Andrew asked:

When, if ever, should a terminal patient’s right to be told the truth about their condition — that they are dying — be overridden?

Answer by Craig Skinner

I dont think a patient of sound mind who asks for the truth should be lied to.

As a medic, I would say medical ethics revolves around 4 principles:

• beneficence (do good)
• non-maleficence (do no harm)
• autonomy (patient’s right to truth and to decide)
• justice (fair sharing of limited resources)

Your question relates to autonomy. Relatives often say the patient shouldn’t know the truth because she couldn’t cope with it — she would give up, wouldn’t fight any more. So, they say,  autonomy clashes with doing no harm, the latter should prevail, I should lie. Whilst I always take account of relatives’ views, I am not bound by them, and I have never agreed with this view. It usually means it is the relative who cant cope, won’t know what to say if mum starts talking about death. And if we go along with it, the outcome is bad: the patient soon realizes she is dying anyway, but can’t talk about it because her family don’t want to, and so she is alone and isolated just when she most needs family support. So, I explain all this to the relative, and tell the patient the truth.

Two caveats.

First, a patient’s right to the truth doesn’t mean I have a right to ram the truth down her throat, as it were, when she doesn’t want to talk about it. I am guided by the patient’s wishes. So, having examined her and got back test results, I will start in nonspecific terms — there’s a shadow on your x-ray we need to investigate further, say. Then, “Is there anything you want to ask?”, and now we find out how much the patient wants to know, at this stage anyway. Some say no, that’s fine, lets get on with the tests, others ask if it could be cancer. And so it goes as we investigate further. If it turns out to be a fatal condition for which little can be done, I will say so if asked directly, otherwise will talk of treatment which may help for a time. If a patient has, or probably has, a very serious condition, but one which may be curable, and decides to bury her head in the sand, keep clear of doctors and hope for the best, then I will make sure she knows the serious position even though she did not ask me to spell things out.

Second caveat. Docs know only too well that they often get it wrong, so we must always consider very carefully before pronouncing an illness terminal or being too exact or sure about life expectancy. Second opinions may be a good idea.

I hope this is helpful to you.

Hubertus asked:

In view of Hitler or Trump, by what criteria — if any — would you call a person or its ardent followers sane or insane? Or don’t you see any difference between, say, Jesus and his followers and Hitler and his followers? Are there no valid criteria?

Answer by Geoffrey Klempner

First off, allow me to decline your invitation to share my views about Hitler, President Trump, or Jesus Christ. Except to say that there are readers of this page who are neither ardent or fanatical, who think that Trump is a good guy, and there are also readers of this page who think that Jesus was actually not such a good guy.

Seven decades after the end of WWII it is still politically incorrect to say anything good about Hitler or his followers. Few would doubt that Hitler was evil. But what is really scary is that many of his followers were ordinary people, decent folks who helped their neighbours and were kind to animals.

Sanity/ insanity is a much abused distinction — witness the Soviet treatment of dissidents. Anyone who objects to communism must be insane, mustn’t they? I would be very careful bandying that label!

Charles Manson, who died just a few days ago, would be a better example. Were his followers insane? If the answer to that is, No, then you really couldn’t have a better case. Were they brainwashed? Is being brainwashed a form of insanity? Certainly, if the result is that you become a jibbering idiot (as in the movie The Ipcress Files, 1965). But if it’s just another name for indoctrination, then you would have to call a large proportion of the human population ‘insane’.

Being ‘ardent’ or ‘fanatical’ isn’t a form of insanity. It’s one of the normal ways in which human beings express themselves. Normality is a spectrum. It is normal to be what some would term ‘irrational’ about some person or topic. Having the power of reason doesn’t entail that an individual is particularly good at reasoning, or that they are what you or I would call a ‘reasonable’ person.

And even if you are a ‘reasonable’ person who is ‘good at reasoning’, there may still be particular things — in fact, there probably are — which you are irrational about. (Call me irrational, but I won’t listen to any argument, however persuasive, for the view that Eric Clapton wasn’t the greatest rock guitarist of all time.)

What is the difference between the people who followed Jesus and the people who followed Hitler? Do I have to say? We admire those who preach love, and despise those who preach hatred. But don’t you hate Hitler and the Nazis? At least you can say you hate what they did, even if you are willing to extend to them Christian ‘love’.

If you are looking for criteria for sanity, there’s the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Evil isn’t listed in the manual because it isn’t a form of insanity. There’s a lot of evil about. Sad to say, evil and malice are natural human tendencies, a place on the spectrum of normality.

