The Disappearance of Moral Knoweldge

Ben 0:00
Hey y’all welcome back to beyond surviving residency, a podcast dedicated to helping residents like you find more rest, fulfillment and clarity amidst the chaos of residency. I’m your host Benjamin long. Through this series, I hope to equip you with practical tools to move away from just surviving presidency and toward flourishing despite it. Today we’re diving into what I mean when we’re talking about moral knowledge and its importance in becoming a good physician. My guests today are Dr. Aaron Preston, who is a professor of philosophy at Valparaiso University, and Dr. Steven Porter, who is a professor of spiritual formation and theology for the Talbot School of Theology and Rosemead School of Psychology, both of which are at Biola University. Both Aaron and Stephen earned their PhD at USC under Dallas Willard, and if you’re not familiar with Dallas’ work – Dallas was a philosopher and devoted Christian, known for his writings on spiritual formation. And today, we’re chatting about his book, “The Disappearance of Moral Knowledge,” which was completed posthumously by three of his pupils, including Aaron and Steven. Y’all, this was such a good conversation, we break down what moral knowledge is, how it disappeared over the last 100 years or so, and why it’s important for us to know on our journey to becoming a good physician. I can’t wait for y’all to hear this. I’m happy to introduce you to my new friends, Dr. Aaron Preston and Dr. Steven Porter. Let’s get started.

All right, I am here with Dr. Steven Porter and Dr. Aaron Preston, thank you all so much for joining me today on beyond surviving residency.

Steve 1:59
Thanks for having me here.

Ben 2:00
Yeah, yeah, absolutely. And, you know, y’all are kind of the first for this podcast. First time, I’ve had two guests at the same time. And kind of the first time that I’ve had, I guess you would say, non-medical persons on the show, so I’m really excited for you all’s perspective and being here today.

Steve 2:24
that would be non medical would be a very good description of me. I mean, I don’t even like to put on band aids on my kids.

Aaron 2:36
Steve’s a joker,

Steve 2:37
No, I’mSerious, Aaron! I am a joker but “Non-medical,” I mean, I take that label. I own that label.

Ben 2:48
Good! All right. Well, I do have to start off by just saying thank you so much for your work in helping to finish Dallas’s work with “The Disappearance of Moral Knowledge” has really been formational in my thinking, as I’m kind of moving forward. And some of the things I’m trying to help bring to medicine, although I have to frame that within that I’ve done some ambitious things in my life, but just picking up this book without any kind of background in philosophy or anything! Now kind of into it. I was like, “Man! what? How presumptuous was I like, ‘oh, yeah, I can read this book, this no problem.'” It’s, it’s so good. But I do find myself reading a couple pages. And I’m like, “wait a second, what did I just read?” So thank you all for your minds, and being able to like, think about ideas and things. And that is just something that I am not versed on. So thank you all for that.

Aaron 3:55
Well, you’re welcome. I think, for all of us, it was a real honor to be able to participate in that project. And we are grateful to you and others, like you who have shown interest in the project beyond the boundaries of academic philosophy. So that’s a wonderful thing. And thanks for your efforts and grappling with the text.

Ben 4:15
Ah, thank you all. So one of the main focuses of this podcast is kind of digging deeper into the formation of persons during medical residency. And specifically, I’m really interested in the moral formation that occurs with physicians-in-training. So whether you know, unconsciously or consciously kind of taking in what is good or bad or appropriate or inappropriate within medicine. And so I think this book, and this idea of the disappearance of moral knowledge is really a helpful framework, because although, you know, we’re kind of going through some of the history of how that has happened within philosophy. I think it’s certainly mirrors some things that have also happened within medicine as well. So I think a deeper understanding of what has happened here within this domain will be really useful for people to understand. You know, when we we show up to medicine and to medical training, I think I had shared this before we started recording with Aaron and that I just thought that I just had a deficit of knowledge. And so once my brain uploaded, all of the medical knowledge, then out would come a good physician. And I realized that’s not the case. There’s so many decisions that you make that are outside of kind of biomedical decisions. And I think one of my previous guests, Dr. Warren Kinghorn from Duke said it really well, that he said, “how we practice as physicians is really, ultimately inseparable from the kinds of human beings that we are.” And so I am excited for you all to kind of help us maybe lay a little bit of a foundation when we are starting to talk about good persons in medicine, maybe giving us something to build off of when we’re talking about good persons, essentially.

