November 1994

How It Is

On the subject of deism or theism, no one knows anything at all: it is all smoke and mirrors.

The professional philosophers (but I don’t know how much of a living one can make doing that or even if there are such people in this age) have classified our sources of knowledge. That is, how we come to learn things, whatever they be. Among these is what is called “recourse to authority” or, more simply, “ask someone who knows.” I often wondered if I am an authority on anything and concluded that I would classify myself as a guru on:

  1. How to buy things for a business on the cheap.
  2. How to get tickets to the Stat Opera in Munich.
  3. How to finish the interior wood trim (casing) on windows even when the walls are neither even nor plumb.
  4. How to remove cedar clapboards so they can be used again (well, at least most of them.)

As one gets older one is increasingly amazed at how few experts there are on anything. On the subject of deism or theism, no one knows anything at all: it is all smoke and mirrors. In spite of protestations to the contrary, not one person in our universe knows a whit more about this than anyone else, and certainly not more than you. Just imagine: nobody knows any more than you do about this; you are the expert. Less is known about this subject than people know about economics, where it is generally recognized that indeed nobody knows anything at all. There is nobody with any secret trove of information–nobody…

So you can’t ask anybody because nobody knows. Nobody has any special knowledge, any private knowledge or revelation. Those who claim they have are either liars or charlatans or both. They want something from you, either your money or your power. It’s best to be careful in giving away either; both wells can run dry.

You can’t ask me. Aside from the fact that I finally know the meaning of life, there isn’t much I can add to the discussion that will make you a happy person. I am only a deliverer of fact, an unrelenting pragmatist, an unrepentant humanist. There is no “good news,” only news.

Something happened during the survival/evolution of the human species that makes it difficult for us to accept “I don’t know” as an answer. It’s as if we would rather be fooled and lied to than face uncertainty. And to this most difficult of questions, which is best simplified as “Why is there something instead of nothing?” comes the most frustrating of answers: nobody knows.

With one exception all the rest is mind games, sort of a semi-intellectual mental masturbation. And none of it results in long-term satisfaction, let alone relief. If anything could be proved it wouldn’t be called “faith,” would it? For faith is belief in the intrinsically unbelievable. That exception–apart from the idiocy that passes itself off as serious cerebration–is the search for evidence of extraterrestrial influence on human affairs, so-called divine intervention.

The phenomenon referred to as “miracle” is what might be called hard evidence for otherworldly “interference” in the affairs of people kind. But the concept of miracles has been considerably cheapened–consider the TV preachers…In spite of the theoretical impossibility of proving the negative, it is clear that there are no miracles. Not an iota of evidence supports the role of any extra worldly being in human affairs. Much is still unexplained. But that is the wonder: what a dull world if we understood everything! We perhaps never shall.

Humans have an overwhelming tendency to think that their kind is something special, more than just an evolutionary step just beyond the step before us, that some kind of quantum barrier divides us from the rest of the primates. But consider. It seems that once a species starts down a path where one characteristic provides some significant survival value, that road is traveled to the very end. So if what we call intelligence was profoundly important to us naked apes, then the brighter among the bright had an advantage. Evolution has provided no short-necked giraffes, no miniature elephants. There seems to be a minimum brightness level if people, excepting perhaps politicians, are to function.

The ultimate problems with dabbling seriously in theism or deism are twofold. First, the dabblers can’t leave well enough alone. Associating with all that purported power, they are tempted to borrow some for themselves. And thus, inevitably, abuses follow. Not only do the professional deists/theists (otherwise known as the clergy) borrow some of the power they conjure up to control the foolish faithful, but, as if trying to maintain balance in their bizarre universe, they create anti-deities, the antitheses of their gods: fallen gods, defective god, gods gone bad. Both their gods and anti-gods are created in their own images. So with this bizarre parity created from whole cloth we have access to the two great cop-outs of our civilization: “It was god’s will” and its brother, “The devil made me do it.” Both are easier than taking responsibility for our own actions and behavior.

We are indeed alone, we apparently have no purpose, no noble goal. We are the result of stellar evolution, then chemical evolution, and finally biological evolution. In the end we must look to ourselves for ourselves. There is nothing else. That’s how it is.

