SPEAKER 1: Ladies and gentlemen, this is going to be too loud. And I can see it was loud back there. It's a pleasure to be with you all. When I signed the consent form, I was very clear to say that I won't have the questions and answers recorded. So if people want to ask questions, we can all sue them if they don't stop recording. And since it's a small group, I will venture to make his life even more difficult by saying that if you have any questions as we go along, don't have to hold them to the end. I'm not a shy person, and I will be able to pick up where we left off. What I'm going to do today is do what a philosopher ought to do, just tell you about the obvious. The focus of the presentation is about how little we agree about. A remarkable element of our culture is that, as Alastair McIntyre has remarked, it is characterized, and he gave two characteristics, I'm going to add a third, one by incessant moral disagreement. People engage in moral language primarily to disagree with each other. Secondly, there does not appear to be any philosophical basis, a basis through sound, rational argument of resolving the disagreements. So, one, we're in disagreement. There appears no way, by sound rational argument, of discovering a way out. And lastly, people go around talking about us having a consensus in the face of such disagreements. It's a very peculiar cultural context. And what I'm going to do today is lay out the obvious. That is, the geography of our disagreement. Now, to make things easier, I've given you a handout. English is not my first language, as probably you could hear. And it isn't really, I guess, my second language, the English I speak being Texan. So if you have questions, you shouldn't suffer under a concern about what I'm about-- what I'm saying. Raise your hand, and we'll have this man be vexed by deciding how he's going to excerpt those parts. I'll remind him, I come from a dysfunctional family. My brother's a lawyer, and my sister-in-law is a lawyer. So pick up the first, and you'll see that the presentation tells you I'm going to offer the geography of moral and metaphysical disagreement. And to point out, we really don't agree with each other. And the second paragraph reminds you that we, and you in America and I in Texas, we don't have one moral community. People often talk in that fashion, but individuals find themselves in diverse moral communities that are spanned by a society. And within that society, they struggle to see who is going to get ideological control over that society. And that's what fuels the culture wars. So what I'm going to be doing is, in a sense, giving you an account of what moves us in the cultural wars. That is, the great disagreements we have to remind ourselves that often we try to hide from that by saying we're a moral community. Well, America is not a moral community. It's a bunch of very contentiously engaged communities. And I'm going to try to lay out the differences between them with regard to bioethics. So if you look on the first page, I tell you the things that I promise to do. So if you nod off and go to sleep, and if I've kept my word, you'll see what the paper is about. The first thing I'm going to do is try to give an account of the moral geography in which bioethics finds itself. The whole field of bioethics is a concatenation of various battles in the culture war. So I'm going to lay out that diversity. The second thing I'm going to do is to show how bioethics came about. Now, part of doing that is to explain that bioethics developed in the 1970s to meet a very particular cultural need. And then thirdly, I'm going to show why it didn't actually do what it promised to do, that it came into existence because of the culture wars, promised people a way out of the culture wars. Turned out it could not deliver on what it promised. And the last part of the presentation will say, well, what do we do now? So looking at Roman numeral I, moral pluralism and its intractability, I start off by reminding us what a morality is. A morality is a generally coherent set of central judgments about what it is to act rightly, about how to pursue the good, and about what it means to be virtuous as well as of a good character. We disagree about those issues. Look at the Arabic too. I asked the question rhetorically, do we really face a plurality of moralities, because most people don't like facing that. And the answer is, sure, we do. The polarized political discussions in America, in part, reflect the viewpoints of different communities, often characterized as the cultural moral conflicts between communities in the blue and red states. Anybody who didn't think that, wanted to admit that we have no consensus on basic moral issues, hasn't been, honestly, reading the daily newspapers about how the candidates look at each other, decry each other's positions. The idea that we are in agreement about morality or moral issues is obviously a false. I point out these conflicts constitute the culture wars, referencing the book The Culture Wars by James Davison Hunter and by foundational disagreements about the moral probity of abortion, homosexual acts, social welfare states, capital punishment, physician-assisted suicide. Just to pick up a few points where you probably disagree with other people in American society. Moralities are different