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Slow Cures and Bad Philosophers: Essays on Wittgenstein, Medicine, and Bioethics

Slow Cures and Bad Philosophers: Essays on Wittgenstein, Medicine, and Bioethics

by Carl Elliott (Editor), James C. Edwards (Contribution by), Larry R. Churchill (Contribution by), James Lindemann Nelson (Contribution by), Grant Gillett (Contribution by)

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Slow Cures and Bad Philosophers uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to


Slow Cures and Bad Philosophers uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present.
As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism.
Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine.

Contributors. Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy

Editorial Reviews

From the Publisher
Slow Cures and Bad Philosophers breaks new ground, contributing to a fresh understanding of familiar questions in and about bioethics. This is a high quality, useful work.”—Martin Benjamin, author of Splitting the Difference: Compromise and Integrity in Ethics and Politics

“A startlingly original and very important collection of essays. Wittgenstein’s insights should help the field move away from fruitless battles and back to what its business really is: deepening our shared understanding of what would count as better health care and policy.”— Judith André, Center for Ethics and Humanities in the Life Sciences at Michigan State University

“Carl Elliott always writes intriguing essays at the intersection between ethics, medicine, and general philosophy, so it is a real pleasure to have a new installment in his continuing reflections on the fascinating problems that arise in this territory. Aside from anything else, he writes well for the general reader, who can enjoy and learn from his work.”—Stephen Toulmin, University of Southern California

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Duke University Press Books
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Slow cures and bad philosophers

Essays on Wittgenstein, medicine, and bioethics
By Carl Elliott

Duke University Press

ISBN: 0-8223-2646-9

Chapter One

Introduction: Treating Bioethics Carl Elliott

What would Ludwig Wittgenstein have made of professional bioethics? It is not hard to guess. Wittgenstein loathed professional philosophy. He called it a "a kind of living death." He referred to Oxford as the influenza zone and once compared a meeting of philosophical societies at Cambridge to an outbreak of bubonic plague. When his student Maurice Drury was rejected for a lectureship in philosophy in favor of Dorothy Emmett and instead went to work in a Welsh garden cooperative for unemployed miners, Wittgenstein told him that he owed a great debt to Emmett, because she had saved him from becoming a professional philosopher." Part of Wittgenstein's attitude toward professional philosophy was rooted in his disdain for academic life. Universities not only smothered creative thought, Wittgenstein believed, they made it difficult to be a decent human being. He claimed to prefer the gossip of his college bedmaker to the artificial conversation at the Cambridge high table. But he was only marginally less contemptuous of philosophy written for a popular audience. According to Wittgenstein, the only thing worse than professional philosophy was journalism. Bertrand Russell's books of popular philosophy, for example, he despised. The Conquest ofHappiness was a "vomative."

Not exactly grounds for optimism about a book like this one. An uphill battle lies ahead for any book that claims to find useful guidance from Wittgenstein for bioethics and the practice of medicine. His personal feelings about the academic life aside, Wittgenstein simply produced very little work that dealt directly with ethics. Bioethics as an academic discipline did not get its start until years after his death. The pairing of Wittgenstein with bioethics will seem even more incongruous to those who know anything of his life and character. The media-savvy, money-driven world of contemporary U.S. bioethics could hardly be further from the world Wittgenstein inhabited, nor could it be much further away from his austere ethical sensibility. For Wittgenstein, ethics was an intensely personal, deeply serious affair. It was not even simply about good conduct and good character, but about the sense of life, the state of one's soul, or as he often put it, about being decent. The form that bioethics often takes-as a kind of anonymous, impersonal, rule-writing exercise in which we advise other show to behave-could hardly be more alien to this sort of interior ethical quest.

Certainly Wittgenstein and bioethics make a very odd pair. Yet the match may not be quite as eccentric as it initially seems. While it is true, for example, that Wittgenstein produced little formal writing on ethics, there is also a powerful sense in which ethics permeates the entirety of his work. Indeed, he claimed that the point of the Tractatus logico-philosophicus, to outward appearances a dense treatise on logic and language, was fundamentally ethical. And while in the Tractatus Wittgenstein relegated ethics to the realm of the unsayable, later in his life he rejected his Tractarian views on language. Some of his later work, such as the "Lecture on the Freedom of the Will," points toward the direction his later philosophical writing on ethics may have taken had he lived longer.

Wittgenstein also worked in a hospital during World War II, and at one time seriously considered giving up his philosophy post to go to medical school. This might seem like a relatively trivial fact about Wittgenstein's life, but it is connected to a deeper part of his sensibility, and that is his desire to do work that was useful. He discouraged his students from going into philosophy and sometimes urged them to do manual work instead. He himself gave up philosophy after writing the Tractatus and became a schoolteacher to the children of peasants in rural Austria. This need to do useful work seemed to extend to his vision of philosophy as well. In a letter to Norman Malcolm, Wittgenstein wrote, "[W]hat is the use of studying philosophy if all that it does for you is to enable you to talk with some plausibility about some abstruse questions of logic, etc., & if it does not improve your thinking about the important questions of everyday life."

