2.1 - What it Means to be Human with Carter Snead

What is common to all humans? What characterizes a human being? Professor Carter Snead provides an answer to these questions with the "anthropology of embodiment" described in his book, What it Means to be Human. Join us as we explore the shared nature connecting all humans beyond our perceived differences, divergent ideas, and preconceived notions.

52 minutes • Published Nov 18, 2024 • Download • Transcript

Recommended readings

What it Means to be Human, Carter Snead
After Virtue, Alasdair MacIntyre
Enough: the failure of the living will, Angela Fagerlin, Carl E Schneider
Taking Care, President's Council on Bioethics
President's Council on Bioethics
Justice: What's the Right Thing to Do?, Michael Sandel

Transcript

[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi and welcome to the Hippocratic Society Podcast where we aim to help physicians and trainees thrive by giving them the tools to pursue and practice good medicine.

My name is Michael Egan and I'm joined by Dr. John Rhee and Professor Carter Snead.

Dr. Rhee is a board certified neurologist, neuro-oncologist, and palliative care physician at Dana-Farber Cancer Institute and Instructor of Neurology at Harvard Medical School.

He's a young member of the Pontifical Academy of Life and co founded the Hippocratic Society as well as serving as its Vice Chair and Executive Director.

Professor Carter Snead is the Charles E. Rice professor of Law and Concurrent professor of Political Science at the University of Notre Dame, as well as the former Director of the de Nicola Center for Ethics and Culture.

He's also one of the world's leading experts on public Bioethics and was appointed to the Pontifical Academy for Life in 2016.

He also served as General Counsel to the President's Council on Bioethics and has written more than 70 journal articles, book chapters, and essays,

including the book that we will be discussing today,

what It Means to Be Human the Case for the Body in Public Bioethics. Thank you both very much for joining me today. It is an honor and pleasure to have you here and I'm very excited for the discussion today.

Thanks Michael.

Great to be with you. Thanks for having me.

Great. So we are dealing with an ambitious topic today. We what it Means to be Human.

Obviously a huge question and initially it seems obvious why this would be important. But before we really dive into the discussion, I'd like to take a moment just to understand why we really care about this.

So, I mean, I've gone most of my life as a human interacting with other humans.

Most of your life?

Most of it.

But living a human life. Certainly not perfect. But why do we need to examine what it means to be human?

I'm a human, you're a human. We have our own experiences. We've each contributed to our understanding of life and identity. So why do we need to talk about what it means for everyone to be human?

Well, it's a very big question,

as you suggested.

My own area of expertise, as you mentioned, is in law and what I call public bioethics, which is the governance of science, medicine and biotechnology in the name of ethical goods.

And law is an irreducibly normative enterprise, just as medicine is it, is it all law aims to promote some sort of a good, or to avoid or remediate or punish some kind of a harm.

And so it necessarily trades in thick principles of justice and freedom and autonomy and equality and these kinds of questions. But at its root, what law is for in the same way that medicine is,

it's for the protection and flourishing of human beings, it's for the protection, flourishing of persons.

And so. And to understand law, all law, but especially public bioethics,

to practice medicine,

you have to have a kind of orienting presupposition, at least about what human beings are and what constitutes human flourishing.

So to know whether a law is just, wise, or humane, ultimately you have to ask, the question is whether or not this law contributes to or detracts from the flourishing of human beings, which requires you to have at least some operating definition of what a human being is.

And frequently in my book, I looked at different particular legal contexts, the legal context of abortion, the legal context of assisted reproduction, and the legal context of end of life decision making,

and asked the question, in American law, in the American legal landscape, what does the law presuppose a human being is and what human flourishing is, and does it get that question right?

And if it gets that question wrong, it goes off the rails pretty quickly and erects structures and puts in place processes and provisions and substantive arrangements that are antithetical to human flourishing.

If it gets the question of what a human being is wrong. And same thing in the context of medicine.

Medicine is a profession organized around the good that stands outside of the practitioners themselves. It's not simply a set of techniques that are learned and applied for whatever purpose a person chooses or whatever a customer is willing to pay for,

but. But rather,

medicine is organized around an objective, discernible, discoverable good. The good of human health.

And health itself is an objective criteria that helps us understand what medicine should and shouldn't do.

What's, for example, what is enhancement versus what is therapy? Just to take a context out of bioethics and health is ultimately a question of what it means to be and flourish as a human being.

What does a healthy human being look like Presupposes the prior question of what a human being is in the first place.

Yeah, thanks so much, Carter. And I think that summarizes it so well.

To give a little bit of context of perhaps an example in medicine, where this is very relevant is in the area of end of life care. I often hear, especially as a neurologist and neuro-oncologist, this question of when there's cognitive deterioration, for example, where a family member may say,

oh, this is no longer my father in front of me. And I think that this is a really important question that is really frequently brought up by both patients and their family members.

And we would treat that person in front of us differently if we no longer considered them the person that the person thinks is the patient. Right. And so these questions have a much bigger impact on how we think about the care that we offer to patients and also how we think about maintaining their sense of dignity at the end of life.

