Marty Fitzgerald

Epicurean Ethics, Fall 2017

Can there be an Epicurean Clinical Ethics? Can there be an Epicurean Doctor?

Epicureanism is a therapeutic philosophy. Its ends are toward the proper rehabilitation of

its students such that they can dispel false beliefs and put in their place ones which allow for

unadulterated pleasure. As such, the “workhorse” of the Epicurean tradition has been the

therapist. It's easy to see what an Epicurean therapist's goals are, even if it may be difficult to

imagine how a therapist will respond to a given situation. But can there be such a thing as an

Epicurean doctor? While an Epicurean could perhaps be a doctor, it's a different matter to ask if

there would be something particularly Epicurean in his or her practice. Asclepiades of Bithynia

managed to incorporate Epicurean atomism into his study of medicine, but does Epicureanism

have more to offer? Would the Epicureans expect certain things from their doctors in the same

way that they expect things from their therapists? And, if they were to, would their approach be

recognizable to modern clinical practice?

Other authors have used Epicureanism as a touchstone to address issues within the larger

field of medical ethics. James Taylor defends what he calls a “full-blooded” Epicureanism in his

book Death, Posthumous Harm, and Bioethics whereby he argues that posthumous harm is

impossible and that one cannot be wrong after their death1. He follows this line of inquiry in

order to address questions concerning research on human cadavers, euthanasia, suicide, and

organ harvesting. Carlo Strenger, by contrast, defends a “mild Epicureanism” in order to sketch

1 Taylor, James Stacey, Death, Posthumous Harm, and Bioethics (New York: Routledge, 2012).

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out an approach to meta-normative claims in psychotherapy2. However, the question of whether

or not there can be a truly Epicurean medical ethics on the whole remains open.

To answer this question, I propose to examine how an Epicurean doctor would behave

and what values he or she would hold when practicing medicine in a community of other

Epicureans. In doing so, I hope to isolate the peculiarly Epicurean aspects of medical practice

without needing to worry about the response to non-Epicurean systems of ethics imposing

themselves when in a different setting. Against this backdrop, the role of the Epicurean doctor

can be understood as a compliment to an Epicurean therapist. Where the position of the therapist

is already known in Epicureanism, it is easier to start with the therapist as a given and simply

proceed to a discussion of doctors, seeking to avoid the collapse of the two roles into one

another. It seems that, in an Epicurean community, the role of the doctor is generally threefold.

The doctor ought to:

1. Address pains not arising from the presence of false beliefs or which arise due to a lack

of information necessary to form and hold beliefs

2. Restore the body to proper functioning such that katastematic pleasure is attainable.

3. Discern the patient's natural from his or her unnatural desires and restore the body such

that, at a minimum, the patient's natural and necessary desires can be obtained without

any pain.

There is an innate difficulty in defining who the Epicurean doctor is as Epicureans are

2 Strenger, Carlo, “Mild Epicureanism: Notes Toward the Definition of the Therapeutic Attitude,” Am J
Psychother. 62(2) (2008):195-211.

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unlikely to believe that there is an abstract form of what it means to be a doctor. More precisely,

the individual Epicurean who is a doctor will likely draw their professional ethics from what is

most acceptable to the surrounding community. Justice, for the Epicureans, “is not a good thing

in its own right, but [exists] in mutual dealings in whatever places there [is] a pact about neither

harming one another nor being harmed.”3 Likewise, injustice “is not a bad thing in its own right,

but [only] because of the fear produced by the suspicion that one will not escape the notice of

those assigned to punish such actions.”4 A patient's happiness to the Epicurean doctor is not taken

as a good in and of itself, excepting where it directly benefits the doctor. Even differed benefits

are still considered only as they relate to the direct pleasures and pains of the doctor; the patient's

good is never even indirectly an independent good to the doctor. Thus, it is not unreasonable to

expect that an Epicurean who is “behind enemy lines,” so to speak, will be perfectly willing to

do something they find abhorrent insofar as it is expedient, e.g. insofar as it is approved by the

surrounding community and not disproportionately harmful to the self. If this is the case, it

would seem as if there isn't anything particularly Epicurean about any given Epicurean doctor.