Marden asked:

What do these words mean in Kant’s 12 Categories: Inherence and subsistence, and community? These three terms are in the third group of categories (of Relation). I’d be happy with any url that would define and discuss all 12 of Kant’s categories.

Answer by Martin Jenkins

The Categories of Relation: Substance (Subsistence), Causality (Inherence) and Interaction (Community) are outlined by Kant in Section 3, Chapter 2, Book 2 of the Critique of Pure Reason.

As written, in Section 3 ‘Systematic Representation of all Synthetical Principles of the Pure Understanding’, the Analogies of Experience are outlined.

Perception is only possible by the continuous connection of Intuitions. Otherwise, they would be isolated, contingent and unconnected. So what connects them? Time cannot, as an a-priori condition of experience, (See the Transcendental Aesthetic of the Critique) be a subject of perception. Here enter the First Analogy.

First Analogy: The Permanence of Substance.

As Time is not an object for perception, there must be something by which it is represented; a something in which change, modification and successive changes of state, occurs. For Kant, this ‘something’ is precisely Substance. Whilst there are changes, modifications etc to objects, their underlying Substance remains unchanged. Otherwise there would be an unconditioned, chaos of perceptions without coherence. For example, the tree exudes a succession of changes: buds become leaves, leaves which fall yet the underlying ‘thinghood’ of the tree remains as a ‘ground’ for such changes.

Second Analogy: The Principle of the Succession of Time according to the Law of Causality.

When a human subject looks at a house, gazes from its roof to its foundations to its windows and so on, there is a succession of intuitions in Time which is not causally determined. This is because they are dependent on that human subject — they are a Subjective sequence of events. It is otherwise when gazing at a boat flowing down a river.

Here, there is a linear, successive sequence of events: A then B, then C, then D and so on which cannot be otherwise. The boat was once high upon the river, then it was adjacent to the perceiver, then it is further down the river. This succession is conditioned by and made objective by the Transcendental Law of Causality. It cannot be otherwise, for then knowledge deriving from linear, successive perceptions would be made impossible – contrary to our actual experience.

Substance underpins the succession of Time according to the Law of Causality.

Third Analogy: Principle of Co-Existence according to the Law of Reciprocity or Community.

All Substances, existing under the conditions of Space and Time, exist in a simultaneous relation of reciprocity: of reciprocal action co-extensive with each other in a plurality of ways hence, – a reciprocal community of substances. Unlike the Law of Causality above where we have A then B then C and so on, here we have A affecting D or B (or any other term affecting any other) and vice versa – simultaneously in Time and Space.

The synthesis of the Understanding thus has objective, Transcendentally conditioned intuitions of a ‘compositum reale‘ – distinct phenomena, all in inclusive connection with each other in various ways such as inhereing with each other, consequences as effects of causes and composition as a manifold of intuitions in unity (or Reciprocal Community), simultaneously experienced by the ‘I think’ as the unity of apperception

Hope this is useful, Marden.

Sasha asked:

To act morally is it necessary to fight against one’s desires?

Answer by Paul Fagan

This all depends upon what desires one has and what moral background we are comparing them with; but in general, I would say that one does not necessarily have to wrestle with one’s own desires to act morally. About a month ago I answered the question ‘What is a Moral Society?’ and I would reassert part of my answer: that it is a society or at a lower level a community, that sets a shared code of conduct, that is agreed by the majority of its inhabitants, that we may term ‘morality’. As most of the inhabitants of a society would agree upon its values and live their lives by them, then it follows that the seemingly presupposed notion that persons have to restrain themselves to live morally would be fallacious.

I suspect that the majority of persons do not need to restrain themselves in society as they have a desire to be part of a community, or in other words a sense of belonging, which outweighs any other desires to better oneself through antisocial acts that harm others. Additionally, one’s conscience would ensure that one’s behaviour aligns itself with the prevailing morality. Either reason may be enough to ensure that most individuals behave themselves but the combination of both ensures all but the most errant individuals cannot be considered to be moral actors.

With regard to persons needing a sense of belonging, this may be a facet that has evolved as living in social groups has been beneficial to humanity’s survival; and without it society would undoubtedly crumble. I would think that there is a deep-seated, innate desire to belong to groups and this entails absorbing one’s community’s standards. Hence, most persons’ desires would coincide with others’.

Accompanying this, most persons also have a conscience and this facet is often called into play when persons are tempted to commit antisocial acts. In fact society exercises so much disapproval over persons who do not believe or adhere to its standards that this phenomenon alone may guide persons’ actions and ensure compliant behaviour; although disincentives are also provided by punishment established through criminal justice systems. Hence, persons with antisocial desires often align their behaviour with moral standards; and the more they align their behaviour the easier this process seemingly becomes.