when they support discordant views about the cardinal elements of human life, such as when it is obligatory, permitted or forbidden to take human life, have sex, and redistribute property. Characterizing the secular societies of the West, for example, as a great Satan, is another example of real cultural disagreement. We disagree about the cardinal passages of life. TS Eliot in Sweeney Agonistes says birth, copulation, and death, those are all the facts when you get down to brass tacks, and we disagree about the significance of them. I teach a course or a number of graduate courses in Texas, and have the great joy of having a young woman who's a Texas lawyer. And so I always call on her for her moral intuitions, such as, if you're sitting in your backyard and the sun has set and you're reading your textbook on peace studies with your 357 Magnum in your lap, and someone crawls over the back fence, what are you doing? She answers, shoot the person, finish reading the text, then call the police and have the remains taken away. If you agree or disagree with her, you'll probably know that some people who don't agree and will have a different position. That's what it is to be separated within different moral frameworks and have different views about when it is listed obligatory or permitted to kill someone, have sex with someone, or redistribute property. So we are separated, going down now to Roman numeral I-III, by different moralities. Because within divergent moralities, we order key human goods in different fashions. Imagine, rather than having asked who was the vice president of your country or who was the first vice president of my country, I'd ask which is the best country in the world in terms of realizing the goods that one would want in a society? You might decide that you would just look at four cardinal values, liberty, equality, prosperity, and security. But you couldn't calculate, if that was the way you were going to compare countries, until you knew how to rank liberty, equality, prosperity, and security. If you put liberty and equality very high, you end up something like, maybe Minnesota. If you put security first, then prosperity, don't worry much about equality and liberty, you have Singapore. And what you take to be the thin theory of the good that people should affirm will lead to quite different moral visions. Any attempt, for example, to ask what a rational person would choose requires the rational person already to have a moral sense. But the question is, which moral sense? If they have a Singaporean moral sense, they will affirm an ordering quite different from a Texan moral sense, where freedom was going to be up there real high. It's not going to be a Rawlsian sense of liberty. So there are going to be differences, though, even if we agree about the very same values and simply order them in a different fashion. So at the bottom of page 1, which you've made through now, a fourth of the presentation, what I've been doing is to point out why the morality we live in are really divergent. We don't share often moralities with others. And so it should come as absolutely no, a no-point of amazement, we don't have one bioethics. So looking up at the top, do we face a plurality of bioethics? Answer, sure. Bioethics presuppose a particular morality. If you're going to have an applied ethics, you've got to have which ethics to apply. And if you go across the world, you'll find all kinds of different views of bioethics. The Hong Kong Medical Association would think it's absolutely horrible for a physician to ask a patient a consent for [AUDIO OUT] treatment. They know that any decent physician will ask a family member. It's bad enough to be sick, without making choices about how you're going to be treated. The respect of patients is to respect them as members of families. And try your best, never, ever, to get a consent from an individual patient, looking at us as a society that's fallen into decrepitude with the collapse of families and no idea how to respect a patient. So if you go across the world, you will see quite different bioethics, given different rankings of cardinal values and different understandings of what right- and wrong-making principles should actually govern. Now, if you look on the top of page 2B, I explain to you why, in fact, the pluralism won't go away. It shouldn't come as any shock that we can't resolve the controversies. Clement of Alexandria and his stromata, taken on the philosophers, pointed out that reason you can't get any conclusion amongst philosophers is philosophers don't agree about basic axioms. And you can't prove the axioms without begging the question. Well, that point was reiterated by a man by the name of Agrippa. I'm sure you all have all read there's a wonderful history of philosophy written about the mid-third century by Diogenes Laertius, called The Lives of Eminent Philosophers. And amongst them, he lists Agrippa. Agrippa points out the [NON-ENGLISH], five reasons why you shouldn't think a philosopher will ever resolve a foundational dispute through sound, rational argument. One, they've been engaged in it for 800 years and haven't been able to do it. That's number one. Number two, it's a contextualist argument. Everyone argues from their own context and therefore past each other. Three, to actually resolve the