A summary of my research interests is provided below and a more detailed account is available here.
I am a philosopher of science, but my work aligns closely with the history of ideas and with moral philosophy. The problems that intrigue me – personal identity, the value structure of science, the effort to find coherence in a world fragmented by competing notions of truth – have carried me into topics that each demand an interpretation guided by a self-conscious appraisal of our ethics, broadly construed. The inter-disciplinary nature of this work makes unusual demands on the reader.
A bioethicist might not appreciate how discussions of patient autonomy relate to Thoreau’s personal journey, or how a study of psychoanalysis complements a philosophical analysis of immunological theory, but for me, everything is of one piece. Below, I will briefly explain the bare architecture of my work.
Typically, one’s biography shapes one’s scholarship. In my case, the central challenge I faced was to bridge two careers, biomedical research and philosophy. That transition occurred after I had established myself as a scientist, and thus my journey into the humanities was framed by an over-arching question: How might such a bridge be constructed and what drove me to build it?
In answer to that inquiry, I regard Henry David Thoreau and the Moral Agency of Knowing (2001) as my central work. There I explored the problem of translating scientific knowledge into personal meaning. Thoreau’s reaction to the 19th century’s professionalization of science and the ascendancy of new forms of objectivity offered me a case example of how science might be contextualized into its larger humanistic meanings and thereby present a picture of reality within human subjectivity. The effort does not pit scientific ways of knowing against other epistemologies, but recognizes how moral, aesthetic, and spiritual dimensions of experience might cohere within the reality offered by science. That effort built upon Thoreau’s credo of imaginative individuality, one that I embraced as a powerful antidote to the nihilism born in his era and to the postmodern suspicions of individual autonomy so current in our own.
The basic message of Thoreau was extended in Science and the Quest for Meaning (2009). There I presented contemporary science from the perspective of current science studies, which generally maintains that science is unified neither in its methods, its standards, nor its interpretative strategies; that its various epistemologies fail any final form of objectivity; that theories and models evolve from loose creative strategies; and that the pragmatic assembly of facts relies on varying degrees of certainty and interpretative facility. These positions had been amply illustrated in my earlier critique of immunology’s governing theory (The Immune Self, Theory or Metaphor? ), but with Quest I had a larger agenda. Quest offered a humanistic account of how science must ultimately be integrated into notions both of social reality and of the existential placement of humans in their natural cosmos. The metaphysics of science and the metaphysics of personal experience can hardly be the same, but the effort to find coherence represents a critically important un-fulfilled project.
This position had been inspired, in large measure, by the challenge of practicing humane medicine. As a research clinician, I faced the daunting task of integrating my scientific persona, and the demands of employing a scientific medicine, with the imperative of offering empathetic care. In Confessions of a Medicine Man (1999), I explored the emotional and moral tensions that resulted. This short book, my most popular, is a testament of my own professional awakening of the physician’s moral identity. Readers appreciated the personal vignettes that I sprinkled in between my discursive descriptions of modern health care and my pleas for making medicine’s science and technologies subordinate to the moral mandate of caring for the patient.
While Confessions combined autobiography and analysis, Patient Autonomy and the Ethics of Responsibility (2005) offered a detailed examination of the doctor-patient relationship coupled with a critique of current notions of patient autonomy. I argued that differing notions of autonomy depend on how personal identity is construed. In my view, politico-judicial models of citizen autonomy only confound the lived experience of illness and the realities of the clinic. I maintain that physician responsibility must be based on an interpersonal, relational construct of identity, not the severe autonomy of patient-as-independent-agent-and-consumer now so well adapted to the commodification of health care. To circle back: my Thoreau grounds this ethical position by highlighting a heightened moral sensitivity to everyday experience coupled with the sensitivity requisite to understanding not only others, but also ourselves.
Freud, the Reluctant Philosopher (2010) draws all of these issues together. Dispensing with arguments about the scientific standing of psychoanalysis, I seek to understand the abiding truth that Freudianism offers: We are strangers to ourselves, because we live largely unconsciously; and as we recall our past and recognize a reconfigured personal history, we gain the opportunity to assume responsibility for who we are and what we might become. That psychoanalysis has been called a “religion” seems perfectly apt to me: it holds that insight leads to redemption, a promise that despite the determinism governing our inner psychic life, a freedom beckons. The paradox – we are determined yet free – echoes Thoreau’s own anthem.
I call my guiding philosophy a “moral epistemology.” I define this as the inextricable weaving of our personal values into our knowledge and into our ways of knowing. Values not only evolve over time and across and within cultures: they are at play as each of us constructs the world in which we live. Understanding this process offers us the potential freedom of exercising moral responsibility.