Steve 6:12
Yeah, I think that’s a great vision, then, and in whatever discipline we’re in, I think it becomes a very important question to ask, and this is certainly central to what Dallas Willard was attempting to do in the disappearance of moral knowledge, but to ask ourselves, “what is a good person?” And “how does a good person function in this field or in this setting or with these conditions?” And that’s a different question, really, then, you know, “what do the rules say?” or, “what is ethical?” or, “how can I avoid litigation?” or something like that. It’s really to think what would actually be good for the people that I’m trying to care for. And I think, I mean, I’m, again, I’m non medical, I’ve already declared that but but in all sorts of areas of life, right things change, when we’re motivated by what is good, and what is good for others, and what is good for ourselves and those who are most impacted by our decisions. I think I’ll just real quickly, I think of the example of, you know, for a long time, I follow traffic laws stopping at stop signs, you know, not trying to jet through a yellow light drive, you know, trying to drive the speed limit. I follow traffic laws not so well, partly because I just didn’t want to get caught. If I could float through that stop sign without getting a ticket, then I was probably prone to do it. So, I was really thinking about traffic laws as a constraint on my freedom and in an unwelcome constraint. And I was, you know, oftentimes looking for, for whether there was a policeman, you know, hidden behind the bushes so that I could bend the rules. And it took a very close call actually, on the freeway, when I realized no, the reason to stop at stop signs, it’s because I don’t want to hurt anybody. And I drive much differently now because I’m motivated by what is good, and what it means to be a good person behind a steering wheel of a, you know, a loaded half ton or full ton vehicle that that can go 100 miles per hour. You know, there’s a different kind of way of living when when we begin to see what is actually at stake. And I think that’s what moral knowledge can do for us in life is it gives us that different motivational structure, that different moral psychology and it changes the texture of how we approach the world and how we approach our profession. So all that to say, a long, long diatribe there, but I think what you’re describing for people in the medical field is, is is vitally important for for all of us in all sorts of areas of life.

Ben 8:55
Yeah, thank you. And I think that is a kind of good segue, I would like us to bring maybe the cookies down a couple of shelves a little bit. And for people who haven’t quite thought through this or been exposed to this before just laying the foundation of first when we’re talking about moral knowledge, how would we kind of describe that?

Aaron 9:17
Well, Steve, you want to take a shot at that? Or would you like me to

Steve 9:20
Aaron, why don’t you go ahead.

Aaron 9:22
Okay, well, so moral knowledge, just to put it in what I hope are intuitive terms is just knowledge about how one ought to live one’s life. So it involves knowledge of good and evil, right and wrong. And you know, for Dallas, the center of our understanding of the moral life is the good person. So a central question when it comes to moral knowledge, if you’re approaching this from a Willardian standpoint is, “Who is the good person? What is the nature of the good person in general?” And then, “how can I take this general understanding of a good person and try to incorporate into the particulars of my life?”

Ben 10:02
Yeah. And then I think, you know, I think most people who kind of come into medicine just, they’re so driven and focused. And really, so many people also wanting to serve as well, that there’s really a lot of good intentions, and even commitments and callings, especially people from maybe more of like a religious background that, you know, really feel like this is where God has kind of called them to serve and to do their work in the world. And I think there’s so much of these discussions within medicine that aren’t necessarily directly biomedical decisions or things that can be necessarily tested in a lab, and moral knowledge. It seems like it’s – as I’ve been reading through this book and kind of learning more about it – it’s like, “yeah! this is something that occurs in everyday life of what I’m saying is good or bad, or what I’ve been taught in the kind of medical training environment, and yet no one seems to talk about that explicitly.” And so I think that’s a good segue into maybe, how did it disappear? What has been the evolution of that?

Steve 11:21
Yeah, I’ll try to tackle that. It’s for Willard – it’s a long story. But I think what you’re describing Ben, in your field, Willard would say, is fairly widespread in our culture, which is that when moral knowledge of the sort that Aaron was discussing disappears from society, what Willard meant by that was that we were no longer able to present moral claims as how things actually are in the world capable of rational scrutiny and rational and reasonable disagreement. And so, moral judgments moral claims are oftentimes either we just say, “well, that’s just my opinion,” or, “that’s just kind of our group’s point of view.” And of course, you can have your own. And so we don’t engage out of a kind of default moral relativism. Almost that no one, you know, it’s kind of rude to say that, “I’m right about morality.” So there’s that kind of disengagement and silencing of the conversation. And then there’s a kind of, you know, moralism – in our at least in the North American context today – which is, at least in certain settings, where you can’t, to actually defend a certain moral point of view is almost seen as a betrayal like, “we don’t actually have to, we all know this is the obviously right thing.” And so to even try to question it, or even argue for it better or refine it or scrutinize it, that’s almost seen as kind of a betrayal of my tribe, whatever my tribe is, because we all know that, “vaccines are right,” or we all know that, “vaccines are evil.” And so to have a rational conversation with evidence, and to really try to pursue knowledge on morality is again, almost – and Willard would say, for various historical and kind of cultural causes sociological kinds of reasons that really stemmed back over, you know, several hundreds of years, in our context, we’re at this place today – where you really can’t have a sustained, careful conference conversation about moral disagreement, or even moral agreement for that matter, that goes very well. It’s just kind of, you know, either immediate dismissal of alternative points of view, or an extreme reluctance to present differences of opinion, at least on certain moral issues. I find in my classes that sometimes it’s far easier to have a an interesting moral discussion about some issue that’s not, you know, that there isn’t a lot of controversy around because, again, my students are so well, some of my students again, just to kind of illustrate are either so careful not to upset anyone that they’re unwilling to engage, even though they might have a different opinion. Or the other side of that I have other students that are just so certain that they have the right perspective, that they’re willing to kind of silence any sort of consideration, even if it’s a hypothetical, you know, kind of what about, you know, the other perspectives on this, they want to silence those other perspectives. And so it’s really so the disappearance of moral knowledge is a kind of a cultural condition where we can’t refine our moral point of views in public discourse, and that seems to be there and I’m curious your perspective on that. But that seems to be a very A good diagnosis of a lot of what’s going on in our in our culture today.

