In After Virtue, Alasdair MacIntyre once said that “it is the lawyers, not the philosophers, who are the clergy of liberalism.” That is, in modern societies – liberal in the broad sense – it is lawyers who do the work, and have the status, once given to the medieval European Christian priesthood.
On this point I think MacIntyre is half right – or perhaps three-quarters right. He is quite right to note the low status that the modern West accords philosophers; but he overemphasizes the role of lawyers, because his concept of the good is (to my mind) overly political. Lawyers do play the role of medieval clergy as the rulers’ intellectual assistants in determining what a good state will be in practice. When it comes to the good life itself, however, the intellectual heavy lifting is done by a very different group: namely doctors, and medical researchers. It is medicine, not law (and certainly not philosophy), that plays the greatest role in telling moderns how they should live.
Law merely sets the boundaries, limits beyond which our lives may not go. Medicine tells us far more: what we should do within those boundaries. The point is most obvious in the case of psychology, which has always aimed to tell us what we must do to avoid a miserable and wretched life; now, in the days of positive psychology and happiness studies, it goes further and aims to tell us what a good life is. But it’s not only psychology. The other branches of medicine also tell us what kind of work to do (don’t do something too stressful), instruct us how to spend our spare time (exercise, don’t go out in the sun too long), and provide us with an arcane and ever-fluctuating set of prescriptions on how to eat that make kosher laws and dharma??stra look simple. (At least Leviticus is not supposed to keep changing.) The idea of health has, in practice, become one of the most important concepts in the normative ethics of Western life, the ways we think about how we should live. Sometimes we even think about happiness for its health benefits rather than as an end in itself.
Academic philosophy, however – and “continentals” don’t seem much better than analytics here – has done little to bring the concept of health into dialogue with the rest of our ethical worldview. (Nietzsche, for whom “healthy” was always an important term of ethical praise, is a major exception, though empirical research may have disproven much of what he thought was healthy. But then Nietzsche tends to make himself an exception in many ways.) “Bioethics” or “medical ethics” deals with something very different – ethical decisions made by medical practitioners in extreme situations, not the ethical implications of medicine for everyday life. Bioethicists think about how ethics guides medicine, not about how medicine guides ethics.
For their part, medical researchers, like most scientists, typically claim to be value-free – they’re just telling us about cause and effect, about what phenomena cause us to be healthy or unhealthy. But the normative weight of the concept of “health” is the reason we use it so much – we wouldn’t pay doctors and medical researchers so much to tell us how to be healthy if we didn’t think that, other things being equal, health is a very good thing. And the kind of cause-and-effect relations that the medical sciences establish are not so different from what some philosophers have tried to establish. From the start the Buddha’s teachings, as recorded in the Pali suttas, dealt with psychological causation: suffering is caused by craving. The project of establishing psychological causation becomes even clearer in the Abhidhamma.
We haven’t done nearly enough, it seems to me, to think philosophically about the claims of medicine. What role should health play in our conceptions of the good life? When should we do what is healthy, and when should we ignore our doctors’ advice and seek out competing goods?