III: Utilitarian and Medical Goodness. The Beneficial and the Harmful. The Notions of Health and Illness
1. IN this chapter we shall discuss two more uses of the word ‘good’ or two more forms of goodness. One of them is related to instrumental, the other to technical goodness.
Instances of that use of ‘good’ which is related to instrumental goodness are provided by many cases, when we say of something that it is good for a certain thing or being. For example: Medicine is good for the sick, rain for the crops, lubrication for the car. The reign of a king can be good for a country or people.
Instead of saying that something is good for a being or thing, we often also say that it does good to the being or thing in question. To take a holiday or to get married will do him good, we say.
That which, in the sense of the above examples, is good for or does good to some being or thing, I shall call beneficial.
Related to the category of the beneficial is the category of the useful and its sister-categories the advantageous and the favourable. For the last three we shall coin the term utilitarian goodness. I shall, however, also frequently employ ‘useful’ as a common name of the three sister-categories and ‘usefulness’ as a synonym for ‘utilitarian goodness’.
There are typical uses of the phrase ‘good for somebody’, under which we would not translate ‘good’ by ‘beneficial’ but by ‘useful’. For example: to know the language of the country in which he is travelling, is a good thing for the tourist—knowing the language he will get more out of the journey. Such knowledge is useful under the circumstances. But we do not normally call it beneficial.
When ‘good’ in ‘be good for somebody’ means ‘useful’, then the whole phrase cannot—as when ‘good’ means ‘beneficial’—be replaced by ‘do good to somebody’. But of that which is useful, we often say that it is ‘good to be’ or ‘good to have’. For example: to be courageous or to have courage is a good thing for a man, it is useful in situations, when he is facing danger. Many other states of character, traditionally called virtues, such as temperance or industry, are useful too. But virtues are not normally called beneficial.
Which is the logical relation between the category of the useful (and its sister-categories) on the one hand and the category of the beneficial on the other hand? I think it is right to say that the second is a sub-category of the first, or that beneficiality is a sub-form of utilitarian goodness. Everything beneficial is also useful, but not everything useful is also beneficial. Things which are useful without also being beneficial I shall call ‘merely useful’.
On the view which is here taken of the relation between beneficiality and utilitarian goodness, the two must have some feature in common. The beneficial, in addition, must possess some distinguishing feature, which marks the beneficial as that which is in some special sense useful, advantageous, or favourable.
The common feature seems to be this: Something is useful or beneficial by virtue of the way in which it causally affects something else. I shall call this causal relevance of the useful or beneficial a way of affecting favourably the thing in question. The ‘logical mechanism’ of affecting things favourably will be briefly examined in section 4. This form of causal relevance will be seen to have two main branches. I shall refer to them using the words promote and protect respectively.
In the case of useful things, which are also called beneficial, that to which the useful is favourably causally relevant—ultimately if not immediately—may be characterized as the good of some being. Instead of ‘good’ we can here also say ‘welfare’. Physical exercise, for example, is beneficial, because good for the health. ‘Health’ is another name for the good (welfare) of the body. The good of the human body is an aspect of the good (welfare) of man. Thus to say that exercise is beneficial is to say that it affects favourably, immediately the good of the body, and ultimately the good of man. Generally speaking: everything which is beneficial affects favourably the good (welfare) of some being.
It appears to be the case that a thing which affects the good of some being protectively rather than promotively, we call (merely) useful rather than (also) beneficial. The reason, for example, why we call the causal relevance of virtues to the good of human beings usefulness rather than beneficiality, seems to be that virtues are protective rather than promotive of this good.
Things are thus sometimes useful without also being beneficial on the ground that they affect favourably the good of some being. In most cases, however, things which are merely useful are this on the ground that they are favourably causally relevant to (the attainment of) some end of action. It is convenient, we have said, to call anything which is an end of action a good. Accepting this terminology, one could also say that a thing is useful when it is favourably causally relevant to some good; and that it is beneficial when it is promotive of that peculiar good which we call the good of a being.
2. Things which are useful for the attainment of ends are often also said to be instrumental to the attainment of those ends.
In view of this common use of the word ‘instrumental’, it may be asked whether we ought not to have reserved the term ‘instrumental goodness’ for the category of the useful. This, I think, would correspond to the way in which many philosophers actually have used the term.
The dispute about terminology is futile. It is important, however, to realize that ‘good’ in ‘a good knife’ or ‘a good watch’ or ‘a good car’ does not ordinarily mean the same as ‘useful’. Even a poor knife can, under circumstances, be useful. It is useful, whenever the use of this knife is a good thing. But this usefulness of the knife does not necessarily mean that it is a good knife.