controversy, we're back to Clement of Alexandria, you either beg the question or you circle and have an infinite regress. So not only do you have intractable, secular moral pluralism, that moral pluralism is not solvable through sound, rational argument, all the protests to the contrary notwithstanding. So we start off, now you have the top of page 2, with not only knowing that, one, we have moral pluralism, but, two, it's not going to go away. If you thought a philosopher is going to argue your way out of it, you haven't spent time in philosophy departments. If you have three philosophers working on moral theory, you probably have six substantial views about moral theory. We're now looking at C, to remind you that we have the culture wars, as we see them right now in the United States and Western Europe, are the result of a number of fragmentations of the dominant culture, where you get a little bit of a history lesson pointing out that after the Reformation split Europe, then there were the two large bloody wars, the Thirty Years' War from 1618 to 1648 and the Civil War, not the late unpleasantness, from 1642 to 1649. And after that, the Enlightenment comes in as an attempt to resolve controversies amongst people. The hope was that philosophical reflection would be able to discover our way out. Now that was a plausible way to proceed, given the history of Western Christianity. And that Western Christianity, in a sense, was created by a marriage between philosophy and theology in the beginning of the second millennium. So to get that across, I will now ask you to imagine being in a bar, drunk as skunks, and the deputy sheriff coming in. And it is, for the purpose of this illustration, 1275, one year after the death of Thomas Aquinas. And I come in as the deputy sheriff. Amongst the sins of my youth, of which I will speak, I was a deputy sheriff. And I tell you all, hush up. And you say, well, what authority do you have to tell us to hush up? So while you're stereotyping me, you presume I'm just an uneducated peace officer. I actually studied in Paris under Thomas Aquinas, who died going to the second council of Lyon, a most unpleasant memory. And he taught me, and I know that I have authority for two reasons. One, pick up your Bible, Romans 13:4, that the representatives of the state don't carry the gladium in vain. So I swing around my sword a little bit. And secondly, in his commentaries on Aristotle's politics, he explained that a [NON-ENGLISH] reason needs a [NON-ENGLISH], right way of acting. You have to have a Commonwealth. So I give an argument based both in Revelation and in reason, which was this hope that created Western Christianity. And you all hush up. Now, imagine you're in the same bar, and it is now 1690. What happened in 1688? Great and glorious bloodless revolution in England. 1689 is the Bill of Rights. In come William and Mary, and Enlightenment begins to move. And I tell you all, hush up. And you say, by what authority? Well, the last thing I'm going to do is mention the Bible. Just after the Civil War, we'll have all the Anglicans against the Presbyterians, the Presbyterians against the Anglicans, and both of them against the Roman Catholics, Jews and everybody else. It will be a riot. So I'm not going to mention at all the Bible. But I'm going to try to say, well, gee, you stereotyped me again. I went to Oxford. I studied philosophy with John Locke. He couldn't make any money in philosophy. He went into medicine. I went into peace work. Now let's go through Locke's Second Treatise on Government. So the idea would be you'd be able to reason your way to an authority that would bind us together. Well, it turns out there's not one sense of secular reasoning. And that little paragraph shows that what happens is you end up with a gulf first between what had been the dominant Western Christian culture and the new Enlightenment culture. But the Enlightenment culture itself fragments, leaving us now in 2008 with a very clear set of camps with considerable historical roots at the foundations of our culture wars. Now, looking at D, I point out that, again, reminding us that despite all of this, people come up with passion, declarations of consensus, lists of human rights that include vacations as basic human rights. And the question is, how could people so sensibly believe in all of this? And there are two reasons, or maybe three. One is it is much more powerful rhetorically if I tell you, this is what all rational people will hold. You're not holding this, therefore you're not a rational person. Which would have worked if philosophers could have cashed in the argument that they can make a unique sound, rational argument to defend one moral view. That would have been the outcome. And of course, philosophers would be the most powerful people in the world. Because let's say, if you took a Kantian view or any view of that sort, where morality and rationality were the same, then we philosophers would tell you, what's rationality? You ask, where the authority of the state comes? Well, from reason. And when the state gives you a good attitude adjustment, you're not having anything done to you that's alien to you, you're being restored to a true rational nature. So there have been a dream world for philosophers, turns out to be a false world, but it still sounds good rhetorically. And