Thursday, March 07, 2019

Concierge physician for the Khmer Rouge

I did a post responding to a comment by progressive theologian Randal Rauser:

Here's his attempted rebuttal:

The first problem with Hays’ “rebuttal” is that the doctor’s behavior would constitute a gross breach of the Hippocratic Oath. Sadly, Hays doesn’t seem too worried about that! (Perhaps he should consider taking a class in bioethics before invoking more doctor analogies?)

i) I reject Rauser's illicit argument from authority. Unlike him, I don't regard what is taught in modern medical ethics as the touchstone of morality. Nowadays, the bioethics community in medicine promotes eugenic abortion, puberty blockers and sex-change operations for gender dysphoric minors, the voluntary and/or involuntary euthanization of the senile, comatose, developmentally disabled, organ-harvesting "vegetative" patients, &c. That's documented by Wesley J. Smith, among others. For instance:

Unlike Rauser, I don't issue a blank check to whatever med students are taught in their bioethics class. But that's just me.  

ii) For those of us who don't suffer from Rauser's moral superficiality and giddy capitulation to the Zeitgeist, there's the question of whether professional ethics obviates our general social duties. Is a doctor a doctor first, or is he a moral agent first and foremost, with preexisting duties that transcend professional ethics? 

Take a doctor or prospective doctor who's a husband, father, brother, son, and friend. When he becomes a doctor, does his medical code of conduct supersede his prior social obligations, or do those remain in force? In case of conflict, do general social obligations continue to take precedence over professional ethics? 

In my counterexample, if the physician administers the antidote to the Khmer Rouge as well as other Cambodians, the Khmer Rouge will go right back to killing Cambodian citizens. 

Suppose I'm not a doctor. Suppose I run across a wounded Khmer Rouge soldier who will die of his injuries without medical intervention. I know that if I seek treatment for him, he will resume murdering families. Murdering women, children, grandparents, &c. If, as a private citizen, it would be wrong for me to be an enabler of the Khmer Rouge, when I'm in a position to avoid that, does my becoming a doctor automatically nullify my prior social obligations? Does donning a stethoscope and white jacket suddenly make morally obligatory what had been morally prohibitory? That's the kind of question that morally serious thinkers ask–in contrast to progressive theologians who substitute moral preening for right and wrong. 

You can argue that physicians have a prima facie duty to treat all patients alike. However, like so many rules, it's becomes amoral when we robotically obey our man-made rules, when we imagine that mechanically following man-made rules absolves us of the duty to take salient differences into consideration. There's nothing moral about a morally indiscriminate policy. We should treat people equally, all other things being equal. But moral agents can do things that forfeit their prima facie rights and immunities. Mass murderers aren't entitled to the same treatment as innocent victims. If Rauser lacks the conceptual space for that elementary distinction, then so much the worse for his progressive theology. The moral imperative isn't a simplistic policy to treat everyone alike, regardless–but to treat like things alike and unlike things unalike. Is the Khmer Rouge solider who puts a bullet in the back of a child's head entitled to the same deference and consideration as a child? I'm happy to compare my answer to Rauser's. 

Setting aside the egregious ethical nature of the doctor’s conduct, the biggest problem with Hays’ response is that the doctor (who obviously parallels God) distinguishes between two groups: the innocent Cambodians who are worthy of being saved (i.e. the “elect”) and the wicked Khmer Rouge who deserve to die (i.e. the “reprobate”). However, if the analogy is to be relevant then it follows that God distinguishes between the elect and reprobate based on the worthiness of the elect (relatively innocent citizens) and the unworthiness of the reprobate (genocidaires!).

And that, ladies and gentlemen, is what Pelagian Calvinism looks like.

And that, ladies and gentlemen, is what a progressive demagogue looks like. Here is Rauser's original example:

Imagine a doctor who has enough antidote for an entire population inflicted with a fatal disease. The doctor's choice to provide the antidote only to a subset of those inflicted would invite the reasonable question: why only some? Why not all?

