A Conversation on the implications of Death

Oregon State Hospital

Physician-assisted suicide (PAS) is a controversial topic in the political world and in popular culture. Questions range from whether individual states should be allowed to legalize the practice, or if doctors should have to provide the service. All these concerns at their root return to the philosophical question of the ethical nature of the practice. It is important to ask what the implications of allowing or preventing someone from taking their own life would be. By looking at the specifics of the procedure, understanding the underlying reasons we so value life and review the remaining arguments against PAS it will be clear that it, rather than giving cause for concern, we are ethically obligated to allow this freedom.

In this discussion, it will be important to clarify what form of PAS will be argued for. Rather than arguing for anyone to be able to take their life, or for doctors to be able to take the life of a person for them, we will instead be arguing from the perspective of PAS for those capable of taking their life and within six months of death due to an illness. This limits the scope of patients greatly and with current protections as enacted in US state laws requiring multiple doctors to confirm diagnoses and ensure the patient is not affected by some mental illness that would push them toward suicide, the practice is less likely to be abused.

With an understanding of just what sort of PAS is to be argued for, we can discuss the ethical questions surrounding it. The first subject to explore is what about life makes it necessary to protect, and by inference is endangered by allowing PAS. Life is made up of a multitude of experiences that, in aggregate, are seen by many as positive. When considering the future the same generally positive outcome is assumed, resulting in our designation of that future as something good. It’s claimed that this good is then threatened by practices such as PAS which some argue devalue the lives of others. (Singer, 529)

This argument against PAS along with many others will interact with this central value of life claim and can be answered by returning to it. The confusion comes from thinking that the good that we assign to future experiences is still maintained by someone who is six months from death. In that situation, the evaluation of the future must change because of the assured pain and suffering this person will experience. By recognizing that the future for these people is radically different from that of any other person, and understanding how that changes the way we place value on life, it becomes clear that someone taking the option of PAS is doing so for the same reasons we make the decision in normal life to continue living. While we evaluate future experiences and see a net benefit, they see a medically assured negative. This alone upsets the claim that allowing PAS devalues life and will be the underlying response to most other arguments against PAS.

The first of those arguments is that it’s possible the disease will be resolved. Either through miraculous remission or a sudden breakthrough in science, there is potential for the person to be taking their own life when a better solution lies just around the corner. This argument ties back into the argument about the value of life discussed above, as if this is the case then life suddenly stretches out ahead and the patient is losing those highly valued experiences. These possibilities, however, are simply that, highly unlikely potential scenarios that will unfortunately never happen for many of those placed in this position. As such it is a judgment call about the odds of the solution coming just in time, or the disease to continue unabated causing unbearable pain. This, like the decision to take chemotherapy instead of hoping that some cancer might go into remission by itself, is a decision that should be left up to the patient. If they find the chance slim they ought still to have the option of PAS. (Singer, 537-538)

There is also the argument that if we allow for PAS patients will be pressured into the practice or a slippery slope will be found at the end of which all suicide is legalized (Singer, 538-541). This, however, is less a philosophical argument and more an argument easily addressed with facts. Several studies have been done on PAS in both the Netherlands and Oregon. The most recent report on the Netherlands looked at two decades of data from the time since the law was passed to 2009 and found that, “A last important lesson that can be learned is that the legalization of euthanasia in the Netherlands did not result in a slippery slope for medical end-of-life practices . . . Our studies show no evidence of a slippery slope. The frequency of ending of life without explicit request did not increase over the studied years” (Rietjens, J. A. C., et al. 2009). 

Furthermore in a study comparing the Netherlands and Oregonian laws on PAS found that “a smaller percentage of older people received assistance in dying than of younger patients; gender ratios were slightly higher for males over time; and assistance was not more common among uninsured. Socioeconomic data of intermediate strength, usually inferred from other, more robust data, also suggest similar pictures in the two jurisdictions: recipients of assistance in dying were likely to be of equal or higher educational status and were less likely than the background population to be poor” (Battin, et al. 2007). These reports all point towards the conclusion that no heightened risk appears for any in vulnerable groups, nor does it show that over time people are euthanized without consent. The facts simply do not bear out the slippery slope argument that many people attempt to draw from PAS laws. 

Finally, there is the argument that physicians should not be asked to prescribe such medication. The first oath a doctor takes is to do no harm, and many have argued that this is one of the reasons PAS should not be permitted. The assumption underlying such a claim, however, is that to do no harm is defined as preserving life for as long as is humanly possible. This fails to speak to the value or experience of that life. By doing no harm do we really mean, attempt to preserve the best possible life for a person, rather than prolonging any existence at all. Surely under such a view taking a patient off of life support would be just as problematic, but that clearly isn’t the case. This comes back again to how we value life, a person on life support does not have the potential to experience anything that we determine to make life good or worth continuing.

