Critique

HEALTH CARE ANALYSIS VOL. 2:310-316 (1994)

Critique The Silence of Philosophy

Michael Loughlin

In discussions of social policy the views of philosophers are often all too easily dismissed by those lacking either the ability or the inclination to follow their reasoning through to its conclusions. When confronted with detailed arguments dem- onstrating the incoherence of their pronuncia- tions or the irrationality of their policies politicians, managers and others in positions of power find it is usually sufficient to respond by labelling such criticisms 'abstract' or 'esoteric', and then to proceed exactly as before. The assumption, sometimes implicit, sometimes spelled out, but rarely supported by argument, is that philosophy is by its nature incapable of con- tributing to the discussion of substantive questions. Philosophers may be 'logical' people but despite, perhaps even because of this they are not sufficiently 'practical' to understand such 'real life' issues as justice in health care and the distri- bution of scarce resources. Anything they have to say on such matters may therefore be declared a merely 'academic' observation, and effectively ignored.

Those of us who are philosophers by training or profession might like to think that such dismiss- ive attitudes toward our discipline are entirely the product of the stupidity (natural or wilful) of those who hold them. Unfortunately the truth is not so comforting. Philosophers themselves are at least in part responsible for the misconceptions surrounding their subject. The view that philosophy has nothing to say about matters of practical importance is itself the product of a doctrine pro- moted enthusiastically by many philosophers this century. Perhaps even more seriously, however, it can be argued that even those philosophers dedi- cated to applying philosophical methods to such questions as the nature and purpose of health care can, and frequently do, fall into the trap of con-

structing models of reality whose application to the world they purport to analyse is at best unclear. ~

This situation is disastrous, and not only because intelligent people are wasting their skills. The absence of any serious philosophical com- ponent to political debate throughout the West- ern world is glaringly obvious. The agenda is dominated by crude appeals to self-interest and to unanalysed dogma; appeals made by those whose years of experience sitting on committees and reciting slogans in public have convinced them that these are the only elements of human

"Philosophers are fiddling while the city burns.. ."

thought worth evoking. The stupidity which increasingly characterises political comment is accompanied by increasing barbarism in the societies where decisions are made in such a brutish fashion. While the relationship between the stupidity and the barbarity of a society may not be a straightforward matter of cause to effect, the failure of philosophy to influence popular thought means that one more line of defence is lost against those who would reduce every aspect of life to a brutal competition. Fiddling while the city burns may still be wrong, even though it is not the cause of the fire.

The Need for Applied Philosophy

It is evidence of the pervasiveness of the view of philosophy outlined above that the statement that it is misconception of the subject may well require explanation. Those who claim that philosophy is

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practically irrelevant are correct in asserting that it is concerned with logic. Their error is in thinking that there is some sort of opposition between the practical and the logical. Philosophers are trained to identify the logical structure of arguments and to identify and analyse key assumptions, clarifying debates by exposing ambiguities and errors of reasoning. Far from being an al- ternative to practical thinking it is essential--if thinking is to provide the basis for coherent prac- tice that logical confusions about the meanings of terms and about the implications of statements are identified in this way. The choice is not between practical or logical thinking, but between clear practical thinking or confused thinking.

'The choice is not between practical or logical thinking, but between clear

practical thinking or confused thinking"

It is fair to say that philosophy is characterised not only by its style of answering a question, but also by the sorts of questions philosophers tend to raise. These are typically questions of a fundamental nature, and it is the characteristic style of philosophical enquiry which determines that such questions should constitute its typical con- tent. In most discussions, logical analysis of the key terms used leads fairly quickly to the questioning of fundamental assumptions. For instance, when confronted with claims about what would or would not improve the efficiency of the health service, philosophers will raise questions about the concept of health itself and about the purpose of health care. They may also want to discuss the nature of "benefit', as well as what it means to describe something as a 'cost'. It is impossible to assess the claim that a particular policy would improve efficiency unless one knows what its ends are, why they are thought to be "beneficial' and which effects of the policy are to be counted as amongst its 'costs'. (One obvious but nonetheless pertinent example is whether or not the psychological and material damage suffered by persons deprived of employment should be counted amongst the costs of 'labour-saving' policies which result in redundancies. If so, how are

these costs to be incorporated into the calculation of a policy's "efficiency', and if they are not, then what is the justification for employing a conception of "cost' which ignores such social factors?)

