The Ethics Blog

A research blog from the Centre for Resarch Ethics & Bioethics (CRB)

Author: Pär Segerdahl (Page 24 of 43)

The apparent academy

29 November, 2016 / / 0 Comments

Pär SegerdahlWhat can we believe in? The question acquires new urgency when the IT revolution makes it easier to spread information through channels that obey other laws than those hitherto characterizing journalism and academic publishing.

The free flow of information online requires a critical stance. That critical stance, however, requires a certain division of labor. It requires access to reliable sources: knowledge institutions like the academy and probing institutions like journalism.

But what happens to the trustworthiness of these institutions if they drown in the sea of impressively designed websites? What if IT entrepreneurs start what appear to be academic journals, but publish manuscripts without serious peer review as long as the researchers are paying for the service?

This false (or apparent) academy is already here. In fact, just as I write this, I get by email an offer from one of these new actors. The email begins, “Hello Professor,” and then promises unlikely quick review of manuscripts and friendly, responsive staff.

What can we do? Countermeasures are needed if what we call critical reflection and knowledge should retain their meaning, rather than serve as masks for something utterly different.

One action was taken on The Ethics Blog. Stefan Eriksson and Gert Helgesson published a post where they tried to make researchers more aware of the false academy. Apart from discussing the phenomenon, they listed deceptive academic journals to which unsuspecting bioethicists may submit papers (deceived by appearances). They also listed journals that take academic publishing seriously. The lists will be updated annually.

In an article in Medicine, Health Care and Philosophy (published by Springer), Eriksson and Helgesson deepen their examination of the false academy. Several committed researchers have studied the phenomenon and the article describes and discusses what we know about these questionable activities. It also proposes a list of characteristics of problematic journals, like unspecified editorial board, non-academic advertisement on the website, and spamming researchers with offers to submit manuscripts (like the email I received).

Another worrying trend, discussed in the article, is that even some traditional publishers begin to embrace some of the apparent academy’s practices (for they are profitable). Such as publishing limited editions of very expensive anthologies (which libraries must buy), or issuing journals that appear to be peer reviewed medical journals, but which (secretly) are sponsored by drug companies.

The article concludes with tentative suggestions on countermeasures, ranging from the formation of committees that keep track of these actors to stricter legislation and development of software that quickly identifies questionable publications in researchers’ publication lists.

The Internet is not just a fast information channel, but also a place where digital appearance gets followers and becomes social reality.

Pär Segerdahl

Eriksson, S. & Helgesson, G. 2016. “The false academy: predatory publishing in science and bioethics.” Medicine, Health Care and Philosophy, DOI 10.1007/s11019-016-9740-3

This post in Swedish

Approaching future issues - the Ethics Blog

The brain develops in interaction with culture

16 November, 2016 / / 0 Comments

Pär SegerdahlThe brain develops dramatically during childhood. These neural changes occur in the child’s interaction with its environment. The brain becomes a brain that functions in the culture in which it develops. If a child is mistreated, if it is deprived of important forms of interaction, like language and care, the brain is deprived of its opportunities to develop. This can result in permanent damages.

The fact that the brain develops in interaction with culture and becomes a brain that functions in culture, raises the question if we can change the brain by changing the culture it interacts with during childhood. Can we, on the basis of neuroscientific knowledge, plan neural development culturally? Can we shape our own humanity?

In an article in EMBO reports, Kathinka Evers and Jean-Pierre Changeux discuss this neuro-cultural outlook, where brain and culture are seen as co-existing in continual interplay. They emphasize that our societies shape our brains, while our brains shape our societies. Then they discuss the possibilities this opens up for ethics.

The question in the article is whether knowledge about the dynamic interplay between co-existing brains-and-cultures can be used “proactively” to create environments that shape children’s brains and make them, for example, less violent. Environments in which they become humans with ethical norms and response patterns that better meet today’s challenges.

Similar projects have been implemented in school systems, but here the idea is to plan them on the basis of knowledge about the dynamic brain. But also on the basis of societal decision-making about which ethics that should be supported; about which values that are essential for life on this planet.