so people will go and say, these are basic rights. Everyone agrees with them, and it just turns out to be false. They go around the world. And you'll see people in other countries having quite different views of what are the basic consensus we should embrace. But it's still one can see the rhetorical power of it. It has a force in realpolitik. That's number one. Two, people may have not paid attention to how ethics committees are set up. Usually when one sets up an ethics committee, you don't set up with people with real moral diversity. You don't do it. Imagine, if you were in the '90s, and the disputes about sex education in New York public schools had set up an ethics committee, and had on it Jesse Jackson, Jesse Helms or Bill Buckley, you get enough people, it would have gone on forever. The discussion would have been engaging, and no conclusion would have been reached. Because most people are not stupid enough to build up such an ethics committee, They choose people more or less of their own ideology. And lo and behold, they come out with their own conclusions. So there is a logic of the function of ethics committees that might blind people to what's going on. So they might come to the view that they were actually discovering a consensus of humans, in general, rather than the adroitness of those who put the committee together. Another reason people might have thought that there was a consensus is a function of the first book, The Principles of Bioethics, by Beauchamp and Childress. Beauchamp and Childress, I'm sure, always voted for the same political party, had the same political views. One, though, was a utilitarian, the other was a kind of deontologist. And lo and behold, they could reconstruct four principles that they could use together. No one noticed. All they had done is use two different philosophical devices to reconstruct the same ideology. So we end up with a very peculiar circumstance. One, we're in deep moral disagreement. Two, it looks, in principle, beyond solution by philosophical argument. And three, people don't want to face it. We've made it to Roman numeral II. How did bioethics come about in this strange circumstance? I give a little footnote showing bioethics. The term goes back to about 70 years old of Fritz Jahr. The bioethics that we have came into existence in the 1970s. Why did that happen? Well, it was a constellation of a number of forces. One was the deep professionalization of medicine. I'm an old man. I will soon be 67. I remember walking around Houston with my father, who was a physician. And when he was always concerned about how big the shingles were, advertising the presence of a physician, that is, up until the 1970s and '80s, generally, of physicians were able to control and impose their own set of etiquette. The real change took place in 1943, when a case got to the Supreme Court. And the Supreme Court of the United States held that medicine was equivalent of a trade, not a guild. And that if it imposed any moral or ethical views that turned out to be in restraint of trade, one could sue physicians for triple damage. I said, I come from a dysfunctional family with a brother who's a lawyer and a sister-in-law who's a lawyer, and that scares physicians. Just as a footnote, my father's father was part of one of the county medical societies that was sued all the way up to the Supreme Court and lost. So the ability to be able to discover our own view of how one should act as physician and impose it was brought into question. Secondly, the United States went from being a established Christian country to being a secular country. Those who know history know that Supreme Courts talked about the United States being a Christian polity up until the mid '50s. And it was taken for granted that Christianity, meaning except in New Orleans, Protestant Christianity, was part of the common law of the United States. If you remember the First Amendment to the compact style, the Constitution of the United States, it says that the Congress shall make no law establishing a religion. It doesn't say Texas couldn't have established the Southern Baptist religion, Louisiana, the Roman Catholic, the Lutheran, I presume, in Minnesota. Who knows? But there was no constitutional bar, and people happily went away in different ways and did establish religions up until that point. What one has then is a moral vacuum being created by, one, marginalizing physicians as a guild; two, marginalizing what had been predominantly a Christian moral ethos. But generally, marginalizing priests, ministers and rabbis as a secular society, was established by Supreme Court holdings from the '50s to the '60s. And in addition, the accent went from what wise people generally thought to individuals making their decisions. The changes, for example, in consent law, such as Canterbury versus Spence in 1972, that said it was a reasonable and prudent person, not the wise physician who tells you, decides how much information you should have in order to make a decision. So what had the deprofessionalization of medicine, the secularization of American society, and moved towards an individual accent in the culture. Roman Catholicism, which was the largest source of textbooks, went into cultural crisis with Vatican II. And the manualist tradition, which was a tradition of writing textbooks