Anyone who denies the practical relevance of raising such fundamental questions is only mask- ing his or her own deep confusions about them, or else (perhaps more dangerously) is supposing that certain answers to these questions are just obvious, and as such are in need of no support, nor even explicit articulation. Philosophers are sometimes criticised for raising queries about matters too obvious to merit serious discussion, and if an explanation is given for this statement it is likely to be that most people do not need to discuss such matters because there is general agreement about them.

But even the fact that a belief is widely held is not, of itself, sufficient grounds to assert its truth. The move from the claim that many people hold a certain belief, to the assertion that one's audience ought to believe it also, embodies one of several highly controversial philosophical assumptions about the nature of truth and its relationship with belief.

It might be the assumption that the truth of a belief is somehow irrelevant to the question of whether or not one ought to believe it; that one ought simply to accept the views of the majority without question. Or it could be the assumption that the very fact that a belief is widely held is sufficient to make it true, that that is all there is to a belief's being true. Or, less radically, the suppo- sition could be that wide acceptance of a belief is good, if not conclusive, evidence for its truth, since on the whole people tend to have good reasons for what they believe. However, if we are discussing beliefs of a fundamental nature, about the nature of health or about what sorts of things are really valuable or beneficial even this assumption is highly questionable, especially when one considers the extent to which we are subjected to irrational persuasion aimed at swaying public opinion on such matters. The assumption would hold true only in societies where people gave serious thought to fundamental questions. It can hardly, therefore, be evoked to imply that such serious thought is unnecessary, and that it

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can satisfactorily be replaced by appeals to what people generally believe.

Thus philosophy is unavoidable in practical discussion, not only in that its methods are a necessary feature of coherent practical reasoning, but also in that one cannot avoid making philosophical assumptions when discussing any sub- stantial question whatsoever. The refusal to discuss philosophy is the intellectual equivalent of putting one's fingers in one's ears whenever one's own most cherished assumptions are subjected to questioning.

'Philosophy is unavoidable in practical discussion"

How then did philosophy acquire the reputation of being somehow distant from the 'real world', having no application to, nor interest in, the concerns of ordinary life? I have already claimed that philosophers themselves are at least partially responsible. Certainly the belief that philosophy is somehow an 'other-worldly' occupation may to some extent be influenced by a caricature of Plato. It is, however, unlikely that a somewhat unfair reading of one great philosopher could determine the public perception of the entire discipline more than two thousand years after that philosopher's death.

Ironically, the perception that there is a gap between the concerns of philosophy and all non- trivial discussion derives largely from the work of professional philosophers this century. Logical empiricism (or positivism) was for a long period the dominant view amongst philosophers and even today, although many of the epistemological assumptions of the positivists have been dis- credited, many philosophers still accept their irrationalist account of moral thinking. Positivists denied that philosophy could play a role in any practical discussions about what ought to be done, either by individuals or by societies, not because they took a dim view of philosophy but because they viewed 'the practical' as an arena where rationality has no role. According to this doctrine, there is no right answer to any question about what is good, or about what we ought to do. The answers to such questions are determined by irrational (or 'non-rational') considerations, in

that individuals appeal to their own, purely sub- jective preference, and any attempt I make to convince you that you ought to behave in a certain way must involve a large dose of emotive persuasion. Moral debate, on this view, is like a battle ground where the strongest passions win out, and there is no tenable distinction to be drawn between rational argument and sheer propaganda. 2

For this reason policy-makers cannot with con- sistency appeal to such a view to defend a dis- missal of philosophical criticism of their policies, unless they are also prepared to admit that their own policies are not only rationally unjustified but in principle unjustifiable, and that their decisions are not a reasoned attempt to work for something called the public good (whose nature they, with their 'practical' knowledge, understand), but are rather simply the expression of their own non-rational preferences. It seems clear

"Positivists viewed "'the practical" as an area where rationality has no role"

that public officials do in fact assume an irrationalist account of human decision-making, in- dicated by the fact that discussion about what is valuable, and about what makes a society a good society, is reduced in so much political debate to the invention of persuasive rhetoric and the rep- etition of slogans. The hope is, apparently, that one's own side's slogans will have the most emotive appeal for most people, for when these slogans are subjected to serious questioning there appears to be nothing underlying them, other than some gut reactions which are taken to be somehow unchallengeable. The result is the intellectual vacuum that is late twentieth century political conversation.

