Platonic Biomedical Ethics (Paper)

The following paper was written for a Bio-medical ethics class at the University of South Florida under the guidance of Mr. Nathan Draluck. May it be informative to you. Enjoy.

Platonic philosophy provides a way for doctors and patients to operate on the same intellectual plane by providing a stable and apparent ethical system based on the 'form' of good and the derivatives of good actions. The doctor and patient will be shown to rationally be of the same biological entity. The differences between doctor and patient are merely physical and the ability is real for all patients to be doctors. Because of an overpoweringly strong current in the biomedical community, dualism^# has become smothered and doctors have become intensely concerned with biological treatment, even when it is harmful to intellectual activity. Due to this lack of understanding on the part of doctors they have effectively relegated the patient to a subjugated role in lieu of affording them any large autonomy.

This paper will focus predominately on the relationship between doctors and their patients through the prism of Platonic Ethics. Furthermore, the paper will show that when considered in a rational way, Platonic Ethics provides an approach that is both safe for the doctor and engaging for the patient.

The reader will find three imitative case studies in which will be found a clear argument for the use of platonic ideals in treating a patient. Case one will expound on The Theory of the Forms and attempt to explain the actual differences between the patient and the doctor. While this may seem clear on the surface, the true difference, I believe, is actually nonexistent. In the second case we will examine the dualistic nature of Platonism and how this is translated, or not, into biomedical ethics. In the final case we will examine the autonomy of both parties involved in medical decision making, the patient and the doctor, and attempt to discover how autonomous each party actually is by defining autonomy in a platonic sense.^*

The Platonic theory of the forms is a rationally sound argument for the understanding of things around us. In order to give the reader a basic understanding of the arguments that follow it is necessary to provision the reader with the basics of Platonism. The chief metaphysical quality for Plato is The Theory of the Forms.^¤ The following will explain in detail the fundamentals of Platonic philosophy which will then be expounded upon later.

The basic principle upon which The Theory of the Forms is based is participation, particularly participation in the the Forms themselves. The Forms are metaphysical traits that exist separately from humans but are present in the world through different objects participation in them. For instance, a person is tall because they participate in the form of Tallness. In a more basic understanding, anything that can be denoted as a adjective, whether it is a color, size, or description of any kind, is a reflection of that things participation in said forms. In addition to these forms is an overarching Form of The Good, under which all forms fall. A trait of all forms are that they are forms of good. The way in which humans understand the various objects around them and, in some sense, their own being itself, is through their understanding of forms. These forms are discoverable through dialectic discussions with other intelligent beings.

One of the most important ideas contained in The Theory of the Forms is the idea that once a person has begun to understand forms as forms themselves they are ethically required to help other beings, through dialectics, to understand these forms. Now if dialectics is the only way to discover forms and forms are what allow us to understand the intelligible things around us, it stands to reason that through dialectics all knowledge has the ability to follow. While these may seem like rather arcane ideas when presented in short, it is strongly suggested that the reader view the complete Platonic works for themselves.

This brief overview has the ability to directly improve the doctor-patient relationship through several means. If we understand that doctors have a larger degree of understanding than their patients then we must also concede that because of this the doctors have a larger responsibility to impart this knowledge to their patients. The doctor must be willing to impart information, through dialectics, to the patient to increase the patients understanding of any medical conditions, preconditions, possible and probable outcomes from procedures, etc. A failure to do this on the doctors part would result in actions that would not be in accordance with Platonic Metaphysics and therefore would not fall under the form of The Good but would rather be a privation of good.^* While the doctor would have the ethical obligation to inform the patient of knowledge in which the patient was lacking, it is also the responsibility of the patient, in pursuit of knowledge, to attempt to discover, through dialectics, as much knowledge as possible. In doing so, medical knowledge would naturally be incorporated into this knowledge. From these interactions one may gather that through the form of the Good anything that transpires between a patient and doctor will be for the benefit of both parties as long as both parties willingly engage in Good, Selfless acts in accordance with Platonic Metaphysics.

