As a (self-declared) rational person, I take pride in my ability to reason through decisions. But how do we rational people actually go about deciding what to do? One straightforward explanation is this: We identify the thing we most want among the available options, investigate the various ways of getting it, and choose the means most likely to bring it about. This goes for everything from deciding what to have for breakfast to deciding to start a family. Simple, right?
Philosopher L. A. Paul says not so fast. While we tend to make everyday decisions — like toast or cereal — in light of our given preferences, some of the things we decide to do — like having kids — actually end up shaping them. Paul refers to experiences that change what we care about as transformative. The problem with making decisions involving potentially transformative experiences is that we are forced to decide whether to pursue them under the influence of our current set of preferences and values.
The issue here is not simple uncertainty. Making future-oriented decisions always involves aiming at a moving target. In cases of transformative experience, though, we are shooting at a moving target from a moving platform. Consider Paul’s striking example of deciding whether to become a vampire. I can reflect on what life as a vampire might look like, talk to other vampires about their experience, weigh the likely costs and benefits — but I do all this as a non-vampire. I don’t much care for cloaks and blood now, but who knows what the sartorial and culinary preferences of my vampire self will be?
The question Paul poses is how we rational people can ever make rational decisions about potentially transformative experiences. This brings me to the matter at hand: The decision I (and my accommodating family) made to move across the country so that I could pursue Baylor College of Medicine’s two-year Clinical Ethics Fellowship.
At the time, the decision was easy. Baylor’s Center for Medical Ethics and Health Policy is an amazing place with a high-volume ethics consult service and faculty engaged in a wide range of exciting scholarship.
Upon reflection, though, I realized that training programs pose an epistemic dilemma related to transformative experience: You enroll in a training program because you think you want to do the thing you’re being trained for. But if you had adequate knowledge of what it is to do that thing, you wouldn’t need to enroll in the training program in the first place.
As a first-year doctoral student in a philosophy department, I envisioned myself taking the “traditional” path from Ph.D. in philosophy to professor of philosophy. This, after all, was the path taken by all those training me. But once it was time for me to prepare for the notoriously scanty academic job market, I thought it would be wise to apply broadly — postdocs, professorships, temporary positions, and, of course, clinical ethics fellowships.
The decision to consider a clinical ethics career trajectory wasn’t out of the blue. In addition to my academic interest in biomedical ethics and the philosophy of medicine, I had some experience as a clinical ethics intern and hospital ethics committee member. I had also done my best to gather information about the field by speaking with clinical ethicists and other fellows. Yet, none of this could prepare me for the subjective experience of the work: rounding in the ICU, helping guide patients and families though incredibly difficult circumstances, and contributing to hospital policy in response to a global pandemic.
While practicing clinical ethics in an academic medical center is a departure from the standard career trajectory of a philosophy Ph.D., it offers a fairly unique middle path: a non-traditional academic career that involves some traditional aspects. I continue to write the same kinds of papers and give many of the same kinds of lectures I would if I were in a philosophy department. But deviation from the traditional path, while it has advantages, also involves a greater deal of uncertainty.
My experience as a clinical ethics fellow has been transformative in an uninteresting sense: before it, I wasn’t a trained clinical ethicist; once I’m finished (if all goes according to plan), I will be. But it has also been more substantially transformative. It has changed the way I think about philosophical problems, which questions I find interesting and important, the ways I communicate ideas to students and learners, and the body of examples I draw upon (not as neat and tidy as they once were, but certainly more vivid and complex).
My decision to pursue clinical ethics may not have been a perfectly rational one, but my fledgling-clinical-ethicist-self is happy that my graduate-student-self took the leap.