Towards the Bioethics of Individual's Health: Introduction of the Cosmist Philosophical Fundamentals
- Konstantin S. Khroutski, M.D., Ph.D.
Institute of Medical Education, Novgorod State University after Yaroslav-the-Wise, Novgorod the Great, Russia
A/B 123, PO-25, Novgorod the Great, 173025 Russia
Eubios Journal of Asian and International Bioethics 12 (2002), 2-9.
"Is a comprehensive moral philosophy of medicine possible? Is this still a philosophical enterprise?" Meeting this challenge, the author endeavours to give positive answers to these substantial questions of Professor Edmund D. Pellegrino. In pushing his way, the author primarily attempts to ground bioethics in the higher order philosophical - cosmological, ontological, epistemological, axiological - principles, sufficient for the further advancement of the concept of universal bioethics, capable, in turn, to deal precisely with the object of individual's health. It is essential that author's novel bioethical system builds on the great potential of the Russian cosmist philosophical tradition of pan-unity and active evolution.
Key Words: Philosophical cosmology, wholistic ontology, cosmist epistemology and axiology, CosmoBiotypology, bioethics of individual's health
"Philosophy is a science and therefore, like every other science, it seeks to establish truths that have been strictly proved and are therefore binding for every thinking being and not only for a particular people or nation." N.O.Lossky (Lossky, 1951, p.402).
At present, the broadest spectrum of complicated ethical issues is brought into the arena of interrelations of biomedical knowledge and human values. Therefore, bioethics of today, dealing with these problems, seems to challenge an enormous, even historical task for contemporary humankind. Traditionally, however, the goal of bioethics is the research and reflection of the ethical issues brought to life by the new developments in the life sciences and ultimately aimed at the clarification of the content of judgements, decisions and policies designed to harmonise individual rights and wellbeing with the common good of the contemporary society.
Therefore, we have herein the obvious paradoxical situation. The matter is that the contemporary bioethics does not include at all (in its scope) the object of individual (personal) wellbeing of an individual's health. In other words, we have at present great advances in biomedicine, and we need "to take over the numerous conflicting positions on how advances in the life sciences may, should or should not be applied." (Glasa, 2001). At the same time, however, the great address of a naturally healthy (wellbeing) human has been totally lost for contemporary philosophy and science. In fact, (post)modern biomedicine and bioethics deals, in principle, with the already diseased or disabled person (secondary to morbid processes), but, never, with the naturally healthy (wellbeing) person. Hence, at this point, the evidence of the crisis of contemporary biomedicine (bioethics) in relation to philosophical issues is easily disclosed.
In reflection to this situation and intending to resolve the philosophical crisis of contemporary biomedicine and bioethics, I wish to push forward new philosophical bases, which are substantive for the advancement of the true bioethical proposals, capable to treat the individual (personal) health of human individual's health. In other words, instead of the traditional research and reflection of the already (originally posed by science and technologies) ethical issues, I propose a new systemic framework of philosophical assumptions and theoretical deductions: cosmological, ontological, epistemological, and axiological, and thus attempt to ground a novel wholistic concept of biomedicine (and bioethics) in higher order philosophical principles and, thus, to comprehend theoretically the phenomenon of individual's health as the direct object of bioethics.
It is essential that this approach, which I believe is original, builds substantially on the Russian - but not Soviet (!) - cosmist philosophical tradition of pan-unity and active evolution. Significantly, for a common unsophisticated philosophically reader there may be no difference at all between the Russian cosmism's 'pan-unity' and Soviet Marxian (totalitarian) 'pan-unity'. In reality, however, these are the two extremely opposite things, for the former pursues the ultimate end of absolutely free and wellbeing Man's personality (treating Society as an instrument for the reaching of this end, and man - a person - as a main motive force of Society's and the whole Earth's Life on-going evolution), while the latter serves to the utmost depersonalisation and subordination of Man to Society (treating, vice versa, Man precisely as an instrument of Society).
Importantly, Russian philosophical cosmism at present - that is an actually a forgotten layer of world culture, which, to author's firm belief, ought to be restored and actively included into the current world cultural life. Author's presentation of this exploration is, as a matter of fact, a direct attempt to recover and translate the basic ideas of Russian cosmism (having their origin mainly in the last decades of the XIX-th and beginning of the XX-th century and represented by creativity of such authors as Vl.Solovyov, Prince S.Trubetskoy, Prince E.Trubetskoy, Florensky, Bulgakov, Berdyaev, N.Lossky, Losev, I.A.Ilyin, and others).
In completion, it should be also emphasised, that author does not focus on the innovative philosophical analysis in relation to the interdisciplinary inquiry in the life sciences and the humanities (on the interrelation of biomedical knowledge and human values), but he is seeking precisely for new kinds of paradigmatic exploration and, even, to comprehend the phenomenon of individual's health in the broadest possible sense and thus to present the "breakthrough" article. It is likewise essential that the author's cosmist approach and process thinking is not merely the speculative reflection on the 'good life' (Eubios, Macer), but it is intended to become precisely the 'real-world' instrument for man in changing the unfavourable reality through personal cosmist action. Crudely speaking, the being proposed cosmist trend constitutes the personalist philosophy and science of 'emergent future and personal (functional) action'.
At last, author hopes that his philosophical synthesis will advance some fruitful thinking in the novel (being proposed) field of the bioethics of individual's health or, at least, provide the readers of EJAIB with new provocative insights and ideas.
