What the Body Needs

For a tech-skeptic lover of Wendell Berry, Ivan Illich, and Neil Postman, as a family physician I sure picked the wrong job. Doctors have always used various technologies for treating patients, from the ancient Egyptian prescription to fumigate the womb with incense for eye pain to today’s slightly more informed but still ineffective placebo surgeries. The human body as it has been given to us by God has all sorts of vulnerabilities — to infection, to trauma, to its processes gone awry — and technology gives us power to prevent or treat a wide variety of problems that arise from those vulnerabilities.

To make matters worse, though, nowadays doctors have admitted that they cannot know everything and so they have abandoned their pocket handbooks for databases on smartphones. A good doctor, I tell my students, looks up something new every day and books cannot be printed quickly enough to keep us all up to date. My use of WhatsApp to examine rashes or read ECGs is a bit more primitive than the systems that are evolving in highly developed contexts, but medical practitioners everywhere are finding that technology is invading every imaginable aspect of their work.

This might be tolerable if it was all beneficial, but it’s clearly not. Francis Bacon famously urged us to use science and technology to ameliorate human suffering, but now the Baconian Project has fooled us moderns into thinking that suffering ought to be optional, and we must use technology to eliminate suffering. If technology gives us the power to turn stem cells into useful organs, turn useful organs into simulacra of the opposite sex’s organs, or eliminate un-useful children before they are born, the logic of technology is that those powers ought to be used. If technology doesn’t work, as it often doesn’t, Stanley Hauerwas has suggested that doctors who are unable to ameliorate suffering effectively often feel the need to kill the sufferer.

One can find countless examples of Jon Askonas’ thesis that technological innovation bulldozes tradition throughout medicine; a new drug or device can make years of careful study and practice unnecessary. For the most part, this is a good thing: the vexatiously difficult-to-dose blood thinner warfarin was replaced by much simpler drugs about a decade ago, requiring far less expertise and work from the doctors prescribing it. Yet the existence of any new drug, device, or treatment tends to inspire a search for patients with insurance who will pay for them. Disease mongering, indication creep, overuse of fancy gadgets, and the marketing of insecurity to sell cosmetic surgery have been problems for decades, now reaching a horrifying apotheosis in the current craze of teenagers being memed into thinking that they should be chemically or surgically altered to change their gender expression.

More subtle are phenomena like antibiotics, which are one of modern medicine’s greatest gifts and thus have been terribly abused to the point where now it is an open question whether we will have any working antibiotics in fifty years. The culture that the technology of antibiotics created — desiring a pill or injection to immediately cure an infection — has made antibiotics less effective. Whenever one tries to assert the dangers of technology to human culture and flourishing, antibiotics are one of the first examples that uncritical devotees to the Baconian Project point to: So, you conservatives want to take us back to when we didn’t have penicillin? No, in fact, the revolutionary way in which we have been shaped by technology is already taking us back to the pre-antibiotic era.

So how do we move forward? How do we use technology for good in the realm of health and medicine? We must circumscribe the role of medicine, embrace the limits of embodiment, and learn how to suffer and die well.

Circumscribing the role of medicine allows us to give the state and other medical institutions the appropriate amount of power. Political authority over human bodies is inevitable, which means that it is the duty of political authorities to incorporate bodily health into their decision-making. This requires observation of and attention to the qualities of bodily health that are relevant to decision-making as well as a commitment to appropriately fund or officially encourage actions which can provide clear benefits to the health of the body politic and the judicious restriction of things that are clearly harmful to health.

Political authorities and other institutions responsible for health (for example, hospitals and health networks) are severely limited in their ability to attend to or act on things that are not legible to them. That which can be observed and quantified is both useful and necessary in pursuing the common good, but it is also an extremely narrow component of health and human flourishing. Institutional health authorities should collect and study the data that is clearly legible to them so that they can act on it: disease prevalence and severity, the efficacy of various sub-institutions in reducing certain diseases, the uptake of various essential screening tests, the effects of various environmental factors on morbidity and mortality, and even QALY calculations are just a few of the things worth attending to. However, this knowledge should always be qualified by its limitations; these institutions and the people who work in them must accept and acknowledge that their field of action is, at best, only a portion of what determines health.

Embodiment is an increasingly popular word these days, and for good reason: the technological revolution has often treated our bodies as if they are machines with customizable parts and our souls as if they are just images on a screen. Embracing the limits of embodiment, then, means attending to the cycles of rest and rhythms of work we need, rebuilding our neighborhoods and towns so that we can primarily travel within them at the speed of God (that is, by walking), and pushing back against any technological development that tries to separate our bodies in physical space rather than letting us fellowship together face to face.

A conservatism that affirms “human nature rooted in man’s bodily dwelling upon the earth,” in Askonas’ terms, must begin with a recovery of the tradition of learning how to suffer and die well. Some suffering is inevitable and it is only the cultural traditions and practices of a community that can help us to walk through these times. (But watch out: the medical-industrial complex is trying to horn in there, too, with its “prolonged grief disorder.”)

Other suffering could be alleviated, but like some pains that will only get worse if you continually increase the dose of opioids, we must choose a more difficult and less technologically smoothed path out of the pain. Less high-stakes endeavors like suffering more boredom by turning off our screens or building communities where we can walk everywhere instead of driving are important, but these practices help fortify us for the more difficult challenges like taking care of people who are suffering rather than letting them be killed or building relationships with children whose character has been stifled by mass media and family dysfunction.

The greatest rebuke to the excesses of the Baconian Project are communities of people who choose to embrace suffering and pain over comfort and ease, particularly for the sake of others. This may, as I have argued before, involve deliberate choices about being neighbors with people in need. It will certainly mean welcoming the disabled no matter how much suffering and difficulty that might bring. For conservatism to truly guard the common good, it must comprehensively care for those who are not autonomous rational decision-makers (and comprehensive care is no less than, but far more than, appropriate state funding for the additional medical care that disabled persons need).

Even more, our communities and households must be active in reaching out to those whose lack of virtue, tradition, or culture is harming themselves and others, the countless refugees from human nature that technological destruction is creating. This of course includes political refugees fleeing climate change or violence, many of whom probably have a thing or two to teach us about human nature, but far more often it includes the people in our neighborhoods, towns, cities, and counties whose capacity for flourishing has been decimated by the forces conservatives love to decry but rarely have a strategy to do something about. Going from “a rearguard defense of tradition to take up the path of the guerrilla” means that we are no longer protecting “ourselves” from “them”, but trying to help the most of vulnerable of them become one of us.

Askonas is right: technology has torn through all that’s worth conserving, and it has often preferred to wear a white coat while doing so. Yet medicine and health cannot escape the human body in all its glory, frailty, and limits, and it is out from that center of moral gravity that we can build. Strictly defining medicine’s rightful authority, embracing the limits of embodiment, and building communities where we suffer together and embrace those who are suffering even to our own hurt gives us the framework we need for technology that serves human nature rather than destroys it.

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