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SOME ROOTS OF THIS PARADIGM

 

Without entering into complex Eastern thought but remaining within the Western cultural sphere, we find two opposing ways of thinking, in varying conditions of contradiction with each other, about the ethical point that logically arises from their mental worlds. These two approaches have registered major successes but also great failures. Those two positions we find in the line of to be and to become, and in the line of to be and to think. In this second part, we will also proceed in a very schematic way.

 

To be and to become

 

In classical Greek antiquity we find two philosophers Parmenedas and Heraclitus with divergent approaches: that of Parmenedas of one and all, immobility, and that of Heraclitus of everything evolves, mobility. Classical Greek philosphers would, through Aristotle, join the two alternatives in hylomorphism. Many centuries later, in the face of nominalism, St. Thomas Aquinas declared "ens est id quod est" (being is what is), objective reality, whereas Duns Scoto stated "ens est id quod potest esse" (being is what can be), mere possibility. This last way of thinking, opens the door to the Empirisme of Bacon, Hobbes, Hume and Locke, with all its advantages and disadvantages. The science will be separated from its transcendental goal, in the sense of St. Agustin, and closed in the material experience as such.

By another point of view, Nominalism of William of Ockham is very important in the Middle Age problem of the reality of Universals, according to whom the Universal is nothing else but a mere vocal emission. Consequently there are no universal truths, and as a result, no norms of universal mandatory application.

 
Thinking and being

 

The great change came with Descartes, or to put it more accurately, with his followers, because Descartes probably remains in the platonic way of thinking belonging to the Oratory of LaBerule. The alternative was: do I think it because it is being, or is it being because I think it? If one accepts the first part of the alternative then an objective truth exists; if one accepts the second, the truth is what I accept it as.

In the context of the second part of the alternative a large part of contemporary thought was forged, and this had decisive consequences as regards ethics because it meant the absolute autonomy of man: it is he who decides in the final analysis what is true and what is false, what is good and what is bad. This full autonomy would also be deduced from other key points in the thought of Descartes, that of "clear and distinct" ideas which belong only to substances: God, the conscience, and extension. The basic condition for a thing to be seen as a substance is its full independence. Descartes said that a substance "est id quod ita existit ut nulla alia re indigeat ad existendum" (it is what exists so and does not need anything else to exist). This Cartesian concept would lead later to the full independence and autonomy of man. Man in himself, was held to be, absurdly, his own project.

His own present reality was his future project and in the best of cases, along the lines of Engels, the "pious atheist", his project was the myth arising from the multiplication of his own wishes to the point of mathematical infinity. We are here in the line of the positivistic way of thinking in the Encyclopaedism, specially of August Comte.

In this line of not objectivity, denying the possibility of acceding to the noumenon, Kant advanced in ethics to collective and formal subjectivity with his "categorical imperative"; so He formulate the norm according the consensus of the majority.

For his part, Hegel gave political consistency to this subjectivity by locating the highest realisation of the "spirit" in the State, in the prusian State, and so making the political power the norm of morality.

Subsequently, following the path of Engels, Marx said that "Hegel would be made to walk with his feet on the ground" in dialectical materialism, where the classless society was seen as the only source of morality in the autonomy of consequent historical materialism.

 

Contemporary currents

 

In the logical development of this subjectivism, six currents of thought have today become established. They are easily applied to this Paradigm, and they are: Eclecticism, which accepts any type of behaviour, outside its system, context or evaluation; Historicism, according to which truth changes according to adaptation to a specific epoch; Scientism, in which it is affirmed that the only acceptable truth is experimental truth in the scientific field; Pragmatism, where ethical decisions are made taking into account only the criteria of utility according to the cost/benefit tandem guided by the opinion of the majority; Nihilism, in which there is the simple abandonment of the idea of reaching objective truths; Post-modernity, in which nihilistic positions are adopted.

It is obvious that in this whole way of thinking in the field of Ethics, the outcome was merely subjective ethics opposed to the objectivity of nature, which was no longer seen as real, because objectivity is conceived statically (here include also the Natural Law). As a result, it was declared that "objective" ethics, based upon nature, is the outcome of ignorance or out of fashion, belonging to the Ages of darkness of the mankind. The experimental sciences are based in the mobility of things that is the only reality. Especially in the field of medicine: it was asserted that whereas until a short time ago this belonged to the field of the observable, now, instead, all its action develops within the field of "that which can be manipulated".

