Pro-Life Vegetarians: Can’t We All Just Get Along?

I broached the ethical linkage between the pro-life and vegetarian movements in a blog post a couple of weeks ago, where I introduced an essay by Matthew Scully that purports to make a case for vegetarianism on ethical grounds. I have mentioned before my dislike of the moniker “pro-life,” though I have yet to find a more politically-palatable name when “anti-choice” is offered as its replacement. Given my options, I’ll run with “pro-life” henceforth. I have also mentioned my dislike for the manner in which Scully makes this argument, appealing less to rationality than engaging a PETA-like appeal to theatrics.

In this second overview of the issue, I reference an article in First Things from over four years ago written by Mary Eberstadt, an author and research fellow at the Hoover Institution, and someone for whom I have a high regard. She finds herself in agreement with Scully’s overall principles, with a more intellectually cautious, less bombastic approach than his, but carries the moral imperative for vegetarianism further, connecting it to the defense of human life. That the proponents of each appear to find little common ground today she finds less an issue of intellectual and moral acrimony than a failure of competing ethical frameworks to engage one another. This dedication to the ethical agenda of various groups has essentially led (as I quite loosely paraphrase) to people that can’t play well together in the sandbox.

She describes the principal proponents of ethical vegetarianism (if I can call it that; it suggests that people like Bill Clinton who have essentially embraced veganism to avoid an imminent death from cardiovascular disease are “unethical vegetarians;” I will leave it to political non-partisans to parse those terms). They are a group of utilitarians like Peter Singer and postmodern eco-feminists like Carol J. Adams. Neither group is especially amenable to the views from an alliance of conservative Catholics and evangelicals that make up much of the pro-life movement. Evangelical Christians and conservative Catholics put away their differences in a conjoined white-hot lather against people like the utilitarians and eco-feminists who do the same against them. It’s like the 1980s where the Moral Majority and People for the American Way largely existed to antagonize each other and finally just got tired of it. But these groups aren’t tired yet.

Eberstadt notes that, among the “pro-animal” (again, I dislike the term, but will stick with it) adherents within utilitarianism and feminism, “both are hostile to the idea of admitting unborn human life to their circle of approved moral sympathy.” In the case of utilitarianism, animals can suffer pain in ways that unborn humans cannot, so they “trump” the unborn ethically. Eco-feminists find that both women and animals have been victimized, by rape and slaughter, respectively. Protection for animals means that they should not be killed for food; the protection of women means that all rights, including reproductive rights like abortion, must be preserved at all costs. Add that to an open hostility of both groups to matters of religious faith and you have created a very inhospitable sandbox indeed.

The pro-life forces, in Eberstadt’s view, are largely against vegetarianism because it is so often associated with wackos. We’re against it because they’re for it. This defensive crouch, she finds, is counter to the long history in the church of vegetarians like Francis of Assisi and John Chrysostom. Unfortunately this is where her explanation of this position ends, failing to address Biblical scholarship that permits meat-eating, in moderation like most things, as morally-acceptable.

Her solution rests upon an appeal to moral intuition (she avoids the term “natural law” for whatever reason). The comparison is made between those who joined the pro-life or pro-animal (i.e., vegetarian) cause as a consequence of a moral epiphany. Something happens, and we realize that our prior position is wrong. Certainly pro-life supporters use ultrasound images to sway the thinking of those who don’t seem to fully comprehend the moral significance of an unborn human. Likewise, images from grievous practices in some commercial farming or slaughter operations can create a moral reprehension toward the eating of livestock. Eberstadt now finds that we really are all playing in the same sandbox, one where our deepest, most intuitive assessments will prevail to embrace the value of all life, human and animal.

But this is where natural law, or moral intuition, loses me. Moral intuition is a terrific system in the absence of sin, when separated from the realities of the fall. It is still with us in some form, as the notion of “common grace” would have it, but it isn’t perfect. Our moral intuition may change with a compelling argument, perhaps a morally-invalid one. Moral intuition is not disembodied from our feelings at any given time.

During a recent time-wasting exercise of clicking-on-a-link-from-another-link, I was led to an advice column in Salon magazine, that sentinel of moral rectitude. I didn’t expect a lot, but was taken aback by the comment of what should prevail in moral decision-making:

“I think, within certain limits, in our social arrangements, it is right for us to behave according to how we feel. Feeling is a great regulator of human behavior.”

I won’t go further in how ghastly that idea is; I’m glad flash mobs are so in touch with their feelings. Fallen human beings can and do fall prey to their feelings and emotions when setting a moral compass. There need to be deeper principles than just profound moral intuition when processing ethical claims.

More importantly, frankly there are frankly moral issues that trump others. It is not necessary to make false equivalencies to justify moral repugnance to meat-eating and taking the lives of unborn humans. Both are substantial moral quandaries, but they aren’t the same. To make them so is little better than how the utilitarianism of Peter Singer or the rights-theory of Tom Regan sentimentalize all life, with no distinctions made for the moral weight of human beings. At some point, there needs to be recognition that there are indeed two very different games being played in the sandbox.