Personally I’m attracted by “co-existence thinking” as such, which I believe applies to many phenomena. For not only the brain develops in interaction with culture. So does plant and animal life, as well as climate – which in turn will shape human life.

Maybe it is such thinking we need: an ethics of co-existence. Co-existence thinking gives us responsibilities: through awareness of a mistreated nature; through awareness of our dependence on this nature. But such thinking also transcends what we otherwise could have imagined, by introducing the idea of possibilities emerging from the interplay.

Do not believe preachers of necessity. It could have been different. It can become different.

Pär Segerdahl

Evers, K. & Changeux, J-P. 2016. “Proactive epigenesis and ethical innovation: A neuronal hypothesis for the genesis of ethical rules.” EMBO reports 17: 1361-1364.

This post in Swedish

Approaching future issues - the Ethics Blog

What is the risk?

2 November, 2016 / / 0 Comments

Pär SegerdahlTo communicate about genetic risk with patients, we need to know how people think about risk and that experts and people in general often think differently.

A common feature, however, is this: Risk has to do with future adverse events. We talk about the risk of getting sick. But we rarely talk about the risk of getting well. We must then imagine people who value their disease (perhaps to avoid enrollment in an occupation army).

The expert’s concept of risk presupposes the negative value, but does not delve into it. It focuses on the probability that the unwanted event will happen (and how certain/uncertain the probability is).

For patients, however, the value aspect probably is more in focus. A couple learning about a 25% risk of having a child with a certain disability probably considers how bad such impairment would be: for the child and themselves. Maybe it isn’t so bad? Perhaps there is no great “risk” at all! They evaluate the risk scenario rather than calculate the probability.

How can we understand this value aspect, which risk presupposes and patients ponder? Ulrik Kihlbom at CRB asks the question in an article in the Journal of Risk Research.

Kihlbom describes two common ways of understanding value. The first is in terms of preferences. People have different preferences. Most prefer health before sickness, but occasionally someone may prefer disease. Value lies in satisfying these preferences, whatever they are. There is then only one value: preference satisfaction. The problem is that we can object that these preferences are not always reasonable or well informed. Additionally, patients can adapt to their illness and prefer their lives as much as healthy persons prefer their lives. Is it valuable to satisfy even such preferences?

Not surprisingly, the other way of understanding value is more objective. Here one assumes that value depends on how well certain basic human capabilities are supported. Such as being able to use one’s senses, imagine, think, play, be healthy, etc. Here there is a more objective measure of value. The problem is the authority the measure is given. May not a person lack some of these capabilities and still live a full and dignified life? Who decides which capabilities should belong to the measure?

Actually, I would say that both proposals impose a measure of value. Preference satisfaction is, of course, a general measure too.

Kihlbom proposes a third way of understanding value. No measure of value is imposed and value is not separated from that which has value. If someone gets cancer, the negative value lies already in the disease, so to speak. A person who knows what cancer is does not ask: “Why is it bad to get cancer?” And hardly anybody would answer: “Because it frustrates my preferences” or “Because it prevents me from flourishing as a human being.”

Knowing what disease is means knowing that it is bad. It is part of the point of the word. To exclaim, “I’m so sick!” is to complain (not to rejoice). The value lies in the phenomenon itself and in the word. If some people still value their disease (perhaps to avoid military service), the value lies in the situation where the disease can appear as a good thing.

This is probably how people approach genetic risk information: What does this mean in my life? How bad is it? They immerse themselves in the value aspect, which the numerical probability presupposes. The 25-percent risk of having a child with a certain disability leads to concerns over what such a life might turn out to be like; how it can be described; how it can be valued.

So what should we keep in mind in genetic risk communication? The novelty about genetic risk information is not only that patients get difficult to interpret percentages of probability. The scenarios are new. These scenarios can involve time perspectives that extend throughout one’s future life, even to future generations. They can be about diseases and treatments that we do not know what it means to live with.

