Tuesday, June 23, 2015

Some Teachings of the Dao De Jing

The Dao eludes naming and namelessness. It cannot be conveyed by means of language. It transcends all attempts to formulate or conceptualize it. It cannot be spoken or thought. It cannot be seen, heard, or touched. It is a gate to ephemerality and durability, to impermanence and permanence, to transitoriness and eternity. It is the origin of all things, and the source of all mysteries (stanza 1).
      The Dao is neither a name nor a part of speech. Words or names cannot articulate or describe it. It is light within light, and darkness within darkness. Its presence is found in its absence, and its absence in its presence. 
      Inclusivity rather than exclusivity seems to belong to the Dao, but the former does not depend on the latter. The Dao is a doing and not-doing that does not need to, and cannot, be verbalized. Indeed, it transcends speech and verbalization (stanza 2).
      The Dao is not a construct, nor is it a way of acting on constructs. It is not to be found by searching for wisdom and knowledge. But to be wise and knowing is to follow the Dao and to be guided by it.
      The Dao is not a sign, nor is it a signifier of truth or meaning. It is rather a way of acting and not acting. It endures forever, because it is uncreated. It cannot be destroyed, because it does not destroy. It cannot be resisted, because it does not resist. By yielding to resistance, it overcomes resistance.
      Acting according to the Dao is not a way of seeking fame or making money. It is not a way of accumulating unnecessary things (stanza 9). It is also not a way of seeking admiration or recognition. Rather, it is a way of being gentle and kind, true and just, reliable and competent, selfless and trustworthy, compassionate and understanding (stanza 8).
      To act according to the Dao is to act virtuously, but not to strive for mere virtuosity. When virtues are actualized, mere virtuosities disappear. Thus, the Dao is elusive and indefinable (stanzas 21, 32). It transcends all boundaries of perception or knowledge, and it surpasses all limits of perceptibility or knowability.
      Forgetting or remembering does not lead to the Dao. Once remembered, the Dao is forgotten, and once forgotten, it is remembered. Following the Dao is not an act of intellect or mind. It is a way (or more accurately, The Way) of acting effortlessly and virtuously, as manifested by compliance with natural law and non-resistance to the ceaseless flow of events in the universe (stanza 28).
      To follow the Dao is to find that softness can overcome hardness, that gentleness can overcome roughness, that temperance can overcome intemperance, and that tolerance can overcome intolerance (stanza 43).
      In acting according to the Dao, less and less acting on constructs is done, until no acting on constructs is done, and thus everything that is in accordance with the Dao is done, and nothing that is in accordance with the Dao is left undone (stanza 48).
      Acting according to the Dao is not acting unnecessarily. It is also acting by not acting, and doing by not doing. It is also decreasing by increasing, and increasing by decreasing. It is also losing by gaining, and gaining by losing (stanza 63).
      Acting according to the Dao is also responding to harshness by offering mildness, responding to roughness by offering gentleness, responding to unkindness by offering kindness, and responding to enmity by offering friendship.
      To act according to the Dao is to avoid doing too little by doing too much, and to avoid doing too much by doing too little (stanza 75). It is to recognize the mutual dependence between acting and not acting, between doing and not doing, between rising and falling, between gaining and losing.
      It is also to promote forgiveness rather than retribution, mercy rather than punishment, impartiality rather than partiality, and empathy rather than resentment (stanza 79). 


REFERENCES

Lao Tsu. Tao Te Ching. Translated by Gia-Fu Feng and Jane English, (New York: Random House, 1972).
Laozi. Tao Te Ching: On the Art of Harmony. Translated by Chad Hansen, (London: Duncan Baird Publishers,  2009.
Keping Wang. Reading the Dao: A Thematic Inquiry. New York: Continuum, 2011.


Some of my further thoughts about the Dao De Jing can be found here.


