What is Dialectical Materialism? - Irfan Ajvazi

Philosophy

What is Dialectical Materialism?

What is Dialectical Materialism ? Joseph Dietzgen once said that official philosophy was not a science, but a safeguard against socialism. He was quite right. No matter how indignantly they deny it, professional philosophers have been enlisted by the defenders of the status quo as allies in the struggle against Marxism. This was particularly blatant in the period of the Cold War, when the CIA used philosophy and art as weapons against communism, but it remains true today. Ever since Marxism emerged as a significant force, challenging the existing order, the establishment has been in a perpetual state of war on every aspect of Marxist ideology, starting with dialectical materialism. The very mention of Marxism is guaranteed to provoke a knee-jerk reaction in such circles. 'Out of date', 'unscientific', 'disproved long ago', 'metaphysics', and all the rest of the threadbare and tiresome litany of reaction. Not only are Marx and Engels personae non grata in the hallowed halls of the philosophy departments, but poor old Hegel, who was once hailed as the philosopher's philosopher par excellence, is subjected to a quite shameful conspiracy of silence, or worse. This situation is not only a reflection of ignorance and prejudice (though there are plenty of both). Powerful material interests are at stake, which soon convince all but the bravest souls that it is not wise to offend those who provide the grants and control academic careers. This text also appears as an introduction to our new edition of Lenin's classic book on Marxist philosophy, Materialism and Empirio-criticism. The book is available to buy now here! It is also available in ebook format. It is also evident that the postmodern academic gang do not like to be reminded of the fact that there was once a time when philosophers actually had something profound and important to say about the real world. THE IMPORTANCE OF THEORY Already in What Is to Be Done? Lenin pointed out: Without revolutionary theory there can be no revolutionary movement. This idea cannot be insisted upon too strongly at a time when the fashionable preaching of opportunism goes hand in hand with an infatuation for the narrowest forms of practical activity. (V. I. Lenin, What Is to Be Done, Wellred Books, 2018, p. 26.) He added that \"the role of vanguard fighter can be fulfilled only by a party that is guided by the most advanced theory.\" (Ibid., p. 27.) And one of the most important contributions to Marxist theory is undoubtedly Materialism and Empirio-criticism. Lenin began writing this Marxist classic in February 1908. This was at the height of the period of reaction following the defeat of the Moscow uprising in December 1905. The working class was exhausted. The peasant revolt upon which Lenin placed his hopes for a revolutionary revival came too late. The initiative passed to the tsarist regime, which went on the offensive. A wave of black reaction followed, lasting several years. Mass arrests, summary executions, and the merciless crushing of any opposition decimated the movement. The Marxists (then known as Social-Democrats) were subjected to the most brutal persecution. Their leaders hunted down, imprisoned and sent to Siberia, or executed. Thousands more were murdered without trial. Lenin began writing this Marxist classic at the height of the period of reaction following the defeat of the Moscow uprising in December 1905 This defeat had a profoundly demoralising effect on the movement, and especially on the intellectuals who had sympathised with the revolution when it was in full tide, but began to abandon it as soon as the reaction set in. A mood of pessimism swept through the petty bourgeoisie. This found its expression in a general feeling of hopelessness, a tendency to abandon the class struggle and look inwards, to seek new ideas and panaceas, including mystical and semi-religious ideas ('God building'). It is in this context that one must see the real significance of Lenin's fight against philosophical revisionism. It was about this time that the subjective idealism of Richard Avenarius and Ernst Mach became fashionable among a layer of the intelligentsia in Russia. It corresponded closely to the prevailing mood of dejection, pessimism, and mysticism. The socialist movement was not immune to this development, and a layer of it began to make concessions to Machism. This was part of the process of counter-revolution in the sphere of ideas. THE PETTY BOURGEOISIE AND REVOLUTION The same pattern can be observed time and again in the wake of defeated revolutions. As soon as the revolutionary movement encounters setbacks, we see a long line of depressed intellectuals, falling over themselves, one after another, in an indecent haste to abandon the movement and retire to the safety of their studies. The intelligentsia provides a fairly accurate barometer of the shifting moods of the petty bourgeoisie. As an intermediate stratum standing between the proletariat and the bourgeoisie, they are an organically unstable social layer, constantly oscillating between the two great poles in society. Insofar as the intelligentsia is capable of gravitating towards the working class and revolutionary socialism, it always proves to be a highly unstable, vacillating, and unreliable ally. When the working class moves in a revolutionary direction, a section of the petty-bourgeois intellectuals can experience ecstatic moods of enthusiasm, but these mood swings can very soon turn into their opposite. Losing its faith in the strength of the working class, the intelligentsia gives in to the pressure of reaction and moves to the right. The ideals of collective struggle give way to a search for individual solutions. Subjectivism, relativism, and agnosticism, in other words, philosophical idealism, begin to gain ground. They invent all kinds of fancy ideas to explain the causes of defeats. They always blame the working class for their own failures. And they invariably start chattering about the need for 'new ideas', and 'freedom to criticise' in order to put an end to the 'suffocating orthodoxy' (Marxism) that, in their view, has let them down. 'FREEDOM TO CRITICISE' In Russia, between 1906 and 1908 a series of books and articles appeared, written by Alexander Bogdanov, Anatoly Lunacharsky, and V. A. Bazarov, as well as other leftist intellectuals such as the Menshevik Pavel Yushkevich and the main theoretician of the Socialist-Revolutionary Party, Viktor Chernov. The main thrust of these works was that Marxism was 'antiquated'. It needed to be updated by infusing it with the 'new' discoveries made by Mach and Avenarius. But Marxism is a unified and harmonious world view. It is not a collection of good ideas, each of which can be changed at will. These so-called 'minor adjustments' amounted, in practice, to a complete negation of Marxism and its materialist philosophy. Not only were these ideas fundamentally wrong, but they were beginning to find an echo in the ranks of the Bolsheviks – even at the leading level. Bogdanov was at this stage one of the most prominent people on the Bolshevik central committee and a member of the editorial board of the Bolshevik paper, Vperyod. In the period prior to the 1905 revolution, he and others who followed his philosophical line had played a prominent role. He was also building himself a position as an expert on the question of philosophy. However, being well read in the field of philosophy does not necessarily mean that one understands it. Bogdanov and his followers repeatedly revealed that their understanding of Marxist theory was narrow and quite superficial, tending to rigid schemas and formulae. They displayed a complete lack of understanding of Marxist philosophy: the dialectical method was quite alien to them, a fact that was later to lead them into a series of ultra-left errors in the field of tactics. Like other revisionists before (and since), the Bolshevik Machists raised the cry for the 'freedom to criticise'. They insisted that they were not against Marxism, but merely wished to 'bring it up to date', in line with the 'latest discoveries' of science and philosophy. But this was merely a ruse and a distraction from the fact that they were drifting away from Marxism and that they wanted to drag the party along with them. Lenin was very clear about this: Comrade Sazhin... demands that 'Party members' must be 'ensured' 'complete freedom for their revolutionary and philosophical thought'. This slogan is thoroughly opportunist. In all countries this kind of slogan has been put forward in the socialist parties only by opportunists and in practice has meant nothing but 'freedom' to corrupt the working class with bourgeois ideology. 'Freedom of thought' (read: freedom of the press, speech and conscience) we demand from the state (not from a party) together with freedom of association. The party of the proletariat, however, is a free association, instituted to combat the 'thoughts' (read: the ideology) of the bourgeoisie, to defend and put into effect one definite world outlook, namely, Marxism... Some Vperyodists long with all their heart and soul to drag the proletariat back, to the ideas of bourgeois philosophy (Machism), while others are indifferent to philosophy and merely demand 'complete freedom'... for Machism. (V. I. Lenin, 'The Vperyod Faction', 1910.) The bible informs us that there is nothing new under the sun. And in reality, there was nothing new, either in the ideas of Mach and Avenarius, nor in the Russian Machists' claims to possessing an update to Marxism. Marx and Engels waged many struggles against idealist revisionism, the most famous case being Engels's polemic against Eugen Dühring. Throughout the history of the revolutionary workers movement, every now and then, some clever people thrust themselves forward with claims that they wish to bring Marxism up to date. Bogdanov and his co-thinkers were just such people. In practice, these elements reflect the pressures of alien classes. The working class does not exist in a vacuum; it is surrounded by other classes and social layers, whose class outlook can find a reflection within the workers movement. The class struggle is therefore not only an economic and political struggle, but just as importantly a philosophical struggle, as Lenin repeatedly emphasised. LENIN'S FIGHT AGAINST REVISIONISM Lenin never hid his differences with the likes of Bogdanov on the question of philosophy / Image: public domain Lenin had never hidden his differences with Bogdanov on the question of philosophy. But for several years, he was willing to collaborate with him and to put his other skills to the use of the party. However, as soon as Lenin became aware of the systematic attempts to undermine the philosophical basis of Marxism, he declared war on the Machists. He embarked on a determined struggle to defend the fundamental ideas of Marxism against revisionism. The highest expression of this struggle was the publication in 1909 of Materialism and Empirio-criticism. At the time, Lenin wrote to Maxim Gorky, who was a close friend of Bogdanov as well as Lunacharsky and sympathised with some of their views: Now the Studies in the Philosophy of Marxism [A series of articles arising from a Symposium organised by Bogdanov and his allies – AW] have appeared. I have read all the articles except Suvorov's (I am reading it now), and every article made me furiously indignant. No, no, this is not Marxism! Our empirio-critics, empirio-monists, and empirio-symbolists are floundering in a bog. To try to persuade the reader that \"belief\" in the reality of the external world is \"mysticism\" (Bazarov); to confuse in the most disgraceful manner materialism with Kantianism (Bazarov and Bogdanov); to preach a variety of agnosticism (empirio-criticism) and idealism (empirio-monism); to teach the workers \"religious atheism\" and \"worship\" of the higher human potentialities (Lunacharsky); to declare Engels' teaching on dialectics to be mysticism (Berman); to draw from the stinking well of some French 'positivists' or other, of agnostics or metaphysicians, the devil take them, with their \"symbolic theory of cognition\" (Yushkevich)! No, really, it's too much. To be sure, we ordinary Marxists are not well up in philosophy, but why insult us by serving this stuff up to us as the philosophy of Marxism! I would rather let myself be drawn and quartered than consent to collaborate in an organ or body that preaches such things. (V. I. Lenin, 'A Letter to A. M. Gorky', 1908.) This was not at all a debate on obscure philosophical doctrines. It was a struggle for the soul of the revolutionary movement. Lenin was very clear as to what the Machian attack effectively meant: \"...we have among us people who would have us regard them as Marxists, yet who bring to the masses a philosophy which comes very close to fideism.