The commonest schools of philosophy have realised that persons wish to live lives attuned to their society’s standards. Virtue ethicists wish to channel this phenomenon by educating persons from a young age to behave compliantly and rely upon heightening a person’s sense of belonging to ensure this; whilst deontologists or utilitarians may set boundaries by which persons actions may be judged and therefore seemingly place more reliance upon invoking a person’s conscience.

Hence, I would conclude that for the majority of persons, for the majority of the time, they do not have to restrain their desires as they either coincide with society or become aligned. Furthermore, in general, all persons in a society are judged by the same standards although there are times when the logic fails: for instance, those with prestige, talent or even illness may be offered more latitude when they are judged by others.

As a coda, I would add that there are always those who cannot comply with society’s morality and often must be punished. Hence, since the times of early Greek philosophy, much debate has occurred as to why persons intentionally refrain from acting morally and for further reading, one may seek entries in philosophical dictionaries concerning the conundrum of akrasia.

Dennis asked:

Why is life on Earth so precarious, with old age and death necessary?

As the truths of metaphysics and overcoming of aging is on the human threshold, it looks like that is what humans were designed to do — True?

Answer by Gershon Velvel

Let me make a confession, Dennis. I want to live forever. I really do. And I also want to know the ultimate nature of reality. I mean, really know. And do you know what? In my mind, somehow the two are inextricably linked. If I knew the ultimate nature of reality, I could not die. Death would be impossible. And if I found a way to escape death, now and forever more, I would surely know the ultimate nature of reality.

Actually, that’s not a new idea. That’s what Jesus told his followers. ‘I am the way, the truth, and the life,’ he famously says to Thomas (John 14:6). For many millions of people, the Christian (not only Christian) ‘family story’ IS the ultimate reality, and sincere belief is all you need — to live forever.

And if you are a philosopher, on the track of truth — or so you hope and believe — does that necessarily mean you have to be a sceptic, accept limitation and finitude, Heideggerian ‘being towards death’ and the ultimate nihilation of everyone and everything you have ever cared for?

If that thought makes you depressed, then maybe Plato is more your man. Actually, the Pythagorean idea of reincarnation — the Pythagoreans were one of Plato’s major influences — is not a million miles away from what the contemporary philosopher Daniel Dennett preaches. The self is just a program (a Pythagorean ‘number’ — it could be a Gödel number, get it?). Logic and set theory are eternal, true in all possible worlds. The Dennis-program is eternal. All you need is suitable equipment to ‘upload’ it to and off you go. Again. And again, for ever.

All material structures are finite by their very nature. Nothing can escape the ultimate death of this material universe. But sets and numbers don’t need a ‘universe’, because they form a permanent universe of their own. Your fragile human body will certainly die, but the possibility that YOU will come back is logical, not physical. The ultimate nature of reality is just as Plato said: logical and rational. The eternal Forms. And you — a ‘soul’ — are another entity of a similar kind (‘akin’ to the Forms, as Plato claims in the Phaedo), logically indestructible.

I’m not going to attempt to fill the serious logical gaps in this story, because although you ask whether your idea is ‘true’, I don’t think truth is really the issue. (You weren’t seriously thinking that somehow technology will solve the problem of human finitude, were you?!) This is about what you and I want, deep down. Trying to understand what that is about.

As a matter of empirical fact, or, rather, speculation, it is conceivable that human beings and all life on Earth were designed — say, by a superior multi-dimensional alien race. Why not? Maybe the multi-dimensional aliens didn’t need to ‘evolve’. Make up any story you like. But, obviously, it’s not going to solve any problem if the aliens are, essentially, in the same predicament as we are, dependent on a long chain of contingencies that could alter at any time, leading to their total extinction.

That’s not what we want. That’s just another ‘story’. So all all that’s left is metaphysics. See if you can improve on Plato. So long as you are on the way to a solution, however long that way may be, there is always hope. — Better put that thinking cap on!

Reghu asked:

How far is Strawson’s theory of Persons a critique of Hume’s theory of Self?

Answer by Geoffrey Klempner

I was looking for my old copy of P.F. Strawson’s Individuals: An essay in descriptive metaphysics (1959) which discusses Strawson’s view of ‘Person’ as a ‘primitive concept’, in Chapter 3. Then I did a search on the internet and found his paper, ‘Persons’ published in the Minnesota Studies in the Philosophy of Science Vol. II (1958) at http:mcps.umn.edu/assets/pdf/2.7_Strawson.pdf. This looks to be a fuller treatment.