Passing from the scientific plane to the religious plane, the Christian Protestant approach has strongly contested the very concept of "nature", at least of human nature, because it sees nature as essentially vitiated. If nature is indeed like that, it is logical that human nature cannot be moral norm.

 

SOME EVALUATION AND PROJECT

 

The values of the new paradigm

 

It is right to react against environmental degradation, and it is also right to be aware of the fact that development has its limits and that development that does not take into account the degradation that it causes to nature should not be supported. At the same time, it is right to search for prosperity and well-being and that the greatest prosperity and well-being for the greatest number of the inhabitants of the planet should be ensured.

It is equally right that quality of life should be procured, especially if by this is understood self-awareness of the position that a person occupies in his overall - both ecological and cultural in a broad sense, situation, which includes the economic, social, religious, political and cultural aspects, in the strict sense of the terms, of the field of education.

It is right to defend human rights, respect for social minorities, for democracy, for fairness amongst all men, that is to say their fundamental equality, both as regards men and women, to re-establish a correct relationship between man and the environment and between the individual and the community. It is right to defend social justice, and the economic injustice present in today's world is very evident.

To require health for everyone, at least as regards its basic elements, is an inescapable requirement, and obtaining education for all is also a primary need.

 

The anti-values of the new paradigm

 

The most important anti-value lies in the fact that the new paradigm presents itself, as they say, as a new spirituality, which takes the place of all religions because these are inadequate to the task of preserving the ecosystem. In practical terms, this is a new secularist religion, a religion without God, or to put it another way, with a new God, the earth itself, which they call Gaia. The subordinate element of this divinity is man.

The series of values that the new paradigm upholds are values that are subordinated to this divinity, which is translated into the supreme ecological value, known as sustainable development. Within this sustainable development the supreme ethical goal is prosperity and well-being.

It is certain that this paradigm totally denies Christianity and its founding historical fact, namely the Word made flesh, the redemptive death of Christ and his glorious resurrection. If one accepts this historical fact, the pre-supposition of the new paradigm collapses completely.

This does not means that the values espoused by the new paradigm also collapse. Indeed, these are not extraneous to Christian thought but are to be placed within it. Ever since Genesis, reference has been made to homo sapiens and homo faber. The two have to be reconciled: man is not the despotic master of nature but a wise worker who dominates nature and respects its laws.

What makes the new paradigm unacceptable is its denial of God and the life beyond, and, in concrete terms, the denial of Christ as the only saviour.

The use of terms in the New Paradigm often carries some confusion: they never speak of persons but individuals, not equality, but equity, not government but new governance, not family but peer, not procreation, but reproductive health, etc.

The equality of the sexes is to be accepted, not, however, in the sense of homosexuality and the destruction of the family. Birth control is to be accepted, but not in a destructive sense such as that planned through the culture of death, which is applied in a special way in the third world.

Prosperity and well-being is not the same as happiness. Christ does not promise us in an illusory way total prosperity and well-being in this world, but he does promise us happiness. The point of discernment for any religion, or as the new paradigm says, any spirituality, is the solution to the problem of death. This is something that the new paradigm does not in the least possess because it simply avoids it, and what death involves, and in a special way suffering, pain and illness. Christ is the only person to give a satisfying answer to it: with his glorious cross in the resurrection.

One of the great problems of the new paradigm is when it becomes aware of the fact that everything has to be based upon examples of agreement that do not arise from objective truths but from subjective opinions. It thus tries to create artificial forms of agreement. Such forms of agreement are absolutely variable and for this reason ethics or bioethics based upon the new paradigm do not have consistency. An ethical law without authentic foundation cannot be a true law. Saying that the actual behaviour must convert itself in norm for the future generations is totally insane.

 

Regarding to the principles of bioethics

 

As we can see, in each of the given explanations to justify those principles one arrives at a form of relativism, not only in observing the alleged origins of these principles but also in examining the principles themselves. It is indeed the fact the principle of autonomy corresponds to acting with freedom, but this means that for this moral action those who do not possess freedom are not taken into consideration: people such as invalids, children, foetuses, and embryos.

Regarding to the principle to do good, but what is good? What really does good to a person? If we do not know anything about what can be good for a person, we cannot do good to that person. The same applies to the principle of justice: what is due to every person?

