Pain, Pleasure and the Greater Good by Cathy Gere
Pain, Pleasure and the Greater Good
By Cathy Gere
Chicago University Press £22.50 Oldie price £18.23 inc p&p
dragged down by the mind-numblingly complex evidence and its hiatuses. The heart of the problem is that, while adamantly refusing to explain openly what had transpired, Annabella remained for the next 35 years ferociously defensive both of her conduct and her husband’s genius.
Byron never saw his sole legitimate daughter, Ada, after the first weeks of her life, but it is fascinating to see how much of his temperament he bequeathed her. A wilful ‘gobblebook’ (her own coinage) of a child, always scratchy with her doting but controlling mother, she was dreaming up flying machines before she hit puberty and giving notice that she would not conform. Her love life was excitable – she had her first boyfriend when she was barely sixteen, and her marriage to the biddable Earl of Lovelace would be interrupted by at least one reckless affair. Because she was uninterested in domesticity, her three children were treated in cavalier fashion.
Cycles of mysterious illness and nervous complaints alternated with periods of fanatical energy. Playing the harp was one passion; another was gambling on the horses, which would ultimately ruin her. She explored the refraction of sunlight on raindrops and planned ‘a calculus of the nervous system’ – her own being so highly strung. Most remarkable is her visionary insight into the implications of Charles Babbage’s prototype computer, the Analytical Engine, set out in essays that rank with the greatest imaginative leaps in the history of science.
Ada’s was a messy existence, but Seymour vindicates her thoroughly Byronic claim that ‘the Devil’s in it if I haven’t sucked some of the life-blood from the mysteries of the universe’. I recently got into a bit of an argument in the hospital where I work, over the management of a patient with a severe head injury. He had been found unconscious on the street and, even after several days, no relatives had appeared. His brain scan showed severe damage to the front of the brain which, at least in my opinion, meant that he would almost certainly be left with catastrophic personality change and unable to return to any kind of independent life.
Two days after admission, he came close to dying but was saved by ‘aggressive’ medical treatment. I argued he should have been allowed to die as he (and his family and friends, if he had any) could only look forward to a future of misery. My colleagues felt otherwise.
Was I subscribing to a utilitarian ethic – that the consequences of our acts are all important in deciding what should be done? Were they subscribing to a humanistic ethic – that he had an inalienable human right to live? Or was it just uncertainty about his prognosis, because you can rarely be entirely certain about the future?
Most doctors, including myself, dislike philosophising and find ‘trolleyology’ absurd – a thought experiment about ethical decision-making, beloved of philosophers. It describes the dilemma where several lives can be saved by pushing one man (originally a fat man, now a more politically correct man with a backpack) onto a railway line, to prevent a runaway trolley killing a group of workers farther down the line.
In the real world, medicine is all about uncertainty. We have to make practical decisions without the aid of exquisite philosophy; even though – as Keynes said of practical businessmen with regard to defunct economists – as practical doctors, we are probably slaves of some defunct philosopher.
Cathy Gere is an English historian working at the University of California, San Diego. Pain, Pleasure and the Greater Good is an intellectual history of the utilitarian ethical system advocated by Jeremy Bentham over 200 years ago. She bases it around the development of the principle of informed consent in medical practice after the Nuremberg Trials. She sees this as representing the triumphant defeat of utilitarian ethics (which elsewhere she calls ‘the Oxford disease’, as many of its proponents came from Oxford University – as did she).
Bentham’s aim was to establish morality on the basis of the consequences of our actions in terms of pain and pleasure for sentient beings. (Bentham was ahead of his time in not limiting his ethical calculus to humans.)
Before Bentham, ethics had been specified by authority (gods, priests, kings or otherwise) not subject to rational calculation. Gere sees Bentham as the father of an intellectual tradition that spawned ‘a network of British scientists, economists and philosophers [who] had agreed on a vision of the nervous system as a stimulus-andresponse mechanism, directed by a pain-pleasure system that had evolved to guide the organism towards survival and reproduction’. She fears that modern psychology and neuroscience, which see the brain as a physical system, are surreptitiously taking us back to utilitarianism, with an implicit threat to human freedom.
She has written the book, she tells us, ‘with the aim of making it just slightly harder for Bentham’s two sovereign masters – pain and pleasure – to reassert their rule’.
The simple truth is that brains are so complex that we do not even begin to understand them. Above all, we do not understand how or why physical matter gives rise to conscious experience. I therefore see no ethical consequences to seeing our brains as physical systems.
On the other hand, the question of criminal responsibility has been rendered very difficult by our
increasing understanding of how brain damage – from trauma, both physical and psychological, especially in childhood – predisposes to criminal and antisocial behaviour.
We just don’t know enough about our brains to draw definite moral conclusions from neuroscience. Still, we know more than enough to draw political conclusions – for instance, for improving childhood and education, and lessening inequality, if we want to reduce criminal behaviour.
Just as with the patient I argued about with my colleagues, real life remains muddled, uncertain and full of compromise. Anybody who claims otherwise – and in this, I agree with Gere – is not to be trusted.