\"[1] (V. I. Lenin, Materialism and Empirio-criticism, Wellred Books, 2021, p. 55.) MATERIALISM AND IDEALISM The main outline of the Marxist philosophy (dialectical materialism) was explained by Friedrich Engels in AntiDühring and Ludwig Feuerbach and the End of Classical German Philosophy. Here Engels writes that the fundamental philosophical trends are materialism and idealism. In his book, Lenin explains the difference between these philosophical trends: Materialism regards nature as primary and spirit as secondary; it places being first and thought second. Idealism holds the contrary view. This root distinction between the \"two great camps\" into which the philosophers of the \"various schools\" of idealism and materialism are divided Engels takes as the cornerstone, and he directly charges with \"confusion\" those who use the terms idealism and materialism in any other way. (Ibid., p. 74.) Lenin's struggle was first and foremost to bring to light the fundamental distinction between idealism and materialism and to introduce clarity as to the real significance of Machism, which in effect amounted to nothing but a form of idealism. He mercilessly attacked the Russian Machists for their \"mutiny on one's knees\" and demanded that they come to the fore \"to 'settle accounts' openly, explicitly, resolutely and clearly with the views they had abandoned\". (Ibid., p. 2.) As is usually the case with revisionists, Bogdanov and Lunacharsky tried to disguise their break with Marxism by a series of dishonest tricks and ruses. But Lenin mercilessly tore away the mask to reveal the reactionary idealist content that lay beneath. Step by step, layer by layer, this book exposes idealism in all its guises. In the same thorough way that Engels answered the ideas of Dühring, Lenin quotes at length from the philosophical writings of the Russian Machists as well as the writings of other scientists and philosophers. Some people complain that Lenin's book makes for heavy reading. Maybe so. But the only way in which one can answer false ideas, without being accused of distortion or misunderstanding, is precisely to quote what is written, word for word. This is what Lenin does, and nobody can complain that he does not treat his opponents fairly. But for that very reason, he is entitled to pass the harshest judgement upon them – which he does not hesitate to do. He calls them blockheads and other things that one is not accustomed to hearing in university seminar rooms. But as we know very well, there is no shortage of blockheads there either, even if no-one dares to call them by their right name. Lenin's aim was very simple: to bring out in the open the real difference between Marxist dialectical materialism and the subjective idealism of the Machists. In that, he succeeded brilliantly. Analysing the different shades and expressions of Machism internationally, Lenin stressed that in \"every philosophical question raised by the new physics, we [trace] the struggle between materialism and idealism.\" (Ibid. p. 283.) And he showed that: Behind the mass of new terminological devices, behind the litter of erudite scholasticism, we invariably discerned two principal alignments, two fundamental trends in the solution of philosophical problems. Whether nature, matter, the physical, the external world should be taken as primary, and consciousness, mind, sensation (experience – as the widespread terminology of our time has it), the psychical, etc., should be regarded as secondary – that is the root question which in fact continues to divide the philosophers into two great camps. (Ibid.) So seriously did Lenin take this ideological struggle that he was prepared to break with the entire leadership of the Bolshevik faction on these issues. The split occurred in 1909, when Lenin chose to break with Bogdanov and Lunacharsky rather than make the slightest concession to their revisionism in philosophy and their sectarian formalism and ultra-left politics. This was after almost two years of internal struggle. However, by the time the split occurred, Lenin had succeeded in winning over the majority of the party to the position of dialectical materialism, and it was Bogdanov and the Machists who left. IDEALISM AND RELIGION Materialism rejects the notion that mind and consciousness is something separate from matter. Thought is merely the mode of existence of the brain, which, like life itself, is only matter organised in a certain way. Mind is what we call the sum total of the activity of the brain and the nervous system. But, dialectically, the whole is greater than the sum of the parts. This view corresponds closely to the discoveries of science, which is gradually uncovering the workings of the brain and revealing its secrets. By contrast, idealism persists in presenting consciousness as a 'mystery', something that we cannot comprehend. It mystifies the physical and causal link between the thinking mind and the human body. This so-called mind-body problem arises because of the fact that mental phenomena appear to be qualitatively different from the physical bodies on which they appear to depend. Consistent materialism, however, maintains that mind and body are of one substance. Lenin clearly shows the relationship between idealist philosophy and clericalism, quoting at length from the works of Bishop Berkeley and other protagonists of the Church / Image: public domain The idealist trend in philosophy is at least as old as Plato and Pythagoras, who saw the physical world as a poor imitation of the perfect Idea (Form), which existed before the world came into existence. This is a view that fits in very nicely with the vested interests of the religious lobby, which is highly vocal in defending whatever can still be defended of the primeval prejudices about the soul, a life after death, and all the other religious rubbish that has accumulated in the human brain from the most remote and primitive times. Hiding behind the respectable façade of philosophical idealism is religion and superstition. The Immaculate and Eternal Soul was supposed to be locked up inside the grubby, imperfect and short-lived material body, longing for release at the moment of death, when we 'give up the ghost' and float up to Paradise (if we are lucky). Throughout history religion has been a barrier to the advance of science. The Church is hostile to the advance of knowledge because every step forward in science removes yet another basis for religious superstition. Religion is based on blind faith, not knowledge. It relies on the fear of the unknown, and therefore the unknown is its greatest ally. That is why all religions are based on mysticism, obscurantism, miracles, etc. The Church attempted to block the path of progress and science with the fires of the Inquisition, but to no avail. The sixteenth and seventeenth centuries were a period when philosophy still retained all its vigour. Its ideas were relevant, in a way they no longer are. Philosophy really was science and science philosophy. In this brave new world, it seemed that God had no place. Isaac Newton, a Theist, provided God with a role in his clockwork universe: that of providing it with an initial impulse. But after this elementary task, there was really nothing else for the Almighty to do for the rest of eternity. The new philosophy provided a basis for atheism, and the defenders of the Faith were well aware of it. The most outspoken opponent of materialism at the time was George Berkeley (1685-1753). Berkeley was an Englishman who became bishop of Cloyne in Ireland. As the final and definitive answer to materialism, he argued that matter itself did not exist, and that the world only came into existence when it was being observed. He attacked the concept of matter on the grounds that it was so full of contradictions as to be useless in the search for knowledge. Lenin clearly shows the relationship between idealist philosophy and clericalism, quoting at length from the works of Bishop Berkeley and other protagonists of the Church: \"For as we have shown the doctrine of Matter or corporeal Substance to have been the main pillar and support of Scepticism, so likewise upon the same foundation have been raised all the impious schemes of Atheism and Irreligion... How great a friend material substance has been to Atheists in all ages were needless to relate. All their monstrous systems have so visible and necessary a dependence on it, that when this cornerstone is once removed, the whole fabric cannot choose but fall to the ground, in so much that it is no longer worth while to bestow a particular consideration on the absurdities of every wretched sect of Atheists.\" (Ibid., p. 12.) As we can see from the above, Bishop Berkeley developed his subjective idealism as an answer to what he saw as the materialist atheism of Newton and the other scientists of his day. He rejected the infinitesimal calculus of Newton and Leibnitz because the recognition of the infinite divisibility of 'real space' contradicted the basic postulates of his philosophy. He cleverly used the arguments of empiricism to refute materialism and defend religion. He did this quite deliberately in order to combat the atheism that he felt – quite correctly – was gaining ground as a result of the progress of science. Bishop Berkeley showed very ingeniously that the logic of empiricism, when taken to the extreme, leads us to the conclusion that we cannot prove the existence of the physical world independent of our (my) senses. Proceeding from the undeniable proposition 'I interpret the world through my senses', he drew the conclusion that I cannot know anything except my sensations. In place of Locke's statement \"Nihil est in intellectu quod non sit prius in sensu\" (\"Nothing is in the mind that was not first in the senses\"), Berkeley asserted: \"esse est percipi\", that is, \"to be is to be observed\". Things can only exist insofar as they are perceived. Therefore, it is impossible to say with any certainty that the world exists outside my sense perception. This philosophical doctrine, where the subject determines being, is called subjective idealism. But there was a fatal flaw in Berkeley's case. The inescapable logic of his argument is solipsism – only I exist. Since my sense perception determines being, hence I cannot prove the existence of anything but myself. But if that is the case, where does God come into it? Surely, he too must be just a figment of my imagination – just another 'sense content'! Berkeley was no fool. As we shall see, he was well aware of this inconvenient fact, which he attempted to get around by positing the existence of a multiplicity of spiritual substances and also a \"cosmic mind\" (God). This dilemma was the subject of an amusing Limerick, which goes as follows: There was a young man who said \"God Must find it exceedingly odd To think that the tree Should continue to be When there's no one about in the quad.