If we do really believe that despite the fact that somebody has deteriorated cognitively, whether that's due to cancer, whether that's due to a neurodegenerative condition,

how we still maintain that essential dignity for that human person.

Okay, yeah, thank you both very much. That was very clear. So obviously very important for ourselves, for our patients, for the law, and what it means to actually function as a society and community.

So let's turn to the question at hand. What does it mean to be human?

Well, actually, I'd like to start on the other side. What does it not mean to be human?

In the framework for public bioethics, you identify expressive individualism as an anthropology that lacks a true account of what it means to be human,

but nevertheless has formed a lot of American public bioethics. And in explaining expressive individualism, you quote Alasdair MacIntyre as saying that it is forgetful of the body.

So my question to you is, how can someone forget the body? Or what does that even mean? And what are the consequences for that?

Yeah. So as I mentioned a moment ago, when I took a hard look at the current legal landscape in the United States concerning abortion,

assisted reproduction, end of life decision making, the question I asked is what vision of the person comes to the surface when you look at these laws sort of inductively and work backwards from what the law says and what it does to what it must be, presuming about what human beings are and what human flourishing is?

And what came to the surface was a kind of vision of the person that very closely tracks what philosopher Charles Taylor and Alasdair MacIntyre and social scientist Robert Bella describe as expressive individualism.

And it's a kind of imperfect and Impoverished partial vision of what human identity, human flourishing is.

That becomes highly problematic when it becomes the sole account of what we are,

when it's meant to be the comprehensive account of what we are and what it is. Expressive individualism, it sounds like a hyper technical philosophical or social science term. It's really not.

When you unpack it, it becomes immediately recognizable as presuppositions about who we are and what. And what our flourishing consists in.

Expressive individualism understands human beings as individuals. That is first and foremost the fundamental unit of human reality is the individual person, the individual self defined,

separate from, abstracted, from, shorn of any constitutive attachment. You don't understand the person in the context in which the person arises through his or her attachments to family or tradition, or to religion, or to culture, or to civilization.

You define them strictly as an abstracted unit, which already you can imagine is very artificial because there's no such thing as a human self that exists in isolation.

So already you were beginning with an abstraction.

It's a kind of, it's. It's a kind of conceit about what persons are like. We start with the atomized individual self, unencumbered by any sorts of attachments. And then you move to the definition of what the person is defined entirely according to their will and their mind and the operation of their mind.

The person, the real you,

is your mind and your desires and your will and everything else about you, your body,

your relationships, is instrumental to the flourishing defined through the lens of the will. And what flourishing consists in, in this framework is the interrogation of the depths of one's interior sentiments,

your own sensibilities, your own views that are unique to you. To sort of introspectively think about what truths are inside of you,

authentic, original, sometimes transgressive truths. And then to articulate those, to express those,

and then the configure your life plan accordingly to, to use the truths that come from inside to configure your life plan and to orient your life and to configure your life in a way that in pursuit of those goals that, that arise from that process of introspection.

And,

and so what again, what defines the person is his or her capacity for cognition and the content of that cognition.

And you can already see how that divides the world up of humanity into persons and non persons, right? Those who are capable of that kind of cognition, that kind of introspection, that kind of creative process,

are deemed to be persons. And those who can't are not yet persons, maybe never will. Be persons are no longer persons based on that cognitive model of personhood. And that's something that we in bioethics see an awful lot, especially in the debates over abortion and embryo research and end of life,

where you say, okay, well, this actually picks up on what Dr. Rhee was saying. This is no longer a person because they're no longer capable of the kind of cognitive activities that we associate with personhood.

And within this framework,

you not only define the person as an individual chooser, that's the fundamental reality of personhood, but it becomes what philosophers say, or it is what philosophers say. Anti teleological in the sense that external givens, your body, your relationships, nature, et cetera, are not useful to help you understand and,

and negotiate the world around you. There's nothing you can learn about who you are or what you owe to other people. For example, by thinking about the natural configuration of your body, of nature itself, of your relationships and so on, the only truth that matters is the truth that comes from inside you.

Only the inner voice is definitive. And by extension, there's no such thing as an unchosen obligation or a constitutive attachment. There's no one who has a claim on you, a natural claim on you, for example,

that obliges you to do anything or entitles you to certain kind of privileges or help or assistance or care by virtue of your relationship, your embodied relationship. So, for example, parents and children don't have a natural relationship that is normatively important,

that provides children with.

With privileges that they don't have to earn, and parents with obligations that they don't, they don't choose.

And relationships become transactional, even family relationships become transactional. And so the world of expressive individualism is the atomized individual will,

you know, seeking to pursue their own goods as they understand them, their own authentic truths as they understand them, sometimes in collaboration with other wills, but often, maybe even more often than that, in adversarial relationships where they have to overbear other wills to achieve their goals.

And you can see, and Robert Bella found this in his social science research,

that under this framework, under this anthropology, and I'm going to use the word anthropology to describe what it means, a vision of human identity, human flourishing, not in its academic sense, but it's kind of more literal sense of an account of what it means to be a person.

This anthropology of expressive individualism is corrosive of family relationships because people see their lives and their. And their destinies is not bound up in these natural relationships, but Rather,

through the lens of their own will, their own projects. And when a natural relationship, let's say a relationship between a husband and a wife or parent and child, becomes antithetical to the goal that they have, that they have in their minds.