Bioethics, even more than most areas of philosophy, aims to be useful. Even the most speculative work in bioethics is intended to improve our thinking about everyday life. Thus, the real test of a book such as this one is not Wittgenstein's personal views or his character, or even what he might have thought about bioethics, but how useful the book is. Can Wittgenstein's work help us think better and more clearly about bioethics and medical practice? If so, how?

There is probably no single uncontroversial answer to these questions, but one possibility needs to be mentioned first so that it can be put to rest. The point of this book is not to determine what Wittgenstein's opinion would have been on various problems in bioethics. That kind of book would run the danger of becoming a quasi-theological dispute ("What would the great man have thought about legalizing euthanasia?") and even at its best would have become just another collection of scholarly criticism on Wittgenstein's philosophy. The point of this book is not to examine Wittgenstein's personal moral convictions or even Wittgenstein the historical figure, but rather to explore the question of whether a deep engagement with his work can illuminate some of the problems that medicine and biological science place in front of us. And while it would be misleading to suggest that the essays collected in this book offer a unified answer to that question (some of the essayists are in striking disagreement with one another), several themes and ideas gesture toward the ways in which Wittgenstein can help us think about bioethics.

Theory and Anti-Theory

Perhaps the most thoroughgoing of these themes relates to Wittgenstein's later views on philosophy itself: his hostility toward philosophical "theory" and, in particular, toward a quasi-scientific model of philosophy. In his later work Wittgenstein rejected the notion that the philosopher's task is to build explanatory philosophical systems. In the Philosophical Investigations, he writes, "And we may not advance any kind of theory. There must not be anything hypothetical in our considerations. We must do away with all explanation, and description alone must take its place" (PI § 109). As for philosophy, so too for moral philosophy: "If I needed a theory in order to explain to another the essence of the ethical, the ethical would have no value at all" (WWK, p. 116-17). The danger here is that of seeing philosophy as an impersonal, objective science, in which philosophers gather data and construct theories that can then be analyzed, argued about, tinkered with, and revised. For Wittgenstein, this is a mistaken conception of what philosophers can expect to accomplish: "Philosophers constantly see the method of science before their eyes, and are irresistibly tempted to ask and answer questions in the way science does. This tendency is the real source of metaphysics, and leads the philosopher into complete darkness" (BB, p. 18).

Wittgenstein's student and lifelong friend Maurice Drury, who studied medicine and later specialized in psychiatry, tells this story about an oral examination he once took in physiology. Drury's examiner explained to him that Sir Arthur Keith had once told him that the reason the spleen drained into the portal system was of the utmost importance. But Keith had never explained just why this was so important. "Now," the examiner asked Drury, "can you tell me?" Drury confessed that he could not. The examiner went on. "Do you think there must be a significance, or an explanation? As I see it, there are two sorts of people: one who sees a bird sitting on a telegraph wire and says to himself, 'Why is that bird sitting just there?' The other man says, 'Damn it all, the bird has to sit somewhere.'"

This is just the kind of story Wittgenstein might have told. We are led into philosophical confusion, thought Wittgenstein, by seeking explanations at times when we should instead simply stop and say, "This is how things are." At some point, reasons give out; explanations come to an end. As he famously put it, "If I have exhausted the justifications I have reached bedrock, and my spade is turned" (PI § 217). The urge to discover ultimate explanations, to seek out final justifications for a philosophical position, is what leads us to the sort of foundational, metaphysical philosophy that the later Wittgenstein rejected: "This is connected, I believe, with our wrongly expecting an explanation, when the solution of the difficulty is a description, if we give it the right place in our considerations. If we dwell upon it, and do not try to get beyond it.... The difficulty here is: to stop" (Z § 314).

For Wittgenstein, philosophical problems arise because we do not command a clear view of our language. "A philosophical problem has the form: I don't know my way around" (PI § 123). Philosophy does not add to what we know about the world; rather, it untangles the knots in our thinking caused by the way we represent the world through language (Z § 452). Solutions to our philosophical problems are not found through the construction of metaphysical foundations for our practices, or by building ever more elaborate philosophical theories, or even by constructing rules to restrict the way we are allowed to use words (PI § 133). Philosophical problems "are solved, not by giving new information, but by arranging what we have always known. Philosophy is a battle against the bewitchment of our intelligence by means of language" (PI § 109).

Wittgenstein's view of the role and purpose of philosophy clearly runs against the grain of quite a lot of contemporary bioethics scholarship, much of which operates explicitly within the domain of ethical theory. In at least one regard, however, Wittgensteinians have some company. Feminists, clinical ethicists, medical anthropologists, literary scholars, and, perhaps most notably, the new casuists, who take their bearings in part from the distinguished work of one of Wittgenstein's students, Stephen Toulmin, all have criticized ethical theorists for preferring the thin air of moral theory to the thick, particular contexts in which moral problems are situated. As a result, many bioethicists have been refocusing their attention lately on the concrete particularities of moral problems and the way they are described-for instance, through narrative, ethnography, and clinical case studies.