\" Reply: Dear Sir: Your astonishment's odd; I am always about in the quad. And that's why the tree Will continue to be Since observed by, Yours faithfully, God. (R. Knox, God in the Quad) The poem is amusing and ingenious, but only of serious interest to those who feel the need to invoke an invisible Spirit to prove that the tree we look at really exists. Before we take such a leap of judgment, however, what needs to be demonstrated is not the reality of a tree, which we can all see, but of an invisible Spirit, which, by definition, we cannot. THE THEORY OF KNOWLEDGE The theory of knowledge – also known as epistemology – occupies a central place in the history of philosophy and it lies at the heart of the difference between philosophical materialism and idealism. The so-called subject-object problem has occupied the attention of philosophers for centuries. It is concerned with the analysis of human experience, and of what within experience is 'subjective' and what is 'objective'. How do we know the world 'outside' us? The question is posed in terms of a dichotomy: a) the thinking 'subject' ('I'), and b) the object of thought (the 'external' world). This question was already raised in the writings of Aristotle, but in the modern – epistemological – sense, it dates from the 17th century, raised by bourgeois philosophers such as René Descartes and John Locke. Descartes, who was an idealist, introduced the notion of dualism. Descartes' dualism depicts mind and body as two entirely separate substances. Hence the 'dual' element. The mistake is to treat consciousness as a 'thing', an independent entity, separate and apart from human sensuous activity. The insurmountable difficulty with dualism is this: if the mind is entirely different to the physical body, how can they interact? We now know what Descartes did not know about the workings of nature, the world of molecules, atoms, and subatomic particles, of the electric impulses that govern the workings of the brain. In place of a mysterious soul, we are beginning to acquire a scientific understanding of how the human body and brain function. The discoveries of modern science have forever banished the notion of consciousness as an independent 'thing'. Yet, strange as it may seem, this mystical nonsense does not lack advocates even in the 21st century. SUBJECT AND OBJECT AND DIALECTICS The first question is 'what' is known. The second problem is that of 'how' do we know what we know. That is essentially what epistemology attempts to answer. It is an elementary proposition that I interpret the world through my senses. This assertion, in reality, is a pure tautology, inasmuch as I cannot possess any knowledge of the world without eyes, ears, hands, and brain. Subjective idealism interprets this to mean that, in reality, I can have no real knowledge of the world outside of my own sensations. Dialectical materialism sets out from the proposition that the objective world exists independently of the subject, but the two form part of a dialectical unity / Image: public domain To use the expression of the logical positivist philosopher A. J. Ayer, all I can know are my \"sense contents\". The so-called problem of knowledge only arises when consciousness is regarded: a) as something separate from a physical body, and b) as something separate from the material world. In reality, subjective idealism and philosophical dualism are merely an idealisation of the rigid separation between mental and manual labour. In effect, the mystification of human thought is carried to such an extreme that it is alleged that only my thought is real. 'This side' is juxtaposed to 'That side' as if the two were separated by an impenetrable barrier. Dialectical materialism sets out from the proposition that the objective world exists independently of the subject, but the two form part of a dialectical unity. Consciousness is not a 'wall' separating subject and object, but a bridge connecting the two. The subject is itself an object, insofar as humans are subject to the objective laws of nature and society. But through their subjective activity, humans can and do interact with the objective world that surrounds them, profoundly modifying not just nature but also society. Thus, subject and object are not eternally fixed and immutable antitheses, but can and do change places, the one passing into the other. They constantly react on each other, as a result of humankind's socio-economic practice. It is practice, not passive contemplation, through which men and women have constantly transformed their environment, and thereby have transformed themselves. This is not necessarily related to thought at all, since most of the modifications have taken place without any planning or conscious thought whatsoever. These transformations are the result of human sensuous activity: human labour, from the work of primitive stone tools to the activity of nuclear reactors. THE POWER OF ABSTRACTION Human activity enables us to understand the world we live in and its laws, and therefore ultimately enables us to master these laws, rise above them and attain true freedom, which is the recognition (understanding) of necessity. We do not think only with a brain, but with our whole body. Therefore, a baby begins to understand the material world by the simple procedure of putting it in its mouth and trying to eat it. In the words of Goethe, \"in the beginning was the deed\". But thinking must be seen, not as an isolated activity ('the ghost in the machine') but as part of the whole human experience, of human sensuous activity and interaction with the world and with other people. It must be seen as part of this complex process of permanent interaction, not as an isolated activity that is mechanically juxtaposed to it. When we say that all knowledge is based on experience, this does not at all mean my personal experience, but includes all the collective experience of humans over a period of hundreds of thousands of years. The world existed long before humans or any other life form was present to observe it. Animate matter (life) arose naturally from inanimate matter. At a certain point, simple one-celled creatures evolved into more complex life forms, invertebrates into vertebrates, and so on. The further development of a central nervous system developed into a brain, and eventually into the human brain and human consciousness. We are matter that has become conscious of itself. This explanation is corroborated by all the discoveries of science. But for idealism this remains a closed book. All forms of idealism are inseparably linked to religion and invariably lead back to religion. In relation to this, Trotsky wrote shortly before his assassination: \"We do not know anything about the world except what is provided through experience.\" This is correct if one does not understand experience in the sense of the direct testimony of our individual five senses. If we reduce the matter to experience in the narrow empirical sense, then it is impossible for us to arrive at any judgement concerning either the origin of the species or, still less, the formation of the earth's crust. To say that the basis for everything is experience is to say too much or to say nothing at all. Experience is the active interrelationship between subject and object. To analyse experience outside this category, i.e., outside the objective material milieu of the investigator who is counter-posed to it and who from another standpoint is a part of this milieu – to do this is to dissolve experience in a formless unity where there is neither object nor subject but only the mystical formula of experience. \"Experiment\" or \"experience\" of this kind is peculiar only to a baby in its mother's womb, but unfortunately the baby is deprived of the opportunity to share the scientific conclusions of its experiment. (L. Trotsky, Writings of Leon Trotsky: 1939-1940.) It is precisely this collective experience that enables us to make sense of what we know of the world, to make accurate and scientific judgements of the information we receive through our senses and draw the inferences that permit us to make correct predictions about the physical world and society. Knowledge is therefore not confined to the narrow sphere of individual sense perception, since, to understand the limited information derived from my individual experience, I must rely on a vast amount of information that is transmitted from generation to generation in the form of theoretical abstractions. The very word abstraction comes from the Latin \"derived from\", which shows very clearly how all theoretical generalisations (including the most abstract mathematical formulae) are ultimately derived from the observation of the physical world. We count up to ten, not because the decimal system is superior to any other (it is not) but only because we have ten fingers which we still tend to count to work out simple sums. Once these abstractions are established, they seem to take on a life of their own and provide a powerful tool for understanding the world and an indispensable instrument for the advancement of science, which represents the dialectical unity of deduction and induction, of theory and practice, of scientific hypotheses with observation and experiment. One thing is unthinkable without the other. THE PHYSICAL ORIGIN OF CONSCIOUSNESS The progress of science has provided the answers that explain the physical origin of consciousness. We know that organic matter (life) arises naturally from inorganic matter. Even the earliest forms of life display signs of sensibility. Irritability, which is precisely the way in which living organisms react to the physical stimuli that come from the external world, is present in all forms of life. Even in plants we find a similar phenomenon, as when flowers turn to face the sun. When they do this, what are they reacting to? Not 'sense contents', because plants do not have senses as such. They are reacting to external stimuli from the physical world. It is the same for all living organisms. In every case they are reacting to external stimuli. We now know that the action of nerve cells is both electrical and chemical. At the ends of each nerve cell there are specialised regions, the synaptic terminals, which contain large numbers of tiny membranous sacs that hold neurotransmitter chemicals. These chemicals