The distinction between usefulness and that which I have called instrumental goodness can be illuminated by considering the difference in meaning between the phrases ‘be good for a purpose’ and ‘serve a purpose well’. To say of something that it is good for a purpose ordinarily means that it can be used to serve this purpose. If we are in pursuit of the purpose in question, then this thing is useful, a good thing to have. But to say of something that it is a good so-and-so, e.g. knife, is to presuppose that it can be used for a purpose essentially associated with so-and-sos, and to say that it serves this purpose well. (See Ch. II, sect. 2.) The opposite (contradictory) of ‘good for this purpose’ is ‘no good for this purpose’, i.e. ‘cannot be used to serve this purpose’ or ‘useless for this purpose’. The opposite of ‘serves this purpose well’ is ‘serves this purpose poorly’. Nothing can serve a purpose even poorly unless it can serve it, i.e. unless it is in a sense good for this purpose.
Instrumental goodness is typically an excellence or a notion of rank and grade, whereas usefulness is not. This is reflected in the different role, which absolute and comparative judgments of value play in connexion with instrumental goodness on the one hand and in connexion with the useful or the beneficial on the other hand. We are more often interested in knowing whether one knife is, within a given subjective setting of purpose, better than another, than in knowing whether it is, in that setting, good simpliciter. This is so because of the intimate connexion which there is between judgments of instrumental goodness and preferential choice. When judging of usefulness again we are primarily interested in the question whether something can be used or is no good for a certain purpose, and in judging of beneficiality whether something will or will not do a being good—for example whether it will be good for him to go into business. This is not to say that we do not also sometimes grade things as being more or less useful or beneficial. But whereas even the less good of two medicines, which both work to cure an illness, does the patient good and in this sense is beneficial, useful for restoring his health, not even the better of two knives, which can both be used for carving meat, needs be a good carving knife.
To call something an instrumentally good K is to say that it is a K which is good as such, i.e. as a K. When ‘good’ in a phrase ‘a good K’ means useful or beneficial, then, for all I can see, we are not attributing a goodness of its kind to the K. A good habit, for example, is not good as habit. Habits have no special excellence of their kind, as knives or watches or cars have. (Cf. Ch. II, sect. 1.) The logical picture, however, is complicated here by the fact that many kinds, the members of which are judged useful or beneficial in some respect, are also essentially associated with purposes, as e.g. medicines with purposes of curing illness. When this is the case, the useful or beneficial thing can also be judged from the point of view of its instrumental goodness. Then the instrumental goodness of the thing can be said to measure its degree of usefulness.
3. We must now consider the opposites of the useful and its sub-category the beneficial.
One opposite of the useful is the useless. To call something useless can mean several things. It can mean that the thing in question has no use for any purpose whatsoever, or that it cannot be used for a certain purpose. When ‘useful’ means ‘good for this purpose’, i.e. ‘can be used for this purpose’, and ‘useless’ means ‘no good for this purpose’, i.e. ‘cannot be used for this purpose’, then the useful and the useless are opposed to one another as contradictories, and not as contraries. This seems to be the way the two are normally opposed.
If one had to name the opposite of the beneficial, the first name to suggest itself would probably be the adjective ‘harmful’. Others which would also come to the mind are ‘detrimental’, ‘damaging’, and ‘injurious’ or ‘injuring’.
The beneficial, we said, is something which is good for or does good to a thing or a being, i.e. serves the good of the thing or being in question. Clearly, no thing is harmful merely on the ground that it does no good or does not serve the good of any being. ‘Harmful’, unlike ‘useless’, is not a privative term. The harmful which is the opposite of the beneficial is that which affects the good of a being unfavourably, adversely. And to affect the good of a being adversely is not the same as not to affect it favourably. If it were, then to be harmless (= not harmful) would be the same as beneficial, which it obviously is not.
Good habits, for example, have beneficial effects on a man, good laws and institutions beneficial effects on a community or country. Bad habits have detrimental effects on the good of a man, e.g. because they ruin his bodily health. Similarly bad laws and institutions do harm to the community. But habits can also be harmless without being good, and institutions and laws useless or ‘pointless’ without being harmful, positively obnoxious. Thus whereas the useful and the useless, and the harmful and the harmless are opposed to one another as contradictories, the beneficial and the harmful are opposed to one another as contraries. They exclude one another, but between them there is a neutral zone.
The harmful, when it is the contrary of the beneficial, is also said to be bad, or sometimes evil, for the being whose good it affects unfavourably. It is further said to do bad or evil to this being. It is called a bad thing or maybe even more frequently an evil thing. Often it is called simply an evil. The institution of ostracism, one could say, was an evil to the Athenian republic; the reign of Ahab was an evil to Israel, that of Hitler to Germany and Europe. I find it convenient to adopt the substantive form an evil for anything—be it an institution, an act, a state of affeirs or of character—which is harmful in that sense of ‘harmful’, which is the opposite of beneficial, i.e. for that which is bad for the good of a being.
The notion of evil, thus defined, is a sub-category of the notion of the harmful. Anything which frustrates or hampers the attainment of some end of human action is harmful or detrimental, viz. to the attainment of that end. But not of everything, which is in this sense harmful, do we say that it does evil to the being in pursuit of the end. Sometimes we say that it was good for a man that this or that plan of his became ruined—but that which ruined his plans was nevertheless a harmful thing, viz. to his plans. This observation shows that the adjective ‘harmful’ is commonly used also to mean the opposite of utilitarian goodness in general, and not only to mean the opposite of its sub-category the beneficial.
