Abstract
There is no medical situation that could escape risk taking; however the main characteristic of psychiatry is that the risk of a treatment or of a release from hospital -after involuntary commitment- is not only taken for the patient (as in other medical sectors); it is also taken with a view to the close contacts of the patient and the other people he will be able to interact with. We advocate for a medicine that may enjoy room to manoeuvre in order for the doctor -particularly the psychiatrist- to make the best decisions for the patient; but it is evident that a decision taking must not be an adventure. What is a rational decision? We will mark our Bayesian preferences.
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Notes
- 1.
Pensées, 98: «How is it that a lame man does not annoy us while a lame mind does? Because a lame man recognizes that we are walking straight, while a lame mind says that it is we who are limping. But for that we should feel sorry rather than angry» ([19], p. 25).
- 2.
The two concepts of person and personality are differentiated in Kant’s works in the following manner: ‘A person is a subject whose actions can be imputed to him. Moral personality is therefore nothing other than the freedom of a rational being under moral laws.’ ([10], p. 378). From this it follows that ‘a person is subject to no other laws than those he gives to himself (either alone or at least along with others)’.
- 3.
We tried to demonstrate its weaknesses in our first volume: see Rethinking Medical Ethics, Ibidem-Verlag, Stuttgart, 2018, pp. 35–61.
- 4.
Rousseau’s declaration was made in another context , that of The Social Contract.
- 5.
- 6.
In his Reflection of the general part of the Principle s of Descartes [13], Leibniz remarks on Article 2, which poses as a criterion for a good rational method that ‘qu’il est utile de considérer comme fausses toutes les choses dont on peut douter’ < it will be useful to consider as false what is doubtful>: ‘Je ne vois pas à quoi sert de tenir les choses douteuses pour fausses. Ce ne serait pas là se dégager des préjugés, mais en changer. Que. si l’on ne veut y voir que fiction, il ne fallait pas en abuser’ ([12], p. 288). <I do not see of what use it is to consider doubtful things as false. This would not be to cast aside prejudices, but to change them. But if fiction is so understood, it must not be abused> [11]. In other words, there is an ethics of fiction and it should not be introduced haphazardly.
- 7.
The second maxim of the Third part of Discourse on Method which defines ‘quelques règles de la morale tirées de la méthode’ is ‘d’être le plus ferme et le plus résolu en mes actions que je pourrais et de ne suivre pas moins constamment les opinions les plus douteuses, lorsque je m’y serais une fois déterminé, que si elles eussent été très assurées’ < to be as firm and resolute in my actions as I was able and not to adhere less steadfastly to the most doubtful opinions, when once adopted than if they had been highly certain> [6].
- 8.
‘Entre plusieurs opinions également reçues, je ne choisissais que les plus modérées, tant à cause que ce sont toujours les plus commodes pour la pratique, et vraisemblablement les meilleurs, tous excès ayant coutume d’être mauvais; comme aussi afin de me détourner moins du vrai chemin, en cas que je faillisse, que si, ayant choisi l’un des extrêmes, c’eût été l’autre qu’il eût fallu suivre’ < Amid many opinions held in equal repute, I chose always the most moderate, as much for the reason that they are always the most convenient for practice, and probably the best (for all excess is generally vicious), as that, in the event of my falling in error, I might be at less distance from the truth than if, having chosen one of the extremes, it should turn out to be the other which I ought to have adopted> (idem). Which is what is recommended by Rawls in the principle of the maximin.
- 9.
Bentham had already seen in what chain of events that principle crushed us: ‘In proportion as the rule is safe, secure against being productive of erroneous decision, it is in the same proportion useless. Safe, it is not effective; effective, it is not safe’ ([2], 226).
- 10.
‘The prevention of suicide. – There is a certain right by which we may deprive a man of life, but none by which 29 we may deprive him of death; it is a mere cruelty. […] Old age and death. – Apart from the commands of religion, the question may well be asked, Why is it more worthy for an old man who feels his power decline, to await his slow exhaustion and extinction than with full consciousness to set a limit to his life?’ ([15], §§ 88, 80). A few years later, in [17], § 36 of ‘Skirmishes of an Untimely Man’, Nietzsche wrote, in a statement that was at the limit of the unacceptable transgression, in ‘Morality for physicians’: ‘(…) In a certain state it is indecent to live longer. To go on vegetating in cowardly dependence on physicians and machinations, after the meaning of life, the right to life, has been lost, that ought to prompt a profound contempt in society. The physicians, in turn, would have to be the mediators of this contempt – not prescriptions, but every day a new dose of nausea with their patients. To create a new responsibility, that of the physician, for all cases in which the highest interest of life, of ascending life, demands the most inconsiderate pushing down and aside of degenerating life – for example (…) for the right to live. To die proudly when it is no longer possible to live proudly (…)’ ([16], p. 151). http://www.inp.uw.edu.pl/mdsie/Political_Thought /twilight-of-the-idols-friedriech-nietzsche.pdf.
