Monday, May 11, 2009
by Gerald Dworkin
What we do is never understood, but only praised and blamed.
It is easy enough to look back to the beginning of the century and see many ethical views that we now believe to be profoundly mistaken. Views about the rights of women, about who should vote, about separate but equal, about the rights of children to work in oppressive conditions, about the rights of patients in medical experimentation. To take only the latter, in 1963 researchers injected live cancer cells into nursing home residents, some of whom were Holocaust survivors, to determine whether the immune systems of sick individuals could identify and eliminate foreign cancer tissue as those of healthy people. Although the researchers were correct in thinking that no harm could come to their patients from the injection the fact remains that no consent was asked for.
It is much harder to look at out contemporary views and try to predict which of them will seem as mistaken 100 years from now as those above. Possible candidates include-- eating meat, thinking of homosexuality as in some ways sinful or immoral, allowing the extremes of inequality of income and wealth that exist in contemporary America, allowing receipt of medical care to depend on income.
When Mary Wollstonecraft wrote the defending the rights of women, a contemporary , Thomas Taylor, mocked her by writing A Vindication of the Rights of Brutes (animals). The idea being that the logical implication of granting rights to women is that they be granted to animals and since the latter is absurd so is the former. So one persons drawing the logical conclusion is another person's refutation of one of the premises.
Henry Salt, in Animals' Rights, informs us that Thomas Taylor's "A Vindication of the Rights of Brutes…designed to, throwridicule on the theory of human rights…ironically lays down the proposition 'that God has made all things equal'" and "furnishesus with a notable instance of how the mockery of one generation may become the reality of the next." (Henry Salt, Animals' Rights , "Bibliography of the Rights of Animals").
Bernard Williams advanced a thesis which might be called the relativism of distance; where distance here means is moral and conceptual rather than geographical. There had to be a possibility of a justification to those who lived with institutions which we, now, see as unjust, for them to be unjust. This is the relativism part. The fact that we see slavery now as the essence of an unjust institution does not mean that if we were transported in a time machine to 4th century Athens we could frame an argument for this position that would make sense to the slave-holders of the time. It's important to note that this is not simply a question of whether our arguments would persuade. People whose self-interest would be harmed may , for various reasons, not be persuaded they are wrong but that does not mean they are not wrong.
As Tom Nagel puts it, " Williams believed that political theory, too, should be in a sense local, rather than universal, because it must be addressed to individuals in a particular place and time, and must offer them a justification for the exercise of political power that has persuasive force in the light of standards that are accessible to them. "
Now one might take this in a stronger or a weaker sense. The weak sense is that those not persuaded are not to be held responsible for their support of unjust ( by our lights) institutions they are not be blamed for what they could not be expectedto see as wrong. The strong sense, which Williams seems to have held, is not just that they are not to be condemned but that the institutions are not unjust. It is not that they are just either. If one wanted to talk like Nietzsche one woulds say they are beyond justice or injustice.
But, and here comes the non-relative part, for Williams, none of this does has any implication that now, for us ( all of us), there is any doubt that slavery is unjust and that those who now support it, or condone it, are fully responsible for their mistaken views.
I believe that the issue of what might be called "moral anachronism" is a fruitful one to think more about. When do the concepts we employ in moral discourse, and the empirical situation we find ourselves in now, make it-- and here the rightnotion to use is crucial-- too difficult, too crazy, impossible, meaningless, pointless-- for we and them to understand one another sufficiently for a certain kind of criticism and evaluation to be possible? When does the fact that our current understandings and commitments were not historically present in an earlier period get people off the hook for behavior that, today, would be universally viewed as outrageous?
As a test case for the latter issue one could not do better than to look at Richard Shweder's "Tuskegee re-examined". This is a study of the notorious Tuskegee experiment in which rural, black men were, it is claimed, allowed to suffer from syphilis so that doctors could study the natural course of the disease. Leaving aside the many factual questions which Shweder explores about what was known, what could have been done to cure the disease, what actually happens to people with untreated syphilis, etc. suppose the following two statements are true.
(1) ... in 1932 the concept of informed consent had not even been imagined by medical professionals, almost all of whom, if has been argued, deeply believed in the Hippocratic 'tradition of paternalistic secrecy in the doctor/patient relationship' (2). ... there were no generally accepted ideas before WW II about what information physicians were obliged to give their patients.
How does that affect whether the doctors were blameworthy for not getting informed consent from their patients?
Note: With respect to the first issue, was the conduct wrong, Shweder raises the question of whether had there been a system of Institutional Review Boards in place in 1932, an IRB would have approved the experiment. It is assumed that one or another answer to that counter-factual question is relevant to the question of whether the original doctors acted wrongly.. But so much would have had to be different for there to be a system of IRB' in place-- they were partly a response to Nazi doctors, they assume the importance of informed consent, they arise in an era when physician paternalism is under attack, they assume a concern for how voluntary decisions made by the poor and oppressed can be, etc-- that the answer is either they obviously would not have approved, or if the assumption being made is that everything is being held constant--other than the fact that a system of IRB's was in place-- then one has no idea how to think about what the answer might be. Perhaps people confronted with an IRB, with no history of how it got there, no context for its existence, might regard it as so mysterious that they would ignore its requirements.
Posted by Gerald Dworkin at 12:10 AM | Permalink