Lessons from Aquinas on the importance of embodied emotion for practical reasoning in medical ethics and clinical decision making
Michael Buttrey, BSc, MCS, University of Toronto
Apart from popular television portrayals (e.g. Dr. McCoy in “Star Trek”), the emotional doctor is rarely celebrated. Medical professionals often speak of their craft in passionate terms, but medical texts typically promote the ideal of detached, objective, scientific medicine, and even works dealing specifically with emotion focus on the dangers of becoming “enmeshed” in patient emotions (Zabarenko and Zabarenko, 1978) and dispense advice on medical emotional “management.” (Sotile and Sotile, 2002) But in recent years bioethicists (Callahan, 1988), neurologists (Dimasio, 1994), and philosophers (Nussbaum, 2002) have argued that the emotions are essential for rational thought, and their insights have begun to appear in discussions of clinical reasoning or “how doctors think.” (Montgomery, 2006; Groopman, 2007) Yet considerable work remains to overcome an influential philosophical tradition stretching from Plato to Hume that regards the emotions as purely negative forces responsible for clouding the intellect, enslaving reason, and producing error.
Here the Christian tradition, in particular the medieval theology of Thomas Aquinas, is a surprisingly valuable source. In his Summa Theologiae, Aquinas develops a nuanced account of practical reasoning that includes a positive role for what we call emotions, a modern category that overlaps with Aquinas’ passions. Against Plato, Aquinas holds that the body, including its passions, is essential to human flourishing; against the Stoics, he argues the passions are not intrinsically evil; and against Aristotle, the theological doctor insists the passions work through reason, not around or in spite of it. (Pasnau, 2002) Aquinas’ ability to depart from past philosophical positions was enabled by an underlying theological confidence in the goodness of created human nature. In his understanding, passions like love or anger are active appetites that move human beings to engage the world by driving attention to particular sensible objects. Human flourishing is therefore achieved not by reason simply suppressing the passions, which would result in complete detachment, but by cultivating their natural openness to reason through the development of intellectual and moral skills. (Lombardo, 2011) These skills, better known as virtues, perfect the passions by ensuring they are true to reality, in harmony with reason, and responsive to the will.
In my paper, I will summarize Aquinas’s understanding of emotion and bring it into conversation with questions of bioethics, philosophy, and medical sociology. First, I will argue that Aquinas’s positive appraisal of bodily passions offers a needed corrective to the latent mind/body dualism encouraged by modern medical science, technology, and training. Second, I will demonstrate how Aquinas’s view of the passions can underwrite Sidney Callahan’s claims that emotional detachment is as problematic as excessive emotion and the emotions are necessary for accurate bioethical reasoning. Finally, I will conclude by showing how Aquinas’s account of practical reason provides the content needed to fill out Jerome Groopman and Kathryn Montgomery’s interest in a role for emotion in clinical decision making.
Apart from popular television portrayals (e.g. Dr. McCoy in “Star Trek”), the emotional doctor is rarely celebrated. Medical professionals often speak of their craft in passionate terms, but medical texts typically promote the ideal of detached, objective, scientific medicine, and even works dealing specifically with emotion focus on the dangers of becoming “enmeshed” in patient emotions (Zabarenko and Zabarenko, 1978) and dispense advice on medical emotional “management.” (Sotile and Sotile, 2002) But in recent years bioethicists (Callahan, 1988), neurologists (Dimasio, 1994), and philosophers (Nussbaum, 2002) have argued that the emotions are essential for rational thought, and their insights have begun to appear in discussions of clinical reasoning or “how doctors think.” (Montgomery, 2006; Groopman, 2007) Yet considerable work remains to overcome an influential philosophical tradition stretching from Plato to Hume that regards the emotions as purely negative forces responsible for clouding the intellect, enslaving reason, and producing error.
Here the Christian tradition, in particular the medieval theology of Thomas Aquinas, is a surprisingly valuable source. In his Summa Theologiae, Aquinas develops a nuanced account of practical reasoning that includes a positive role for what we call emotions, a modern category that overlaps with Aquinas’ passions. Against Plato, Aquinas holds that the body, including its passions, is essential to human flourishing; against the Stoics, he argues the passions are not intrinsically evil; and against Aristotle, the theological doctor insists the passions work through reason, not around or in spite of it. (Pasnau, 2002) Aquinas’ ability to depart from past philosophical positions was enabled by an underlying theological confidence in the goodness of created human nature. In his understanding, passions like love or anger are active appetites that move human beings to engage the world by driving attention to particular sensible objects. Human flourishing is therefore achieved not by reason simply suppressing the passions, which would result in complete detachment, but by cultivating their natural openness to reason through the development of intellectual and moral skills. (Lombardo, 2011) These skills, better known as virtues, perfect the passions by ensuring they are true to reality, in harmony with reason, and responsive to the will.
In my paper, I will summarize Aquinas’s understanding of emotion and bring it into conversation with questions of bioethics, philosophy, and medical sociology. First, I will argue that Aquinas’s positive appraisal of bodily passions offers a needed corrective to the latent mind/body dualism encouraged by modern medical science, technology, and training. Second, I will demonstrate how Aquinas’s view of the passions can underwrite Sidney Callahan’s claims that emotional detachment is as problematic as excessive emotion and the emotions are necessary for accurate bioethical reasoning. Finally, I will conclude by showing how Aquinas’s account of practical reason provides the content needed to fill out Jerome Groopman and Kathryn Montgomery’s interest in a role for emotion in clinical decision making.