transmit nerve impulses from one nerve cell to another. After an electrical nerve impulse has travelled along a neuron, it reaches the terminal and stimulates the release of neurotransmitters from their sacs. The neurotransmitters travel across the synapse (the junction between the neighbouring neurons) and stimulate the production of an electrical charge, which carries the nerve impulse forward. This process is repeated over and over again until a muscle is moved or relaxed or a sensory impression is noted by the brain. These electrochemical events can be considered the 'language' of the nervous system, by which information is transmitted from one part of the body to another. This scientific explanation immediately does away with the mystical-idealist view of thought and consciousness as something mysterious and inexplicable, something divorced from the normal workings of nature and other bodily functions. These, in turn, are formed and developed by constant interaction with the material environment through collective social labour. Evolution has developed different ways of reacting to the physical environment in order to ensure the survival of the individual (food) and the species (reproduction). Just as we share some genes with even the lowly bacteria, so we share this common facility. But in humans this bare potentiality has evolved into something on a qualitatively different level to other animals. It may be said that there is something resembling consciousness in cats, dogs, horses, and other higher mammals. Certainly, experiments on chimpanzees have suggested that they may possess something akin to self-consciousness. In fact, it may even be possible to demonstrate elements resembling consciousness in lower forms of life, such as birds or even ants. But the further we go from humans, the less do these things relate to self-consciousness. What we are dealing with here are sentient life-forms, not consciousness. Therefore, to equate human consciousness with that of other animals is not possible. These facts are well-known to anyone with the least interest in modern science and only an ignorant person or somebody who desires at all costs to ignore the facts and defend religious prejudice and superstition can deny them. Seen in its proper context, there is nothing mystical about the human mind. Nevertheless, confusion has been introduced into the question by philosophers, who, in some cases quite deliberately, distort, misinterpret, and ignore the facts in their desire to peddle religious and mystical ideas. EMPIRICISM The origin of this confusion in epistemology is to be found in the 17th century, when humanity was struggling to free itself from the religious obscurantism of the Middle Ages. An important step forward in the struggle was the development of empiricism in England. In its early days empiricism played a most progressive and revolutionary role when it was directed against the Church and proclaimed the freedom of science and the superiority of observation and experiment over dogma. The early empiricists (Bacon, Locke and Hobbes) were materialists. As noted, their battle cry was \"Nihil est in intellectu quod non sit prius in sensu\". (\"Nothing is in the mind that was not first in the senses\".) Their insistence upon sensory perception as the basis of all knowledge represented in its day a gigantic leap forward with regard to the empty speculation of the medieval Schoolmen. It paved the way for the rapid expansion of science, based upon empirical investigation, observation, and experiment. Yet despite its tremendously revolutionary character, this early form of materialism was one-sided, limited, and therefore incomplete. The assertion that there is nothing in the intellect which is not derived from the senses contains the germ of a profoundly correct idea. This is materialism. But the one-sidedness of empiricism leaves the door open to subjective idealism, which denies the existence of a material reality independent of the observer. Presented in such a confused way, this idea had the most harmful consequences on the future development of philosophy. The great advances made by the early English materialists Hobbes and Locke were succeeded by the superficial epigone, David Hume, who later exercised a negative influence on the philosophy of Kant. In Bishop George Berkeley, this form of subjective idealism found its most consistent advocate. This one-sided empiricism, that is to say, subjective idealism, has repeatedly made its influence felt on both modern bourgeois philosophy and science in a variety of different disguises. One of the most pernicious of these was socalled logical positivism. Under the influence of these ideas, the Austrian scientist Ernst Mach, whom Lenin deals with thoroughly in the present book, denied the existence of atoms, since they could neither be seen, felt, nor heard. SUBJECTIVE IDEALISM: A PHILOSOPHICAL SWINDLE The arguments of subjective idealism at first sight may seem to possess an unanswerable logic. And indeed, if one accepts the initial premise, it is virtually impossible to answer. But one cannot accept such a premise without falling into the most absurd contradictions, as Bishop Berkeley himself soon discovered. In reality, they are based on an intellectual swindle, the philosophical equivalent of the conjurer's sleight of hand. The argument sets out from the following premise: \"I know the world through my senses.\" This statement is true and undeniable, as far as it goes. I can only know the world through my senses. But, as we have pointed out, we must add to this another statement: the world exists independently of my senses, or else we fall into the most grotesque contradictions and absurdities. The whole of science is based precisely on the fact that: a) the world exists outside of ourselves, and b) in principle, we can understand it. The proof of these assertions, if proof were required, consists in over 2,000 years of the advance of science, that is, of the steady advance of knowledge over ignorance. The very word science comes from the Latin word \"to know\", whereas the word ignorance is merely the Latin word for not-knowing. There are, of course, many things we do not know about the universe. But the whole history of science proves that what we do not know today we will know tomorrow. It is this constant search after truth that is the motor force for all progress in the field of thought and ideas. As Lenin says: ...In the theory of knowledge, as in every other branch of science, we must think dialectically, that is, we must not regard our knowledge as ready-made and unalterable, but must determine how knowledge emerges from ignorance, how incomplete, inexact knowledge becomes more complete and more exact. (V. I. Lenin, Materialism and Empirio-criticism, p. 78.) LOGICAL POSITIVISM The re-emergence of long-dead ideas in different disguises reflects, on the one hand, the crisis of capitalist ideology. But on the other hand, it also reflects the philosophical vacuum that has been caused by the fact that Marxism was thrown back for a whole historical period following World War Two. In 1909 Lenin's book comprehensively demolished the subjective idealism of Mach and Avenarius. But subjective idealism itself is very much alive and well to this day. Ejected from the front door with a well-aimed kick in the pants, it merely crept round the back and sneaked in, unobserved, through a side window. In 1909 Lenin's book comprehensively demolished the subjective idealism of Mach and Avenarius / Image: public domain This subjective idealism was carried over into 20th century philosophy by the school represented by Ernst Mach and later the Vienna Circle (O. Neurath, Carnap, Schlick, Frank, and others) and logical positivism. In Britain, it was advocated by Professor A. J. Ayer, whose book Language, Truth and Logic was influential in the universities in the 1960s. The basic thesis of Ayer's book is that the only certain knowledge we can have is what he calls \"sense contents\". In the early chapters of his book, this thesis is developed and repeated in different ways, giving the impression of an absolutely irresistible chain of logic. But the entire construction breaks down the moment he tries to explain what these sense contents actually consist of. We can pose the question very simply, such that even a university professor can understand it: Can there be sense contents without eyes, ears, and a material brain? Can there be a material brain without a central nervous system and material body? And can there be a material body without the existence of a physical environment to provide it with the means of sustenance necessary for its existence? Needless to say, none of these questions are answered, or even posed. As usual, the author assumes what has to be proved, and then concludes that he has proved it! For all its 'clever' and sophisticated appearance, this is a mode of thinking that is childish in the most literal sense of the word, as when a baby cries when its mother leaves the room because for it, she has ceased to exist. These false and pernicious ideas represent the outlook of the petty-bourgeois intelligentsia, for whom everything starts and ends with 'me'. 'My business, my career, my individuality, my feelings, my oppression, my experience, my struggle against the unfair world, which does not understand me' and so on and so forth. 'If the world does not conform to me, something is wrong with the world.' This summarises the world outlook of the petty-bourgeois intelligentsia, and determines its entire psychology. It is therefore hardly surprising that subjective idealism is its natural philosophical habitat. It holds the same fascination for the petty-bourgeois 'thinker' as a pot of honey does for a fly. Now, even from the point of view of utility, one would have to say that this theory is absolutely useless. It cannot advance our knowledge a single millimetre. What difference does it make to a chemist in his laboratory to deny that the chemicals in his test tube possess objective being, or to describe them as merely a collection of sense-contents? At the end of the day, he must still carry out his experiments in order to try to determine what the reality of these 'unreal' objects consists of. And after Professor Ayer finished spending all day denying the objectivity of matter, he presumably did not refuse to eat his dinner on the grounds that it did not really exist. No doubt our logical positivist friends will reject these arguments as 'naïve realism', by which they mean materialism. This is a word they use as a term of abuse, which is intended to ward off any conceivable criticism. For our part, we prefer to use the same unsophisticated language that Lenin used when he referred to the subjective idealists merely as blockheads. This is an adequate characterisation of people who attempt to put forward ridiculous notions as serious arguments. In Materialism and Empirio-criticism Lenin shows that subjective idealism inevitably leads to solipsism. Most logical positivists attempt to shrug off the allegation of solipsism, to deny it indignantly, to confuse the issue with all manner of complicated and abstruse jargon or simply to dismiss it as a joke. But it yet remains for them to answer it. The British philosopher Bertrand Russell once met a lady at a party who informed him that she was a solipsist, and wondered why