The End of Amniocentesis? (and the Discontents Thereof)

This blog has carried posts about the development of non-invasive prenatal testing for chromosomal or genetic abnormalities.  Because some DNA of a fetus (unborn baby) circulates in the mother’s bloodstream, it is now possible to identify genetic abnormalities just by drawing a blood sample from a pregnant woman’s vein.  The more traditional techniques, done much later in pregnancy, are amniocentesis and the related procedure chorionic villus sampling.  Those techniques are invasive, requiring obtaining a sample directly from a pregnant woman’s womb (with some risk to the fetus).  Because diagnosis of conditions such as Down syndrome may lead to the decision to have an abortion, pro-life advocates such as the late Dr. C. Everett Koop called amniocentesis “a search-and-destroy mission.”  One does not have to be too prescient to see the day, fairly soon, when the mission moves much earlier in pregnancy, is done non-invasively, and covers a host of not only serious disorders that greatly shorten the life of a born child, or abnormalities like Down syndrome, but other genetic diseases or even variations that may or may not be desirable.  It is also a short but timely step to consider how this will affect the number and timing of abortions in the future.

Geneticists remind us that we should be careful not to let concerns run ahead of the state of the art.  They point out, for example, that:

  • The current non-invasive tests are mainly focused on chromosomal abnormalities—specifically, three trisomies:  Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13).
  • By professional guideline and, in some states, law, non-invasive testing should only be done in pregnant women who are at high risk for bearing babies with one of these syndromes.
  • The tests are not fully diagnostic, but only screening tests.  A positive result should still be confirmed with one of the more invasive tests.
  • The tests may be highly sensitive and specific for what they are assessing, but that is not the same as having a high predictive value.  The predictive value of positive or negative results may not be well-established, and depends critically on how prevalent, or common, the condition being tested for is in the population being tested.  For example, a positive result of a very accurate test for a rare disease still has a low likelihood of having actually detected the disease in an individual who tests positive.  This is an entirely trustworthy, if seemingly counterintuitive, fact—trust me.
  • Consequently, at the present, non-invasive prenatal genetic testing should not be done routinely, and should be done only with prior and ongoing careful medical counseling.  Also, care should be taken that women not rush into a decision to terminate a pregnancy based on one of these tests, out of a sense of feeling pressured not to wait too late into pregnancy.  This last point is likely to be apropos as legislative restrictions on abortions after 20 weeks—which I generally consider laudatory—gain some traction.

It seems to me that the basic ethical issues are the same, but one’s day to day approach should keep the current state of the art in mind.   This post was prompted by my morning email from Medscape, with more detailed discussions here and here, a brief visionary statement here, and a brief very top-level comment on the implications for abortion, by Dr. Arthur Caplan, here.

Pro-Life Equals Pro-Animal

There is some buzz being generated within the political and religious blogosphere these days about animal welfare issues, and it is standing out because of its appeal to an unusual audience of perceived kindred spirits. It makes the argument that “pro-lifers” are the intellectual and spiritual brethren of “pro-animal” advocates. To some this would seem an interesting, if somewhat opaque, syllogism, perhaps akin to Knights of Columbus who are also Master Gardeners.

But it has some intellectually-serious proponents. I must admit to being a fan of one of them, Matthew Scully, a former political speechwriter for figures including George W. Bush and Sarah Palin, in large measure because his writing is eloquent and compelling. I’m a sucker for both, and I freely confess that I would be a model of Stockholm syndrome for anyone making an argument in such a way as Mr. Scully typically does. I have to tread cautiously when I read people whom I like stylistically so as not to be easily persuaded by their prose alone.

So Mr. Scully has posted an intellectually rigorous and rather long post in the National Review Online entitled “Pro-life, Pro-Animal,” which links the issues of respect for human life and the welfare of animals. He starts off well-enough, with an argument that I can support in the context acquitting responsible animal stewardship as a hazard to the notion of human dignity:

“Far from presenting any threat to human dignity, animals and their moral claims upon us — the basic obligation never to be cruel, not just the option to be kind when it suits our purposes — are a constant hindrance to human presumption. What is the mark of that special status of ours, anyway, if not precisely the ability to be just instead of merely dominant, to be the creature of conscience and bring mercy into the world? A loving concern for humanity that stops there, instead of spreading outward in a sense of fellowship and active respect toward ‘our companions in creation,’ to borrow a lovely phrase from Pope Benedict, is too close to self-worship, and bad things come of it.”

I agree with this; human dignity is affirmed, not threatened, when we reflect the compassionate God in whose image we are made. The animals over which we have been granted dominion, in the Judeo-Christian conception at least, offer abundant opportunites to display the full measure of our humanity as stewards of God’s creation.

Where I part company with my erudite friend begins when he starts to wander into the weeds of anti-scientism. I am insulated in small animal practice, a practice filled with animals that are pets and where I am able to totally ignore the fact that the meat my patients and I eat is not harvested from “steak trees” but involves the death of animals to get it. Understood. But I have also spent time on the “kill floor” of a slaughterhouse, and I have colleagues who are intellectually-serious and ethically-motivated as they fulfill their oaths in family farms and within large commercial operations alike. They use moral reasoning as they care for their porcine and bovine patients. Veterinarians are grudging philosophers, generally a sort with a practical bent and a love for scientific proofs. But we are often moral idealists, ones that use the science of animal behavior and physiology to undergird our practice. It is science that recognizes that most livestock don’t lead a charmed life in most environments, that there are dangers in seemingly-idyllic settings, and that safety is an appropriate motivator for their appropriate care. This is why a statement like this from Scully is so difficult to take:

“No matter what new perversion of animal husbandry the industry might devise, it can always count on the sign-off of friendly veterinarians, as true to their oath (“to promote animal health and welfare, to relieve animal suffering”) as Dr. Gosnell was to the Hippocratic oath.”