Following this, one must make the argument that in these situations the parties involved have an overt obligation to do certain things. In order to arrive at this point the reader must first realize the following: that both the doctor and the patient are human beings who are capable of knowledge. If this supposition holds true then we can infer that there are obligation that each party must meet. The doctor has an obligation to search for knowledge in the same manner as the patient has an obligation to search for knowledge. With this primary obligation the reader can draw, among others, two distinct conclusions: That the patient should take into account the doctors suggestions for treatment only if they are unwilling to complete their own studies on the subject matter and, if this is the case, paternalism is to be considered opted into at this point in time. In cases in which the patient is unwilling, while possessing the ability to, attain the same knowledge as the doctor they have themselves mandated that their relation with their doctors will be a paternalistic one. While paternalism carries a heavily weighted connotation of loss of power, or immediate and unwarranted deference, it carries the heavier connotation of the inability to use dialectics. Therefore, paternalism should not be viewed as inherently negative but rather negative due to its association with non-dialectics.

Drawing upon The Theory of the Forms as outlined above, the reader shall find a discussion of Platonic Dualism, and how this is translated, or not, into biomedical ethics, in the anteceding argument. The first necessity in order to do this is a more thorough understanding of Platonic Dualism itself. Like most dualistic philosophies Platonic Dualism is a dualism of the mind an the body in which the mind is always superior to the body. In Platonic Dualism the terms for mind are many and varied but this paper will use only two interchangeably: mind and soul. Upon the death of the body the soul/mind are loosed to live among the forms and the forms are the highest ecstasy the mind can have both while contained in a body and upon the souls release from said body. Of paramount importance in this dualism is the idea that one should not deliberately kill ones body in order to release ones souls. To do so is an act of both desperation and an act demonstrating the pinnacle of a privation of good. While suicide is not acceptable in Platonic Dualism the body should always be treated in an inferior manner while the mind should be treated in a superior fashion. The reasoning behind this is that it is through our minds that we control our bodies therefore making our bodies a tool for our minds.

The dualism presented above has a very real connection with contemporary medicine. While this type of dualism is still extremely relative in contemporary society, many doctors focus their attention solely on the bodily ailments of their patients even when it can be detrimental to the patients mental health. The focal point of modern medicine is to prevent the death of the body through natural causes and this death is viewed as the ultimate item to beat. However when viewed realistically through a Platonic prism the death of the body can actually be a good act because it frees the mind from the constraints of the body. This is not to say that it is not worthwhile to treat the body, for it is worthwhile but only to the extent that it helps the mind. Put another way, the mind should be the focal point of medical procedures, while the body should only be treated in a fashion that neither hinders the mind nor makes the mind powerless. The example we can use to illustrate this is hypothetical in nature but revealing none the less.

A patient who has experienced some worldly calamity is in a coma and there is evidence that the brain has retained its capacity to function. The body of the patient is kept alive through a life support system. The doctors have the ability to bring the patient out of the coma but doing so will have repercussions on the mental state of the patient. Modern medicine will tell us that the patient is alive but comatose and therefore removing the comatose state is of the utmost importance even if this will result in a diminishing of the patients intellectual capabilities. From a Platonic viewpoint this is unacceptable. While the removal of the comatose state would certainly benefit the patient, it would only be of benefit if said removal was non-damaging to the intellectual abilities of the person in question. Therefore the 'Good' act in this case would be to let the patient either: remain in a coma or die of natural causes and thus have their soul separated from their body thereby preserving the intellectual capacity of that being.

The final sense in which Platonic Metaphysics has a role in Biomedical Ethics is in the sense of autonomy. The Platonic Sense of autonomy can be summed up in 4 points:

1. Autonomy is based upon the mind and its power over the body. ^*
2. Autonomy is for the mind to be free from coercive outside influence.
3. To be autonomous one must understand that actions that are willed through the body from the mind affect other individuals, who also have autonomy.
4. To be autonomous one must be cognizant of the fact that their mind has the capacity to learn any number of forms and their derivatives that are present in material objects.^*

Through these four points the reader can draw several conclusions about the roles of patients and doctors in autonomous relationships.

In order for a patient to be autonomous the mind must have power over the body and therefore the patient must have an active mind.^* A patient must understand their medical conditions and should only assent to things that they understand. If they do not understand things then they are willing themselves into a paternal relationship. This is acceptable but must be actively recognized by the patient. This lack of understanding is a lack of participation in dialectics on the part of the patient as the patient has the same mental ability as anyone else to learn. This understanding is predicated on the patient having an active mind.