And those relationships are no longer important, and they get discarded.

So expressive individualism is true in some limited sense. It's true in the sense that we are free and we are particular.

We are particular individuals and viewed from some perspectives,

but it's not the whole truth about who we are.

And when you don't take into account,

and this is to your question,

what does it mean to forget the body? It doesn't take into account the fact that human beings are not mere individuated wills, but. But rather human beings are dynamic, integrated unity of mind and body.

What Jewish philosopher Hans Jonas called a psychophysical unity.

Or what Aristotle has called a hylomorphic unity,

integration of mind and body.

When you forget the body, the embodied aspect of our essential natures,

you can first of all have a deformed view of what our obligations are. You can forget entire segments of humanity who are not capable of flourishing as defined by expressive individualism.

Children, both born and unborn, the elderly, the disabled. They all are not even recognizable as within the boundaries of the moral and human community.

Because they're, or at least they're not deemed persons. And the word person becomes distinguished and disentangled from the word human being,

which has, in my view, very dangerous and deleterious effects both for law and medicine.

Again building on what Dr. Rhee was saying a moment ago.

And so by forgetting our embodied nature,

you leave behind an enormous amount of what it means to be and flourish as a human being. And you leave behind huge whole segments of the human family.

And so remembering the body is an essential corrective to this. And what does embodiment mean? Well, embodiment brings with us because we're finite beings. We're fragile beings. We're beings that age and get sick and die.

That means that that situation situates us into a kind of relationship with one another. In which we're reciprocally dependent upon one another.

We are vulnerable,

as I said, by virtue of our embodiment. And we. And that. That puts us. And that actually has consequences for defining human flourishing, which I'm sure we'll get to in our conversation.

I don't want to jump too far ahead,

but if you define human beings exclusively through the lens of expressive individualism, you miss a massive amount what it means to be human being both in your own Sense.

In fact, if you think about expressive individualism, it only really describes human identity and human flourishing at a small,

finite temporal moment in the arc of human existence, which begins in the womb in a state of total dependence upon other people. When you're incapable of the kind of cognitive creativity that expressive individualism presupposes for flourishing.

And then if all goes as well as it could possibly go, you begin a kind of gentle arc upwards through where you become eventually independent, sort of. Of other people capable of.

You sort of grow into your powers and you have the cognitive capacity and probably the social privilege and. And positive circumstances that are sufficient to actually impose your will in the way that expressive individualism contemplates.

But then you immediately pivot backward, downwards towards a state of total dependence again at the end of your life. And that's the very best case scenario.

There are people who are radically dependent their entire lives, or people have disruptions throughout their lives in which they become dependent on others.

And expressive individualism misses all that and acts as if human identity, human flourishing, can be understood through the lens of one precise,

short moment in the human developmental lifespan really reserved to the most privileged among us.

Yeah, thanks so much, Carter. And I think that there are a couple things that came up as you were talking that I just was reflecting on. One is this growing,

I think, understanding in medicine of psychosomatic disorders and how really the body is so important, even in just medicine and diagnosis too,

that for a while we've been thinking about just persons as kind of these, like, feelings or perhaps just their will or just their cognition.

And the reality is that, like, that spills over into one's body because one's body is also part of oneself. Right.

And I think a greater acknowledgement of that will also help us with treating patients better as well.

The other thing that it made me reflect on is this idea that as a palliative care physician, I take care of people at the end of life. And repeatedly, again and again, when I ask a patient in front of me, what is the most important thing to you?

It's always,

I'm thinking about my daughter or I'm thinking about my family or my wife. And, you know,

it's always relational.

And so though we have in our culture this idea of perhaps an extreme of this idea of autonomy, the reality is in the lived experience of the everyday person,

it's the relationships that matter the most. And at the end of life, it's those relationships that get accentuated. Right. Because when you have limited time and you're thinking about what's most important to me right now.

People always think about relationships and what will happen to those people that they love after they die.

And the other day I was having a discussion with another physician friend of mine who's also a palliative care doctor,

and he was talking about this idea where, you know, we spend so much time talking about advanced care planning and making sure that we have our decisions set so that if we lose consciousness, the doctors know what to do for us.

And he made this comment that I thought was really interesting where he said, but, you know,

it doesn't really matter for me because if my wife wants me to be on a ventilator for a longer period of time and that would give her more peace, then I would want that too, because what she cares about is what I care about, and if it would give her peace,

then I would be okay with that. And I think also that is how generally people feel. Generally people feel that if their loved ones needed more time, if their loved ones felt like they, you know, were going through this tough decision making process or whatever it might be, that their loved ones decisions actually trump their own decisions because of this fact that there is this intrinsic understanding that we depend so much on one another and that the

most meaningful aspect of this lived experience, experience is this relationality.

And so I know you talked about the embodiment, Carter, but I was wondering if perhaps you could also talk a little bit more about this aspect where you're talking about the relationality between persons.

