Callahan's reflections (https://pubmed.ncbi.nlm.nih.gov/14593219/), I wrote this (https://familymeetingnotes.substack.com/p/the-political-intentions-at-the-end?utm_source=publication-search):
"Daniel Callahan lamented this cost when he described liberalism’s inability to answer deep, important, unavoidable questions in bioethics like what are the proper goals and uses of medicine, what are realistic expectations for our health, what do we want to make of ourselves as human beings, and what kind of lives ought we aspire to live. As Callahan wrote, 'Liberal individualism’s greatest weakness is what is often thought its greatest strength: eschewing a public pursuit of comprehensive ways of understanding the human good and its future.' This is a problem because
'The inescapable reality of the kinds of changes that biomedical progress introduce is that they affect our collective lives, our social and educational and political institutions, as well as those tacitly shared values that push our culture one way or another. As an individual, I need to make choices about how I will respond to those changes. But more important, we have to make political and social decisions about which choices will, and will not, be good for us as a community, and about the moral principles, rules, and virtues that ought to be superintend the introduction of new technologies into the societal mainstream.'
Talk like this can make any person living in the modern West a little squeamish. Specters of dictatorship haunt these ruminations. Callahan continued:
'The greatest fear of liberal individualism is authoritarianism. But that fear, reasonable enough, fails to take account of the fact the power of technology, and the profit to be made from it, can control and manipulate us even more effectively than authoritarianism. Moral dictators can be seen and overthrown, but technological repression steals up on us, visible but with an innocent countenance, and is just about impossible to overthrow, even as we see it doing its work on us. Liberal individualism makes this scenario more easily possible, and that is why it is not a tolerable guide to the sensible use of medical knowledge and technology.'
One need only look as far as Facebook, the electronic medical record, spiraling healthcare costs, and the loneliness “epidemic” to see that merely leaving people to their own devices hasn’t yielded a society of flourishing."
Yes, I think that patient values should be the primary consideration in clinical decision making, though that's just at the clinical level. As we discuss, there are other contexts where patient values won't work: funding, public health, paediatrics, decision making for unconscious people whose values are unknown. These are of low relevance for MAID though.
As a liberal, I believe that the good of the community is a function of the good of the individual members of the community. Communities don't have well-being; people do. But besides that, I don't see how I'm not engaging in the same pursuit you're advocating for. Since I have a paper on the goals of medicine, I can hardly be accused of being unable to answer that question, even if you don't like my view.
Perhaps the confusion is that liberalism is a political theory which is, almost by definition, opposed to answering so-called 'thick' questions about the good life. That's what ethics is for. As an ethicist, I have many thoughts about the good life. I can have strong views about these questions without thinking I'm justified in pushing those views on others. We as a society can talk about how we should live, but there's conceptual space between leaving people to their own devices and telling them whether they can access abortion, MAID, or any other medical technology.
Respectfully, Callahan's claim that technology "can control and manipulate us even more effectively than authoritarianism" is laughable, not just because authoritarians use technology as a means of control, but also because I can log off Facebook. I'm sorry to say that even authoritarian countries have EMRs! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932845/