Several of the obligations that are required of patients are also required of doctors, namely that they possess an active mind, among others. In addition every doctor should understand their patient's medical conditions and only recommend things that they understand. If they do not understand things then they are responsible for informing their patients of such. This is acceptable but must be actively recognized by both the doctor and the patient. One of the most damaging things that a doctor can do to impede upon the patients sense of autonomy is coercing a patient into a therapy that is not agreed to by the patient unless that patient has willingly approved of a paternalistic method of treatment with said doctor. If the patient has knowingly entered into a paternalistic relationship with the doctor then any treatment that the doctor orders that is beneficial to the patient is acceptable.

To display the way autonomy would work in a Platonic sense we turn again to our coma patient. In this thought experiment the coma patient is alive in the body but dead in the mind. In this situation the patient would not be able to control their body as they have no mind of which to speak. Without the use of their mind the patient would lack any type of autonomy and if autonomy is central to person-hood then this coma patient could not be considered to be a person. While they are still a human being genetically and they have a living body, the lack of a fit mind robs them of all right to person-hood. The doctor would not be able to treat the patient due to the fact that without a mind they are not human and therefore cannot understand their condition nor their treatment and could not consent to any given medical approach.

In conclusion the doctor-patient relationship can be effectively governed by a thorough understanding of Platonic metaphysics as they apply to Biomedical Ethics. The doctor and patient are both capable of the same knowledge and patients who willfully lack the knowledge of a doctor are knowingly committing themselves to a paternalist relationship with their physician. In addition, the modern medical approach places an inordinately large emphasis on the bodily health of their patients and not nearly enough of doctors resources are dedicated to ensuring the intellectual activity of a patient is preserved. Finally, the autonomy of a patient must be preserved at all times in order to serve the best interests of the patient.

#Body-mind dualism.

*In this sense autonomy would involve the definition of 'self/soul' as opposed to the definition of biological entity, further expanding upon the dualistic nature of Platonic philosophy.

¤A much broader understanding of The Theory of the Forms can be found in other works by Plato: The Republic, Phaedrus, Parmenides, and Sophist among others.

*Borrowed from Aquinas, Summa Theologica .

*Refer to Platonic Dualism

*Refer to Platonic Theory of the Forms

*Here active is used to mean fully functional

Greed (Paper)

Inherent greed is, much like inherent value, an abstract, insupportable idea. In order for greed to be inherent it must be able to remain the same object in everyday life as well as in a complete vacuum. This is not a viable position for the following reasons: it is ever affected by human ideas and ideals, it is a contextual concept, and it is a creation of emotion put into words by human minds. For these reasons greed has, for the vast majority always been a word with a dark connotation, describing someone or some action that seems to be divergent from their beliefs. In this sense environmentalists have a long history of decrying the business world, among others, for their selfish and self serving ends in essentially raping the environment. While this may be true is some sense and from some perspectives it is not, by far, a universal Truth. Greed as defined by Miriam-Webster Dictionary: a selfish and excessive desire for more of something (as money) than is needed. This need has indeed led into a serious conflict between humans and the environment. Surprisingly enough however is that it might also be the beginning of a recovery leading to a better situation both for the inhabitants of the Earth and the Earth itself. Greed, therefore is contextual in its meaning and, among the more compelling human actions, has the capability of being one of mans lowest driving forces, that of self betterment.

One of the most ideal situations for a relationship between The Earth and Humanity is the principle of Stewardship in which humans see themselves as custodians of the earth instead of the earth being subjected to the wanton Wants of our desire. This stewardship is easily justifiable as a good business model. The past trend of simply taking from the earth what we need and not caring about its long term survival was less than solid in an economic sense. We were living for immediate gratification that in the end would have left both us and the earth worse off. While the businessmen of that time, as they always are and probably always will be, were motivated by turning a quite buck, perhaps in addition to slightly more altruistic motives, it soon became apparent that continuing the path of earthly destruction would no longer be accepted by the vast majority of people. This idea is particularly supported by 'Deep Ecologists'. This greed that drove business then however is still prevalent now. Businesses still strive to earn the most money while spending the least. To this end however stewardship is the best investment that can be made. Instead of creating machines and technology to deplete the earth to its breaking point business are now seeing the immense profit that can be made by investing in the welfare of the earth. Investment in renewable resources has been on the rise for the last decade. This trend shows not only a move towards helping the earth but also a move into an economically stable mind set for businesses. When an investment into solar energy is completed the investment would pay for itself over time and after the initial cost has been recouped become a fiscal money maker. In this way stewardship ethics is not only become morally responsible but also fiscally responsible by preserving the resource that is used to create profit and this urge to create profits is driven not by the selfless cause of conscience but by greed for that extra dollar, by greed.