2. Challenge to a Novel Philosophical Foundation for Bioethics
I fully support Prof. Pellegrino's claim in "some comprehensive philosophical underpinning for medical ethics that will link the great moral traditions with principles and rules and with the new emphasis on moral psychology." (Pellegrino, 1993, p.1161). What is the reason of the current crisis in bioethics (in respect to philosophical issues)? To author's view, the gist is that the contemporary bioethics does not possess its own philosophical basis, but obediently follows the mainstream paradigm of the modern Western biomedicine (being, thus, a direct 'science-driven' phenomenon). The latter, in turn, has the essence of the subject-object relationship between a doctor and the patient, scientist and the object of investigation, man and the world. These - subject-object - interrelations have the mutual character. A patient is an 'object' for the practising physician, but he is simultaneously a 'patient-subject' enjoying full rights within the democratic civilised society of his existence. It means that as much a doctor treats his patient as the object, as a patient of-today considers the doctor as the object who ought to provide him with the best possible treatment and in the full compliance with his family's interests, religious values, personal authentical convictions, etc. Moreover, the situation of-today calls for "to balance the autonomy equation with some attention to physician autonomy." for, "autonomy (of a patient. : Note) now verges on the absolute." (Pellegrino, 1997, p.375). In outcome, as Edmund Pellegrino judges:
"There is today, much confusion now about the nature of the physician-patient relationship. Is it a contract, a commodity transaction, a visit to one's mechanic, or covenant? There are proponents of each model... Add to this the fear of litigation and the intrusion of the courts into ethical issues, and you end up with so much confusion that neither physicians nor patients are sure what to expect of each other ethically." (Ibid, p.375.)
The heart of the matter is that a doctor and the patient, man and the world are universal elements of the one-whole process of the Life on the Earth. The latter is the incontestable fact of natural sciences, at least since the discovery of the structure of DNA by Watson and Crick in the year 1953, which proves the unity of all kinds of life and the genetic transmission of psychic characters by these molecules. Therefore, the way of subject-object (pathocentric) consideration of the 'civilisatory' : chronic non-infectious and non-traumatic - diseases is a 'blind alley' in principle, and, hence, we badly need the subject-subject (wholistic, health-centric, natural) approach at the scientific consideration of the object of individual's health.
Therefore, the necessity for new philosophical foundations really exists. In this, my view is that the sole substance exists capable to integrate (and resolve) the existing diversity and controversies (in any sphere of philosophy and science, naturally including bioethics) of the existing positions, values and standpoints - that is the one of emergent 'uterine' future. Thus a cell integrates the molecules, a tissue - the cells, an organ - the tissues, an organism - the organs, a human being - the organism, a family (any other social body) - the human beings (persons), a society - the social bodies, etc. In this, the direct analogy for the cultural development can be traced, that precisely the new philosophical foundations ('from the emergent future') are capable to bring the possibilities for science to unite the primarily controversy paradigms and to explain the formerly unexplainable phenomenon. Noteworthy, this principle is the core one of the process philosophy of Sir Alfred North Whitehead, namely that "Philosophy will not regain its proper status until the gradual elaboration of categoreal schemes, definitely stated at each stage of progress, is recognised as its proper objective." (Whitehead, 1967, p.12); and that "all general truths condition each other; and the limits of their application cannot be adequately defined apart from their correlation by yet wider generalities." (p.15)
Henceforth, the needed foundations for bioethics (capable to deal with the object of individual's health) apparently should acquire the essence of the wholistic - subject-subject - philosophy of the future (of the personal emergent future), thereby - of the wholistic personalist process philosophy.
3. Naturalistic and Metaphysical 'Presentism' versus Cosmist Dialectics
In my view one of the origins of the on-going crisis of contemporary philosophy and science (in respect to individual's health) lies in the metaphilosophical realm. That is, so called by him, Western philosophical (and, hence, - scientific) 'presentism'. Herein the traditional Western philosophical stress on being, permanence, and uniformity is meant, which opposes the elements of becoming, change, and novelty in experienced reality. In other words, Western worldview is chiefly based on the static spatial concepts of the given real - in the present - world, and thus, in general, ignores the temporal and novel aspects of the universe (given in man's experience).
Indeed, since Aristotle, Western world strictly pursues two chief goals for a philosopher and scientist: first, to investigate the nature and properties of what exists in the natural, or sensible, world, and second, to explore the characteristics of "Being as such" and to inquire into the character of "the substance that is free from movement," or the most real of all things, the intelligible reality on which everything in the world of nature was thought to be causally dependent (Metaphysics, 2001). The first was called in the Aristotelian treatise as the Physica (author correlates the latter, in his context, with the entire naturalism), the second - Metaphysica (with metaphysicism).
In reality, 'presentism' is a very characteristic (inherent) feature of the Western type of mentality on the whole. Even Georg W.F.Hegel, a great dialectician - creator of a critical method for the investigation of dialectical process, considered the contemporary (present to him) 'Germanic world' to be the final stage of the evolution of his Absolute. Hence, he was a true metaphysicist, who explored the existing (in the present) reality as the given and ultimate one, which, however, had its specific (dialectical) origination and development in the past (manifesting historically the self-consciousness of the Absolute).
The other prominent example is the recent creationism-evolution controversy in American public education: in the 1999 Kansas State Board of Education voted to delete evolution from State's science curriculum (please, see the references to Belluck, 1999; Davies, 1999; Glynn, 1999). What is the very characteristic point in this case (from author's point of view): 1) scientists from both 'fighting camps' (creationists and evolutionists) had no disagreements in treating the current (present) stage of evolution; but 2) they fiercely argued over the treatment of the origin (the emergent past) of the whole evolutionary process; and 3) they have no interest at all to the emergent future of the one common whole evolutionary process of the life on the Earth. (To the point, 'emergence', in author's context, has the accepted - in evolutionary thinking - meaning: Of the rise of a system that cannot be predicted or explained from antecedent conditions).
