/LMAR=0/XLINE=3/FONT#0=BASL30/FONT#1=BASI30/FONT#2=BASB30/FONT#3=STA200/FONT#4=NGB25
␈↓ ↓H␈↓␈↓βS␈↓∧ Artificial Intelligence Laboratory, STANFORD UNIVERSITY, Stanford, California 94305

␈↓ ↓H␈↓∧Telephone 415 497-4430␈↓ 
⊃April 10, 1977 




␈↓ ↓H␈↓␈↓↓American Scientist␈↓
␈↓ ↓H␈↓345 Whitney Ave.
␈↓ ↓H␈↓New Haven, CT 06511

␈↓ ↓H␈↓To the Editors:

␈↓ ↓H␈↓        Doctors,␈α∂psychologists␈α∂and␈α∞psychiatrists␈α∂may␈α∂be␈α∞tempted␈α∂to␈α∂push␈α∞their␈α∂moral␈α∂and␈α∞esthetic
␈↓ ↓H␈↓ideas␈α∂about␈α∂life␈α∂style␈α∂in␈α∞the␈α∂guise␈α∂of␈α∂medical␈α∂advice.␈α∞ This␈α∂is␈α∂immoral,␈α∂because␈α∂it␈α∂takes␈α∞unfair
␈↓ ↓H␈↓advantage␈α∂of␈α∂the␈α∞patient's␈α∂illness␈α∂and␈α∂the␈α∞doctor's␈α∂reputation␈α∂as␈α∂an␈α∞expert,␈α∂and␈α∂it␈α∂is␈α∞dishonest,
␈↓ ↓H␈↓because the therapist's moral and esthetic premisses are not explicitly stated.

␈↓ ↓H␈↓        David␈α⊃Glass␈α⊂in␈α⊃"Stress,␈α⊂Behavior␈α⊃Patterns,␈α⊂and␈α⊃Coronary␈α⊂Disease"␈α⊃(␈↓↓Am.␈α⊃Sci␈↓.␈α⊂65:177-187,
␈↓ ↓H␈↓March␈α
1977)␈α
classi≡es␈αbehavior␈α
patterns␈α
as␈αtype␈α
A␈α
or␈αB␈α
and␈α
describes␈αtheir␈α
relation␈α
to␈αcoronary
␈↓ ↓H␈↓disease.␈α∀ Unfortunately,␈α∀the␈α∪classi≡cation␈α∀itself␈α∀and␈α∀his␈α∪choice␈α∀of␈α∀scienti≡c␈α∀questions␈α∪contain
␈↓ ↓H␈↓unstated␈α
moralistic␈αpremisses␈α
that␈αseem␈α
to␈αunderlie␈α
the␈αwhole␈α
trend␈αin␈α
medicine␈αdiscussed␈α
by␈αhis
␈↓ ↓H␈↓70␈α⊃references.␈α⊃ Worse␈α⊃yet,␈α∩since␈α⊃the␈α⊃premisses␈α⊃are␈α∩inexplicit␈α⊃and␈α⊃therefore␈α⊃undisclosed␈α∩to␈α⊃the
␈↓ ↓H␈↓patients, the pharmacological and behavioral treatments advocated violate the patients' rights.

␈↓ ↓H␈↓        Let␈α∞us␈α∞assume␈α∞that␈α∞all␈α∞the␈α∞studies␈α∞reported␈α∞were␈α∞correctly␈α∞done␈α∞and␈α∞provide␈α∂the␈α∞reported
␈↓ ↓H␈↓answers␈αto␈αthe␈αquestions␈αthat␈αwere␈αposed␈αin␈αthem.␈α Nevertheless,␈αthe␈αarticle␈αand␈αthe␈αresearch␈αand
␈↓ ↓H␈↓therapy by Glass and others reported in it are open to serious moral objection.

␈↓ ↓H␈↓        Here are the grounds for complaint:

␈↓ ↓H␈↓        1.␈αThere␈αis␈αa␈αlack␈αof␈αrespect␈αfor␈αthe␈αvariability␈αof␈αhuman␈αbehavior␈αpatterns,␈αthe␈αright␈αof␈αa
␈↓ ↓H␈↓person␈α⊂to␈α∂maintain␈α⊂his␈α∂own␈α⊂except␈α∂where␈α⊂it␈α∂infringes␈α⊂the␈α∂rights␈α⊂of␈α∂others,␈α⊂and␈α∂the␈α⊂duty␈α⊂of␈α∂a
␈↓ ↓H␈↓therapist␈αto␈α
help␈αhim␈α
reduce␈αhis␈α
disease␈αrisks,␈α
however␈αhe␈α
chooses␈αhis␈α
life␈αstyle.␈α
 "It␈αtakes␈αall␈α
kinds
␈↓ ↓H␈↓to␈α
make␈α
a␈αworld"␈α
is␈α
the␈αold-fashioned␈α
way␈α
of␈α
putting␈αit.␈α
 Can't␈α
there␈αbe␈α
a␈α
therapeutic␈α
ethic␈αthat
␈↓ ↓H␈↓recognizes a patient's right to his life style and helps him avoid disease within it?