There are thus two senses of ‘harmful’ which must be distinguished: ‘harmful’ in the broad sense, which names the contrary of utilitarian goodness, and ‘harmful’ in the narrower sense, which names the contrary of the beneficial.
There are also two senses of the word ‘evil’ to be noted in this connexion. When ‘an evil’ means something which affects the good of a being adversely, then ‘an evil’ means something which is a cause of harm (to the being involved). But instead of ‘a cause of harm’ we can here also say ‘a cause of evil’. Thus the word ‘evil’ sometimes means the cause of harm and sometimes the harm caused. The word ‘harm’, it would seem, has not the same double meaning. It nearly always means the thing (damage) caused or suffered.
The term ‘poor’, be it noted in conclusion, is also sometimes used in connexion with assessing utilitarian goodness. Then ‘poor’ does not mean the same as that which is the ordinary meaning of ‘bad’ in such contexts. The poor thing, in a utilitarian sense, is to some low degree favourably relevant to some end or purpose. It is thus not entirely useless, still less is it harmful, for the end or purpose in question. The poor is some, but very little, use. A poor medicine, for example, still does some good. If it affects the patient adversely, it is not called poor. But it may be called bad in the utilitarian sense of harmful or obnoxious.
4. The property of being useful or harmful, and a fortiori also the property of being beneficial or evil, belongs to a thing by virtue of a causal relationship between this thing and something else (cf. sect. 1). In the case of things useful or beneficial this causal relationship is one of affecting favourably or being favourably relevant to the other thing in question. In the case of things harmful or evil this relationship is one of affecting adversely or unfavourably this other thing.
There are two principal ways in which something can be causally favourable to the attainment of an end. Either this thing is favourably relevant to the end by taking us, metaphorically speaking, nearer or even up to this end. Or it is favourably relevant by preventing us, metaphorically speaking, from being taken farther away from the end. We have already (p. 42) coined the terms promotive and protective for these two forms of favourable causal relevance to ends.
In a similar manner one may distinguish between two main forms of affecting the attainment of ends unfavourably. Something is unfavourably relevant by taking us farther away from the end or goal, or by preventing us from getting nearer to it. When the adverse effect is of the first kind, it is also called deteriorative.
The promotive effect of some useful or beneficial thing is sometimes described by saying that it makes bad better and sometimes by saying that it makes good better. The former type of promotive effect is often also called an effect of curing or healing.
Take, for example, the case of a beneficial medicine or cure. It serves the good of the being to whom it is administered, by curing some illness and thus restoring health. An illness is an evil, something which affects the good of the body—ultimately the good of a man—adversely. A beneficial medicine or cure thus works for the good of a being by working against an existing evil. Generally speaking: it promotes the good by making bad better.
In a similar manner, the deteriorative effect of some harmful or evil thing is sometimes described by saying that it makes good worse and sometimes by saying that it makes bad worse.
When, for example, the wrong medicine is administered to the ill man making him sicker still, the effect of the harmful consists in making bad worse. When excessive use of tobacco or of alcohol ruins the health of a person, the harmful makes good deteriorate. Bad habits, generally speaking, promote evil by ruining the good of the being who practises them.
It would be an interesting and worthwhile task to investigate the formal logic of these various forms of the causal efficacy of utilitarian goodness and its opposite. The investigation would show, for one thing, in how many different senses something can be a ‘cause’ of good or of evil. To observe these different senses is essential to any ethics, which measures the moral value or Tightness of acts in terms of the consequences of action. Yet it is an observation which traditional ethics has habitually neglected to make.
5. Are value-judgments, of the kind which we are now considering, objectively true or false? In discussing this question it is important to separate judgments which involve the notion of the good of a being, from judgments which do not involve this notion. The case of the latter is much simpler.
In judgments of usefulness and harmfulness, which do not involve the notion of the good of a being, we judge the causal relevance of something for some purpose or end which we pursue. The existence of the purpose or end is presupposed in the judgment. An end, we said, can also be called ‘a good’ simply by virtue of being desired. The question, however, whether an end is good or bad in some other sense, i.e. the question of the value of ends, is totally irrelevant to judgments of usefulness and its opposites. Such judgments are purely causal.
For example: A man wants to train himself to become a good runner and deliberates whether he should give up smoking. Is the habit of smoking detrimental, harmful, obnoxious to the attainment of his end? He has to consider the causal effects of smoking upon excellence in running. The problem can be viewed under the various aspects of causal relevance, which we distinguished in the preceding section: does smoking prevent him from improving his talents, or does it positively ruin them? Which aspect of the causal problem that will interest him most, will largely depend upon the state which he has already reached with a view to the end.