Aaron 15:05
Now, I think you’re exactly right, Steve. I mean, for Dallas, when he talks about the disappearance of moral knowledge, he’s careful to say he doesn’t mean that moral knowledge isn’t out there to be had. He doesn’t mean that there are no individuals who have moral knowledge. He thinks that, as individuals, many people do have some moral knowledge and operate on the basis of it. But it’s rather a cultural condition where the leading institutions of culture, from government to the universities to the professions no longer operate as if they were in possession of a body of knowledge. Concerning, right, wrong, good, bad, the nature of the good person, how to live your life. And of course, that extends into issues like how you practice medicine, how you conduct business, so on and so forth. So as as a recognized body of knowledge at the level of our cultural institutions, moral knowledge has disappeared. And as Steve mentioned, there’s a long historical process involved here. That stretches well, I mean, you could go way, way back. One of the most interesting things about Dallas’s book, The disappearance of moral knowledge is that he gives us sort of quick sketch in chapter one of the book about some of the concerning some of the main contributing causes to the disappearance of moral knowledge that mainly focuses on things that were going on in the, in the 19th and 20th centuries. But then, in the final chapter of the book, he reaches back much further in history and give just a very quick gloss on some of the main trends in moral philosophy, beginning with the time of Plato, and then sort of advancing to the contemporary world. And so you could take this all the way back to the beginnings of Western culture, if you wanted to. But here are just a few of the more recent contributors to the disappearance of moral knowledge, again, with the question in mind, how did moral knowledge disappear. And you can see this in chapter one of this disappearance of moral knowledge. Also, you know, for your Christian listeners, there is a book by Dallas called, “Knowing Christ Today,” which has a chapter – chapter three – in that book directly addresses some of these issues. It’s kind of like a synopsis almost of a lot of the disappearance of moral knowledge.

But in any case, one of the things that Dallas always mentioned was the moral failures of Christian culture and the discrediting of the visible church as the moral and intellectual guide to human life in the West. He thinks that this was a significant contributing factor to the disappearance of moral knowledge, because once people lost faith in the institution of the church and the content of Christianity, as a morally transformative teaching, they started to have doubts about moral knowledge more generally.

