Abstract
This essay considers implications of formal mereologies and ontologies for medical metaphysics. Edward Fried’s extensional mereological account of the human body is taken as representative of a prominent strand in analytic metaphysics that has close affinities with medical positivism. I show why such accounts fail. First, I consider how Fried attempts to make sense of the medical case of Barney Clark, the first recipient of an artificial heart, and show that his analytic metaphysical categories do not have the right kind of fit with the case. A proper medical metaphysic should involve a richer two way dialogue with medicine, and it should not just “apply” formal accounts worked out in other settings. Second, I argue that any effort to account for real wholes with extensional mereological sums requires all sorts of ad hoc, supplementary mechanisms that do the real work, and the full repertoire of these mechanisms involves inconsistencies and semantic shifts. Finally, I consider an alternative strand of work on non-extensional whole/part relations that is closer to medicine and that can deepen reflection on some core problems in bioethics, for example, associated with the determination of death when an organism ceases to function as a whole. In addition to the utility such formal ontologies have for addressing traditional problems such as the determination of death, philosophers of medicine should appreciate the increasingly influential role such formal tools are playing in the development of data system ontologies. Assumptions integral to these ontologies have far reaching implications for the way future research and practice in medicine will be conducted, and much greater critical reflection is needed on the full range of issues associated with the development and use of such medical ontologies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
A more careful consideration of the kinds of ontological dependence might have helped clarify concepts used in the casuistry of treatment withdrawals. In Sulmasy [9] and Paul Mueller et al. [12], a distinction is drawn between replacement and substitution therapies, and the legitimacy of withdrawal/deactivation depends, among other things, on the burdens associated with the device and its support systems. This analysis assumes that the technology can be isolated as something that is discrete and separable from that which makes a patient a whole. If this were not possible, withdrawal/deactivation would involve something analogous to the kind of dismemberment that would occur if one of the interdependent organs of a person were excised or deactivated. Sulmasy [9] suggests that if there were a replacement technology that was seamlessly integrated, this would thus alter the casuistry. In that case, deactivation might require the introduction of a new pathology and might imply killing. Sulmasy’s analysis makes clear that the issue is not a one-way versus two-way dependence, but rather the dependence of all other parts of the body upon an implant that is transparent in its proper functioning. What makes an implant a replacement is the absence of any dependence of that implant upon external props. Even if one accepts Fried’s claim that an implant, like an artificial hip or heart, might not be ontologically dependent in the same way as other body parts are upon one another, there is still a kind of functional dependence, since no implant could function as a joint or pump without the rest of the body. If one takes the implant qua joint or implant qua heart, then it is just as dependent on the whole as any other body part.
Here, I roughly follow Simons’s account in [10]. This work elegantly condenses, summarizes, and systematically organizes the many contributions in mereology. Simons notes that many other primitives could be used as alternatives to part or proper part, but Leśniewski’s preference was for the latter [10, pp. 70–74]. Czeslaw Lejewski notes that Leśniewski was a strong critic of pure formalism, and he “insisted that only true propositions should be allowed as axioms of a deductive theory and that only those rules of transformation should be admitted which embodied intuitively valid rules of inference” [15, pp. 123–124]. For Goodman, however, worlds are made rather than found, and there are multiple ways of constructing category schemes that enable us to determine identity and individuation [16]. If overlap allows the transitivity of the proper part relation to arise as a theorem rather than as an axiom, then that parsimony might be sufficient to select overlap rather than part as the primitive [17]. The image of a philosopher who goes in the closet to develop a formal system that is then “applied” to the world thus fits Goodman far better than Leśniewski. On this, I follow Wimsatt’s criticism of Goodman [11, pp. 160, 180–181].
This citation is from [24, p. 132]. There Simons makes much of the intensional character of this formulation, and the above-mentioned expression is distinguished from the like-sounding “s, which is an α is founded on t, which is a β.” Simons then step by step introduces refinements of his initial modal expressions. These ideas are further developed in [10, pt. III]. In Husserl’s and Simons’s formulations, the parts are discussed in relation to one another, and Husserl’s independent/dependent relation between parts does most of the work. In what follows, I try to bring together this Husserlian approach with Wiggin’s sortal concepts [18]. When I speak of P as a Φ and assume a formal, modally qualified continuant relation of α, β in Φ, I am thus departing from Husserl and Simons and moving closer to Wiggins. Simons already draws on Wiggins when he clarifies Husserl’s concepts by using a necessity operator on predicates/property abstracts (called “nec”) in addition to the traditional necessity operator used on propositions (see [24, p. 118] and also notes 16 and 19 in [24, p. 156]). Wiggins normally gives priority to the concepts of the whole, specifically the role of a sortal category of such a whole in determining identity conditions of continuants. For both Wiggins and Simons, if P is a Φ, then it is necessarily one. This is central to the way Wiggins interprets sortal concepts and it follows automatically from a necessitation rule that is included in most current modal systems. (Simons uses a quantified version of S5 given in [10, pp. 287–289].) The necessitation rule says that if anything is the case, then it is necessarily the case. In the summary I give, I sweep over many of Simons’s finer distinctions and provide a variant that is weaker than that given by Wiggins. I also fuse Simons’s Husserlian approach with that of Wiggins, who uses the sortal category of the whole to preserve the intensional character of the founding/founded relations when species are considered in relation to their instances. In a more complete discussion, all of this would need to be carefully worked out. At present, I am unclear about whether the required clarification is possible without a much richer account of the instantiation relations between the formal types and their instances. I am not even sure if the clarification can be accomplished with the logical resources utilized by Simons. Despite these reservations, I think Wiggins, Simons, and Smith are clearly bringing us in the right direction.
