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Introduction by President Dillon It is my privilege tonight to introduce a graduate of Thomas Aquinas College, Dr. Tom Cavanaugh, who is the Chairman of the Philosophy Department at the University of San Francisco (USF). After graduating from the College in 1985, Dr. Cavanaugh obtained a doctorate in philosophy from the University of Notre Dame. He was appointed to the faculty at USF in 1994, where he has since taught in the philosophy department as well as the Ignatius Institute. While Dr. Cavanaugh spends most of his time teaching, his influence is not confined to the classroom or even to the philosophy department at USF. A specialist in bioethics, he is widely published and is active in the practice of medical ethics, serving on medical ethics committees and debating issues of medical ethics in public across the country and abroad. He also lectures internationally at conferences such as the World Conference of Bioethics. Dr. Cavanaugh’s works have appeared in publications such as the Journal of Applied Philosophy, the Cambridge Quarterly of Healthcare Ethics, and the Journal of Pain and Symptom Management. He is also the author of the book Double-Effect_Reasoning, Doing Good and Avoiding Evil, recently published by Oxford’s prestigious Clarendon Press. At a time when society seems to have lost its moral compass—and this is perhaps nowhere more evident than in the medical field—Dr. Cavanaugh’s work, guided as it is by the twin lights of faith and reason, is tremendously important. I am sure we are all eager to hear from him about that work. So without further ado, it is my pleasure to introduce to you our graduate, Dr. Tom Cavanaugh. Dr. Cavanaugh’s Remarks It is always an honor for me to speak on behalf of my alma mater, Thomas Aquinas College, because she is indeed a “nurturing mother.” My talk tonight has two parts: the first addresses the importance of sound foundations; the second considers the education offered by Thomas Aquinas College as a solid foundation for ethical medical practice and medical ethics more generally. To the first part: Consider the foundations of two houses. The first house, the well-founded or sound house, sits on a foundation that has been grounded in bedrock. The second house, the unsound house, rests partially on bedrock and partially on fill. The sound house has drains, well-placed in order to prevent water’s flow around the foundation, and to gather and to carry water away, for water is the nemesis of every foundation. The unsound house lacks these features. Water can and will flow to and around, and eventually under and around, the foundation, and it will thereby undermine it. The sound foundation has reinforcing bars of steel, making it a unit, withstanding the forces of water and shifting soil. The foundation of the unsound house lacks this integrity of design and is therefore further susceptible to being undone. A decade or two after their construction, with no further differences between these houses, the sound house remains pretty much the same. Of course, there are the dings and dents from the children’s play, but the drywall is un-cracked and one can easily open and shut doors. When mom cooks pancakes, they come out flat and even, just the way she likes them. Things are not so rosy in the unsound house where nature has done her work upon the flimsy and hastily-prepared foundation. Doors do not open and close so readily; drywall has telltale cracks; the stovetop challenges mom to keep the pancakes of a uniform thickness; indeed, even the gutters no longer properly drain. Let us step back from this picture and look at it. Initially, the houses appeared identical. As the decades pass, they differ dramatically. What does this image show? Over time, small errors grow, they compound themselves and become large. With this picture and truth in mind, consider the College’s education as an intellectual foundation. We speak of graduations as commencements, a word that points us towards what is to come after. While the word points us towards the future, one must note that the students have been at something for four years, and it is a little late to speak of beginnings. Parents might justifiably ask, just as their children did during those long trips on California’s Highway 5, “‘Are we there yet?’ Are we finished yet with this task of educating? If four years results only in a commencement, what have the students been up to?” Of course, you anticipate my answer. They have been excavating and finding sound bedrock, getting rid of the sand, and compacting the dirt. They have been insuring that their intellectual foundation makes one integrated unit upon which to build something of great pith and moment: their very lives. Those lives will go well or badly as determined by the ideas in accordance with which they are lived. Let us focus upon how a Thomas Aquinas College education serves as a sound foundation for medical ethics and for medical practice. Let us do so by considering what is at issue currently in medical ethics and how the disputes and controversies of our times result from bad beginnings compounded to drastic effect. Just as the sound and unsound houses illustrated the principle that we must begin well or we will end badly, so we now need a foil, a contrasting image that will illustrate what has gone wrong in medical ethics. Let us consider the work of Professor Peter Singer, the DeCamp Professor of Bioethics at Princeton University’s Center for Human Values. I should mention that I have met and opposed Professor Singer not far from where we stand today, a number of years ago at the World Conference of Bioethics. He and I differed over the wisdom of legalizing euthanasia, particularly in light of the historical fact that the Nazis thought it was a good idea to do so. Professor Singer did not think that counted against the idea, and I thought it did. Professor Singer is a thorough-going consequentialist. As such, he thinks that an act is right or wrong entirely in terms of the net pleasure or pain that it produces. He thinks that pain and pleasure alone have moral relevance. By pain and pleasure, he means the pain and pleasure experienced by any sensing being, human or animal. That is, he asserts and maintains-—in writing and in speech, in books, articles, and public appearances, and no doubt, regularly in his classes at Princeton—that what has ultimate ethical relevance is the possession and activity of a central nervous system. The pleasures of a central nervous system are good; the pains of a central nervous system are bad. The more pleasure, the better; the more pain, the worse. Be it the pleasure or pain of a human or of a horse or of a dog, it has moral importance, and this is what ethics is about: producing the greatest amount of that pleasure for the greatest number of sensing beings. Singer follows the utilitarian thinker John Stewart Mill, whose seminal ideas one finds in the work entitled Utilitarianism. Mill there asserts that ethics is about the maximization of the good. When one judges an act, one must ask: Of the acts available, does this one produce the greatest amount of good for the greatest number affected or possibly affected by the act? Now this, on the face of things, seems like a very reasonable approach, for if goodness is what one seeks, and that certainly seems to be a rock solid truth, and goodness is, of course, good, then is not more goodness better and ought one not to maximize it, the more the better? Who could argue with that idea? There is a lot to talk about here. In particular, the question: What is good? But let us isolate one issue that may already be at the fore of your thoughts, namely, what about badness? What about evil? Ought one to do evil and produce badness, if by doing so, one may bring about more good? Mill and Singer answer, yes, one may, ought, must—indeed, one has a serious moral obligation, according to these thinkers, to do evil or badness to produce badness in order that good may come of it. The end justifies the means, and a good enough end will justify literally any means. That follows inexorably from their first principle that the morality of an act is entirely a function of the net goodness of its consequences. Students at Thomas Aquinas College read Mill. They also read another thinker who excavates more deeply and penetratingly to sounder ground, true, permanent bedrock. I speak of Aquinas, St. Thomas, the College’s namesake. In his consideration of the first principle of morality, Aquinas discerns that we must seek and pursue goodness and—this is a crucial ‘and’—we must avoid evil. Neither the pursuit of goodness nor the avoidance of evil alone suffices for morals. Rather, sound morality is the marriage of the doing of good and the avoidance of evil. Of course, Mill and Singer do not entirely reject Aquinas’ insight. They simply divorce the doing of good from the avoidance of evil. They leave off the ‘and.’ It is a small word; indeed, hardly even a word, just a conjunction; three letters of the alphabet; a small, insignificant thing. Yet it makes a world of difference and far different worlds. Consider medicine practiced in accord with St. Thomas’ insight. Doctors and nurses pursue the health of the patient while avoiding and shunning harm to the patient. Of course, sometimes they cannot avoid some harm to the patient. For example, chemotherapy involves, for a time, giving the patient harmful drugs with the goal of curing him. Yet, following Aquinas’ discernment of the first principle, they do not seek or try to harm the patient as a means of helping the patient. In short, they do not intend harm. In keeping with the pursuit of health and the avoidance of sickness —good and evil in the realm of medical practice—nurses and physicians rule as out