In his discourse author opposes resolutely to currently dominating (naturalistic and metaphysical) 'Western presentism' a novel philosophical and scientific trend of Cosmist Dialectics. The latter strives to comprehend and embrace the real world in its gradual ascending : emergent - becoming. The term 'dialectics', herein, does not naturally relate to logical disputation and have no commitments to either Hegelian dialectical (historical) process, or the Marxian critique of this process. Cosmist Dialectics precisely serves the present and emergent future wellbeing of any living subject on the Earth: since a molecule - up to a human being, society, humankind, etc.
In development of this section, it would be relevant to present the definitions of human health, upholding by adherents of the three main (considered) approaches in philosophy and science: Naturalistic, Metaphysical, and Cosmist.
I will take the naturalistic (evolutionist) definition of health from the Encyclopaedia Britannica (Health, 2001). In this, the fundamental principle for health (natural law) is defined as the man's "ability to cope with environment", and the whole definition is that "health in human beings, the extent of an individual's continuing physical, emotional, mental, and social ability to cope with his environment."
The metaphysical definition of health is represented by the famous one of the WHO, of the year 1946, that health is a "state of complete physical, mental, and social well-being and not only the absence of disease and infirmity." Essentially, this definition (similarly to the naturalistic one) treats human health as a state. At the same time, this truly wholistic definition has the metaphysical character, insofar as it advances the a priory (speculative, of contemplation) principle (or the ultimate meaning), but lacks any natural law to be based upon (as, in the above, - "to cope with environment") and, hence, is not empirically testable and thus is "beyond the senses".
Finally, author's cosmist approach (originally given in Jozef Glasa's Medical Ethics and Bioethics, 2000) defines that "individual health is successful cosmist unity of adaptational and creative processes of the human organism and personality." In other words and more accurately, individual's health is the 'process of processes' ('ontogenesis of ontogeneses') of man's wellbeing. It comprises:
a) the man's successful ontogenetic macro-evolution (the process of the constant man's gratifying activity, directed to the ascending functional integration of the whole man's being into the successively hierarchical levels (of the ascending emergent complexity) of the man's specific (in the given circumstances) integrated wellbeing); and at the same time,
b) the regular and necessary man's micro-evolution (process of man's successful development and adaptation, from initial, elementary (infantile) forms up to the mature 'homeostatic' forms and stages of man's integrated wellbeing on the given macro-evolutionary level).
As we see, in conclusion, both naturalistic and metaphysical philosophies treat human health as a state - the present wellbeing situation, caused by the past occurrences. On contrary, cosmist dialectical paradigm considers individual's health as an evolutionary process of processes (adaptational and creative) of the man's wellbeing, ultimately directed towards the macro-levels of the man's personal creative activity.
4. Cosmological and Ontological Fundamentals of the Cosmist (Universal) Trend in Bioethics
Apparently, the author's approach has some essential similarities with the "philosophy of organism" (also called as "process philosophy") by Sir Alfred North Whitehead. Indeed, Whitehead introduces the notion of an actual occasion, which, on his view, is not an enduring substance, but a process of becoming. However, Whitehead's system has basically the metaphysical character - of relying on a priory (speculative) meanings and structure. In contrast, the author's original (cosmist) organismic (process) philosophy initially is based on positive and objective principles. Namely, the author builds his 'cosmist system of axioms' on the principally positive foundation - the phenomenon of Process (CEPLE): cosmic evolutionary process of the life on the Earth. Moreover, author argues that the scientific value of Process is comparable with such fundamentals as Newton's "Universal Gravitation" or Maxwell's "Electromagnetic field".
The substantial characteristics of Process are given in author's previous works (on "Philosophical Cosmology", 2001; and "The Doctor of Tomorrow", 2001; the latter is published in the printed and electronic versions). Thereby, in the current discourse author just itemises the most essential characteristics of Process: its cosmic origin and its essence of the ascendant emergent self-unfolding evolutionary process. All these vital properties are simultaneously the natural sciences' truths. Process is the objective phenomenon of the Earth's real world and simultaneously the most basic notion in the whole framework of author's cosmist systemic assumptions.
The other basic notions are:
- Emergent future, that is the successively coming integrated macro-level of a subject's (human) wellbeing ontogenesis (the university for a schoolboy; the vocational body for a graduate student, etc.).
- Subject is one more specific notion in the author's special (cosmist) language. 'Subject' designates the 'integrated functional subject', which ever is integrating itself/himself (to be the functional whole) and simultaneously ever being functionally integrated by the higher organised subject ('organism'). In other words, subject means - from the cosmist point of view - every living organism on the earth: molecule, cell, biological organism, biosphere, human being, family, community, social body, society, mankind, and, ultimately, Process itself (CEPLE) - the one common whole cosmic evolutionary process of the life on the Earth.
Process naturally is the ultimate subject ('Absolute') of the whole Earth's life. In this, Process actually is an autonomous subject: although having the unknowable - transcendent cosmic - origin, it exists and evolves entirely independent of our interpretation of its origin (God, Nature, Big Bang, Spontaneous Origin, Panspermia, etc.). In reality, Process acts autonomously and independently (exploiting biological evolution and, further, man's Mind, Reason, and Action merely as a mean): reasonably, Process has produced Man as the crown of the biological evolution not only for the role of creator of Earth's Society (of the world social and cultural historical process), but on the looser yet crucial role as creator of the emergent future (integrated macro-levels) wellbeing of itself (Process) - one common whole cosmic evolutionary process of the life on the Earth.