The Appeal of Irrationalism

In what remains of this Critique I want to suggest some reasons why we should reject the irrationalism which for so long has dominated philosophical approaches to both ethics and political debate. It would be impossible in a short article to refute irrationalism in its various forms, since to do so would require giving a full account of the correct

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role of rationality in moral thinking: in discussions such as this, the only truly adequate way to refute the declaration that something cannot be done is to do it. Instead of attempting so huge a task I shall more modestly attempt to explain why many people are still attracted to the view that rationality and morals have nothing to do with one another: the claim that ethics is 'a matter of opinion' is very common, and is apparently taken as read by many non-philosophers. I shall argue that the considerations which make this view seem attractive do not in fact establish its truth, that on the contrary they in fact provide reasons to search for an account of moral thinking compat- ible with the view that there are good and bad ways to argue about ethics, and that the truth about how we ought to treat one another can sometimes be discovered.

"Imagine an alien being watching the 1990 World Cup Final"

Many students of philosophy are attracted to irrationalist (or 'subjectivist') accounts of moral reasoning because these seem to provide the most 'realistic' account of how moral arguments are framed. Moral discourse most often does resemble a verbal battle field where people use any tactics at their disposal to sway others round to their opinion. The description of contemporary moral and political debate given in C. L. Stevenson's anti-rationalist classic Ethics and Language 3 is perhaps the best in existence, and I have argued in a previous Critique 4 that his analysis of the use of persuasive language accurately describes very much of the discussion taking place in health service management today: lengthy discussion papers purport to be about how to solve complex problems, when their real function is to invent new ways to describe the current state of the health service, ways which have a more positive 'feel' to them and so, it is hoped, may persuade people to approve of policies which they would otherwise recognise as disastrous.

For these reasons Stevenson's picture may 'ring true', but we should not confuse a good description of moral and political argument, as it is con- ducted at a particular time in a particular culture, with an account of the essential nature of all

practical thinking, as it is and must be for all time. Consider this analogy. Suppose an alien being visited the planet Earth in the year 1990, and watched the 1990 World Cup Final between Ar- gentina and West Germany. It might conclude that the game of football is characterised by certain key features: players attempt to render the other side ineffective either by physically injuring them, or by convincing an individual called 'the referee' that members of the opposing team are guilty of attempting to inflict injuries on one's own side. The more times you deceive the referee, either by injuring an opponent without his notic- ing, or by convincing him that a collision with an opponent was the result of an intentional and vicious attack, the better you are doing. The more pain you inflict on your opponents the less able they are to compete with you, and every time you convince the referee that the other side's violence has left you in unbearable agony, you are re- warded with something called a free kick, and perhaps, if your display of suffering is very convincing, the referee waves his red card at one of your enemies, who is then removed from the game altogether.

Given that this match was broadcast all around the globe, the alien might be forgiven for thinking it representative. More importantly, it would not matter if it were representative of how professional footballers in fact, typically, play the game: this would still not imply that the alien had understood the game's essential nature, because there is no need to play football in this way, and because, in fact, this is how football should not be played. The alien could not be said to have fully understood what it saw until it recognised that what it witnessed was a bad game. (The alien may well have had related difficulties with the 1994 Final.)

Similarly, Stevenson's description of methods of argument in twentieth century Western society may be an accurate description of public debate in our society, simply because the standard of debate is typically very poor. It may be, as Alis- dair MacIntyre claims, 5 that we have forgotten how to argue properly, or simply that we often do not argue very well. But Stevenson's account becomes less plausible when we realise that it implies there is nothing wrong with such methods of argument; that, for example, there is nothing illegitimate about describing a service which

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spends ever more money on highly paid adminis- trators, while making skilled carers redundant, as thereby exhibiting 'total quality'. Until you understand that there is a distinction between good and bad arguments, there is something missing from your account of our common conception of what an argument is. Stevenson's account would suggest that our only conception of a good argument would be one which did in fact convince most people, and similarly a bad one could only be an argument which failed to convince. 3 But it is part of our concept of a rational agent that he or she is convinced only by good arguments, and is convinced by them because they are good: we cannot, therefore, say that arguments are good in virtue of the fact that they convince people, without vicious circularity.

We may have further reason to doubt that accounts of moral discourse based on an analysis of contemporary debates represent the right theory about ethics as such, when we realise that the nature of moral argument in our culture is to some extent determined by the dominance of the same theory whose plausibility it is being used to defend. The influence of subjectivism in ethics goes back well before twentieth century forms of positivism. The philosophical and economic theories which helped to shape the intellectual culture of Western society were massively influenced by subjectivist assumptions, so it is no sur- prise that the conversations of persons within that culture seem to reflect those assumptions.