We evaluate risks daily (like the risk of missing the train), but here patients encounter novel risk scenarios that are difficult to evaluate. If I understand Kihlbom right, he thinks that the challenge is not only to explain probabilities to patients. The challenge is not least that of talking with patients about these new risk scenarios: about how they react to them in terms of value, how they describe them as “catastrophic” or “not so bad.”

Patients need support to evaluate genetic risk scenarios reasonably; not only to understand probabilities.

Pär Segerdahl

Kihlbom, U. 2016. “Genetic Risk and Value.” Journal of Risk Research, DOI: 10.1080 / 13669877.2016.1200653

This post in Swedish

We like real-life ethics : www.ethicsblog.crb.uu.se

How to listen to (the right) patient voices? (By Ulrik Kihlbom)

25 October, 2016 / / 0 Comments

Ulrik Kihlbom, Academic co-lead of PREFER's methodology work packageWe all think patients’ voices are important. But how do we make sure we listen to the right ones? Patient engagement and patient perspectives have come into focus in health care in recent years. Though this is especially true for the clinical setting, this development can be expected to continue for decision-makers at other levels.

We are just starting to research these questions in a project called PREFER. The aim is to establish which methods to use to bring in patient perspectives into important decisions regarding medical drugs; decisions made by different stakeholders, such as physicians, regulatory and reimbursement authorities, and the industry. In short: how and when should decision makers listen to the patients?

But, how can we make sure that the methods enable decision-makers to listen to the right patient voices?

Now, the expression “the right patient voices” should plausibly be understood as comprising several aspects such as being representative of the actual views patients have, being adequately informed, and as being non-biased. Each of these aspects require thorough consideration and also methodological development. I am myself responsible for one task that will specifically address these questions. One of the many intriguing issues here is when, during the process of falling ill, coming under treatment, and hopefully convalescing, a patient’s voice should be listened to? The patient’s preferences will probably change during the trajectory of illness. Imagine that you fall seriously ill, are treated and recover, and suppose also that your preferences for a risky treatment change during this period of time. Do you know when your preferences are such that your physician should listen to them? And when they merit less attention? I am myself far from sure how to answer this question.

Another set of questions concerns how the (right) patient perspective should be incorporated into the decision making. How, for example should a reimbursement authority weigh the patient perspective against cost-effectiveness when making a decision of subsidising a medical drug? Or how should a regulatory authority, such as EMA in Europe, FDA in the US, and Läkemedelsverket in Sweden, weigh patient effectiveness against safety concerns? It seems fair to say that everybody agrees that the patient perspective should have a weight, but no one has an established scale.

These are some of the very hard and intriguing questions that the PREFER project will address over the coming five years. 33 partners from academic institutions, patient organisations, health technology assessment bodies, small companies and the pharmaceutical industry are putting their heads, competence and resources together. Uppsala University is coordinating the project, with CRB’s director Mats G. Hansson at the helm. Apart from me and Mats, Josepine Fernow, Elisabeth Furberg, Jorien Veldwijk and Karin Schölin Bywall at CRB are involved in PREFER. We are looking forward to interesting research questions, but also to learning by working in, and leading, a public-private partnership of this size.

In the autumn of 2021, the project will issue recommendations. By then we will know better how decision makers may find and listen to the (right) patient voices. And how patients’ voices can make themselves heard in the decisions of regulators, health technology assessment bodies, reimbursement agencies, and pharmaceutical companies.

Ulrik Kihlbom

About PREFER: The Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115966. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. The contents of this text reflects the author’s view and not the view of IMI, the European Union or EFPIA.

This post in Swedish

The Ethics Blog - Exploring preferences

Did medicine save the life of ethics?

18 October, 2016 / / 0 Comments

Pär SegerdahlAbout thirty-five years ago, Stephen Toulmin wrote an article on the topic: How medicine saved the life of ethics. I think it is still worth reading.

Toulmin argued roughly as follows:

During the first six decades of the 1900s, ethics wasn’t feeling well at all. One might say that it suffered from moral aphasia: it couldn’t talk sensibly about real ethical problems.

While moral philosophers were preoccupied with formally specifying what distinguishes moral questions and judgements in general, without taking sides on specific ethical issues, ethics debaters outside of academic philosophy were trapped in the opposition between dogmatism and relativism.

