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Psychiatric EngagementThe Virtues of FreedomThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled 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Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy Does Inequality Matter?Why Honor MattersWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Although this book is published in
a series entitled 'Philosophical Studies in Contemporary Culture' (edited by H.
Tristram Engelhardt, Jr.), the bulk of its content concerns the way in which
the virtue of temperance was theorized by Aristotle and Thomas Aquinas and the
way in which the ideas of Sir William Osler (1849--1919) and his doctrine of aequanimitas
represents a modern articulation of this virtue in the context of medical
practice. Just how this relates to 'contemporary culture' is not immediately
clear. The thesis of the book is that clinicians are in need of the virtue of
temperance (or of aequanimitas) so that their judgments and decisions
might not be overly influenced by inappropriate emotion.
Mark Carr, who teaches in the
Faculty of Religion at Loma Linda University in California, draws a scenario in
which a medical team needs to make a decision whether to place a dying patient
on dialysis for his failing kidneys. The medical indications are that such
treatment would be futile. However, the team observes the patient's young son
in tears by the bedside. The lead physician says, "Now if that doesn't
make a difference in the way we think of that man's treatment, nothing will!"
It is to explore just what difference it should or could make that Carr then
embarks upon his exploration of the virtue of temperance. He returns to his
scenario at the end of the volume in order to deliver his judgment.
This situating of the problem
places stress on the way in which temperance might be considered a mode of
management of our emotions. Whereas the common conceptions surrounding this
virtue concerns the management of our desires, Carr brings a considerable body
of scholarship and a sophisticated philosophical psychology drawn from Thomas
Aquinas to bear on the question of what the role of temperance is and of what
the emotions are and how they are to be managed. Temperance is not so much a
matter of restraining or suppressing the passions as of giving them careful
direction and guidance. Given that the emotions are importantly cognitive as
well as being affects, temperance becomes in part an intellectual virtue.
Carr explores the concept of
temperance with reference to its origins in classical Greek philosophy, when it
was variously thought of as a balance between parts of the soul (Plato),
moderation in one's desires and inclinations (Aristotle), or more narrowly as a
suppression of unruly affects (the early Stoics). Carr does a lot of work
analyzing both primary and secondary texts in relation to temperance before
turning towards modern cognitive conceptions of emotion. These in turn are
compared to the rather arcane philosophical psychology of Aquinas in order to
demonstrate that 'the virtue of temperance helps us act and feel in a morally
appropriate manner' (96). This supports the claim that the importance of
temperance is to enable sound judgment on the part of practical reason. Such
sound judgment is appropriately affected by relevant and appropriate emotion.
Carr's discussion of the work of
Sir William Osler on the notion of aequanimitas seeks to show that Osler
was not espousing a cold and dispassionate approach to patients but rather a
form a temperance moderating the concern and empathy that clinicians would
appropriately feel towards those in their care. Carr goes on to applaud the
care ethic in contemporary clinical thought but calls for a balance between
such emotion and intellectual and cognitive elements in decision making. Just
how this balance is to be struck is not theorized in general terms. This is the
particularist task given to the virtue of temperance. And so the conclusion is
that the emotions and such 'affiliative virtues' as caring are appropriate in
clinical practice, along with scientific clinical reason, provided they are
moderated by the virtue of temperance so as to yield 'care-ful, rational, moral
We should evaluate this book with
reference to its intended audience, which the cover tells us is: 'upper-level
undergraduate and graduate-level students interested in ethics, bioethics, moral
psychology, Oslerians, and students of Aristotle and Aquinas' view of the moral
virtues.' It certainly would not be of interest to clinicians or others working
in the health and helping professions. It is much too scholarly a book for
that. I wouldn't recommend it to undergraduate students either. But would even
scholars enjoy it or profit from it? The problem that I find with the book is
that one seldom hears Carr's own voice. He constantly makes his points by
quoting other authors. It is as if we have his literature review but not his
own theses. Certainly he tells us what he wants to argue for but instead of
argument we get a fragmented series of citations with all too brief commentary.
While Carr's scholarship is impressive one wishes that he would leave it behind
and simply tell us what he himself thinks.
Perhaps more important than this
annoying stylistic point, the conclusion seems to give us too little guidance.
That there should be a balance between emotion and reason is a platitude,
albeit one that has been won with painstaking care. While texts in virtue
ethics cannot consistently offer ethical principles, they should give us more
than one example on which to test our intuitions and on which to develop a
sense of the kind of balance that the virtue of temperance requires. There
should have been many more case studies than just that of the dialysis patient
so that the reader could develop a feel for the kind of judgment a clinician
with the virtue of temperance is likely to make. Only this would guide us as to
the kind of judgment clinicians should make.
© 2003 Stan van Hooft
Stan van Hooft
teaches philosophy at Deakin University in Australia. He is the author of Caring: An Essay in the Philosophy of
Ethics, Niwot CO, University Press of Colorado, (1995), and numerous journal
articles on ethics, philosophical psychology, and applied philosophy. He can be
contacted at firstname.lastname@example.org
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