of bounds certain actions, echoing the Hippocratic code: not to abort, kill, poison. Consider the implications of this commitment to the avoidance of evil in the medical arena. Nurses and physicians will not torture, will not maim, will not develop biological weapons, and so on, for to do so is to abandon the medical ethic that specifies the principle Aquinas articulates: Do good, pursue health, and avoid evil; shun what harms your patient. Mill and Singer have a different take on the medical ethic, for if killing or poisoning, or torturing, or sickening produces more overall good, then one ought—indeed, one has a serious moral obligation, according to these thinkers—to do so. If all we are to do is to maximize health, one half of the Hippocratic ethic goes out the window. According to these thinkers, physicians and nurses may abort, poison, kill, use their knowledge to produce sickness, develop biological weapons, participate in torture, and so on. Moreover, Singer asserts that doctors and nurses have a serious moral obligation to euthanize their terminally-ill patients and to commit infanticide upon less than perfect infants. According to him and logically following upon his ill-founded beginning, because the central nervous system of the anencephalic infant or infant with Down Syndrome cannot fully function and fully realize the pleasures he would were he healthy, we ought to kill him to make way for other central nervous systems that fully function. Here again we glimpse an erroneous beginning, namely, the understanding of the human as simply one central nervous system amongst others. This view of the human Mill and Singer inherit from thinkers such as Descartes, Hume, and Locke, again all of whom are read at the College. Roughly and without the refinement called for by the history of philosophy, these thinkers, in particular Descartes, equate the human with a thinking thing. This bad beginning then focuses our attention upon brain activity, and before one knows it, we have our current situation that asserts that humans lacking higher brain activity are, in the words of the Princeton bioethicist, organisms, not persons. Students at Thomas Aquinas College know better. They know better because they spend long hours reading Aristotle’s fundamental work bearing on the human, namely, the De Anima, the book Concerning the Soul. That long study serves as the foundation of so much and, of all works, best answers the Greek command inscribed over the Delphic oracle: Know thyself. In studying Aristotle’s treatment of the human being, students at the College see that the sound ground is that which holds the human to be neither entirely soul, as Aristotle’s teacher, Plato, said, nor entirely body, as Singer would have it. Rather, the human is the union and marriage, ‘til death do them part, of body and soul. The ‘human’ is the ‘and’ of those two. We see again the importance of this small word. Graduates of the College know better than to think that an infant whose central nervous system is less than perfect or a patient who no longer has higher brain activity is thereby no longer a person. For the person is not brain activity; rather, brain activity is the result of the person. Absent higher brain activity, we may not conclude that the person is absent, for the one is the sign of the other and not identical to it. Indeed, rather than the wounds of anencephaly and the loss of higher brain functioning being reasons to act against persons who suffer these disabilities, they serve as reasons to take special care of and consideration for persons who, but for these infirmities, would exercise the brain activity appropriate to them, and in virtue of which they’re lacking. We ought not further to victimize them. After all, as Aquinas notes, need grounds our claim to assistance. Allow me to conclude. Small errors in our beginnings make for profound errors in our endings. Thomas Aquinas College offers a sound beginning, drilling down to the bedrock upon which the human enterprise can be safely erected. The College is an intellectual and, therefore, a moral enterprise of great moment and importance. It is about the truth that makes us free. The alternative to that truth amounts to enslavement to false ideas. Be they true, be they false, ideas have consequences. True ideas have good consequences; false ideas, such as those advocated by Professor Singer, have bad consequences. They wreak havoc in our lives, the lives of our loved ones, and the lives of our fellow citizens as they percolate through our colleges, our universities, our medical schools, our law schools, our hospitals, our nursing homes. To quote Hobbes: Lives founded upon faulty ideas are “solitary, poor, nasty, brutish, and short.” With that sobering truth in mind, I commend this College to your beneficence. Thank you. -- Qtrly Newsletter, Spring 2007 |
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