Second, there was an increasing demand for scientific education. And this was mainly driven by military and market needs in the latter quarter, let’s say of the 19th century and, and then into the 20th. One of Dallas’s favorite books that he often would recommend is by a woman named Julie Reuben. It’s called, “The Making of the Modern University.” And she details these shifts in education in some detail. She explains how this came about in the context of leading American universities. And so part of the story there is increasing demands for scientific education. And one of the things about science is that it traditionally has been viewed as not capable of addressing issues of value. So one of the things that emerges in the rise of scientism in the 20th century. scientism is essentially the view that only science yields knowledge. Bertrand Russell, an influential, influential philosopher of the 20th century, said in a 1935 book, “what science cannot discover mankind cannot know. And science has nothing to say about values.” This was the mentality that emerged by the 1930s in leading American universities, sometimes referred to as the, “Fact-Value Distinction.” And this was, I think, the real turning point when it comes to the disappearance of moral knowledge. Because once values were separated from the category of facts, then it’s really not possible in principle, to have moral knowledge at all. All you can have are moral feelings. That’s how Russell thought about it. Values were just ways you feel about things. You either like them or you dislike them. But there is no fact about whether these things you like are actually good, whether these things you dislike are actually bad. And then by extension about what is right or wrong to do in relation to these things that You value or reject is valuable. So those were the educational shift plus the rise of scientism, as a sort of cultural mentality was a big part of the story of the disappearance of moral knowledge. You’ve got then a number of very specific curricular changes in university education in the United States, again, detailed by Julie Reuben in “The Making of the Modern University,” one of the very interesting things that happened is that between about 1870 and 1930, responsibility for moral education, which originally resided with philosophy in the form of moral philosophy, this responsibility for moral education was was handed over to the sciences. And there was a for several decades and attempt to make moral training as scientific in various ways. And when that failed, moral education in the universities was handed over to the humanities, other than philosophy, and they generally at this point, under the guidance of the Fact-Value Distinction, tried to teach morality on the basis of feelings. So, you know, reading inspiring works of literature with good role models, and so on. The hope was that this would cause certain sorts of moral feelings to emerge in the reader, and that one would sort of be shaped on an emotional level, by their exposure to literature and art and so on. And that’s somehow make them good people. And, you know, feeling does have an important role to play in the moral life. But the traditional view is that it’s not sufficient on its own, it needs to be coupled with actual cognitive insight. And certainly Dallas’s view as well. And so trying to base morality on feeling alone, sort of inevitably led to a kind of subjectivism or relativism. And ultimately this was reinforced, as time progressed, and the humanities became infiltrated by what we might loosely call postmodern thought. The relativism that was already grounded in this scientific fact value distinction was reinforced by postmodern relativism, which was taught in various humanities and then also social science disciplines. And this is the sort of thing that if you remember the book, “The Closing of the American Mind,” by Allan bloom, published back in the 1980s, was a very popular book, this is the sort of thing that he was pointing out and criticizing in the American University and Bloom doesn’t realize that there’s a much longer backstory, it wasn’t just infiltration of postmodern thought. This sort of scientism that had emerged in the early part of the 20th century played a massive role in in the disappearance of moral knowledge as well. And then you’ve got the rise of a dogmatically imposed hidden curriculum, as Dallas calls it, which is essentially oriented around progressivist ideology. And that’s where a lot of this unwillingness to hear each other and speak with each other and reason with each other, and the attempts to silence each other sort of comes from. So there’s a somewhat more fine grained discussion of some of the general themes that Steve was speaking about a few moments ago.

Ben 23:13
Yeah, absolutely. Yeah. I couldn’t help but think, you know, the starting point of that of the church’s own moral failing to not produce these persons who have been significantly changed by their their faith as just like, “Well! We’re not doing too much of a good job of that nowadays.”

Aaron 23:36
And, of course, it’s Dallas, his writings on precisely that issue in the form of talking about discipleship and spiritual disciplines and their role in transformation that he’s best known for. So it’s interesting, when you stand back and look at the whole body of Dallas’s work, a lot of it is really oriented toward this phenomenon of the disappearance of moral knowledge and how we might recover from it, even if it’s not obvious on the surface.

Ben 24:08
Yeah. And I think such a good corollary to that within medical education to is just this concept of the hidden curriculum, and we talk about that often on previous episodes. But it really is this, I think, in the book says something along the the forcefully imposing this comprehensive moral outlook, that then like, doesn’t accept responsibility for that outlook in and of itself. And seems like the same thing kind of happens within medical education, from my perspective of that, you know, we’re striving to be good physicians and yet, on an individual level, if I asked you to think of a bad physician, probably most people would kind of think of someone but then responsibility for producing those bad physicians, no one really talks about that, you know it when we see things in the news of these physicians who have hurt patients who have done things for their own gain, you know, at least me it feels like that, “Man! That’s so sad that that person progressed to that point and hurt so many people.” And yet I feel like much of the blame is put on what that person’s just doing their own decisions and actions, and they’re a bad person. And we need to do better about screening bad apples from medicine. And my perspective that I don’t really see many people talking about is, “Is it possible that we are forming vulnerable persons and residents to make decisions and have behaviors that are more and more antithetical to the patient’s good?” that results in these physicians who do these egregious things that we think are wrong, but then also at the same time, then even just that kind of goes back to then it’s really obvious to see, you know, someone has been abused or a patient neglected that that is wrong. But then once you try and bring that more to the moral margins, I guess I would say, then it goes back to we don’t have this common standard or way of discussing in this situation, what should the good physician do? And there can be a lot of talk on different opinions and different kinds of perspectives on things. But it seems like trying to bring my point back around, that having all these things in the hidden curriculum is actually quite dangerous, because then we aren’t able to actually look at and analyze and critique and challenge when things are arriving in that hidden curriculum that are antithetical to a patient’s good. Essentially. I don’t know if you’ll have any thoughts on that whole diatribe?

