By Gordon Nary
Gordon: I understand that you recently built a new house and are now a member of Sacred Heart Church in Suffield, CT which has an exceptional number of ministries. Approximately how many parishioners does your parish serve?
Dr. DePergola: My wife and I are delighted to join the town of Suffield and the vibrant Catholic community at Sacred Heart Church. The parish serves approximately 1,000 families, comprised of 2,000 adults and 550 children.
Gordon: You are the Founder and President of V.I.P. Bioethics, Assistant Professor of Medicine at University of Massachusetts Medical School, Assistant Professor of Medical Humanities at the College of Our Lady of the Elms, and Director of Clinical Ethics at Baystate Health. Please explain the difference between ethics and bioethics.
Dr. DePergola: Ethics is a branch of philosophy that involves the systematic analysis and rational justification of concepts relating to right and wrong conduct (morality). The three primary modes of ethical inquiry include (1) metaethics (concerning the theoretical meaning and reference of moral propositions, and how their truth can be determined), (2) normative ethics (concerning the practical means of determining a moral course of action), and (3) applied ethics (concerning what a person is permitted or obligated to do in a specific situation or a particular domain of action).
Bioethics is the branch of normative and applied ethics that concerns itself with the biological and medical issues emerging from the inter-relationships shared between biotechnology, medicine, politics, law, religion, philosophy, and the life sciences.
Gordon: Please explain the four fundamental principles of American bioethics.
Dr. DePergola: Commonly referred to as the “Georgetown Mantra” (after the Jesuit institution whose scholars most thoroughly developed them), the four fundamental principles of American bioethics are (1) autonomy, (2) nonmaleficence, (3) beneficence, and (4) justice. It is important to note, from the outset, that each of these principles falls under the umbrella principle of human dignity. Dignity refers to the notion that each human being is invaluable, and that persons cannot be reduced to their past or future contribution to society. We are of worth, that is to say, by virtue of who we are, not as a result of what we do. This worth remains even when it is ignored by others, which means that all human persons, by virtue of their dignity, have a right to respect and ethical treatment.
Autonomy refers to the right we normally enjoy to choose our own way in life and to make our own decisions within moral limits. Respecting this principle does not mean honoring one’s preference to do whatever he likes (license), but honoring his responsibility to do what is good (freedom).Nonmaleficence refers to the obligation we have not to inflict unnecessary harm on others. It is based on the Hippocratic maxim, “Primum non nocere” (“First, do no harm”). Beneficence refers to the responsibility we have to promote the overall good of others. This principle typically demands much more than nonmaleficence, because agents must take positive steps to help others, not merely refrain from harmful acts. Finally, justice refers to what we are due as human beings by virtue of our dignity. This concept is concerned with fairness, desert, and entitlement.
Gordon: You are also a Bureau Expert of the International Neuroethics Society. Please explain what your responsibilities as a Bureau Expert are.
Dr. DePergola: My specialty within bioethics is neuroethics, which concerns the neuroscience of ethics and the ethics of neuroscience. As a Bureau Expert for INS, I am tasked with working to refine and build the foundations of neuroethics for the next 20 years. The mission of this 50-member, by-invitation-only collaboration of globally-renowned scholars, scientists, and clinicians is to promote the development and responsible application of neuroscience through interdisciplinary and international research, education, outreach, and public engagement for the benefit of people of all nations, ethnicities, and cultures. Topics currently being addressed by the Bureau include cognitive enhancement, deep brain stimulation and neural engineering, global health, brain-based legal implications, neuroscience and national security, the nature of free will, Alzheimer’s disease, and addiction.
Gordon: Your current research explores the neurophilosophical and neurotheological relationships shared between episodic memory, emotional rationality, and narrative identity in light of contemporary capacities in cognitive manipulation, particularly as it relates to ethical decision making and to the metaphysics of hope. Could you share with our readers the title of your recent book on the topic, as well as an overview of the project?