–Thomas Kelly

This article is from Religious Humanism, Journal of the Fellowship of Religious Humanists, Vol. XXVI. No. 3, Summer, 1992. Thomas Kelly teaches in the School of Medicine of the University of Maryland, in Baltimore.

Forming A Moral Community

The following is a summary of an address by Morris Litton, Senior Legal Counsel, Intermountain Health Care, October 13, 1994 to the Humanists of Utah.

The forming of a moral community from a bioethics community is made necessary because, in our society, advancement of medical technology has changed life. And it has also changed death. It has changed life in that many of us have experienced life or know of someone who would have been deprived of life a generation ago. Many of us have also known or heard about what medical technology can do to keep bodily functions going after sapience, or awareness, has disappeared.

The record is of a person who lived on a ventilator in a comatose state for over thirty years. An example of this condition is the Nancy Krusan case of Missouri, who drove off the road into a ditch and was found face down. She was without oxygen about nine to thirteen minutes. She was revived and breathed on her own but was in a persistent vegetative state; she had no cognizance. Reviewing this case, the Supreme Court cited expert testimony saying that Nancy was not in a terminal condition because she could be sustained in that condition for thirty years.

Older people as well as others are horrified at the possibility that they might face a prolonged death or a sustained dying period hooked up to machines to keep them alive after they are no longer sapient. They have nightmares of spending their life savings and their children’s inheritance or causing their families financial hardship at their insistence during that time. There is also the fear that government regulators or health care providers, who are supposed to be advocates, will cut their lives short because they are old, or sick, or no longer sufficiently productive. They worry that they will be prohibited access to modern medical technology.

As response to these concerns, several movements have begun in the United States and the world at large. The most popular is that related to advanced directives, such as Living Wills and Medical Treatment Plans. This is in partial response to the advancement of medical technology and the feeling that we are somehow being deprived of the right to make decisions regarding our own care. Another movement is Death With Dignity which promotes self determination both in terms of time and means of death. A third, perhaps a less radical and less publicized movement, is Bioethics.

(A video was presented by Mr. Litton which portrayed the anguish experienced by a typical family facing ethical decisions after being swept into the health care system by misfortune. A discussion then followed about how a Bioethics Committee functions and how it responds to the ethical needs not only of the patient but also the family members.)

A Bioethics Committee, or Interdisciplinary Ethical Committee (IEC), is a group of individuals who are brought together not to make decisions but to engage in an evaluation to recommend ethical alternatives to dilemmas that arise in health care. This Committee does its best work when functioning as a moral community. The following is from a handout:

Ethical Dilemmas are a matter of legitimate differences of opinion among people around a moral choice; the very existence of an ethical dilemma implies that more than one perception of value is involved. Ethical reflection is a process for resolving conflicting moral visions and claims, not simply a matter of applying clinical competence or technical expertise. Thus, it is believed that the best way to resolve such dilemmas is in a forum that is interdisciplinary and involves representatives from all clinical units as well as representatives from the community the institution serves.

The differing viewpoints provided by such a multidisciplinary approach ensure that every option is explored. With fresh minds working together, a “synergy” develops that helps everyone rank and weigh his or her values to single out those that are most critical to the issues in the balance, helping to ensure the most thoughtful decisions possible.

As a moral community, a well-functioning IEC [Interdisciplinary Ethical Committee] provides a new model, a new modus operandi, for resolving tensions, values and conflicts through a sense of collaboration and mutuality.

When the family asks the Physician how to make a decision, they are invited to be a part of a Bioethics Committee, or an IEC, to deliberate all the medical, ethical, and personal concerns involving the patient’s care. The Committee would include all the physicians involved with the patient, the nurses, the care personnel, representatives of the care facility, and the family members. The outside world would be shut out, the door literally closed so a sense of security and confidentiality would prevail. There would be great effort to form a close relationship within the group. Everyone would be able to speak and everyone would be heard. Someone will be conducting the Committee meeting but no one should be afraid to speak out, even to the Physician.

