11 January 2012

Reflections on the Ethics of Vegetative State Awareness

A comment at the Institute for Science and Ethics on the implications of "Bedside detection of awareness in the vegetative state", a cohort study published in The Lancet (2011), really got me thinking:
Science is invaluable in discovering what the world, including ourselves, is like. But it can never alone tell us what we should do. The big question – how such patients should be treated – remains as open as ever. We need more science to find out what the life of such patients is like. But we also need ethics to decide what we do when we discover that.
Firstly that seems to me precisely why we need the humanities and social sciences. Ethics without history, philosophy, literature or art to me seems equivalent to imaging science without ethics. But, of course, that requires believing that one appropriate approach to the question of ethics is based upon an analysis of the intent behind action. And I think that an understanding of intent can only come from the moral frames as recorded, observed, and analyzed in history and the human sciences or appreciated imaginatively in literature and art.

I've noted a rather popular fondness for approaching ethical questions purely in terms of the consequences of action. This approach is typical among my students. Such a view, while compelling, does beg the question in the case of these medical patients whether anyone would have anything but good will towards them and about this situation? I mean is there really anyone who is callously thinking about this in only economic or sadistic terms?

And since we cannot really know the outcome of our choices here, and since we know from the history of science and medicine that our choices in situations like these tend to be determined by fleeting social and cultural values, is not the best choice here to assume good will? I'm not really this Kantian, but the idea that somehow we will be able to use new scientific findings to think through such problems as these in order to better understand the consequences our actions, strikes me as painfully naive.

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