These famous words were written by Rene Descartes in his book Meditations in 1641. It deals with the philosophical theory of knowledge or as known as epistemology. The reason I am writing the blog on this topic is derived from the lecture in week 6. During this, the lecturer mentioned sensation and haptics in prostheses that bring another level of sensory input for the disabled. This topic echoed my previous reading on Descartes. In the book Meditations, Descartes advocates the separation between the mind and the senses. Where senses are gathered from experiences, the mind holds some fundamental knowledge. For example, Descartes gave the example of a dream argument, that the senses in a dream can deceive a person, such as the smell and the touch. But fundamental knowledge such as colour, and the three-dimensional environment are the same as reality. While the senses can be wrong, and the mind is fundamental, as a result, the separation enables one to seek the fundamental truths, as Descartes argues. However, Descartes is also a mathematician. And the fundamental truths in Descartesā view are factors that form our reality, such as physics, and 1+1=2. But what about the senses? Our own way of perceiving reality?
For matters such as a person predicting when the bus will arrive, or the action of a person if one says certain phrases to them, the prediction can usually be correct, only if they have gathered enough knowledge through senses in the past. This type of knowledge can be fitted into Bourdieuās theory of practice, where some of the predictions are formed by habitus, in another word, a societal structure that determines how we think and act.
But what about instincts? A newborn baby will instinctively seek nutrients, we breathe with our lungs without learning it from schools, and we retract our hand muscles when we touch something hot. These actions are not determined by habitus but by stimuli. Lorenzās research on animal instincts (ethology) with ducklings points toward that the hatchlings are born with learning programmes, which only need to be activated by stimuli. The ducklings were born to be attracted to certain stimuli that resemble the features of a mother hen, which is similar to human infants learning to recognize faces. Humans have fight-or-flight instincts that trigger certain parts of the brain when faced with dangerous situations. We also eat, drink, and rest based on body chemistry.
Reflection
Based on scientific evidence, the habitus of society, as mentioned, guides oneās behaviour. Yet the habitus itself is created through a social pattern. And it could be argued that social patterns are based on biological responses. One could, as I did as well, fall into the trap of a nihilistic view on this matter, that society is nothing but a complex exchange of chemistry responses that guides what we perceive as the ārealityā. However, āI think, I amā, I refuse to be defined by a set of chemistry responses, but through my senses, and what I experienced throughout time.
From this mode of thinking, strong moral support for medical advancement can be derived. Imagine the reality perceived by someone who suffers from nerve damage that affects any of the five senses since birth. The reality perceived by them will be totally different. Without medical advancement for prostheses and other surgical treatments, living in a reality without realising the reality is false due to uncontrollable factors is a really cruel thing to think about. Like Descartesā theoretical example of a deceptive god that intentionally created reality to always be false. It is a great evil if this was to be true. As such, some medical advancements can really be something to be awe of.
Before I begin this blog on philosophical arguments and medical consents, it should be noted that there usually is no ārealā definitive ethical answer to an argument as I follow JS Millās view that knowledge is not infallible, and that All sides contain plausible explanations. Truth, lies, or partially true, should be brought together in discussion (JS Mill, On Liberty).
Case analysis
In the paper by Murray (1990), the author stated many legal cases through out the history, providing evidence in how the medical consent was progressed. From the legal cases provided, in general, it can be observed that utilitarianism and deontology were combined. Although mainly, in the cases where informed consent was present, patient-centred deontological view is followed, and that the surgeons will respect patientsā individual liberty, and oneās right to oneās body. Some examples containing the theoretical traits are:
Luka v Lowrie, 136 N. W. 1106, Michigan 1912: A child, who experienced a crash injury to his foot, was deemed by the surgeons that amputation was necessary. Normally, a child would not be considered to have competence for consent, therefore the parents should grant consent to the surgery. However, the parents were unavailable for discussion during the duration of the surgery. Without consent, the surgeon, after consulting with several physicians, performed the amputation. From this case, it can be justified based on act utilitarianism, where the goal of an action should be to achieve the maximum amount of happiness. Had the surgeon acted in a strong deontological view, and that the surgeon absolutely respects individual liberty and consent, the childās situation may have turned another way.
In re Melideo, 390 N. Y. S. 2d 523, New York, 1976: Mrs. Melideo received a dilatation and curettage of the uterus for diagnostic purposes. The patient developed significant bleeding soon after. The patient however, refused blood transfusions based on her religious belief. The court ultimately ruled that blood transfusion should and was not ordered to the patient, since the patient has consent competency. This follows the patient centred deontological view, where certain rules are unethical to be broken no matter the circumstances, and the patient has the ultimate right. Interestingly, in this case, there are two layers of deontological reasoning present. The first layer exists in the surgeons who acts as the āagentsā. The surgeons respected the rule for a patientsā liberty based on the patient centred deontology, and the patient followed the basic deontology view where the decisions should never break certain rules laid upon oneself.