Aaron 27:04
I mean, that sounds exactly right. To me. And I think, I think it’s, it’s fair to say that, you know, hidden curricula are they’re probably an unavoidable part of human life. Because basically, a hidden curriculum is a form of inculturation. And inculturation is unavoidable. But what is avoidable? Is this attitude of unwillingness to examine the Hidden Curriculum when it comes into conflict with our our sort of, in the moment, moral sensibilities, okay, here’s the way we normally do things. But in this particular case, this doesn’t seem right. And so, you know, let’s talk about this, you know, maybe we need to maybe our standard operating procedure that we just sort of unconsciously employ, as a matter of routine needs to be revamped in light of the experience of this present case, whatever it is you’re dealing with. And so being open to scrutinizing the rational basis of standard operating procedure, and whatever field you’re in, is an important part, I think of being a good person. But what tends to happen, in part because of the particular ideologies that are that are now in place behind this, this hidden curriculum in the universities, but also, in part just due to, I think, a natural human tendency to not want to, you know, open cans of worms and so forth, it is to say, No, I don’t want to talk about that. Or, you know, to question this makes you a bad person somehow, why are you questioning the standard ways? Why are you questioning tradition? Why are you questioning professional norms, and that there’s a sort of incentive to, especially within professions, think that one’s moral obligations are exhausted by a professional code of ethics, or something like that, but really, the moral domain is much more complicated than anything that could ever be presented in a professional code of ethics or system of laws and customs. So we need to be open to asking these questions, you know, why? “Why do we do things the way we do? Could we be doing them better?” And the unwillingness to do that as a real problem.

Steve 29:17
I’ll just just add to that, you know, I think that discussion of the hidden curriculum is is vitally important. And then what’s not in the curriculum, and I and Ben, as you describe training in medicine, you know, I imagine that it’s very competency driven, and I’m thinking of that Walker Percy quote, that, “you can get all A’s and flunk life.” And I think, you know, is it possible to be a well trained, competent, highly proficient physician and yet be a bad person. And then what I mean by that is, is to have character defects that that are that are going to get one into trouble one way or another, and, and so is character formation, part of medical training, and oftentimes, you know, in whatever field and certainly professions, again, we, we put this into an ethics class. And I think part of what we want to say is, you know, adding another ethics class, you know, might help, but how is moral and spiritual formation an intrinsic part of training in, in medicine? So that, I mean, is that is that something that, that students are kind of just left to deal with on their own, you know, and, and then, of course, in medical training, in most fields of advanced training, there’s hardly any time and so the, the whole issue of, of self care comes up, but self care oftentimes gets turned into a kind of, you know, are you getting downtime or something, and, and, in good sleep and good exercise, and all of that’s vitally important, but it’s, it’s only a small piece of this larger overall way of life, of living well, and becoming a good person. And that’s part, that whole discussion, and that, that there’s actually any hope of developing moral character. That’s part of what’s what’s really dropped from our, from our conversation. And we, you know, we to, quote another book title that was popular back in the mid 20th century and mentally, you know, we’re amusing ourselves to death. I mean, we just, we’re an entertainment culture, and we, you know, we think self care is a binge watching Netflix or something like that, rather than again, what are the practices, spiritual and otherwise, that I’m involved with on a daily and weekly basis that are actually forming my character, such that I’m, I’m becoming more patient, more kind, more compassionate, more loving? And that’s, that’s what’s needed in any field? And again, that’s what’s missing in the church, oftentimes, unfortunately, and it’s, it’s certainly what’s missing in in our cultural conversation.

Ben 32:04
Yeah, absolutely. And I think this is a, you know, definitely moving us toward the solution that Dallas was proposing to step outside of that long conversation and kind of locating this distinction in real life and to have the good person as the central subject of moral theory. So could you all kind of give us a little bit of an overview of this argument and Willards description of a good person?

Steve 32:34
Well, let me read Willards description and say a couple of things about it. And then Aaron, you can you can take a deeper dive, but Willard defines a good person as, “someone who is intent on advancing the various goods of human life with which they are effectively in contact in a manner that respects the relative degrees of importance of those goods, and the extent to which their actions can actually promote the existence and maintenance of those goods.” And part of what Willard is doing is, I mean, he’s speaking to moral philosophers and ethical theorists. And so in some ways, he’s advancing this thesis on the good person as a way to return ethics to, to the person and to see the person and really the human will, as the fundamental subject matter of ethics. So he’s making a theoretical move. But he’s also making a very existential move that I think he’s trying to return. And maybe this is where, you know, for non philosophers, non ethicist. This is where you can kind of connect with this, which he’s trying to take us back to a basic fundamental human experience, which Willard at one point refers to another thinker named Emmanuel Levinas, Levinas who talks about the face, the face of the other, but this human experience of being confronted with another person, as a person, and being confronted with their pain or their distress or their their concern and addressing that and the demand that is put on us. existentially Not, not so much of the demand that society puts on us or God puts on us but but really trying to root ethics in that first person acquaintance with I’ve got to do something about this, you know, this is not right. And so Willard is trying to help us and help I think, his readers and help his students help all of us kind of come back to that experience that that hopefully we all have, and in various ways, though, again, for various reasons, some of us, you know, are not very attuned to this, but that experience of, you know, this person’s suffering needs to be remedied and it’s in it’s not just a physical matter of how do I put a bandage on this or how do I fix this physical condition, but some moral injury, and it’s a moral injury due to our society or due to someone’s actions, and I need to stand for this person, I need to stand with this person, perhaps I’m the perpetrator in some ways, and I need to seek forgiveness and restitution and reconciliation. So, the whole point of the good person is to acquaint us with ourselves and our own awareness of what is good and what is bad and and then our own growing intention to count for good to be persons who are appropriately aware and concerned and responsive to the goods that can be advanced within our sphere of influence. And that point about, you know, that I read there that actions that can actually promote the existence and maintenance of the goods. Willard was a realist in many ways, but one of the ways he was a kind of practical realist, when it comes to ethics, as he thought he thought we should act locally that we should really start from where we’re at, and what we are in the best position to accomplish and be most effective at, which oftentimes is, you know, the people we live with, or the people that we work with, or the or our literal neighbors. And so to start with those whom were in effective contact with and seek their good, and what can we do to bring about the goods of those around us? And I think that’s very actionable for, for people in the medical field, because you’re, you’re constantly thrust in front of people who are suffering, who are in pain, who are needing help, and then to seek their their care in various ways.