This simplest way for the environmental crisis we find ourselves currently mired in is entirely mental in its formulation. With only a slight change of thinking on the part of many, the terrible costs that the earth has been made to bare on account of overzealous businesses and unconcerned humans could be entirely reversed with dramatic benefits not just for the earth but also for those attempting to gain a better social position in life through money. With the implementation of this change the world itself would, at the risk of sounding naive, become a better place. If people began to think of their actions in relation not just to themselves but to other people and other things around them then the human race would find themselves quietly sliding into roles of stewardship instead of remaining greed-driven. The immediate rewards in the short term would in fact perfectly coincide with the current attitude of 'me first' thinking. With realizing that people can be made happier by helping the planet by feeling proud of their accomplishments, the move from selfishness to stewardship is not a long road.

Along these sames lines, Emmanuel Kant, seen by some as an ardent advocate for animals to not have the same rights as humans, in essence creates a list of traits that reserve human rights for those that have rational thought, mobility, and inherent value. As with many other philosophers, the very idea of something having inherent value is plagued with a myriad of problems. In order for something to be valuable in and of itself it must be able to maintain this characteristic in a vacuum uninfluenced by any other object. In Kant's essay Rational Beings Alone Have Moral Worth, he advocates a system in which Humans, and Humans alone have wroth because they are intrinsically valuable. He says that we are “an end in itself” not merely a means for others to use or exploit to their own ends. He supports this idea by labeling everything that does not think rationally as things and everything that does think rationally as persons. Here he begins to exhibit the very anthropocentric view he has of the world. He goes further to use this view as a reason for humans to use anything not capable of rational thought for their own ends and he supposes that anything not able to rationally think for itself has value only as a conditional property that is contingent on a humans need for it. With this view he has given the world a view in which human needs, human greed, has become the central tenant by which we assign value to non-human entities.

Pushing the boundaries even further than Kant, Utilitarianism is a prime example of human greed especially as it interacts with nature. Many utilitarians, such as Peter Singer, contest that the best way in which to serve the environment is to simply act rationally without the interference of emotion. While on the surface this would appear to be an acceptable way of thinking it is, in fact, not. By creating a “weight-watchers” theory for human interaction Singer simply creates a system in which the person committing the action is able to step back easily and justify their actions with a simplified mathematical equation. For instance, one could easily justify cheating on ones spouse through utilitarian thinking. After the act of cheating the person justifying it might say that they became more relaxed afterward resulting in a (+1) effect for them. The same can be said of the person with which they had relations with resulting in an additional (+1). However the significant other of the cheater is devastated when they find out resulting in (-1). However, according to utilitarianism the overall outcome of the episode is a net effect of (+1) therefore making it a “good” practice. One can easily see how the same reasoning can be used in an environmental sense with Humans and nature interacting with business as the cheater. In this scenario, anyone sufficiently fluent in both utilitarianism and business could endlessly justify their actions on paper through a mathematical equation similar to the one above.

Among one of the more contentious ideas submitted by environmental philosophers is the idea of an Experiencing Subject of a Life (ESL) and their place in the world. Tom Regan is a major advocate of this idea. The problem with Regan's proposal is the fact that as a rational Human he has the ability to guarantee animals rights as ESLs but can reject other forms of life. This difficulty still retains that humans are at the top of the spectrum of life that can give or take away rights as easily as one might blink. This in turns leads to the thought that if humans are still at the head of the table of life, why do we remain there. The most obvious reason is because we, as humans, still retain rights for ourselves that create a better living. In other terminology we are basically greedy. We subject the other life forms of this earth to our own “rational” interpretation of what constitutes an ESL. In this way we are able to continue taking advantage of other life forms, plants for instance, that sustain us. The problem with this theory is that it has exactly the same problems as Contractarianism. Regan says that Contractarianism is arbitrary as it requires the metaphorical ability to sign a contract in order to be elevated to having rights. If an animal can't “sign the contract” then they are just out of luck and will continue to be viewed as resources for human consumption. This resource oriented view by humans in regard to nature is the central problem with humanity in respect to the environment. However, while he puts this problem forward as being backward in thought he actually advocates a system in which he is willing to accord rights to animals but not to any other life form. In this aspect he is both contradicting himself in theory as well as practice. While this may be so one must ask the paramount Socratic question: Why? Why would Regan want to include only some living things and not others while at the same time subjecting humans to the same rights as animals but still allowing humans to delegate who or what receives those rights. Once again we must welcome or trusty old friend greed to the stage. It is for greed and self image for which these mistakes are committed.