However, the investigation ought not to stop here as the same objections hold true of any

profession an Epicurean could hold. Even the therapist, the exemplar of Epicurean praxis, will

likely change their approach with others if the surrounding community demands it. Should the

surrounding community find the tenants of Epicureanism unpalatable, it wouldn't be difficult to

imagine that our Epicurean therapist would leave their beliefs at the door and practice according

to a different set of values. Yet, therapists do have a particular role in the Epicurean tradition that

can be dissected and studied. It is precisely as the Epicurean therapist relates to other Epicureans

3 Brad Inwood and L.P. Gerson, trans. The Epicurus Reader, (Indianapolis: Hackett Publishing, 1994), 35.
4 Ibid.

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that their function is most fully on display. As such, if we are to understand the Epicurean doctor,

it would be most useful to look at who the Epicurean doctor is in relation to a community of

fellow Epicureans.

In the Epicurean garden, a doctor is free to practice anything which would compose a

distinctively Epicurean medicine. Under these circumstances, the fellow community members

are amiable to such an approach given that they also, in varying degrees of perfection, hold the

tenants of Epicurean thought. What, then, is the role of the doctor in such a place? Again, as the

Epicureans are unsympathetic to thinking of what the “perfect doctor” ought to be and then

deriving the properties of a particular practice, it is most appropriate to think of the role of the

doctor under the as something which directly contributes to the community's well-being. Most

properly, “doctor” accounts for the name given to a role which the Epicurean garden finds

expedient, given their particular arrangements.

Although it may seem trivial, it's not a given that the Epicureans would actually have a

doctor in their most favorable community. After all, if the function(s) which a doctor would

perform are already subsumed under other professions, there would be no need for a doctor.

Analogously, an Epicurean garden may not find it worthwhile have a courthouse with judges

simply because the surrounding community did. We could imagine that the Epicureans would

rather have a council of sages or some other form of arbitration, or perhaps even to dispense with

legal arbitration altogether. What we would call a doctor, broadly speaking, is one who

administers interventions for the either purpose of restoring a patients health to proper function,

or for the purpose of preventing future compromise in proper functioning. Yet, this definition

sounds very similar to that of the Epicurean therapist. Even if the two do not overlap entirely, it

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seems certain that there are regions of contact such that, for a given patient, a doctor and an

Epicurean therapist would perform similar actions. Is it fair to imagine, then, that the proper

Epicurean therapist is also the community's practitioner of medicine, or ought we to imagine

otherwise?

I think the most tenable position is for us to think otherwise. Although it may seem a

simple objection, the fields of medicine and therapy both possess enormous content such that it is

difficult to become proficient, let alone master, only one of them. Even if the Epicurean sage can

be considered a master of therapy (ignoring that there's no intimation that there could ever be an

abundance of sages), modern medicine alone has far more information to grapple with than could

ever be expected for one person, sage or not, to grasp. In ancient times alone, the Epicureans

note that medical science already represents its own field of practice. Lucretius notes that it is the

doctors who deliver tinctures of wormwood to treat coughs and so on 5, even if medical science is

occasionally useless in the face of particularly horrific diseases 6. I thus contend that an Epicurean

garden will thus desire both therapists and doctors for itself, giving each a separate function to

perform, even if their work occasionally overlaps, given that each contributes a good to the

community.

Although the Epicureans strongly urge their disciples to strive for the pleasures of the

mind, their materialism both allows them to find goods in the body's pleasure as well as to admit

that the mind can be influenced by physical stimuli. Yet, the mind is still considered different

enough to be interacted with as a different kind of thing than simply the flesh of the body. Both

the mind and the body are important to proper functioning and both of them need to be given

5 Smith, Martin Ferguson, trans., On the Nature of Things (Indianapolis: Hackett Publishing, 2001), 28.
6 Namely St. Anthony's fire – Ibid., 209.

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attention, potentially by either doctors or therapists, for a properly happy life. While Epicurus is

able to set against his physical pains “the joy in [his] soul produced by the recollection of the

discussions [he's] had”7, the Epicureans still nevertheless see types of goods which arise from the

body itself. Contrast this with the Stoics, many of whom who would refuse bodily pleasures,

even if they were available in ample supply. There could perhaps never be a truly stoic doctor

given the stoic's fear of placing any moral value in the body's proper functioning. Where the

body is, on last inspection, fundamentally out of our control, it is not sensible for the stoics to

place worth in its health or pleasure. Rather, we could better imagine that a stoic community

would simply instruct its students to learn to endure his or her body's pain.

