Utopian Surgery and the Wisdom of Repugnance

Al Roth points to this Boston Globe story about the initial opposition to anaesthetic. I’m reminded of this great essay by David Pearce, which nicely draws out the lessons for bioethical thinking today. The introduction:

Before the advent of anaesthesia, medical surgery was a terrifying prospect. Its victims could suffer indescribable agony. The utopian prospect of surgery without pain was a nameless fantasy – a notion as fanciful as the abolitionist project of life without suffering still seems today. The introduction of diethyl etherCH3CH2OCH2CH3 (1846) and chloroform CHCl3 (1847) as general anaesthetics in surgery and delivery rooms from the mid-19th century offered patients hope of merciful relief. Surgeons were grateful as well: within a few decades, controllable anaesthesia would at last give them the chance to perform long, delicate operations. So it might be supposed that the adoption of painless surgery would have been uniformly welcomed too by theologians, moral philosophers and medical scientists alike. Yet this was not always the case. Advocates of the “healing power of pain” put up fierce if disorganised resistance.

The debate over whether to use anaesthetics in surgery, dentistry and obstetrics might now seem of merely historical interest. Yet it is worth briefly recalling some of the arguments used against the introduction of pain-free surgery raised by a minority of 19th century churchmen, laity and traditionally-minded physicians. For their objections parallel the arguments put forward in the early 21st century against technologies for the alleviation or abolition of “emotional” pain – whether directed against the use of crude “psychic anaesthetisers” like today’s SSRIs, or more paradoxically against the use of tomorrow‘s mood-elevating feeling-intensifiers i.e. so-called “empathogen-entactogens”, hypothetical safe and long-acting analogues of MDMA.

It’s worth recalling too that early critics of surgical and obstetric anaesthesia weren’t (all) callous reactionaries or doctrinaire religious fundamentalists. Nor are all contemporary critics of the use of pharmacotherapy to treat psychological distress. The doubters, critics and advocates of caution were right to consider the potential diagnostic role of pain – and to emphasise that the risksmechanisms and adverse side-effects of the new anaesthetic procedures were poorly understood. In Victorian Britain, around 1 in 2500 people given chloroform anaesthesia died directly in consequence. Around 1 in 15,000 died as a direct result of being administered ether. This statistic pales beside the proportion that died from post-surgical infection; but it compares with the present-day mortality figure of 1 in around 250,000 people who die as a direct result of undergoing surgical anaesthesia in the UK. Safe and sustainable total anaesthesia that is 100% reliable – and reliably reversible – is as hard to achieve as safe and sustainable analgesiaeuthymia, or euphoria. Yet the technical and ideological challenges ahead in banishing suffering from the world shouldn’t detract from the moral case for its abolition.

I just don’t get how anyone can defend the wisdom of repugnance when history shows us that those things we find repugnant today will often seem unobjectionable tomorrow.  I get very angry when queasiness backed by the force of the state forces people into lives of unnecessary suffering and/or kills them. Only the status quo bias allows us to see a moral difference between forcibly denying a child cognitive enhancement drugs and forcibly inducing brain damage to make him less intelligent,  or between killing a person and forcibly preventing them from acquiring life-saving medicine.

As a rule, if you feel queasy about something but can’t rationally justify that queasiness, there is no wisdom in your repugnance. Unfortunately, people seem quite capable of using horribly bad arguments to convince themselves that their gut reactions are rational.

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