Friday, June 22, 2007

Ethics is More About Background Assumptions: Reflections Spurred on by Propanolol

I was a busy little (well, no so little these days) feminista yesterday and never got a moment to post. But, there is a lot going on in my little brain that I want to share so, I will start with my reflections on a conversation with colleague, PD, on Propanolol. PD had just seen a 60 minutes special on Propanolol, which addressed (I didn't see it) the ethical implications of giving this drug to people who have experienced traumas in order to help the "forget" or readjust to normal life.

I have read a lot about this drug since it is part of my general interest in enhancement drugs, and so I was interested to see what PD thought of this debate. His response was, what I call, classic Psychopharmacological Calvinism. PD's concern was that if any old chap or chica could get her hand on Propanolol, then we would be encouraging a cohort of "shallow" people. For PD, the pain and disappointments of life tend to deepen us, make us more mature, moral and thoughtful. This is view that pain makes us deeper is pervasive in Western thought. It is not only part and parcel of the Judeo-Christian tradition (and there used to be a medical diagnoses called 'religious melancholy,' which indicated that the sufferer was being challenged in her faith), but more secular thinkers such as J.S. Mill held the same view (see Chapter 5 of his Autopbiography).

Intuitively, I share some of PD's concerns, and when I first started writing and thinking about the ethics of enhancement drugs, I found myself equally concerned that this technological approach to tweaking our personality and making us more socially acceptable was bad, bad, bad. After all, I was a student of European philosophy--I loved the Existentialism of Martin Heidegger and Simone de Beauvoir. But, alas, enough reading and thinking about this issue has challenged this view for me.

And, I credit my change of position to thinking more carefully of the stories that we construct prior to or simultaneously with thinking through the ethical question: is it ethical to give Propanolol to people who want to forget traumatic experiences and live 'normal' lives? Before any of us begin to answer an ethical question, we have a host of background assumptions at play about what people are like. PD's background assumption was that the typical "patient" asking for Propanolol would be a young woman or man, who had his/her heartbroken and wants a "quick fix" to overcome the pain of unrequited love.

PD's intuition is a reflection of how he understands the majority of Americans around him and he is not alone in this view. Surely many of the opponents to enhancement drugs think that what is wrong with contemporary American culture is its rampant consumerism, its ultimate faith in technology to "fix" all perceived problems, and the pervasive and perhaps, shallow view, that we all deserve to be happy. The ethicist, Carl Elliott has an interesting book on this: Better than Well: American Medicine Meets the American Dream.

I don't think PD is totally wrong about this, but over the years, my intuition about the typical patient seeking out enhancement drugs has transformed. I no longer envision snively, whiny, and weak willed Americans looking for a quick fix. Rather, I envision people battling real tragedies and real stresses seeking for relief. One of the reasons why I don't think that we will ever have droves of people seeking out enhancement drugs is that another cultural meme goes, perhaps, deeper than the veiw we are entitled to pursue happiness, namely, individual responsibility. No matter how nuanced our sociological analyses might be about why people become criminals, homeless, or poor, Americans are deeply committed to a view of ourselves that we be responsible for our actions. To turn ourselves wholly over to technological aids would require totally rejecting that cultural meme, which would be as difficult to do as eradicating religion.

However, our commitment to 'individual responsibility' is not why I am less condemning of enhancement drugs. Rather, it comes from the stories that I hear, the images I conjure up of the typical person seeking these drugs out. While PD might see an overprivileged, upper-middle class white boy looking for an easy way out of the hardwork of learning, I see a really stressed out young man, with a great deal of pressure on him, and a world that is speeding up rapidly throwing him into some horrendous competition. I think that my intuitions about the patients' seeking enhancement drugs is similar to how I now picture the typical woman seeking an abortion: it is not an irresponsible young girl who just wants to have sex and no consequences and is rather cavalier about "life."

So, the point of this post is not so much an endorsement of taking Propanolol, but rather a reflection on how powerful our intuitions are about what people are like, in particular, the people who are figured in ethical scenarios, shape our view of what is ethical. We always approach ethical questions with a rich and multi-layered set of background assumptions about the individuals involved and if ethicists don't challenge those assumptions, then we will not get very far in persuading others of what is indeed the ethical course to take.