there were not more of them. This amusing anecdote strikingly reveals the internal contradictions of subjective idealism. However, Russell's joke cannot dispose of the philosophical problem of knowledge. This must be answered philosophically, that is, theoretically. Marx did this in the 'Theses on Feuerbach', and Lenin even more comprehensively in Materialism and Empirio-criticism. For decades the advocates of logical positivism arrogantly presented their ideas as 'the philosophy of science'. There is a deep irony here, since they also accused dialectical materialism (without the slightest foundation) of aspiring to the role of the 'Queen of the Sciences'. With the natural advance of science, open support for subjective idealism, just like religion before it, becomes increasingly untenable. Yet paradoxically, the ideas (or rather, the prejudices) of subjective idealism still exert a powerful influence on the minds of some scientists who were subjected to the half-baked nonsense of logical positivism in their student days and never recovered from the experience. HOW MARX AND ENGELS POSED THE QUESTION In Ludwig Feuerbach, Engels states that the great basic question of all philosophy, especially of modern philosophy, is that concerning the relation of \"thinking and being\", of \"spirit and nature\". He then proceeds to deal with one of the most important questions in philosophy: the theory of knowledge. He asks: ...In what relation do our thoughts about the world surrounding us stand to this world itself? Is our thinking capable of the cognition of the real world? Are we able in our ideas and notions of the real world to produce a correct reflection of reality? (F. Engels, Ludwig Feuerbach and the End of Classical German Philosophy, Marx and Engels Collected Works (Henceforth referred to as MECW), Vol. 26, Lawrence and Wishart, p. 367.) \"The overwhelming majority of philosophers give an affirmative answer to this question\", says Engels, including here not only all materialists, but also the most consistent idealists like Hegel, who considered the real world to be the realisation of a mystical 'absolute idea.' But he adds: In addition there is yet another set of philosophers – those who dispute the possibility of any cognition, or at least of an exhaustive cognition, of the world. Among them, of the more recent ones, we find Hume and Kant, and they have played a very important role in philosophical development. (Ibid., p. 367.) Thus, we see that there are really three trends in philosophy: two consistent, or monist tendencies – materialism and idealism – and one inconsistent tendency that vacillates between empirical materialism and subjective idealism. The latter school of thought was given its fullest expression in the philosophy of Immanuel Kant. Hume and Kant, the true ancestors of logical positivism, both tended to fence off 'the appearance' from that which appears, the perception from that which is perceived, the \"thing-for-us\" from the \"thing-in-itself\". Kant granted the existence of the material world, but tried to establish a boundary beyond the world of appearance, the \"thing-in-itself\", which he declared to be \"unknowable\", something fundamentally different from the appearance, belonging to the \"beyond\" (Jenseits), inaccessible to knowledge, but revealed to faith. Here sense perception appears as a third term separating the external physical world from the perceiving subject (the Ego). The senses appear as a barrier to real knowledge, rather than a bridge to understanding and thus dominating the real, physical world. The Kantian trick was to confuse the unknowable with the unknown. In reality, the \"thing-in-itself\" gradually becomes a \"thing-for-us\" through the constant progress of human consciousness, science, industry, and technology. Through this progress, what was unknown yesterday is known to us today or will be known tomorrow. For Marxists human ideas and concepts are in the final analysis nothing but reflections of the material world. The truth of these reflections is tested, and if necessary, the ideas adjusted, on the basis of human activity. THE MATERIALIST POINT OF VIEW Early, mechanical materialism was unable to solve this problem and arrive at a scientific understanding of the real relationship between subject and object. This is what Marx deals with in his Theses on Feuerbach. The early materialism was limited by the level achieved by the science of the day, which was very rigid and mechanical in nature (Engels referred to it as the \"metaphysical outlook\", although we use the word metaphysics differently today). Mechanics sees the relation between subject and object in a simplistic, static and one-sided way: pushing, pulling, levers, pulleys etc. All motion is imparted from without. Newton's mechanical universe required the Almighty to give it a push to set it in motion, but after that it worked perfectly, like clockwork. The relationship was passive and one-sided. In this clockwork universe, there is little or no room for subjective activity and creative initiative. Every action is predetermined by Nature's Eternal Laws. By contrast, the idealists exaggerated the role of the subject, seeing it as all-important. They even derived the existence of the object from the subject. The conception of the activity of the subject was contained and developed by the objective idealist, Hegel. That is what Marx meant when he said that the subjective element was developed by the idealists, not the materialists. It was the bringing together of the two elements, the concept of activity of the subject of the idealists and the notion of the objectivity of the material world, which was the key to solving the problem. The arguments of subjective idealism and the subject-object problem are easily dealt with once we adopt the standpoint of practice and approach the theory of knowledge from a concrete historical point of view, and not from the standpoint of empty and static abstraction. This was dealt with by Marx in the second of his Theses on Feuerbach: The question whether objective truth can be attributed to human thinking is not a question of theory but is a practical question. Man must prove the truth, i.e., the reality and power, the this-worldliness of his thinking in practice. The dispute over the reality or non-reality of thinking which is isolated from practice is a purely scholastic question. (K. Marx, 'Theses On Feuerbach', MECW, Vol. 5, p. 367.) Ultimately, the truth of materialism is provided by the history of science itself. Humankind does not merely contemplate nature but actively transforms it, and this ceaseless productive activity is what demonstrates the correctness or otherwise of ideas, as Engels explains: The most telling refutation of this as of all other philosophical quirks is practice, namely, experimentation and industry. If we are able to prove the correctness of our conception of a natural phenomenon by bringing it about ourselves, producing it out of its conditions and making it serve our own purposes into the bargain, then the ungraspable Kantian 'thing-in-itself' is finished. The chemical substances produced in the bodies of plants and animals remained just such 'things-in-themselves' until organic chemistry began to produce them one after another, whereupon the 'thing-in-itself' became a 'thing for us'... (F. Engels, Ludwig Feuerbach and the End of Classical German Philosophy, MECW, Vol. 26, pp. 367-368.) A PERIOD OF DECLINE In the period of its historical ascent, the bourgeoisie played a most progressive role, not only in developing the productive forces, and thereby mightily expanding humanity's power over nature, but also in pushing back the frontiers of science, knowledge, and culture. Luther, Michelangelo, Leonardo, Dührer, Bacon, Kepler, Galileo, and a host of other pathfinders of civilisation shine like a galaxy, illuminating the broad highway of human cultural and scientific advance opened by the Reformation and Renaissance. In its youth the bourgeoisie was capable of producing great thinkers: Locke, Hobbes, Kant, Hegel, Adam Smith, and Ricardo. In the period of its decline, it is only capable of producing flea-crackers. The degeneration of bourgeois philosophy is a reflection of the dead-end of the capitalist system itself / Image: public domain The latest major wave of such ideas came in the 70s, 80s, and 90s as a reaction to the defeats of a series of revolutions worldwide – defeats which were compounded by the collapse of the Soviet Union. This led to the growth of the school of postmodernism which covered postmodernist philosophy, poststructuralism, postcolonialism, queer theory, and a whole host of so-called theories based on identity politics. But whereas Mach and Avenarius, as Lenin brilliantly showed, were bad copies of Berkeley, Kant, and Hume, today's postmodernist geniuses are bad copies of bad copies. Desperate to appear original and trying hard to hide their incompetence they stuff their works with incomprehensible, convoluted, and intentionally ambiguous language. They say there is nothing new under the sun. That statement is proven to be true by the entire history of bourgeois philosophy in our times. Every single school of philosophy for the last 150 years at least is merely a regurgitation, in one way or another, of the irrational ideas of subjective idealism – the crudest, most absurd, and pointless varieties of idealism. The latest postmodernist craze is just another one of these variants. It has served to confuse and disorient a whole generation of philosophy students in the universities, who imagine that they have discovered something entirely new and novel, when in reality they merely repeat the absurdities of earlier philosophies, which were already comprehensively demolished by Lenin as early as 1908. Here we have the most striking proof of the correctness of Marx's celebrated dictum: \"social being determines consciousness\". The degeneration of bourgeois philosophy is a reflection of the dead-end of the capitalist system itself. A system which has become irrational must lean on irrational ideas. In attempting to maintain itself, the bourgeoisie has turned against its own revolutionary past. Turning against the best traditions of the enlightenment, capitalism is clinging ever harder to the modern-day descendants of feudal mysticism and scholasticism. A man on the edge of a precipice is not capable of rational thought. In a vague way, the ideologues of the bourgeoisie sense that the system they defend is reaching its end. The spread of irrational tendencies, mysticism, and religious fanaticism reflects the same thing. Nowadays, the subjective idealists are reduced to fighting a desperate rear-guard action, which amounts to the total dissolution of philosophy, reducing it entirely to semantics (the study of the meaning of words). The endless arguments about meaning and semantics and the minutiae of meanings resembles nothing so much as the interminable debates of the medieval Schoolmen on such fascinating subjects as whether angels had sex and how many of them could dance on the head of a pin. The problem is that in their obsession with form, they forgot the content altogether. As long as the formal rules were obeyed, the content could be as absurd as one liked. Marx once observed: \"Philosophy and the study of the actual world have the same relation to one another as onanism and sexual love.