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How to be a good doctor

The following will not convince anyone deeply opposed to consequentialist lines of thinking. But for those who waver, and for consequentialists who regret that they are committed to this, I hope to provide some encouragement.

Imagine you invent an amazing luck changing machine: the serious illness concentration machine (TSICM). The TSICM doesn't affect the total number of serious illnesses that affect the population of the group it targets, but does change their distribution.

Let's imagine that 1/10 people die of heart disease, 1/10 of lung cancer, 1/10 of liver cancer, 1/10 of gender specific cancers, and 1/10 of stomach cancer. Let's further assume that (a) a person cured of one such illness will live an equal number of extra healthy years as a person cured of any other such illness, (b) that none of these is, in fact, treatable, and (c) that all of these illnesses are not encouraged by any lifestyle choices their sufferers have made. (These assumptions are untrue of the above, but will be true for some other diseases)

So as it is, 5/10 people die of these illnesses. The TSICM does something quite peculiar about this. It recognises when a patient gets a gender specific cancer, and automatically gives them the other four illnesses. They were doomed anyway, so the extra illnesses make little difference to their fate. But since the TSICM doesn't affect the total number of serious illnesses in the population, this means that four other people will now avoid death from these things.

So the overall outcome is that the death rate from these illnesses drops by 4/5. One patient still dies, but four fewer than would otherwise.

If we were in possession of such a machine, should we turn it on? Of course! It is, under my assumptions, pareto optimal. No-one is worse off, and four people in ten are better off.

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Now a brief twist: Your engineers can't quite make a TSICM. But they can manage a TSICM-beta. The TSICM-beta doesn't assign four illnesses to one person who already has one. Instead, it assigns all five randomly to one healthy individual. Should we still turn it on?

Previously, someone was unlucky enough to receive a gender specific cancer, through no fault of their own. That's pretty arbitrary, and effectively random. So previously, under the TSICM regime, one person died at random. This is equally true under the TSICM-beta regime. It also leads arbitrarily to a random death. So it seems to me that the TSICM-beta is not worse than the TSICM. We should also turn it on.

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The final twist: Now imagine you are a doctor, and have just had five patients admitted to your hospital, each in need of a different organ without which they will die. You also have a perfectly healthy patient down the corridor. You could kill her, and distribute her organs amongst the newcomers, saving all their lives.

Many forms of consequentialism commit you to endorsing such redistribution (at least under various conditions that rarely hold in the real world: e.g. that no-one should know what you've done). Is this unpalatable?

Well, how does it differ from the previous machine? If it does not differ, then I can see no reason for rejecting it but accepting use of the TSICM-beta.

What happened to wisdom?

Look up genius in some dictionaries, and you'll see the word "intelligence" a lot. But why can't a genius be one who is extremely wise? Wisdom is one of those words that seems to have fallen out of common language, but I can't see why.

You might think that "wisdom" and "intelligence" are really synonymous, and I'm just making a mountain out of a mole-hill. But I'm not so sure.

To be intelligent is to know what happens to be true. Memorising the whole of wikipedia, parrot fashion, might make one intelligent.

But this wouldn't make one wise. Wisdom has more to do with understanding and insight. It is partly a matter of knowing how truths relate to one-another, and what their significance is.

Why has wisdom been forgotten? It seems to be the correct word for a desirable state of mind, and one which some people still aspire to.

Emphasis on intelligence just seems to ignore a whole realm of what it is to have a grasp on how the universe is.

Arbitrary choices in theoretical reasoning?

Some writers (e.g. Harman) say that arbitrary choices are sometimes reasonable in practical reasoning, but never in theoretical reasoning. So when choosing which baked bean can to take off the shelf at the supermarket, it's ok to just randomly pick any old one. In contrast, there is no piece of reasoning where it's ok to just randomly pick something to believe.

You might think that it's false that arbitrary choices are rational in practical reasoning (perhaps you ought to take the closest and least-dented can). But even if that's true, here's an example that might be a case of rational and arbitrary theoretical reasoning.

I'm deciding whether or not to believe the proposition:
P: By the time I finish this piece of reasoning, I will believe P.

I take an arbitrary choice to be one where where doing nothing is worse than some options available, and where there is more than one jointly best option. This is true of this piece of reasoning. If you believe that P is true, then P is true, and so you have one more correct belief. If you believe that P is false, then P is false, and so you have one more correct belief. So these options are equally good. And each is better than not believing either P or its negation. To withhold belief here is just to miss out on a 'free' true belief.
(I mean that not believing this is irrational to some extent. Obviously people have better things to do with their time than believe such bizarre propositins, and so this extremely low level of irrationality is outweighed by the vastly more important things we can devote mental energy to.)

