Thank Goodness!

Daniel C. Dennett, uno dei maggiori filosofi viventi, ha sofferto poco tempo fa di una dissezione dell’aorta, che per poco non l’ha reso uno dei maggiori filosofi del passato. Dennett ha raccontato per Edge cosa ha significato questa esperienza per il suo ateismo e per la sua visione del mondo («Thank Goodness!», Edge, n. 195, 3 novembre 2006).

As I now enter a gentle period of recuperation, I have much to reflect on, about the harrowing experience itself and even more about the flood of supporting messages I’ve received since word got out about my latest adventure. Friends were anxious to learn if I had had a near-death experience, and if so, what effect it had had on my longstanding public atheism. Had I had an epiphany? … or was my atheism still intact and unchanged?
Yes, I did have an epiphany. I saw with greater clarity than ever before in my life that when I say “Thank goodness!” this is not merely a euphemism for “Thank God!” (We atheists don’t believe that there is any God to thank.) I really do mean thank goodness! There is a lot of goodness in this world, and more goodness every day, and this fantastic human-made fabric of excellence is genuinely responsible for the fact that I am alive today. It is a worthy recipient of the gratitude I feel today, and I want to celebrate that fact here and now.
To whom, then, do I owe a debt of gratitude? To the cardiologist who has kept me alive and ticking for years, and who swiftly and confidently rejected the original diagnosis of nothing worse than pneumonia. To the surgeons, neurologists, anesthesiologists, and the perfusionist, who kept my systems going for many hours under daunting circumstances. To the dozen or so physician assistants, and to nurses and physical therapists and x-ray technicians and a small army of phlebotomists so deft that you hardly know they are drawing your blood, and the people who brought the meals, kept my room clean, did the mountains of laundry generated by such a messy case, wheel-chaired me to x-ray, and so forth. These people came from Uganda, Kenya, Liberia, Haiti, the Philippines, Croatia, Russia, China, Korea, India – and the United States, of course – and I have never seen more impressive mutual respect, as they helped each other out and checked each other’s work. But for all their teamwork, this local gang could not have done their jobs without the huge background of contributions from others. I remember with gratitude my late friend and Tufts colleague, physicist Allan Cormack, who shared the Nobel Prize for his invention of the c-t scanner. Allan – you have posthumously saved yet another life, but who’s counting? The world is better for the work you did. Thank goodness. Then there is the whole system of medicine, both the science and the technology, without which the best-intentioned efforts of individuals would be roughly useless. So I am grateful to the editorial boards and referees, past and present, of Science, Nature, Journal of the American Medical Association, Lancet, and all the other institutions of science and medicine that keep churning out improvements, detecting and correcting flaws.
Do I worship modern medicine? Is science my religion? Not at all; there is no aspect of modern medicine or science that I would exempt from the most rigorous scrutiny, and I can readily identify a host of serious problems that still need to be fixed. That’s easy to do, of course, because the worlds of medicine and science are already engaged in the most obsessive, intensive, and humble self-assessments yet known to human institutions, and they regularly make public the results of their self-examinations. Moreover, this open-ended rational criticism, imperfect as it is, is the secret of the astounding success of these human enterprises. There are measurable improvements every day. Had I had my blasted aorta a decade ago, there would have been no prayer of saving me. It’s hardly routine today, but the odds of my survival were actually not so bad (these days, roughly 33 percent of aortic dissection patients die in the first twenty-four hours after onset without treatment, and the odds get worse by the hour thereafter).
One thing in particular struck me when I compared the medical world on which my life now depended with the religious institutions I have been studying so intensively in recent years. One of the gentler, more supportive themes to be found in every religion (so far as I know) is the idea that what really matters is what is in your heart: if you have good intentions, and are trying to do what (God says) is right, that is all anyone can ask. Not so in medicine! If you are wrong – especially if you should have known better – your good intentions count for almost nothing. And whereas taking a leap of faith and acting without further scrutiny of one’s options is often celebrated by religions, it is considered a grave sin in medicine. A doctor whose devout faith in his personal revelations about how to treat aortic aneurysm led him to engage in untested trials with human patients would be severely reprimanded if not driven out of medicine altogether. There are exceptions, of course. A few swashbuckling, risk-taking pioneers are tolerated and (if they prove to be right) eventually honored, but they can exist only as rare exceptions to the ideal of the methodical investigator who scrupulously rules out alternative theories before putting his own into practice. Good intentions and inspiration are simply not enough.
In other words, whereas religions may serve a benign purpose by letting many people feel comfortable with the level of morality they themselves can attain, no religion holds its members to the high standards of moral responsibility that the secular world of science and medicine does! And I’m not just talking about the standards ‘at the top’ – among the surgeons and doctors who make life or death decisions every day. I’m talking about the standards of conscientiousness endorsed by the lab technicians and meal preparers, too. This tradition puts its faith in the unlimited application of reason and empirical inquiry, checking and re-checking, and getting in the habit of asking “What if I’m wrong?”. Appeals to faith or membership are never tolerated. Imagine the reception a scientist would get if he tried to suggest that others couldn’t replicate his results because they just didn’t share the faith of the people in his lab! And, to return to my main point, it is the goodness of this tradition of reason and open inquiry that I thank for my being alive today.

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