Suppose our man arrives at the conclusion that smoking is a bad habit in the sense that it has adverse effects on the attainment of his end. The conclusion is true or false—and in this sense ‘objective’. Assume that it is true. Does it then follow that smoking is a bad habit with every man who pursues the same end as he?
Obviously, identity of aim or end or purpose is not enough to make the judgment concerning the badness of smoking generalizable. Another man may pursue the same end, but have a different constitution or otherwise be differently circumstanced and therefor ‘immune’ to the harmful effects of tobacco. What is a bad habit for one man in pursuit of a certain end, need not be a bad habit for another man in pursuit of exactly the same end. With a view to this one may call the value-judgment passed on the habit ‘subjective’. But this subjectivity—if it be called by that name—does not remove the judgment from the province of truth and falsehood.
Suppose we generalized the case which we have been discussing, and said that smoking is bad for any man who pursues the same end and is exactly similarly circumstanced. This would be trivial, unless we specified the circumstances, in which case the generalization might easily be false.
If we want to generalize in matters of usefulness and harmfulness, we shall on the whole have to be content with rough generalizations of the following schematic type: For most men in circumstances C the thing X is good or bad with a view to the end E. The corresponding holds true also for the special form of the useful, which we call the beneficial, and the special form of the harmful, which we call the evil.
Judgments of utilitarian goodness, which do not involve the notion of the good of a being, are, we said, purely causal judgments, though of limited generalizability. Judgments of the beneficial and the evil, however, are not purely causal. They split in two components. One is causal. It concerns the consequences or effects of certain acts or habits or practices or institutions or what not. The other component could conveniently be called axiological. It concerns the relations of these effects to that which we have termed the good of a being. This is not a causal relation. It is more like a relationship of belonging. We shall later have occasion to investigate the nature of this relationship in more detail.
6. What kinds or species of being have a good? What is the range of significance of ‘X’ in the phrase ‘the good of X’?
Can, for example, artefacts and other inanimate beings have a good? It is not unnatural to say that lubrication is beneficial or good for the car, or that violent shocks will do harm to a watch. The goodness of a car or a watch is itself instrumental goodness for some human purposes. Therefore that which is good for the car or watch is something which will keep it fit or in good order with a view to its serving a purpose well. It may be argued that, since the goodness of the car or watch is relative to human ends and purposes, that which is good for the car or watch cannot properly be said to serve the good of the car or watch themselves. If it serves anybody's good at all, it will be the good of the human being to whom the instrument belongs or who uses it.
A being, of whose good it is meaningful to talk, is one who can meaningfully be said to be well or ill, to thrive, to flourish, be happy or miserable. These things, no doubt, are sometimes said of artefacts and inanimate objects too—particularly when we feel a strong attachment to them. ‘My car does not like the roads of this district very much, as shown by the frequent overhaulings which it needs’, we may say. But this is clearly a metaphorical way of speaking.
The attributes, which go along with meaningful use of the phrase ‘the good of X’, may be called biological in a broad sense. By this I do not mean that they were terms, of which biologists make frequent use. ‘Happiness’ and ‘welfare’ cannot be said to belong to the professional vocabulary of biologists. What I mean by calling the terms ‘biological’ is that they are used as attributes of beings, of whom it is meaningful to say that they have a life. The question ‘What kinds or species of being have a good?’ is therefore broadly identical with the question ‘What kind or species of being have a life?’ And one could say that it is metaphorical to speak of the good of a being, to the same extent as it is metaphorical to speak of the life of that being.
Artefacts, such as cars and watches, have a life and therefore a good, only metaphorically. Plants and animals have a life in the primary sense. But what shall we say of social units such as the family, the nation, the state? Have they got a life ‘literally’ or ‘metaphorically’ only? I shall not attempt to answer these questions. I doubt whether there is any other way of answering them except by pointing out existing analogies of language. It is a fact that we speak about the life and also the good (welfare) of the family, the nation, and the state. This fact about the use of language we must accept and with it the idea that the social units in question have a life and a good. What is arguable, however, is whether the life and a fortiori also the good (welfare) of a social unit is not somehow ‘logically reducible’ to the life and therefore the good of the beings—men or animals—who are its members.
It would seem that man, among beings who have a good, holds a position, which is peculiar in two respects.
Man is not the only living being who has a social life. But there are a vast number of social units, which are peculiar to man. These are the units which presuppose a normative order. The supreme example of such units is the state. How the good of such ‘covenanted’, as they may also be called, social units is conceptually related to the good of the human individual, is a major problem of political philosophy.
The other respect in which man holds a peculiar position among beings who have a good, is that he may be regarded as quasi composed of parts, of whose independent life and good one can speak. Man is body and mind, one sometimes says. Or one makes a tripartite division of man into body, mind, and soul. It makes sense to speak of the life of the body and also of the welfare of the body. The same holds true for the mind and the soul. The welfare of the body and mind is called (bodily and mental) health.
In the rest of this chapter I shall discuss a form of goodness which is connected with that aspect of the good of man, which we call health. We may call this form medical goodness.
