CBHD: Grey Matters When Eloquence is Inarticulate by William P. Cheshire, Jr., M.D.

	Printer-Friendly Version Send Page To a Friend

	William P. Cheshire, Jr., MD, Consultant on Neuroethics, The Center for Bioethics & Human Dignity, Associate Professor of Neurology at the Mayo Clinic College of Medicine, and Consultant in Neurology at Mayo Clinic in Jacksonville, Florida.
	Post Date: January 26, 2007

The French have an expression – je ne sais quois – which refers to an indescribable attractive quality. There is, for example, in addition to the goal of attaining procedural competence, a certain something that draws people to such fields as bioethics. Some of the reasons for one’s fascination with a discipline find expression in rational terms, while others may lie just beyond the grasp of explicit language. Like the mood evoked by a faintly familiar melody of forgotten origin is the je ne sais quois underlying the inexpressible feature of one’s personal aspirations.

One intriguing aspect of bioethics is that novel technologies and the choices their applications present challenge us to reflect anew on what it means to be human. At this frontier of life decisions, which is at once bright with possibilities and dim with grey uncertainties, the faculty of reason is indispensable for the clarification of ideas. Reason distinguishes what is rational from imagination’s apparitions. Reason can be more or less unambiguously stated, its presuppositions defined, its arguments logically arranged, its conclusions tested analytically and confirmed against empirical data. Reason also demands consistency, coherence, and efficiency.¹ Reason is trustworthy, but is it complete? Are there truths essential for bioethics that lie beyond the competence of reason to define or explicit language to express?

This question lies at the heart of the current debate within bioethics over what forms of meaning should be admissible in public discourse in a world where people differ in their views and values. Ruth Macklin, writing in the Hastings Center Report, argues that the one true basis of bioethical discussion is reason. Appeals to metaphor, emotion, and moral intuition, according to Macklin, should be excluded because they are not understood in the same way by all people and thus ought not to have a role in the formulation of public policy.² On this point Macklin vigorously (an attitude that itself cannot be reduced to rationality) disputes Yuval Levin who, writing in The New Atlantis, also advocates for the use of explicit reasoned arguments. These writers disagree, however, on reason’s limits. Levin suggests that reason, while necessary, yet is insufficient to encompass the full meaning of human existence.³ There are, according to Levin, moral truths that are reasonable but not fully rational, that can be understood but not adequately articulated. These, he writes, “are the realms where many ethical limits express themselves not in syllogisms but in shudders.”³ Such insights glimpse a deeper wisdom that, if unheeded, could lead, he cautions, to “a culture without awe filled with people without souls.”³ Likewise, Leon Kass has written persuasively on the wisdom of repugnance.⁴ Meanwhile, Macklin insists that these are not arguments.

Neuropsychology has traditionally emphasized the role of “higher cognition,” referring to rational thought, in contrast to affective or emotional thoughts generally associated with intuition. This distinction roughly parallels the division in moral philosophy between consequentialist and deontologic ethical perspectives.⁵ Consequentialist perspectives emphasize rationally calculated outcomes aimed at maximizing the greater good, as contrasted with deontologic perspectives, which argue for respecting certain intuitively discerned moral obligations and not crossing certain moral boundaries. Although useful, the distinction blurs, however, where consequentialist ethicists such as Mill may seek to maximize an emotion (happiness), and deontologists such as Kant justify the universality of moral principles on the basis of reason.