The Epicureans, as I have said, do not place such restrictions on their body. If anything,

they gravitate towards the other pole, freely admitting that a body's pleasure is indeed based on

proper functioning and the properties of pleasing objects. Even Epicurus admits:

“Nor do I know what I could understand the good to be, if I set aside the pleasures we get from sex,

listening to songs, looking at [beautiful] shapes, from smooth motions, or any other pleaures which affect

any of man's senses. Nor, indeed, can it be said that only mental rejoicing is [to be counted] among the

goods; for his is my understanding of mental rejoicing: it lies in the expectation that our nature will avoid

pain while acquiring all those things I just mentioned”8

While the mind's pleasure can be set up and against the body's pain if need be, Epicureans are not

only happy to accept bodily pleasures coming about by fortune, they place an active emphasis on

procuring these pleasures, provided they are of a choiceworthy quality. While every pleasure is

7 Inwood & Gerson, The Epicurus Reader, 79.

8 Ibid., 58.

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innately good to the Epicureans, not every pleasure is innately choiceworthy. Rather, pleasures

are subject to what has been termed the “hedonistic calculus,” such that one is able to

differentiate between kinds of pleasure and to balance long-term and short-term pleasures and

pains. An Epicurean seeks these pleasures by developing appropriate desires. Thus, the

Epicurean doctor, in the interest of promoting pleasure in their patients, ought to understand the

distinctions between types of desires.

In the Epicurean schema, there are three important categories of pleasures: natural and

necessary, natural and unnecessary, and unnatural. There are three passages from the Principle

Doctrines which help elucidate exactly what constitutes this classification.

Principle Doctrine 26:

“The desires which do not bring a feeling of pain when not fulfilled are not necessary; but the desire

for them is easy to dispel when they seem to be hard to achieve or to produce harm.” 9

Principle Doctrine 29:

“Of desires, some are natural and necessary, some natural and not necessary, and some neither natural

nor necessary but occurring as a result of a groundless opinion.” 10

Principle Doctrine 30:

“Among natural desires, those which do not lead to a feeling of pain if not fulfilled and about which

there is an intense effort, these are produced by a groundless opinion and they fail to be dissolved not

because of their own nature but because of the groundless opinions of mankind.”11

Exactly what this amounts to is still a point of contention. Easiest to understand are

9 Ibid., 34.
10 Ibid.
11 Ibid., 35.

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natural and necessary desires. These desires are for actions or objects which will stave off pains

which follow from their non-fulfillment. Under this category we may place desire for food and

water. Without either, we would die, but, perhaps most importantly for the Epicureans, we would

suffer tremendously before our death. Hunger and thirst are inevitable and one rightly believes

that these pains will occur in the privation of food and water. Under the category of unnatural

beliefs certain things are easy to place, such as desires for things which will actually cause us

harm. Outside of this, though, it's not a trivial matter to determine how to populate the remainder

of the unnatural desires versus the natural but unnecessary desires. This is especially true given

that Epicurus uses desire itself to investigate what human nature is rather than propose a human

nature and then use desire what a given person's desires ought to be.

Annas proposes that Epicurus' system rests on an assumption not found in any of his

extant texts. She divides the three types of desire as follows:

“...desires which for humans are natural and necessary are generic. That is, they are desires

for food, for shelter and so on, without any specification of what kind of food, shelter and so on. My

desire for food springs from my nature as a self-maintaining organic being which needs to replenish

itself every now and then; and it is necessary that I fulfill this desire if I am to continue as such a being

at all, and a fortiori as a healthy and happy such being. … And if natural and necessary desires are

generic, for food rather than for any particular kinds of food, then they contrast in the right way with

empty desires, for they do not rest on any false beliefs … They will also contrast in the right way with

natural and non-necessary desires if these are taken to be specific, specifications of the desire for food.

