On July 25,2000, the Canadian Medical Association (CMA) published an update on its policy in regard to organ and tissue donation and transplantation. In it they stated that such "policies and protocols ... must be based on the professional ethics that underlie the patient-physician relationship in the practice of medicine. Professional ethics incorporates the values of respect for persons, justice, beneficence, autonomy, confidentiality, and privacy." They go on to state that the ethical issues involved in the policy ... "should be resolved in an open process involving public dialogue and debate." Of paramount importance and significance is their statement that these CMA policies and protocols "should be developed in recognition of the values of Canadians and the values that underlie our publicly funded health care system."1 Thus the CMA has made it clear that the source from which it derives its ethical principles which govern its policies, is some sort of societal consensus or majority vote.
The classical Greek philosophers were the first to teach that one could regard as real that which was behind the phenomena which appear in our sensations and our consciousness. This approach to the study of what was real, of being, was called metaphysics. The classical tradition taught that metaphysics gave man access to first principles and causes. Because of the Revelation we have received from the old testament and the teachings of Christ and His Church, man can know more fully about the origin, meaning and purpose of human life.
Science, in contrast to metaphysics, is a generalized knowledge of the laws governing matter as obtained and tested by the scientific method. Matter presents itself for scientific investigation in the form of phenomena which we sense and appreciate in our conscious mind. Science does not, and cannot, deal with the fundamental realities, being per se, morality, and the ultimate cause and purpose of existence.
In the early centuries of the Church's existence, the church fathers appropriated the classical Greek philosophical tradition. By the thirteenth century, Thomas Aquinas had brought about a synthesis of philosophy and religion. Starting during the Renaissance, with the work of Bacon2 and later of Hobbes3, Descartes4, Spinoza5 and of others, Revelation eventually became separated from Philosophy. By the eighteenth century, Rationalism had become the dominant philosophy in the west. Rationalism maintains that the mind should assent only to the truths that are proved by reason. It also repudiates supernatural Faith and revealed religion, and, transgressing the limits of science, substitutes morality for religion. It takes an optimistic view of history, and has predicted a future of inevitable progress and improvement.
The twentieth century's appalling experience of evil, however, has ushered in the collapse of rationalism, and we are now left with nihilism. What is nihilism? William A. Frank6 says that " ... the core idea of nihilism is the absolute meaninglessness of human life." Some accept this completely. Many simply decide to give life a meaning that suits them and act accordingly. The Unites States Supreme Court in its Planned Parenthood Vs. Casey decision ( l992) certainly did so. " ...at the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life."
Richard Rorty is one of the most celebrated opponents of metaphysics today. He tells us that each person who thinks as he does, "takes satisfaction in accepting the 'radical contingency of his or her own most central beliefs and desires', which have no foundation beyond the reach of time and chance".7 If a sufficient number of people who are politically powerful decide to agree on a specific moral norm they can, and indeed often do, promote that norm by the use of rhetoric, the art of persuasion. Rorty has said that what is needed in order to have a common world and a common moral standard is a consensus.8 To achieve this consensus he holds that speech, rhetoric, is of prime importance, because it has the power to convert our desires to truth.9
In our modern world a consensus is not hard to build. First of all, it is not defined. It can mean an agreement arrived at by most, but not necessarily all, of those concerned. It can also mean merely group solidarity in sentiment and belief. It can be a sham perceived as true but which is in fact fictitious. Achieving a consensus is facilitated by the use of public relations specialists, advertising techniques and the communication facilities of the internet and the media. These are powerful catalysts of the selfish life style which is sought after by means of the new norms which are advanced. Subordination of truth to power of persuasion becomes subordination of truth to the will of the elite. The legitimate claims of truth upon our minds yield to political power, and our democracy becomes more and more a euphemism for totalitarianism.
