Wednesday, December 7, 2011

“Dans le doute, mon cher… abstiens-toi”1?

If science has one defining tenet, it would be the pursuit of knowledge. By pushing boundaries and expanding the horizon of the possible, science itself seems antithetical to the old adage "Where ignorance is bliss, 'tis folly to be wise."2 But the philosophy of truth and the reality of its application are two very different things. As clinicians’ ability to diagnose conditions earlier and earlier improves, a complex ethical issue arises. Where exactly does one draw the line between the bliss of ignorance and the benefits of knowledge? Such a debate hinges on two questions: What are the inherent ramifications of that knowledge, and what benefits does it grant. The first question is the more complex, as it begs at the very ontology of disease, when knowledge is but an echo of future sorrow, whose ears wish for such a burden. Yet by knowing the future, you can prepare. Thus knowledge, in itself, of a future disease or disorder is a double edged blade. It cuts through the wilds of uncertainty, but not without drawing the blood of its wielder. The second question is less metaphysical. As the science of bio-markers improves and genetic screenings become commonplace, disease may become as predictable as the weather. If this prediction permits valuable treatment that could turn the tide of fate, then aren’t all the difficulties of knowing, suddenly so much less damning? Healthcare as we know it could be transformed. People will no longer get disorders, they will get antidotes. When knowledge offers a way out of doom, only the fool would cover his ears.

This bright future is not yet upon us though. So we must balance the state of preventative medicine with the risk of false diagnosis, because as anyone who has been caught unprepared by a mid day rain shower knows, predictions are only predictions, and even the most reliable forecasts can be very wrong. When the predictions are about your health and the forecasts prescribe intense treatment, the costs of error suddenly become much greater. For most disorders, adequate early treatment does not yet exist, so all the risks and all the sorrow of impending fate seem without reconcile. But knowledge begets knowledge, and as science pushes forward the benefits granted by early diagnosis will only improve. And if we do not begin with early diagnosis, scientists will be unable to properly track how diseases and disorders develop over time. Early diagnosis also offers a pool of subjects for clinical trials. Finding the at-risk population is the first step towards treating them. The science of medicine is inexact, but for it to improve, sometimes difficult steps must be taken. When knowledge of doom is only that, it seems better not to know. But herein lays the role of science: doubt need not leave us frozen in inaction. From doubt, science can weave truths. Only by embracing the scattered pieces of knowledge, can those pieces be formed into more coherent wholes. For the time being, it can only be voluntary that people should submit themselves for early diagnostic screening. And by doing so they may not help themselves, but they will likely be invaluable in helping the future.

--Dan Curry
Neuroscience Graduate Program

Want to cite this post?
Curry, D. (2011). “Dans le doute, mon cher… abstiens-toi”? The Neuroethics Blog. Retrieved on , from


1 Leo Tolstoy, War and Peace, 1869.
2 Thomas Gray, Ode on a Distant Prospect of Eton College, 1742.

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