This is an ad hominem attack and, sadly, reveals a growing divergence between livestock veterinarians and groups like the Humane Society for The United States, formerly natural allies. There are bad characters in the food animal industry, without a doubt. Scully paints a picture in his piece of some of the bad ones, and reminds us of the worst practices in some of the large-scale food operations. Yet the idea that all veterinarians involved in this industry (for Scully doesn’t narrow down his condemnation) are morally-equivalent to the reprehensible abortionist Kermit Gosnell loses me rhetorically from then on. No thinking anti-abortion advocate considers all those who perform abortions to be the equivalent of a Gosnell, despite a profound dislike of their work. To paint livestock veterinarians with the same brush as a convicted murderer is offensive, and careless in its symbolism.

He notes, as he references other authors that are making the case for moral equivalency between the pro-life cause and vegetarianism (or, less dramatically, the pro-animal cause), that “author Mary Eberstadt writes that factory farming and similar abuses of the animal world are ‘simultaneously morally urgent and widely ignored by many people, including and inexplicably by many well-meaning but hitherto under-informed Christians.’” On this I suspect he is mostly right (as, then, is she) and Christians need to better engage the issue before a watching world. I am hopeful that we can be in agreement where they have good points and criticize them when their arguments seem to fall short. There is much to be mined in both areas.

Ukrainian Bioethics

I returned from Kyiv, Ukraine, last week as part of a team that is working to strengthen a partnership with a Christian seminary there. As we met with various program heads within the school, I asked a few questions about how ethics are taught, and what bioethical issues the Ukrainian people face. Some of the answers were surprising.

Ukraine, of course, is the long-suffering nation to the west of Russia, most often remembered as the breadbasket of the former Soviet Union, as the nation where millions starved to death in Stalin’s effort to break the farmers that resisted collectivization, as a nation where much of the fighting—and death—from World War II occurred, and as the location of the horrific Chernobyl nuclear disaster of 1986, some seventy miles north of Kyiv. Ukrainians know what it means to endure; their national anthem is “Ukraine Is Not Yet Dead.” Ukraine’s history has witnessed many affronts to human dignity, perhaps one most chillingly on display at the “Museum of the Great Patriotic War” (a.k.a., World War II) where gloves made of human skin and a bar of soap made from human fat show just what human beings are capable of doing to each other. The Ukrainian people were saved from the atrocities of the Nazis to be dominated by the Soviets, exchanging one form of tyranny for another.

Years of communist rule still leave their mark on Ukraine. Something especially notable when out and about in Kyiv is the utter absence of physically-challenged people, the handicapped, on the city’s streets. It isn’t that they don’t exist. But communism in the Soviet Union served to create an “ideal society,” free of suffering and disability, filled with “perfect” people. In reality, this meant warehousing the mentally and physically-handicapped—and orphans—into hidden-away institutions. This mindset has been slow to change. Handicapped access is limited, to be charitable, and it is hard to imagine that a shopping trip would be anything but excruciating for anyone in a wheelchair. As much as I groan at some of the excesses, as I perceive them, in our “Americans with Disabilities” Act, I’ll probably now more gladly accept its quirks and demands as a way of affirming the dignity of those who suffer challenges I have yet to face in my own life.

It is easy to criticize the post-Soviet outlook, this vestigial communist view of human beings, as an American. But how much do we sanitize the pursuit of perfection here? What are enhancement technologies but a reflection that we have a need to be free of problems, to be our “best selves?” We tuck away our dying elders in nursing homes so that the inevitability of decline and death don’t confront our pursuit of happiness.

A member of our team wryly reflected that, in Ukraine, their faces are from the West but their minds are from the East. As I mentally checked off the list of bioethical issues we face in the West—challenges with assisted reproductive technologies and pre-implantation genetic testing, with use of technologies for human enhancement, and with limitation of burdensome treatment at the end of life—it became clear in discussing bioethics with the seminary faculty in Kyiv that most of these issues are completely off the radar of the vast majority of Ukrainians. Abortion is still hideously common as a method of birth control in Ukraine, as it is in Russia and elsewhere in the former Soviet Union. But the idea that we would use medicine to end life with physician-assisted suicide or euthanasia, or spend scandalous amounts of financial treasure on cheating the aging and dying process, seem arcane in Ukraine. One director even noted that the people of his country don’t have time to be depressed (even as they have faced generations of addictions) because they are too busy just surviving. A study in contrasts, this nation, where children are forgotten in orphanages and old women, the babushkas, may beg for money to supplement their meager pensions, but where children are bundled for warmth with the smallest hint of chilly air and people give up their seats on crowded buses for the elderly and for women with small children. These are a people acquainted with suffering and sorrow, and they have a certain respect for those who have suffered for more years than most (the elderly) and for those who hold the eternal promise of a better future (the children). A rather elegant ethic there: respect and promise.