Yeah, well, so I think they're deeply connected to each other. I say in the book that by virtue of our embodiment, we're made for love and friendship. So the relationality emerges from the acknowledgment that we're embodied, finite beings that are subject to sickness and senescence and injury.

And so the expressive individualism posits that what you need for flourishing through that lens of anthropology is radical freedom to do whatever you want to do without encumbrances of family or even nature.

Whereas anthropology that takes embodiment seriously recognizes that the fundamental reality of our existence is mutual dependence.

And what, what human flourishing is.

Well, in the first instance, by virtue of our embodiment, we're dependent upon other people for our survival. Right? Like you, all of us, all three of us here on this podcast are here today because someone,

when we were completely vulnerable at the beginning of our lives, made our good their good, decided to put all of their energies and interest into. Into making sure that we were taken care of and not in a transactional way, not because they had a contract to do it, not because they were expecting some kind of return on investment for doing it,

but because that is the intrinsic to the nature of the relationship itself. And probably for those, for, for all three of us, it was probably our parents that did that.

And so but as we grow and as we, we, we, we, we, we. In taking a step back, what's required for flourishing through an anthropology of embodiment is what Alasdair MacIntyre calls networks of uncalculated giving and graceful receiving composed of people who are willing to make the good of others their own good.

And that gets to the relationality that you're asking about. John it is by virtue of our embodiment we stand in a kind of relationship to one another of reciprocal dependence which becomes the foundation of even our self definition.

I can't understand myself and Alasdair MacIntyre says I can't understand myself or what I'm to do unless I understand the stories that I'm a part of and those because human beings are ultimately narrative creatures and understand the world through narrative.

But the fundamental feature of those narratives are our relationships, our families, our friends.

And I argue that what flourishing consistent is not the radical assertion of the unencumbered will, but rather taking care of one another. In factually we are most human and we are at our highest flourishing when we're caring and being cared for by one another.

And that's why medicine is essential obviously to this worldview.

Also and it's interesting you're talking about the end of life decision making piece and people and what you've observed empirically in your practice has been also demonstrated in social science evidence.

Carl Schneider,

I think her name was Amy Fagerlin, if I'm not getting that right, wrote a really interesting piece in the Hastings Center Journal. I think it was called Enough the Failure of the Living Will.

And the President's Council on Bioethics in its book, in its report Taking Care also picks up on this thread the idea of if you understand human beings solely through the lens of will and autonomy,

the end of life procedure that makes the most sense is this kind of remote control document where you say I'm going to govern my, my treatment through this living will, this, this written instrument that tries to contemplate and anticipate and imagine what all my needs are going to be,

set them forth according to what I want right now, when I'm in the peak of health, when I execute this document. But what most people actually really want.

And Schneider and Fagerlin found this when, when you go to the doctor, you don't go to the doctor because you're trying to assert your unencumbered will and exercise your autonomy.

You go to the doctor because you are sick or you're hurt and you need help and you need somebody to take care of you, someone to take care of you who knows what they're doing and who's committed to your flourishing and your healing.

Not merely a transactional relationship, but rather someone who wants to take care of you. And in the ideal scenario, and sadly, tragically, not everybody has this. You have loved ones, family members who accompany you in that setting.

And when they did social science research, they found that most people really would rather to do the thing. First of all, they just want the doctor to help them and they're happy to pursue whatever treatment protocol that a well meaning doctor informed by their loved ones wants to do for them.

Not a sort of a single minded focus on maximizing autonomy.

And it is the case that people would rather have their family make decisions for them. Which is why, by the way,

operationalizing this, and I don't mean to bring everything back to law,

but in the President's Council on Bioethics I talked about the legal form that most closely tracks the human context. Here is not simply an advanced directive that sets out in a discursive way in a document, which one, but rather durable power of attorney, where you have a decision making process,

where you designate someone, optimally, someone who loves you and wants to take care of you, who takes into account your wishes, of course, and a document can help inform that process, but a real human being who's making decisions in your best interest, informed by the patient that you are now,

and what you need now is more consistent with embodied flourishing than a kind of artificial conception of human beings as disembodied wills.

I really love that Carter and I wanted to bring it back to some of the precepts that we think about in the Hippocratic Society,

especially as it relates to when patients are making decisions towards the end of life. There's a sense where, this growing sense that I've been feeling where it's really unfair for the patient and their family when a doctor presents to them two to three options and says choose.

Really what the family wants is actually guidance. Because the doctor is the one who has the idea of what may make the most sense and also what may be good for the patient.

And that's why we're trying to do this here at the Hippocratic Society, right To help people form an idea of what the good is for patients in order to then be able to accompany them.

And I think that it's also good to think about and reflect on, especially for the medical students, residents, but also the physicians who are listening right now,

the idea that it's relationality that brought us to medicine in the first place. I mean, the reason why medicine has become so competitive or has always been competitive and is really hard to get into is because it is a profession which people really want to be, because they want to place other people's goods ahead of their own,

that they want to be in a place where somebody comes in a state of suffering and. Or distress,

and that you, as a physician, want to be there for that person.