The two cases above represented how the two views can be at play at the same time instead of counter arguing. The deontological approach respects oneās autonomy and liberty, while the utilitarianism view fulfils certain situations where emergency consents are needed. Murray confirmed this in one of the conditions for emergency consent: the proposed treatment is for the ultimate benefit of the patient.
One possible reasoning for this might be the importance of liberty from both viewpoints. In an action-based context, such as the world-famous trolly cart problem, where 5 people will die if you donāt push the lever, and 1 person will if you do, the deontologist will not push the lever, only if the person has a doctrine to never kill in their mind. The utilitarian will push the lever for the maximum amount of happiness. This may make the utilitarianism seem like a violation of some individual liberties in some cases.
However, in the context for information, Mill argues that even though some truth may result in harms, they should still not be suppressed. The reason for this is that Mill follows the empiricism of knowledge, that knowledge can only be gained by experience, and that future knowledge (or truth) cannot be known. Therefore, suppressing the truth will assume its infallibility, which contradicts to Millās empiricism. This also supports the importance of information transparency to the patients so construct patientsā well-rounded judgement toward the procedure.
“Had the patient, judged as a reasonable and prudent person, been provided adequate information about the procedure and its risks prior to consenting to the procedure, or if some material risk had been presented, would the patient have refused to proceed with surgery?”
This leads to another philosophical debate on free will and determinism. From the determinism point of view, Paul Ree is an example, that he holds a hard deterministic view. Ree believes that every decision was made from past events, and that an association of causation is present. Ree also argues that free will is an illusion since the causes are internal. For example, when a rock was thrown, the causation was observable, and it is external. Those events can be replicated and proven, given the exact force applied and other factors such as wind speed. To say that the rock has free will would not be plausible. From this logic, internal factors such as body chemistries or past experiences leads to determined behaviours of a person or an organism. Ree gave the example of a donkey between two of the same haystacks. If the donkey was observed to turn left and eats the left haystack, externally, it would seem like the donkey has free will, but what about hidden factors? The wind may be blowing towards the donkey from the left side, or a hidden body behaviour gathered from past experiences. Therefore, since some factors were internal and unobservable, and created the illusion. Ree believes that if the exact past causation, both internal and external were recreated to the exact same extent, the donkey would still choose to turn left. Same as when a person makes certain decisions.
While not many philosophers support purely on free will, many of them believes that free will and determinism can exist at the same time (Compatibilism). Compatibilists argue that if only causal determinism exists, there wonāt be any needs for moral responsibilities. Since determinism argue that only one path was available to the person, and that person must act in that way. Therefore, there isnāt a responsibility for that personās action. To apply moral responsibilities then, free will will be required. For compatibilism, theories vary. But Fischerās (1994) theory can provide a supporting ground for information transparency in medical consent. Fischer provides an element called regulative control which is a control agent that can bring and refrain one from doing certain behaviours. As a result, different paths open for one to choose at that exact moment. For medical consent, the importance for surgeons to provide patients a clear view of the procedure surfaces. Therefore, the compatibilist view justifies the need for risk disclosure that it provides the patients a clear, rational judgement when they are competent for consent.
From the example and arguments above, medical consent is constructed on the foundation of individual liberty. While it can be fitted into many different philosophical debates. For novel medical research, personally I would argue for the respect of liberty and autonomy, and transparent communications for patients to create rational and justified decision. Yet, certain context may prove otherwise and incite debates.
My name is Yifan, and the course I take is Business Management. There are two main reason for my choice of this module. First, limb prosthetic interests me the most from all the biology aspects of the module. Mainly deriving from the fictional works of all types I was exposed to. Moreover, thinking of the benefits of a limb prosthetic that is able to mimic the full functions of a real limb is beyond my imagination. The type of pain of a person’s daily life brought by accidents or genetic issues is imaginable. So if a seamless technology become available to offer to those in need, it would bring the world a ton more joy. Secondly, the ethical theory application to the module interested me as well. This is mainly because of the ethics module undertaken last semester. It would be interesting to make that connection and see how different theories debate with each other when applied to different situations. For example, if I am correct about the main content of the ethical part of this module, which is about consent, this can be applied to many ethical theories such as Kantian’s and JS Mill’s. Also, it would be interesting to see how some of the practices can be justified or condemned based on deontology and utilitarianism views.
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