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.

The Irony of “Rational” Secularism

This past week I attended the meeting of the Council on Health Care Ethics for our state medical society. In the packet of information for the meeting was a resolution on “right of conscience” along with 2 “supporting” documents, one by Julian Savulescu and the other by Alta Charo, both addressing the issue of abortion and both filled with “entitlement” rhetoric (the article by Salvulescu even stated that those who are unwilling to provide services to which people were “entitled” should not be physicians, as if abortion is the vital core of healthcare). Based on the “supporting” documents, the tenor of the meeting seemed less than balanced.

To my great surprise, the author of the resolution was a first-year medical student. The resolution had been brought to the state convention, where it encountered considerable opposition and was sent to our committee for further discussion (presumably out of deference to her status as a young student). The resolution in its current state was greatly truncated, seeking merely to  preserve “collegiality” among physicians  through support of the right of conscience of all physicians by the state medical society.

When the resolution was read by the author to our committee, there was silence in the room. To break the uncomfortable tension I applauded the resolution and spoke of the importance in a pluralistic society of protecting the right of conscience of all practitioners, noting that much of our disagreement centers on differing definitions of conscience (self-chosen values vs. moral obligation to a Higher authority).  Taking advantage of the opportunity, I then addressed the fallacies of the “supporting” articles by Savulescu and Charo, pointing out that both ignored (or implicitly denied) a crucial fact: that abortion is a negative right which entails no corresponding obligation–a fact ignored by most supporters of abortion “rights.”

There. It was out in the open: that “a” word. I watched with curious amusement as the other members danced around that word for the remainder of the brief discussion. Brief? Yes, brief, because one member quickly responded by slinging out the term “moral fascists.” Moral fascists? Really? (I seem to say that a great deal lately.) Really? The comment was profoundly ironic: those trying to establish protection from the moral encroachments of others are labeled “moral fascists”; and secularists who label religious sensibilities “irrational”–who claim no higher power than reason–are unable to mount a rational argument in defense of their position.

The discussion detoured briefly before dead-ending in the issue of “referral for abortion” which has curiously become the central contention in the debate–another curiosity. For 25 years I have practiced obstetrics and gynecology–now just gynecology–in rural communities with no abortion services, located in both eastern and mid-western states. In those 25 years I have never had a patient come to me 1) seeking an abortion,  2) asking where to go to obtain an abortion, or 3) requesting a referral for abortion. Two patients (two!) have made appointments with me to discuss their decision and/or to receive assurance that they could return to me for care after the procedure. In both cases those women already had appointments scheduled for the procedure. Patients “know” where to go, whether through family or friends or general “street knowledge”–not to mention that it is first listing in the yellow pages after “abortion alternative.”  Nor are referrals required by the provider or insurer. In cases involving congenital fetal anomalies or life-threatening maternal health conditions, the patient is sent to a tertiary center for evaluation, counselling, and treatment–not specifically for abortion. Quite frankly, the issue seems like a red herring…

Right of conscience extends far beyond the issue of abortion into many other aspects of care, a horizon that will no doubt expand even farther in the coming years as our technological innovations continue to outstrip our moral sensibilities, yet the same principles apply. A decade ago, Nigel Cameron suggested that given our ideological disparities, medicine might best be served by the establishment of two separate factions of  healthcare providers: Hippocratic and non-Hippocratic. Perhaps it is an idea whose time has come. Just as all businesses have “mission statements” today (another irony–or oxymoron…), hospitals, clinics, and individual providers could have their mission or value statements posted on-line or at the facilities, allowing individuals to choose  primary providers and facilities whose values were most consistent with their own. It would also fulfill the idea of informed consent, enabling individuals to make informed choices about the providers of their care. It is an option that would eliminate “moral fascism” and promote freedom in a pluralistic society–the essence of “liberty and justice for all” in healthcare.