As a corollary, philosophical cosmology advances its guiding principle of the equality of the three main evolutionary elements of the whole Process - of Nature (Biosphere), Society, and Man. In this course the basic notion of Homo Sapiens cosmicus is proposed (HSC, in abbreviation). In other words, together with the notions of biological and social evolution, the notion of the Personal Cosmist Evolution of the Free Civilised Man is characterised as the present-day forefront of Process. The further wellbeing of one common Process depends nowadays neither so much from the biological evolution (it has reached its high point in the emergence of Homo Sapiens animalis (HSA), nor from the social evolution (it has reached its high point in the emergence of contemporary Western civilised society and Homo Sapiens sapiens (HSS). Further continuation of the evolution is to-be-mission of a new evolutionary active subject - Homo Sapiens cosmicus: the man, who, living in a civilised society, is ready to realise his intrinsic creative (basic) specific functional ability and ultimately contribute, as a cosmist person, directly to the wellbeing preservation and continuation of Process.
Likewise, in the cosmist context, it is very significant that insofar as Process has its own emergent past and present, there is no logical reason to refuse (Process) to have its continuance in the emergent future. Henceforth, Process (CEPLE) has as its Past and Present (biological evolution, past and present world social and cultural history), as the Future of its further emergent evolutionary advancement - of the whole mankind. Equally, every other subject (integrated in Process) has its own times of past, present, and future emergent being - its/his individual (personal) emergent future of the ascending functional integration into the new successive level of the whole subject's (man's) wellbeing ontogenesis.
It is also essential, in conclusion of the cosmological theme, that Process naturally all-embraces the total number of subjects (and natural wellbeing of any subject, insofar as Process - is naturally an autonomous all-embracing evolutionary process) of the life on the Earth. Hence, wellbeing of any Earth's living subject (including man for the first hand) naturally is a direct function of Process.
Next, on the bases of philosophical cosmism, the central element of the whole philosophical approach - the system of basic ontological assumptions, named as Absolute Cosmist Wholism (ACW-system) is presented. Likewise, the detailed characterisation of this system is given in the previous author's work : in "The Doctor of Tomorrow", 2001).
This system is constituted of ten chief principles. In this discourse it is possible only to give very brief characteristics to them:
1) Principle of universal functional integration - 'all living is a whole - functionally integrated subject'.
2) Principle of universal emergent evolutionism - 'all living - any subject - is the evolutionary process'.
3) Principle of creativity - 'man is a creator': here are introduced and discerned two basic categories of human creativity: a) Adaptational creativity (micro-evolutionary, actual, constructive c.); b) Creative creativity (macro-evolutionary, ascending, cosmist c.).
4) Principle of unity of evolutionary levels - 'of man's constant active creativity'.
5) Principle of cosmist hierarchy of evolutionary levels - 'of the managing priority of the higher integrated level'.
6) Principle of cosmist functionalism - 'every subject of the lower level is a function of the higher, 'uterine', whole organised subject (level, organism)'.
7) Principle of evolutionary selection from Above - 'evolutionary selection from the emergent future'.
8) Principle of the particular role of modern humans in the being of common cosmic evolutionary Process of the life on the Earth (Process): 'the future wellbeing of one common Process - of Earth's life - entirely depends on the man's deliberate cosmist creative activity'.
9) Principle of personal functional elitism: 'the meaning of man's life is embedded in the successful ascendant evolution of man through all macro-levels of his ontogenesis for the ultimate attainment, in the period of maturity, of specific (cosmist) personal macro-level of his being, to realise here the man's personal specific (functional, of 'elite selection' - differentiation) contribution to the wellbeing of common whole Process'.
10) Principle of subject's individual wellbeing - 'the subject's wellbeing directly depends on the extent of one's belongingness and integration into Process'.
Solely, in conclusion of this section, I necessarily highlight the substantial features of the two basic cosmist categories of human creativity: adaptational and creative creativity. Adaptational creativity has the synonyms of 'micro-evolutionary, actual, constructive creativity'. Essentially, it largely conforms with Carl Popper's evolutionary emergentism - the constant production of novel tentative behavioural and cognitive patterns through actual problem solving in the present situation; here, man expediently uses the method of trial and error, as well as he effectively exploits the already existing (of Popper's 'world 3') scientific and cultural material; the means of pragmatism, positivism, rationalism, subjectivism, existentialism and phenomenology are equally relevant herein; human adaptational creative activity ends ultimately in the attainment of the highest level of stability of his existence in the given environment.
Creative creativity has the synonyms of "macro-evolutionary, ascending, cosmist creativity". It is a creative activity personally gratifying humans, aimed at the production of specific personal effects or results, directed to the satisfaction of the basic human need and thus to be functionally (successfully) integrated into the successively (evolutionary) higher : future emergent, absent in the present reality : macro-level of the ontogenesis of human wellbeing. In other words, creative activity is the manifestation of the specific ability of a person to realise his gratifying functional inclusion into the integrity of a successively new higher macro-level of the man's wellbeing ontogenesis. Thus, in the cosmist context, the 'fourth world' emerges of human's (personal) gratifying feelings, perceptions, motivations.
At this point, an example of a diligent medical student can be relevant. Due to the cosmist approach, a medical student ought as much to work intensively and successfully to comply with all the requirements of the higher medical school of his education, as, at the same time, he ought to exploit his own free time (above the curriculum) - to actively discover (re-discover) and self-realise his basic intrinsic gratifying functional ability (the latter notion will be characterised below). For instance, he could work as an assistant at the surgical unit, there where he feels genuine satisfaction of the activity itself and of the results of his activity (which are observable for the specialists from the higher integrated levels of the man's ontogenesis).