References
Fried, Edward. 2013. Prolegomena to any future mereology of the body. Theoretical Medicine and Bioethics. doi:10.1007/s11017-013-9263-3.
Kant, Immanuel. 1788 [1956]. Critique of practical reason. Trans. Lewis White Beck. Indianapolis, IN: The Bobbs-Merrill Company, Inc.
Faden, Ruth, and Tom Beauchamp. 1986. A history and theory of informed consent. New York: Oxford University Press.
Beauchamp, Tom, and James Childress. 2001. Principles of biomedical ethics. 5th ed. New York: Oxford University Press.
Annas, George. 1993. Standard of care. New York: Oxford University Press.
Jonsen, Albert. 1998. The birth of bioethics. New York: Oxford University Press.
US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1978. The Belmont report: ethical principles and guidelines for the protection of human subjects of biomedical and behavioral research. DHEW Publications. Washington, DC: Department of Health, Education, and Welfare.
Emanuel, Ezekiel, Christine Grady, Robert Crouch, Reider Lie, Franklin Miller, and David Wendler. 2011. The Oxford textbook of clinical research ethics. New York: Oxford University Press.
Sulmasy, Daniel P. 2007. Within you/without you: Biotechnology, ontology and ethics. Journal of General Internal Medicine 23(Suppl. 1): 69–72.
Simons, Peter. 1987. Parts: A study in ontology. Oxford: Clarendon Press.
Wimsatt, William. 2007. Re-engineering philosophy for limited beings: Piecewise approximations to reality. Cambridge: Harvard University Press.
Mueller, Paul S., Keith M. Swetz, Monica R. Freeman, et al. 2010. Ethical analysis of withdrawing ventricular assist device support. Mayo Clinic Proceedings 85(9): 791–797.
Tauber, Alfred. 1994. The immune self: theory or metaphor? Cambridge: Cambridge University Press.
Watson, James, Michael Gilman, Jan Witkowski, and Mark Zoller. 1992. Recombinant DNA. 2nd ed. New York: Scientific American Books.
Lejewski, Czeslaw. 1984. On Leśniewski’s ontology. In Leśniewski’s systems, ed. J.T.J. Srzednicki, and V.F. Rickey. Wroclaw: Martinus Nijhoff Publishers.
Goodman, Nelson. 1966. The structure of appearance. 2nd ed. Indianapolis: Bobbs-Merill.
Goodman, Nelson, and W.V. Quine. 1947. Steps toward a constructive nominalism. Journal of Symbolic Logic 12: 105–122.
Wiggins, David. 2001. Sameness and substance renewed. Cambridge: Cambridge University Press.
Chisholm, R.M. 1976. Person and object: A metaphysical study. London: Allen & Unwin.
Degen, Wolfgang, Barbara Heller, Heinrich Herre, and Barry Smith. 2001. GOL: Toward an axiomatized upper-level ontology. In FOIS ’01 Proceedings of the international conference on formal ontology in information systems, ed. Barry Smith and Christopher Welty, 34–46. New York: Association for Computing Machinery.
Smith, Barry, ed. 1982. Parts and moments: Studies in logic and formal ontology. Munich: Philosophia Verlag.
Smith, Barry, and Achille Varzi. 1999. The niche. Nous 33: 214–238.
Husserl, Edmund. 2001. Logical investigations. Vols. 1 and 2. Trans. J.N. Findlay and ed. Dermot Moran. London: Routledge Taylor & Francis Group.
Simons, Peter. 1982. Three essays in formal ontology. In Parts and moments: Studies in logic and formal ontology, ed. Barry Smith, 111–260. Munich: Philosophia Verlag.
Shewmon, D.A. 2001. The brain and somatic integration: Insights into the standard biological rationale for equating “brain death” with death. Journal of Medicine and Philosophy 26: 457–478.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khushf, G. Beware of mereologists bearing gifts: prolegomena to a medical metaphysics. Theor Med Bioeth 34, 385–408 (2013). https://doi.org/10.1007/s11017-013-9269-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11017-013-9269-x