on morality, that began around 1603, it depends on your view when exactly it begins, just ended with Vatican II. Beforehand, there were all these textbooks one could have picked up to tell Roman Catholic hospitals exactly what they ought to do. So there was this immense cultural crisis. And the question is, where were you going to get someone now to answer all the important questions being posed, such as how much money should we put in health care, when we should stop treatment, is abortion really bad, how do you define death? So what was created was a profession really made out of two different elements. One, secular theologians, and the other, secular priests. It's no accident that it comes into existence at Georgetown, a Roman Catholic university that had very robust assumptions regarding natural law. And they presume that if you've got a bunch of philosophers together, they would discover the truth, and you would have then for a society, the equivalent of a secular theology. So one has a move to fill this vacuum, which had marginalized all physicians as good leaders, marginalized religious leaders. And in came a hunger, on the one hand, for new theologians, those were the bioethicists who were the scholarly bioethicists. And now you need a new secular chaplains. They are the clinical bioethicists. So, amazingly, Georgetown starts its course called a total immersion course, real religious metaphor, in order to produce the new cadre of secular chaplains. So bioethics comes into existence, as one would expect in the 1970s, when this immense vacuum in the culture is created. And you need someone to go in to fill the vacuum. You all, for those who are nodding off getting a little tired, we've made it through three pages, and we're on the top of page four. Now I come to the bad news. Obviously, if there's moral pluralism, bioethics couldn't do what people wanted them to do. The hope was that bioethicists, as the secular theologians, would get together, and they would agree with everything. And it turns out, the more they talked, the more they disagreed with themselves and even with their own views over time. So what ends up with a secular, theological diversity in the academy. But also one turns out that the clinical. bioethicists don't agree with each other. What one ought to do? Get a well brought up clinical bioethicist in Hong Kong, and he will explain, the last thing you ever do is talk to a patient, talk to the patient's family. They say, thank God we have nothing like HIPAA. We tell everything to the patient's family that we think ought to be communicated. We live in the right framework of clinical bioethics. So given that, you would find out, if you're looking at Roman numeral IIIB2, it turns out then, you ask a question, why was bioethics and clinical bioethics still so well liked? People want to have them in hospitals. One wants to produce more of them. And if they can't do what they were supposed to do, what do they do? Well, if you go around and listen to what they do, they usually, look at B3, B2, they usually give legal advice. But most, if you look at the consultants, most of the requests for consultation in the places I've been, maybe Minnesota is different, is to ask the bioethicists, well, what is real Texas law on this? What do we have established statutes? Tell me, Doctor, I don't want to be sued by your brother. So the first thing is, bioethicists give legal advice without being admitted to the bar, which is illegal. Two, they mediate conflicts. Three, they clarify concepts and analyze arguments. Rarely do they give straightforward normative advice, such as, the law says you should do this, but the law is wrong. And I'm an ethicist here to tell you what you ought to do. I just never heard that. It might happen someplace. So you end up having a creation of a hope for an enlightenment secular theology. Both the theologians are in disagreement, as well as the practitioners. Now we're down at the Roman numeral IV. Where do we go from here? Well, the first thing that I suggest is that we should be honest about the circumstance. That's the reason I've given the paper, because we live in a very peculiar culture where most people, when pressed, will agree that we have secular moral disagreement and disagreement with those who know God exists. And there is little, though, appreciation that philosophers will not get us out of the disagreement. Beyond that, there are robust statements about consensus. And a lot of people participate in writing consensus doctrine. Not all of them. I know one who came up with the bioethics consensus statement from the United Nations. And she had only things I would never put on tape to say about the people who could think you would come up with any consensus. If you look at the consensus statement, it is as strategically ambiguous and empty of content as one could get and still not be too embarrassed by the outcome. So we should look to see what is taking place. We should also notice how the reflections in the philosophical literature represent at least a partial critical retreat from ambitious statements about what moral reflection can produce. One sees, for example, John Rawls, who wrote the Theory of Justice in 1971, he, quite soon after writing the book, begins to step back from the view that this is the only comprehensive doctrine