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Rationality or Reasonableness as the Methodology of Ethical Medicine

Only recently has British academic and ethicist Oliver O’Donovan made me see how different these two concepts are, despite the same purpose of providing guidance for peaceful living. Behavioral norms are common to all societies, and once established they resist change very effectively for long periods of time.

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by John Patrick, MD

Only recently has British academic and ethicist Oliver O’Donovan made me see how different these two concepts are, despite the same purpose of providing guidance for peaceful living. Behavioral norms are common to all societies, and once established they resist change very effectively for long periods of time. They become what Hungarian philosopher and author Michael Polanyi and British philosopher Lesslie Newbigin call tacit knowledge. Things we know without being able to rationalize the process. To readers of this journal, the best example of tacit knowledge in your life is your conversion. It is an undeniable foundational reality, but we do not know how it happens except that our Lord likens it to the wind, which we cannot explain but simply experience. Our Lord says it is an analogy to the work of the Spirit in our souls.

 

The worst secularists, despite their alleged loyalty to evidence, try to call conversion subjective nonsense. The fact that “the nonsense of conversion” changed the world and ultimately gave birth to modern experimental science is simply ignored by the arrogant secularists. It has taken modern ideas of rationality, which are tacitly atheistic, centuries to displace commonly held views derived from Judeo-Christian religion. The fact is all the behavioral norms that have ruled the West go back to a belief that our laws are a gift from God and are, therefore, authoritative with their consequences worked out in history. Common law, arguably the greatest gift to democratic government, enshrines respect for the reasonableness and sense of justice of the common man. The modern ideas of secularism have only succeeded amongst the so-called “elite.” They persuade themselves that their theories are pure rationality, but they fail at the first question: What is your self-evident starting premise? Their answer that matter and chance are all we need is not self-evidently true. Do they really think true love can be founded on their premise? Can an evolutionist truly explain the love that will die for others? C.S. Lewis insists quietly but firmly that if nothing can be assumed nothing can be proven. The traditional views found roots in the life experiences of the tribe, nation or people group, and they were accepted by almost everyone because they produced solidarity and gave everyone a sense of belonging. They were used to resolve differences, and that history was revered and accepted as reasonable. Quibbles were common, but denial of the narrative was not.

 

Michael Polanyi expressed the strengths and wisdom (a word which does not appear in the modern curricula) of ancient ways beautifully. In 1946, he wrote:

 

“The adherents of a great tradition are largely unaware of their own premises, which lie deeply embedded in the unconscious foundations of Practice… if the citizens are dedicated to certain transcendent obligations and particularly to general ideas such as truth, justice and charity and these are embedded in the traditions of the community to which allegiance is maintained, a great many issues between citizens, and all to some extent can be left —and are necessarily left to individual consciences to decide. The moment however a community ceases to be dedicated to transcendent ideals, it can continue to exist undisrupted only by submission to a single centre of unlimited secular power.”

 

Polanyi watched Communism destroy the moral backbone of Russia and eastern Europe. The last election in the United States had this phenomenon as a sub-text, which was not understood by the elite, but President Trump, perhaps unconsciously, was evoking these deeply embedded premises of Western society.

 

I grew up in a society where the deeply embedded and certainly unconscious foundations were biblical, and its citizens settled differences as Polanyi describes. Arguments would usually stop when one side could say, “The Bible says….” Even more impressive was the frequency where one side could say their treatment had been unfair and the other side would not deny the charge but try to deflect the argument by some form of special pleading. (Read the first chapter of Mere Christianity for this to be laid out by C.S. Lewis.) Race is irrelevant; it is all about culture, and cultures decay when they are not taught. Multiculturism leads to division and identity politics, trapping large groups into a narrative of victimhood and hatred.

 

Vishal Mangalwadi, whose tacit world had been Hindu, gives an amusing yet profound account of his first encounter with Judeo-Christian culture in rural Netherlands in The Book That Made Your World: How the Bible Created the Soul of Western Civilization. Mangalwadi and his host, Jan, went to collect milk from the local dairy farm: “a neat and tidy dairy farm with about 100 cows but no human beings. The cows were milked automatically; the milk was pumped into a large tank… Jan filled his jug, put 20 guilders into a bowl and helped himself to change from the bowl.”