Naturally, when graduated, the given student certainly will be selected and employed in a manner deeply satisfactory to his basic personal functionality. Henceforth, our student would be largely free (on his next ontogenetic level of vocational activity) from the unfriendly surroundings, thereby - from the harmful (long-term) conflicts and emotional stresses (of external and internal origin), forming hard pressure on psychophysiologic systems of his organism and eventually throwing the man into a chronic ('civilisatory') disease. Therefore, our student, basing his activity on the cosmist principles, will preserve his wellbeing (health) during the studentship and further on the vocational level, and also will get more favourable perspectives to realise successfully the further stages of his macro-evolutionary ascendance (to become, for example, a manager : a head of the surgical department).
5. Introduction to Cosmist Epistemology and Axiology: Developing the Humanist and Pragmatism Principles
Derived from the fundamentals of philosophical cosmology and ACW ontology, the basic characterisation of the deduced cosmist philosophical and scientific trends follows: of cosmist epistemology and axiology, for the first hand. I would like to present the distinctions between the terms 'cosmic' and 'cosmist'; and also to make a short historical excursion to the 1950s of the world psychology development (to the emergence of humanist concepts). The term cosmist stresses chiefly on two points: a) on the inborn subjective (personalist) origination of the primary perceptions of a person's adaptational and creative creativity; b) the deliberate character of a person's adaptational and creative activity, aimed at the eventual ascent on the successively higher level of his integrated wellbeing. In turn, the term 'cosmic' just means that a subject has the origin in Process and ultimately is the function of Process.
Next, let us refer to the history of world psychology - to the late 1950's, when a "Third Force" (originally initiated by Abraham Maslow and Clark Moustakas) - Humanist Psychology - emerged on the scientific scene, having soundly pushed forward such novel psychological themes as self, self-actualisation, health, creativity, intrinsic nature, being, becoming, individuality, meaning, etc. Soon, humanist concepts (of such prominent psychologists as Maslow, Rogers, Allport, May, Murphy, Murray, and other) formed a strong trend in world psychology, which expanded its influence throughout 1960-1990s.
In 1962 the Association of Humanist Psychology (AHP) was founded, which, by virtue of its members' activities, has inspired many people's quest for personal growth and health. Author deeply shares the core values of AHP, especially the first three: 1) dedication to the development of human potential; 2) an understanding of life as a process; 3) an appreciation of the spiritual and intuitive (O'Hara, 2001).
Maslow's "holistic-dynamic" (sometimes called - "organismic") theory is of especial significance, for, it utmost approaches author's framing and substantiating the bioethics of individual's health. As a prominent representative of the organismic (or holistic) theory, author highlights and supports the following Maslow's conceptions (relying on Maslow's major work Toward a Psychology of Being):
1) of emphasising, in a full accord with the basic tenets of organismic theory, the unity, integration, consistence, and coherence of the normal personality: and
2) of stressing on the inherent potentials of the organism for growth: "That is, general-illness of the personality is seen as any falling short of growth, or of self-actualisation, or of full-humanness. And the main source of illness (although not the only one) is seen as frustrations (of the basic needs or the B-values, of idiosyncratic potentials, of expression of the self, and of the tendency of the person to grow in his own style and at his own space)" (p.193)
3) The equalising by Maslow the meanings of the notions 'value' and 'need', and thus corresponding the sense of subjective (intrinsic) needs of the man with their extrinsic value projection on the objective reality of surrounding world, thus achieving the possibility "to study this inner nature scientifically and objectively" (p.191);
4) that each person has a hierarchy of needs that must be satisfied, ranging from basic physiological requirements to love, esteem, and, finally, self-actualisation, which has one single meaning (in other words, ultimately the individual is motivated by one sovereign drive): "These basic needs or basic values therefore may be treated both as ends and as steps toward a single end-goal. It is true there is a single, ultimate value or end of life and also it is just as true that we have a hierarchical and developmental system of values, completely interrelated. (p.154)
5) That the chief mechanism for a person really free choice and for his growth rests on the sense of gratification, "because it tastes good, feels good, gives pleasure or delight" (p.198); "The implication here is that man's higher nature, ideals, and aspirations, and abilities rest not upon instinctual renunciation, but rather upon instinctual gratification." (p.173)
'Satisfaction' and 'growth' (and 'adjustment') - these are likewise basic conceptions of pragmatism ethics. Indeed, alike with humanist psychology, author finds deep relationship with pragmatism philosophy - in his attempt to frame the bioethics of individual's health. Noteworthy, Charles Pierce, the American pragmatist, also was a strong believer in a 'selection from the future'. Furthermore, the very characteristic 'purposive thought' of pragmatists, which strives to explain both meaning and truth of subjective values in terms of the application of ideas or beliefs to the performance of actions that have observable practical outcomes - fully correlates with 'personalist active evolution' character of cosmist philosophy. Both cosmism and pragmatism recognise in principle: a) that existence is fundamentally concerned with action; b) the functional character of ideas: ideas are suggestion and anticipations of possible conduct; they are hypotheses or forecasts of what will result from a given action; they are ways of organising behaviour in the world rather than replica of the world; c) human interpretations of reality are motivated and justified by considerations of efficacy and utility in serving his interests and needs. (Pragmatism, 2001)
However, there are substantial disparities between philosophical cosmism and pragmatism or humanist psychology. Crudely speaking, philosophical cosmism is humanist psychology and pragmatism, which are 'turned into emergent future'.