- 11.
Indeed, in his address Celeberrimae Matheseos Academiae Parisiensi (1654), Pascal indicates that in order to participate in games, ‘il faut chercher [à résoudre le problème] d’autant plus rigoureusement par la raison que les possibilités sont moindres d’être renseigné par l’expérience. En effet, les résultats ambigus du sort sont à juste titre attribués plutôt au hasard de la contingence qu’à une nécessité de nature’ ([18], p. 1034–1035). This text is quoted more extensively at the end of this book.
- 12.
Starting with Gabriel Marcel , the founder of ‘personalism’ himself, who understood it in a more specific meaning than that which we have given it up to now.
- 13.
The promotion of the maxim of his action to the status of law does not imply any calculation nor the taking into account of the degrees of probability.
- 14.
In a letter to E. Acollas of 20th September 1871, Mill recalls that the principle of his On Liberty is that of the ‘autonomy of the individual’. Indeed, the fifteen pages of Chapter III of On Liberty are about ‘Individuality, as One of the Elements of Well-Being’, and the last five pages of the conclusion are about freedom as individuality. ‘Je reconnais’, he says in French, ‘cette autonomie comme une règle rigoureuse dans les choses qui ne regardent que l’individu lui-même ou, si elles intéressent les autres, qui ne les intéressent que par l’influence de l’exemple ou par l’intérêt direct que d’autres peuvent avoir au bonheur et à la prospérité de chacun. Par cette doctrine, j’affranchis de tout contrôle, hors celui de la critique, le cercle de la vie individuelle proprement dire’ ([14], pp. 1831–1832). Those sentences could never have written by Kant for whom a person gives the individual duties and does not free him from any control without failure. In another letter, from the same time, of 20th January 1871, addressed to the New York Liberal Club, Mill supports the value of the individuality of thought and character, combining it with the possibility that it be criticized, ‘There cannot be a higher or more important air than of assertion & maintaining individuality of thought & character, together with its necessary complement, the fullest latitude of mutual criticism’ (ibid., pp. 1801–1802).
- 15.
What exists of what is called a person, which properly carves the being and maybe gives it some sort of eternity, is the ‘fact’ that it has been, since even when it is no more, the event that it has been is impossible to take away from it, without it being quite possible to know from whom it is impossible to take it away. Some resistance, some necessity, some hardness thus happens through that frailty and that having been does not only work upon those who, as the saying goes, remember the dead, but – even though there were nobody to remember them – upon existence itself which it structures and to which it gives specific duties. (See [4]). Our first volume, published last year, addressed this point: see Rethinking Medical Ethics, ([5], pp. 35–61; pp. 139–160).
- 16.
See Bentham J.: ‘Of an action that is conformable to the principle of utility, one may always say either that it is one that ought to be done, or at least that it is not one that ought to be done. One may say also, that it is right it should be done; at least that it is not wrong it should be done: that it is a right action; at least that it is not a wrong action. When thus interpreted, the words ought, and right and wrong , and others of that stamp, have a meaning: the otherwise, they have none.’ ([1], p. 2, §X).
- 17.
At the same time, it could be possible to show, as Harsanyi has done, that Rawls’ principle of maximin is but a particular case of the Bayesian approach to ethical problems that one should have. From time to time, the Rawlsian approach is in harmony with the Bayesian. The latter can explain why it is so, but the reverse is not possible. When the rule of the maximin is followed in isolation , it is ‘a highly irrational decision making rule’. see Harsanyi, ([8], p. 47).
- 18.
This first assessment , which is being roughly sketched without refinement, requires further elaboration and lacks proper nuance, which might be supplied by further reflection on, for instance, the idea of merit, which lies at the heart of educational values, and involves extremely complicated and contradictory relations with the concept of person, which most often does nothing more than muddling it.
- 19.
Plato, Epinomis, 977c: ‘if we should deprive human nature of number we should never attain to any understanding. […] and the creature that did not know two and three, or odd or even, and was completely ignorant of number, could never clearly tell of things about which it had acquired sensations and memories’ ([20], p. 439).
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Cléro, JP. (2021). Ethics of Risk Taking in Psychiatry the Game of Risk and Probability. In: Reflections on Medical Ethics. Philosophy and Medicine, vol 138. Springer, Cham. https://doi.org/10.1007/978-3-030-65233-3_2
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