And traditionally, that was the role of the physician. I mean, it was vocational in the sense that sometimes you also knew that you might not get out in time because you know that this person who's in front of you is suffering,

that you are thinking about their good. When we saw this during COVID too, right, where physicians were putting their life at risk, their lives at risk by taking care of patients, knowing that they may also have harm to their own body, right?

Own bodily harm, but recognizing that there was a good in which they were self sacrificing themselves for the good of the patient.

And that though we often talk about this idea of autonomy, that in our. In the way that we actually make decisions, every day, we are striving for this ideal, I would say, of self sacrifice, a desire to give of self to other.

And that comes from this importance on relationality.

And the last part that I just was thinking about is this idea, when I also hear this often, where perhaps there's a slight misunderstanding of this relationality in end of life care, where a patient, where I repeatedly hear patients saying to me, for example,

doc,

you know, maybe I shouldn't live anymore because I'm just being a burden on my daughter, or I'm just being a burden on my wife, or I'm just being a burden on my family.

And I always try to help patients reframe that a bit because it is actually, like you said, Carter, the most human when we are taking care of others, when we enter into this dependency of one another.

And there's a sense in which, though you may not be able to physically do certain things, that in that vulnerable state, if you accept the love of another person who cares for you, that you actually help them become more human, you help them grow in the virtues of love,

of service, of humility, of all of these things. Right. And that helps them flourish in a way that is.

Yeah. So deep. And I try to remind patients of that, that the importance that sure, they might not be able to physically do certain things anymore, but that doesn't mean that there isn't growth that they're helping their loved ones still grow in through this flourishing framework.

Yeah, I mean it's,

it's really important what you,

what you just said. I mean in my own work I've, I was doing research on end of life decision making and, and one of the major factors in people deciding to pursue assisted suicide in those jurisdictions that allow it or even to discontinue life sustaining measures is because the sense that they believe that they're a burden to their family and,

and it just can't be. I mean it's in the 90, 90 plus percent people who, who pursue those end of life choices are.

That's what's motivating them.

And,

and that's really.

It can't. And, and the thing that you just said about the kind of role of the physician in that setting as a kind of healer, not just in terms of the body, but also in terms of the,

in terms of the familial context,

really makes the case for the indispensability of the Hippocratic Society, I have to say. Because one of my big worries, I mean I, I was formed,

mentored by extraordinary physicians in my own, I mean, not as a doctor, but as in bioethics, by people like Ed Pellegrino and Paul McHugh and Dan Foster and Leon Kass.

And the biggest worry that I have about the practice of medicine and the ethic in the clinical context and the ethical context, which includes these familial relationships, not just up or down decisions about particular interventions,

is how do you train doctors so that they know have any idea at all how to do what you just described?

Right.

If you, if the, if the medical education that we have and the premedical education we have is, is a reductive account of how to technically change different physiological processes or to steward physiological processes in a particular direction without attending to the human dimension of this, the deeply human and fraught dimension of the doctor patient relationship,

not just with the patient, but with the family and the patient's relation and what the patient wants and needs,

we're in huge trouble.

And the question I've always come back to is how do you make more Ed Pellegrinos, Leon Kass's, Dan Fosters and so on. How do you form doctors in the humanistic sense,

to be able to recognize and do something in that situation where they see the human drama unfolding, where the patient in most cases probably wrongly believes that they're a burden to their beloved ones and all the loved ones want to do is take care of them.

And so that requires a kind of humanistic formation that at least medical education, as it's currently configured both pre med and at medical schools, as I understand it, is not designed to do.

What you end up with are extremely talented and creative and smart technicians.

And so that human formation is why what you're doing is absolutely indispensable.

Now, I'll tell you a funny story.

When I finished my clerkship with an amazing judge, Paul Kelly in the US Court of Appeals for the 10th Circuit, I went back to DC and was working at a law firm and it was awful.

And I would get home late at night and this is going to date me,

I'm old,

er would be on and I'd come home, my wife would be there and er, come on. I'd get a lump on my throat. I was like, why didn't I go to medical school?

I could be doing something that helps people actually,

as opposed to,

as my 1 critical legal theory professor in law school said, instead of creating and resolving ambiguities in language for the purposes of benefiting a corporate client.

Right. So that was. Now that's a little bit of an exaggeration, but. But it is the case that medicine is a. Is a profession, as Gil Meilaender and Paul Ramsey and Leon Kaz.

Leon said you know, famously and Gil and Ed, that medicine is a profession which means you have to have something to profess. It's not simply a set of skills that you learn to become a technician to do whatever the client pays you for.

It's actually profession that's organized around a set of goods that are external to the individual and the techniques themselves, but they're oriented towards namely the good of restoring human health.

And that.

But the human context that you're talking about is so complex and so difficult and so rich and thick that it requires a formation that,

that you all are hopefully going to fill in some gaps.

That's big gaps that are missing in medical education.

Yeah, that's exactly what the Hippocratic Society is for and exactly. We're hoping to do with these podcasts and our monthly meetings and everything that we do. So I'm glad that you also see the importance from it, even from the legal side and the education side of things.

But on that Note specifically with the anthropology of embodiment, are there any practical ways that our doctors, students,

residents, everyone can live out this anthropology of embodiment both in the clinic, in their daily life,

just any sort of practical ideas that they can keep this at the front of their minds and not just let it be another idea?

