Cancer, rape, and choice
November 16th 2006 23:45
You're diseased. You're in constant pain, and some days are worse than others. There are certain activities you can't do anymore, and certain activities it's difficult to do. And here's the kicker. Not only is your condition getting worse, but you'll probably die in a year.
You're offered an experimental procedure. It is expensive, time-consuming, and painful. It could cure you, or it could have no effect, or it could worsen your condition, or it could end you outright. Or it could save your life while compounding your pain. The outcome is unclear, but the sooner you start it, the more likely it'll work.
So what do you do? Should you go for it? Or should you simply make the best of the time you've got left? Or should you wait for your condition to worsen before taking any action?
Should you undergo cryonics no matter what -- given that it's a non-zero chance of survival, and that it's better odds than being buried in the ground?
David Rieff mentions the idea that the "power of the doctor is absolute" to influence the patient's decision. That is, a lot can depend, for instance, on how doctors express themselves, how exactly they state the facts.
... the odd suggestion that, in some situations, we are unable to choose freely.
And similarly, the odd suggestion that it is misleading to picture doctors as impartial presenters of options. That you can't help but be influenced by the doctor, or that doctors can't help but bring their own biases to bear, or that unbiased and uninfluencing expression is itself impossible.
Does anyone have a single desire?
Say, in the case of euthanasia.
Today, I might tell you to pull the plug. But tomorrow, mightn't I say differently? And vice versa.
-- Depending on what issues are forefront in my mind, depending on my mood, depending on the influences from those around me, depending on what I've been reading and watching, depending on my life situation and prospects and how I conceive them...
What does "consent" mean? Is it a simple black-and-white yes or no?
This is the normal legal presumption -- used, for instance, in the contexts of rape or contract. But, in some circles, there is the idea that consent is, or should be, a pattern over a period of thinking and discussing.
The discussion model arguably is (and arguably isn't) the more representative of a patient's consent. It can amount to an averaging out of varying wishes, and it could give the best opportunity for the most rational in the patient to emerge.
But, if matters came to court, wouldn't they be messy? Isn't black-and-white neater?
Should a rape defendant be allowed to argue that the overall pattern was towards consent, and that last-minute refusal was irrelevant? Should a rape plaintiff be allowed to argue that the overall pattern was refusal, and that a last-minute "yes" is no yes at all?
How bad, exactly, is my current quality of life; what activities are restricted and how; how likely is it that without treatment I'll die; how old am I and how many years would I have left anyway; who depends on me; how much does it cost; how painful is it; how likely is it that the procedure will work...?
One wants a lot more information. But the reality might be, that not every inquiry could be answered.
But is this a problem that can be worked out at all? Is it like a maths question? Even if one had all the information, would it be possible to decide?
Sartre says (in "Existentialism is a humanism"): "I can neither seek within myself for an authentic impulse to action, nor can I expect, from some ethic, formulae that will enable me to act…. You are free, therefore choose -- that is to say, invent. No rule of general morality can show you what you ought to do: no signs are vouchsafed in this world."
You're offered an experimental procedure. It is expensive, time-consuming, and painful. It could cure you, or it could have no effect, or it could worsen your condition, or it could end you outright. Or it could save your life while compounding your pain. The outcome is unclear, but the sooner you start it, the more likely it'll work.
So what do you do? Should you go for it? Or should you simply make the best of the time you've got left? Or should you wait for your condition to worsen before taking any action?
***
Should you undergo cryonics no matter what -- given that it's a non-zero chance of survival, and that it's better odds than being buried in the ground?
***
David Rieff mentions the idea that the "power of the doctor is absolute" to influence the patient's decision. That is, a lot can depend, for instance, on how doctors express themselves, how exactly they state the facts.
... the odd suggestion that, in some situations, we are unable to choose freely.
And similarly, the odd suggestion that it is misleading to picture doctors as impartial presenters of options. That you can't help but be influenced by the doctor, or that doctors can't help but bring their own biases to bear, or that unbiased and uninfluencing expression is itself impossible.
***
Does anyone have a single desire?
Say, in the case of euthanasia.
Today, I might tell you to pull the plug. But tomorrow, mightn't I say differently? And vice versa.
-- Depending on what issues are forefront in my mind, depending on my mood, depending on the influences from those around me, depending on what I've been reading and watching, depending on my life situation and prospects and how I conceive them...
***
This is the normal legal presumption -- used, for instance, in the contexts of rape or contract. But, in some circles, there is the idea that consent is, or should be, a pattern over a period of thinking and discussing.
The discussion model arguably is (and arguably isn't) the more representative of a patient's consent. It can amount to an averaging out of varying wishes, and it could give the best opportunity for the most rational in the patient to emerge.
But, if matters came to court, wouldn't they be messy? Isn't black-and-white neater?