It is clear that PAS is not going to deteriorate down a slippery slope, and by virtue of understanding why we truly value life we know that simply allowing the practice will not make life worthless, violate Hippocratic oaths, or that we should force those so close to death to value life in the same way others do. Allowing physician-assisted suicide for those with only six months left to live is unambiguously the correct conclusion.

The Metaphysics of Aristotle and Whitehead: A Comparative Analysis

The positions Aristotle took some 2000 years ago set a precedent for how other religions and philosophies would understand the world and the things in it. While many philosophers have now left his original position it is still interesting to see how the views of two revolutionary philosophers match up. In a contrasting of Alfred North Whitehead’s view with Aristotle's we will see the vision both had for a robust philosophical system and understand how views have shifted over time and end by contrasting their respective strengths and weaknesses.

In as early a time as Aristotle’s, the field and depth of knowledge surrounding metaphysics was still shallow and into this void his work became the defining view for the years after its writing and then again upon its rediscovery. It really provides the basis for our understanding of the field and Aristotle intends this, stating at the beginning of his work that, “all men suppose what is called wisdom to deal with the first causes and principles of things.” Wisdom he believes is intrinsically linked with an understanding of the causes of the things around us and that is his narrative path to reaching a discussion about the metaphysics of the world in which we live. 

These fundamental issues are at the highest level of generality. Aristotle writes that the way in which we reach these extrapolations is by first looking at those things which are “more known to us.” Ultimately by investigating those things to their full extent we as philosophers will reach those things which are “more known in themselves,” but only after we have first studied nature and Aristotles Physics to learn those basics.

To really grasp his arguments about metaphysics however it’s helpful just to generally understand the categories he sets out in the book before this, helpfully titled Categories. In this work he divides out the ten distinct categories that all beings can be: substance; quality; quantity; relatives; somewhere; sometime; being a position; having; acting; and being acted upon. The most important of these is ousia or substance. Each item in the substance category is a singular independent being, and everything that comes in the other categories rely on one or more substances. This is a term he will return to in the Metaphysics, and will underpin his entire philosophy.

There are also those descriptions which can be said of other realities. This relates to the fundamental relation between those things which are the general and then the less general. This can be stated as cup is said of a particular tea cup or human is said of a particular woman and also in the case of non-substance categories like taste is said of umami. Now this language he uses in categories is specific to this book but it is congruous in form with the system he sets out between accidental and essential predication as well as universal and particular things which are set out in his Metaphysics. Without these universal substances nothing else could exist Aristotle thinks, because each secondary thing is either a part of or said of the primary substance and exists only in relation to it.

This understanding of substance accompanies us into the Metaphysics and helps us grasp the meaning of Qua Beings. This is just being in general but Aristotle want’s to make sure that this is kept from becoming an ambiguous discussion and really ensure this is a single science of being, “Something is said to be in many ways, however, but with reference to one thing and one nature— that is, not homonymously.” This is an ontological claim about being encompassing a series of complex qualities and related things. When we talk of health we can say that someone is healthy and that some food is healthy but when we think of what health is personified as in a healthy organism we can say that is the primary meaning. Everything else like a healthy diet and healthy snack are just related things that are healthy in the primary sense.

This argument is made clearer as a way to equate being and substance in book Z where he says that being in the primary sense is the same sense in which substances are beings. Its secondary sense links to non-substance categories which I’ve already set out from his work in the Categories. This means that the question we ask when we say "what is being” is the same as when we ask “what is substance.” His real concern here is the essential feature of what substance is. While he feels he has set out the kinds of things that substance is in Categories he hasn’t answered what makes it a substance — the essential feature, “for it itself is unclear, and furthermore the matter becomes substance.” 

Aristotle continues to battle with himself on just what that could be and as he continues he causes dissension in the ranks of his followers as they try to parse out the apparent contradictions that he has built into his work and definitions. This question, however, of the most basic most essential feature of the primary objects is also what Alfred North Whitehead is attempting to grasp at throughout his Process and Reality, and what he lays out his ground work for in the first section of the book. I will look at how that argument is structured and how his pieces flow together, and how others have helped to interpret this dense tomb.

