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05/11/2015

The Impossibility of Regret: Implications for Medical Decision Making Disability Ethics

by J.S. Blumenthal-Barby, Ph.D.

In his recent book, “The View From Here: On Affirmation, Attachment and the Limits of Regret,” philosopher R. Jay Wallace enters interesting philosophical territory that has significant implications for bioethics topics such as medical decision making and disability ethics. Wallace begins his book by introducing the example of a young girl who becomes pregnant as a teenager, has the child, and is now an adult “looking back.” Wallace holds that it is impossible for the now woman to regret the decision she made to have a child so young because of the attachment she now has to the child, despite the fact that she recognizes that this was, objectively, a “bad” or unjustified decision. The main phenomenon that Wallace focuses on in the book is what he calls the “attitude of affirmation” which refers to the tendency people have to abjure regrets for earlier events we look back on (i.e., we say we would make the same choice over again). This tendency is conditioned by our attachments resulting from that decision. And Wallace points out that there is often a divergence between our attitudes of retrospective affirmation and our evaluative assessment about justification (i.e., we admit that it may not have been the right or justified decision under the circumstances). This divergence allows for a person to have two views, in a way. One is the view that they would “do it all over again” and the other is the view that in a way “it was the wrong thing to do.” Whereas others have viewed these two positions to be in tension, Wallace believes it is common and uncontroversial for people to simultaneously hold both.

Medical Decision Making
There are interesting implications for medical decision-making, which often focuses on assessing regret about decisions (there is even a validated decisional regret scale!). For one, assessing regret may not be so simple given the complexity of the phenomenon (just because someone indicates that they do not “regret” the decision they made does not necessarily mean that they do not view it is unjustified or wrong). Second, assessing regret may in some ways be a futile exercise if Wallace is correct about the impossibility of regret (at least in cases where attachments result).

Disability Ethics
There are also interesting implications for disability ethics that Wallace himself recognizes and devotes some discussion to. Wallace writes, “There are cases that involve disability, for example, in which agents find themselves unable to regret their own handicaps if those are conditions for the projects that have come to give meaning to their lives. Writing about these cases, commentators have supposed that agents in this situation are committed to endorsing the objective value of the disabilities to which they are subject. But the framework I offer shows that this conclusion is false; the inability to regret a condition by a situated agent doesn’t entail that the agent endorses the condition, or things that it would, e.g., be better if other people were subject to it as well” (p. 6). And that “There is no inconsistency whatsoever involved in being glad that one has suffered a given disability oneself, when one looks back on the life one has led, even while one chooses that one’s children should not experience the same condition in the life that they are just embarking on” (p. 126). And, “There is no theoretical inconsistency between acknowledging the value of activities that essentially involve a given disability on the part of the adults who already have the disabling condition and seeking to eradicate the same condition in future generations” (p. 129).

Wallace goes so far as to say that, in a case where deaf parents refuse cochlear implants for their deaf child, they are confused, or fail to make the distinction between retrospective affirmation of their deafness and evaluation of it. Wallace writes, “There has notoriously been some resistance within the adult deaf community to the new technologies that are giving hearing-impaired people the ability to participate in the world of oral communication. I would suggest that at least some of this resistance might rest on the confusions of the kind I have attempted to uncover, between the retrospective point of view of adults whose defining life projects presuppose their deafness and the situation of children who are just starting out in life…deafness can be bound up constitutively with forms of activity that are distinctively valuable…The value of these activities, however, does not mean they should be forced on people who are just starting out in life, and who could potentially be given the means to participate fully in the different forms of communication and exchange the most human beings are capable of. The tendency to think otherwise seems to reflect a confusion…” (p. 127).

There is much food for thought here, including the question of whether the answer is as “clear” from the evaluative standpoint as Wallace seems to think it is regarding what the “right” or justified decision is in such cases. In the young mother case, it may be fairly clear. In other words, we may agree that she was not “justified” in having a child at such a young age (provided she did not have the means to care for it, having a child at that age would thwart her own interests, etc.). But the evaluative case does not seem as clear in the case of disability. On the other hand, Wallace may be correct that we may gain some precision to these debates if we separate out points about affirmation (non-regret) and points about evaluation. This is yet another example where good work in philosophy (drawing distinctions, teasing out concepts, etc.) can contribute to (if not stir up controversy about!) important questions in bioethics.

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