The very principles advanced, seen in themselves, doe not have an explanation. It is usually said that these principles must be understood as actual principles, that is to say as merely principles to be actually applied, and not as prima facie principles, that is to say as theoretical principles. But the difficulty remains in the case of principles to be actually applied as well: why should I act in this way if it is not reasonable?

In addition, when these principles come into conflict with each other which of them should prevail? For example, if the principle of autonomy comes into conflict with the principle of doing good and this, in its turn, comes into conflict with the principle of justice, which principle should we follow? We need a further and prior principle, which gives them unity and which resolves a possible conflict. The principle of autonomy, and thus the principle of freedom as well, has its own limits when it has before it the good of a third party, and the good of a third party is also limited when it has before it what is due to another person. In the final analysis, however, the principles do not lay down what is due to that person. Thus some people make recourse to what they call ethical narrative, in which they narrate, one after the other, only the cases that occur, and action is taken following the example of what came before. Or refuge is taken in what they call female perception, that is to say what the refined goodness adjudges advisable. In this way one draws near to another criterion that they call the criterion "of virtue", by which the person who decides what is good and what is bad is the person who has sufficient virtue, where by virtue is understood acting according to recta ratio. In referring to upright reason, one draws near to the classic conception of objective bioethics.

The principles must be accepted only by their objective foundation, withdrawing them from the relativism of the mere subjectivity.

 

Being and thinking

 

The answer to the question we raised at the beginning according the Cartesian mentality must be: the being is not because I think in it, but I can think in it because it exist. This is the objectivity in which the Ethics must be founded.

As regards the current of thought that gives objectivity to ethics, we encounter the Aristotelian-Thomistic position, which, in fundamental terms, was adopted by the Magisterium of the Catholic Church, without neglecting the valid elements that are found in the subjectivist discourse already discussed and in all the inputs from Catholicism that have enriched it.

In this current of thought therefore truth lies in the conformity of thought with the object. It is not the thought of man that creates reality, but the existence that gives reality the possibility of being thought. The criterion of morality by which we know if an action is good or bad is certainly man, the subject, but this subject is objective, is the human nature, considered in his complexity which implies his opening to the Transcendent.

Morality consists of the pathway by which to realise the "human project" but this pathway not only does not exclude the transcendent model from man himself but necessarily includes it. A person cannot at the same time be his own present and his own future. In this form man does not create morality, morality transcends him, it is there and he meets it, is object "ob-jacet". It is not the case that the subject is not implied, indeed it is the subject who follows the pathway and in a certain way marks it out, even though not according to his absolute free will because there are norms that transcend him. Man has his own autonomy in enjoying his freedom. However, this autonomy, this norm of being himself, is not absolute. Man in his limited and constantly constructed reality must necessarily be open to a model that transcends him.

  

THE PROJECT: SUBJECTIVITY, OBJECTIVITY AND MOBILITY OF THE HUMAN NATURE

 

Bioethics as a project

 

In speaking about the life sciences and in asking ourselves about correct human behaviour to be followed in the experimental sciences that manipulate life, the question includes the following factors: human life, lack of human life, increase in human life, improvement of human life, norms to be followed to obtain this improvement, and deviations to be avoided. In other words, we find ourselves face to face with the tandem "need-satisfaction". This means that there is a living subject who aspires to improve himself, he has to tread his path; if he has to follow a path he must mark it out, and if he marks it out, he must first know where it leads if he wants to mark it out. In the field of life one has to know what life is, what the best life that one wishes for is, which pathways should be followed to achieve it and which should be avoided, because these latter, rather than giving life, could lead to its loss. Bioethics thus appears as a project for the construction of man through the life and health sciences.

 


Technology and bioethics

 

To make the point more clearly, we could imagine neutral technology (since in fact there are no neutral sciences because every science is analysis and synthesis, and synthesis can never be neutral). If then we could speak about neutral technology, closed within itself, we would have to say that according to the laws of the laboratory, hypothesis, experimentation, thesis, new hypothesis, new thesis and new experimentation - the framework of technology in itself is mere possibility, whereas the framework of ethics is the goal. For this reason, technology in itself can build or destroy man, technology in itself is blind, however advanced and marvellous it may appear to be. Biotechnology in itself is blind and ambivalent.

