Friday, November 14, 2008

The role of philosophers in teaching and counseling about practical issues

I gave this paper at the Third International Conference on Philosophical Practice in New York City, 1997.

The role of philosophers in teaching and counseling about practical issues

Philosophers teaching practical ethics
Philosophers are increasingly called upon to teach undergraduate and pre-professional students subjects such as business ethics, health care ethics, professional ethics, and critical reasoning. In many cases the reasons for this are pragmatic and even to do with the internal politics of universities. While few students major in philosophy, a large number major in business, pre-med, nursing, or administration. If Philosophy departments manage to make such ethics courses mandatory for these students, this can mean that they are able to hire more faculty to do the extra teaching, and with more faculty, the department becomes more important and vibrant. In other cases, the move to teach these courses is a way of justifying the existence of a Philosophy department to an administration which is looking to make budget cuts, and might consider merging Philosophy with Religion, for instance, and reducing the number of faculty in both departments. Teaching practical ethics is a way in which a Philosophy department can appear relevant to the world and not stuck on ethereal level of metaphysical discussion which no one else can understand.

Professional schools often like to have their students take courses in ethics because they are under increasing pressure from different directions to give their students some guidance about ethical behavior, due to the impression that sometimes professionals such as lawyers and business people have no sense of ethics whatsoever, while doctors and nurses are unable to deal with the increasingly difficult decisions necessary with the advent of more sophisticated technology. It is supposed that Philosophers have the necessary skills to teach these issues, and the Philosophy Department is a good place for these courses to be taught.

However, there is often a good deal of doubt about the usefulness of these courses. Many philosophers dislike teaching such courses because the students they have to teach can often be unmotivated and unprepared to any sophistication in philosophical or ethical argument. Furthermore, a good many philosophers are unimpressed with the quality of work in practical ethics, and regard it as theoretically uninteresting, hardly deserving of the label 'philosophy' at all. From the other direction, students and professionals doubt that such courses are at all useful, because the philosopher teaching it has little or no practical experience in the field of business or medicine, for instance. The philosophy seems divorced from reality and is thus irrelevant. Even when the philosophers talk about real life situations, they don't bring to them a 'feel' for what the job is really like, and they tend to be extremely idealistic. So this line of criticism goes.

This leaves us with questions. How useful is practical ethics? How much experience of the actual field under discussion do philosophers need in order to have anything of any relevance to say? What can philosophers hope to achieve when teaching practical ethics? Is there anything particularly interesting from a philosophical point of view in practical ethics, or is it just a lot of familiar problems in a slightly different context?

I don't hope to answer all these questions here. But I can relate what I know from teaching practical ethics myself. In my teaching medical ethics to undergraduates, I hope to achieve three things:
1) For students to learn some of the most controversial important issues in modern medical ethics.
2) For students to learn the skills of looking at particular real life situations, analyzing what ethical issues are involved there, and coming up with possible solutions.
3) For students to learn a principled way of deciding which is the best solution for a particular situation.
Teaching involves giving the students many real life cases of difficult choices to look at, drawing useful distinctions as they come up, and pointing out "midlevel" moral principles that are relatively uncontroversial, as opposed to any grand theories of morality. I see the teaching process as sensitizing students to ethical concerns in the medical profession, and giving them ways to reason their way through cases, drawing on their own moral views and ways to negotiate cases where other people involved have quite different ethical view, and some resolution or compromise is necessary. A lot of times the most important skill necessary is creative thinking, in learning to think of new options which avoid the moral dilemmas which the case seemed to present.

What about my training as a philosopher makes me especially qualified to do this job? Could we imagine that other professionals might have more appropriate skills to do this? Simply knowing what issues have been controversial is not the prerogative of philosophers. However philosophers maybe do have special training in being able to identify and understanding ethical worries. This may be especially true when it comes to issues in conceptual definition, such as personhood, motherhood, life, killing, letting die, natural processes, and so on. It is noticeable that much of practical ethics depends little on discussions of Utilitarianism verses Deontological theory, but rather restricts its scope to more productive lines of thought, trying to find generally agreed upon moral principles which help in solving a problem.[1] So the volumes of philosophical discussion of whole scale Ethical Theories are of indirect relevance at best to practical ethics.

The final decision stage in practical ethics, of deciding what should actually be done in a given case, depends on formulating some ranking of competing principles, or some other method to adjudicate between them. While philosophers may have useful points to make about consistency of views across different cases, I would suggest that at this stage philosophers have little claim to have more developed ethical sensibilities than anyone else, and while they can help at showing methods of arriving at final decisions, they can not claim to be experts on what those final decisions should be. So philosophers as teachers cannot require their students to come to the same conclusions as themselves.

Philosophers as ethical advisors.[2]
In recent years philosophers have increasingly worked on Ethics Committees advising hospitals what to do, and on policy review boards determining what hospitals, corporations, cities, states and nations should deal with difficult social issues. Here again we can ask what special expertise do philosophers bring to such a job? Why shouldn't these boards simply be composed of experts about the factual issues and people who are sensitive to the workings of the law and government?

The previous discussion of the role of philosophers in teaching practical ethics is relevant here. Will Kymlicka has argued that high level moral theory is irrelevant to such policy review boards.[3] Recent surveys have suggested that having philosophers on committees makes little practical difference.[4] Bernard Gert said at a recent conference that in 25 years as a medical ethics, he has only ever been involved in 2 cases where his philosophical knowledge was needed in order to solve the problem. Gert himself says that everyone is capable of doing medical ethics, because ethics is a matter of common sense.[5] He believes that philosophers have no special prerogative in medical ethics, and have no special claim to expertise. All this tends to suggest that philosophers can mainly help as conceptual clarifiers.