It would be unreasonable, if not disappointing, to regard reason and emotionally-laden intuition as categorically independent. In the words of William James, “The universal conscious fact is not ‘feelings exist’ and ‘thoughts exist,’ but ‘I think’ and ‘I feel.’”⁶ More recent neuropsychological perspectives recognize emotion (affect) and intuition (quick gestalt judgments reached without conscious awareness of a process of thought) along with reason to be aspects of intelligence that correspond to brain processes that inform and drive decision-making.⁷ Furthermore, the appreciation that emotional valuations also involve neural information processing underlies the emerging field of affective computing.⁸

Current research is applying functional imaging techniques to chart the brain regions subserving moral judgments. Utilizing functional MRI, Joshua Greene and colleagues have identified specialized brain regions associated with abstract reasoning, including the dorsolateral prefrontal and parietal areas, which become active when the brain is considering impersonal, non-moral dilemmas. In contrast, the medial frontal gyrus, posterior cingulate gyrus, and superior temporal sulcus become active when the brain is presented with personal moral dilemmas that evoke emotion.⁹ These investigators theorize that the tensions between reason and emotionally-laden intuition are due to competing neural subsystems.⁵ Neuroscience continues to explore how the brain resolves ethical dilemmas where the pathways of reason and emotion converge in the dorsolateral prefrontal and anterior cingulate cortices. There exists within the brain what C. S. Lewis termed a liaison between “cerebral man and visceral man.”¹⁰

To divorce emotion from reason would be to oversimplify wisdom. Both are necessary, yet each is insufficient, for bioethics. Either reason or emotion, if pressed to the extreme and isolated from the other, can mislead and endanger. Solitary reason, unaware of the feelings and values discerned emotionally, overlooks the meaning of compassion. Cold logic offers no compelling reason to be concerned about the suffering of others. Affectively neutral, impersonal, calculatingly bland thought can be blind to empathy. Notably, brain lesions that damage the processing of the emotional content of speech impair understanding by rendering the person deaf to affective nuance.¹¹ Emotions are the brain’s method of assigning value and priority to experiences and their memories. Situations that arouse emotion immediately bring to mind knowledge related to emotions engendered by similar past experiences, which greatly aids decision-making in the face of uncertainty.¹² Moreover, there are reasons why we have emotions. There are things that ought to be loved or feared.

Reason not only informs the will; it is also instrumental to the will. As a cognitive tool, reason can be applied to good or evil purposes. By use of reason one articulates what the conscience knows to be right or wrong. By use of reason one also rationalizes moral transgressions.

Pure reason, though informative, yet is morally inert. If purged of emotional content, reason is impotent to motivate. Neurologist Donald Calne summarizes that “The essential difference between emotion and reason is that emotion leads to actions while reason leads to conclusions.”¹ As regards moral knowledge, the conscience may clarify what is right or wrong in a given situation without producing the desire to act in accordance with that knowledge.¹³ J. Budziszewski has proposed the term “paraconscience” to describe the desires and emotions that assist the conscience by arousing motivations consistent with its conclusions.¹⁴

Nor should we prefer to be guided by uninformed emotion. Unaided by reason, sentiment is unreliable. Rational principles are needed to distinguish valid moral intuition from prejudice, to hold introspectively discerned knowledge to a standard of consistency, and to outline clear moral boundaries. “Compassion is a virtue, not a principle,” writes Edmund Pellegrino. “Morally weighty as it is, compassion can become maleficent unless it is constrained by principle . . . Compassion, too, must be subject to moral analysis, must have its reasons, and those reasons must also be cogent.”¹⁵

Considering these things together, it must be concluded that there is no single cognitive domain that defines bioethics. It may be that efforts to perfect the discipline of bioethics, or for that matter to perfect human intelligence, by maximizing either sheer sentiment or absolute reason can only result in loss of mind.¹⁶ Soundness of mind entails both restraint and initiative, neither yielding habitually to the brain’s most fervent urges nor submitting automatically to control by computations or algorithms. Likewise, a free and flourishing society legislates neither according to those who cry out the loudest nor in obedience to those who calculate most efficiently. And so in bioethical discourse, as in the individual brain, affective intuition and abstract reasoning function best as collaborators. When faced with difficult moral dilemmas, we need all available resources and access to all valid ways of knowing the world and understanding ourselves. The parietal lobe cannot say to the cingulate gyrus, “I have no need of you.”¹⁷

A truly human bioethics thus welcomes poetic expression. A proper union of analysis and imagination would, in the words of poet David Yezzi, “achieve a balance between thought and emotion, such that every word, every sound and rhythm, is responsible for maintaining this mysterious union.”¹⁸ Encompassing both code and imagery, conveying both information and metaphor, the nuances of language open wide the possibilities of probing beyond existing knowledge to analyze, to analogize, to reflect, to edify, to warn, to encourage, and to inspire.