Dogmatists referred respectfully to universal principles and authoritative religious systems, while relativists and subjectivists dismissed the absolute claims with reference to anthropological and psychological findings about differences in people’s attitudes.

In short, while philosophers analyzed what characterizes morality in general and left living ethical issues to their fate, dogmatists and relativists fought fruitlessly about whether these issues have absolute answers, based on universal principles, or if the answers are relative to cultural and individual factors.

In this near-death state, medicine came to the rescue. Medical practices gave rise to very definite ethical questions that insisted on answers and guidance. When philosophers in the 1960s began to pay attention to these issues, ethics was rescued from the life-threatening condition in which it found itself.

Toulmin suggests that medical ethics saved the life of ethics through four resuscitation efforts:

By focusing on situations, needs and interests, which are more objectively given than the attitudes, feelings and desires that anthropology and psychology were interested in. Whether a person’s actions threaten another’s health can be discussed in objective terms, as opposed to questions about habits and tastes.

(Here I think of the emergence of empirical ethics, where more objective aspects of ethical problems are explored in various kinds of studies.)

By analyzing concrete cases, instead of striving towards the universal principles to which dogmatists referred. Toulmin compares medical ethics to medical practice. Diseases described only in general terms become abstract and without specific relevance: they acquire practical relevance only for health professionals who learned the art of identifying real-life cases of the diseases. The same applies to ethics, which requires an art of identifying real-life cases of, for example, “disrespect”; otherwise ethical concepts become abstract and without practical significance.

(Here I think, among other things, of the emergence of ethics rounds in the ethics training of healthcare staff.)

By focusing on professional activities, giving rise to definite responsibilities and duties. To understand our duties to each other, we cannot assume an abstract image of humans as individuals. We live in communities and act in forms of life that shape our obligations. Issues in medical ethics are often about obligations shaped by professional roles and contexts.

(Here I think of the previous blog post, about boundaries between public health and healthcare, which sometimes might be transgressed. Practices such as research, healthcare and industry shape different types of obligation and responsibility, which it sometimes can be difficult to keep separate or balance.)

By reintroducing assessments of equity and personal relationships in ethics, assessments of how the circumstances alter the cases. What, in a doctor-patient relationship, is a routine examination, can outside of this context give us reason to speak of an assault. Circumstances alter the cases, and Toulmin compares medical ethics with how courts make assessments of what is just and reasonable between people, given what we know about them.

(Here I think of how medical ethics increasingly is done in dialogue with patients, health professionals and researchers, to better understand the circumstances.)

– Why do I find Toulmin’s article worth reading today?

Among other things, because it provides a broad and realistic description of ethics as a practice and art, in time and in particular contexts, partly comparable to the doctor’s or the lawyer’s practice and art. The article also makes the development of bioethics understandable, such as the emergence of empirical ethics, of ethics rounds, and of the endeavor to work in dialogue with stakeholders and with the professions.

The article also nuances a simplified understanding of how ethical questions are answered. We are inclined to think that empirical studies give us the facts. Then we add general moral principles and derive the ethical conclusions. This could resemble a relapse into dogmatism, where religious principles have been replaced by secular philosophical principles.

Finally, I want to mention that the article sheds light on a problem that we encountered in some empirical studies lately. Colleagues have made ethical education interventions in different healthcare professions. The participants appreciated the practical exercises and found them instructive. But no clear effect of the exercises could be measured by comparing results of knowledge tests before and after the interventions.

Toulmin’s description of how medicine saved the life of ethics may suggest an explanation. The exercises were practical and concerned cases with which the participants were familiar. But the knowledge tests were formulated roughly in those general terms which constituted such a large part of the illness of ethics. The interventions might have been vitalizing, but not the method of measurement.

Pär Segerdahl

This post in Swedish

We think about bioethics : www.ethicsblog.crb.uu.se

Public health campaigns in healthcare: mothers should breastfeed!