I think that this is the wrong conclusion. It may well be true that philosophers have no special ethical knowledge. However, they do have much greater expertise and ability to understand other parts of philosophy, such as metaethics, epistemology, and metaphysics. These areas also come into play in making decisions about policy or particular cases. Thus philosophers do have a special role to play in advisory boards and policy review panels, in providing specialized knowledge and skills.

Furthermore, philosophers are trained in ways in which other professionals are not, and they tend to be more sensitive and aware of ethical issues than other people. This is not an exceptionless generalization, and indeed it needs to be given some empirical evidence apart from anecdote if it is going to be taken seriously, but there is at least anecdotal evidence for its truth.

Philosophers as counselors
While I have argued that the importance of philosophers is underestimated in ethical advising, I have serious qualms about the role of philosophers in the relatively new field of ethical or philosophical counseling. I take counseling to be a one-on-one situation between a counselor and a person in need of help. Sometimes counseling can be extended to couples or groups. Counseling is generally seen as a short term procedure, lasting just a few sessions. If it lasts longer, then it starts to tackle serious emotional issues and becomes a form of therapy.

I do not wish to insist that philosophers can have no appropriate role in counseling. Clearly what I have said in the previous two sections shows that philosophers do have special knowledge and skills that can help people. My main qualm about the involvement of philosophers in counseling is that counseling requires important personal skills which is not part of philosophers' professional training, and indeed we have grounds to suspect that philosophy as a profession tends to draw people who precisely lack these skills. Counseling requires emotional empathy and a non-judgmental attitude. Philosophers have a reputation for making strong truth and falsity claims, and they have an antagonistic style. It is part of good philosophical method, generally, to argue an issue via direct disagreement and confrontation. Thus the methods of philosophers and those of counselors seem to be mutually exclusive.

Furthermore, a counselor has to be aware of the emotional impact that she or he is having on a client. Clients tend to project their fantasies and fears onto the person that they are opening up to. It is common for a counselor to be seen as a parental figure, as authoritarian or nurturing. A client can be disappointed and angry with his or her counselor, or alternatively he or she can idealize and even worship the counselor. This occurs not because of the real qualities of the counselor, but because of the emotional tendencies of the client. The effect of the counselor on the client may go well beyond whatever words are exchanged, no matter how rational the dialog between them seems.

A popular stereotype of philosophers may have some truth to it. The stereotype goes as follows: Philosophers often are very comfortable with abstraction and the world ideas at the expense of a strong grip of the real life emotional subtleties going on around them. Some people go so far as to speculate that it is precisely because Philosophy offers an escape from real life that it is attractive to people who are not very adept at dealing with the messiness and difficulty of everyday experience. This stereotype, which is related to, but is different from that of the "absent minded professor," may contain some truth. Obviously it will not be universally true. On the other hand, there probably are particular character traits which predispose people to enjoy and do well at philosophy. I am on dangerous ground here, because I do not want to claim that counselors' own personal lives need to be going well in order for a counselor to do his or her job well. There is no strong evidence that psychiatrists and psychotherapists have any better emotional lives or less mental health problems than anyone else, and there is a good deal of anecdotal evidence that mental health professionals tend to behave bizarrely and tend to over-theorize their own emotions and those of their families, doing more harm than good. Fortunately a person does not need to have perfect mental health and happiness in order to be a good therapist. In fact, we do not have much evidence as to what qualities do make a good therapist, but the ability to understand the subtleties of others' emotions, listening carefully to what a person says and also leaves unsaid, would seem to be essential. Philosophers are very good at analyzing language and the structure of arguments, and these can be useful for a counselor, but these skills are not enough. Here I merely voice the worry that philosophers tend to lack the other skills that make a good counselor and therapist.

We should not just worry about the characters of the people offering counseling, but also the methods of counseling that they use. There is a deficiency in the model of counseling that is adopted by many philosophers, that of cognitive or rational emotive therapy. On this model, the role of the counselor is to identify the mistakes in reasoning that the client is making, and to help the client to see these mistakes. However, this rationalistic model is overoptimistic in its assumption that people's behavior is so easily changed by rational insight. There are two obvious problems with the model:
(a) a person often has very little insight into the motivations behind his behavior, and so will be unable to identify the real reasons why he behaves as he does.
(b) even when a person has identified the real emotional states that cause his behavior, there is no guarantee that he will be able to change. Often emotional outlooks are deeply rooted, and are extremely resistant to change. Mere intellectual insight is ineffective in helping a person, except in reducing the frustration of the mystery of understanding why he behaves as he does.

The conclusions to be drawn here are not that philosophers should never be involved in individual counseling. Rather, we should conclude that:
(a) If philosophers are to be counselors, they should receive special training. We should not assume that standard philosophical graduate training will be sufficient.
(b) Philosophical counseling is best limited to short term provision of well-defined professional services. Philosophers should not model themselves on therapists, but rather on other professionals providing services, such as lawyers, dentists, or carpet cleaners. This reduces the dangers of emotional entanglement on the part of the client.

[1]Here my comments are largely motivated by the discussion by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (Oxford, 1994) 4th edition. I have also be influenced by a talk by Will Kymlicka relating his experience as an advisor to the Canadian Committee on New Reproductive Technologies.
[2]I have benefited from a conversation with Kristen Nelson in formulating the ideas in this section.
[3]At a talk at Princeton University in about 1992 -- this may have been published in a paper, but I have not been able to find any such paper.
[4]I need to find the reference to this -- maybe Hastings Center Reports.
[5]In a seminar on Principlism with Tom Beauchamp, at the 1996 Pacific APA meeting in Seattle.

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