While advocating rights for all animals Regan still reserves the ability to award rights just for humans. In this way humans are still seated in that Zeus like chair at the pinnacle of the Pantheon. This image of humans as originators of rights still propels Regan to entitle us to more lucrative rights in order to maintain his ingrained ideas about life with humans centrally located. In addition to these problems the Idea of an ESL having inherent value poses a problem for many of the societal institutions of the world. For instance, when would it be appropriate to deprive a human of their rights? If it is whenever they harm another ESL then the animal world run into a huge problem for the same rules would have to apply to them as well. Any carnivorous animal would be deprived of right simply for engaging in actions that it considers required. A lion would be right-less for hunting, an instinct that has evolved over hundreds of thousands of years. Also part of this dilemma is figuring out who is responsible for taking these rights away. Would it be humans? It seems like Regan would attempt to make it so simply by the fact that we are the ones dispensing rights in the first place.

Perhaps one of the best explanations about humans and their desire to amass as much of anything they can is the late German born Philosopher, Erich Fromm. His headline work in relation to human greed is To Have Or To Be? In which he describes his two modes of humanity, having, a materialistic oriented thought process, and being, the emotional, productive mode of life. He states the the overwhelming majority of humanity is stuck in a having mode of life. This leads in turn to greed in which one try to achieve happiness through material wealth instead of intellectual thought. The being mode is something that he advocates as the ideal form of thought in which one does not have possession of things in a permanent manner but instead attempts to share with the world with others in our pursuit of happiness. This idea though is, in my opinion just as greed-driven as the having mode of being. That is not to say it would not better humanity to embrace his idea of being instead of having for it would drastically cut the amount of material possessions which we have. Instead it would substitute our desire for material possessions for those of ideological possessions. Instead of coveting the most up to date technology we would strive to acquire the latest thoughts and ideas. We would begin to envy people of higher intellect instead of people with more wealth. While this would certainly improve the lost of the earth in a very practical manner, i.e. trash, it would not help remove the idea of greed from the human psyche. It simply replaces it with something else.

Al Gore's treatise on environmental concerns proposes the idea that humans are simply addicted to abusing the environment. He explains that in order to leave our bad habit behind we must enter into a therapy course to change our mindset away from destroying the earth and instead preserving it. While his thesis is intriguing it is simplistic of its view of human nature and proposes and at its heart lies greed. In order for the world to continue and for our lives to continue we must take drastic action in the way that we think about the earth. Changing our philosophical outlook is indeed a requirement. However changing our view of the world is of immense benefit to ourselves. Our self-preservation is the driving force behind this required change. That is not to say that severing our addiction to abusing the earth by this means is a terrible thing. On the contrary it is a requirement. However when doing so it is necessary to be honest with ourselves. We must admit that the reason we are doing so and embrace greed as a power that will do “good”.

The core tenant of greed as exhibited by humans is closely tied to an overwhelming feeling of anthropocentrism. These two concepts correlate directly with each other with greed becoming the central offshoot of an anthropocentric mind. When a person sees the world as revolving around themselves and think that they have a a larger impact on the earth than anything else, that person comes to see the world in a largely anthropocentric way. As they continue to view the world in this way they are better suited to view the earth as merely a resource waiting to be plundered for their own personal benefit. This leads to serious problems when this person comes into a position to reap what the earth has, as in a business position or government position where they would have the direct ability to affect the earth over a large area. When found in this type of position these individuals would be more prepared to use the earth as a way to better themselves without considering the impact of their actions over a wider area. This greed driven decision stemmed from the way that they view the world, through anthropocentric eyes.

In all the majority of philosophers currently speculating on the idea of an environmentally sound relationship between humans and nature have largely failed to deal with the anthropocentric, selfish, greedy motives of humans. Instead they have focused on other more narrowly defined traits rather than deal with the ultimate issue at hand. If they had instead dealt with the problem at its base, greed, they would have come to much the same conclusion, that greed and nature are not inherently opposed but rather opposed because of the human use of greed for things that damage nature. This realization should come as no surprise to those who study human interactions. The simple step to stewardship is not far and would have a resounding impact on the world. Business would continue to make money, people would remain happy, if not become happier, and nature would become revitalized all through a simple attitude adjustment. And this is, I think, exactly what is needed.