␈↓ ↓H␈↓        2.␈α_Hard-driving␈α_personalities␈α_get␈α_short␈α_shrift␈α_from␈α_Glass.␈α_ Hostility␈α_is␈α_one␈α_of␈α↔the
␈↓ ↓H␈↓characteristics␈α
included␈α
in␈αthe␈α
type␈α
A␈αcluster.␈α
 When␈α
they␈αdon't␈α
show␈α
it,␈αit␈α
is␈α
because␈α
␈↓↓"they␈αoften
␈↓ ↓H␈↓↓keep␈α
such␈α
a≥ect␈α
under␈α
deep␈α
cover"␈↓.␈α
 They␈α␈↓↓"believe␈α
that␈α
with␈α
su≠cient␈α
e≥ort␈α
they␈α
can␈α
overcome␈αany
␈↓ ↓H␈↓↓obstacle"␈↓.␈α∨ Any␈α∨obstacle?␈α∨ They␈α∨are␈α≡␈↓↓"compulsively␈α∨hard-driving"␈↓.␈α∨ Could␈α∨a␈α∨person␈α≡be
␈↓ ↓H␈↓uncompulsively␈α∩hard-driving?␈α∩  They␈α⊃exhibit␈α∩␈↓↓"excessive␈α∩achievement␈α⊃striving"␈↓.␈α∩ No␈α∩criterion␈α⊃is
␈↓ ↓H␈↓given␈α
for␈α
distinguishing␈α
this␈α
from␈α
normal␈α
or␈α
subnormal␈α
achievement␈α
striving.␈α∞ Any␈α
hard-driver
␈↓ ↓H␈↓who␈αcomes␈αto␈αthe␈αNational␈αHealth␈αResearch␈αCenter,␈αfor␈αexample,␈αhas␈αreason␈αto␈αfear␈αthat␈αthere␈αis
␈↓ ↓H␈↓more on the agenda than lessening his risk of a coronary attack.
␈↓ ↓H␈↓α␈↓↓American Scientist␈↓␈↓ ¬kApril 10, 1977␈↓ 
pPage 2␈↓↓ 


␈↓ ↓H␈↓        3.␈α∀With␈α∀the␈α∀decline␈α∀of␈α∀explicit␈α∀discussion␈α∀of␈α∀the␈α∀"good␈α∀life",␈α∀there␈α∀is␈α∀a␈α∃tendency␈α∀to
␈↓ ↓H␈↓incorporate␈αideas␈αof␈αthe␈αgood␈αlife␈αunder␈αthe␈αnotion␈αof␈αhealth.␈α Unfortunately,␈αthe␈αreader␈αcan't␈αtell
␈↓ ↓H␈↓whether␈αGlass␈αthinks␈αhe␈αhas␈αa␈αduty␈αto␈αbe␈αless␈αhard-driving␈αand␈αwhat␈αGlass␈αthinks␈αare␈αlegitimate
␈↓ ↓H␈↓social␈α
means␈α
to␈α
achieve␈α
this␈α
result.␈α
 Now␈α
I␈α
think␈α
hard-drivers␈α
have␈α
contributed␈α
much␈α
to␈α
the␈α
world,
␈↓ ↓H␈↓and␈αthe␈αtype␈αmerits␈αencouragement␈αand␈αhelp␈α
with␈αits␈αspecial␈αmedical␈αproblems␈α(if␈αthere␈α
are␈αany),
␈↓ ↓H␈↓but the relevant arguments are surely sociological, historical and moral - not medical.

␈↓ ↓H␈↓        4.␈α∩Glass's␈α∩own␈α∪studies␈α∩show␈α∩that␈α∩type␈α∪A's␈α∩calm␈α∩down␈α∩and␈α∪do␈α∩better␈α∩when␈α∪they␈α∩have
␈↓ ↓H␈↓discriminated␈α∂what␈α∂they␈α∂can␈α∂change␈α∂from␈α∂what␈α∂they␈α∂can't.␈α∂ This␈α∂might␈α∂suggest␈α∂helping␈α∞people
␈↓ ↓H␈↓discriminate␈α∞better,␈α∞but␈α∞perhaps␈α∞a␈α∞bias␈α∞in␈α∞favor␈α∞of␈α∞reforming␈α∞their␈α∞personalities␈α∂prevents␈α∞Glass
␈↓ ↓H␈↓from␈αconsidering␈αwhat␈αmight␈αbe␈αdone␈αin␈αthis␈αdirection.␈α In␈αthe␈αdays␈αwhen␈αpreaching␈αwas␈αexplicit,
␈↓ ↓H␈↓we heard, "Lord help me change what I can, endure what I can't, and know the di≥erence".

␈↓ ↓H␈↓        It␈α∞seems␈α∞to␈α
me␈α∞that␈α∞scienti≡c␈α
authors␈α∞owe␈α∞the␈α
public␈α∞a␈α∞duty␈α
to␈α∞state␈α∞explicitly␈α∞their␈α
moral
␈↓ ↓H␈↓premisses␈α
when␈α∞these␈α
substantially␈α∞a≥ect␈α
the␈α∞content␈α
of␈α
their␈α∞work,␈α
and␈α∞referees␈α
and␈α∞editors␈α
are
␈↓ ↓H␈↓duty bound to help them.


␈↓ ↓H␈↓John McCarthy
␈↓ ↓H␈↓Computer Science Department
␈↓ ↓H␈↓Stanford, University
␈↓ ↓H␈↓Stanford, California 94305