 

Mangalwadi comments that in India both the milk and the money would be taken. He could see what a difference this kind of trust makes. In India, neither business owner nor customer are trusted. A cashier would be needed, along with inspectors to make sure the farmers don’t add water to the milk, all paid for by the customer. Milk then becomes more expensive, corruption is part of each step and bribes are necessary to complete the simple task of buying milk. Cashiers, inspectors and bribes add no value to the milk. Ice cream does add value, but it is now too expensive to buy. He wrote, “That reduces our economy’s capacity to create jobs.”

 

As an illustrative aside, my neighbor sold sweet corn and other produce for years by putting a sign at the farm entrance and simply leaving the produce in a shed with a pricelist and a box for payment. Theft forced him to stop, because our culture is decaying. In the Darwinian worldview, everything is a battle for resources and ends entirely justify means. As C.S. Lewis put it in The Abolition of Man, “we laugh at honor and are surprised to find traitors [and thieves] in our midst.” And of course, the thieves are rational because, why wouldn’t anyone brought up as Darwinian rationally do that? (If you haven’t read David Stove’s book Darwinian Fairy Tales, order it now for a serious read of wonderful humor and intellectual honesty by an atheist who sees more clearly than we do.)

 

Scholarships took me to university, and within weeks I had become a reductionist without anyone using the word. So-called “higher education” changed my world, by displacing the Scriptures with their rich morally consequential narrative with another god—scientific rationality. Claiming no need for God, we were taught that science, using only objective measurements, will make a better world. In those days in the 1950s, it looked realistic: the power of the first antibiotics was stunning; effective drugs of all sorts were appearing; and new techniques like dialysis and open-heart surgery were being developed. Only a few doctors were doing laboratory research, and those who were all knew one another, meaning there was virtually no fabrication of scientific data because we presented our data orally to one another. It was both terrifying and wonderful, particularly how the great and famous had time for neophytes. There was no discussion of ethics, because everyone knew everyone else and knew whose work might need to be repeated before being believed! Can we say we have made the world better in the ensuing 65 years of technological brilliance and moral decay?

 

Providentially, right at the beginning of university, I was also introduced to a high level of expository preaching, literally my first Sunday in London. A Christian student took me to hear Dr. Martyn Lloyd Jones at Westminster Chapel, where he offered 50 minutes to an hour of rigorous exposition. I was enthralled and soon learned there were several preachers of similar quality in London. For the next five years, they educated me in the Scriptures, but integration of my two worlds was not part of the process. The question of morality and its foundations are still the big questions for a medical student. Meaning, justice, suffering, death and sexuality are still not given the depth of teaching needed. A few physicians did try, but I did not know them personally. The majority seemed to live intellectually incoherent lives, as I did too. The physicians I admired seemed to have no need of Christianity, and those who wore their faith on their sleeve were often not the best of physicians. (These days, I tell students not to try to evangelize their class because they are watching you; instead, you must just try to live a life worthy of your Lord, that it will be noticed.)

 

The books that first brought the two worlds into conversation with each other for me were Lesslie Newbigin’s Foolishness to the Greeks, Dietrich Bonhoeffer’s The Cost of Discipleship, Martyn Lloyd Jones’ Surprised by Joy and, of course, C.S. Lewis’ works, especially The Abolition of Man. Between them, they showed what a coherent Christian life would look like. It is a life made up of experience, passion, duty and wisdom all recognized as grace and coming out of serious study. Salvation as the daily process of being saved, is an inch-by-inch struggle. This is Paul’s admonition to Timothy to study to become a workman who needs not to be ashamed rightly dividing the word of truth (2 Timothy 3:15). This process produces a world where what is reasonable is also true, always a humbling experience as you realize how much could have been done but hasn’t been done, sins of omission and commission. This is why I think our churches need to look at worship to see if it recognizes that confession and assurance of forgiveness are the basis for genuine worship.

 

The contrast between this way of life and the angry, patronizing rationality of today’s world is unmeasurable. As real scientists make the case, there is hope the complexity of modern molecular biology, genetics and cosmology are simply not explicable based on random events, and neither can their tacit belief that every problem is simply a matter of ignorance so education will fix it. We all know that good and evil are real; our problem is to develop the will to study to become a workman and live within God’s truth.