No, it's a great question. And I mean, I'm not sure how practical this is, but I. I'll start with this, right?

The most important,

the thing that especially people who are, who live in their heads, people who are smart and people who are academically accomplished, which are, which describe people who go to medical school and are practice as physicians.

There's a deep temptation to reductively think about ourselves only through the lens of mind.

What I am is my mind. What I am is my capacity for make, analysis and formulation of desires and pursuing those future directed plans that emerge from introspection and cognition.

Like to think of ourselves when, when. When you're really good at thinking and you're really blessed and it is a blessing because it's not something that you earn, you don't earn.

I mean, you obviously hard work, you develop your capacities and so on. But like it is,

we have to understand the fundamental nature of the giftedness and of our situation, that we're given extraordinary tools and not that not everybody has.

People have different kinds of gifts. But you can start to think of yourself exclusively in terms of cognition.

And that is a dangerous path to go down because that leads you,

could lead you into embracing expressive individualism.

So one of the counter measures for that, it seems to me, is sort of practicing cultivating moral imagination, right? Thinking, remembering, trying to think about. This gets into what MacIntyre calls remembering the body.

But thinking about and remembering the arc of our life and its fullness, both in the first instance looking backwards, but also looking forwards and thinking about conditions of dependence, like moments in your life when you were radically dependent on other people.

And everybody has them at the very most fortunate people have them at the beginning and the end of their lives, right?

Think about people that you love who suffer from disabilities. Think about children, think about the elderly, think about the disabled,

think about your neighbor and try to imagine,

Imagine what that life looks like, what your life looks like. Everyone, as MacIntyre says, exists on a scale of disability. The arc of human life is marked by dependence because of our embodiment.

And you have to be remind yourself and to remember and to cultivate that kind of moral imagination. To remember so that you can feel those connections and you can Hear those calls of other people who have claims on us that we didn't choose right.

And not just in the limited to the context of medicine. Right. Think about the poor and the vulnerable. Think about the claims of our friends and neighbors and people that we've never met before have on us by virtue of our shared membership in the human family.

And what I talk about in the book to try to cultivate the sort of the ethic that I'm talking about is through the practice of what MacIntyre calls the virtues of acknowledged dependence.

Now, he has my list of the virtues of acknowledged dependence is a little bit longer than Alistair's,

but he wasn't talking about bioethics. And in any event, what I mean by that. The virtues of acknowledged dependence are the virtues and practices that are appropriate to the flourishing that embodied human beings aspire to and hopefully have, namely,

the flourishing that exists only in these networks of uncalculated giving and graceful receiving.

The flourishing that is marked, that is basic survival right at the very beginning of life or at the end of life, but also learning to become the kind of person that makes the good of his or her,

of others his or her own good,

friendship in the deepest sense of the word, in the Aristotelian sense of the word. The idea that seeking and desiring and acting for the good of the other is what human flourishing is in the framework of the anthropology of embodiment.

And what that requires you to do is to practice and to think about these virtues.

The virtues of uncalculated giving are the virtues of just generosity, that is, giving to the other. For this in proportion to and because of the need of the other, not because you're seeking to maximize a return on investment or get something for yourself.

Hospitality, welcoming the other because he or she is a stranger. And this one, the third virtue of uncalculated giving is essential to the practice of medicine is misericordia,

that is the virtue of making the suffering of another person your own suffering,

to seek to ameliorate that suffering through the art of medicine. But when the art of medicine is exhausted, to simply accompany the other in his or her suffering.

And then the virtues, the flip side of the virtues of graceful receiving, and the principal virtue of graceful receiving is the virtue of gratitude.

The virtue and gratitude engenders a whole array of other virtues, namely, humility, the understanding that we have what we have and we are where we are because other people made our good their good.

Everything is a gift. Everything is dependent upon the beneficence of others.

And that leads you to embrace what Michael Sandel is called the ethic, and others have called the ethic of giftedness, which leads you to the openness, to the unbidden. Not approaching the world with an attitude of rational mastery.

The idea that everything and every person I encounter is an opportunity for harnessing and bending them to my will, to try to extract from them or from nature the things that are essential to my life plan, but rather taking people as you find them.

And this becomes essential in the context of parenthood and re. And reproductive medicine in particular, where instead of approaching infertility with an idea of rational mastery and ordering nature to your preferences,

welcoming children as gifts,

understanding that the. The child that you. That you,

God willing, have, whether it's through natural procreation or adoption or whatever family formation mechanism is at work,

is a gift that stands to you in equal dignity. It's a child that's begotten and not made,

as Gil Meilaender puts it,

the virtue of solidarity, that we're all connected to each other, whether we like it or not or whether we choose it or not. The virtue of human dignity, the inexorable and matchless worth of every human being from conception and natural death.

The virtue of truthfulness, which is obviously essential to the practice of medicine. All of which the virtues of receiving and giving can be understood through the lens and under the aegis of the good, of friendship most richly understood.

And the things that can help you to cultivate those virtues and practices which are necessary to creating and sustaining the networks of uncalculated giving and graceful receiving that I'm talking about.