Yet it is also probably fair to say that many philosophers feel these particularist critiques as threatening, not simply because of what they believe philosophy is about, but because of what they believe morality is about. For many philosophers, if morality has no theoretical architecture, no foundation on which to stand, then our moral judgments and practices in particular cases seem to rest on nothing at all. As Margaret Olivia Little puts it, the "presumption that there are moral principles capable of codifying morality is deeply tied to the presumption that there had better be such principles"-or else our moral judgments seem to become dangerously idiosyncratic.

For Wittgenstein, judgment need not be codified by rules or principles. Indeed, it cannot be codified, at least not entirely: "Our rules leave loopholes open, and the practice has to speak for itself" (OC § 139). Because rules are uneliminably ambiguous, as James Lindemann Nelson notes, their ambiguity is resolved by initiating learners into a practice. Learning how to make sound clinical judgments or sound moral judgments requires that "a community of some sort initiate a learner into the various ways of seeing and of going on to which that group regularly resorts."

On a practical level, a rejection of moral theory is worrying to many bioethicists simply because it seems to rule out much of what they see as their most important job: providing theoretical order to the array of moral problems that practitioners face and developing a philosophical system for dealing with them. This could hardly be more different from the later Wittgenstein's conception of philosophy. Wittgenstein once remarked that while other philosophers wanted to show that things that looked different are really the same, his aim was to show that things that look the same are really different. Wittgenstein was wary of the seductive appeal of theories and warned against explanatory schemes that bring a wide array of seemingly disparate concepts together. Wittgenstein considered using as an epigraph for the Philosophical Investigations Bishop Butler's remark, "Everything is what it is and not another thing."

Perhaps even more worrying to bioethicists is the fear that by doing away with ethical theory, we also do away with the notion of the bioethicist as a kind of professional expert. If bioethicists cannot even claim any privileged access to theory, traditionally the domain philosophers have felt most comfortable calling their own, then any claims to expertise appear to be effectively squashed. So much the better, some might say; if expertise means a claim to authority or knowledge, then perhaps we are better off with bioethics purged of experts. But what if getting rid of bioethics experts means taking seriously the idea that bioethicists can claim no privileged position whatsoever-no special authority to guide a moral conversation, no special position from which to evaluate moral arguments, no claim to authority by virtue of having read and written about bioethical issues? Paul Johnston suggests that bioethics without experts would mean that there would be no difference between a bioethicist's speaking as a professional and her speaking as a layperson, and that the bioethicist as teacher would have no right to claim that her assessment of ethical issues was superior to that of her students. Johnston writes that in such circumstances, "the bioethicist does not have a unique perspective to offer doctors, nor does she know something they do not. If she offers a direction, a vision or warnings, she can only do so in the same way as anyone else."

Perhaps then the work of the (so-called) bioethicist would look less like the work of a moral authority and more like the work of a philosopher, sorting out sense from nonsense, clearing a way through linguistic thickets, battling against the bewitchment of our intelligence by language. Yet there maybe reason to worry about this view of bioethics as well. That is, if the philosopher is limited to a kind of conceptual analysis-if philosophy truly "leaves everything as it is"-then we seem to be left without the philosophical tools to press for radical moral change. For many philosophers, especially those who see cruelty or injustice in our current practices, this picture of moral philosophy seems dangerously conservative. Does Wittgenstein's view of philosophy have room for moral reformers? If, like Cora Diamond and David DeGrazia, you see the way we treat non-human animals as morally unjustifiable, then how, on Wittgenstein's account, do you move toward changing these practices?

One option, of course, is to reject Wittgenstein's view of philosophy. DeGrazia, for example, concedes that passages from the Investigations indicate that Wittgenstein was probably opposed to any sort of ethical theory, but he regards Wittgenstein's position as wrongheaded and dogmatic. For DeGrazia, Wittgenstein's anti-theoretical stance is a mistake. Yet even taking Wittgenstein's anti-theory seriously, he says, does not necessarily rule out radical moral reform. DeGrazia reads Wittgenstein's stance against theory as an argument against the effort to evaluate our ethical and epistemological practices from a privileged, authoritative moral framework. But this stance, suggests DeGrazia, is still compatible with arguments for moral reform. That is, even if we admit that we cannot escape our own moral framework and achieve a God's-eye view of the world, we can still make the linguistic and conceptual moves allowed within that framework. For us, these moves might include things such as plausible reason-giving, fidelity to truth, and other conceptual commitments that can be marshaled in support of moral change.


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What People are Saying About This

Martin Benjamin
Slow Cures and Bad Philosophers breaks new ground, contibuting to a fresh understanding of familiar questions in and about bioethics. This is a high quality, useful work. (Martin Benjamin, author of Splitting the Difference: Compromise and Integrity in Ethics and Politics)

Meet the Author

Carl Elliott is Associate Professor of Pediatrics and Philosophy at the Center for Bioethics, the University of Minnesota. He is the author of A Philosophical Disease: Bioethics, Culture, and Identity and The Rules of Insanity: Moral Responsibility and Mental Illness, and coeditor of The Last Physician: Walker Percy and the Moral Life of Medicine, also published by Duke University Press.

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