Tuesday, July 6, 2010

Natural childbirth and the problem of evil

A significant number of women believe there is a value in giving birth without medical intervention, and in particular without pain medication. Some of them change their minds once they are actually experiencing the pain, but some do not. What is interesting about this kind of a case is that people are accepting pain which they could permissibly avoid. This is a different sort of case from someone who withstands torture to protect her friends from a dictator, since the latter person—immensely admirable as her action is—is doing her moral duty. In the natural childbirth case, the woman accepts excruciating pain for the sake of a morally optional good, apparently of an aretaic sort.

Some may doubt whether there is in fact an aretaic good in this. I think a case can be made for it. There is a value in being fully perceptually in touch with the central processes of human life. Whether the value is great enough to make the acceptance of severe pain rational is a question to which I don't have an answer (in part because I have not experienced this pain), but it seems reasonable to leave that to the prudent judgment of the individual. In any case, it is widely accepted that what these women do is not unreasonable, and I think the following conditional is pretty solid:

  1. If natural childbirth makes possible a very significant but morally optional aretaic good, it is rational to engage in natural childbirth despite severe physical pain.

Notice, too, that the aretaic good here is one that presumably is mainly experienced retrospectively. I would expect that while in labor, there is no leisure of mind for the experiencing of the aretaic good. What makes the acceptance of pains reasonable, assuming the antecedent in (1), is the way they fit into a whole story that involves the child's coming into the world and later retrospection.

One of the challenges, both intellectual and pastoral, with the problem of evil is our difficulty in imagining how it is that an afterlife can transform the meaning of suffering for an individual. The natural childbirth case provides a helpful analogy. The child's coming into the world and the retrospection, together with the intrinsic aretaic good (assuming for the sake of the argument that there is one—this is easily imaginable), make the suffering make sense. Now, in the childbirth case, the time scale between the suffering and the experience of the good may be shorter, but from the point of view of an infinite afterlife, the difference between twelve hours and seventy years is not so significant.

An apparent disanalogy is that in natural childbirth, the pain is voluntarily accepted by the sufferer, while many other sufferings are imposed on us whether we will or nill. There are, however, several ways of defusing this disanalogy (I am grateful to Trent Dougherty for the first two or three points below, though I may have modified them):

  • We all will the greatest happiness for ourselves (or so Aristotle, Augustine and Aquinas say). Insofar as we will this happiness to ourselves, we will the necessary means to it--and that may include suffering. So in some sense there is a voluntariness.
  • God knows the structure of our desires better than we do, so he can choose for us more wisely even by our lights than we ourselves do.
  • We are all small children. The greatest wisdom of the wisest humans is as the insight of a smart toddler. Or so we will see it from the viewpoint of eternity, if we are received into the joy of union with God.
  • The kind of right we have to impose suffering on someone for the sake of a good to that person depends a lot on the relationship. For instance, for some children, the total suffering over thirteen years of compulsory schooling (even if not all legally compulsory, the parents may impose all of it) is quite horrendous (I am not talking about myself: I actually had quite a lot of fun at school myself, though I also suffered a lot, but not horrendously so). But parents have the right to impose this suffering for the sake of the good of knowledge. (Of course, if there are alternatives available, such as a different school or homeschooling, that do not involve so much suffering for the child, parents shuld opt for those.) X's parents, thus, are permitted to allow much suffering to X for the sake of X's good. X herself, as the childbirth example shows, is permitted to allow even more suffering to herself. And on this scale, God has the kinds of rights in respect to us that we ourselves have.


Tim Lacy said...

Professor Pruss,

It seems possible to me that one could desire to experience this pain for the greater good it confers (e.g. sense of purpose, fidelity to a perceived naturalness), and that experiencing that pain is permissible, yet be physically unable to bear it. This is entirely subjective---dependent on a pain threshold that is individual.

Also, one my verbally cry out for something that she internally desires to avoid. In sum, all of her care-givers (family and medical) might administer relief due a verbalized, contrary desire. The woman might be upset about this later, but it would be better as a family member to not take the chance. And of course medical personnel would, for insurance reasons if nothing else, violate the prior desire of the mother if a verbal desire for the contrary was uttered.

In sum, the permissibility of consent seems entirely beside the point of the individual pain threshold, which a mother would not understand (even partially) until having experienced at least one child birth.

Interesting conversation.

Alexander R Pruss said...

Do you have any thoughts on what it means to be unable to bear a pain?

Here are some options:
1. A pain is unbearable1 for x iff x would die or lose consciousness given this pain.
2. A pain is unbearable2 for x iff x would literally do anything physically possible (including such acts as murder) to stop the pain.
3. A pain is unbearable3 for x iff x would do anything anything morally permissible to stop the pain.
4. A pain is unbearable4 for x iff x would be unable to refrain from not unreasonable steps towards the alleviation of the pain.
5. A pain is unbearable5 for x iff x would be unable to refrain from reasonable steps towards the alleviation of the pain.

I don't think senses 1 and 2 are what's going on. Senses 3-5 seem closer to describing it. Note that sense 5 is too weak. It might not take a very major pain for one to be unable to refrain from taking reasonable steps to its alleviation.

Alexander R Pruss said...

Another option:

6. A pain is unbearable6 for x iff x would suffer permanent psychological damage from the pain.

Tim Lacy said...

Good options. The inability to bear pain probably has something to do with "training" and prior experience with pain. An individual who had, voluntarily or not, experienced great pain would likely avoid scenarios 1 and 2 longer, as well as be cognizant of permissibility and reasonableness in relation to her pain. In sum, our pain target moves with the individuals history with pain, particularly of the child-bearing variety.

On #6, this seems to move from an individual's self-evaluation to the evaluation by another---a problem I hinted at in paragraph 2 of my first comment. Someone else would have to help you determine whether you were on a threshold of permanent psychological damage. - TL

Tim Lacy said...

By the way, I apologize for hijacking this from a question of goods in relation to voluntary pain, to a question about our ability to measure/assess pain. - TL