Those virtues are cultivated and developed by practices that take you outside of yourself, that draw your gaze up from inside to outside,

to looking around to find the people who need us to hear the voices that are calling out for our help, whether they're in our own family or they're around the world.

And the paradigm of virtues, of giving and receiving and these networks and these virtues, the paradigm is parenthood, right? The relationship between parents and children is the relationship between,

in its optimal form, best embodies the relationship of uncalculated giving and graceful receiving. And not everybody's a parent. Not everybody has the vocation to parenthood.

There are spiritual parents a lot. Everybody is somebody's child, of course,

but not. But there are different kinds of parenthood. There's spiritual parenthood, there's biological parenthood,

there's adoptive parenthood. And all of them give persons the opportunity for the practice of these virtues.

Thanks so much, Carter and These are things that we're going to hopefully continue talking about in some of our. A sub podcast related to this larger podcast. This idea of how we could have more of this reflective approach to life.

Right. Especially as you talk about this idea of misericordia, I was thinking about this idea that somehow, even in the context of friendship,

when you share something that you are suffering from with another person, just talking about it, and then that person receiving that suffering and accompanying you somehow lessens that suffering on your heart.

Right.

And so just the sharing in that relationship lessens that burden of suffering. And I think that that's like the beautiful idea of how when we can enter into taking on the burden of suffering from our patients,

that we could do that. I mean, just the patient telling us about what they are going through. If we are there, present, attentive as physicians, we can actually alleviate their suffering just by being present in their suffering with them.

The other thing that I was just thinking about was this idea that last week I was with a friend's family whose brother has autism, and we were spending a lot of time together.

And it's amazing how.

Yeah, oftentimes when we are with others with disabilities, whether they be physical or cognitive, intellectual,

that somehow it naturally draws from us this empathy or this desire to love and care for that other person,

and that there is something very deeply human about that and that we should reflect a little bit about that, why we feel that and why we feel so drawn to that naturally.

I think that those natural sentiments, feelings,

things that we're drawn to are oftentimes also indicators within ourselves as to what is deeply human. And I think that those aspects are important as we approach patients who are also suffering,

recognizing that there's a sense in which we desire to accompany them, but also that they draw out from us these. These virtues, this desire to be with and accompany,

and then also in that context,

to not react to our sometimes initial gut reactions, which is somebody suffering and I have to end their suffering right at that moment at all costs. That actually in some ways is counterproductive because of the fact that there is a sense in which being with another person in their suffering draws out one from another.

This. This dependency, this relationality that makes us very human.

And so I think that just generally, this reflective approach to our patients and will only help us be more human ourselves. And then also to understand their humanity and their inherent dignity, too.

Yeah, no, I think that's.

That's very well put. And I would say not to circle back to law. And I should Add I'm happy that I went to law school and I'm a lawyer and I think practicing law and teaching law is really fantastic and richly human and rewarding.

I just was not happy with the particular moment in my professional life at that time.

But the reason I mentioned law is because what you just said to me is relevant in two ways to bioethics, right? So medicine exists within a legal framework. Law, law, law sets the boundaries of what's permissible and not permissible with a wide array of flexibility for doctors to practice medicine according to their ingenuity and their creativity and so on,

and rightly so. And there's not a lot of day to day regulation of the practice of medicine which we could talk about separately. It's mostly, it's done at the front end licensure and certification of doctors.

And then once that happens, there's wide flexibility for doctors to practice. But there are outer boundaries, right? The law actually touches and shapes medicine in important ways. And there are two senses in which that's relevant to what you just said, one of which is the fact is when there is,

because of the shape of our law and because of the, the, the, the widespread practice of eliminating unborn babies who have certain kinds of disabilities, especially down syndrome in particular,

we are robbed of the opp. Not just is those lives are for the sake of themselves. Being lost is a grave tragedy and injustice. But we are lost of the teachable moment of being with people who deserve our care and need our care in that way.

And obviously people with disabilities don't exist to teach us things. That's not their role.

They exist for the sake of themselves and are dignified and imagine the image likeness of God and deserve all the protection and care that we can muster. But if we live in a world where there are no people who are suffering in the way that you're describing, no kids with autism,

no kids with down syndrome,

no elderly people who we have to take care of.

We are not going to learn what human flourishing really consists in. And we're not going to be able to become the kind of people that we're supposed to be because we've eliminated those opportunities through a kind of misguided sense of compassion or emphasis on autonomy or something like that.

So the law matters a lot in terms of the pedagogical benefits of those human relationships and drawing out those natural inclinations we have to take care of other people.

And the same thing's true at the end of life also, right? Not just the beginning of life at the end of life. I mean, you hear in places like the Netherlands and places where assisted suicide and euthanasia become legalized and become part of the menu of possibilities for what when you go to see the doctor,

the kind of frustration and the lack of capacity to alleviate suffering can lead a frustrated doctor into choosing or recommending assisted suicide, euthanasia, etc. And that's been shown time and again in interviews with these doctors that live in these,

in these jurisdictions. And one of the most chilling examples is a doctor who, when asked about a particular kind of bowel disorder, which you can surgically treat and correct in children with down syndrome, doctors, I usually just deal with that through euthanasia.

