Being Medical: Between the Frontiers of the Natural and the Artificial
Rainier A. Ibana
Ateneo de Manila University
Introduction
Please allow me to begin this presentation by thanking the organizers, Kumamoto University
Philosophers since the time of Parmenides, the Pre-socratic Philosopher of Elea, have wondered on the primordial question of being. Even a positive understanding of the opposite of being, the notion of nothing which has been touted as an Asian way to negate the so-called western conception of being, must mean something, a no-thing or not a thing, in “deference” to a non-entity that grounds all other particular beings. Heidegger, for example, expounded on this ontological “difference” between the ground of being and the other entities that exist in a particular way.
The connection between the ground of being and other entities, however, has been debated since modern times as an abyss that cannot be bridged between finite beings, on the one hand, and the infinite plenitude that grounds all other beings, on the other hand. Please allow me to propose, in an emboldened sort of way, that this so-called abyss can be bridged if we see the world from the perspective of the dynamic symbiosis of living beings. From the perspective of a country like the Philippines
The Act of Existence
It is no wonder then that the first precept of natural law, according to one of my favourite philosophers, Thomas Aquinas, is to exist (ST I-II, q. 91 a 2, c.). All other activities such as breathing, eating, procreating, reading a book, becoming friends with others, are derived from this initial act of existence. We would not be able to experience anything at all if in the first place, we did not exist.
The act of existence, however, must express itself through the finite entities that we experience in our daily lives. A being that does not express itself in a particular way, even if such expressions are made in a seemingly passive way such as listening or meditating, might as well not exist since we would not be able to even encounter, let alone know, its being. Even diseases express themselves through symptoms exhibited by the patient. A diagnosis cannot be completed if the client does not cooperate and withholds information from the doctor. Even our sophisticated medical instruments are meant to receive information from the involuntary action or behaviour expressed by an illness.
The art and science of healing, therefore, can be defined as an attempt to support the natural capacity of a being to express its particular form of existence. These medical interventions can range from conservative methods of regeneration, such as rest and sleep, to invasive procedures, such as excision or organ transplantation, that intend to save the biological existence or life of the client.
The Natural and the Artificial
The line between natural healing procedures and artificial interventions can be drawn at that point when external elements such as medication and operative procedures are introduced in order to support the client’s inherent capacity to heal himself or herself.
The success of medical interventions ultimately depends on the natural capacity of the client to receive the external mechanisms that are intended to support its life. Self-medication, for example, is not advisable because of the possibility of over-dosage or unintended consequences that can produce harmful side-effects. Medical practitioners, as experts in their fields of endeavour are supposed to determine the mode and measure of external interventions that can help the healing process. But this again presupposes that the physical constitution of the human body must always already have the inherent capacity to receive or even reject the introduced intervention if the prescription or medical procedure is to become successful.
Nature, therefore, defines the way existence is expressed through particular forms of being while artificiality refers to the external support made by medical practitioners as a means of sustaining and enhancing the various expressions of being: plant pathologists diagnose and cure plant diseases, veterinarians study and heal the physical pains suffered by animals while medical doctors estimate the quality of human life attainable by their clients with respect to the mental functions that can still be sustained by medical interventions.
This distinction between the natural and the artificial can have implications on medical practice that range from personal and social issues such the debate between natural and artificial family planning methods, the use of technological innovations that extend the natural power of the human body, psycho therapy, and the decisions required by end-of-life situations.
Medical Applications
The main argument of natural family planning methods hinges on the conviction that life is a continuous process that begins from the moment of conception until death and that the stages of human development cannot be simply divided up into temporal slices, the way David Hume and other sceptics tried to do. The whole created world, for those who believe in the sanctity of life, is intimately interconnected and every being ultimately derives its existential dignity from the pure act of existence that shared its own act of existence by making other beings be.
Artificial family planning methods that range from contraception to abortificients, on the other hand, presume that the dignity of the human being can be defined only at particular moments of the process of physiological development such as the emergence of the nervous system or the transient awareness of feelings. As one Church document puts it, life cannot be divided up into segments of time, such as the fourteenth day when the embryonic cell has not divided itself into various parts to produce the different organs of the human body (Manila Standard, Aug 18, 2000).
