A case for thinking expansively

Philosophy and medicine – doesn’t seem like a very obvious combination at first sight.
Nizar El Manouzi: ‘It was actually during my medicine classes, when we started discussing things like mortality and technological developments in healthcare, that I got the idea of doing something with philosophy. Because I kept on asking: why? Why is that necessary to improve healthcare? What does life mean, or how do we define what it means to have a “better” life? During our practice consultations, we ask the patients: “And how does that make you feel?” The conversations you end up having aren’t medical in nature. I found what I was looking for in philosophy – new perspectives that I can use in medicine.’
Marli Huijer: ‘What this story illustrates, really, is that every form of science begs several metaphysical questions about what’s behind our daily reality. Medicine certainly has that. It makes you consider what “good” means and what “life” means, or it makes you consider mortality. This applies to all sorts of fields: every science is based on concepts that have been defined vaguely and are subject to constant change. What’s nature? What’s life? What’s death? What is good, and what isn’t?’

Nizar, did you want to avoid a future where you were a doctor and one day you woke up thinking
– what am I doing?
NEM: ‘Exactly. I hope to be able to provide the kind of care that’s tailored to the patient’s needs. In order to do that, you need to understand the patient – but also your own self. I want to be able to explain why I see certain things the way I do. Sometimes medicine is about protocols, about preventing as many mistakes as possible. But the moral framework that surrounds this is, for me, equally interesting. That’s what I find in philosophy.’
MH: ‘In the Netherlands, we currently have a generation of elderly people that is quite vocal. When a patient asks their doctor, “Can I stop living?”, you end up at a philosophical conversation pretty quickly. What is a good life, what is a good death? Same questions with pediatric medicine. For a long time, we considered a fetus of 25 weeks viable – now that’s gone down to 24 weeks. An interesting question is: should we push that line further down, even if the chance of survival is marginal?’
NEM: ‘We see that with echograms. Do parents want to know what’s wrong with the fetus at twelve weeks, at twenty? If you have the chance of knowing what’s wrong, would you want to?’
MH: ‘Precisely, you quickly end up with these layered conversation. Answers can differ per person, but they’re also a part of the culture they’re positioned in – the way a society thinks about surety and uncertainty.’

It doesn’t make it any easier, does it, adding philosophy?
MH: ‘I also studied medicine first, then went into philosophy. I used to be a GP for a while. In a certain way, medicine is a very job-oriented field. There’s a lot of students who, like Nizar, would like to think and unpack next to the practicality of medicine. In that case, philosophy and medicine become a wonderful combination.’
NEM: ‘And patients know so much more these days. They research everything, they come to you with intelligent questions. What we do these days as doctors is truly shared decision making. You can’t get away with a “just do it ‘cause it says so on the paper” mentality.’

Marli Huijer is professor in public philosophy as well a public philosopher herself. In 2018 she presented her third (!) inaugural lecture: Thinking Imagination: Public Philosophy in the 21st Century. In it, she wrote: ‘In my dreams is a future where philosophy gets everyone thinking. That, in particular, is the purpose of public philosophy. (...) Not just thinking, but expansive ways of thinking that consider how to answer contemporary societal and political questions. Ways of thinking that align with lived experiences, and that consider as many viewpoints of as many people.’

Does everyone need philosophy?
MH: ‘I think that no matter what you study, it’s always good to be able to see through to the foundations of your field, to understand how sciences work.’

You believe that we should all be doing more thinking?
MH: ‘I make the case for expansive thinking. The role of the public philosopher is to make sure that people are able to grasp other perspectives. Our whole democracy – or even the sciences at large – wouldn’t exist if there wasn’t a constant practice of thinking against the grain. If there wasn’t a continuous practice of asking critical questions. You think it has to be done this way, but could you also look at it differently? Especially in a city like Rotterdam, which has such a great diversity of people, it’s important to be able to understand another’s modes of thinking.’

Empathy?
MH: ‘No, that’s not it. It’s about seeing that people in other situations from yours truly think differently. That people live differently, work differently, reason differently. To come to a solid standpoint, it’s important to consider as many viewpoints as possible. In the process of thinking you can come to the best conclusion, which will later on again be subject to change. We should
all keep questioning our own thinking. And keep incorporating other people’s perspectives.’

Does that fit in with our current society?
MH: ‘Yes. Perfectly so, even, considering we’re less inclined to listen to authorities. Think, again, of doctors: when I was studying medicine in the 70s, doctors were put on pedestals. That attitude is gone completely. How do we solve issues together in a world with no authority, no big leaders? We’re getting pluckier, which gets us into situations where we have to bound together and collaboratively think of solutions. How do you organise the medical field? How do you organise a city? A society? Sometimes I start off a lecture by saying: I might end up undermining your sense of certainty, but let it happen. Because while we consider – while we think – together with others, that’s how we end up creating new certainties. Not everything is relative.’