7. Goodness of the form here called medical is referred to when we speak about a (in the medical sense) good heart, good lungs, or good eyes—but also about a good memory or understanding.
The heart and the lungs are organs of the body; memory and understanding are often called faculties of the mind. That which is here called medical goodness could also be spoken of as the goodness of organs and faculties.
Are the eyes an organ of the body or of the mind? Perhaps we could say that they are an organ of the body, which serves as the bodily substratum of a faculty of the mind, viz. sight. The same holds good of the other so-called sense-organs.
Organs resemble instruments or tools in that they have both morphological and functional characteristics. Faculties again have no morphological features proper to them; in this and other respects they resemble abilities and skills. The functional characteristics of organs, too, resemble abilities; they consist in things which the organs themselves do, such as pumping blood or breathing air, rather than—as is the case with tools—in their usability for various assigned purposes.
In speaking of the goodness of various organs we are primarily concerned with their characteristic functions and not with their morphological features. A deformation of the heart may be a cause why it performs badly and is thus called a bad heart. But if the deformation did not impede the performance of the organ, we should hardly call it bad merely because deformed.
When ‘good’ in the phrase ‘a good K’ refers to medical goodness and K thus is some organ or faculty, we have another case of a goodness of its kind. In this respect medical goodness resembles instrumental and technical goodness, but differs from utilitarian goodness. (Cf. sect. 2.)
Instrumental goodness of its kind presupposes, we found, an essential connexion between the kind and some purpose; technical goodness again an essential tie between the kind and some activity. In a similar manner, medical goodness of its kind can be said to presuppose the existence of an essential connexion between the kind (of organ or faculty) and some function.
There is a conspicuous resemblance between medical and technical goodness by virtue of the fact that both forms of goodness manifest themselves as a certain excellence of performance. But there are noteworthy differences as well. I shall here mention the following three:
The technically good man is good at something. But the phrase ‘good at’ is seldom used in connexion with good organs or faculties. A good heart is not ordinarily said to be good at pumping blood or good lungs to be good at breathing. Good eyes are not said to be good at seeing, nor even the man who has good eyes. But the man of good sight may be good at, say, discerning landmarks at a great distance. The man of good memory may be good at, say, remembering dates or telephone numbers or knowing poems by heart. In these last cases the things at which the man is good is some special activity in which one can train oneself, and not the function, as such, of the organ or faculty concerned.
This observation takes us to a second difference between technical goodness and the goodness of faculties and organs. Activities at which men are said to be good, are for the most part acquired rather than innate. Teaching and training are normally needed to reach technical excellence. The functions of organs and faculties again are substantially innate. By training one's body and mind one can, to some extent, develop those functions to greater perfection, and by caring for one's body and mind one can, to some extent, prevent them from decaying and deteriorating. But substantially the goodness of faculties and organs is not dependent upon what a man does with a view to perfecting them, but upon what might be called the graces of nature and fate.
The term ‘innate’, incidentally, must not be misunderstood. It does not mean that all faculties and organs perform their proper functions from the birth of the individual. It may take time for them to mature. Man can quite properly be said to be innately endowed with sight, and yet a newly born baby cannot see.
A third major difference between technical goodness and the goodness of organs and faculties is constituted by the way in which organs and faculties serve the good of the being who has them. A man can use his acquired skills and special talents to promote his good. He need not, however, do this. But good faculties and organs he needs. To have a bad heart or bad lungs or a bad memory is bad for—an evil to—the man who has it, and it is because of the detrimental effects on the good of the whole that we judge the organs or faculties in question bad. (See below, sect. 9.)
Because of the intrinsic connexion which holds between the goodness of organs and faculties and the good of the being to whom they belong, I propose to call the functions, which are proper to the various organs and faculties, essential functions of the being, or rather, of the kind or species of which the individual being is a member. The ‘essentiality’ of the functions does not entail that every individual of the species can actually perform all those functions. But it entails that, if an individual cannot do this ‘at the time when by nature it should’—to quote Aristotle—we call it abnormal or defect or faulty or, sometimes, injured. It follows by contraposition that the essential functions of the species are functions which any normal individual of the species can perform. The essential functions are needed for that which could conveniently be called a normal life of the individual.
The notion of normalcy, as we shall soon see, is of great importance to the understanding of the special form of goodness which belongs to organs and faculties.
8. Medical goodness may be said to be related to the notion of the good of a being thanks to the intermediary rôle of the notions of health and illness.
An organ which performs its proper function well is said to be good or well. It is also often said to be healthy and sometimes said to be in good health. This last, however, is more commonly said of the man, or being, whose organs are concerned.
An organ which does not perform its proper function well is sometimes called ill and sometimes weak. It is also called had or poor. One can distinguish between the meanings of ‘ill’ and ‘weak’. ‘Bad’ and ‘poor’ again are used pretty much as synonyms in the field of medical goodness; perhaps one could maintain that ‘bad’ is more often used for the ill than for the weak, and ‘poor’ more often for the weak than for the ill organ.