The heart of the matter is that both Humanists and Pragmatists treat human as a bio-social-individual creature - a function of Nature (biosphere), Society (the given societal and cultural environment), and Individual himself - creature of biological nature and social environment, but the owner of his unique inherent potential (hierarchy of needs) and creator of his unique values. The latter precisely lead people to the self-actualisation, or provides him with 'workability' ideas : fully appropriate for the problems at hand (at the present). This 'bio-social-individual' road naturally leads to the endless pluralistic and eclectic structuring and cognition of the whole world. The latter, however, is undeniably a universal phenomenon. Reasonably, therefore, scientific knowledge in Human, Social, and Life sciences (including Bioethics) ought to be universal as well. At present, however, as Roger Sperry fairly judged, "Despite great advances in our knowledge about universe and the ways of nature, current belief systems around the world remain so incompatible that, if we accept as true the cherished beliefs of one people, it follows that many truths upheld as sacred by other peoples must be false and misleading." (Sperry, 1986, p.420).
In contrast to chiefly naturalistic presentism of humanists and pragmatists, the cornerstone principle of the cosmist approach is to treat man as a bio-social-cosmist creature. Henceforth, philosophical cosmism naturally upholds not only the necessity of the 'present survival' and thus - of the adaptational creativity and growth, but likewise grounds the evolutionary priority of the emergent future for a person - to re-disclose, on the every macro-level of the man's ontogenesis, his basic functionality and to realise its functional mode for the successful integration into the higher level of the man's wellbeing ontogenesis.
Therefore, in the full accordance with the ACW's principle of the unity of evolutionary levels we ought to treat, when considering human health, as much environmental (societal), as the personal (cosmist) determinants of individual's wellbeing (health). At this point, listing them, author firstly states the bio-social determinants of individual's health, profoundly elaborated by Egon Diczfalusy (Diczfalusy, 1997, p.195). They are 1) sufficient food, 2) potable water, 3) shelter, 4) sanitation, 5) health services, 6) healthy environment, 7) education, 8) employment, 9) personal security. Further, however (insofar as man is as much a physical and moral being, as a cosmic one), follows the necessity to assist man in the realisation of his cosmist needs - to make available the man's constant (ascendant) transcendence on the successively higher levels of his wellbeing ontogenesis. It is precisely in this : cosmist way - man's zygote needs to become fetus; fetus - newborn; newborn - child; child - schoolboy; schoolboy - student; student - employer; employer - mature professional; mature professional - manager; etc.
The most essential thesis at this point is the following: If the ascendant evolutionary line of man's ontogenesis is being unrealised (by the person themself, 'from within'), or blocked or suppressed by societal factors - 'from outside', then the being constantly produced creative energy of human ontogenesis stops to be consumed and, being locked (in abundance) inside the man's organism, inevitably causes different psychophysiologic disturbances (including the appearance of the 'civilisatory diseases' - chronic non-infectious diseases).
In other words, if traumatic (broadly taken) injuries, or infectious invasions have the external origin and thus are adequately treated by the modern biomedicine - within the current dominating paradigm of biomedical development, based on the naturalistic and metaphysical foundations and the subject-object epistemological approach; then the diseases of pathopsychophysiologic etiogenesis (namely, 'civilisatory diseases') are largely depend on the excess amount of the unrealised and non-utilised psychophysiologic (creative) energy, which damages human organism from inside and causes the chronic non-infectious diseases. The latter (internal origin of chronic diseases), objectively calls for a novel line of biomedical and bioethical evolution.
To the point, the aforementioned thesis, in its essence, is the original idea of Hippocrates himself, who stated in his time, that "the majority of all diseases does not come from without (like injury or infection), but from within..." (in this, Berndt Ashner is cited: Aschner, 1941, p.261).
6. Cornerstone Cosmist Law of CosmoBiotypology
From all the above stated fundamentals of philosophical cosmology and ACW ontology, and also developing the humanist and pragmatism principles - the basic characteristics of the being deduced cosmist philosophical and scientific trends follow: of cosmist epistemology and axiology, for the first hand.
To begin with, cosmist epistemology and cosmist axiology state their common cornerstone principle - of the whole-triple nature of human knowledge and values: 1) of human (being HSA) biological and biosocial innate patterns of behaviour and maintenance of physiologic homeostasis; 2) of human (being HSS) social learning to objective realities or predefined norms and, as well, of the lived experience of the person's meanings, relations, values, patterns, etc.; 3) of human cosmist (being HSC) - subject-subject - perception of the world and the transcendental realisation of the person's unique successful route of the ascent ('evolutionary selection from Above') on the future emergent level of his wellbeing ontogenesis. Essentially, cosmist epistemology and axiology treats HSC (Homo Sapiens cosmicus) as a positive phenomenon of reality (alike to HSS and HSA). Thereby, all knowledge about humans is derived as much from their present and past experience (both of empiricist and rationalist origin), as from the future emergent experience, coming from the transcendental apprehension by a person of the (cosmist) values of their future (emergent) functional integrated wellbeing. In this comes the task to explore thoroughly the creative evolutionary "process of processes" ofan individual's wellbeing - of the unity of evolutionary levels: of the constant active macro-evolutionary ascent of humans on the successively higher - of the emergent future - levels of their wellbeing and, simultaneously, of the micro-evolutionary adaptational development on the given macro-level - up to the optimal grade of equilibrium and stability with the environment.