a person could, as a rational person, affirm. So he retreats. And by the time he gets to his book on political liberalism, he's retreated from a view of what reason was, to what reasonable people will agree. But of course, everything is put into reasonable people, so as to exclude the people who don't agree with him so that he can get them in, like Habermas would want, in a [NON-ENGLISH] and come to an agreement. So one can see the problem in secular society emerging. This is not to say that I celebrate this. This is the fact of, as father well knows, of Adam sinning and us being blind to anything, at least in Texas, but our passions. One would expect that the disagreement would be quite salient. Now, we have to have the last picture of the deputy sheriff coming in 2008 into the postmodern bar. Everyone in the postmodern bar, it says noise is horrible. And I come in, I say hello. Hello, you all. I don't want to interrupt anybody. Excuse me. And I see you all are doing a lot of wild and strange things to each other. Is anybody here having some of this done to them without their permission? Then, no, we're all consenting adults! OK, sorry. Go. One's given up on any notion of moral content. And the only way in which moral strangers are able to collaborate is by sparse consent. That's why one finds that the mechanism that brings moral strangers together are contracts, consent, the market. People can be not just moral strangers, but moral enemies, and collaborate in that fashion. But philosophy will not find us the way to free ourselves from this diversity, except through the presentation by Mary Faith Marshall, who will now show how one can indeed come to substantive agreement. I will entertain questions after that. MARY FAITH MARSHALL: My days, they are the highway kind. They only come to leave. But the leaving, I don't mind. It's the coming that I crave. Pour the sun upon the ground. Stand to throw a shadow. Watch it turn into a night and fill a spinning skull. So those of you who are fans of country music or fans of folk music, or are the relatively newly coined genre of Americana music, will recognize that as the first verse of Townes Van Zandt's masterpiece, The Highway Kind. Country musician Steve Earle has claimed that Townes Van Zandt is the best songwriter ever, and I'll stand up on Bob Dylan's coffee table and say so. So Earle idolized Van Zandt for his musical genius. Van Zandt, on his part, thought that Earle was a pain in the ass and referred to him pejoratively as the kid. And you might say that typifies my relationship with Tris. [CHUCKLES] But the point here is that Tris and I can agree on the fact that Townes Van Zandt is the best, but we might get there from different places. Tris, because Van Zandt is a Texan, whose family established Fort Worth. Myself, because I love Americana music. And both of us, perhaps because of the poetry in Van Zandt's soul. So there are things that I think we should be able to agree on as bioethicists and within the field of bioethics. I'm not going to say it's a discipline. And given that this event is sponsored by the program in human rights and health, I want to perhaps use human rights as a vehicle for having that discussion. So there's a beautiful work of fiction called The Dream of Scipio. And in it, the philosopher Sophia maintains that the purpose of action is to allow philosophy to continue. For if men are reduced to the material alone, they become no more than beasts. So I got off the phone recently with my colleague Steve Miles. He's helping me with a poetry compilation on the downside of war, and we're designing the cover. And he said, I have a picture of a guy with a severed ear that I could send to you. And I thought, do I want the photo of the guy with a severed ear, or instead, one of a pile of severed ears? And I think I'll go with a pile. Maybe juxtapose it with a picture of a woman filing her nails. Play up the indifference angle. Play off the Carolyn Forché poem, The Colonel, regarding a true story in which a Salvadoran colonel emptied a bag of ears on the dining room table while his daughter sat by and plied her emery board. He said to Forché, something for your poetry. No. As for the rights of anyone, tell your people they can go fuck themselves. All of this is preparatory to Steve's upcoming Abu Ghraib talk on campus. Not that they severed ears at Abu Ghraib. They favored interrogatories, like smothering, electric prods, rape, beating, attack dogs, pretzeling, sexual humiliation, bodily suspensions, feces smearing, some of which resulted in death. Not of course that we didn't sever ears in Vietnam or Iraq. That's part of war's basic horror show. Consider this Milesian thought exercise. Place yourself in a room. It is cold. A naked man is there. He is a prisoner. His back is arched at an awkward angle, in a stressed position. His wrists are cuffed, crucifixion style, to the top bunk. His feet brush the floor. A pair of underwear covers his head and face. He has been suspended like this for a long time. Place yourself in a hallway. A man inches towards his cell. He is a prisoner. He has just been released from the hospital where his gunshot wounds and broken leg have been treated. He cannot walk, so he crawls. His captors beat his injured leg. Place yourself in a room. A man is placed head first into a sleeping