A truly human bioethics also acknowledges the finitude of human reason and the fallibility of human emotion. People of faith believe that intelligence finds its origin in the unfathomable mind of the Creator, whose thoughts immeasurably surpass our thoughts,¹⁹ and by whose words the universe came into being.²⁰ One hundred billion neurons in the human brain are inadequate to comprehend this great mystery. When contemplating the transcendent, the brain encounters impenetrable unutterables. In humble awareness of this, Jewish tradition rarely pronounces God’s ineffable Name, but refers to Him indirectly by way of evasive synonyms.²¹ All the powers of human reason are speechless in response to why this awesome God would send his only Son to dwell among us and to die for our sake.²² And though our human brain lacks language adequate to pray as we ought, the Scriptures teach that the Holy Spirit intercedes for those who are in Christ in groanings which cannot be uttered.²³

A perfectly rational bioethics sanitized of all emotional content and immune to intuitions might seem at first glance reasonable, but would it be wise? Though a bioethicist might write with angelic eloquence, yet dismiss the value of love and other emotions, the conclusions will sound clangingly mechanical.²⁴ “Men without chests,”¹⁰ in the haunting words of C. S. Lewis, would be eminently qualified to organize an exclusively cerebral bioethics. But reason is not the brain’s sole purpose. Intuition, compassion, and prayer, too, are cerebral processes. A fully cerebral, and hence fully human, bioethics must reason. It must also listen, feel, wonder, heed the conscience, remain humble, empathize, and serve others.

Granted, emotions are unpredictable and at times unsafe. Reason may seem more tame, but a fully human bioethics seems preferable to a tame bioethics.CBHD

1. Donald B. Calne. Within Reason: Rationality and Human Behavior. Pantheon, 1999, pp. 236, 286.

2. Ruth Macklin. "The new conservatives in bioethics: Who are they and what do they seek?" Hastings Center Report 2006;36(1):34-43.

3. Yuval Levin. "The paradox of conservative bioethics." The New Atlantis 2003(Spring);1:53-65.

4. Leon Kass. "The wisdom of repugnance." In, Leon R. Kass and James Q. Wilson (editors): The Ethics of Human Cloning. Washington, D.C.: AEI Press, 1998.

5. Joshua D. Greene, Leigh E. Nystrom, Andrew D. Engell, John M. Darley, and Jonathan D. Cohen. "The neural bases of cognitive conflict and control in moral judgment." Neuron 2004;44:389-400.

7. A. R. Damasio. Descartes’ Error: Emotion, Reason, and the Human Brain. New York: Putnam, 1994.

8. Rosalind W. Picard and Jonathan Klein. "Computers that recognize and respond to user emotion: theoretical and practical implications." Interacting with Computers 2002;14:141-169.

9. Joshua Greene and Jonathan Haidt." How (and where) does moral judgment work?" Trends in Cognitive Sciences 2002;6:517-523.

11. M. D. Pell. "Cerebral mechanisms for understanding emotional prosody in speech." Brain and Language 2006;96:221-234.

12. Raymond J. Dolan. "On the neurology of morals." Nature Neuroscience 1999;2:927-929.

14. J. Budziszewski. What We Can’t Not Know. Dallas, Texas: Spence, 2003, pp. 188-191.

15. Edmund D. Pellegrino. "Compassion Needs Reason Too." Journal of the American Medical Association 1993;270(7):874-875.

18. David Yezzi. "The unrealists’ return." The New Criterion April 2006; 24:24.