\" (K. Marx and F. Engels, The German Ideology, MECW, Vol. 5, p. 236.) Modern bourgeois philosophy prefers the former to the latter. In its obsession with combatting Marxism (and materialism in general), it has dragged philosophy back to the worst period of its old, outworn, and sterile past. The fact that all this fussing and fiddling and playing with words could be given the name of philosophy at all is a proof of how far modern bourgeois thought has declined. Hegel wrote in The Phenomenology of Mind: \"By the little with which the human spirit is satisfied, we can judge the extent of its loss.\" That would be a fitting epitaph for all of bourgeois philosophy after Hegel and Marx. In the present period, the honour of fighting against the stream, of combatting mystical and irrational thought, falls to the revolutionary vanguard of the working class, the Marxists. To cite once more the words of Joseph Dietzgen: \"Philosophy is not a science, but a safeguard against social democracy.\" (In those days, the Marxists called themselves social democrats.) And he added: \"Then it is no wonder that social democrats have their own philosophy.\" That philosophy – the philosophy of Marxism – is called dialectical materialism. It remains one of the most important weapons in our revolutionary arsenal. And anyone who wishes to understand how to use that weapon correctly should consider it a duty not just to read, but to make a careful study of one of the most fundamental texts in all the rich arsenal of Marxist thought, Materialism and Empirio-criticism. London, 16 December 2020 [1] The word fideism comes from fides, the Latin word for faith, and it is a theory that maintains that faith is independent of reason, and faith is superior at arriving at particular truths.


Biotechnology, Justice and Health

Philosophy

New biotechnologies have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. This paper addresses a question that lies squarely on the fault line of these two claims: When as a matter of justice are societies obligated to include a new biotechnology in a national healthcare system? This question is approached from the standpoint of a twin aim theory of justice, in which social structures, including nation-states, have double-barreled theoretical objectives with regard to human well-being. The first aim is to achieve a sufficient level of well-being in each of six core dimensions. In the special case of healthcare systems, this aim is focally but not exclusively attentive to achieving health sufficiency as one of the core dimensions. The second aim is to combat the emergence and persistence of densely woven patterns of systematic disadvantage that tend to undermine the achievement of a sufficient level of health and the other core elements of well-being of some persons and groups. Judgments about entitlements to health related resources, including new biotechnologies, are made in light of a threshold notion of health sufficiency. What is enough or sufficient health? The answer that is defended here is that sufficient health is enough health for a decent human life, understood as enough health to live a full life course without preventable, significant functional disability or decrement in health, or treatable pain or suffering. When a state must include a new biotechnology in its national healthcare system is also influenced by ancillary concerns about the connection between health and other core dimensions of well-being. What counts as a significant functional impairment or health decrement is thus explicated, in part, in relation to the theoryâs sufficiency aim for the other essential dimensions of well-being, and thus for a decent life, overall. Those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individualâs prospects for sufficiency in these other dimensions, including the relational egalitiarian concerns they entail, constitutes a significant functional impairment. Within national borders, individuals are thus entitled to those health-related goods and services that are essential for a sufficiency of each of the dimensions of well-being; with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. The content of any entitlement to health-related goods and services is also necessarily dynamic. What can be done for health and the other core dimensions of well-being as a function of technological innovation and diffusion is in constant flux. The paper concludes by considering the implications of this analysis for the conditions under which states are obligated to include access in their healthcare systems to one biotechnology, deep brain stimulation

Volume 1, Issue 1 Biotechnology, Justice And Health 49 Biotechnology, Justice and Health RutH Faden Johns Hopkins Berman Institute of Bioethics Madison PoweRs Department of Philosophy and Kennedy Institute of Ethics, Georgetown University aBstRact new biotechnologies have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. this paper addresses a question that lies squarely on the fault line of these two claims: when as a matter of justice are societies obligated to include a new biotechnology in a national healthcare system? this question is approached from the standpoint of a twin aim theory of justice, in which social structures, including nation-states, have double-barreled theoretical objectives with regard to human well-being. the first aim is to achieve a sufficient level of well-being in each of six core dimensions. in the special case of healthcare systems, this aim is focally but not exclusively attentive to achieving health sufficiency as one of the core dimensions. the second aim is to combat the emergence and persistence of densely woven patterns of systematic disadvantage that tend to undermine the achievement of a sufficient level of health and the other core elements of well-being of some persons and groups. Judgments about entitlements to health related resources, including new biotechnologies, are made in light of a threshold notion of health sufficiency. what is enough or sufficient health? the answer that is defended here is that sufficient health is enough health for a decent human life, understood as enough health to live a full life course without preventable, significant functional disability or decrement in health, or treatable pain or suffering. when a state must include a new biotechnology in its national healthcare system is also influenced by ancillary concerns about the connection between health and other core dimensions of well-being. what counts as a significant functional impairment or health decrement is thus explicated, in part, in relation to the theory's sufficiency aim for the Journal of Practical Ethics RUTH FADEN & MADISON POWERS50 other essential dimensions of well-being, and thus for a decent life, overall. those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individual's prospects for sufficiency in these other dimensions, including the relational egalitiarian concerns they entail, constitutes a significant functional impairment. within national borders, individuals are thus entitled to those health-related goods and services that are essential for a sufficiency of each of the dimensions of well-being; with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. the content of any entitlement to health-related goods and services is also necessarily dynamic. what can be done for health and the other core dimensions of well-being as a function of technological innovation and diffusion is in constant flux. the paper concludes by considering the implications of this analysis for the conditions under which states are obligated to include access in their healthcare systems to one biotechnology, deep brain stimulation. intRoduction deep brain stimulation, or dBs, is a biotechnology in which guide wires are inserted through the skull and into the brain, where they deliver electrical currents to clusters of neurons that are no longer performing properly. dBs was first employed to control the tremors of Parkinson's disease and is now routinely used in many countries to treat other movement disorders as well, such as seizures and tourette's, and also increasingly recalcitrant depression. in early 2012, the new england Journal of Medicine reported the results of an experiment to use dBs for yet a different purposeto boost failing memory (suthana et al, 2012). two key memory regions of the brain were stimulated in 7 seizure patients, all of whom showed improved cognitive performance during stimulation. these findings have generated excitement about the prospect that dBs might become an effective treatment for dreaded memory disorders like alzheimer's and also about Volume 1, Issue 1 Biotechnology, Justice And Health 51 the prospect that dBs might someday be used to enhance memory in those with no functional memory loss. new biotechnologies like dBs have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. in this paper, we tackle a question that lies squarely on the fault line of these two claims. when, as a matter of justice, are societies obligated to include a new biotechnology in a national health care system or otherwise assure that all have reasonable access to it? the paper proceeds in three parts. we begin by explicating one way of thinking about this question by providing a very brief sketch of our twin aim theory of justice as presented in our book, Social Justice (Powers & Faden, 2006), and a new book currently in progress. in Part two, we focus on the concepts of a decent life and sufficiency, which play prominent roles in our theory in helping to explicate what goods and services individuals are entitled to receive. in Part three, we illustrate some of the implications of our approach by looking more carefully at the example of dBs in these promising new memory applications. PaRt one: a twin aiM tHeoRy oF Justice For us, claims in justice to healthcare goods and services draw their foundational legitimacy-their ultimate justificatory structure-from the essential and direct role that these goods play in human well-being, which we take to be the primary object of social justice. ours is a twin-aim theory of justice, in which social structures, including both global institutions and nation-states, have double barreled objectives or aims with regard to human well-being. the target of each barrel is morally distinct from the other, but strategically reinforcing. one aim is the improvement of well-being. in the special case of healthcare systems, this aim is focally but not exclusively attentive to improving health as an essential dimension of well-being. the other aim is to combat, whether by prevention or amelioration, the adverse effects on wellbeing caused by densely woven patterns of systematic disadvantage that profoundly compromise or will compromise the health and other core elements of well-being of some persons and groups. the well-being aim begins with a broadly aristotelian-inspired effort to identify some core components or elements of human well-being that are among the suitable objects of concern within a theory of justice. we specify core elements of human wellJournal of Practical Ethics RUTH FADEN & MADISON POWERS52 being as having three characteristics. they are (1) typical of normal human development and valuable for their own sakes, apart from any further good they might bring; (2) of value to anyone, on reflection, whatever their particular life projects, chosen activities, or personal aspirations might be; and (3) humanly alterable and profoundly and pervasively influenced in their development and maintenance by basic social institutions and social practices. tHe well-Being aiM and its coRe eleMents the well-being aim of social justice is defined in terms of a level of sufficiency of each of its core elements. although it is beyond our task here to fully engage the thorny questions of just how sufficiency for any element is assessed, we will have more to say about this later, particularly with regard to health. the key point for now is that sufficiency represents a moral minimum of justice. inequalities in well-being in which individuals fail to meet even this moral minimum are among those most morally urgent to address. our list includes six core elements. though these six overlap in terms of both determinants and effects, each is of independent and equal moral value. 