This seminal work from Whitehead has had great influence on the philosophical world and was originally a lecture series given at the University of Edinburgh in the late 1920s. I will start with chapter one where Whitehead focuses on setting the stage by discussing large picture views on the very nature of philosophy itself similar to the discussion we see around substance in Aristotle. He divides his chapter into six parts which I will individually discuss and look at the main themes he espouses.

Like any good philosopher, Whitehead begins his first section with a definition, and will continue to focus on defining his terms throughout the chapter. His first is of speculative philosophy which he sees as a

“endeavor to frame coherent, logical, necessary system of general ideas in terms of every element of experience.”

A definition that, while perhaps encompassing its meaning, far from elucidates its underlying impact upon the discussion. My interpretation is that this means a type of philosophy that looks at the world and attempts to draw generalized and logical systems of explanation for everything that is around. This system includes both rational and empirical study and will face certain frustrations common to theories like these that intend to answer these more general questions.

In the second section Whitehead explores just what generalization means in this context. He says that philosophic generalization should be understood as a means to utilize specific notions, applying to a restricted group of facts, for the divination of generic notions which apply to all facts. This is similar to Aristotle who also believed we must move from the things “more known to us” and move to the things “more known in themselves.” These in their final form ought to be rationalistic ideals which bring coherence and logical perfection Whitehead holds. This, however, is no simple task.

He writes in his third section that many philosophers attempt generalized theories but few successfully avoid two fallacies that he has noted in his research. The fallacy of misplaced concreteness comes about when the philosopher forgets how much you can actually abstract the question being worked upon. This leads into the second which is a false estimate of the logical procedure in respect to certainty and in respect to the premises. What he is essentially saying here is that by abstracting too far from those specific facts, philosophers are liable to build these complex generalizations on a weak foundation. This harm can be compounded when philosophers fail to heed his advice in section four in which he argues that in a similar way to how the Newtonian physics had to be updated as time continued, so too our foundational generalized principles should also be updated and changed, reflecting our new and growing knowledge of those things around us. He says that one aim of philosophy should be to challenge these first principles of both science and previous philosophical thought.

In section five he discusses the tools of the philosopher, namely language. This he believes is a powerful tool but limited in that by using it in the form we have it we can allow language to hide complex diverse meanings in a simple subject predicate statement. This impact is most clearly felt when we forget that metaphysical systems should only be approximations of the general truths sought. This is some of the motivation behind his use of very convoluted and complex language which, while difficult to grasp, accurately and precisely states his intentions.

Finally he writes about philosophy in relation to science and religion. He has been referencing how philosophy and rationality can critique each other but now he puts a finer point on it by suggesting that philosophy should be the conjoining point between science and religion bringing those both into one rational thought. This will play a greater piece in the picture when it becomes clear that an understanding of a god figure is intrinsic to his view of the universe at the end of the section.

In chapter two of Process and Reality Whitehead focuses on setting out the different building blocks of his philosophical theories. At the very end of the chapter in section four he refers to these categories he sets out as indicative of the rest of his work, or as the solution every question that is coming up in his work. As a result each idea he describes and category he goes over is packed with detail and meaning. He starts, however, with a discussion of what makes up speculative philosophy and how it endeavors to frame the logical and necessary general ideas we need to describe our surroundings.

To best understand these general ideas, he writes, we must depart from using the kinds of terms philosophy did at the time of his writing. He draws a comparison to regular science where in the past more flimsy terms, which he refers to as old faculties, were used to describe those functions and abilities of the body and human experience we didn’t quite comprehend. It’s his analysis that these same less than substantive terms have made their way into philosophy, and while science has weeded them out philosophers still lean upon them.

He proposes that we do away with them then, and begin to refer to such things as actual entity, prehension, nexus, and ontological principles. These will replace those very abstract notions such as

“mere awareness, mere sensation, mere emotion, mere purpose, mere appearance, mere causation.”

By failing to replace these, he fears, we build our systems of philosophy upon weak grounds.

These changes he feels also get to the purpose of philosophy. Philosophy ought to focus on drawing explanation from abstract ideas that can be pulled from the physical around us and in order to do that we must have a strong system for organizing the world into categories which he explores in sections two through four. The top line categories are that of the ultimate, existence, explanation, and obligations. Each breaks down further, with existence having eight categories below it, explanation having twenty-seven and so on.

A thought he returns to regularly during this chapter is the idea of limitation around what can and can not be abstracted from and towards the end he writes that “every entity pervades the whole world.” I read this as arguing that some things are not able to be abstracted from the rest of existence and must be considered in concert with the rest of reality. This comes out of the fourth category of explanation where it seems that the idea of "complete abstraction” is a self contradiction. I think that’s because he believes every ultimate actuality has a principle of unrest within it which is Whiteheads way of saying those things are in the state of becoming.

