Sensibility and Rationality in Bioethics

Abstract

In his preface to The Liberal Imagination, Lionel Trilling remarks on John Stuart Mill's discovery of a troubling tendency in liberalism's attitude toward the sentiments and the imagination, an inclination to view the world "prosaically," which is to say, devoid of variousness and possibility. I stress the cultural rather than the political meaning of liberal here, though the two senses are inseparable. Following Trilling, I note that "the word liberal ... defines itself by the quality of life it envisages, by the sentiments it desires to affirm." The paradox at the heart of liberalism is that "in the interests of its great primal act of imagination ... in the interests, that is, of its vision of a general enlargement and freedom and rational direction of human life--it drifts toward a denial of the emotions and the imagination."(1) In its zeal to organize the sentiments rationally, liberalism tends to select dispositions and emotions that are most susceptible of organization and to develop theories that account for that selection. In doing so it risks omitting much of what makes life meaningful. As a godchild of liberalism, bioethics is prey to this paradox, against which those who value liberalism's virtues must be vigilant. Bioethics organizes the moral life of illness and injury around some central propositions, such as, "Patients are the rightful arbiters of medical interventions upon their person" and, "Everyone has a right to basic medical care." Propositional discourse, in the service of bioethics, distills such ideas from the unruly abundance of deep feeling about life and death, suffering and healing, and argues their merit. Some such simplifying impulse is an indispensable prerequisite to an orderly engagement with the welter of emotion and opinion characteristic of contemporary medical morality. But as propositional discourse has become the preponderant mode of analysis, the link between sensibility and rationality has been severed. Bioethical rationality has lost sight of the fact that the imagination is the joint possession of the emotions and the intellect; it has become, in Mill's sense, "prosaic." Narrative discourse, using the figurative language of fiction, drama, and poetry, is an alternative mode of knowing and naming, sorting and sifting through experience. It asks of experience not, Is it true? but, What does it mean? Whereas the organizing impulse of propositional discourse is to bring rational order to experience, narrative discourse is driven by the desire to discern meaning through metaphorical approximation and refinement. The poet reflects upon a mother's dying: How can I think what thoughts to have of you with a mind so unready? What I remember most: you did not want to go. Then choice slipped from you like snow from the mountain, so death could graze you over with the sweet muzzles of the deer moving up from the valleys, pausing to stare down and back toward the town. …