bag, his hands cuffed behind him. He is a prisoner. One of his captors sits on his chest. The prisoner dies. He has been asphyxiated by his captors, who subsequently lie and report that he has suffered a heart attack. Place yourself in these rooms. You are a nurse or a physician. You are a witness. You do nothing. You are complicit. Or you aren't in the room, but you know of these things. The dead bodies bear the evidence. The wounded prisoners bear the evidence. You do not report these abuses up the chain of command. You might even falsify death certificates. Either way, you are an accessory to torture. You are an accessory to murder. Or you write the truth. You record the cause of death, asphyxia due to smothering and chest compression. A Pentagon spokesperson maintains that the prisoner died of natural causes. Does your honesty suffice? Is honesty the minimum moral requirement for maintaining your oath as a healer? Is honesty the minimum moral requirement owed to your patients? Place yourself in a room. It is your office. You are a nurse, physician, historian, anthropologist, professor of literature. You are a medical humanist or a bioethicist, or both. You learn that these things have happened at Abu Ghraib, that some have happened in the presence of nurses and doctors and medics. On the internet, you see photographic evidence of torture and abuse, or on television. You remain silent. Why? You are perhaps indifferent or cautious. Torture at a distance is unpleasant to consider, inconvenient to act on. Perhaps the subject doesn't fit your research portfolio. The NIH doesn't fund it. Nor, for that matter, does the Department of Justice. You lose your claim then to humanism. You lose your claim to apply to ethics because you have done nothing, even if you claim to abhor torture or murder or to espouse patriotism. Conversely, you choose, when solicited, to endorse a protest, perhaps the call to prevent torture and abuse of detainees in US custody by physicians for human rights, or a similar call from Amnesty International, one admonishing the complicity of doctors and nurses who bore silent witness at Abu Ghraib or did worse than nothing. Is this the minimum moral requirement for you as a medical humanist or a bioethicist? We are beholden to our core competencies and values, for those who do applied ethics, because these values are the foundation for the conduct of our profession. The character traits, for example, identified by our professional organization, include tolerance, patience and compassion, honesty, forthrightness and self-knowledge, courage, prudence, and humility and integrity. These competencies require of each of us as individuals, beg the question of what we collectively, and what our professional organization owes to its members and to its larger constituency, to our patients, to research subjects, to health care providers, the public, our government, the world's populations and environment, to those who are treated inhumanely, to those whose human rights are abrogated, to refrain from upholding our standards in a clear and public fashion. Not to condemn collectively injustices that violate those standards is to engage in the conspiracy of silence, which for a purported ethics organization is morally reprehensible. SPEAKER 2: I invite Tristram, if he has a couple of comments to Mary Faith's presentation. SPEAKER 1: Because you could not have had a more forceful enforcement of everything I said. First of all, I don't listen to country Western music. No, because it's not being recorded, and they can hear me. That's why I turned it off. So first, I thank her very much. I could listen to country and Western, even though I [INAUDIBLE]. But when I was a kid, the person I liked the best as a singer was Caterina Valente. So all this country and Western stuff, I know about. I'm just not part of that mall community, thank God. Two, my presentation was about secular, moral, epistemological skepticism. That philosophers couldn't get us to the truth. Obviously, I know there is a truth. I would like to convert all of you to it, but I don't think my philosophical arguments will do the trick. The other thing is that people we very like have used that-- I would take to be morally appropriate. Thomas Aquinas would have me burned. I am a apostate from the Roman Catholic Church. It is clear that Thomas Aquinas, who was a supporter of the Inquisition, supported the burning of persons who remain a obdurate and public apostate, which I am. Do I think I could generate a moral argument that would convince Thomas Aquinas? The answer is no. He had different premises. Wrong premises. But they would like Clement of Alexandria to realize without directly agreeing with my rules of moral evidence. [INAUDIBLE] agree with him. We will not come to a common view of the reason why the things go on, that I and my morality would require, is that people of other moralities don't see them as bad at all. I recommend sometime you reading The Elder Edda, which was sort of the Old Testament for the Vikings. It has a passage, early should a man rise if he wishes to kill his neighbor or steal his property. For seldom does a sluggish wolf get its prey or the sleeping man, victory. There are different views about how one ought to flourish as a human. Secular moral argument will not let us discover that.