The desire for lobster will be a specification of the desire for food.”12

12 Annas, Julia, The Morality of Happiness (New York: Oxford University Press, 1993), 193. Emphasis hers

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In other words, natural desires are ones which will cause pain if left unfulfilled whereas

unnatural desires will not cause pain when unfulfilled, given the one who desires possesses

correct beliefs. Necessary desires, which are definitionally also natural beliefs, are generic given

that their end lies in preventing a pain rather than lusting for a particular object. Unnecessary

desires are still based on a correct belief, making them a category within natural desires, but due

to their fixation on a particular good rather than on the alleviation of a pain, they are not properly

necessary. Per Annas' account, unnatural desires are the ones based on false beliefs.

Yet, pains also arise from other sources than false beliefs or the nonfulfillment of

necessary desires. Were I to trip and break my ankle, doubtless I would feel pain, but it seems

inaccurate to say that this pain springs forth from perverted desires or false beliefs. Although one

may be tempted to say that the desire to have such bodily pains removed itself is a type of natural

and necessary belief, this doesn't fit with Epicurus' classification of goods. First, it's not as

though bodily pains are only pains when some desire is neglected, such as it is with hunger, but

rather that they are active pains which really do hurt of their own volition. Secondly, Epicurus

states that natural goods are “both limited and easy to acquire” 13, but we know from direct

experience that the pleasure which comes from removing many types of bodily pain is difficult to

obtain. Even when Epicurus was plagued with kidney stones “which could not be surpassed for

their intensity,”14 his sagacity led him to set a mental pleasure against his bodily pain seeing as it

was difficult (in his time nigh impossible) to fix this pain.

Even though a sage can suppress this pain, pain is still always an evil. Pain's

choiceworthiness is due only to its promise of some future pleasure. In the case of a simple

13 Inwood & Gerson, The Epicurus Reader, 33.

14 Ibid., 79

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bodily malady like kidney stones, it's difficult to imagine any circumstance in which kidney

stones would be choiceworthy (except maybe if treatment would bring about even worse pains

than non-treatment). Because the pleasure which arises from the removal of pain is a great good,

we can conclude that the removal of pains not arising from false beliefs is still in itself a good

thing. Given this, and given that many bodily pains require specialized knowledge to treat, the

Epicurean garden will likely wish to have someone who can do so. Thus, it seems reasonable that

an Epicurean doctor will be tasked with removing pains which do not arise from the presence of

false beliefs.

The pleasure which arises from restoration and the avoidance of bodily pain are not the

only two benefits to proper bodily health. While not coming from teleological motivation, the

Epicureans still do acknowledge that the body can function either properly or improperly. From

either proper and improper functioning there are two important potential implications. First, it's

possible that improper functioning results in bodily pain during the fulfillment of natural desires.

Second, per Gosling and Taylor, it may actually be the case that the highest pleasures only arise

from the pleasure experienced by a body in proper functioning.

In the first case, there are types of pains which arise only due to the consequence of

certain actions combined with improper functioning of the body. For example, it could pain us to

eat food. In the later stage of rabies, it is well known that humans can't tolerate any liquids at all.

These types of pains are different from the general pains mentioned above in that they aren't

constant and are instead triggered by the satisfaction of certain desires via certain actions 15.

Pointless generalized bodily pain, such as kidney stones, will never do any good for an

15 Properly basic bodily functions are excluded here. If my foot only hurts when I walk or my lungs only hurt when
I inhale it seems as though my body pains me on a layer beneath even the most basic of desires and instead I am
pained by basic bodily functions.

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Epicurean. However, it's also the case that a body in proper function will rightly feel pain given

certain stimuli and will feel pleasures given others. We would be disturbed if a body didn't feel

pain when exposed to fire given that burns impair the body's function, perhaps even fatally so. If

a patient laments to his or her doctor that touching fire hurts them, ought the doctor to make it so

that's not the case? If a patient can't tolerate any food, should a doctor provide remedy?

While the answers are obviously 'no' and 'yes', respectively, there are situations where the

answer is less obvious for an Epicurean. Let's say that a patient (who happens to be male) is

overcome with sexual desire whenever he says anyone he's attracted to. He never finds any

satisfaction in his desire and it causes him immense duress. To stifle this passion, he requests that

his doctor castrate him. Surely, this stands a reasonable chance of quelling his perceived pain, but

the consequences of such a procedure are also permanent. Ought the Epicurean doctor to do

this?16 How can the doctor decide? To differentiate between these types of pains requires the

doctor to understand at least some type of Epicurean therapy.