Even so, subjectivist ethics do have an indepen- dent appeal since they stress the role of feelings in the formation of moral attitudes. Perhaps the most compelling defence of subjectivism is found in the work of David Hume, and it is his account which provides one of the clearest statements of the irrationalist position on the relationship between reason and feeling. 6 Reason, he claims, can under no circumstances motivate: only 'the passions' can do this. If morality were only about reasoning then it would have no influence over human action, instead of having the enormous influence which it in fact has. This certainly rings true: we don't deduce or infer the wrongness of torture, we feel that such things are wrong. However, it is a long way from this observation to the assertion that all there is to something's being wrong is our feeling that it is wrong.

Hume's Passions

Hume's view on the relationship between feeling, reasoning and action seems to be straightfor- wardly causal. On his view both our beliefs and our attitudes are the causal product of non- rational factors, either biological or cultural, and our feelings motivate us by causing us to act in certain ways. For instance, if I am so constituted that I abhor violence then I will view violence as wrong, and this will cause me to avoid violent behaviour. The role of reason in action is to 'serve' my feelings by telling me how to act in order to achieve my end of avoiding violence.

Hume's concept of the feelings or passions is overly simplistic, and thus the view which it determines of the relationship between attitudes, beliefs and behaviour is somewhat misleading. He claimed that the relationship between tastes, things we simply like or dislike, and more sophisticated types of feeling, such as emotions or attitudes, was a matter of degree. I dislike peanut butter, and I dislike people being tortured. The only difference is that my feelings with regard to torture are much stronger, so someone who felt as strongly about peanut butter as I do about torture could--according to Hume be said to have a moral conviction about the eating of peanut butter.

But the correct view would seem to be that these categories represent logically very different types of thing altogether. If asked why I dislike the taste of peanut butter, it makes sense for me to say that I just do, and no matter how intense my dislike for it the explanation that this is just the way I feel will suffice. On the other hand, suppose I have an emotion such as fear. Emotions presup- pose beliefs: if I am afraid of something then it follows, logically, that I believe that the thing I fear can harm me. This is why we can be criticised for having irrational fears. To give an obvious example, insects are a threat to hygiene, but for many people their fear of particular insects is out of all proportion to the potential for harm which these creatures possess. Such people are rightly labelled irrational, but this criticism simply would not be meaningful if emotions were logically on a par with tastes. Suppose someone feared peanut butter: when asked why it would not do to say that he just did. This fear is so bizarre that it would require special explanation: we might

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perhaps search for the incident in his life which led him to associate this food with something harmful. (Perhaps he was force-fed with it as a child.) What we would not say is: that's just the way he feels, and be satisfied with that explanation.

It is also true that emotions have logical links with behaviour, such that my claim to fear something can be questioned by observation of my behaviour. If I claimed to be terrified of spiders, but did not seem the least worried when one began to crawl up my arm, this would require some explanation. I might be said, for instance, to be exercising enormous self-control, perhaps because I am embarrassed at being caught out with an irrational fear: the point is not that no explanation can be offered, but that one is required. If I had no reasons to tolerate the company of spiders, but made no efforts to avoid them whatsoever, then it would make no sense to say that I feared them. On the other hand, my behaviour in avoiding spiders might be adequately explained by saying that I fear them, and thus, if my fear is irrational, my behaviour is susceptible to rational criticism.

If it is correct to equate moral attitudes with feelings of some sort, then it is clear that the feelings in question are more like emotions than tastes. Thus the claim that morality would not be possible unless we had feelings may be true, and yet it does not show that reason has no role in morality, since we can and do have reasons for the ways we feel, reasons that can be examined and found to be good or bad. Nor does it show that reason cannot be used to criticise behaviour, since to the extent that we explain behaviour with refer- ence to feelings, it is possible rationally to assess those feelings.

The Basis of a Positive Account of Morafity

These considerations provide the basis for a positive account of morality when we consider that our concept of a rational being is that of a being which has feelings, in this sophisticated sense. It is doubtful that we would, in any sense other than a metaphorical one, describe a computer as a 'rational being'. Rather, it in some ways resembles a rational being, since it is capable of performing some of the cognitive functions (for example

deduction) characteristic of such a being. But it most certainly is not a rational agent, so it does not conform to what might be described as our fullest conception of rational being.

Similarly it can be argued that psychopaths are lacking in their understanding of those features of reality we call other sentient beings. To be com- pletely incapable of sympathy is to fall short of our full concept of a rational agent--a t least if this incorporates the idea of a rational moral agent. (A genuine psychopath might conform to some more 'shallow' conception of rationality: in some sense such people may be "very rational'. But this is analogous to the sense in which a computer may be 'rational '--i t may be much better at deductive reasoning than the average human being, but incapable of exhibiting any richer forms of reasoning.)