That a man has bad health usually means that he suffers an illness of some or several of his organs. Bad health is also called poor health. If a man is said to be of weak health, this weakness of health must be reflected in the weakness of some or several of his bodily parts. Weak health too is sometimes called poor health.
What is the difference between illness and weakness of organs, or between bodily illness and weakness of health? Ordinary usage can hardly be said to maintain a rigorous distinction between the concepts. But it may be said to hint at a distinction which can be made and maintained with a certain rigour.
Illness, we shall say, is an actual and weakness a potential evil or cause of harm to the being concerned. The ill or diseased organ causes harm or suffering to the being whose organ it is. The weak organ may cause suffering. The meaning of ‘may’ here is not that of mere physical possibility. The ‘may’ has to be explained in terms of probability. Roughly speaking: weakness as a potential cause of harm to the body is a probability of illness. How this probability is estimated need not concern us here. Weakness could also be called a disposition or tendency to deteriorate into illness. This holds good both of weakness of organs and of weakness of health.
Poor or bad organs thus function in a way which affects health adversely, by being either an actual or potential cause of illness. Shall we say contrarywise that good organs function in a way which affects health favourably, i.e. promotes the physical well-being of the being or at least prevents it from deteriorating? It seems to me that it would not be correct to say thus. For, let us ask, what is ordinarily meant by ‘good eyes’, ‘good lungs’, etc. Primarily, it seems, organs which are not bad (poor), i.e. neither ill nor weak. ‘Good’ as an attribute of an organ of the body means very much the same as ‘all right’. Organs are good when they are in order, fit, as they should be, normal. Organs which are better than normal are called ‘exceptionally good’.
Thus in the case of organs, badness (poorness) appears to be logically primary to goodness. ‘Good’ is here a privative term. It means ‘not bad’, ‘all right’, ‘no source of complaint’. If I am not mistaken, this is a logical feature in which the form of goodness, which we are now discussing, differs basically from both instrumental and technical goodness. In their case, ‘poor’ (for technical goodness also ‘bad’) is a privative term, ‘good’ a positive term. The positive is logically primary to the privative.
It follows from the definition of medical goodness as an absence of weakness and illness that ‘good’ and ‘poor’ as attributes of organs or of bodily health denote contradictories rather than contraries. But from the definition of weakness as likelihood of illness it also follows that the border separating the good from the poor will be vague. (The meaning of ‘likely’ is inherently vague.) Because of this vagueness it will frequently be impossible to pronounce definitely on the question whether a certain organ of some individual being should be considered good or not.
If a being is said to be in good bodily health, when its organs perform their proper functions well, and if organs are good, when there is nothing wrong with them, i.e. no illness or weakness, then the notion of (good) bodily health too is a privative notion. From this privative notion of health one may distinguish a positive notion of health, which is present when the being positively ‘enjoys’ good health, feels fit, thrives or flourishes physically. But of the two notions, the privative seems far more important. It would be correct to say of an individual that he is in perfectly good bodily health merely on the ground that there is nothing wrong with his body and bodily functions.
The privative notion of goodness of organs and of bodily health has an interesting connexion with certain ideas relating to causation. If an organ functions unsatisfactorily, i.e. suffers from some weakness or illness, we think of this bad as having a cause—for example some constitutional morphological defect of the organ or some injury, which has befallen it in the course of the life of the individual. But the normal state of the organ, i.e. the state in which it is when it functions satisfactorily, is not in the same sense ‘caused’.
The idea that a cause is primarily a cause of harm and thus is an evil, i.e. a disturbance of an equilibrium or normal state or good order (a kosmos in the literal sense of the Greek word) seems to be the very root, from which the idea of causation as we know it to-day has originated. The Greek word for cause is aitia, which also means guilt, i.e. responsibility for harm or evil. It is an interesting observation that the Finnish word for cause, syy, has precisely the same double meaning as the Greek aitia. The received meaning of the term aetiology is the study of the causes of diseases, but the literal meaning of the word is science of causes in general.
9. Organs are bad, i.e. weak or ill, by virtue of their adverse effects on the being whose organs they are. Briefly speaking: organs are bad because of some bad or evil of which they are the cause. But, as noted in the preceding section, organs are not good, because of some good they cause, but simply by not causing harm.
An organ may be judged diseased on the ground that it exhibits a certain deformation. But, as said before (sect. 7), morphological anomalies can at most be symptoms of badness, not defining criteria. For the deformations are bad only to the extent that they impede the function.
The relation between the functioning of an organ and its effects on the body is a causal and thus extrinsic relation. But the relation between the badness of the effects and the badness of the organ, whose functioning is responsible for those effects, is a logical and thus intrinsic relation. The evil which bad organs cause is constitutive of the badness of the organs themselves, one could also say.