Ben 36:36
Absolutely. Aaron, did you have anything to add?

Aaron 36:39
Yeah, sure. Yeah, that was great, Steve. And I just, you know, sort of extend some of what you were saying there, right, focusing on Dallas’s description, he also had, this isn’t a definition of the good person. But it’s a true description of the good person, as someone who is intent upon advancing the various goods of human life with which they’re effectively in contact in a manner that respects their relative degrees of importance. I just want to stop there and say, that seems to presuppose the existence of an objective moral order, where some things are better, or more important than others. So among goods, you’ll have more important goods and less important goods, but then also the extent to which the actions of the person in question can actually promote the existence and maintenance of those goods. And that’s what Steve was just sort of talking about there toward the end. You know, Dallas is understanding of good person is not a picture of someone who is automatically going to aim for the highest possible good no matter what they may or may not be in a position to pursue that. So what you need to pursue is the highest possible good that you are in effective contact with meaning that you from where you are in the concrete situation of your life, can actually promote the existence and maintenance of of that particular good, and sort of orient your life to an extent around that one of the things that Dallas says when he paints this picture of the good person in the final chapter of the disappearance of moral knowledge, and this statement, that Steve and I have been quoting here is just a general description. But then Dallas goes on to list a number of more specific features of the good person, one of them is that the good person has some sort of station in life, from which they can launch their their efforts to promote and maintain the goods with which they’re an effective contact. And one of the ways of thinking about what this what this might be having this sort of station in life is to think in vocational terms. I mean, there are certain goods that physicians precisely as physicians are in a position to maintain an advance that say, Steve and I, as philosophy professors are not, we cannot promote the health of the physical, or perhaps even the mental health of individuals the same way that that you can as a physician, and there are certain things that society will legally allow you to do that, Steve, and I can’t do precisely because you have the requisite knowledge that puts you in this special position of being a physician. And so this is something to keep in mind, especially since this is a podcast focused and oriented toward physicians is that your status as a physician puts you in a very good position to deploy this mission that Dallas is setting for every one of us. You are in a noble profession, where you can do a lot of good, but there’s also a sort of liability here, especially in contemporary culture, and the way that we tend to think about professional ethics, which we’ve mentioned before, but it perhaps bears repeating, that one of the tendencies that we seem to have nowadays is to think that one’s ethical obligations as a professional are discharged so long as you remain within the boundaries of Have your professional code of ethics. And I think one of the things that Dallas would say is, is that’s just not the case. You should not allow your station in life to put blinders on when it comes to the fullness of the moral domain, which extends well beyond, again, any form of codification that we could try to impose on it. And one of the things that I think Dallas very firmly believed and and this has to do with his use of, of Levin OSS, Steve Steve mentioned a few moments ago, and also another thinker, a Lutheran moral theologian by the name of new Lok strop. What he and Levinas had in common was this idea that the fundamental dimension of human moral life was in the immediacy of lived experience with other people, and that in experiencing other people, as people, not as patients that you know, the primary or fundamental relationship is human person to human person, you should if you’re a morally sensitive individual, feel some sort of obligation or duty to do justice to that other person’s personhood. And that means caring about their needs, it doesn’t mean that you’re obligated to meet all their needs, but you at least need to care and then sort of do what you can. And that general orientation toward the good of the other is going to require us to attend to things that don’t fall within any sort of official purview that our profession orients us towards. And so, you know, when I teach, I need to attend to my students as persons, and not just as students, and I need to realize that they have complicated lives that extend beyond the classroom, and I need to, in sensible ways, balance what we’re supposed to be doing in the classroom context, in the in the university context, you know, I’m the teacher there, the students were supposed to be learning, there are certain standards of excellence, they need to meet certain standards of responsibility that they’re accountable for, with the fact that these are, these are young people who live in an incredibly difficult world right now. And I need to try to have a holistic view of that, even while my main focus is on our sort of teacher student relationship and the things that we’re supposed to be doing in the context of that relationship.