"Philosophy should attempt to raise the tone of popular political debate"

Our concept of rationality (in the 'full' sense which is surely the sense we mean when we talk about 'rational human beings') is a practical concept. It applies to the behaviour of persons, allow- ing us to evaluate it. So the claim that all voluntary behaviour is motivated by feelings, far from sug- gesting irrationalism, actually provides the basis for an account of morality which is not irrationalist. We can discuss the appropriateness of specific feelings/att i tudes in specific contexts, and we can ask whether or not there are any specific feelings/at t i tudes which are essential characteristics of a rational agent. It should be the job of philosophy not only to examine such deep questions, but to develop answers which can be applied not only to guide individual behaviour, but also to practical questions about how a moral society would behave. (Once we have worked out what sort of beings rational moral agents are, we can answer questions about how such beings would treat each other, what sorts of institutions and com- munal practices they would set up etc.) This job is undoubtedly very difficult, but wholly worthwhile.

Given that philosophy, by releasing political discussion from the obligation to be rational, may have thereby helped to impoverish it, it is high

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time that phi losophy atoned for its sins by break- ing its silence on important social issues and at tempting to raise the tone of popular debate. Some philosophers believe that the role of philosophy in practical discussion should be entirely critical: that we should spend our time (to adapt Locke's view about the relationship between philosophy and science) sweeping away some of the rubbish that stands in the way of progress, sub- jecting nonsense to analysis to expose it for what it is. I have a great deal of sympathy for this view, al though from my claims here it should be clear that I also believe it is both possible and desirable for philosophers to make positive contributions to popular debate. In any case the activity of sweeping away rubbish only makes sense on the assumption that there is something other than rubbish which might replace it.

References

1 Dworkin, R. (1994). Prudence or rescue? Fabian Review 106(2), 10-14.

2. For a classic statement of this position, see Ayer, A. J. (1936). Language, Truth and Logic, Victor Gol- lancz, Oxford.

3. Stevenson, C.L. (1944). Ethics and Language, Yale University Press, London. (Stevenson, of course, would deeply resent being associated with the claims that 'there is no distinction between moral argument and sheer propaganda', and that there can be no distinction between good and bad arguments. However, with respect to Stevenson there is a difference between what Stevenson says about

4.

5.

6.

his own theory and its logical implications. He would undoubtedly disapprove of many of the more unpleasant uses of propaganda which we have seen this century, particularly of forms of propaganda which sway people by means of straightforward deceit. But his objections to such forms of argument would surely be moral, rather than logical and on his own emotivist analysis his moral views should surely be analysed as ex- pressions of his personal emotive reactions, no more right, objectively, than anyone else's. Since what I say about his analysis concentrates entirely on his statements about 'non-rational' persuasive techniques, it is fair to point out that Stevenson does allow that there is a limited role for rationality in moral arguments, in that very much of moral argument concerns pointing out inconsistencies and exposing the fact that the reasons given for certain attitudes involve appeals to false beliefs. However, given that there seem to be no logical limits on what sorts of beliefs can provide reasons for specific attitudes, it is not clear how I can be criticised if, when you point out the claims I have made in order to justify my attitudes are false, I accept your statement but do not change my attitudes: your argument has simply failed to convince me. You might criticise me morally for my failure to alter my attitudes, but you could do that anyway, simply for holding attitudes different from yours, and similarly I could criticise you. The point is that neither of us, on this view, could be said really to be right.) Loughlin, M. (1993). Critique: The Illusion of Qual- ity. Health Care Analysis 1(1), 69-73. MacIntyre, A.C. (I981). After Virtue, Duckworth, London. Hume, D. (1978). A Treatise of Human Nature, ed. by L.A. Selby-Bigge, Clarendon Press, Oxford.

HCA Features is edited by:

Ian Buchanan, Bury and Rochdale Health Authority, Staffing Offices, Birch Hill Hospital, Rochdale, OL16 9QB, UK

Linda Delany, Manchester Metropolitan University, School of Law, Elizabeth Gaskell Site, Hathersage Road, Manchester, M13 0JA, UK

Michael Loughlin, Manchester Metropoli tan University, Crewe and Alsager Faculty, Crewe Road, Crewe, CW1 1DU, UK

Godelieve van Heteren, Department of Ethics, Phi losophy and History of Medicine, Catholic University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Mary Chiarella, Director, Continuing Education and Special Projects, The N e w South Wales College of Nursing, 55 Hereford Street, Glebe, New South Wales 2037, Australia.

Correspondence about any HCA Feature should be addressed either to the appropria te Editor, or c / o Editor-in-Chief.

Critique

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