3 October, 2016 / / 0 Comments

Pär SegerdahlPublic health campaigns do to some extent infringe upon our lives. Maybe we are prepared to allow some of these intrusions. We protest a little, just for show, but still adopt the message and begin to think that we probably ought to eat a little more X and a little less Y.

Some campaigns, however, encroach on sensitive areas of life, in more vulnerable situations, and in places where one would expect more personal respect.

Campaigns to encourage mothers to breastfeed, instead of giving infant formula, provide an example. These campaigns occur not least in healthcare, in contacts with new mothers who for various reasons may have difficulties with breastfeeding, or who don’t want to breastfeed.

Earlier this year, Jessica Nihlén Fahlquist had an article published in Nursing Ethics about such mothers’ experiences. It’s about mothers who don’t breastfeed and about their experiences of contacts with healthcare and being met with campaigning.

The survey responses described in the article suggest that these mothers can feel like bad mothers. They are told that breastfeeding is the best and safest option for the child, that all mothers can breastfeed if they just try, and that “artificial” formula feeding increases the risk of malnutrition and various diseases in the child.

The mothers feel that they don’t get opportunity to talk about their problems or desires to find a way of feeding their child that works for them. Might not bottle feeding be the better option for some mothers and children? The information seems, to a great extent, to be about communicating the norm that a real mother should breastfeed. That’s at least how the mothers in the study appear to experience the situation, and they may feel guilty not only because they don’t breastfeed, but also because they don’t enjoy it.

Nihlén Fahlquist points out that information about feeding infants in essence is a form of risk communication where parents are informed about the risks and benefits of breastfeeding and bottle feeding. She suggests that breastfeeding campaigns tend to be deficient in three ethical respects, which need to be addressed:

Parents are informed about risks and benefits on a collective level, without regard to individual problems, needs and circumstances. The public health perspective overshadows the unique situations of these mothers, even though the question how to feed one’s child is intimate. Risks and benefits should be weighed individually.

Campaigning collides with respect for autonomy, which is important in healthcare. The risk communication is one-way; questions and doubts are not taken seriously. It’s about informing parents about “the best option.” One-way communication should be replaced by dialogue.

The effects of breastfeeding campaigns should be evaluated not only statistically, in terms of how many mothers are breastfeeding. They should also be evaluated ethically, in terms of good care. The mothers who responded to the survey don’t seem to experience good care, sensitive to their individual needs.

For me, the article shows how public health campaigns conducted in healthcare need to be adapted to the type of meetings that we need and expect there. Otherwise, risk communication might be perceived as an unwarranted intrusion. Additional sensitivity is required when campaigns revolve around strong norms that easily give rise to feelings of guilt, such as norms of motherhood.

Pär Segerdahl

Nihlén Fahlquist, J. 2016. Experience of non-breastfeeding mothers: Norms and ethically responsible risk communication. Nursing Ethics 23: 231-241

This post in Swedish

In dialogue with patients

Physicians’ experiences of do-not-resuscitate orders

21 September, 2016 / / 0 Comments

Pär SegerdahlCritically ill patients sometimes have such a poor prognosis that cardiopulmonary resuscitation for cardiac arrest (CPR) would not help. They are so weak that they would not survive the treatment. If they survive, they do so with even poorer quality of life. The physician can then write a so-called DNR decision, which means that CPR should not be performed.

Mona Pettersson, PhD student at CRB, writes her thesis on these decisions. I have previously written about her first study, in which she interviewed nurses about their experiences of DNR decisions at Swedish hematology and oncology departments.

This summer the Journal of Palliative Care and Medicine published the second study, in which physicians were interviewed about their experiences of these decisions.

In the interview material, Mona Pettersson discerns three roles that physicians perceive they have. They act as decision maker, as patient advocate and mediator for relatives, and as team member. Physicians describe their experiences of these roles, such as the importance of making clear to relatives that it is the physician who makes the decision – so that relatives don’t risk feeling guilty.

