The Doctor’s Worldview
by John Wyatt

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Worldview in Medical Ethics

Since our worldviews affect every aspect of the way we view reality, and especially our understanding of right and wrong, it is not surprising that they are critically important in determining our attitudes to fundamental ethical questions. But it is interesting that writers, speakers, and teachers of bioethics rarely refer explicitly to their fundamental presuppositions and beliefs. When academic philosopher discuss bioethics they tend to imply that reason and rational argument are their only starting points. The fundamental presuppositions and assumptions tend to be concealed within their arguments, and hence it is easy to miss their central importance.

As an example, let’s look briefly at the writings of the influential bioethicist Peter Singer, and particularly his book Practical Ethics (Singer P. Practical ethics. Cambridge University Press, 2nd edition. 1993). Singer starts by claiming that ethics has nothing to do with religion: ‘I shall treat ethics as entirely independent of religion'(p3). However, he also opposes relativism and argues that ethics require us to go beyond the individual to the universal law, the standpoint of the impartial spectator (p12). He supports utilitarianism: the rightness or wrongness of an action is justified solely by its consequences – whether it increases or decreases the total happiness in the world (p3,14).

Singer draws a distinction between membership of the species Homo sapiens and being a person, a self-conscious being aware of having a past and a future (p85-90). He famously argues that to give preference to the life of a being simply because it is a member of one’s own species, as against another species, is ethically identical to racism where one’s own race is preferred against another (p55-82). He then goes on to argue on logical grounds that killing an embryo, a fetus, a newborn infant, and a demented adult may all be morally good acts if they accord with the preferences of conscious adults and lead to an increase in the total amount of happiness in the universe.

Although Singer does not explicitly state most of his presuppositions, it is possible to deduce most of his fundamental beliefs from his writings.

1. What is ultimate reality?

Singer states that ethics has nothing to do with religion. Presumably by ‘religion’ he means orthodox theistic religious beliefs about the existence of a Supreme Being who created us and to whom we are accountable. Since he believes that the morality of human actions as important as homicide can be decided without reference to religion, he must assume that there is no Supreme Being to whom he or anybody else is accountable. Hence it seems that Singer is a naturalist. He believes that ultimate reality consists of matter, and energy, and the scientific laws which govern their interaction. There is nothing else.

2. What is a human being?

As a naturalist, Singer believes that human beings are self-replicating organism which have arisen on the planet by random and meaningless processes over 3 billion years. Homo sapiens has now evolved to the point at which self-awareness has emerged from our neutral functioning. So human beings cannot have any ultimate purposes or goals beyond passing on our genes to the next generation, or other goals which we choose to invent for ourselves. This is also evident in his refusal to treat members of the species Homo sapiens as morally different from other self-aware organisms or more valuable than them.

3. How is it possible to know anything at all?

As a naturalist, Singer must believe that human knowledge is only possible because of a particular quirk of brain functioning which had a survival advantage in our evolutionary past, allowing us to reproduce successfully.

4. How can I know the difference between right & wrong?

As a utilitarian, Singer believes that the only way to know the difference between right and wrong is by calculating and summing from the objective of an impartial spectator the total preference satisfaction, happiness, and pain caused by any action, sometimes called ‘the perspective of the universe’.

5. What is the point of existence?

Singer clearly believes passionately that human beings should commit themselves to reducing the total amount of suffering in the world, with regard to the suffering both of humans and of animals. He famously attempts to live and behave in a manner consistent with these beliefs, at considerable personal sacrifice. So Singer believes that at least part of, if not the whole point, of existence is reducing human and animal suffering and maximizing the personal preferences of conscious self-aware organisms.

6. What happens to people when they die?

Singer believes that death involves the extinction of consciousness, and the permanent dissolution of any self identity.

7. What is the meaning of human history?

As a naturalist, Singer must believe that ultimately human history can have no meaning, as ultimately the universe has no meaning. The only meaning of human history, like the only meaning of our lives, is the meaning which we choose to give. As we have seen, Singer appears to have chosen to put the reduction of human and animal suffering as a goal of ultimate significance for his own life, and he argues it should be the same for everybody else.

It is clear that Singer’s presuppositions have a decisive effect on his bioethical argumentation and on his conclusions. It is also clear that if we start with different presuppositions about the way the universe is, we are likely to come to very different conclusions. So for the orthodox Christian, ultimate reality resides not in matter and energy, but in the being of the creator God who made each one of us, and to whom we are ultimately accountable. If it is true that this creator God is a speaking God, a God who has revealed himself in nature, in Scripture and ultimately in the person of Jesus, then we have to take what he has said about matters of life and death with profound seriousness. Clearly, starting from the presupposition of a Christian believer, it would be illogical, irrational and indefensible not to do so.

So it is not the case that Peter Singer is being logical and rational while the Christian believer is being irrational, bigoted and prejudiced. What is the case is that we have different worldviews, and these lead us logically to different conclusions.

Of course there are many different worldviews which impinge on the ethical conclusion which people come to. Some worldviews emphasize the right of personal autonomy – my right to do with my life as I please. Some lay stress on respect for ‘nature’ – leading to acceptance of disease and death as part of the natural order. Others assume that death is the ultimate evil and that there is a moral duty to use technology to extend human lifespan indefinitely. What is clear is that a person’s worldview plays a critical role in their decisions about good and evil, and about right and wrong.

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