Sunday, June 7, 2015

Medical Indications as Epistemic Justifications

A medical indication to perform a particular test or to administer a particular treatment may be a medical reason to perform that test or administer that treatment. Stedman’s Medical Dictionary (2005) defines a medical indication as “the basis or rationale for using a particular treatment or diagnostic test,” and says that it “may be furnished by a knowledge of the cause (causal indication), by the symptoms present (symptomatic indication), or by the nature of the disease (specific indication).”1
      A medical indication may also be a situation or condition in which a particular test or treatment is advised or recommended, based on the available scientific evidence. For example, according to the Physicians’ Desk Reference (2015), the indications for prescription of an albuterol inhaler include “Treatment or prevention of bronchospasm in patients 4 years of age and older with reversible obstructive airway disease,” and “Prevention of exercise-induced bronchospasm in patients 4 years of age and older.”2
      A medical indication may also be an evidence-based justification for a particular test or treatment. The strength of the indication may depend on the strength of the available scientific evidence for that indication.
      Factors affecting the indication for a particular test or treatment include not only the nature of the particular disease process under consideration, but also the potential benefits and efficacy of treatment, the age of the patient, the overall condition of the patient, the personal desires and preferences of the patient, the potential side-effects and burdens of treatment for the patient, the costs of treatment, the availability of treatment, and the projected goals of treatment.
      A medical non-indication for the performance of a particular test or administration of a particular treatment is an absence or lack of indication to perform that test or administer that treatment. Reasons that medical tests or treatments may not be indicated include: the non-health-threatening nature of some medical conditions, the lack of treatment efficacy with regard to some medical conditions, the potential side-effects of some treatments, the potential financial burdens of some treatments, and the personal desires of some patients not to undergo arduous tests and treatment.
      A medical contraindication to a particular test or treatment is a medical reason not to perform that test or treatment (because the test or treatment may be injurious or harmful to the patient). A contraindication may be described as relative or absolute. A relative contraindication to a test or treatment may sometimes be outweighed by the potential benefits of that test or treatment if the potential benefits are significant and the risk of harm is very low, but an absolute contraindication to a test or treatment is never outweighed by the potential benefits of that test or treatment (because of the severity and magnitude of the potential harms that the test or treatment may cause to the patient)
      What then is the relation between medical indications and epistemic justifications? To say that a particular test or treatment is medically indicated is to make an epistemic claim regarding the appropriateness, correctness, and advisability of that test or treatment. If we make such a claim, then we may have an epistemic duty to justify it by thoroughly examining all the available evidence for and against it. In order to be epistemically justified in saying that a particular test or treatment is medically indicated, we must have sufficient epistemic grounds for saying so.
      Let’s consider the following propositions (where the letter “T” stands for a medical test or treatment) as a method of investigating the role and function of medical indications as epistemic justifications:
1.     If T is medically indicated, then it is medically (and epistemically, and ethically) justified.
2.     If T is medically indicated, then there are good medical reasons for it that sufficiently outweigh any possible or actual reasons against it.
3.     If T is medically indicated, then there is sufficient scientific evidence in favor of it, and there is insufficient scientific evidence against it.
4.     If T is medically indicated, then there is sufficient scientific evidence of its benefit, safety, and efficacy.
5.     The proposition P that a particular test or treatment T is medically indicated is epistemically justified if there is sufficient scientific evidence in favor of the truth of P.
      The above propositions may all have their corresponding negations.  Thus, if T is not medically indicated, then it is not medically (and not epistemically, and not ethically) justified, and so on.
      To what extent may medical indications differ from epistemic justifications? Medical indications may be more than epistemic justifications, insofar as they may be not only epistemic, but also ethical (and practical) in nature. They may be not only situations or conditions in which particular tests or treatments are said to be appropriate or advisable, but also parameters and guidelines for performing tests and prescribing treatments.
      Medical indications may also differ from epistemic justifications insofar as in some cases an argument can be made that a test or treatment may be epistemically (and ethically) justified without clearly being medically indicated (its justification may not be apparent at first glance and may only be apparent on later examination). A test or treatment that was not clearly indicated at first glance may turn out to have an unanticipated beneficial effect. However, such a possibility may still not provide sufficient grounds for the argument that the performance of non-indicated tests or treatments can in some cases be medically justified. The justifiability of a medical test or treatment may in fact depend on the strength, clarity, and sufficiency of the indications for that test or treatment. Tests or treatments that have weak, unclear, or insufficient indications may be medically (and epistemically, and ethically) compromised by their weak, unclear, or insufficient justification.
      Non-indication, or lack of indication, for a test or treatment may in some cases be a contraindication to that test or treatment, insofar as that test or treatment may pose unnecessary risks to the patient and may expose the patient to unnecessary harms. Non-indicated tests or treatments may also cause unnecessary financial expenses for patients, for third-party payers, and for a whole healthcare system.
      Medical indications may constitute reasons to perform particular tests, procedures, or treatments, based on our knowledge of the potential benefits, safety, and efficacy of those tests, procedures, and treatments, and based on our knowledge of the natural history of the disease processes under consideration. Medical indications may also affirm the usefulness, appropriateness, and rationality of particular tests, procedures, and treatments within the context of particular medical illnesses, disease processes, and conditions.


FOOTNOTES

1Stedman’s Medical Dictionary for the Health Professions and Nursing, Fifth Edition, edited by Thomas Lathrop Stedman (Baltimore: Lippincott Williams & Wilkins, 2005), p. 735.
2PDR, LLC “Full Prescribing Information, ProAir HFA (albuterol sulfate),” 2015, at http://www.pdr.net/full-prescribing-information/proair-hfa?druglabelid=569.