The interviews with physicians also contain descriptions of ethical difficulties associated with DNR decisions. Although the physicians emphasize that the decision is made on medical grounds, they also describe ethical challenges and trade-offs. The decisions seem to be especially difficult in hematology wards, where patients can get intensive treatment for a long time, and where even the treatment makes them ill, but almost up to the last moment can be regarded as treatable. Here decisions are made quickly and at a late stage. Physicians’ experiences of the decision not to resuscitate vary from experiencing that they make themselves God, to experiencing it as just one medical decision among others.

In her conclusion, Mona Pettersson emphasizes that the results indicate how DNR decisions are made not only on medical grounds (such as prognosis and prospect of surviving cardiopulmonary resuscitation). They are made also with reference also to ethical values such as autonomy and quality of life after resuscitation.

In her future research, Mona Petterson will examine the ethical skills needed in DNR decisions and how they can be learned and developed.

Pär Segerdahl

Pettersson, M. Hedström, M. and Höglund, A. Physicians’ experiences of do-not-resuscitate (DNR) orders in hematology and oncology care – a qualitative study. Journal of Palliative Care and Medicine. 2016. DOI: 10.4172 / 2165-7386.1000275

This post in Swedish

We have a clinical perspective : www.ethicsblog.crb.uu.se

We look for a PhD student

30 August, 2016 / / 0 Comments

Pär SegerdahlAt CRB we seek new ways to study how people respond to health information, especially risk information, and how they make trade-offs between risks and benefits. We are right now looking for a PhD student who can work in one of these projects. The task involves both qualitative and quantitative work, including so-called Discrete Choice Experiments.

CRB is an international research environment and the working language is English. However, for this position the applicant must be proficient in Swedish, to be able to carry out the qualitative work.

If you know a Swedish speaking person who might be interested, please inform him or her about the advertised position. The Swedish version of this post contains links to information about the position.

Deadline for applications is 12 September.

Pär Segerdahl

We like real-life ethics : www.ethicsblog.crb.uu.se

Identifying individuals while protecting privacy

24 August, 2016 / / 0 Comments

Pär SegerdahlResearch ethics is complex and requires considering issues from several perspectives simultaneously. I’ve written about the temptation to reduce research ethics to pure protection ethics. Then not as much needs to be kept in mind. Protection is the sole aim, and thinking begins to resemble the plot of an adventure film where the hero finally sets the hostages free.

Protection is of course central to research ethics and there are cases where one is tempted to say that research participants are taken hostage by unscrupulous scientists. Like when a group of African-American men with syphilis were recruited to a research study, but weren’t treated because the researchers wanted to study the natural course of the disease.

Everyday life is not one big hostage drama, however, which immediately makes the issues more complex. The researcher is typically not the villain, the participant is not the victim, and the ethicist is not the hero who saves the victim from the villain. What is research ethics in everyday situations?

There is currently a growing concern that coding of personal data and biospecimens doesn’t sufficiently protect research participants from privacy invasions. Hackers hired to test the security of research databases have in some cases been able to identify the individuals who provided their personal data to research (in the belief that the link to them had been made inaccessible to outsiders through advanced coding procedures). Such re-identified information can obviously harm participants, if it falls into the wrong hands.

What is the task of research ethics here? Suddenly we can begin to discern the outlines of a drama in which the participant risks becoming the victim, the researcher risks becoming the villain’s accomplice, and the ethicist rushes onto the scene and rescues the victim by making personal data in research databases completely anonymous, impossible to identify even for researchers.

But everyday life hasn’t collapsed yet. Perhaps we should keep a cool head and ask: Why are personal data and biological samples not fully anonymized, but coded so that researchers can identify individual patients/research participants? The answer is that it’s necessary to achieve scientific results (and to provide individual patients the right care). Discovering relationships between genetics, lifestyle and disease requires running several registries together. Genetic data from the biobank may need to be linked to patient records in healthcare. The link is the individual, who therefore must be identifiable to the research, through the use of advanced code keys.

The need to identify participants is particularly evident in research on rare diseases. Obviously, there is only scant data on these diseases. The data needs to be shared between research groups, often in different countries, in order to collect enough data for patterns to appear, which can lead to diagnoses and treatments.

