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, doing and not doing, rising and falling, 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.

Medical Indications as Epistemic Justifications

A medical indication to perform a particular test or 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.

James McCune Smith's The Destiny of the People of Color

James McCune Smith (1813-1865) was an African-American physician, abolitionist, educator, and writer. He was the first African-American to earn a medical degree and become a physician. He was born in New York City, where he attended the African Free School, a public school for the children of slaves and free people of color, which had been founded by the New York Manumission Society, an organization dedicated to the abolition of slavery. Other students at the school who went on to have distinguished careers included Henry Highland Garnet (1815-1882, African-American abolitionist, minister, and educator), Ira Aldridge (1807-1868, African-American actor), Alexander Crummell (1819-1898, African-American minister, missionary, and educator), and Samuel Ringgold Ward (1817-1866, African-American minister, abolitionist, and newspaper editor).

      After graduating from the African Free School, McCune Smith applied to Columbia College in New York City and Geneva Medical College, in Geneva, New York, but was unable to gain admission, due to racial discrimination.¹ However, with financial assistance from the New York City community, he was able to travel to Scotland to attend the University of Glasgow, where he was awarded a bachelor’s degree in 1835, a master’s degree in 1836, and a medical degree in 1837.² He returned to New York City in 1837 to start the first general medical and surgical practice by a university-trained African-American physician, and he opened the first pharmacy operated by an African-American.³ He was active in the abolitionist movement, and he worked with Frederick Douglass to establish the National Council of Colored People in 1853. He wrote the introduction to Douglass’ second volume of autobiography, My Bondage and My Freedom (1855). He also published articles in medical journals and was a founding member of the New York Statistics Society, as well as a member of the American Geographic Society.² He was appointed a professor of anthropology at Wilberforce College, Ohio in 1863, but he died two years later on Long Island, New York in 1865.

      The Destiny of the People of Color is a lecture that McCune Smith delivered to The Philomathean Society and The Hamilton Lyceum in 1841. It was published in 1843. (The Philomathean Society is a collegiate literary society that was started at the University of Pennsylvania in 1813. The Hamilton Lyceum was a literary society that was based in New York City.⁴)

      McCune Smith explains that in order for people of color to investigate their destiny, they must have some understanding of their present position in society. The basic truths of this position in society, and thus the basic premises for investigating the destiny of people of color, are: “First. We are a minority held in servitude by a majority. Secondly. That majority simulate a Republican form of Government. Thirdly. We, the minority held in servitude, are distinguished by a different complexion from the majority who hold us in thrall.”⁵

      The social position of people of color in America is unusual, says McCune Smith, because they are held in servitude and yet live in a country that aspires to, or pretends to have, democratic principles of government. However, the proper destiny for people of color is not for them simply to leave the country and flee from oppression, but rather to remain and struggle against injustice by working to make sure that the American system of government lives up to its democratic principles.

      In order to overcome slavery and oppression, people of color must refute the principle that “might makes right,” by showing that “right makes right.”⁶ The power of the social majority to hold a minority in servitude does not make that majority morally right. The basis of a democratic system of government is that all citizens are recognized as having equal rights.

      In order to fulfill their destiny, people of color must think not only of the present, but also of the future. They must consider the welfare of future generations whose rights will be affected by their actions. They must show the moral wrongness of returning evil for evil, by showing the rightness of returning good for evil. Acts of injustice cannot rightfully be answered by further acts of injustice; they must be answered by acts of justice.

      McCune Smith quotes the words of the Roman playwright Terence (c. 190 -159 BCE), “Homo sum humani nil a me alienum puto” (“I am human, and nothing human is alien to me”), which express a sentiment that McCune Smith finds particularly noteworthy, given that Terence was a slave who gained his freedom. McCune Smith regards Terence’s words as an affirmation of the common brotherhood and sisterhood of all humankind. The destinies of all human beings are inextricably intertwined. Thus the destiny of people of color, given their being held in servitude by a social majority that pretends to be democratic in its system of government but deprives them of their rights of citizenship, is to save that system of government from perishing as a result of its own contradictions, and to convert it into a system that is truly democratic.

      McCune Smith makes clear that people of color cannot overcome their oppression merely by overthrowing or becoming like their oppressors. Only by affirming the common brotherhood and sisterhood of all humankind can liberty and justice truly be achieved.

      The destiny of people of color is a subject also explored by other nineteenth-century abolitionists, including Frederick Douglass (1818-1895), Martin Robison Delany (1812-1885), and Henry Highland Garnet (1815-1882).

      Douglass (1849) says that the destiny of people of color and the destiny of white people are tied to each other, and that in order for society as a whole to flourish, both people of color and white people must flourish. White people and people of color can flourish only if they do so together.⁷

      Delany (1854) argues that people of color must be in control of their own political destiny if they are to secure the right to full citizenship. People of color will never secure the right to full citizenship unless everyone has an equal opportunity to participate in government. However, Delany considers it unlikely that there will ever be equality of opportunity in American society, and he therefore advises people of color to consider emigration and the pursuit of nationhood abroad.

      Garnet (1848) explains that the destiny of white people and the destiny of people of color are inseparable, insofar as distinctions between white people and people of color will eventually be erased by the advent of a society in which “mixed race” will be the norm. An increasing number of people will be “mixed race,” making it more difficult to separate people into distinct racial groups. Prejudice against people of color, or “colorphobia,” may therefore one day become an anachronism.

     

FOOTNOTES

¹John Stauffer, “Introduction,” in The Works of James McCune Smith: Black Intellectual and Abolitionist, edited by John Stauffer (Oxford: Oxford University Press, 2007), p. xxi.

²Ibid, p. xxi.

³Thomas M. Morgan, “The Education and Medical Practice of Dr. James McCune Smith (1813-1865), First Black American to Hold a Medical Degree,” in Journal of the National Medical Association, Vol. 95, No. 7, July 2003, pp. 603-614.

⁴William Henry Ferris, The African Abroad: Or, His Evolution in Western Civilization, Volume 2 (New Haven: Tuttle, Morehouse & Taylor Press, 1913) p. 866.

⁵James McCune Smith “The Destiny of the People of Color (1843)” in The Works of James McCune Smith: Black Intellectual and Abolitionist, edited by John Stauffer (Oxford: Oxford University Press, 2007), p. 50.

⁶Ibid., p. 52.

⁷Frederick Douglass, “The Destiny of Colored Americans,” in The North Star, November 16, 1849.

ADDITIONAL REFERENCES

Delany, Martin Robison. “Political Destiny of the Colored Race on the American Continent” (1854), in Martin R. Delany: A Documentary Reader, edited by Robert S. Levine (Chapel Hill: University of North Carolina Press, 2003), pp. 245-279.

Garnet, Henry Highland. “The Past and the Present Condition, and the Destiny, of the Colored Race” (Troy, NY: J.C. Kneeland, 1848).