In such cases where select desires are fulfilled only with accompanying pain, the

Epicurean doctor ought to alleviate those pains which result from the fulfillment of natural and

necessary desires. It is precisely these desires which are meant to alleviate pains when the

organism is in proper function, meaning that pains in these cases indicate a set of proper beliefs

inhibited by improper functioning. For unnatural desires, the opposite holds true. As unnatural

desires stem from false beliefs, it is not unfitting that pain should accompany attempts to fulfill

unnatural beliefs. In this way, it's not fitting for an Epicurean doctor to try to intervene in these

pains as an unnatural desire is not an otherwise pleasurable thing. Indeed, much as with burning,
16 There are competing interpretations of Epicureanism which would answer the question(s) of love and sex
differently. The purpose here is not so much to resolve the issue of voluntary castration/sex as much as it is to
pose it as a question which doesn't have an immediately obvious answer in the same way that the other examples
do.

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pain as the result of an unnatural desire may actually be a good thing in that it helps correct what

is ultimately a painful or at least unhelpful desire. More complicated, however, is the doctor's

response to a natural and unnecessary desire.

On one hand, a natural and unnecessary desire, in virtue of its being a natural desire,

represents a desire stemming forth from a body in proper functioning. As a paradigm case, Annas

notes that a desire for lobster is still a natural desire in that a lobster is a type of food which sates

our natural hunger. However, on the other hand, given that other types of food also sate this

hunger, it's not a necessary desire because it's not yet a fully generic desire. The problem here is

that a patient can approach lobster with two categories of natural need which are difficult to

separate for a doctor. And, once/if the doctor determines the cause of the pain, the patient's

relationship to the object of his or her desire may change drastically. For example, if it turns out

that a patient is allergic to shellfish, the patient's desire for shellfish becomes unnatural. Yet, the

desire was not originally unnatural in that the patient's beliefs about shellfish were not at that

time false. It's not the case that he or she originally thought that their allergic reaction to shellfish

is tolerable given his or her immense craving for it. If, however, it turns out that the patient's pain

upon eating lobster is due to an underlying digestive problem that can be cured, I can't think of

any good reason why the Epicurean doctor wouldn't try to treat it, even if the desire isn't a

necessary one17. Presumably, the only contraindication for treatment is if treatment carries with it

a significant risk of causing future pains. Given that the Epicureans see a place for regular

unnecessary desires as a compliment to necessary desires, they too constitute a desirable good.

Hence the Epicurean advice that “one must not force nature but persuade her. And we will

persuade her by fulfilling the necessary desires, and the natural ones too if they do not harm [us],

17 Bracketing, of course, the question of distributive justice, which constitutes an examination in its own right.

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but sharply rejecting the harmful ones.”18 Thus, a doctor ought to diagnose, potentially

recategorize the relevant desires, and then afterwards use his or her discernment to choose a path

of treatment (or non-treatment). It is this discernment which would make for a distinctly

Epicurean doctor.

In the second case, there are authors who think that the highest pleasure, that is,

katastematic pleasure, is contingent on the proper functioning of the body. Gosling and Taylor

state that, while the katastematic is a subset of kinetic pleasures, nevertheless “katastematic

pleasure of the organism in proper condition.”19 The exact difference between a kinetic and

katastematic pleasure in Epicureanism, or whether there actually is such a difference, is still a

matter of active debate. I don't intend to resolve that debate. Rather, all I want to show is that, if

the katastematic is a desirable category of pleasure and if katastematic pleasures are contingent

on the proper functioning of mind and body, that a doctor can play an active role in returning the

body to proper functioning. In this case, a patient could presumably think themselves perfectly

happy with the kinetic pleasures they provide for him or herself, not realizing that they are

deprived of the katastematic. If Gosling and Taylor's interpretation is correct, that is that “when

the organism is functioning properly it will be in a state of pleasure,” 20 then it's conceivable that a

patient with some sort of chronic condition could never have even conceived of the katastematic,

owing to a longstanding, but perhaps unknown, pain. Because the Epicureans do not believe in

an “intermediate state between pleasure and pain” 21, it's not accurate to say that such a patient

would simply not have known the pleasure, but perhaps more correctly that they have never

realized their pain. A patient who was born cross-eyed may not realize truly what a pain it is to
18 Inwood & Gerson, The Epicurus Reader, 37.
19 J. C. B. Gosling, and C. C. W. Taylor, The Greeks on Pleasure (Oxford: Clarendon Press, 1982), 373.
20 Ibid., 374
21 Inwood & Gerson, The Epicurus Reader, 60-61.