Sexual union, it is further argued, is a process of participation in the act of existence and that those who make use of artificial contraception merely extract the pleasure of self-expression from the possibility of participating in the momentous event of co-creation (LR). The human body, therefore, is conceived as the incarnation of a more profound spiritual dimension that derives its dignity from the umbilical chord of the pure act of existence.
Technological innovations that extend the power of the human body are made possible by the transcendental power of the human mind that reflexively turns into itself in order to abstract ideas and concepts from the particular contingencies of the material world. That we are able to conceive of words and sentences that point to realities that are valid not only here and now but can be relied upon as self-evident when we deal with other similar instances in the future and in the past refers back to an intellectual activity that can be performed only by actors that can transcend the particularity of contingent experiences.
The power of words to heal or hurt the human body has been demonstrated by Jürgen Habermas in his seminal work on Knowledge and Human Interests where he showed how the psychotherapists’ “Socratic reservation” (KHI) from interfering with the emergence of the client’s self-awareness through speech-acts can help the latter in overcoming the psychological and social distortions that block self-understanding and emancipated decision making on the affairs of everyday life.
Habermas contends that contemporary philosophers, like psychotherapists, must act as facilitators of communicative competencies so that conflicts that arise from the particularity and plurality of specialized discourses can be reconciled by referring them back to the affairs of everyday life. Habermas’ proposal is not really new to the phenomenological tradition where philosophers have demanded that we “return to the things themselves” (Husserl) or “to unconceal being (aletheia)” (Heidegger). The only difference that Habermas tries to make is to reveal the validity of our claims through communicative acts.
Specialists in the medical profession are therefore compelled to explain their theories and practices in terms of linguistic utterances that can be confirmed or falsified and validated by everyone else. The democratic impulse that derives its power from the intelligibility of life and the capacity of human minds to comprehend the world at large can very well be extended to the medical profession as it deals with the most intimate and privatized dimensions of the human body.
Even end-of-life decision making are intended to save and extend life as far as possible. Organ donation, for as long as it does not cause the death of the donor and the organ is compatible with the recipient, for example, can become an act of generosity that extends the quality of life of another human being even after the death of the donor. (MMC, 88)
Conclusion: Medical practitioners as mediators between the natural and the artificial worlds
If the first precept of natural law governs self-preservation and the extension of life as far as possible, the second precept expounds on the diffusion of the act of existence by sharing the various modes of being with others: Plants expel oxygen and produce flowers and fruits for our consumption and appreciation, animals take care of their offspring or are consumed by other animals, human beings share their knowledge with others through their speech acts and other educational endeavours. The inherent natures of different forms of beings are actually fulfilled by sharing their very being with others.
Medical practitioners, therefore, are in a distinguished position of serving as mediators that bridge the gap between the natural desire of human beings to extend their lives as far as they can, on the one hand, and the frailties and vulnerabilities of embodied existence, on the other hand. The artificial interventions made possible by advances in the development of science and technology are produced by the human mind in order to extend the lifespan and improve the quality of life itself.
One of the most profound paradoxes of life, therefore, is that it is lived most profusely when given away in the same manner that seeds must be buried to the ground in order to grow and bear fruits (PBE, 62). The products of human intelligence, like medical knowledge, must be applied and shared if wisdom is to be attained by its practitioner. Such acts of self-giving is a dictum of nature that can be characterized by nothing else but an ontological love, the diffusiveness of the inherent goodness of being for the sake of others.
It is perhaps appropriate that we momentarily pause at this point of our reflections and open the floor for discussion on this session which is aptly entitled “The spirit of medicine and love.”
13 December 2009
Citations:
KHI: Jürgen Habermas, Knowledge and Human Interests
(Boston: The Beacon Press, 1972)
LR: Karol Wojtyla, Love and Responsibility (1982)
MMC: Making Life Beautiful: A Bioethics Manual of the
Books, 2008).
PBE: Norris Clarke, Person, Being and Ecology (Quezon
City: Ateneo Office of Research and
Publications, 1996)
ST: Thomas Aquinas, Summa Theologica
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