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How Philosophy Drives Medical Ethics Part 2

Dissolution of truth is like the melting of snow on a cold winter day. It evaporates a little at a time, scarcely perceptible and unnoticed. Only when you look back after passage of time can you see what has been lost.


Rejection of truth is rarely wholehearted embracement of falsehood. Rather, it is a distortion of truth, a manipulation to produce a result reflecting personal prejudice or preference. Truth is often secondary to feelings and to a desired result.


This is the second in a series of blogs of how ethical decisions in medicine are influenced by philosophy. I defined philosophy as the study of the fundamental nature of reality and existence. The most noble purpose of man is the search for truth. In my first blog I explored the tension between empiricism – what may be measured, and metaphysics – the study of existence and the nature of things that exist.


Socrates, Plato, and Aristotle did not use the scientific method. They believed in “natural law” – that moral principles are discernible based on our nature. These, and centuries of other philosophers, applied four causes or explanations to understand all reality. These were material cause – of what the object was made, formal cause – its nature or essence and what it was intended to be, the efficient cause – what produces or changes the effect, and final cause – its purpose.


Unfortunately, this understanding changed following the Enlightenment and Scientific Revolution. Notions of formal cause and final cause were abandoned or reduced to efficient cause and material cause. No longer were natures or purposes treated as legitimate features of reality. Because how does one quantify these? And with that, the notion of objective morality lost its intellectual basis.


Essence and purpose aren’t physical things. They’re mental and spiritual. Purposes and ends, goals and virtue have no color or shape. They come from minds, not molecules. You can see the results of an idea, but you cannot see the idea itself. When modern philosophers claimed exclusivity for the scientific method, mind was reduced to matter (the brain). For the last few centuries, we’ve specialized so much in seeing the matter that we’ve ignored the meaning.


Science describes life, but it isn’t life. It may be useful to think of the brain as matter when brain surgery is done on your mother. But not when you bring her back home to live with you.


The main foundation for modern relativism in medieval Christian philosophy was William of Ockham’s Nominalism who developed the principal of Ockham’s Razor. Always choose the simplest, most reductionistic explanation. Luther, Calvin, and Descartes followed this principal. They discarded the more complex natural law theory in favor of their “divine command theory” which said that God’s command is the only thing that makes an act right or morally good. The simplest explanation.


Natural law theory stated there is both a natural and divine law. An act is good or evil because of the nature of the act itself, the nature of man, and because of God’s will. God’s will is rational, not arbitrary, because it flows from his character. God reveals Himself through nature, and natural law is another language He uses. Two causes instead of one; not the simplest explanation.


Religious Nominalists like Luther thought they could enhance religion by eliminating natural law and nonreligious Nominalists thought they could minimize religion by eliminating the divine law. Both sides used the Razor. So, faith and reason became enemies instead of the allies that they were in all classical medieval philosophy, whether Islamic, Jewish, or Christian.


Unhinged from essence and purpose, utility, and feelings began to inform truth. Follow this pathway now through conversations I abstracted from Peter Kreeft’s book, A Refutation of Moral Relativism.


Libby is pointing out that Americans don’t look at the issue of absolutism by abstract philosophical arguments but by sociological evidence. When people look at religious based cultures, such as those in the middle east, cultures where a preferred form of moral absolutism is enforced, they prefer a pluralistic democracy that endorses tolerance. She engages her defense of moral relativism there.


Libby: I want to address the social importance of the issue first.


Isa: Why first? It isn’t first; its second.


Libby: Second to what? To Philosophy?


Isa: Second to people. Societies are made by people, of people and for people.


Libby: You’re saying there is no such thing as a social conscience?


Isa: There is, but it exists in individuals.


Libby: No collective conscience?


Isa: In a society of one hundred human beings, there are only one hundred consciences, not one hundred and one. Society is not another human being.


Libby: That’s abstract. Is there a point?


Isa: It is a practical point. You can’t blame society instead of individuals. You can only blame real people.


Libby: And what did the old metaphysics, natural law, bring to society?


Isa: It gave an objective standard for morality.


Libby: It justified judgmentalism.


Isa: Yes. If morality is not objectively real, nothing can be morally wrong. All values are private and subjective.


Libby: No, they aren’t. They can be social and collective.


Isa: But where do they come from?


Libby: From consensus. Individuals in a society coming together and agreeing to make their values into laws or societies standards.


Isa: A law is enforced only by force. So, your consensus really means that some

individuals, the lawmakers and powerful, impose their personal values on others. That is judgementalism.


Libby: You don’t think imposing traditional morality is judgmental?


Isa: If morality is objective instead of subjective, if it comes from universal human nature instead of selected human wills, that is not judgmentalism. The relativist is accusing the absolutist of exactly the moral fault he is guilty of.



Isa points out the modern West is the first society in history whose mind molders are moral relativists. No other society in history has ever survived without rejecting moral relativism and believing in moral absolutes. He points to Moses, Confucius, and Muhammad. Mosaic tradition is still alive after 4,000 years, in Christianity as well as Judaism. Confucianism lasted 2,000 years, and Islam is still growing after 1,500 years. He questions America’s place to judge other cultures.

Libby: You see a kind of Western cultural imperialism going on throughout the world?


Isa: Yes


Libby: You think the world will end if everyone buys Calvin Klein jeans?


Isa: No. The world is hurt if everyone buys Calvin Klein sex.