Ben 42:29
Yeah, wow, Man, y’all that so many good things, thank you so much for coming on the show and sharing this with us. And I think exactly that, that. There’s so much that I think this topic has for medicine, especially since it seems like from within without most people would agree that medicine is kind of spinning its wheels. And we are throwing more money at it throwing more things and ideas of how to improve it and trying to focus on these, you know, quality health care and advancing medicine. But I think coming back to this central point of that, within medicine, there’s a bunch of people, and all of these people are touching lives every single day. So if each person within every level of medicine, whether you’re a technician or a nurse or a doctor, or an administrator, or a CEO, or whoever could put this idea of the good person at their center while they’re making decisions, and what they are trying to accomplish, I think could be so transformative. So thank you all so much for coming on today. So I do typically end the podcast with a couple of questions. So one of those questions is what is something that you’re doing in your life to help you move beyond just surviving and toward flourishing right now?

Aaron 44:02
Steve, that’ll be easier for you because you live in California. And I live in Indiana, where the temperature differential is pretty extreme right now. So So you’re in a better situation to talk about flourishing than I am?

Steve 44:16
Well, the example that came to mind doesn’t have much to do with the 80 degree weather that I’m currently experiencing. But you know, the thing that came to my mind Ben was I, you know, actually Dallas had this phrase that we should ruthlessly eliminate hurry from our life, the ruthless elimination of hurry. In fact, John, Mark comer, wrote a book with that title that has done quite well. And I would say in my own ways, I am coming to try to slow down the speed of my life, I realized that a lot of my lack of flourishing comes from unrealistic expectations on what I can accomplish in a day or an hour or are weak and always feeling behind and frustrated and resentful because I’m not getting as much done as I thought I would get done. So I’m trying to just own my limits and slow down and recognize that if I do one good thing in a day instead of the 15th, I had in mind that that’s a good day, and not such an appetite for productivity, and realizing that a lot of my appetite for productivity is actually rooted in probably insecurities and ego and things like that. I think part of becoming a good person is coming to see how we’re motivated by desires and identities that aren’t that aren’t fundamental to who we’re actually meant to be. So that’s a long answer. But the ruthless elimination of hurry, I think, is helping me towards more flourishing.

Aaron 45:50
Wow, that’s, that’s remarkable, Steve, not to be a copycat, I was actually going to say some things in a similar vein. And I think this probably has something to do with the fact that we’re both sort of at a similar stage of life and similar stage of career, and so on. And frankly, for me, it also has to do with the conditions of our society over the last couple of years with, you know, first, the pandemic, and all of the difficulties and tensions that have come along with that. And then, sort of second of all the uprisings around social justice, and a lot of the tumult that has occurred over that, which, you know, frankly, I got really worked up over when that first started happening, and for my own health, for the sake of my blood pressure, had to learn to put some of that aside, and, and focus more realistically on what I could hope to achieve without driving myself nuts. And, you know, I used to be, I still feel like I’m a fairly mission driven person in terms of wanting to do something good for the world with philosophy. But I used to be much more of a workaholic than I presently am. And so trying to put some of that aside and do things like frankly, focus on getting more sleep, not burning the candle at both ends, not pulling all nighters, which, to be perfectly honest, I pulled two all nighters over Christmas break just a few months ago, trying to get a long article finished, that was overdue. And so you know, I’m not perfect with this. But I am trying to do less and less of that. And, as Steve said, Be satisfied with what I can reasonably get done in a given day. And, you know, Benjamin, because your specialty is sleep, I did want to mention sometime during this broadcast that Dallas actually used to refer to sleeping, intentionally trying to get enough sleep as Elijah’s discipline, on account of the tale in First Kings 19, where Elijah, presumably emotionally and physically exhausted from his encounters with the prophets of Baal and Jezebel, went off into the wilderness and just fell asleep. And an angel came and ministered to him. So Dallas thought that was very important.

Ben 48:16
Oh, thank you for that, I did not know that. So that’s, that’s definitely something I’m going to need to think on for a while. And then definitely the I will first I wholeheartedly agree with both of y’all. What you’re saying and our need to not have to be so concerned about productivity. And I, that’s actually something I’ve been thinking about to have this word comes up over and over of being a more efficient physician, and how to use your time and to complete the tasks that you need to during your day for your patients. And more and more, I’m coming back to like, I don’t know if I really want to be an efficient physician. And I think if anything, the best word I can find is I want to be a prudent physician.