1. we have already mentioned health. although health is the element of human development and flourishing most intimately connected with the biological or organic functioning of the body, the absence of health refers to more than biological malfunctioning or impairments. Being in pain, even if that pain does not impede proper biological functioning; sexual dysfunction; and infertility are also incompatible with health. 2. the second element is personal security from actual physical and psychological harm as well, as the threat of such harm. 3. the third element is the development of reasoning, both for deliberation and choice and for the formation of beliefs and inferences regarding facts about the natural and social world. 4. the fourth element involves the formation and maintenance of personal atVolume 1, Issue 1 Biotechnology, Justice And Health 53 tachments of various kinds with varying degrees of intimacy, commitment, and affective engagement. 5. the fifth element is the respect of others. Here, the central concern is that individuals be able to live under social conditions in which others judge and treat them as moral equals, as persons worthy of the same sort of treatment any other person merits, and among co-nationals, as fellow citizens, as persons having comparable political standing. 6. the sixth element is self -determination, the ability to shape the broad contours of a life, to have some significant say over the general course of one's life. Put slightly differently, self-determination is about living a life that is not in crucial respects under the domination and control of others or the tyranny of profound necessity. the importance of these last two elements to our overall account of well being cannot be overstated. whether in the domestic case, in which equal moral standing and political standing are at issue, or in the international case, where moral equality is the paramount concern, the intent is that none is either at grave risk for the tyranny of deprivation or the threat of domination or oppression of others. thus, among the defining concerns expressed in the positive aim of ensuring a sufficiency of well-being are two relational dimensions of well-being -the good of living a self-determining life and the good of having a social standing involving the respect of others- where sufficiency requires nothing less than equality itself. tHe systeMatic disadvantage aiM while the first aim focuses on the injustice of failures in the realization of a threshold level of the core elements of well-being, the second aim focuses on the injustice of creating and maintaining serious social impediments to sufficient levels of well-being. these impediments are wrong on our account even if some systematically disadvantaged individuals and members of disadvantaged groups manage to escape the adverse consequences to their well-being that most others so disadvantaged predictably experience. Journal of Practical Ethics RUTH FADEN & MADISON POWERS54 PaRt two: suFFiciency and a decent HuMan liFe Put another way, the first aim locates injustice in certain adverse consequences for well-being, while the second aim locates injustice in the structural unfairness of forms of social arrangement that distribute advantages and disadvantages in particular ways. there is much that could be said about the work that the notion of a decent human life does within our theory. a few comments should suffice for now. a decent life requires more than mere subsistence, for example, but less than a maximally flourishing life for all. indeed, these very points are familiar ones from within contemporary discussions of human rights where the aim is to articulate the minimum demands of a transnational standard of well-being that is neither implausibly high in what it would require of those upon whom such a duty might fall nor so low that it demands little more than bare subsistence (nickel, 2007, 61-66, 98-103, 138-42; Buchanan, 2010). in addition, our account of a decent life requires satisfaction of the moral demands of the relational egalitarian concerns expressed by a commitment to the goods of respect and self-determination, an emphasis which is also congenial with one strain in the human rights literature that expresses similar relational concerns. James nickel, for example, suggests that there is a place in human rights for a variety of reasonable claims other than those for food, shelter, and education, including concerns for some measure of control over one's own life and some social guarantees of equal standing in political and legal arenas (nickel, 2007, 63-64). with the emphasis on self-determination and respect in our account of well being firmly in place, we can make a few observations about what would be contrary to a decent life. a decent life is not one that is marked by servility, slavishness, the necessity to grovel, or deep dependence on the good will or whim of others for the most basic requirements of life. a decent life is not one marred by the most degrading aspects of poverty, including squalor, helplessness, extreme vulnerability, or the inability to provide for one's own children and family (Powers & Faden, 2006, 138-41; Margalit, 1998). a decent life is not one in which someone is treated as less than a full member of the human community or as someone whose most vital concerns are accorded little or no weight. indeed, to be treated as a second-class citizen within one's own society is to be treated as a second-class human being, as someone who is not due the full measure of respect and concern accorded to other members of a common political community (Margalit, 1998). Volume 1, Issue 1 Biotechnology, Justice And Health 55 a decent human life is one in which someone is not subjugated, marginalized, stigmatized, infantilized, or deprived of the full use of one's mature faculties.12 Much more might be said along these lines, but the essential point we make here is that these relational aspects of well-being earn a place on the list of constituents of a decent human life as securely as concerns about health, cognitive development, and physical security. Moreover, they function as a check on how we should understand what counts as sufficiency for other constituents such as health. Both the notion of a decent human life and the relational egalitarian concerns that are built into our conception of well-being sufficiency bear on what counts as sufficiency in health. they also bear on the answers we give to questions of entitlements to health care goods and services instrumental to health sufficiency. we judge what is enough in the realm of health, for example, in part by reference to the impact of relative inequalities on social standing and the ability of individuals and groups to lead self-determining lives and avoid the kinds of conditions inimical to a decent human life. we then make judgments of entitlements to health related resources, including new biotechnologies, in light of that notion of health sufficiency, influenced by ancillary concerns about the connection between health and other core dimensions of well-being and how resource policy choices impact the full set of well-being concerns. HealtH suFFiciency and HealtHcaRe entitleMents what is enough or sufficient health? and what instrumental goods and services, what resources, are individuals entitled to as a consequence? our answer to the first question is-enough health for a decent human life. For us, this means enough health to live a full life course without significant disability or decrement in health, or pain or suffering that can be reasonably prevented, treated or relieved. clearly and intentionally, this is a higher threshold than one that would require only enough health to escape severe pain or suffering, death in childhood or early adulthood, or the most egregious of disabilities. any account of a decent human life must include living through all the stages of life without significant disability or dec1. Many of these points are developed in Mill's the subjection of women, which for us has been influential in our own thinking about what is central to well-being in view of a decent human life. Journal of Practical Ethics RUTH FADEN & MADISON POWERS56 rement in health that can be reasonably prevented or mitigated, and pain or suffering that can reasonably be relieved. at the same time, however, we are also far from what would be demanded for a maximally flourishing life, which would translate to a threshold of something like maximal health for all. Merely because the world's oldest person just celebrated his 115th birthday in Japan, or even because increasing numbers of people in many countries are now living into their 90s, it does not follow that the threshold of health sufficiency requires all to do so. it is sufficient that all live through each stage of life, including old age. similarly, health sufficiency does not require the absence of any and all limitations on health-related quality life. it is enough that all live lives unmarked by significant disabilities or decrements in health that could reasonably be prevented or mitigated, and pain and suffering that could be alleviated. importantly, what counts for us as a significant health decrement is explicated, in part, in relation to our theory's sufficiency aim for the other core dimensions of well-being, and thus for a decent life, overall. those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individual's prospects for sufficiency in any of the other dimensions, including the relational egalitarian concerns they entail, constitutes a significant impairment. what instrumental goods and services, what resources, are individuals entitled to as a consequence of this sufficiency threshold? our formal answer is deceptively simple: individuals are entitled to those healthrelated goods and services that are required for a sufficiency of health and the other essential dimensions of well-being, as needed for a decent life. with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. it is implausible to think that the content of any entitlement to health-related goods and services, global or domestic, would be fixed for all time. Rather, the content is necessarily dynamic. what can be done to protect, restore and promote health and the other essential dimensions of well-being, is, as a function of technological innovation and diffusion, as well as cost and value, in constant flux. at minimum, interventions that produce at least