 

An intelligent project

 

For this reason, so that a real bioethics can exist that provides us with norms for behaviour in the field of health and life, the first thing that we must ask ourselves concerns the project for man that people have in mind in the manipulation of these fields of health and life. Curiously, having a project denotes intelligence but at the same time also indicates weakness because a project represents an intention to improve reality which appears deficient, because, if such were not the case, the projects to improve it would not exist. Authentic bioethics must appear as a project to improve human life itself which contains all the life and health sciences as its intelligence, as that intus legere (read within) that in every analysis always has present the synthesis of arrival which can be nothing else but the construction of human life.

 

The best self

 

For a project regarding life to function (like any other project), it has to understand as completely as possible the life reality that it wishes to improve, and the "best self" to which it aspires. This best self, which is a goal and a purpose at the same time, is the model whose reproduction is sought. According to these two realities, a tendency, a pathway, an ethos from the self to the best self, is marked out. This pathway is ethics and, in our case, bioethics. In it we find norms that cannot be merely formulations or imperatives outside the self but real constructions of the same "self" that gradually draw it near to this best self, increasing its vital density. Therefore a science must always finally be conceived in the sense of St. Agustin, as a teleological knowledge; if not it will be dehumanising and destroying man himself.

 

Freedom

 

It is ethical theory and practice as a whole that opens up to the true concept of freedom, which does not consist simply in doing what one wishes but in that attribute of will that directs it towards one's own construction. In this sense, the criterion of morality is man himself in his total complexity and not in closing himself up in his own ability to construct himself and in his enormous capacity to destroy himself. This complexity leads him to be aware of his own reality which means being in a relationship, being open and beginning, therefore, to walk, or rather to open himself freely to the Other, which in this case is the fullness of Strength, Truth and Love, namely God. Man, through freedom, in his project of construction, always opens himself to forces of the authentic progress of biotechnology in order to increasingly achieve his life fullness in constant harmony with God, with the whole of mankind and with the total environmental context.

  

Revelation

 

Many times one does not dare to speak in the scientific fields of Revelation, especially in Bioethics, but I think that this is the proper dimension of an authentic objective Bioethics that will be open to the whole project of man.

In Catholic thought such open, "objective", real, without frontiers, ethics open up to full communication with Almighty God the Father who realises in us the Truth of the Son through his Incarnation, Passion, Death and Resurrection. He fills up all our aspirations leading us along the pathway that is Christ in the fullness of the love of His Spirit. Catholic ethics and bioethics are Christ's walking within us to the Father through his death and resurrection through the love of the Holy Spirit. Bioethics is in this way the walking of the Spirit in us through the pathways of the life and health sciences. "Those who are led by the Spirit are the children of God'. The spirit infuses in man the ability to walk towards the construction of total Christ, which is virtuous life, and maps out the understanding of Christ himself as a pathway through the commandments and the Sermon on the Mount. Catholic bioethics, therefore, is:

The systematic and deep study of the behaviour that constructs man through the life and health sciences in walking with Christ towards the Father, fullness of life, through the strength of the Holy Spirit. This theological vision expresses a deep and structural dialogue with all the relevant sciences and forms of technology, with all the unifying forms of thought of analyses carried out by the different philosophical and theological currents, entering into dialogue as well with other religions taking into account the fact that it is a study of behaviour and thus, as a result, it cannot remain within the trajectory of reflection but must take concrete form in light that guides in the difficult solution of the problems raised by genetic engineering.

VINCENZO CAPPELLETTI

BIOMEDICINA DEL VENTESIMO SECOLO
LA FISIOPATOLOGIA COME PARADIGMA

 

Sullo scorcio del secolo decimonono – nell’ultimo venticinquennio dell’Ottocento, per maggiore esattezza -, una rinnovata medicina, «scientifica», dà atto di sé come costruzione e applicazione dell’unità di fisiologia e patologia: un paradigma teorico dovuto a due personalità di sommo rilievo intellettuale, Rudolf Virchow (1821 – 1902) e Claude Bernard (1813 – 1878). Nel periodo considerato, Virchow è attivo a Berlino tra l’Università, di cui diventa rettore nel ’93, e l’Accademia delle Scienze: appartiene a lui, con una formula peculiare, «pathologische Physiologie» [fisiologia patologica], l’espressione poc’anzi adoperata per indicare l’ancoraggio concettuale del sapere medico alla fine dello scorso secolo. Nel primo numero dell’Archiv für pathologische Anatomie und Physiologie und für klinische Medicin, uscito nel 1847 sotto la sua direzione, Virchow aveva chiarito che «le malattie non sono entità a sé stanti, chiuse in sé stesse; esse non sono sostanze intruse nel nostro corpo, e neppure parassiti che vivano alle spese del corpo: le malattie rappresentano soltanto il decorso dei fenomeni vitali in condizioni abnormi.» Così intesa, la fisiopatologia – riprendiamo il termine corrente – finisce con l’assumere un’accezione tanto vasta, da identificarsi non soltanto con la medicina, ma con la biologia, «la teoria della vita in generale e dell’uomo in particolare», come la definirà lo stesso Virchow, in un articolo pubblicato sull’Archiv nel ’53.

