Thinking about medical procedures
Anti-vaxxers notwithstanding
I'm going for a colonoscopy tomorrow (It went well).
It's pretty cool - the doctor can actually inspect my large intestine from the inside and deal with a lot of problems right on the spot.
And this is being done because a routine test detected blood in my - um - stool.
The procedure is uncomfortable so I'll be sedated and a friend will accompany me home because I'll be basically drunk when I wake up.
The thing is that there are laxatives involved as prep - starting at 1pm today I'll be ‘chained to my toilet'
So - here's the thing - I feel no symptoms about this stuff. That's not really a surprise. Preventive medicine involves detecting medical problems at early stages when they are easy to fix as well as encouraging a healthy lifestyle. So here am I; about to undergo being chained to the toilet, then arriving at the hospital at 7am to be sedated and have a camera slid along my intestine.
Throughout this whole process I am depending on people I basically do not know. I'm lucky to have an insider as an adviser though :-) I don't feel symptoms - I trust them that symptoms are present I won't feel the procedure - I'll just trust that it's done And I'll just have to trust whatever the doctor says he found to be true.
Here's the philosophical issue with that - trusting like that - how can I trust like that? What's involved when we trust?
When I was a kid I used to climb trees and clamber through the treetops without touching the ground. Perhaps we can ground the idea of trust there - when we understand a situation well enough that we think it's safe to do something - that is trust
And that works well enough in the physical world that most mammals have that level of trust. People have taken that to a meta-level though - actually meta meta meta meta . . .
Not only do I trust a branch to be strong enough to bear my weight but I can trust my doctor who trusts the specialist who trusts the machine maker who trusts the scientist who invented the tech.
How can we justify doing that?
One response is that we have to trust that way - human existence would be impossible without it.
And the evolutionary idea is we literally evolved the mental capacity to trust each other as we evolved as humans.
And that evolutionary kind of trust has a structure that is common throughout humanity
We tend to trust families and friends more than strangers
And people we think are beautiful are trusted more than ugly ones
And authority figures tend to be trusted more than the powerless.
And that in itself involves many meta levels of trust.
When we trust a system like medicine (indeed any contemporary social institution) we are doing more than that instinctive level of trust. When I trust medicine I am trusting something that I've had a lot of benign experience with. Starting before I could understand anything enough to trust based on understanding medicine was what made me better when I was sick. At least that's the way it seemed. I'd feel bad. Mom would try stuff. Take me to the doctor. The doctor would advise and presently I'd be better again.
The problem in logic there is clear though; even when I was a kid. How did I know for sure that it was the doctor's advice? Maybe I'd have gotten better anyway. Maybe it was Mom's prayer.
Thus as a kid I faced a problem of underdetermination - the evidence I had wasn't really enough to sustain the conclusion I'd drawn. I grew and learned though and by the time I was an adult I understood the contemporary scientific narrative to be able to trust it.
Or, in Quinian terms I had accepted the scientific web of meaning that makes the world meaningful in scientific terms. But we know from Quine that any such web of meaning is underdetermined - there are many potential webs of meaning - and we are not really forced to adopt any one over any other. That choice is more a matter of culture and upbringing than rational choice.
know for a fact that there are other ways of looking at the world that don't involve the level of trust in medicine and science that I do.
I've debated with them for years; friendly extended discussions. These people are not stupid.
But for them science is a hopelessly circular intellectual endeavour that just cannot be trusted.
Which can be a very profound handicap and danger when parents deny medical care to children because they have become embedded in a non-scientific web of meaning.
One does notice that those who don't share the scientific web of meaning still use the fruits of science all the time - isn't this hypocrisy?
I don't think so. When somebody uses a computer or airplane or refrigerator they are using something that manifestly works - no theory involved.
The level of trust people put in an airplane is much like the level of trust a monkey places in a branch. The same could even be said for fixing a broken leg. But if your whole web of belief goes together to make you think that blood transfusions will do something horrible to your child would you trust a narrative that you've already rejected over your own?
I have noticed another aspect about trust in medicine. People don't trust medicine when it tells them to do things they don't want to do.
This is a huge tactical problem when doctors are dealing with smokers.
The doctor needs the smoker's trust in order to remain engaged and so leaning on unpleasant truths can be counter productive.
My own doctor was like that with me about pot smoking. She said that she figured I knew the situation clearly and had no need to bug me more about it. And her practice is involved in community health, and I know when I deal with her I'm engaged in a medical procedure. And I trust her
What do you think
I present regular philosophy discussions in a virtual reality called Second Life.
I set a topic and people come as avatars and sit around a virtual table to discuss it.
Each week I write a short essay to set the topic.
I show a selection of them here.