Libby: America is one of the most religious countries in the world. America has more

religion than almost any other country.


Isa: Yes. And more suicides, abortions, divorces, drugs, pornography, and fatherless children than almost any other country.


Libby: How can that be? Isn’t religion supposed to be the cure for all these social diseases?


Isa: Not if religion is as relativistic as the society.


The conversation moves on to the desired results of morality, with the focus on feelings. Libby is defending relativism on this basis of outcomes. Kreeft is weaving the concept that truths, like promises, are worthless if they depend on how you feel.


Libby: Good morality has good consequences and bad morality has bad consequences. Happiness, freedom, and self-esteem are good consequences, and unhappiness, loss of freedom and guilt are bad consequences. Absolutism produces bad consequences and relativism gives good results. This is why I prefer moral relativism.


Isa: You have given a moral reason for rejecting traditional morality.


Libby: That’s a good thing.


Isa: I do agree that people abandon moral absolutism because it makes them feel guilty. But I don’t think it is a good reason.


Libby: Do you have any idea of all the harm and unhappiness all the guilt has caused all the people in the world?


Isa: Do you have any idea of the greater unhappiness there would be if there wasn’t any guilt? Guilt is to the soul what pain is to the body.


Libby: It isn’t. Pain is necessary. Guilt isn’t.


Isa: The rapist who feels good about himself is happier than the one who feels guilt, but he’s not morally better. Just psychologically better, more well-adjusted. Well adjusted to evil.


Libby: I’m saying bad feelings result from absolutism. This philosophy brings unhappiness to people’s lives. How can you defend that?


Isa: You are assuming that feelings are the standard for judging morality. When morality should be the standard for judging feelings.


Libby introduces the concept of tolerance as a value important to a society. Again, the tension between application of values to a civilization as opposed to the individual is apparent.


Isa: And you think relativism is tolerant and absolutism intolerant?


Libby: Yes.


Isa: Ideas can’t be tolerant. They may be fuzzy or ill defined, clear, or unclear. But people are tolerant or intolerant.


Libby: OK. So, it is relativists that are tolerant.


Isa: Tolerance always presupposes some objective good and evil. Because we don’t tolerate good, only behavior or ideas we disagree with. Things we consider wrong or evil.


Libby: I suppose that’s true.


Isa: When you assume tolerance is good, good for everybody, you assume the moral absolute you are trying to refute.


Libby: No, I’m not.


Isa: Just your personal preference?


Libby: Right.


Isa: But a good society should be tolerant?


Libby: Yes.


Isa: Then you are demanding everybody live by your truth. Is that intolerant?


Libby: Not if there is a consensus.


Isa: But there isn’t. Many people, many cultures don’t think tolerance is always good.

Some see it as a weakness.


Libby: I guess that’s true.


Isa: Should you tolerate other cultures’ intolerance? Because if you do, you need to stop bad mouthing the Spanish Inquisition.


Libby: OK, relativists just prefer tolerance. It’s our consensus.


Isa: But history’s consensus is against it. Why impose yours? Isn’t that culturally intolerant?


Libby: Because it is progressive. Intolerance is regressive. Humanity has evolved.

Isa: Evolved toward what? The concept of moral progress presupposes moral absolutism.


Libby: How does it do that?


Isa: You can only make progress if there is an objective standard toward which you are progressing.


Libby makes the argument that moral relativism is superior because it gives one freedom while absolutism takes it away. Everyone should have freedom to determine their own values.


Isa: And you are arguing that we’re not free if we can’t create our own values?


Libby: Absolutely.


Isa: But freedom cannot create values. It presupposes them.


Libby: What do you mean by that?


Isa: If relativism is good because it guarantees freedom, it presupposes freedom is good.


Libby: OK, so I must presuppose just that one value.


Isa: But if freedom is really good, it must be freedom from something really bad. So, you’re assuming a real objective bad.


Libby: OK, two values.


Isa: Freedom for yourself or everyone?


Libby: Everyone, of course.


Isa: Then you must presuppose the value of the Golden Rule or equality.


Libby: OK, up to three.


Isa: Well, I claim that right. The value system I choose is to create one where your opinions have no weight at all. And I am God and rightly demand total obedience from you. Is that OK with you?


Libby: No, it’s not OK.


Isa: Because it’s insane and it’s not true. You are free to refuse the whole moral order, but you are not free to make another moral order. We’re free to choose to hate, but we’re not free to experience a moral obligation to hate, only to love.


I have abbreviated discussions to illustrate core arguments. There are many other parameters that come to bear when relative morality is supported.


One such argument against an absolute basis of morality states morality is the product of evolution – a mere instrument for biologic survival. This reduces morality to instincts. However, the discussion reveals we choose which instincts to follow and which not to follow. The analogy given is that our instincts are like the keys on a piano and morality is like sheet music telling us which keys to play.


Another fashionable philosophy in American universities today is deconstructionism, the manipulation of language. It makes morality as arbitrary as penmanship. Terminology like “hate speech” and “preferred pronouns” are intended less to inform than to control.


What I am attempting to illustrate is the evolution of human thought. And that ideas have consequences. The snow is melting.


In my final blog, I will address relevance. How these abstract philosophical concepts directly impact human belief, behavior, and cultures. And how clarifying truth in our own mind is essential to the proper application of medical ethics to the human conditions we encounter.


Tim Powell MD

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