Wiser minds than mine have delved into the mystery that, within the crucible of suffering, we may be best equipped to find evidence of grace in daily life. It was a visit to a church in Kyiv that I could best see this illustrated. There is, in Ukraine, a national church that had been suppressed, harassed, and persecuted at every turn, one that has survived communism and the economic anarchy that followed, and today sends workers into other former Soviet republics. It is, in fact, a joyful and beautiful place. It is a church that is ministering to orphans and the mentally and physically handicapped, bringing them out of the shadows to which communism relegated them. Ukrainian bioethics is more, forgive the awful word here, “primitive” in a sense, because the technologies that are such qualified blessings in the West have yet to meet this part of the world. But it is the church that is leading the way toward negotiating the ethical issues in a society in transition and embracing the notion of human dignity, a church that just may impact the course of a nation that is, indeed, not yet dead.

 

Corey’s Apology

My July 25 post included a reference to the controversy over a Biola University student’s attempt to display graphic images of abortion on campus, the university’s rather aggressive response to stop her from doing that, and the reaction of the Center for Bio-Ethical Reform (CBR).

About a month later (August 20), Biola’s president, Dr. Barry Corey, published an open letter addressing the matter.  In it, he apologized to the student and to “anyone of interest” in the public for actions that “were perceived to be heavy-handed and retaliatory.”  Strongly affirming Biola’s pro-life commitments, Dr. Corey outlined five types of steps the university is taking:

  • Communication—restatement by the University, starting with its president, of Biola’s “current and historic position on the sanctity of life” in various venues.
  • Instruction—through sponsoring a pro-life chapel service with invited presenters who will “demonstrate the use of images compassionately, ethically and effectively.”
  • Policy—This term, the University is developing “a clear policy supporting the ethical and compassionate use of graphic images in places trafficked by students.”
  • Leadership—in the “academic team” (the dean’s office, I presume) to ensure that pro-life commitments are reflected in the curriculum, learning objectives, and outcomes measures.
  • Continuing [Biola’s] Commitment—advocating for life in the universities activities “and through our legal action.”

I think that this letter is a model for how to address a sensitive controversy.  My understanding is that it has generally been warmly received in the pro-life community, but that the Center for Bio-Ethical Reform may not be entirely satisfied.  But I think we should be.

Potpourri about recent stories about abortion

It will hardly be news to readers of this blog that many states are enacting laws to restrict later-term abortions.  Formally, states cannot restrict access to abortion before a fetus is “viable.”  Practically, abortion proceeds largely unrestricted, at the sole decision of the woman requesting the abortion, in consultation with her physician.  (I will try not to revisit well-plowed territory here.)  The Gosnell case, having grabbed the attention of anyone willing to pay attention, seems to be a reminder that it is reasonable to take the step of protecting, in law, the lives of unborn children as they approach the point at which our best current medical efforts are capable of giving them a chance at life.   I am a bit reluctant to try to adjudicate too precisely the 20-week cutoff point in the recent Texas bill and others—legislating medical details is unavoidably problematic—but the impulse to establish a zone beyond which we agree we will not venture is appropriate, I think.

Such a step is a small one.  If I have the statistics straight, a distinct minority of abortions—about 1.5% out of a total of about 1.2 million annually in the U.S.—currently occurs after 20 weeks.  So it seems to me that in practice the “restriction” on abortion that we are talking about here would be limited indeed.

A new Wall Street Journal/NBC News poll indicates that a plurality (44% vs 37%, with 19% undecided) favor this small step.  Interesting.

Perhaps more problematic is the move to require that all abortions be done in facilities that meet more stringent regulatory requirements, such as those for outpatient surgery facilities.  I’ve been emailing with Susan Haack about this, and she points out that one might encounter a type of “slippery slope” in which other standard medical office procedures—that are similar in methods but do NOT involve terminating a nascent human life—become over-regulated.   So the counter argument, to the effect that these new regulations by some states constitute, in a sense, an over-reaction to the Gosnells of the world, is not entirely unreasonable.  (Again, however, the fundamental motive and stance behind abortion by choice must be unequivocally challenged.)  The regulatory provisions looked appropriate to me at first blush, but maybe that’s because I spend my efforts in the highly regulated arena of pharmaceutical clinical research.

Finally, perhaps you have read of the recent dust-up (to put it mildly) between the Center for Bio-ethical Reform (CBR) and Biola University, over a student’s insistence to pursue the former’s agenda of aggressively displaying graphic images of abortion, and the University’s response.   Again, I will not attempt to weigh in on the details of that confrontation, but just offer my 2 cents:

  • Visit the CBR website and you are immediately confronted a graphic abortion video that turned my stomach—and I’m an M.D. who generally can stand the sight of blood.  I think it is good that I had that reaction.
  • I think that anyone in the medical field, especially someone contemplating performing abortions in any way, must confront images like this.
  • I am ready to grant that there is a place, from time to time, for insisting that people deal with revoltingly immoral practices on a sensory level.  (Consider William Wilberforce’s “dinner cruise” scene, past the slave ships, in the movie Amazing Grace.)
  • Still, there is a time and a place and a way.  Parading or posting revolting images in public, in general, can backfire, raising resistance in some who are otherwise sympathetic to the message, or communicating condemnation to individuals who, at that point in time, are better addressed more gently.
  • Yes, images of abortion are revolting.  So is watching an amputation.  So is draining a liter of pus from an infected chest.  So are a lot of things in medicine that must be done for the good of the patient.   At issue is not the picture, but the underlying moral judgment.

