Doctors need to provide options
to patients before we treat them. It was
the ratio decidendi of the Montgomery case. I always wonder, how comprehensive should the
list of options be? Of course we need to
explain options that are effective and evidence-based. However, there are forever the
so-called-experts’ difficult-to-measure alternative treatments and state-of-art
novel advances. Is it our duty to
mention such options? Don’t forget that
there should be an option of conservative treatment, which literally includes “no
treatment”. This is in contrast to the
famous quote that “Quitting is not an option.” So it is important to think out of the box. Smart people always do that. And sometimes they physically go out of the boxes.
You know what I mean.
Many a time, patients are in
difficult positions when they need to make the decision of to treat or not to
treat. It is equally difficult for doctors
to help them to make the informed choices. This is called a dilemma. Neither of the two possibilities offered is unambiguously
preferable. In Greek, dilemma means
double proposition. In Buddhist
teachings, there is a kind of logic called tetralemma. It does not carry the hint of negative sense
of dilemma. It just denotes the four possibilities
of an event. Thus “tetra” and “lemma”. Let the event be “A”, then the four possibilities
are: “A”; “non-A”; “both A and non-A”; “neither A nor non-A”. This is in contrast to the traditional Three
Laws of Thought: the Law of Identity; the Law of Non-contradiction; and the Law
of Excluded Middle. However, tetralemma
logic is not very comprehensive to everyone and thus not really useful.
I am going into tetralemma. It is just that while I am watching news, I
think of an interesting set of four combinations. It is about “doing” and “talking about”. As we all know, for some kinds of things, we
can only talk about them but not really put them into action. Actually there are four combinations. “Can talk about and can do”; “Cannot talk
about but can do”; “Can talk about but cannot do”; “Cannot talk about and
cannot do”. It is interesting (sorry, I
can only think of “interesting” as the description) to use this set of four to
look at different events. For example,
about privileges, it all depends on how powerful you are. Some can only talk about it; some can only do
it but need to keep their mouths shut. And
of course there are always a few who can enjoy privileges while showing off to
others. Another example, the hot but
forbidden topic of dependence. Previously,
it was generally understood that this was a topic that could be talked about
but could not be actualized. A few
thought that it could be propagandized and acted upon. However, now it is proposed that such topic is
illegal even to talk about.
Life is not simple. While we were students, professors repeatedly taught
“one man one disease”. This means that
when a patient has several symptoms and signs, we cannot explain them by saying
that the patient is suffering from more than one disease. We have to think hard to find one condition
that can explain all the findings. However,
when we become doctors, every day we see patients suffering from more than one
disease. We have to apply a different
set, or in fact different sets, of upgraded and complicated logic to make a diagnosis
of whether there is one disease to explain all, two different diseases in play,
more diseases, or even normal variations. This is also the case for tetralemma. Apart from the “A”; “Non-A”; “Both A and non-A”;
“Neither A nor non-A”; Nagarjuna, a famous Buddhist philosopher, came up with
another set of four to the original one. They are: “Not-A”; “Non-not-A”; “Both not-A
and non-not-A”; “Neither not-A nor non-not-A”. He found out that there was something that
belonged to none of these eight groups. That
was his famous Eight Negations.
I am not a great thinker. But to enrich my set of four, I add some
by-standers. Take the example of
enjoying privileges again. While someone
is able to enjoy some privileges and talk about it matter-of-factly, others of
course cannot enjoy the same. More than
that, they are not allowed to talk about this unfair situation. There are altogether sixteen combinations. I woon’t list them all out here. Some of them look absurd. However, apart from being complicated, life is
sometime absurd. What you always believe
and enjoy might no longer exist when there is a change in space or time.
Both Tetralemma and the Eight
Negations originated from Buddhism. My
sixteen combinations of doing and talking about came about with the
aforementioned two. Thus, they all share
the same characteristics of Buddhist teachings. You have to get the meanings and feelings of
them by cultivation of your own wisdom. I
cannot explain further.
(Source: HKMA News June 2016)