An overly dramatic heroic effort to protect privacy would have its own victims.

In an article in the European Journal of Human Genetics, Mats G. Hansson and co-authors develop a different, more sustainable ethical response to the risk of re-identification.

Respecting and protecting participants’ privacy is, of course, a central concern in the article. But protection isn’t the only perspective, since science and health care are ethical values too. And here you need to be able to identify participants. The task the authors assume, then, is that of discussing the risks of re-identification, while simultaneously considering the needs for identifiable data.

The authors are, in other words, looking for a balance between different values: simply because identifiable data are associated with both risks and benefits.

You can read a summary of the article on the CRB website. What I focus on in this post is the authors’ overall approach to research ethics, which doesn’t emphasize the hero/villain/victim opposition of certain dramatic situations.

The public image of research ethics is very much shaped by its function in response to research scandals. But research ethics is usually, and less dramatically, about making everyday life function ethically in a society which contains research. Making everyday life run smoothly is a more complex and important task than playing the hero when everyday life breaks down. In this work, more values and challenges need to be taken into account simultaneously than in emergency scenarios where ethicists, very naturally, focus on protection.

Everyday life may not be as exciting as a research scandal, but if we don’t first and foremost take responsibility for making everyday life work smoothly, as a complex whole, then we can expect more drama.

Keep a cool head and consider the issues from a variety of perspectives!

Pär Segerdahl

Hansson, M. G. et al. The risk of re-identification versus the need to identify individuals in rare disease research. European Journal of Human Genetics, advance online publication, 25 May 2016; doi: 10.1038/ejhg.2016.52

This post in Swedish

Approaching future issues - the Ethics Blog

Intending a philosophical system as the truth of life

15 August, 2016 / / 0 Comments

Pär SegerdahlWhat a joy it is to read a real philosopher! This summer I read David Hume and was puzzled by this question: Why is Hume so stimulating to read, when the experts’ comments to his philosophical system are so tedious? If the system is what’s important, shouldn’t the exposition of the system by knowledgeable commentators be just as stimulating?

Is it because Hume’s writes so beautifully and vividly? But even Kant is philosophically more stimulating than the experts’ comments on Kant, and he isn’t known for writing well. What is it that withers away when a philosopher’s system is expounded?

Hume wants to demonstrate how to think about life. The commentator rather wants to establish how to talk about Hume’s system, as one of several historically given systems. The commentator has a bourgeois function: a philosophical grammar teacher who provides instructions for how to reason correctly as a Humean, as a Kantian, as a Husserlian.

I want to say: the scholar’s exposition stands to the philosopher’s work as a grammar book to a living language. What made it so joyful to read Hume was precisely this: spending some time with native speaker; hearing philosophy actually being spoken and thought.

What is it that flourishes in Hume’s philosophical language, but withers away in the scholarly exposition of his system?

I’d say: Hume’s meaning the system as the truth of life. In Hume, life is in focus, not only the system as a conceptual apparatus. Hume’s system germinates in an attempt to intellectually make sense of life. Hume must laboriously make each new thought evident as a true thought about life. The scholar need not make this risky work, but can confidently present the system as a conceptual apparatus that simply exists. Dubious details should, of course, be pointed out and discussed, but doubting the whole project isn’t the commentator’s task. The system was for God’s sake published in the eighteenth century and is much talked-about!

Hume lives more dangerously: “Every step I take is with hesitation, and every new reflection makes me dread an error and absurdity in my reasoning.” This he writes under the heading, “Conclusions of this book,” where one would expect a victorious summary of the system. How could Hume be unsure of his own system, even in the conclusions? It is his creation! Isn’t he its ultimate authority?

The point is precisely that Hume means his system as the truth of something bigger and more difficult to survey. The system is about life itself. What if it fails! What if there is an error in the connection to what the system should be the truth about!

So my question is: How does one mean a philosophical system as the truth of life? Does one make a heroic effort to speak faithfully as a Humean, always calculating “what Hume would have said”? If you wish to become a Humean, you will probably have do something like that. But it wouldn’t suffice for Hume. The system must really be connected to life itself. The thoughts must really be true thoughts about life. This must be scrupulously ascertained, at each new step. Hume continuously makes this work. He takes responsibility for the system vis-à-vis life. He ensures that it satisfies his extraordinary demands as a sincere thinker.