Paying for oocyte donation—update from California

A number of concerned groups in California are encouraging citizens to urge Governor Jerry Brown to veto AB 926, which has passed both houses of the state legislature.   AB 926 would repeal a provision in the California Health and Safety Code that prohibits compensating women who donate their oocytes (eggs) for research purposes.   Wesley Smith has blogged against it, arguing that it would “permit Big Biotech to buy eggs from poor women to conduct human cloning and other experiments.”  One Leah Campbell, a past egg donor and author of a book entitled Single Infertile Female and an eponymous blog and website, writes in the San Diego Union-Tribune that AB926 “aims to turn women’s bodies and ovaries into an assembly line.”

What is going on?  It merits some unwinding.

In 2004, California passed Proposition 71, which established and provided $3 billion in bond funding for the California Institute for Regenerative Medicine (CIRM), to support basic and translational stem cell research.  The proposition explicitly cited human embryonic stem cell research as a major priority.  (In fairness, CIRM funds all things stem-cell, including somatic, or “adult,” stem cell research, and research with induced pluripotential cells [iPSC’s].)

As the California Senate’s analysis of the bill (available here) points out, at the request of the CIRM the Institute of Medicine (IOM) issued a 2007 report assessing the medical risks of oocyte donation for research.  Those risks included ovarian hyperstimulation syndrome (OHSS) which can have serious medical consequences in 1-2 of every 1000 stimulation cycles; risks of the procedures involved; psychological risks; and unknown but potential increased risk of some cancers.  The IOM pointed out that the stimulatory treatments needed for oocyte donation, when used in fertility treatments, are largely self-regulated by the medical specialty society involved, the American Society of Reproductive Medicine (ASRM), and the associated Society for Assisted Reproductive Technology.  Further, there is no ongoing registry of oocyte donors in place to observe women systematically, over time, for medical outcomes.  (This in the age of “evidence-based medicine.”)

Accordingly, in California law: “No human oocyte or embryo shall be acquired, sold, offered for sale, received, or otherwise transferred for valuable consideration for the purposes of medical research or development of medical therapies. For purposes of this section, ‘valuable consideration’ does not include reasonable payment for the removal, processing, disposal, preservation, quality control, and storage of oocytes or embryos” (Section 125350 of the California Health and Safety Code).  AB 926 would not change that part of the law.

However, in accordance with the sorts of concerns identified by the IOM, California law has prohibited paying egg donors more than the actual direct costs of the procedures (the “removal, processing, etc.”).  That is, women should not be charged for the medical and research procedures involved, but they shouldn’t be paid extra for their time and trouble, out of concern that such extra payment would constitute an unacceptable inducement to donate, and amount to impermissible exploitation.  This is what Ms. Campbell (and Mr. Smith, and to be candid, I) am concerned about.

Now, AB would repeal this specific prohibition, and allow this extra compensation of women who donate their eggs for research.  There are a couple of wrinkles:

First, as noted, the language prohibiting payment for the oocytes per se (or for an embryo) would not change, and new wording is provided to put a fine point on that.

Second, the bill tries to distinguish between donation specifically for research and donation for infertility treatment.  How?  To begin with, the rationale for the bill is that we already accept compensation for subjects of medical research, particularly for early clinical trials of experimental drugs given to healthy volunteers.  Such compensation can reach well into four figures per study, leading the phenomenon of the “professional research subject” who serially volunteers for these studies and tries to make a living off the compensation for participating.  Such compensation is for the subject’s time and inconvenience, and the consent form usually says so in so many words.  This is standard practice in research ethics, and there is a substantial body of literature (and ongoing debate) around the merits or harms associated with this practice.  The argument for AB 926 is that it would just treat women who donate their eggs for research like other research volunteers.  Further, without the compensation, people won’t volunteer.  (That is a safe assumption, based on the experience with drug studies in healthy volunteers.)  And, since much of the research is sponsored by industry, Wesley Smith is, in a sense, correct:  industry is not paying for the eggs proper, but they are paying for enhanced research participation.  I leave it to you to judge whether this is a distinction without a difference.

How much compensation is too much?  That is for Independent Review Boards (IRBs) to decide.  AB 926 affirms that the IRB must make this judgment in the case of compensation for women who donate their eggs for research.

But what about women who donate eggs for infertility treatment?  AB 926 tries not to be about them.  But if there are “extra” eggs—eggs that an infertile woman deems, with her doctor, she doesn’t need for her attempts to have a baby—then, if the clinic harvesting the eggs belongs to the Society for Assisted Reproductive Technology, then the IRB “shall disregard” the matter of compensation.