And replying "He didn't need to save anyone" is not a response to the question "Why didn't he save everyone?"

i) Like so many freewill theists, Rauser uses an example which depicts the condition of the lost as a case of misfortune rather than just desert. But that's a loaded question. 

ii) I'm simply responding to Rauser on his own terms. I gave a counterexample in which it wouldn't be arbitrary for the physician to treat a subset of the sick. It's not like flipping a coin.  

iii) Rauser then commits a level-confusion. My response operates within the framework of his illustration. Even if my response is an inexact match for election and reprobation, that's because Rauser used a poor analogy, and my counterexample is pegged to the nature of his faulty illustration. The defect lies not in my counterexample, but in his example–which my counterexample parallels. 

iv) There is, however, an asymmetry between election and reprobation. Unlike election, which is unconditional, demerit is a necessary, albeit insufficient condition in reprobation. God doesn't damn the innocent. So Rauser's Pelagian accusation is theologically maladroit. 


  1. Excellent response. One side thinks, the other side prances and preens itself, even engaging in self-congratulation ('Well said, if I do say so myself!') after quoting its original post!

    The Hippocratic Oath is impotent and irrelevant here given Rauser's theology since, according to Arminianism, the doctor is utterly hamstrung in his abilty/willingness to actually *apply* the antidote and thus make it *effective*, and stands by after merely 'providing' the antidote in some disconnected, meaningless-to-many fashion, and so watches on (or simply walks away) as many if not most (or theoretically all!) of the population does not avail itself of the antidote and continues to perish. Marvellous! Thanks, doc!

    Rauser's example backfires spectacularly.

  2. Good point Danny. Also, the Doctor had the ability to stop the virus from spreading but decided to let it out to see who would come to him for saving? His oath at that point was of course irrelevant would destroy their own position as well.

    1. Indeed. As is so often the case, in an attempt to demonstrate a problem within Calvinism the Arminian offers a clumsy analogy that misses the mark completely (as Steve has demonstrated), providing the Calvinist with an opportunity to turn it around, tighten things up somewhat, and provide a more fitting analogy that gets closer to the heart of the Arminian scheme, exposing it for what it is.

      When will Arminians learn?

  3. I'm someone who has taken "a class in bioethics" in medical school. Just a few brief thoughts for now:

    1. The American Medical Association itself has said: "Physicians have civic duties, but medical ethics do not require a physician to carry out civic duties that contradict fundamental principles of medical ethics...".

    In short, the AMA recognizes that doctors aren't only doctors. Doctors have "civic duties" as well as medical duties.

    2. Nothing necessarily unethical about withholding care. It depends on the particulars of a specific case.

    Of course, if someone has a fatal disease (e.g. stage 4 pancreatic cancer), they may die without treatment, but still it's not necessarily wrong for a physician to withhold treatment from a patient with stage 4 pancreatic cancer. For one thing, Rauser's hypothetical never mentioned what "the entire population inflicted with a fatal disease" wanted to do or not do.

    Suppose a subset of the population refuses medical treatment of a curable fatal disease, which actually happens in the real world of medicine. If that happens, then a doctor could, without violating standard medical ethics, respect their autonomy and withhold care from them.

    Likewise, God could withhold salvation from those who refuse it. That's consistent with Calvinism.

    3. The Hippocratic Oath is outdated. Many contemporary medical ethicists argue the Hippocratic Oath is paternalistic, that the Hippocratic Oath leaves out patient autonomy, that the Hippocratic Oath is sexist by only imparting this knowledge to "sons", the Hippocratic Oath could be regarded as not including surgeons ("I will not use the knife"), it's not as if most physicians literally "swear by Apollo the physician and Asclepius and Hygieia and Panacea and all the gods and goddesses, making them my witnesses", and so on.

    Besides, most social progressives today would vehemently disagree with the Hippocratic Oath's admonition against abortion ("I will not give a woman a pessary to procure abortion") and it would seem against euthanasia ("I will not give a deadly drug to anyone though it be asked of me, nor will I lead the way in such counsel").