Rischiose illazioni e coraggiosi passaggi al limite erano anche incoraggiati dal corso del sapere filosofico negli anni ai quali ci riferiamo. Preparata da riflessioni e interventi propositivi – insigne tra tutti, il documento elaborato dall’ambasciatore del re di Prussia presso il Papa, Wilhelm von Humboldt -; voluta dallo Stato prussiano come simbolo di rinascita nazionale dopo la sconfitta subita a Jena nel 1806 ad opera di Napoleone, era sorta nel 1810 l’Università di Berlino, al fine di ripristinare l’unità del sapere umanistico e scientifico. Ma nei primi due decenni l’influenza predominante sarà quella dei filosofi, attraverso Fichte, Hegel e Schelling, malgrado il prestigio e l’attività del fisiologo Johannes Müller (1801 – 1858), «l’uomo che portava su di sé l’impronta dello straordinario», come lo definirà un allievo, il neurofisiologo Emil du Bois-Reymond, nel discorso commemorativo tenuto l’8 luglio 1858 all’Accademia delle Scienze di Berlino[1]. Sarà il geografo Alexander Humboldt (1769 – 1859), fratello di Wilhelm, a determinare l’avvicendamento del predominio umanistico con quello scientifico, attraverso un ciclo di conferenze con ampie prospezioni naturalistiche, poi raccolte (1845 – ’58) nei cinque volumi del Cosmo[2]. Ma nella cerchia di Müller, pur perdurando la subalternità delle scienze alla filosofia nell’ambiente universitario berlinese, aveva preso forma conclusiva la teoria cellulare con le Ricerche microscopiche sulla concordanza di animali e piante nella struttura e nell’accrescimento, di Theodor Schwann[3]. Finiva permerito dello Schwann una lunga, millenaria incertezza su due questioni fondamentali: dove abbia sede primaria la vita e quali siano le sue proprietà costitutive. Ormai era possibile rispondere, invertendo i quesiti: caratteri distintivi della vita sono l’accrescimento, la riproduzione e l’eccitabilità, mentre la più semplice struttura che li possegga è la cellula, con la quale perciò s’identifica l’entità vivente elementare.

E’ difficile sopravvalutare l’importanza del cellularismo: teoria e sperimentazione si preoccuparono di acquisire un rapporto stretto e in taluni casi fondamentale con la prospettiva schwanniana, equiparata a un’assiomatica primaria delle discipline biologiche. Fissato il concetto della patologia come fisiologia delle situazioni morbose, Virchow l’aveva correlata in modo sostanziale con le nuove vedute di Schwann, intitolando nel ’58 l’opera che rimarrà stabilmente legata al suo nome: Patologia cellulare fondatasull’istologia fisiologica e patologica[4]. Muovendosi nell’ambito della biologia generale, identificata e assimilata alla fisiopatologia, Virchow aveva introdotto nel cellularismo una duplice innovazione: la prima, fondamentale, consistente nella legge «omnis cellula e cellula», secondo cui le nuove entità cellulari si formano attraverso la divisione di cellule preesistenti e non da sostanze interstiziali per «generatio aequivoca», e l’altra, corollario della precedente e consistente nella distinzione dell’accrescimento in assimilazione e riproduzione. Ma, nonostante la straordinaria portata innovativa, la fisiopatologia cellulare mostrava i limiti di un’impostazione che oggi chiameremmo riduzionistica, sacrificando i rapporti non descrittivi, ma interpretativi e esplicativi, con le autonome e insopprimibili realtà degli organi e dell’organismo.