And so, and this is Leon Kass and his really important essay, for Neither Love Nor Money, why Doctors Shouldn't Kill,

talks about the kind of distrust in the doctor patient relationship that will arise from situation legal contexts in which euthanasia is permitted.

And that kind of trust that we've talked about throughout for physicians and patients is eroded in ways that are deeply, deeply problematic. And I would just for your listener's sake,

it's important to focus on medicine, the practice of medicine, the clinical ethics and the humanistic formation. But law matters an awful lot in this setting, and law shapes the practice of medicine by allowing or even mandating what doctors can and can't do.

And I would just say, perhaps just to finish off,

we were talking a lot about how kids or others that we know with disabilities draw this out from us, the sense of love and care for them.

Just kind of wanted to share this beautiful story of the converse side, which is, you know, when I spent the time this past week with this family's friend's friend's family and his brother with autism,

as I was leaving the house,

he, you know, because of autism, he has some difficulties with, like, social relationality.

And so he didn't make eye contact with me, but he was kind of looking off to a distance, but was saying,

mom, when is John coming back? Can John come back for Christmas? Can John come back for Christmas? And he kept like, repeating that. And there was this like, really,

like, deep kind of beauty to that because I felt so loved in that moment by him. Because clearly something about the visit, you know, made him feel like he really wanted to spend more time with me.

But also that there is this vulnerability there when one says that because one is vulnerable to express the fact that he really also enjoyed my presence. Right.

And that is something that I think that when we're vulnerable to each other,

that we help others feel really loved. And also in that context,

I think we could think about our friendships as well and also our relationships with patients that at times that vulnerability, one with another can help us express that love for one another and care for one another at a very deeply human level that makes each of us feel like we are truly loved for who we are.

Thank you, John. That was a very beautiful story and thank you both. This has truly been extraordinarily informative. I hope all of our listeners has gotten something out of it and just really touching discussion on how we live our shared nature.

So be sure to check out the follow up episodes to hear more about how to live like a human,

especially through the virtues of embodiment.

And Professor Snead, you have, you're working on a book currently. Do you would like to say anything about that?

Yeah, I,

I just signed a contract with Harvard University Press, which published my first book, to do another one,

tentatively entitled Ethics at the Edges of Humanity, which is about how different revolutionary developments in biotechnology challenge us to think about the boundaries of the moral and legal community for human beings and the human family.

And in particular I'll be taking a look at the biotechnologies of what are called synthetic embryos. The creation of what may or may not be embryos using pluripotent cells,

the creation of animal human chimeras, especially animal human chimeras that have brains that are made of human neurons and non human animals who can produce human gametes.

And then the third example I'll be looking at are the weirdest and kind of most mysterious neural organoids, the what are sometimes controversially referred to as mini brains that are structurally and functionally behave as brains do, although there is no,

that's, that's the, they're not attached to,

to the rest of a body.

And,

and there are deep questions about markers of humanity and parts and holes and what it means to the grounds of human viability and dignity that I'm going to be exploring.

And the thinker that I would commend to your listeners also that I'm going to be using to help think through these different questions is the Jewish philosopher of science, Hans Jonas,

who had an extraordinary influence on Leon Kass and Gil Meilaender and other towering figures of medical ethics and bioethics. And Hans Jonas thought very deeply about the philosophy of science and the phenomenon of life and the notion of unchosen obligations.

And brilliant, brilliant philosopher student of Heidegger, Jewish student of Heidegger. And for those of you who don't know Heidegger became a **** and was a philosophy professor in Germany and had very famous students, Hans Jonas, Hannah Arendt and others.

And Hans Jonas fled Germany at the beginning, right before World War II, first went to Israel and then went to the United States, where he finished his academic career.

And he dedicated his life and his career to, in his words, saving the concept of being from Martin Heidegger and to show that being is good and that human organisms and all living things are good and worthy of protecting.

And showed the continuities between the lower forms of life and the higher forms of life in a way that inverts the problems of Darwinism. It doesn't simply, it doesn't lower the higher,

it doesn't reduce man's status in the order of things, but rather retains that hierarchy, but elevates,

elevates the lower and brings us into closer connection with the natural world rather than denigrating mankind. So it's a very, he's a fascinating thinker and I think we'll, we'll it'll be interesting to bring his thought to a wider audience with the new book.

Wow. Sounds very interesting. We're very excited for that.

And thank you all so much for joining us. Please Visit us at hipsoc.org to learn more about the Hippocratic Society. Sign up for our newsletter or donate.

And for any questions or feedback, email [email protected] thank you once again, Dr. Rhee and Professor Carter Snead, thank you. We appreciate it.

The Juris Doctorate is also a doctorate, just to be clear.

Great. We'll see you next time on the Hippocratic Society Podcast.

Thank you.

Thank you very much for joining and reflecting with us today.

Keep up with new episodes by subscribing to the Hippocratic Society Podcast.

For more information on the Hippocratic Society, visit us at hipsoc. Org. The Hippocratic Society is a 501 C3 and depends on the generous support of its listeners. And as always, we'll see you next time on the Hippocratic Society Podcast.

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