For example: That the discomfort and fatigue, which a man feels each time he has to climb stairs, should be due to an insufficiency of his heart, is a fact about causation in the human body. But when the heart, because of this and similar effects, is said to be weak or to perform poorly, then the badness of the effects is not ‘symptomatic’, but ‘constitutive’ of the weakness of the organ and poorness of its performance.
Which then is the evil or harm, which bad organs cause, actually or potentially?
One basic form of such harm is pain or pain-like sensations such as discomfort, ache, nausea. Obviously, the pain caused by a diseased organ need not be continuous, in order that we shall call the organ (continuously) ill. These different relationships to change reflect differences in the logic of the concepts of pain and of illness. For example; a diseased heart need not cause pain when the individual is at rest, but it may cause discomfort when he moves.
Wherein does the evil of pain lie? To ask thus is not to ask a triviality. Pain is evil, I would say, only to the extent that it is disliked or shunned or unwanted. It is a fact that pain is not always disliked. The phrase ‘a pleasant pain’ is not a contradiction in terms. We shall have to speak more about this in connexion with hedonic goodness.
Do all tests for judging, whether the function of an organ is impeded and the organ thus is weak or ill, depend logically upon the notion of pain?
At first sight there seem to be ways of testing the functioning of organs and therewith their goodness, which are independent of pain—and even of harm generally. Consider, for example, how a doctor tests a man's sight. A man, broadly speaking, is said to have bad or poor eyes (sight), if he cannot, at the appropriate distances, discern things and movements which most men can discern. Here the standard of goodness is set by something, which can be called the normalcy of the function.
It would, however, be wrong to think of the test of normalcy as being exclusively a performance-test. If the eyes of a man can see exactly those things which normal eyes are supposed to see at the appropriate distances, but if the use of his eyes to see this causes him pain, his eyes would not be normal. The same would hold true if he could look at things only for a short time without his eyes getting fatigued. Thus the tests of normalcy of performance include, or have to be supplemented by, considerations pertaining to pain or fatigue. (Fatigue is discomfort and can for present purposes be counted a form of pain.) The fact alone that the use of an organ is painful may disqualify it in the normalcy-test.
But how shall we judge of a case when the functioning of an organ falls decidedly short of the normal performance, but when there is no pain or bodily discomfort of any kind? Such cases are perhaps rare, but they may occur. Shall we then say that the organ is bad, because its performance is sub-normal, or shall we say that it is all right, since it causes no discomfort?
At this point it is good to remember that a man uses his organs to satisfy various needs and wants of his. If some organ of his performs sub-normally, he can be said to suffer incapacitation. This means: there will then be things which he could do if the organ performed normally, but which now he cannot do. Should he want to do these things, the fact that he cannot do them may be a cause of annoyance, frustration, grief, and similar feelings. These phenomena can, with some caution, be termed ‘mental pains’. The man who suffers them will then complain of the badness of the organ as a source of his mental discomfort.
But suppose he does not want to do things, which he could do, if the organ functioned normally. He will then have no reason to complain of this organ of his either. Shall we nevertheless call it bad? One may hesitate about the answer. It seems to me that, if we call the organ bad, i.e. weak or ill, it is only because of the fact that men normally have the wants and needs, which this particular man happens to be without, and therefore also normally would suffer if they had this man's deficiency. A man who does not put some or other of his organs to their normal use, may be said to be abnormal in a certain respect, or be said not to live a normal life. This abnormality of the man or of his life could, for a variety of reasons, be considered a bad thing and even be regarded as a sort of illness. But this badness is clearly logically independent of that of the organ.
The evil or harm which bad organs cause, and which is logically constitutive of their badness, is thus of two principal kinds, viz. pain and frustration of wants. Abnormality of performance too is logically constitutive of badness of organs, but only indirectly, via the notion of normality of the needs and wants of men. Due to the fact that some men may be lacking in normal needs and wants, it may happen that an organ is ‘objectively’ diseased but that its badness is not ‘subjectively’ noted.
10. We have so far been talking explicitly about the goodness (and badness) of organs only. Much the same things can be said about the goodness of faculties. But there are some noteworthy differences. I shall here touch upon the subject very summarily.
In the case of the faculties too we can distinguish between the ill, the weak, and the good. Calling a faculty bad (or poor) is usually to say that it is weak. A bad memory is essentially a weak memory. When faculties completely deteriorate, the being whose faculties they are is often said to be mentally ill or deranged. The faculties themselves are not commonly called ill. It would also not be generally correct to say that a weakness of a faculty, like that of an organ, is a likelihood of illness.
The harm caused by poor faculties cannot, for conceptual reasons, be pain in the primary sense of bodily pain. The harm is here basically suffering due to incapacitation. It is the annoyance, frustration, and grief which the individual will experience as a consequence of not being able to satisfy needs and wants which a man, whose faculties function in the normal way, can satisfy.