Got that?  The further wrinkle is that, according the California Senate’s analysis and the IOM report, while ASRM endorsed this sort of compensation for women who donate eggs for infertility treatment, it said that “total payments to donors in excess of $5000 require justification, and sums above $10,000 are not appropriate.”  Yet it is common knowledge that these payments can be much greater than that.  But in that case, AB 926 tells IRBs, “never you mind.”

Ms. Campbell (see the Union-Tribune link above) wrote that the aftermath of her egg donation included severe pain from endometriosis related to the ovarian stimulation, and, in a cruel irony, now she is herself infertile.  Her story reminds one of “Eggsploitation.”

So what to say of all this?

  • A decade after Prop 71, the commodification of the egg donation process, in the name of supporting research with created embryos, is a reality.
  • If I were on an IRB evaluating a proposal, it would be a lively meeting:
    • The egg donation is likely primae facie unethical because it supports the fundamentally unethical act to create or destroy human embryos solely for research purposes;
    • Compensation to the donor would have to at least fall within the ASRM dollar limits as described above; higher amounts should be viewed as an unacceptable inducement;
    • The required description of risks to the donor in the consent form must make the risks of severe complications of OHSS, and the lack of data on long-term risks, starkly evident;
    • I would argue strenuously that two basic requirements of IRB approval of the research—that risks are minimized and that they are commensurate with the benefits of the research—could never be met.

This one had flown under my radar, and I now need to send a letter to the governor.

Clashing worldviews in same-sex marriage and bioethics

The recent Supreme Court decisions regarding same-sex marriage have made me think about the fundamental worldview differences that underly the different positions on that very controversial issue and the similarity to the worldview differences involved in many of the issues that we deal with in bioethics. Although there are biological issues involved in the ethical positions that people take regarding homosexuality and same-sex marriage these are usually considered to be issues of social ethics and not specifically a part of bioethics. However, there are marked similarities in some of the basic worldview differences involved.

Primary in many of these issues, whether it is same-sex marriage, euthanasia, embryo destructive research, abortion, or human enhancement, is the place of personal liberty and autonomy in the worldview of the person taking a position on these issues. Much of our society holds to a worldview that says that personal liberty is one of the highest if not the highest value. Arguments for same-sex marriage rely heavily on the idea that society should not interfere with the ability of a person to pursue personal relationships and sexual fulfillment in whatever way that the person chooses. That is very similar to the argument for euthanasia based on a person’s ability to choose how he is going to die, a couple’s ability to choose what will happen to their unused embryos, a woman’s right to choose what to do with her body and a fetus living within her body, and and our ability to choose to enhance our own or our children’s abilities. These arguments are strong because all of us in our society, including Christians, believe that personal liberty and autonomy are important and should be respected. The difference is that in a Christian worldview there is a stronger understanding that personal liberty needs to be limited by objective moral values for it to remain ethically valid. Human sexuality needs to stay within the bounds of traditional marriage. Caring for those who are suffering and dying needs to respect the value of every human life and not cross the boundary of killing innocent human beings. The choices we make about the treatment of human embryos and fetuses need to be limited by that same respect for the value of human life and the proscription of killing innocents. Choices about enhancing human abilities need to be limited by a respect for the givenness of our human nature. Underlying all of these moral boundaries is the idea that there are objective moral values that are grounded in the nature of the God who has created us who is good.

Another key worldview difference involves our understanding of who we are as human beings and what it means for us to flourish as human beings. Many in our society see human beings as animals who have some advanced capabilities that give us advantages over and more moral responsibilities than other animals, but no categorical difference from other animals. This is in contrast with a Christian view of human beings that sees us as being made in the image of God which gives both an inherent value to every human life and an understanding that there is a higher purpose to our lives than fulfilling our basic desires. This difference impacts how we see such things as the fulfillment of our sexual desires, dealing with suffering, the value of the lives of human embryos and fetuses, the relative importance of our own desires and those of ones dependent on us, and whether we should strive to change our nature.

These fundamental worldview differences help to explain why there are such deep divisions on social issues such as same-sex marriage and many issues in bioethics. We need to continue to point out the importance of such basic issues as the existence of objective moral values and the nature of human beings as we discuss these issues that are of great importance in our society.

Michael Tooley’s “package deal”

Further to the May 2013 JME discussion of infanticide was a fairly gymnastic article by Michael Tooley that was in essence given central prominence in the issue.  I say “gymnastic” because, partly by his own admission, Tooley tried to cover, albeit superficially, a lot of ground in a brief essay.  But given that there is so much written, and so much information out there, that one cannot review it all in detail—Tooley himself admits as much vis-à-vis his position—one is often forced to perform similar gymnastics to form a provisional judgment of a series of claims.  And thus do I take to the trapeze for a brief discussion of Tooley’s essay.