I am prepared to admit that Hume’s thoughts are connected to life. This connection makes his language flourish as a philosophical language. My question is what the connection looks like and how he interprets it.

This post now takes a new turn. After having expressed the joy of reading Hume as a thinker with a living, flourishing philosophical language, I will place a question mark where commentators don’t usually place their question marks. I place my question mark not inside the system, but in Hume’s intending the system as the truth of life. I place my question mark outside of the scholarly focus on the system itself.

When I read Hume, I also find a sort of profound comedy in his work. Not in the system, but in his thinking. What is comical resides in Hume’s utterly honest claims on the system; in his systematic, causal interpretations of the psychological observations he makes. Hume’s explanation of why we feel pride in certain situations, for example, differs from the explanations we normally would give in the same situations.

We can explain: “No wonder he is proud of that chair; it is beautiful and he spent weeks at designing it!” Hume would explain: “No wonder he is proud of the chair; it has qualities that cause pleasure and it has a relationship to the person.”

The combination of “qualities in the object that cause pleasure” and “relationship to the person” must cause pride – according to the principles of Hume’s system. Hume’s explanation is super-general and uses the concepts and rules of the system. He can repeat exactly the same explanation every time someone is proud.

Hume’s systematic explanation of pride has a point that we can all recognize. Suppose I said: “I am so proud of this chair!” But when you ask, “Have you made it yourself?” I answer, “No, I haven’t seen it before, whose is it?” – You wouldn’t understand how I can be proud of a completely foreign chair!

“I cannot be proud of something that doesn’t have a relation to me.” This could serve as a reminder of a pattern in pride as human phenomenon. But Hume interprets this observation as if he glimpsed an underlying causal mechanism – “in the human mind” – which explains why pride isn’t caused in such situations.

This duality is an important reason why it is such a joy to read Hume. His system is based on fine observations of psychological traits of human life, sometimes almost like in a Jane Austen novel. But he interprets his observations as glimpses of general mechanisms – “in the human mind” – that cause these traits.

Here we have the connection to life, and also Hume’s interpretation of it! Hume interprets his observations of traits of human life as if they revealed underlying causal mechanisms (“in the human mind”) that cause these traits. The interpretation provides intellectual control over life, as if no significant feature of life could surprise Hume anymore.

I’ve noted all instances of, “No wonder, then, …” in Hume’s work. There are many! They occur when he has described an everyday phenomenon of life (such as a situation where someone is proud) and used the system to explain it. The system allows him to wander through life and exclaim, “No wonder!” before every characteristic trait he sees. – Life intellectually explained!

I thus find an unstated dualism in Hume’s thinking:

  • Phenomena of life / Underlying system

This dualism isn’t part the system and is therefore not in focus for the scholar who expounds the system. The dualism is located in Hume’s claim on the system as the truth of life. It is resides in Hume’s thinking, in his conscientious work to make the system true about life. It is the taken for granted form of systematic philosophical thought.

The dualism intellectualizes life as if it borrowed its traits from general principles. This tendency to always take what is general for what is primary and fundamental – as underlying life – is an intellectual instinct that I believe that today’s philosophy should scrutinize and overcome.

It is about rescuing the connection to life, clearly discernible in Hume’s thinking, from the interpretation of it as a connection to an intellectualized source of all phenomena of life. The connection needs to be rescued, so that those who philosophize about life, as Hume did, can mean their observations as observations of life; rather than as life-penetrating insights into an underlying primary order, which only would be a repetiton, in sublimated form, of what was seen.

The obstacle on our path is that this new question mark, placed not in the system but in the claim on it as the truth of life, will be incomprehensible to experts in the field. Philosophy can flourish again only by freeing itself from the current scholarly grip on it.

Pär Segerdahl

This post in Swedish

The Ethics Blog - Thinking about thinking

« Older posts Newer posts »