Here’s a quote from the concluding section:

“What I have been mainly arguing for is that we should acknowledge the logical primitiveness of the concept of a person and, with this, the unique logical character of certain predicates [viz. psychological predicates]. Once this is acknowledged, certain traditional philosophical problems are seen not to be problems at all. In particular, the problem that seems to have perplexed Hume does not exist — the problem of the principle of unity, of identity, of the particular consciousness, of the particular subject of ‘perceptions’ (experiences) considered as a primary particular. There is no such problem and no such principle. If there were such a principle, then each of us would have to apply it in order to decide whether any contemporary experience of his was his or someone else’s; and there is no sense in this suggestion.”

In the five decades since those words were written, it is fair to say that not many philosophers have taken up Strawson’s idea that the concept of a person is ‘primitive’. Various approaches have been taken to the problem of identifying/ defining ‘self’, the most popular being materialism. According to materialists, there are not two ‘kinds’ of ‘basic particulars’ (to use Strawson’s terminology), spatio-temporal continuants and persons but only one: spatio-temporal continuants, i.e., material entities. Some of these material entities are so internally configured that they have the property of being conscious. The problem of accounting for consciousness is still a major topic of debate at the present time, as is the problem of accounting for the criteria of personal identity.

I have recently expressed scepticism about materialism (Philosophy Pathways 213 Special mind-body dualism issue) but for the sake of this answer I will leave the question open.

First point of disagreement: I don’t read Hume’s ‘perplexity’ as a failure on his part. He is being ironic, at the expense of the Cartesian dualist. When I look into myself (says Hume), no ‘self’ (no soul substance) is to be found. However, Hume has a perfectly workable (in fact, brilliant) alternative theory of how the self is constructed, as what one might term a ‘virtual object’ of knowledge. Here is my take on this:

There is no immaterial ‘self’, but there are ‘ideas’, conceived as discrete, incorrigible mental events. These events form ‘bundles’ according to the following logical principle: If mental event A is co-present with B, and B is co-present with C, then A is co-present with C. (Co-presence is the ‘primitive’ concept.) When are two mental events co-present? An example would be, if I currently have a mental picture of the Eiffel Tower, and simultaneously hear the singing (Humean ‘impression’) of a blackbird outside my window. Let’s say that at the same time, I also experience a twinge of back pain. The three mental events form a ‘bundle’.

Over time, new mental events are added to the bundle and other mental events are discarded. What we term ‘personal identity’ is just the continuity of the bundle — like a flock of birds growing and shrinking as birds join or leave the flock. Memory plugs the gaps of unconsciousness when no mental events are occurring. (Memories are just more ‘ideas’ on Hume’s theory.) That’s it. The self, and personal identity, are ‘virtual’ in the sense explained: they are merely logical constructions. There is no mental ‘reality’ beyond the flux of impressions and ideas.

The weakest link in Hume’s theory is the Cartesian notion that mental events are ‘incorrigible’, a notion critiqued by Wittgenstein in his argument against a Private Language in Philosophical Investigations. But Strawson doesn’t like Wittgenstein’s solution to the problem of explaining how self-ascription of psychological states (such as ‘I am in pain’) is possible. According to Wittgenstein, ‘My back hurts,’ is not a statement with truth conditions but merely an ‘expression of pain’. Strawson calls this the ‘no-ownership view’, which he finds counter-intuitive. Surely if I say my back hurts and you say, ‘GK’s back hurts’ we are saying the same thing about the same thing? We are both making statements with the same truth conditions.

How would Wittgenstein respond to this criticism? Say what you like, it makes no difference to what is actually taking place. There is a huge asymmetry between the first-person and third-person case, but if you want to paper over the crack and call it ‘saying the same thing (is in pain) about the same thing (GK)’ you can, and no-one will contradict you. That’s how we actually talk, that is our ‘conceptual scheme’ to use Strawson’s terminology. Wittgenstein would add that it is part of our ‘form of life’ that we don’t stop to puzzle over the asymmetry of the first- and third-person case — until we are tempted into doing philosophy.

Asserting that the concept of a person is ‘primitive’, in effect ruling out any further attempts at analysis or theory, achieves nothing of substance. The deep philosophical problem remains, how it is possible that there could be such a thing as ‘being in pain’ or ‘being a person’.

As I said, that’s just my take. It remains the case that P.F. Strawson’s Individuals is one of the most important works of 20th century analytic philosophy, which ought to be on every Metaphysics reading list.