Tooley writes that he wants to replace emotional claims with critical thinking, and yet I could not help be irritated by his tone: “pedantic” seems too strong a word, but “tendentious” and “condescending” might fit.  After lecturing non-philosophers on how they ignore critical thinking and eschew calm, dispassionate argument, and in essence telling doctors that they should defer to the wise judgment of professional philosophers (who really are the only ones who have thought long and hard about things) on ethical matters, he urges the reader to accept the “Socratic challenge” that all held beliefs are potentially suspect, and that resistance to some ideas betrays commitment to a “package deal” that includes some basic belief that one is determined to hold despite the evidence.  Of course, opposition to abortion is one such package deal because Tooley apparently has found that all abortion opponents cling to the notion that there is a God.  (He does, in passing, also say that some feminists include abortion support in their own package deal but he does not say anything further about them.)

More substantively, Tooley briefly addresses two strategies supporting “the extreme antiabortion view according to which abortion is always, at the very least, prima facie seriously wrong,” as he puts it:

  • Membership in the biologically defined species Homo sapiens is a suspect ground of moral status because, were we confronted with a lovable extraterrestrial creature that is rational, we would ascribe similar privileged moral status to that being.  We wouldn’t approve of serving him up a la Kentucky Fried Chicken, for example.  (Or, if you prefer, think of the horror of the Narnian visitors eating talking animals in Lewis’s The Silver Chair.)  So, the ground of moral status would be something like possession of “an immaterial, rational soul,” and membership in the species would not be a basic ground for a life to right (the rational soul would be a more basic ground).   But it seems to me that Tooley misses the point here. Humans are the sort of beings which have the ultimate capacity for not just thought but moral judgment, self-awareness, awareness of self-awareness, and so on.  And they are unique within the creation, or the biosphere if you will, as we encounter it.  Were Tooley’s ET to visit us, perhaps we would have another example of the sort of being with ultimate capacities such that it ought to be accorded privileged moral status simply by virtue of being one of that sort of being—a member of that “kind,” or species.  Christopher Kaczor, for one, has defended this position rather more substantially than Tooley seems to be willing to allow.
  • Possession of an immaterial, rational mind or soul is not just suspect, but patently false, for Tooley, because he thinks science has established that the mind and the brain are one and the same.  He calls out Moreland, Beckwith, and Scott Rae (among others) by name—Thomistic substance dualists all.   He may correctly identify their view but he makes it too Cartesian by identifying soul with mind, and he fails to engage the dualist argument with more than a list of science-writer level examples.  Also, in my (limited, to be sure) reading of philosophy of mind, I don’t see people considering Tooley a significant contributor.  So I take his claims against substance dualism as little more than rhetoric.  And substance dualism appears to me to be rather robust in philosophy than Tooley will allow.

Instead, Tooley asserts that “[o]nly neo-Lockean persons have a right to continued existence.”  The “neo-Lockean” person is “an entity that has conscious states at different times, and that are psychologically connected by such things as memories, desires or intentions.”  These are the states that “make for personal identity.”  They persist through temporary losses of consciousness, and so get around one objection (which Tooley considers a “straw man”) about approaches to personhood as consciousness.  And, for him, a right to life is grounded not in an essential characteristic of a being, but in something that is acquired at some point in development.

But it’s not clear why actual rather than anticipatable acquisition of capacities should ground moral status.  If we take care of a baby properly, he or she will quite predictably become Tooley’s neo-Lockean person.  In cases when that is not going to happen, we can still argue, at a minimum, that respect for the sort of beings humans are ought to stay our hand against active killing.  Yet that is not where Tooley is headed.  Because we are talking not just about abortion here, we are talking about infanticide.  And returning to the latter point, Tooley closes by mentioning that, while he thinks human fetuses and neonates “probably” have the same moral status, he seems to be questioning his earlier position that humans acquire capacity for thought episodes only some time after birth.  He says that he doubts that most philosophers are conversant in the relevant science, and that he has not been able to catch up with it.  And so the “crucial underlying scientific premise” that would support killing healthy newborn humans on purpose—viz., that neonates lack the capacity for thought—“has not yet been scientifically, firmly established.”

Well.  And if it is “scientifically, firmly established” that neonates DO have the capacity for thought—as I bet most new mothers would claim, and as I think we ought to assume for the purposes of our moral reasoning—then how established is it that there is NO capacity for thought late term in utero?  And how do we distinguish the unborn healthy 30-weeker from the post-natal 30-week preemie?  And if there is anything whatsoever to the notion that our thoughts have a private character, accessible only to us, how confident ought we to be of our ability to measure the onset of that actualized capacity in tiny humans?  The potential for pseudoscience seems substantial.

And this, finally, underscores Tooley’s own “package deal”—skepticism about the moral status of newborns comes with a firm commitment to naturalism and a physicalist approach to the philosophy of mind, at all costs.  We all start with basic beliefs that we change very slowly, if at all.  And so, rather than think that every belief ought to be held with radical skepticism, we ought to beware lines of reasoning that wind up contradicting the deepest human intuitions and experience—kind of like questioning our work when the answer to a math problem doesn’t make sense.  (I should add that Tooley’s arguments reinforce my conviction—or, in our pluralistic, secular society, should I say “despair”—that naturalism can ground any stable sense of moral obligation.)

In the meantime, while you are catching up with all that Tooley and others have written, I recommend that, rather than abandoning your most basic beliefs, you resist his reading of the Socratic challenge.  Tooley’s approach sounds less like a search for truth than a demolition job.

I wonder whether Socrates would approve.