Should a rape defendant be allowed to argue that the overall pattern was towards consent, and that last-minute refusal was irrelevant? Should a rape plaintiff be allowed to argue that the overall pattern was refusal, and that a last-minute "yes" is no yes at all?
***
How bad, exactly, is my current quality of life; what activities are restricted and how; how likely is it that without treatment I'll die; how old am I and how many years would I have left anyway; who depends on me; how much does it cost; how painful is it; how likely is it that the procedure will work...?
One wants a lot more information. But the reality might be, that not every inquiry could be answered.
But is this a problem that can be worked out at all? Is it like a maths question? Even if one had all the information, would it be possible to decide?
***
Sartre says (in "Existentialism is a humanism"): "I can neither seek within myself for an authentic impulse to action, nor can I expect, from some ethic, formulae that will enable me to act…. You are free, therefore choose -- that is to say, invent. No rule of general morality can show you what you ought to do: no signs are vouchsafed in this world."
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Comment by suitably*wounded
Eternal Days; Author: Illness, M.
For your first scenario, I'd want to simply make the best of whatever time I had left. I'd go to Disney Land and Paris and have sex on a beach. Anything I'd always wanted to do but hadn't.
No cryonics for me either. I'm too cold-natured and too claustrophobic.
I agree with Mr. Rieff, and for that matter, think this particular belief extends well into whether or not we actually have free will. In my humble opinion, I think we live more under an illusion of it than a reality.
As far as single desires go, IE: euthanasia and the like, one must choose to stay the course. At least that holds true for anything that's irreversible. For example, if you have a child, you can't put them back. And although that sounds silly, I suppose you have to decide on certain things knowing, that when the time comes, that choice will not be able to change.
Considering consent with regards to medical applications and rape, I think you've given some very good food for thought. I'll mull over it before I give my first nascent opinion. I'm sure the whole world will be waiting. =P
Such are the questions of existence, right? Awesome considerations Adrian. I'm thrilled that I've subscribed to your blog.
Comment by Damo
Just my opinion.
Comment by katyzzz
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Interesting questions that provide no solutions, just more questions.
The rape one is dangerous in its implications.
With respect to the others they tend to deny the inherent wisdom of man, irrespective of level of intelligence, except in the case of the intellectually impaired, then who gets to decide and why should they and could they?
There are many great thinkers in this world, it is not just the realm of acclaimed philosophers.
But interesting questions on very serious issues. Circumstances alter cases, and I have no intention of becoming deeply involved via such a simple medium as a blog.
I think I would prefer to disuss these things with my nearest and dearest, not on the public record.
The rape, with sex being given away so freely, has quite serious implications and I think it would be better to change the social mores, rather than leave the decisions entirely to judges.
To prove rape can be quite difficult and it is open to abuse by unscrupulous individuals which tends to deprive genuine cases of justice.
All of us can neither agree nor disagree on these issues. There can be no impartial views.
Isn't it great to be able to have an opinion which doesn't have to rely on the slanted views of academics in order to attract the deservedly fair portion of marks?.
katyzzz
Comment by Adrian
Philosophy Blog
Dear Kemi -- Personally I don't know what I do in the sort of situation I painted. It depends on so many factors... My instinct is to say, with Susan Sontag, "I'm not interested in quality of life. I want to fight for as much life as I can get." Even cryonics looks attractive when I'm in this mood. But I don't know what I'd think about, for instance, being brain dead and kept alive by a machine, or what the reality of living constant pain would be like... I went to a talk last year on the rationality of committing suicide and whether it's ever rational to say "I regret having been born". But I haven't clarified my thoughts on the matter...
Thanks for your kind words, and I'm thrilled that you're reading. You're definitely one of the most articulate people who does.
Dear Damo -- I don't think there's such a thing as subjective truth -- that is, truth that varies from individual to individual. I don't think such a thing would deserve the name of "truth". But this is a discussion for another time.
I'm inclined to believe that, in the present context, there's no issue of truth at all! And therefore, that there's no way to answer the questions rationally.
Dear Katy -- You've raised a number of themes, and I just want to pick up on one that I found the most striking, that is, whether these issues simply raise more questions.
I think the obvious thing to reply with is "It depends on what perspective you're coming from, it depends on what you already believe in." That is, it's possible that, from a particular perspective, the questions are quite resolvable.
If you're not coming from such a perspective, it might be asked, if a question is NOT resolvable, is it a real, meaningful question? I'm inclined to say no. (A long argument to be had here.) But I do think it's potentially a resolvable question whether a question is resolvable or not.
Comment by katyzzz
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Good points as always.
And you do acknowledge perspective.
I have thought about all these things before, some with not quite your slant, but apart from semantics, I think I am drawn to Damo's view.
I really did find the juxtapositions of cancer and rape as confronting, almost to the extreme. But, enough said
katyzzz
Comment by Adrienne
Comment by Adrienne