Una fisiologia d’organo non si fece attendere, e sorse per merito di Hermann Helmholtz (1821 – 1894) in quella stessa scuola di Müller, che sul versante scientifico era giunta a pareggiare la fecondità teoretica della scuola di Hegel. Il Manuale di otticafisiologica[5], elaborato e pubblicato in un cinquantennio, tra il 1856 e il ’95, e La teoria delle sensazioni sonore come fondamento fisiologico della teoria musicale[6], uscita nel ’63 e più volte ristampata, non contraddicevano al postulato cellularistico, ma vi aggiungevano l’esigenza di una complessità strutturale, sulla quale appoggiare e dalla quale ricavare la specifica funzione, oggetto della ricerca fisiologica. Già con le Ricerche schwanniane l’analisi, per così dire, fondamentale, definitoria della vita aveva superato l’ambito morfologico: per aver associato proprietà e forma, Schwann era riuscito dove altri erano falliti. Prima di essere altro, la vita è l’unità morfofunzionale che Galeno aveva avvertita nella dimensione macroscopica, e i microscopisti dell’Ottocento avrebbero riscontrata in un ordine di grandezza centinaia di volte inferiore alla normale osservabilità.

Ma parlare di funzione e funzionalità non bastava a rendere sicuro il passaggio dalla morfofisiologia alla fisiopatologia, teorizzata dal Virchow e condivisa, esplicitamente o implicitamente, da tutta la medicina di fine Ottocento: compresa la clinica, dotata di una prerogativa consistente nel proprio diretto rapporto con le malattie e il malato. La prospettiva funzionalistica dava accesso a due innovazioni sostanziali: il concetto di struttura e la categoria della qualità. Non si dà funzione, se non ancorata a un aggregato di cellule o di fattori chimici, come si dirà in seguito. Un aggregato ipercomplesso, chimico e morfologico, finirà con l’apparire anche la cellula, considerata da Schwann l’entità vivente elementare. E neppure si dà funzione senza una specificità qualitativa: la glicogenesi non è il trasporto ematico dell’ossigeno e neppure la percezione del calore e del suono, a non fare che un solo, banale esempio tra i tanti possibili. La fisiologia, o fisiopatologia a dirla ancora con Virchow, con l’abbandono dell’implicito presupposto di una natura uniforme, priva di diversità sostanziali, finiva con il sospingere il geometrismo galileiano e il meccanicismo cartesiano verso un tramonto irreversibile. Ne prenderà atto il neurofisiologo Emil du Bois-Reymond (1818 – 1896), nel discorso su I sette enigmi del mondo[7], tenuto l’8 luglio 1880 nella seduta leibniziana dell’Accademia delle scienze di Berlino. Su una natura concepita come sistema di atomi materiali in movimento, affioravano sette entità problematiche, e per alcune di esse si trattava di una problematicità insuperabile, «trascendente»: l’essenza della materia e della forza, l’origine del moto, l’origine della vita, il finalismo apparente della natura, l’origine della sensazione elementare, il pensiero razionale e il linguaggio, la libertà del volere. In realtà gli «enigmi» erano non sette, ma innumerevoli: ovunque affiorasse una peculiarità da un substrato quantitativo, chi non cercasse una radice del quale accanto all’evidenza del quanto, si precludeva la possibilità di capire l’esperienza o, per dirla con Platone, di «salvare i fenomeni». Consapevole del baratro che si era aperto innanzi alla scienza meccanicistica, il du Bois onestamente concluse il suo discorso accademico con una lucida ammissione di perplessità: «Dubitemus». Drasticamente rinunciataria - «Ignorabimus» - era stata invece l’allocuzione sui Confini della conoscenza della natura[8] all’Assemblea dei naturalisti e dei medici tedeschi, svoltasi a Lipsia nell’agosto ’72: materia e coscienza erano apparse fin da allora inconcepibili, «unbegreifliche», movendo da premesse meccaniche. Ma tra i due termini emblematici di una crisi radicale, quello usato per primo e poc’anzi citato avrebbe riassorbito l’altro, quando il du Bois- Reymond lo avrebbe fatto assurgere a «immutabile e inesorabile verdetto» nella premessa a un’edizione congiunta, 1884, delle due conferenze[9]. Negli stessi anni il materialista e meccanicista Virchow passava sulle posizioni, più moderate, di un «vitalismo meccanico», per cui esisterebbe una forza peculiare, orientatrice dei movimenti nei processi delle singole cellule e dell’organismo.