As in the case of the organs, the harm which bad faculties may cause to the being is logically constitutive of their badness. If use of memory were not vital to the satisfaction of the needs of a normal life, it is not clear why one should call sub-normal capacity of remembering things ‘bad memory’. Perhaps we can imagine a form of life under which that, which we call bad memory, would be an altogether good thing to have and therefore would be called good memory. We too sometimes consider it good to forget, though not on a scale which would make us revise our notion of goodness of memory. Perhaps we can also imagine circumstances, under which remembering would be a completely useless activity. To be good at remembering would then be a technical excellence or something like it. People might be keen on remembering, as on playing a game. Their notion, too, of a good or bad memory would be different from ours, i.e. their notion would lack a feature which is essential to ours.
The harm caused by illness, mental or bodily, is not only a concern of the sick person himself. The ill man may not be able to take care of himself. He has to be helped by others. Thus he easily becomes a burden on his fellow-humans. He can, moreover, also be a menace to the good of others: by spreading contagion, if he is bodily ill, and by harmful acts if he is mentally deranged. The question may be raised, whether the relationship between illness and the harm caused to others by the sick is an intrinsic or extrinsic connexion, i.e. whether it is constitutive or not of the notion of illness of a man—as distinct from the notion of illness of an organ or faculty by itself.
It seems to me that in this respect there is a conceptual difference between physical and mental illness. It is part of our notion of the latter that it upsets the relations of the sick to his surroundings in a way which, from a social point of view, is unwanted, undesirable. A man could not be said to be bodily ill unless he, or at least any normal person in his state, suffers pain or discomfort. But the feeble-minded or maniac, who is perfectly content and happy in his state, we still consider ill. This we should hardly think of him if his state were not from a social point of view a bad thing, an evil. We can imagine forms of lunacy—there may even be such forms in actual existence—which lack these obnoxious effects upon social life and which we would regard as blessed states, which we praise, rather than illness which we deplore or pity.
11. Are judgments of medical goodness ‘objectively’ true or false?
A man who judges of some organ of his that it is diseased on the ground that he feels pain, is not judging that he has pain. What he judges is that the pain he feels is caused by some defect of the organ. In this he may, of course, be mistaken. The judgment is true or false. The fact that pain is a state of consciousness of an individual subject does not detract from or void the ‘objectivity’ of the judgment.
Shall we say that a man, e.g. a doctor, who judges of some organ of another man that it is diseased on the ground that this man complains of pain, is making two judgments—one about the pain of that other man and another about the cause of his pain? I don't think we should say thus. The doctor, who judges about the state of health of the organ on the basis of signs of pain, is presupposing or taking for granted the pain. This presupposition he may have reason to question, say because an examination of the organ does not reveal any functional or morphological anomaly, which were symptomatic of illness. His doubts he may express in a judgment (conjecture) to the effect that the other man actually feels no pain. But the judgment to the effect that an organ of that other man is ill, is a judgment solely to the effect that a cause of a given discomfort is to be located to the organ (including its functioning).
In a similar manner, when we judge organs or faculties bad on the ground that they are a source of annoyance, frustration, or grief, we are not judging that a certain mental discomfort or pain occurs, but that it is due to such and such causes. In these judgments, as will be remembered, certain standards of normalcy are presupposed. These standards may be vague and they may be difficult to apply—for example because they cannot be applied uniformly to all members of a certain zoological species, but must take account of age and sex and training and, maybe, various external circumstances of life too. But this does not constitute a ground for saying that judgments of goodness or badness, which employ such standards, were ‘subjective’.
12. Organs and faculties, we have said, serve the good of a being. The organs of the body, one could say without distorting language, serve immediately the good of the body. This good is also called bodily health. The faculties of the mind serve immediately the good of the mind, our mental health. Remotely, organs and faculties serve the good of man.
The concept of health may be considered a model on a smaller scale of the more comprehensive notion of the good of a being. That is: it may be suggested that one should try to understand this good (welfare) in all its various aspects on the pattern of the notion of health. On such a view, the good of man would be a medical notion by analogy, as are the good of the body and of the mind literally.
The conception of the good of man on the basis of medical analogies is characteristic of the ethics and political philosophy of Plato. The idea is profound and, I think, basically sound. It is worth a much more thorough exploration than will be given to it in the present work.
We distinguished above (sect. 8) between a privative and a positive notion of health. The first, we said, is the more basic notion. Health in the privative sense consists in the absence of bodily pain and of pain-like states, which are consequent upon the frustration of needs and wants of a normal life. Health in the positive sense consists in the presence of feelings of fitness and strength and in similar pleasant (agreeable, joyful) states. In the enjoyment of those states the healthy body and mind can be said to flourish.
In a similar manner, welfare may be said to present two aspects. The one, which answers to the privative notion of health, is the basic aspect. It is conceptually allied to the needs and wants of beings and to the notions of the beneficial and harmful. I am not, however, going to suggest that it is a privative idea in the same strong sense in which the basic notion of health seems to be this. The other aspect of welfare, which answers to the positive notion of health, has a primary conceptual alliance with pleasure. Of the being, who enjoys this aspect of its welfare, we say that it is happy. Happiness could also be called the flower of welfare.