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have such poor eyesight nor what type of katastematic pleasure would arise from fixing his or

her eyes22. Thus, it seems to me that this stands as a different category of intervention than

simple generalized pain. An Epicurean doctor must be aware of what proper functioning is

outside of a patient's simple perception of pleasure or pain in order that the patient gain access to

the katastematic.

There are additional circumstances, however, where a patient experiences pain that is

either generalized, quasi-generalized, or at very least does not have a clear relation to a positive

desire or act; and where the patient's body is in proper functioning. In such cases we would may

expect to find the patient lacking in natural and necessary desires. For example, a patient's diet

may be dangerously imbalanced but be without the presence of any exotic cravings or

obsessions. This patient, say, was unaware that they had to watch their cholesterol levels. As

such, despite only possessing the natural and necessary desire for food, they still managed to do

themselves harm despite their body functioning correctly. In this case it seems unfitting to say

that the patient had false beliefs concerning his or her diet. Rather, it's more appropriate to say

that the patient lacked important natural and necessary beliefs. An Epicurean doctor's expertise in

the medical sciences gives them a unique ability within the Epicurean garden to generate such

desires.

However, the informational content of natural and necessary desires ought to be carefully

distinguished from the conviction with which one holds such a desire. Were a doctor to inform

his or her patient that that patient's cholesterol is too high, the patient could conceivably choose

to ignore the doctor and continue eating however they please. Now, however, the patient has the

22 Hence why young children often are surprised when they are given eyeglasses for the first time, remarking “so
this is what it's like to see!”

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information necessary to make the correct decision. Instead, for one reason or another they

simply choose not to. This marks a good point of transition between the role of the doctor and

that of the therapist. Where the doctor is specially poised to inform a patient about that patient's

bodily function as related to their desires, a therapist possesses the tools to work on that patient's

desire qua his or her desire. Else, the roles of doctor and therapist risk collapsing into one

another to the detriment of the community.

But, it's not necessary that these roles collapse into one another. In an Epicurean

community there is every reason to believe that doctors can and should have their own practices,

bound to their own obligations and rules for ethical conduct. While not needing to be therapists,

an Epicurean doctor still must be aware of the Epicurus' philosophy to practice medicine

effectively. In my derivation, the Epicurean doctor's domain stretches over several key

responsibilities. Namely, a doctor will:

• Treat generalized pains relating to basic bodily function

• Be able to discern natural and unnatural desires for each patient

• Treat pains which occur during the attempted fulfillment of natural and necessary desires

• Discern when a pain response is actually the result of proper bodily functioning and

choose not to intervene

• Remedy improper bodily and mental functions, not requiring Epicurean therapy, which

inhibit experiencing katastematic pleasures

• Provide information to a patient such that a patient can formulate correct beliefs in order

to formulate natural desires

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This constitutes a list of responsibilities not wholly foreign to modern healthcare. Yet, despite

this, I think this treatment still results in a peculiarly Epicurean doctor. As to whether or not these

responsibilities apply to only a doctor in the Epicurean garden or whether or not they would

work for an “Epicurean abroad,” I leave this as an open question.

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Works Cited

Annas, Julia. The Morality of Happiness. New York: Oxford University Press, 1993.

Gerson, L.P. and Brad Inwood. trans. The Epicurus Reader. Indianapolis: Hackett Publishing,

1994.

Gosling, J. C. B. and C. C. W. Taylor. The Greeks on Pleasure. Oxford: Clarendon Press, 1982.

Smith, Martin Ferguson, trans. On the Nature of Things. Indianapolis: Hackett Publishing, 2001.

Strenger, Carlo. “Mild Epicureanism: Notes Toward the Definition of the Therapeutic Attitude.”

Am J Psychother. 62(2) (2008):195-211.

Taylor, James Stacey. Death, Posthumous Harm, and Bioethics. New York: Routledge, 2012.

17