Next, basically, the cosmist epistemology and axiology state the whole-triple origin of knowledge and values: a) knowledge, which is a product of human learning (empiricist disposition); b) knowledge that is prior to experience (rationalist disposition), but which likewise is the knowledge of the present and the past, and which being alike is determined chiefly by the principle of causality; c) the cosmist knowledge and values, which emerge from human's ability to originate the transcendental knowledge and values (primarily - of virtual and abstract essence, but further acquiring the teleological character) of the persons' future (emergent) functional integrated wellbeing. From this stand, each value has its hierarchical place as a function of Process (and, naturally, - a function of the subject's wellbeing ontogenesis). Henceforth, value is a conscious (phenomenal) emergence of the appropriate need having, in turn, unconscious noumenal origin. Reasonably, then, a value is revealed through the intrinsic predisposed sense of gratification; it really motivates human conduct, having been, at the same time, basically energised and formed by the need. Consequently, in this order, the given practical purposes and long-term goals of a person (in the due - natural, cosmist, wellbeing - course) are just the final stages of the entire process of his appropriate dominant need self-realisation.
At this point, author discloses again his close agreement with basic tenets of Russian philosophy, namely with its main task "to work out a theory about the world as a whole, based upon all the varieties of experience." (Lossky, 1951, p.405)
Cosmist epistemology and axiology give a start in life to CosmoBiotypology - a cornerstone element of the entire framing of the derived cosmist theoretical proposals. CosmoBiotypology is a positive cosmist law, which states: Every Earth's living subject is a natural (more accurately, in our context, - cosmic) function of the uterine higher subject (organismic level of integrated organisation), ultimately - of Process itself, and thus naturally bears the biotypological intrinsic traits of this functionality and naturally corresponds to the appropriate environment. The need to realise this ultimate intrinsic functionality - directly to Process - forms the highest meaning of a subject's life. For an enzyme (molecule), for example, that is to actively participate in the due biochemical reactions. For man that means, first of all, a) the discovery of his basic functionality and b) its ultimate realisation chiefly on the man's mature creative level of wellbeing ontogenesis. Author considers this Ultimate Functional (Personalist Cosmist) Need - UF_PC_N in abbreviation - to be, in point of fact, the intrinsic subject's evolutionary program ('subject's absolute' - of hierarchically organised ends-goals) of the entire subject's wellbeing ontogenesis.
Herein, author's cosmist approach comes close to the meaning of Maslow's "a single end-goal" - "a single ultimate value or end of life" (p.154) - self-actualisation. At the same time, in the light of author's philosophical cosmology and ACW ontology, Maslow's positive naturalistic "self-actualisation" transforms into the positive cosmist notion of man's single basic (ultimate) functionality - of man's ultimate functional deliberate (personalist cosmist) direct contribution to Process's wellbeing. That is the true single-whole "end-goal" - meaning - of human life and, simultaneously, - the leading (of the man's wellbeing) single-whole value and, correspondingly, - single-whole need (of executing the ultimate function) of the entire person's healthy (natural) ontogenesis. Really, in this, it is according to logic that the physiological apparatus of human satisfaction - of "basic need gratification" (Maslow, p.199) - should be specifically embedded in human biological organisation (which is cognisable by means of biotypology), so that to lead the person optimally towards the execution of their cosmist function (assignment), aimed, ultimately, at Process's wellbeing - at its preservation and continuation (ascent into the emergent future). In outcome, reasonably, the human's harmonious (wellbeing, healthy) ontogenesis is solely possible on the road of their basic cosmist assignment (function of Process) execution.
From this clearly follows that the individual's health - wellbeing of the entire human's ontogenesis - is highly correlative with the success of execution of their ultimate creative functional contribution to Process's wellbeing. That means constant achieving by them is needed - functionally pre-programmed by UF_PC_N : subjectively gratifying effects and results, i.e. the performance of actions motivated and justified by considerations of their efficacy, adequacy and utility in serving the man's ontogenetic actual and cosmist (creative) needs. Therefore, the wellbeing ontogenesis of man is fundamentally concerned with his personally effective actions.
In other words, the self-discovery by the man of his basic functional need (UF_PC_N) forms merely 'half the work'. The next (most important) part is to realise effectively the function in practice. Subjective (personal) function by itself means nothing. Moreover, useless function can be eliminated as superfluous. Thus, directly upholding pragmatism, I propose the following thesis: Not the function itself, but precisely its successful realisation - the attainment of the needed effects or practical satisfactory results (eventually, realisation of the dominant need) - plays the decisive role for human wellbeing (health). It is the kind of 'cosmist workability' - the attainment of practical effects, which are noticeable for the functional selection from Above - from the emergent future - of the man's on-going (ascending) wellbeing ontogenesis.
In conclusion of this section I emphasise my fundamental position that CosmoBiotypological epistemology and axiology lay claim to rationally link the subjective (satisfying, desirable) intrinsic values of humans with the really existing (given) objective values and demands (i.e. : facts) of the surrounding world (physical, ecological, societal), as well as with the biological peculiarities of human's whole organisation (man's biotype). The author aspires, therefore, that cosmist theoretical proposals (with its cornerstone CosmoBiotypology principle) 'open new land' for the development of a novel integrated (universal) epistemology, axiology, ethics, anthropology, etc. In case of interest for EJAIB's readership, these issues could become, to author's happiness, the matters of his elaboration and the following discussion.
That is a common view that monism in ethics and the realm of values inevitably leads philosophy either to a sort of religion with its 'high priests', or : to totalitarian ideology with prescribing 'moral experts' (as it was in the Marxian Soviet Russia), or : to the utopia of 'communistic paradise' or the kind of 'star wars', etc. Hence, author foresees the main objective to his cosmist framing : that the 'universal bioethics : of individual's health' will certainly cause the "fixed future" and the "pre-determined place" for man (and thus - to the loss of personal freedom) in the higher level organisation. The latter ("pre-determined place") will call, in turn, for the "coercive political power" to be used, etc.