This also leads to his discussion of a thinker not thinking the same thing twice. He extends the principle behind the sentiment that no one crosses the same river twice (referring to the qualitative identity of a being) which comes from Locke’s understanding of ‘perpetually perishing.’ He ends the chapter by tying this all together as his fight to push back against the Aristotelian logic that has been ruling in the metaphysical world, he seems to believe, since the classical period. 

It’s very clear in this chapter that he considers his analysis and his terms to be far superior to the system that we’ve discussed from Aristotle which has held the attention of so much of the philosophical world ever since. Even just changing the vocabulary to be more “precise” in his eye is a snub to the ideas that have come before. I worry perhaps however that such a quick assessment and brushing off, as it were, misses the realities of being one of the first to write comprehensively on this subject matter, as Aristotle was.

Finally, in Chapter 3 Whitehead jumps into the nature of God and explaining how it effects his theories. He explores some very dense language first with statements like

“by reason of this complete valuation, the objectification of God in each derivate actual entity results in graduation…”

which creates a base from which he builds out how his idea that God’s primordial nature, which he understands as unconditioned conceptual valuation of the entire multiplicity of eternal objects. All this is going to help build the foundations for his theory of concrescence.

At a very basic level Whitehead continues to set out in this chapter his view on everything that does exist in this world and each of those existing items he refers to as actual entities. Those actual entities are made up of prehensions. A prehension will concresce together with other similar prehensions through three different phases to at the end form this actual entity. This is a very simple representation of a far more complex series of arguments that utilize very specific language, and doesn’t get into how prehensions are the derivation of the physical feelings of an actual entity or how the private ideals of an actual entity are formed during the valuation of an eternal object. It does however provide the ground level understanding that can allow us to continue to a discussion of how this theory builds up Whitehead’s understanding of what God is and how that entity “God” relates to the rest of us.

Whitehead sees this process of concrescence starting on a very basic level of emotion to prehension, prehension to prehension, and then on to an actual entity. He sees this occurring throughout life, and throughout the universe too. These things concrescing together are analogous to society, how in one sense it is a unified object but in another it is a series of loose and collated pieces that could be separated down. In separating them however it would lose the aspect to it that makes it set apart and makes the society something unique. Similarly Whitehead will argue going forward the universe slowly concresces together to form a higher sense of existence in the form of these eternal entities which make up his understanding of God. Similar to  Spinoza’s god this would not be an accessible being to us, and perhaps not one that we could even experience in any way but comes into existence out of our collective existence.

Towards the end of the chapter Whitehead also discusses the difference between atomism and continuity. Essentially he joins the debate between those who say things are always becoming and those who argue instead that there is some enduring objects. Whitehead takes the position that there is someway to stand between these two positions, and that in the way that light can be both a wave and a particle where a particle is certainly an enduring object the wave shows that at times it is more enduring and sometimes less.

These great thinkers are both developing alternate understandings of the universe but are doing so in similar paths. They both come to the question of what exists surrounded in a miasma of preconceived notions and until-now-unquestioned beliefs that they intend to shatter upon the hard face of systematic argumentation. They both believe we require better all encompassing views that work from what we currently understand back to the ultimate truths that are hidden beneath.

Where they differ however is more interesting. It looks to me like Aristotle is attempting to argue that from these perfect generalities everything else can be formed or at least known. Those ultimate positions would create for us a deep understanding of the rest of reality and that they explain how we can all exist as we do. For Whitehead however he seems to be looking for a way to divide. He wants to do as the scientists have done and divide down to the atom of philosophical thought. With each actual item in reality there is a concrescence of prehensions which are a  brought together from still smaller concepts. He wants to look at how those small building blocks can be divined and then after working out how that structure can work apply its form to other things in our world to understand the relationships between them. If an actual item can be formed by these prehensions then our society can follow a similar arc and so too our universe perhaps can develop and portray the features that might be emergent –– greater than the sum of their parts.

I do not believe either philosopher to be entirely correct with their positions on the realities they both describe. For me it seems that there is not available empirical proof that the universe is greater than the sum of its parts and generally I find arguments to that effect to be greatly problematic. Fundamentally in my view we ought to be basing our understanding in that which is known and not basing views upon a guess at that which is not known. Still that does not leave me following after Aristotle, who I view as putting forward a theory that doesn’t appear internally consistent between his books. I do, however, find his structuring of the universe into categories as a useful endeavor which would be vital to any view I might subscribe to.