Anonymity

Readers will see that I have slightly edited the "About" block at the top-right corner of the site. This is because I have noticed that some google variations on my name turn up this site.

I have never worried that someone who already reads the site might work out who I am. If someone reads blogs already, then I suspect that they already know and understand their limitations. But I do worry about the reverse: that someone who wants to know who I am would find this site. This new development on google has made this a distinct possibility.

"Some readers might judge my ability as a philosopher from my words here. I hope such people use the correct comparison class. This is your handwritten notes for your own reference, and not your published work."

But, you might object, that isn't the correct comparison class. Your words here really are published, for anyone to see.

But this is not quite correct. My words here are not published in the sense of "publically attached to my name". At least, if they are, I had not intended for this to be the case.

My aim with this blog was to have somewhere to store my notes. If anyone is interested enough to read these notes, then it feels unnecessary to deny them. This remains my understanding of this blog.

This is why I see this as my notepad that just so happens to be public, and not a publication that just so happens to be my notepad. I just hope anyone who turns me up on google understands this to be the case.

Any comments on the merits or problems of blogging are welcome. Do you worry that your comments on the internet will be found by potential employers? Should you so worry?

Is epistemology normative?

There are facts about what you ought to do. You ought to not torture small children to appease the tedium of a Sunday afternoon.

Are there facts about what you ought to believe?

I take the answer to this to be yes. You ought to believe that grass is green (because grass really is green). In general you have an obligation to believe things in proportion to the evidence that warrants them, or something similar.

Some people deny this. There are various reasons why you might do so, but the most prominent is this. Scepticism about normativity seems vaguely plausible for statements like "You ought to help other people if you can". You might think that the universe is devoid of value; that there is nothing that you ought to do. But such people almost always want to hang onto the claim that there are some things that you ought to believe. You ought to believe their nihilistic/scientistic worldview, for instance. Truth matters, even if people don't.

But I don't think such a position is tenable. The normativity surrounding belief is the very same normativity that surrounds action.

The best position in this area that I can foresee is something like: "truth is the proper aim of belief; you don't count as believing at all unless you are aiming to believe things that are true".

But, first, this is normative because it refers to the correct application of the concept "belief". Talking of correctness of concept application is to say that you ought to apply concepts in this way rather than that. This position lets in the normativity it tries to deny.

But, second, even if this problem is avoidable, the position still requires normativity in a second way. How is the nihilist going to justify the claim that you ought to believe anything at all? Not only might you withold belief in general, but you also might be a quasi-believer, where a quasi-believer is one who hold attitudes identical to beliefs in every respect except that they don't aim at truth. Even if the proper aim of belief is truth, we still need normativity to get to the claim that we ought to be believers and not quasi-believers.

Some actions are right. Some beliefs are right. You can't easily reject the former claim but accept the latter. That puts nihilism on very weak ground; there can be no reason to believe that it's true.

Criteria of Rightness vs Decision Procedure

Most moral philosophy concerns itself with providing criteria of rightness. "Right acts are those which...".

A second question is how people should deliberate in their lives so as to act well; a decision procedure. "People ought to reason using...".

This distinction all too often gets missed when discussing moral philosophy.

So one thing people sometimes say is that humans are all selfish, so that studying ethics can't be right. But this doesn't follow. Even if it were true - which it very obviously isn't - that people always acted selfishly, this wouldn't undermine the fact that some (many, or all) of their acts would be wrong, and that some would be right. We might be interested in that distinction even if no-one could live up to it.

Another objection is that free-will is an illusion, and that studying ethics is a waste of time (I'm assuming strong determinism here, not compatibilism). But again, this simply doesn't seem to follow. Some, none or all acts will be right and wrong even if there is no free will. Some determined acts will have been better than others. An objector might say that an action can't be right if it isn't performed freely (ought implies can?). But this is simply to grant my point! Such a claim is one about criteria of rightness, saying that any right act is one performed freely. It would be an interesting conclusion if no-one has ever acted rightly because there is no free will. But this is part of the study of ethics, and not a threat to it.

Finally, someone might think that I've seperated criteria of rightness too far from the correct decision procedure. Wasn't ethics the study of how to live? But whilst I say above that criteria of rightness and a decision procedure are two different things, there's still a pretty close link. That is, criteria of rightness, plus some empirically discoverable facts, determine the correct decision procedure. If right acts are those that maximise happiness, but we observe that people are bad at this when they try to do it directly, we can infer the correct decision procedure by working out which decision procedure does maximise happiness.

Criteria of rightness are not, but partly determines, the correct decision procedure.