These are general thoughts from and spawned by the book Erotic Morality: The Role of Touch in Moral Agency by Linda Holler, and just get your mind out of the gutter right now, children. From the back cover, “Erotic Morality examines the role of the senses and emotions, especially touch, in moral reflection and agency. Moving from organic disorders such as autism to culturally induced feeling disorders found in dualistic philosophy, pornography, and some forms of sadomasochism, Linda Holler argues that reclaiming the sentient awareness necessary to our physical and moral well-being demands healing the places where we have become numb or hypersensitive to touch.” One of the things she says is “our understanding of love, like our understanding of morality, has been privatized and sexualized.” So, she’s moving the discussion away from sexual morality and the private arena towards discussing our capacity for intimacy and passion in the public arena.
Anyhow, with that background, this is just basically me thinking ‘aloud’ about the first two chapters (“Autistic Touch–Body as Prison” and “Disembodied Touch–Body as Object”), and speculating on just what an affect-centered ethics might mean, as part of an assignment around my undergraduate thesis.
Shared pain is lessoned, shared joy increased–thus do we refute entropy. -Callahan’s Law of Conservation of Joy and Pain
Autonomy requires a strong clinging to self in order to keep the boundaries of ‘I’ impermeable. To touch the world, to be in contact and communication with it–to affect it–those boundaries must come down. You must be able to dissolve yourself into the perspective of another, not only to feel with them, sharing in their joy and pleasure, but to suffer with them as well. So then we must not only blur the artificial boundary Descartes erected between mind and body, we must also blur the boundary between self and other in order to effectively affect (and be affected).
How does this then apply to medical ethics? It could be that we need to borrow from John Rawls and utilize his theory of justice and the veil of ignorance–make our decisions not based on what we would logically (inherent rational thought coupled with desire) but that we make the decision with emphasis on a feeling and the acknowledgment of pleasure and pain.1 This would likely necessitate doctors moving away from the rational, knowing diagnostic/empiricist machine and towards a more speculative and e-motive (almost literally with movement; doctors have abysmal body language) dialogue. For example, when describing a patient in a persistent vegetative state, a doctor should clearly explain what we know of the autonomous nervous system and the current understanding of the sensory experiences that the PVS patient could be experiencing outside of the higher cognitive processes associated with feeling: that although s/he can experience pain via said autonomous nervous system, and will flinch, this reaction is much in the way an anemone reacts to painful stimulus in the environment, and is not indicative of feeling; pain cannot be processed on a cognitive level that gives name to the feeling.
In an ideal world, the primary caregiver(s) would then need to think, if they could not know if they were the person in this action/reaction feedback loop, the caregiver, or the doctor, would they want to risk being stuck in that feedback loop of experiencing pain and being unable to end it on their own? What sort of decision would they make if they had to assume they were the worst off of the group of options? How would they mitigate damages to receive greatest benefit?2
Of course, then the question comes back to how affect-centered ethics differs from social contract theory, specifically Rawls’ envisioning of social contract theory. The best answer I have right now is that Rawls is still utilizing a very utilitarian cost-benefit approach in his model, and I want to move away from an impartial/empirical notion of ethics and towards one that emphasizes the connectivity between people. Adam3 ran with my original example of autonomy being the idea that we’re all islands unto ourselves and pointed out that if you remove the water between the islands, they’re all a single connected landmass. We have no visible barrier fluid between us as individuals (because we are not going to go to Elizabeth Grosz, no matter how tempting), but perhaps we could refer back to Merleau-Ponty and see the air as that binding medium, and under that binding medium we are all joined as one.4
Any which way, I’m starting to feel a pressure on clarifying the alternative to autonomy. Another suggestion I’ve received is that it’s a question of scale, and I need to shift focus a level up from autonomy and approach the question there. I think this is an incredibly valid and viable suggestion; Powell’s kindly delivered me two books today, O’Neill’s Autonomy and Trust in Bioethics and Gaylin and Jennings’ The Perversion of Autonomy; I’m hoping that these two might give me a bit of direction and grounding. And, of course, I’m more than open to (further) suggestion…