If ever you suspected that the ‘hard problem’ of consciousness was a recondite philosophical matter, of no significance in the real world, a recent piece in the NYT (discussed briefly by our old friend Steve Esser) should convince you otherwise.
It explains how Kanwaljeet Anand discovered that new-born babies were receiving surgery without anaesthetics, and goes on to discuss the evidence that fetal surgery, increasingly common, also causes pain responses in the unborn child.
Why would doctors be so callous? They don’t believe new-born children, let alone fetuses, feel any pain. When they operate on a new-born baby, there may be some reflexes, but there are no pain qualia – no pain is really being felt. So all they need to give in the way of drugs is a paralytic – something that makes the subject keep still during the operation, but has no effect on how it feels.
It seems to me that, although they may not be clearly aware of it, the doctors here are making important real world decisions on the basis of their philosophical beliefs about qualia. Quite bold beliefs too: they don’t believe the fetuses can be feeling pain because the brain, and in particular the cortex, is not yet wired up sufficiently for consciousness, and if you’re not conscious, you can’t have qualia.
It’s quite possible they are right, I suppose, but I think most people who have been through some of the philosophical arguments would doubt whether we can speak of these matters with such certainty, and would be inclined to err on the side of safety. To be honest, it’s a bit hard to shake the suspicion that the real reason fetuses don’t get anaesthetics is because fetuses don’t complain…
I think the real issue here is slightly different. Why was Anand concerned about the babies who were coming back to him after surgery, before he even knew they weren’t being anaesthetised? Because they were traumatised. Their systems had been flooded with hormones usually associated with pain, their breathing was poor, their blood sugar was out of order. When they were given anaesthetics, instead of just paralytics, they survived the operations in better health. There were medical reasons for avoiding the pain, not just subjective ones. The problem arose out of the fact that the surgeons and anaesthetists had got used to the idea that relief of subjective pain was all that mattered. So when they were dealing with patients who they judged incapable of subjective pain, they saw no reason to anaesthetise. They were, in fact, paying too much attention to the idea of qualia, and not enough to the physical, medical events which actually constitute pain even if your cortex isn’t working. (The passage in the NYT piece about people with hydranencephaly is a dreadful red herring, by the way: it just isn’t true that they have no cortex.)
True, there were other reasons for using anaesthetics in that particular case. But where do the doctors get their certainty that no pain is being felt? You can’t talk about your qualia if your cortex isn’t working, but since qualia are an utter mystery and separable in principle from the physical operation of the brain altogether, there’s no strong reason to think you’re not feeling them. We take winces and grimaces as good indicators of pain in normal people: how can we be sure it’s any different in fetuses? Is it just the talking that matters? Is an unreportable pain no pain at all? Surely not.
You say qualia are separable from the physical operation of the brain, but you don’t really believe that in any important way. You know quite well that brain events like the firing of certain neurons are what cause these sensations you misdescribe as ineffable qualia. If I hit you with a physical spade, you’ll feel pain qualia alright, however ’separable’ you think they are.
Let’s get a bit more philosophical here. Why is pain bad? Why is it to be avoided and minimised? There are several traditional answers — I’d say the following just about cover it.
- It just is. Pain is just bad in its essential nature.
- The moral rules agreed by our society enjoin us not to cause pain.
- Ethics requires us to seek the greatest possible balance of pleasure over pain.
- You wouldn’t want pain inflicted on you, so don’t inflict it on other people.
- Witnessing or hearing about pain makes me feel bad.
- Carelessness about pain is the beginning of a general callousness which might undermine our concern for others, without which we’re doomed.
The first doesn’t mean anything, if you ask me. The second might be right, but the established rules, judging by medical practice, seem to say fetal pain is something we don’t have to worry about. Social rules are negotiable, anyway, so there’s no final answer there. The third one, like the first one, just assumes pain is bad. The fourth is OK, but begs the question so far as fetuses are concerned, because we don’t know what I’d want done to me if I were a fetus. I might just want them to get on with the operation, unbothered by the apparent ‘pain’ I wasn’t actually feeling. Numbers five and six, if you ask me, get close to the real motivation here.
Got that? OK, now let’s revert to your question — why do the doctors behave like this, why do they torture babies? It’s not just, I suggest, that they don’t believe in fetal pain. The more crucial point is that they know fetuses don’t remember pain. There was a time, in the not-too-distant past, when some children, not just babies, were merely given curare before being operated on. Just like the new-born babies here, it paralysed them so the surgeon could get on with the job, but did nothing whatever to relieve the pain. Did the doctors think the children didn’t feel the pain? Well, there’s some talk about them thinking curare was aneasthetic, but that’s balderdash — they didn’t use it for adults. No, I believe they knew quite well the children were in pain, they just thought it didn’t matter because children don’t remember these things. Give ‘em an ice cream, they thought, and we’ll hear no more about it. (I’m not saying that’s necessarily correct, by the way).
In essence, the doctors implicitly agreed with me. There were no deep metaphysical or ethical reasons to avoid pain, and reciprocity never really worked, because there were always relevant differences between you and the person suffering the pain (unless you were fighting your twin brother, perhaps). You could always say; yeah, do as you would be done by, but if I were in the state that person’s in, I would want it done to me. So, the doctors rightly concluded, there were only two fundamental reasons to avoid causing pain; first, it upset people. As a result, our social rules were generally set to minimise it, and so second, the unnecessary infliction of pain would tend to have bad social effects, undermining the rules and generally risking a withdrawal of social consent. Pain which will never be remembered cannot upset us or have bad social consequences — so it doesn’t matter.
There’s more evidence that this is the established medical view. Besides paralysing and anaesthetising patients, doctors use drugs which specifically remove the memory. In some cases, drugs which remove the memory have been used instead of anaesthetics, just because in medical eyes, pain you don’t remember is the same as pain that never happened. It’s perfectly normal contemporary practice to use a mixture of true anaesthestics and amnestics.
So, to sum up, pain has three aspects: medical (the hormonal reaction, the changes in the body), psychological (we don’t like thinking about it), and social (we’ve agreed to outlaw pain, and erosion of that rule undermines society generally). And that’s all there is. The medical, psychological, and social aspects add up to what pain is: there’s no mystical component, no qualia.
That just seems mad to me – bonkers and almost diabolical. Surely you can see that the reason pain is bad is because it hurts? That’s all pain is – hurting.
You and your supposed doctor friends are a bit over-confident about your amnesia anyway, aren’t you? The NYT article reports evidence that pain experienced early on affects a child’s responses later. Do you really feel confident that agonising episodes early on — even in the womb — are not lurking in some damaging form in the subconscious of the child, or even the adult?