Dr. DePergola: My recent book, Forget Me Not: The Neuroethical Case Against Memory Manipulation (Vernon Press, 2018; 312 pp). is the first philosophical monograph ever written on the ethics of memory editing. ( The work contends that any attempt to directly and intentionally erase episodic (autobiographical) memories poses a grave threat to the human condition that cannot be justified within a normative moral calculus. Grounding its thesis in four evidential effects - namely, (i) memory manipulation disintegrates autobiographical memory, (ii) the disintegration of autobiographical memory degenerates emotional rationality, (iii) the degeneration of emotional rationality decays narrative identity, and (iv) the decay of narrative identity disables one to seek, identify, and act on the good - I argue that memory manipulation cannot be justified as a morally licit practice insofar as it disables one to seek, identify, and act on the good. Critically acclaimed as “game-changing,” “masterful,” “bulletproof,” and a “landmark achievement in the field of neuroethics ... that will change all future neurological, neuropsychiatric, and neuroethical analyses of memory,” the book makes a timely contribution to both the scholarly and professional community in philosophical and clinical bioethics.
Gordon: You are a prolific author. Please share with our readers some of the projects you are currently working on.
Dr. DePergola: I'm currently writing three books and several articles. The first book is a collection of interdisciplinary essays on moral themes in literature and medicine. The first of its kind, it will cover texts such as Tolstoy’s The Death of Ivan Ilyich on death and dying, Shelley's Frankenstein on clinical research, de Beauvoir’s A Very Easy Death on provider-patient relationships, Kafka’s The Metamorphosis on disability and disease, and so forth. The second book is medical humanities reader (anthology), meant for implementation in undergraduate and graduate courses on the topic. Also the first of its kind, it will cover topics such as medical anthropology, philosophy of medicine, spirituality and medicine, narrative medicine, medicine and the arts, and so forth.
The third book is my next magnum opus, which will address the relationship between contemporary neuroscience and the moral virtue of hope. Another first of its kind, it will mark the first sustained neurobiological and neuroethical analysis of hope as a physical phenomenon, philosophical/theological concept, and practical moral virtue. It identifies hope as the neurological “gateway virtue” to subsequent ethical orientation, ethical behavior, and ethical decision making. Specifically, it argues that hope is the foundation of several other critical moral virtues, such as courage, prudence, justice, resiliency, compassion, solidarity, and so forth. In addition to these major projects, several academic articles are in the pipeline, including, most recently, the ethics of medical miracles.
Gordon: In closing, a question on ethics. What are the ethical concerns of accepting money from the National Rifle Association and not supporting missive gun regulation measures that could protect human life?
Dr. DePergola: There are many ethical concerns in this case. Without delving too deeply into the philosophical and/or theological ethics of formal cooperation with wrongdoing, which is always illicit, and material cooperation with wrongdoing, which can be either licit or illicit depending on the circumstances, a good start is to make sure we are asking the right moral questions. A first question concerns the “what” of our actions -- the nature of what we are doing. Our actions must be ethically reasonable in order to be morally justifiable, and can never be intrinsically wrong or logically disordered. A second question concerns the “why” of our action -- the reason for doing it in the first place. Our “why” must protect and serve the fundamental needs of the most vulnerable individuals entrusted to our care. A third question concerns the “how” of our action -- the means by which we will achieve our goal. Our “how” must always be proportionate, and can never undermine the “why” for acting in the first place. Saint Augustine hit the nail on the head when he wrote, “Ea, quae secundum se mala, nullo fine bene fieri possunt” (“Those things which are evil in themselves, cannot be well done for any good end”).
The fourth and final question concerns the “spirit” of our action -- what we intend to do in performing it. Our “spirit” must always emerge from a place of intentional benevolence for others. Yet we must beware of moral self-deception at this level: intending to do good and actually doing good are two different things. Saint Bernard of Clairvaux highlighted the difference when he wrote, "L'enfer est plein de bonnes volontés ou désirs" (“Hell is full of good wishes or desires”). It is imperative, then, to understand the difference between what we have a right to do, on the one hand, and what is right to do, on the other. Rights and needs are not reducible to preferences and wants. John Stuart Mill summarized the paradox of rights well when he proffered that “the right to swing my fists in any direction I please ends where another man’s nose begins.”
Gordon: Thank you for an exceptional; and normative interview on topics on which some of our readers may not often consider.