Fisiologi, biologi e morfologi, nel loro affidarsi alle certezze dell’atomismo meccanico – salvo a denunciarne, come faceva il du Bois, i limiti esplicativi per così dire superiori -, sembravano non avvedersi della contestazione empiristica, che ne faceva in quegli anni il fisico Ernst Mach (1838-1916) a nome del dato sensoriale, seguito dal fisicochimico Wilhelm Ostwald (1853-1932) a nome di una nuova grandezza osservabile, l’«energia». Creatrice della meccanica moderna, solo la ragione poteva intervenire a sanarne le arbitrarie limitazioni e a trascenderne le scoraggianti aporie. Ma la fisiologia era in mani francesi oltre che tedesche e, vista e valutata oggi da noi, la statura intellettuale di Claude Bernard spicca su tutte le altre per la varietà dei programmi di ricerca, per l’affiancamento alla microscopia di metodi autenticamente fisiologici, e infine per la sorprendente ricchezza d’intuizioni epistemologiche e metafisiche. Il Bernard sperimentatore ha un profilo di assoluta eccezione: processi nutritivi e digestivi, funzioni del succo pancreatico, glicogenesi epatica, attività dei nervi vasomotori, meccanismo della paralisi curarica, rapporti fra sistema nervoso vegetativo e termoregolazione sono le aree principali, dove egli potè acquisire conoscenze sostanzialmente nuove e durature, adottando strategie originali come quella da lui stesso chiamata «autopsia chimica». A un caposaldo della biologia e della medicina come la Patologia cellulare del Virchow si possono affiancare, del Bernard, le Lezioni sulle proprietà dei tessuti viventi, tenute allaSorbona nel 1864 e pubblicate nel ’66[10]: ma attorno ad esse c’è una vasta serie di volumi analoghi, nati dall’insegnamento e distribuiti in un venticinquennio, dalle Lezioni di fisiologia sperimentale del ’56[11], alle postume Lezioni di fisiologia operatoria del ’79[12]. Bernard è tiepido verso i tedeschi: alla nozione di cellula antepone quella di protoplasma, e a Virchow ricorda che nell’ampia sintesi della patologia cellulare non bisogna perdere «il sentimento di ciò che è speciale», per giungere fino all’individuo e alla «idiosincrasia», base di tutta la medicina.

Un Bernard ancora più grande è quello degli scritti che possono e devono essere considerati filosofici: l’Introduzione allo studio della medicina sperimentale del 1865[13], i Principi di medicina sperimentale, inediti e solo nel 1947 pubblicati nella forma di un corposo compendio da L. Delhoume[14], il Cahier rouge, inedito ma integralmente pubblicato nel 1962 da M. D. Grmek[15]. Un mosaico di intuizioni, di dubbi, di argomentazioni che talvolta sembrano andare in direzioni divergenti e finanche opposte; una trama concettuale che mette in evidenza l’inaccettabile semplificazione perpetrata dal materialismo – meccanicistico in Germania, organicistico in Francia; la schietta perplessità preferita alla certezza fallace: messe in una sola cornice, le riflessioni del Bernard filosofo presentano le caratteristiche accennate. Scienza e filosofia devono procedere insieme, ma le pietre dell’edificio scientifico sono i fatti. La vita è creazione, ma è anche morte. I processi vitali obbediscono al determinismo, ma l’individualità s’impone ovunque. L’anatomia studia l’organizzazione, ma la funzione è indeducibile dalla forma. La sola forma del ragionamento è quella deduttiva per sillogismi, ma lo scienziato deve concedersi le «expériences pour voir». Alta e schietta testimonianza quella resa dal Bernard, fisiologo e filosofo, alla vita in sé stessa e all’umano pensiero che l’investiga. La nascita della medicina scientifica da quella prescientifica, osservativa, impersonata nel secolo di Galilei, Boyle e Newton da Thomas Sydenham (1624 – 1689), ha avuto nel Maestro del Collège de France colui che seppe prenderne atto e auspicarne gli sviluppi. Gli fu cara, l’istituzione creata da Francesco I nel 1513, perché aveva il compito di scrutare l’avvenire della scienza e discuterne i metodi. «La médicine scientifique, que je suis chargé d’enseigner, n’existe pas», dichiarò in una sua lezione. Quasi tutto doveva esser fatto, ma era stata conquistata una certezza : il nucleo della futura medicina scientifica non poteva non essere la fisiopatologia.