Our modern philosophical world view originated with the sophists who were not philosophers but cultivated the art of rhetoric in the fifth century B.C. It is not irrelevant to point out that they were the first Greek teachers to charge money for their efforts. Their classes consisted of enterprising young men who had the ambition to be successful in the political arenas of the Greek cities. They used language as a pragmatic tool and were willing to use it for subtle deception. Their Sophist instructors taught them to adopt whatever code of ethics that suited the morality dominant in each city in disregard of the fact that these moralities often varied greatly. For those instructors, the image transcended the reality. Plato regarded them as most dangerous because they "fabricate fictitious reality" which threatened the good. Hegel has said " The Sophists are not as remote to us as we may imagine", and Nietzsche's posthumous line was "The era of the sophists? Our time!" Josef Pieper, speaking of them said, "Abuse of language ... abuse of power."10
It was the Greek sophists who were the first to reject what science could prove. Ironically, it has been to some extent, the rise of the influence of modern scientists who, mistaking what science could prove for what it could not prove, assisted the rise of rationalism. They have held the false philosophy of scientism, which teaches that respect for science is sufficient reason to neglect the real in the metaphysical sense. Stanly Jaki tells us that Galileo, Newton, Einstein, and "a recent chorus of Nobel laureate physicists", have supported this notion. This has led to an unprecedented irony. Rationalism has produced a nihilism which permeates Canadian life. It has had the totally unexpected effect of causing Canadians to lose confidence in science and scientists. To be fair, our scientific, political and professional organizations, are mostly honest in their public activities. However, pervasive public nihilism has hampered their ability to act with consistent integrity. Our elites have accepted many so-called complementary health care practices as true, effective, and safe, despite the fact that they know that most of them are ineffective and sometimes dangerous. In some instances scientists pursue genetic research with no regard for the life of the embryo, or for the ultimate effect of their work on the gene pool. Their weak grip on moral reality renders them easy prey to temptations of aggrandizement. 'Complementary Medicine', includes such things as herbal medicine, Shamanism, Shiatsu, and Reiki, the 'Vedantic universal life force'. The Fraser Institute, in 1999, reported that 73% of Canadians had alternative therapy at some point in their life. This included chiropractic. Every year, Canadians spend 3.8 billion dollars on this alternative health care. By comparison, the total annual capital expenditure in Canada's hospitals stood at 2.1 billion dollars in 1995.11 This, notwithstanding the fact that few of these treatments work and that it has been steadily proven that many are dangerous. It is an outrage that 'complementary medicine' is now practised on a large scale in U.S. and Canadian hospitals, and that it has received recognition by such institutions as the American Nurses' Association, the National Institute of Health, (NIH), U.S.A. and the Ontario College of Nurses.
One might ask how nihilism affects the way in which the medical profession understands its moral responsibilities. Consider the question of euthanasia. When it was first mooted that it might be morally acceptable deliberately to cause the death of a patient if one's motive was to end the patient's suffering through ending his or her life, the medical profession refused to be involved. We must wait and see, they said, and allow all interested stake holders to enter public debate. Soon articles in the media and in professional journals appeared, casting euthanasia in a favourable light and deploring the lack of compassion of care givers who were unwilling to cooperate. Time passed, and in due course, euthanasia was seen by many as a 'right' of the patient, and a 'duty' of the care giver, doctor, nurse, or pharmacist. Both judges and juries have found persons 'not guilty' of euthanasia despite convincing evidence to the contrary. The medical profession, no longer fearing litigation and punishment, is tempted to think that a consensus has arrived.
The ethical principles listed by the CMA policy statement on organ donation and transplantation (beneficence, autonomy etc.) are unexceptionable per se. The problem occurs, not because of the use of these principles in themselves. It occurs because according to the policy of the CMA, before the principles are applied in practice, they must be understood and interpreted exclusively in the light of prior basic principles, the undefined so-called 'values of Canadians'. In finding solutions to complex moral problems there indeed must often be public debate informed by sound evidence. This is necessary so that all of the relevant facts may be accurately established. What is a problem is that the CMA assumes that the principles of moral behaviour can be arrived at, merely by some form of consensus or majority vote.
The ethical principles proposed by the CMA are not based on the claim that they are in fact and self-evidently true. They are based simply on the assumption that they are agreed upon by a majority of the Canadian public. This ethics is the ethics of rest of the western medical world. The secular world considers only what is available through the evidence of the senses presented to the mind by empirical experiment and verification. It refuses to accept the valid intellectual challenge to consider also as real and intelligible the existence of objective truth in regard to the origin, purpose or meaning of human life. It also refuses to consider Divine Revelation. For a Christian, this is unacceptable. Pope John Paul (11). has said, "... People seek the absolute ... something ultimate ... they seek a final explanation, which refers to nothing beyond itself, and which puts an end to all question."12 The CMA ethics is like a weather-vane twisting in the wind. It is dangerous for this reason, and also because, as Pope John Paul 11 has insisted, authentic human freedom is threatened by the absence of objective moral truth, " ...Truth and freedom go hand in hand."13 This absence of truth leaves us at the mercy of our wayward intellects and wills, prey to the hands of tyrants.
1 Canadian Medical Association Policy. Organ and Tissue Donation and Transplantation. (update 2000). CMA Journal, July 25, 2000; 163 (2). [Back]
3 Hobbes. Logica 3, 7; Opera philosophica, l: 32. [Back]
4 Descartes. Willmann, Idealmus 3: 241. [Back]
5 Spinoza. Dunin-Borkowski, Spinoza, 65f. [Back]
6 William A. Frank. Starting Points for Philosophy, History and Metaphysics in Fides et Ratio. Fellowship of Catholic Scholars Quarterly. Vol. 23, No.2, Spring 2000.p.18. [Back]
7 Richard Rorty. Contingency, irony and solidarity. p.189. [Back]
9 William A. Frank. Ut supra. P.18. [Back]
10 Josef Pieper. Abuse of Language ...Abuse of Power. Ignatius Press. 1992 [Back]
11 John B. Shea. "Therapeutic Touch: A Critique" Catholic Insight, Vol. V1, no.9, Nov. 1999, p.14-15. [Back]
12 Fides et Ratio. No.27 [Back]