moderate value at no more than moderate cost are likely candidates for inclusion in the content of the entitleVolume 1, Issue 1 Biotechnology, Justice And Health 57 ment. For us, the value of a health intervention is to be cashed out not only in terms of its impact on health morbidity or life expectancy or pain, but also in terms of the effect it might have on prospects for achieving sufficiency with regard to reasoning, affiliation, security, respect and self determination. thus, for example, the value of providing contraception includes not only its impact on a woman's prospects for surviving into older age, but also how control over whether and when to become a parent affects her prospects for living a life that is sufficiently self determining, with adequate social respect and sufficient capacity to care for those she loves. also, in some cases, value can permissibly be cashed out not only in terms of the impact on the well being of those who are the direct recipients of a health good or service, but also on the well being of those who are caring for that person such as the loved ones of people with special needs. the national entitlement may also include interventions that are higher cost or produce lower value, but only if in so doing there would be no negative impact on the availability of the good and services more essential to securing health sufficiency, or a sufficiency of the other core dimensions of well being, for all within its borders. Here, our theory mirrors, with a moral grounding rather than a strict efficiency grounding, the concern captured in allocational efficiency in economics to avoid expenditures and entitlements that "crowd out" other goods and services that maybe even more necessary for sufficiency of well-being or a decent human life. also, it is important to emphasize that sufficiency in health and the other dimensions is pegged to a decent life, and not an infinitely elastic notion of human flourishing. to do otherwise would result in another kind of unacceptable crowd out in which the pursuit of other valuable individual and social goods such as the arts and play and recreation would suffer. PaRt tHRee: new BiotecHnologies and tHe exaMPle oF deeP BRain stiMulation we turn now to the question with which this paper began: when, as a matter of justice, are societies obligated to include a new biotechnology in a national health care system or otherwise assure that all have reasonable access to it? consider again the example of dBs. the possibility that dBs might become an effective treatment for memory disorders like alzheimer's is extraordinarily important. diseases and injuries that interJournal of Practical Ethics RUTH FADEN & MADISON POWERS58 fere with the cognitive processes that encode, store, and retrieve information threaten prospects for sufficiency in virtually every dimension of human well-being. as patients with progressive dementias lose the capacity to recall even the basic who's, what's, where's, and when's of their everyday lives, their suffering, and those of the people who love them, is enormous. Much more work needs to be done to establish if dBs will prove effective in preventing or mitigating the ravages of alzheimer's and other severe memory impairing disorders (Fell et al, 2012; lee et al, 2013). However, assuming it does, and assuming that providing dBs to all relevant patients does not come at too high a price with regard to other sufficiency claims, then patients with alzheimer's and the like would certainly be entitled to dBs under our sufficiency standard. But also consider what we only hinted at in our initial discussion of the 2012 dBs epilepsy report. some of the seven epilepsy patients in that experiment were not suffering from the memory impairment that sometimes co-travels with seizure disorders, yet all of them did better on the cognitive tasks when their brains were being stimulated. assuming this line of research does succeed and the results are significant enough, it is a certainty that some people with normal cognitive function will seek dBs solely to get an intellectual edge or some other non-invasive neurotechnology such as transcranial magnetic stimulation. we are now in the familiar and contested territory of the ethics of human enhancement, a complex set of issues that has generated a substantial literature (Buchanan, 2011; savulescu & Bostrom, 2009; Harris, 2007; President's council, 2003), much of it specific to cognitive enhancement including a limited literature on enhancement with invasive and non-invasive brain stimulation (dresler et al, 2013; Kadosh et al, 2012; Hamilton et al, 2011). we engage here only one of those issues, the contentious relation between enhancement and justice, to which our account of sufficiency has at least a partial response. some argue that what is most morally troubling about enhancing biotechnologies is their potential to exacerbate or create egregious inequalities in human well being. some even hold that these technologies and social justice are on something like an inevitable collision course. Here we agree with allen Buchanan's trenchant analysis that these criticisms are both overbroad, and misguided (Buchanan, 2011). even if it were possible to draw a sharp line between new biotechnologies that protect or restore health and new biotechnologies that enhance health or other dimensions of well-being, that difference does not itself necessarily pose fundamenVolume 1, Issue 1 Biotechnology, Justice And Health 59 tally different challenges for the kind of justice theory that we defend. in both cases, the same basic question is raised-as the technology diffuses, under what conditions, if ever, do individuals become entitled to it as a matter of justice? whether a biotechnology that enhances memory or any attribute critical to reasoning and cognitive performance should become a service to which individuals are entitled depends at least in part on the impact of access to that technology on considerations of relational equality. Put another way, a key question for us is whether, at some point in the diffusion of dBs in society, people without dBs would be so deprived in absolute terms, or systematically constrained relative to what is possible for others, that they cannot live decent lives as human beings or as members of a particular society. the second aim of our theory, which we have only signaled here, focuses on the profound injustices that arise from conditions of systematic disadvantage. However, not all inequalities confer advantages and disadvantages, and even those that do confer advantages do not necessarily place others in a position of systematic disadvantage. what we are concerned about are the kinds of disadvantages that are so systematically oppressive that people cannot have decent lives. imagine a future in which so many people have dBs-enhanced memory such that, if you do not, your only options are to have the lowest, most menial jobs. More importantly, the negative impact of not being enhanced bleeds into many if not all of the other dimensions of well being. without the enhancement, you cannot lead a self determining life, you cannot understand the world around you well enough to be able to evaluate options and plan the way others can, you cannot assert your own interests in a meaningful way in the appropriate forums, and you cannot interact with others with a sense of your own comparable standing, but instead feel only shame or embarrassment. if not having been treated with dBs renders you like the crossing sweeper Jo to the wealthy landowner John Jarndyce in dicken's Bleak House, feeling unworthy of shelter in the other's person home even when deathly ill, then dBs for memory enhancement would fall within the entitlements of the sufficiency standard under our account. alternatively, imagine a future in which not having dBs is in its disadvantaging effects more analogous to not being able to attend an elite university. although others with enhanced memory maybe advantaged in many arenas of life, much as the connections secured and arguably the education received by graduating from an Journal of Practical Ethics RUTH FADEN & MADISON POWERS60 elite university is advantaging, your information processing skills are still adequate for participation in the economic and cultural life of society as a moral and political equal. you are still able to navigate the social world sufficiently to determine the broad pathways of your life and to advocate for your interests. you do not feel, nor do others perceive you, as less worthy of respect and dignified treatment because you have not been dBs-enhanced. in such a world, dBs for memory enhancement would fall above what sufficiency would require and would be ruled out as an entitlement. consider a further twist on the dBs example. although we framed our original question in terms of national policy formulation, our theory and its implications extend as well to questions of global justice and access to new biotechnologies. imagine that in affluent countries there is now universal access to dBs enhancement and that the global affluent also avail themselves of the intervention. the comparative disadvantages of not being enhanced, which we further imagine are as oppressive as was just described, now fall on the world's poor. Because of continued and escalating global interaction, these people are so systematically constrained relative to what is possible for others that they cannot live decent lives as human beings or as participants in the global order. dBs enhancement would now become required by our entitlement standard, transnationally as well as nationally. in summary, the standards we set for identifying the goods and services that fall under the sufficiency threshold for health and the other dimensions of well-being are necessarily comparative. these standards are also necessarily dynamic, as dynamic as the creativity that is fueling the life and engineering sciences towards technologies that for some seem almost beyond imagining. which technologies are required for sufficient well-being, for a decent life, will change over time and are in part context specific. the answer to that question, and to when on the diffusion of innovation curve the demands of justice are triggered, cannot be prescribed with algorithmic precision. a theory like ours can only provide broad guidance as to what should be taken into account in specific policy contexts. But there is no necessary reason to conclude that these answers, or the approach to these answers, have to be different when the technology is aimed at what some view as enhancing rather than protecting human biology, or even human nature. Volume 1, Issue 1 Biotechnology, Justice And Health 61 ReFeRences Buchanan, a.e. 2010: Human Rights, Legitimacy, and the Use of Force (new york, ny: oxford university Press). ---2011: Beyond Humanity?: The Ethics of Biomedical Enhancement (new york, ny: oxford university Press). dresler, M., sandberg, a., ohla, K, Bublitz, c., trenado, c., Mroczko-wąsowicz, a., Kühn, s., and d. Repantis. 2013: 'non-pharmacological cognitive enhancement'. Neuropharmacology 64: 529-543. Fell, J., staresina, B.P., do lam, a.t.a. widman, g., Helmstaedter, c., elger, c.e., axmacher n. 2013: 'Memory modulation by weak synchronous deep brain stimulation: a pilot study.' Brain Stimulation 6/3: 270-273. 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