However, I resolutely rejects these misgivings. The heart of the matter is that the cosmist approach is precisely the shift (ascent) of the whole philosophy from the traditional biological, social and individual (anthropocentric) standpoints to precisely the cosmist : personalist evolutionary wholistic - position of the man's wellbeing ontogenesis: of the evolutionary equality and unity of Nature (biosphere), Society and Man : the chief elements of Process.
Herein, it is very significant to understand that within the cosmist paradigm there is no place for the 'morpho'-determination of the place for a subject (person) in the given environment and time, but, on contrary, philosophical and scientific cosmism is ever primarily the FUNCTIONAL and SUBJECTIVE approach to any subject. In this, the wellbeing of man is largely based on the primary subjective - personally gratifying - functional activity of a subject to re-discover (on the every macro-level of man's ontogenesis) and realise his basic (intrinsic) functionality and to create (to produce) the results and effects of this functionality so far as to expose them for the 'selectioners' from the higher (above, of emergent future) level of the man's wellbeing ontogenesis.
Thereby, the cosmist future for man is ever open and emergent, insofar as it primarily has its origin (freely and transcendentally) within the man : to be further realised in the man's cosmist (creative) actions and eventually exhibited in the effects and results of this : freely chosen and personally gratifying : functional activity; at the same time, however, the ultimate selection comes as an emergent occurrence - from the higher 'uterine' level of the man's wellbeing ontogenesis. As a corollary, man's wellbeing on the coming level of personal emergent future (as well as the present wellbeing of the man, for, that is the result of the previous successful cosmist macro-evolutionary process of the whole person's ontogenesis) is chiefly depends on the man's primarily subjective activity and, thus, - on his personal responsibility.
There is one more essential characteristic of the cosmist philosophy : that it is basically the practical philosophy, but not the one of academical level. One of the 'real world' implications of the cosmist trend in philosophy and science is the formulation of the new status of a physician. 'Doctor of Tomorrow' (naturally, that is chiefly a family medicine specialist, practising in general medicine), to author's argumentation, ought to be simultaneously physician, psychologist (and sociologist), and philosopher. In this, physician and psychologist (sociologist) treats a patient as an object, aiming at the physiologic preservation and recovery of human health, and also on the disease prevention, treating the harmful influences of the environment. On the contrary, the third : philosophical : macro-level of the 'doctor of tomorrow' activity realises precisely the subject-subject relationship with a patient. That is exactly the level of the application of the cosmist dialectical philosophy and the deduced theoretical proposals and methodologies. This level of doctor-patient relationship leads precisely to psychological ('mental') and psychophysiological wellbeing of the person (patient). It is essential, that here : on the philosophical level : a doctor and his patient are partners in principle; moreover, the subjective (autonomous) personal feelings, perceptions and cogitation of a patient (a person), relative to the choice of values of their current and the whole route of personal wellbeing have the decisive significance, while the activity of the doctor-philosopher acquires mainly the quality of delicate assistance.
This new physician's status leads to a new branch of bioethics - bioethics of individual's health. Based on the cosmist philosophy, bioethics of individual's health opens the perspectives for the universal ethical consideration of a patient. The main point here is the treatment of a patient as HSC - Homo Sapience cosmicus, whose personal wellbeing is the evolutionary process of processes, with the ultimate stage of the successful execution by man of his basic functional - personalist - assignment to contribute to the wellbeing of Process. Hence, health-seeking behaviour must treat as much the determinants of the sociocultural organisation of health care, as the virtual subjective origination of new cosmist values, guiding creative functional (personalist cosmist) objective searches and further purposeful activities. The latter is possible exclusively within the equal subject-subject (_ephilosopher-philosopher') relationship between a doctor and the patient. Bioethics of individual's health is claimed, by author, to be the chief : cosmist personalist - direction of rational endeavours in treating the bioethical issues, concerned with healing of chronic non-infectious diseases.
At any rate, it is essential to state, in conclusion, that the current (Western) mainstream philosophy and science easily recognises the biological, social, and individual (but within the society) levels of man's ascending development, but they categorically deny the existence of the cosmist - Transcending-the-Society - processes of man's being and wellbeing on the whole and on the every given macro-level of the man's integrated ontogenesis. To author's view, however, the time has come long ago for bioethics to rise above its current 'science-driven' or speculative status and to approach substantially (in the positivist manner) to personal and health-centric consideration of practical moral problems, concerned with individual's health. To operate effectively in this course, a doctor (bioethicist) could enter the arena of subject-subject ('philosopher-philosopher') relationship with a patient, relying on the bases of the being proposed cosmist paradigm. Eventually, in the author's firm belief, world philosophy can and should be brought to bear upon the practical issues of individual's health (and life on the whole). In this, Cosmist (personalist and universal) bioethics can and ought to become a vital emergent area of practical concern.
The author is deeply indebted to two persons: to Jozef Glasa, M.D., who was the first to recognise the validity of the cosmist approach in bioethics and whose assistance was of great significance for me; and to Professor Zbigniew Szawarski - due to his valuable comments on the substance of the exploration. Likewise, author thanks his dear colleagues who helped him in various ways: Professors Edmund Pellegrino, Giuseppe Benagiano, Walter Kofler, Michael Puritscher, Alessandro Volpone, David Thomasma, Jozsef Kovacs, Edwina Taborsky, Richard Allen, Albert Musschenga, Valdar Parve, Lennart Nordenfelt, Ingemar Nordin. Particularly, author notes moral encouragement from Professor Georgiy Arkhipov. Finally, author expresses his sincere gratitude to Professor Darryl Macer, whose active practical attitude to 'Eubios' contributions constantly encouraged me during the entire work.
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