Aaron 49:05
Yes. This fits in, if I can just jump in for a sec, this fits in with this idea of you know, how do you weigh the, the value of the goods that that we have, or that we are in an effective contact with? I mean, efficiency has some value. But one of the tendencies in contemporary American culture is to treat it as something like the highest value or at least a very, very high value to which many other goods should be sacrificed. And and I think more and more of us are coming to see that that’s just wrong. It’s not that great of good.

Ben 49:40
Right? Absolutely. And I’m interested in your answer to this last question, since we’ve already established aren’t within the medical field, but tell me about a good physician that you all may personally know in medicine.

Steve 49:54
Well, I what came to my mind on this one is actually a doctor that have helped me i, the story is simple one, I got a piece of broken glass in my foot, and didn’t realize that’s exactly what was going on for several days as I, you know, just kind of hobbled around and was in quite a bit of pain and eventually got to a podiatrist and I, and he, so he one point, I mean, this was a shard of class, I assume I can talk in, in this context about these sorts of things without, you know, making people queasy. But it was a shard of glass about an inch long that was kind of vertically, you know, into my the bottom of my foot. And it was very hard to get out. He tried to just do it under kind of a local anesthetic, painkiller and, and into my foot, and, and he was really having trouble getting it out. And he said, you know, we’re probably going to have to go into surgery. And, and I just explained, well, I mean, what was so great about him is, is he listened, and he understood the conditions and the conditions were that I was getting on an airplane the next day, and it was about the start of vacation. And, and so he, I mean, he continued to work on that shard of glass, and he continued to pump me up with, with painkillers to try to avoid too much discomfort. But I was so grateful. Because he I mean, you know, it’s so it’s so it’s such a wonderful relief when you get something like that out and he was able to get it out. But he had to really work hard at it. But he kept me out of the the operating room, which would have been another complication, in just it turned out to be unnecessary, but he had to take some risk I imagined to, to do that. But he listened to my circumstances. He kind of listened to the other aspects of my life, that, that were, that were that that helped him make a decision that was that ultimately brought great good to my life. But but he was, you know, I guess as I’m thinking about a given our conversation, I think he was approaching me as a person, not just as a patient and a person who had, you know, other concerns and demands and goods that that I was trying to achieve. And he he treated me differently than he otherwise would have. Because of that. And it was it was I felt particularized I felt cared for by him. And it was again in when he eventually got that piece of glass out. I felt so much better.

Ben 52:18
Absolutely, man. That sounds rough. Any anything to add – Aaron?

Aaron 52:26
Yeah, so I’ll just I’ll just say something general, not about one particular physician. But this is sort of applicable to all the physicians that I’ve dealt with over the last couple of years as I’ve, I’ve appreciated as we’ve under the weight of the pandemic move to more sort of tele medicine, avoiding, you know, in person visits, when possible, when necessary, etc. I have appreciated the willingness of physicians to be flexible, and understanding. You know, I have for most of my life suffered from frequent sinus infections, and, you know, getting antibiotics to treat those, you know, for understandably, they always want you to wait a few weeks and see if your body can deal with it and make sure it’s really a sort of ongoing infection, before they give you the heavy duty antibiotics. And almost always, you know, it required an in person visit and my experience with doctors previously as they been hesitant to prescribe, unless they could examine you directly, but, you know, moving to the telemedicine model, the willingness of doctors to look at my history and say, Well, yeah, this does seem to be a thing for you. And so under these circumstances, even though you can’t come in for in person visit, we’re going to go ahead and prescribe you the medicines you need. I’ve been very grateful for that. And that actually strikes me as a, as a good example of doing the kind of thing that that Dallas was talking about, of operating as good people looking at the bigger picture and, and thinking about the various goods that are that are in play with which one is in effective contact and making reasonable judgments, given the limitations of the situation that we’re working within. So I’ve been grateful for that.

Ben 54:28
Yeah. Wow. Well, thank you all so much for the stories and for your perspective and the work that you’re doing. And just for taking the time to talk with me today. I really appreciate it.

Aaron 54:42
My pleasure. Thank you.

Steve 54:43
Yeah, It’s been great!

Ben 54:54
Thanks for listening this week, y’all. I appreciate your support and actually have an exciting opportunity. For any rising interns listening, I’m launching a unique mentoring opportunity for this upcoming academic year called the Wayfarers intern cohort, a small group of interns who want both practical support at things like time management and fatigue mitigation, but also want to dig deeper at the topics that we cover on this podcast. So if you want to move beyond surviving intern year, and towards flourishing despite it to sign up today, it’s super easy. Go to the wholehearted md.com/wayfarers and follow the instructions to sign up and join the intern cohort. It’s totally free. And man, I can’t wait to connect with you. And just walk alongside you for this upcoming year. And for everyone that’s listening, that’s not an intern, please share this opportunity with a rising intern who you think would appreciate this opportunity for support. And with that, that’s all I have for this week, y’all. Thanks so much for your help and your support. And I’ll see you next week. Bye everyone.