The following handout, read as the “IHC Home Health Bioethics Committee Opening Statement”, explains how this Committee functions:

Welcome to all of you who have given of your time and yourselves to this important process of ethical deliberations. Before we begin by introducing ourselves, let us remember that we all come to this process in the spirit of good will and with the best interests of the patient as our individual and collective goal.

It is important that we remind ourselves that what is heard in this room is confidential and not to be discussed outside of this group.

  • We advocate and support patient-centered decision making, and encourage the consideration of all information related to the patient’s care.
  • We support and acknowledge each participant as a colleague, recognizing our unique perspectives and contributions. We consider every individual’s contribution to be of importance.
  • We encourage participants to speak freely, openly, and frankly and to listen thoughtfully and respectfully.
  • We are not a decision or policy making committee. Our purpose is to make recommendations that may enable ethical decisions to be made.

Guidelines have been established to help the Committee make their recommendations. They are as follows:

  1. Decisions on treatment or on terminating, limiting, or withholding life sustaining procedures shall regularly be made, when feasible, within the patient, the family, and the professional staff relationship. In such decisions, the best interest of the patient is always to be the primary consideration.
  2. Bioethical disputes between any members of the professional care team including physicians, any member of the medical team and family, or among the family members regarding a patient, should be referred to the Committee for consultation.
  3. The obligation to do no harm dictates that treatment which is no longer in the patient’s best interest be discontinued; but when there is substantial doubt, continuing treatment or life support is favored.
  4. Parents or legal guardians, along with the competent patient, have the role of primary decision makers concerning any treatment for the patient. Such decisions should be based upon the reasonable medical judgment of the patient’s attending physicians.

Thus, the purpose of the Committee is to make ethical recommendations, not decisions, about the care of the patient. All concerns of everyone in the group will be discussed and evaluated. The group does not jump to conclusions but goes through a process to identify the problem, to present diagnosis and prognosis, and to understand the problems of the family. What are the ideal pictures: who is the number one to be effected, what are the burdens and benefits; who else will be burdened or benefited. The process allows everyone an opportunity to learn and be involved. Everyone has a chance to see how they feel about what has been discussed and then the family can make a thoughtful decision.

A Bioethics Committee, working as a Moral Community, can work to resolve ethical conflicts. It guarantees (1) that similar cases are treated in the same manner; (2) that practitioners attend to all aspects of the case that should be considered; (3) that the quality of a Committee’s work from case to case is consistent; (4) and that it amplifies members’ capacity to learn from their experience and develop a transmissible knowledge base.

–Bob Green and Willa Mae Helmick

The Moral Effect of Suffering

In those three years [in the wards of St. Thomas’s Hospital] I must have witnessed pretty well every emotion of which man is capable…I saw how men died. I saw the dark lines that despair drew on a face; I saw courage and steadfastness. I saw faith shine in the eyes of those who trusted in what I could only think was an illusion and I saw the gallantry that made a man greet the prognosis of death with an ironic joke because he was too proud to let those about him see the terror of his soul.

At that time (a time to most people of sufficient ease, when peace seemed certain and prosperity secure) there was a school of writers who enlarged upon the moral value of suffering. They claimed that it was salutary. They claimed that it increased sympathy and enhanced the sensibilities. They claimed that it opened to the spirit new avenues of beauty and enabled it to get into touch with the mystical kingdom of God. They claimed that it strengthened the character, purified it from its human grossness and brought to him who did not avoid but sought it a more perfect happiness.

Several books on these lines had a great success and their authors, who lived in comfortable homes, had three meals a day and were in robust health, gained much reputation. I set down in my note-books, not once or twice, but in a dozen places the facts that I had seen. I knew that suffering did not ennoble; it degraded. It made men selfish, mean, petty and suspicious. It absorbed them in small things. It did not make them more than men; it made them less than men; and I wrote ferociously that we learn resignation not by our own suffering, but by the suffering of others…

It is curious to note that when they speak of evil, philosophers so often use toothache as their example. They point out with justice that you cannot feel my toothache. In their sheltered, easy lives it looks as though this were the only pain that had much afflicted them and one might almost conclude that with the improvement of American dentistry the whole problem could be conveniently shelved.

