Philosophy Masquerading as Science

Science and technology have revolutionized our world. The average person in a developed country lives better and longer than kings did only 150 years ago. Science is so powerful in the minds of people that it, rather than religion or philosophy, as in an earlier age, is the sole arbiter of truth. Modern people who want to prove their point, whatever that point is, appeal to science. But science cannot answer every question. Often, people and organizations push a political agenda and pretend, or actually believe, that science has proven their agenda to be right. This email conversation is an example.

By Mark D. Harris, MD, MPH, MBA, MDiv, ThM, PhD, DBA

Several years ago, the American Academy of Family Physicians (AAFP) published a policy supporting the requirement for employers to provide contraception for their employees, without a faith-based exception. I sent an email to the AAFP asking why they took such a position.  Such controversial stances would alienate members without achieving meaningful policy goals.  Further, such a position was political, not scientific. AAFP sent me the reply below.

Email String

On Thu, Nov 9, 2017 at 2:00 PM, the AAFP sent a reply:

Dr. Harris,

Thank you for sharing your opinion with the AAFP.  The AAFP recognizes that members come from different faiths and belief systems, but we must address the provision of medical care based on science, not religion or politics.  All AAFP policies are determined by the Congress of Delegates and Board of Directors, which are made up of family physicians from throughout the country.

The AAFP respects a physician’s right not to do something against their belief system – our reproductive policy includes, “If a family physician’s moral or ethical beliefs conflict with the ability to provide the requested resources or education, the family physician should ask a colleague to provide this information in a timely fashion rather than omit it.” But their patients should still have access to all medical options that have been proven safe and effective.

The AAFP supports doctor autonomy and advocates against outside interference in the doctor-patient relationship.  We believe that the faith-based exemption “… interferes in the personal health care decisions of our patients, and inappropriately inserts a patient’s employer into the physician-patient relationship.”

We value your opinion and appreciate the work that you do.  Please don’t hesitate to contact us with any further questions.

(AAFP Representative)

One month later, I replied,

(AAFP Representative),

Your mention of “provision of medical care based on science, not religion or politics,” certainly sounds high flown, even noble. At the very least, it sounds erudite. Presumably, AAFP defines science as “systematic knowledge of the physical or material world gained through observation and experimentation,” or something like that. If so, please explain how forcing employers to provide contraception against their moral belief system is scientific. Is there a study that suggests that the benefits of contraception to one person outweigh the risk of anxiety, guilt, or perhaps even mental health problems of another? Has some prestigious university concluded that the rights of a woman who presumably cannot afford birth control (and can’t get it through any of the numerous free or low-cost options available) outweigh those of a business owner or organization director, small or large?

Is this a case of estimating “the most good for the most people?” If so, then has AAFP decided to adopt John Stuart Mill’s (1806-1873) Utilitarian philosophy in all policy areas, because that is what this is? Has AAFP informed its members of their philosophical position, and is the AAFP applying it consistently? Does science evaluate rights and responsibilities, or are those topics in the realm of ethics, philosophy, politics, and religion? Or is “science”, much as we love and revere that term in our modernistic world view, simply masquerading as an authority in an area in which it knows nothing? It wouldn’t be the first time.

Please forward the comprehensive scientific evaluation by which the AAFP Congress of Delegates and Board of Directors made this decision. I would like to see the in-depth ethical evaluation that AAFP performed before issuing its statement. If AAFP did not do an ethical evaluation but instead opted for a democratic approach (voting), please send the ballot that was sent to members and the results supporting this position.  I will be glad to see how scientific, or at least democratic, this decision was.

Thank you very much for your reply – I wasn’t expecting any. And thank you also for the work that you do. Balancing these issues is not easy.

Mark

I never received an answer to the second missive. No wonder. Truth with charity would have been a better approach. But what I said was still the truth.

Conclusion

In this case, the AAFP mistook a philosophical position, the utilitarianism of John Stuart Mill, for a scientific position. It is not possible to have a genuinely scientific study that compares the well-being of women with business owners regarding the employers’ provision of birth control. Even if it could be shown that one group had meaningfully better well-being, that would not answer the question of who should reap the greater benefit. Questions of “should” or “ought” can never be answered by science as they are inherently moral, religious, and philosophical. The woman, a physician, who replied to me was mistaken in her argument that AAFP took the scientific position. She could have responded more accurately by saying the AAFP took a philosophical position.

When relevant cases made it to the US Supreme Court, they ruled in favor of a faith-based exception for employers.[1][2]  The justices understood that their ruling was not scientific; it was philosophical and legal.

In my opinion, the AAFP is a good organization that does its best to ensure high-quality patient care, both at the individual and community levels. Taking a position is a constitutional right, as free speech applies to organizations as well as individuals. Taking stances outside the realm of science, while pretending a stance is science, is destined to cause meaningless controversy. Insofar as AAFP and any other organization chooses to take political stances in the future, those positions really should be the position held by the majority of its members. This would require a vote of all members (a direct democracy) rather than a Congress of Delegates (representative democracy).

In writing this article, I hope that all those who read this will recognize when philosophy masquerades as science. And when they do, I hope that they will teach others that truth…with charity.

[1] Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014).

[2] Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, 591 U.S. ___ (2020)