 As we struggle in this field to grasp at lasting answers there is always the next person ready with a magnifying glass to pick out the loose leg of our argument and I think fundamentally that’s an excellent thing. I think Aristotle puts us on the right track. Instead of accepting that the gods are mysterious and unreachable he gives us the structure to pull them down from their heavenly seats. With Whitehead I think we see a desire to leave behind some Kantian and Aristotelian dogma that have clutched at our vision of metaphysics and break free once again to ask those starting questions we should so often be revising in Whitehead’s opinion. 

I think it’s even more instructive to see how in recent years Whitehead’s thoughts have really leapt from mere obscurity to be leading contenders in a myriad of fields. I think it belies a desire in our new generation of philosophers to reach back for some of those old gods and structures that we long for but find a way to root it in science and well developed philosophical thought that seems to give itself credence in its complexity.

What I was reading and leaning on:

Aristotle. The Metaphysics. Newburyport: Dover Publications, 2017. Accessed April 21, 2020. ProQuest Ebook Central.

Aristotle. CATEGORIES. United States: CreateSpace Independent Publishing Platform, 2016.

Lango, John. “Towards Clarifying Whitehead’s Theory of Concrescence.” Transactions of the Charles S. Peirce Society 7, no. 3 (July 1, 1971): 150–167. http://search.proquest.com/docview/1303708510/.

Locke, John. An Essay Concerning Human Understanding. Kitchener: Batoche Books, 2000. Accessed April 21, 2020. ProQuest Ebook Central.

Physics. (1999). United Kingdom: Oxford University Press.

The Lure of Whitehead. United States: University of Minnesota Press, 2014.

Whitehead, Alfred North, David Ray Griffin, and Donald W. Sherburne. Process and Reality : an Essay in Cosmology  Corrected ed. / edited by David Ray Griffin, Donald W. Sherburne. New York: Free Press, 1979.

Ethan Somers on Process and Reality Ch2

Find this book here, and find a great resource on Whitehead here.

In chapter two of Process and Reality Whitehead attempts to set out the different building blocks of his philosophical theories. At the very end of the chapter in section four he refers to these categories he sets out as explanatory of everything else he will cover, or as the solution to every other question he will discuss. As such each idea he describes and category he goes over is very dense and I hope he will spend more time delving into each. He starts however with a discussion of just what makes up speculative philosophy and how it endeavors to frame the logical and necessary general ideas we need to describe our surroundings.

To best understand these general ideas, he writes, we must depart from using the kinds of terms philosophy did at the time of his writing. He draws a comparison to regular science where in the past more flimsy terms, which he refers to as old faculties, were used to describe those functions and abilities of the body and human experience we didn’t quite comprehend. It’s his analysis that these same less than substantive terms have made their way into philosophy, and while science has weeded them out philosophers still lean upon them.

He proposes that we do away with them then, and begin to refer to such things as actual entity, prehension, nexus, and ontological principles. These will replace those very abstract notions such as “mere awareness, mere sensation, mere emotion, mere purpose, mere appearance, mere causation.” By failing to replace these, he fears, we build our systems of philosophy upon weak grounds.

These changes he feels also get to the purpose of philosophy. Philosophy ought to focus on drawing explanation from abstract ideas that can be pulled from the physical around us and in order to do that we must have a strong system for organizing the world into categories which he explores in sections two through four. The top line categories are that of the ultimate, existence, explanation, and obligations. Each breaks down further, with existence having eight categories below it, explanation having twenty-seven and so on.

A thought he returns to regularly during this chapter is the idea of limitation around what can and can not be abstracted from and towards the end he writes that “every entity pervades the whole world.” (28) I read this as arguing that some things are not able to be abstracted from the rest of existence and must be considered in concert with the rest of reality. This comes out of the fourth category of explanation where it seems that the idea of "complete abstraction” is a self contradiction. I think that’s because he thinks that every ultimate actuality has a principle of unrest within it which is Whiteheads way of saying those things are in the state of becoming.

This also leads to his discussion of a thinker not thinking the same thing twice. He extends the principle behind the sentiment that no one crosses the same river twice (referring to the qualitative identity of a being) which comes from Locke’s understanding of ‘perpetual perishing.’ He ends the chapter by tying this all up as his fight to push back against the Aristotelian logic that has been ruling in the metaphysical world he thinks since the classical period. In reading his thoughts I found myself a little lost with the number of new concepts but I think by referring back to this chapter regularly throughout the rest of the readings will help in understanding it’s importance immensely.