I have sometimes thought that it would be a very good thing if before philosophers were granted the degrees that will enable them to impart their wisdom to the young, they had to spend a year in social service in the slums of a great city or earn their living by manual labour. If they had ever seen a child die of meningitis they would face some of the problems that concern them with other eyes.

–William Somerset Maugham (1874-1965)

Mothers, Evolution, and Traditional Values

“Traditional values” is a sort of code phrase that refers to imaginary good old days when mother and father and children lived in a stable unit as the father earned the living and the mother ran the home.

Our real traditional values go back way beyond the supposititious times, and we can strengthen families and society if we learn from the implications of our evolutionary roots, the real traditional values that shaped us–especially that prolonged and intensive maternal care is imperative for our young. This traditional value, extending from past eons, is the single most important factor for an infant’s start toward success or failure. The recent and alarming Carnegie Report tells us this.

We can and must learn from anthropology that our hominid and ape-like ancestors were anything but the brutish and aggressive creatures of stereotype. On the contrary, they lived in small, cohesive bands in which each individual knew the others and each mattered. Each had to rely on the others. As bodies stood upright and eye-hand coordination grew greater and brains expanded, tribal ties and communication intensified. People lived at peace with each other, trusting and cooperating, and taught their young to live so. Had they not, our species never could have evolved.

In this context, the mother who carried, bore and suckled her infant was the primary caretaker. Infants born in an increasingly unfinished state required increased care as their brains enlarged after birth and sought it first and foremost from their mothers. But the mother could carry out her caring function during this crucial period only with unstinting support from the tribe.

The report on American children at risk states what is screamingly obvious to anyone who knows how we became human: Our young cannot thrive without “nurturing love, protection, guidance, stimulation and support.” Lacking these traditional values, a young, brainy creature can no more mature normally than a seedling deprived of water, weeding, fertilizer and sun. Worse, these sorts of learning, if not available when the infant is programmed to receive them, are permanently lost.

The human mother nurtures heart and mind and soul as well as body. She is the earliest source of love and trust and interaction. Cuddling her newborn, she contributes significantly to the proliferation of cells in the miraculously exploding brain. Her love and tenderness for her tiny new human are as nourishing and necessary as her milk.

In our heedless ignorance of how we got the way we are, we have sowed the wind and are reaping the whirlwind. Inevitably, unwanted children born to mothers who can’t care for them–and into a society that cannot feed, clothe, educate or protect them–turn into the warped, brutalized products of illness and neglect, cruelty and crime who infest our social fabric and send us screaming for more police and jails.

That’s attacking the problem at the wrong end. It’s wholly futile. It was caring and sharing, structure and family, a tribe that offered a sense of belonging and being important, that brought us to our lofty human status. These were taught to newborns from day one.

These qualities are not adequately taught in our society. Especially in America, young girls bear young long before they are physically or emotionally ready, and without a social structure to lean on. We do not take motherhood and child care seriously. You might suppose women got pregnant all by themselves. Fifty-thousand years ago (when, for all anyone knew, they did) mother and infant nevertheless drew sustenance from the tribe from before the infant’s birth through its puberty.

And they had role models. We are pre-eminently learning animals. Among our chimpanzee and gorilla cousins, zoo-raised mothers must be taught how to handle the offspring. If this is so with animals whose brains only double in size, how much truer must it be for us, whose brains quadruple. As N.J. Berrill explains:

“What has happened is primarily a lengthening of the learning period from birth to puberty. This extension of the period of growth and development, during which the young human could continually acquire new skills, including speech and communication generally and the transmitted experience of elders…was almost certainly the prime factor in the ascendancy of human wits over a hostile environment.”

This is why attention to the beginning years, not those when the child is almost grown, has incalculable importance. Only caring for our young at the very start–in the womb, in fact–and understanding that devoted maternal care is indispensable to our babies’ future, and therefore our own, has a chance of abating our contemporary pathologies.

That is the most important of all the traditional values to which we must return.

–Betty McCollister

Ms. McCollister is editor of the newsletter of the Iowa Chapter of the American Humanist Association. She has long been a humanist activist in her area and with the AHA, writes for humanist publications, and has a regular column in the Cedar Rapids Gazette.