Gosnell, the Journal of Medical Ethics, and Infanticide

On May 13, Kermit Gosnell was convicted of three counts of first-degree murder—for infanticide.  Some news reports said that the convicted man looked stunned, as if he couldn’t understand why anyone would think he did anything wrong.

The May 2013 issue of the Journal of Medical Ethics was devoted to a serious discussion of the notion that infanticide—as in, the intentional killing not only of handicapped but also healthy infants—is morally acceptable, for the same reasons that abortion, including late-term abortion, is accepted in the West.  That issue of the JME expanded on the prior online publication, in January of 2012, of an article by Giubilini and Minerva.  I found the contents of this issue available online for free (for which I was thankful, because nobody should have to pay for this tripe).  Read it, and it will be clear that the authors, and the editors of the journal, don’t understand why anyone could have been upset that it was published in the first place.

In an editorial, Julian Savulescu states that the Giubilini-Minerva article was published because of “the quality of [the] argument, the contribution to the existing literature, and the relevance to current medicine.”  But the article failed the first two criteria, and ought to fail—at least, in a decent and human society, ought to fail—the third criterion as well.

Giubilini and Minerva argue poorly in their piece.  Two key sentences:  “both a fetus and a newborn certainly are human beings and potential persons, but neither is a ‘person’ in the sense of ‘subject of a moral right to life.’  We take ‘person’ to mean an individual who is capable of attributing to her own existence some (at least) basic value such that being deprived of this existence means a loss to her.”  In a reply, Francis Beckwith points out that this position has been carefully refuted on numerous occasions in recent years, and criticizes the notion of a “potential person” as misguided.  An unborn or newborn baby is not a “potential” person in the way that, for example, a piece of wood is a potential desk or Michael Tooley’s cat is potentially smart if only it is injected with the right potion.  Rather, the fetal or newborn human is a being so ordered that it essentially has the capacity to express, when fully developed, the range of higher capabilities that Giubilini, Minerva, and other like-minded people say confers moral status only when realized—either fully, or fully enough.  What would constitute “fully enough” they are unwilling to venture.  They also claim that refusing the burden of caring for a baby is reason enough to warrant infancitide (as it is, de facto, sufficient justification for abortion under our current legal regime).  But Beckwith demonstrates that, for them, infanticide is morally permissible even in the absence of any burdens—so an appeal to “burden” is irrelevant.

At bottom, Giubilini and Minerva’s paper is nothing more than a rehash of old arguments for abortion and infanticide, without proper regard for substantial criticisms that have been previously and extensively published and discussed.  Accordingly, their article adds nothing whatsoever to the current literature save provocation.  It does have one merit: it serves as a reminder that if abortion is morally permissible, it is difficult if not impossible to declare, on the merits, that infanticide—or, for that matter, the elective murder of children of some indeterminate older age—is not morally permissible.  Several contributors to the May 2013 JME point this out in one way or another.

Finally, the relevance to modern medicine:  In his contribution, Robert George states that “killing an infant because he or she is unwanted is evil” and that advocating it, or its moral permissibility, is “madness.”  And so it is.  To ask seriously, “is it permissible to kill an infant because he or she is unwanted?” or “under what circumstances is it permissible to kill an infant because he or she is unwanted?” is to speak from a heart desperately twisted by evil.  We must forcefully reject the premises of such questions.  They can never be relevant to modern medicine.  They are considered relevant only because we live in the days of the Groningen protocol for neonatal euthanasia—which, we are told, is decreasing euthanasia (or so it is believed) in favor or more abortions, for things like spina bifida.  (An “updated report” is due later this year.)

Apparently, after the online publication of their article, Giubilini and Minerva received death threats.  Such a response is also evil.  That is it was affirmed explicitly by several contributors—both pro- and anti-infanticide, or pro- or anti-abortion—to the May 2013 JME.  But again, the authors and editors don’t appear to understand why there should be such outrage, and some of them seem (rather sanctimoniously, to my ear) to cloak themselves in a sense of martyrdom.   Outrage must be controlled, and supported by proper warranted belief and sound argument.  But correctly-directed outrage cannot be replaced by a cool rationalism.

And so, indeed, in responding to what George has properly called this “madness,” we must be civil but we must not be gentle.  Academic freedom and the First Amendment demand that we abide such talk, at least to a point.  However, serious advocacy of killing healthy infants or children by choice ought not to be acceptable in decent, humane conversation, and we should aggressively press the point that this one has been “asked and answered.”  Daniel Dennett has said that people who believe in God should be dismissed with derision from intelligent conversation.  We must be more patient, but I am tempted to ask whether sauce for the goose is sauce for the gander here.

It is said that Hippocratism arose as a counter-cultural protest movement, and that early Christians bore reproach for their opposition to infanticide.  Those of us who consider ourselves “neo-Hippocratists,” if you will, may be facing such a time again.  I wonder: just how many of our fellow citizens think that Gosnell did something wrong?  Or that he didn’t?  And would not most frankly reject infanticide?  I suspect that most people in the general public don’t realize this discussion of infanticide is going on.  We must educate them.  And we must be polite—but not too nice—in opposing the “experts” pushing infanticide.