 

 

Emergent Dualism and the Sanctity of Human Life

My wife and I spent May 10-11 at the annual conference of Biola’s Center for Christian Thought (CCT), where the theme for 2012-2013 has been “Neuroscience and the Soul.”  The plenary talks are not all on the web, yet, although some are on Facebook, but a number of discussions on the general topic may be accessed here.  I encourage readers of this blog to spend some time knocking around the CCT website.

The weekend (though perhaps not the year, more broadly) didn’t have much neuroscience in it.  Most of the time was spent talking about philosophical and theological anthropology—in particular, what is the soul?  As I have previously written on this blog, I am most attracted to a “Thomistic substance dualism” (after Thomas Aquinas) of the sort advocated by J.P. Moreland of Biola, who argues that the “soul” is a simple (it doesn’t have parts) nonmaterial substantial entity that contains all the ultimate capacities of an organism and which is intimately involved in directing that organism’s development and expression of those capacities.  The word “ultimate” is critical here, because, as we all know, not all members of the human race realize all capacities at all times.  Moreland’s development shores up some shortcomings of Aquinas’s dualism (e.g., the notion that human embryos acquire souls at either 40 [males] or 80 [females] days of prenatal development), while attempting to retain its merits.  It, and other approaches that reject equating mind with brain function, appeal to certain Cartesian intuitions, like those of self-awareness, the sense of “what it is like” to have an inward experience, and others.  The philosophers call these “qualia” of mental events, which make them non-identical with physical/biologic events.  At the same time, Moreland and those of like mind reject the radical Cartesian distinction between mind and body in favor of a more wholistic, as it were, view of what the soul is and does.

Now, this fits nicely with the biblical notion of the image of God, even if one rejects Moreland’s view that the image is what man is, not just what man does (tend the earth), or the relationship between man and God, or the “status and standard” of man relative to God, creation, and the ultimate perfection man.  But I would argue that Moreland’s Thomistic substance dualism is not just faith-based, but also supported by formidable philosophic arguments and accessible on the terms of general revelation.   As such, I think it provides the strongest support available for the sanctity of individual and collective human life.  One sees this in arguments most commonly employed (perhaps not surprisingly) by Roman Catholic thinkers like Robert George; to wit, “humans are the kind or sort of being that….”

Two criticisms of Moreland’s view are:

  1. It amounts to vitalism, an otiose idea long-ago relegated to the biology’s scrap heap of history.   Moreland’s rejoinder to this is to claim that bad, old-fashioned vitalism was too crude, and that a more modern view, “organicism,” is more promising.  (I can’t carry on about that, yet.)
  2. Evolution is irreconcilable with the Thomist view of the soul, because the latter requires that genus and species not be degreed properties, but be in a real sense, immutable.  I agree that the Thomist view pushes one there, and I think that (along with Moreland, I believe), as these critics claim, the Thomist view requires one to accept that God is progressively active in creation.  But these points are said to be unacceptable because of the science of human evolution.

So, as an alternative, some philosophers who remain sympathetic to the idea that mental phenomena are not reducible to physical processes, and in fact are different in ways that cannot be fully explained by appealing to physical processes, nonetheless inescapably depend on those processes and “emerge” from them.  However, they would hold, what is emergent is not just mental properties but an actual, and in a meaningful sense, substantial self.  So they are dualists about human nature—even, in a sense, “substance dualists,” but they are less ready to allow that the human soul might exist independently of bodily life and processes—particularly those of the brain.

Now, there is more to be said about this than I can say, here or elsewhere, but it seems to me that the appeal to a “degreed” nature of life or consciousness disallows categorical distinctions of moral status between individual people, or people in general, and other beings.  (It seems to me that the emergent dualist also conceives “soul” as too readily identified with higher mental properties than the Thomist view would insist on.)  It risks making “personhood,” or “dignity” or moral status a degreed property.  Should we be more concerned about an anencephalic baby, or a fetus with Down syndrome, than a fully-endowed and functioning gorilla, and if so, why?  Should we be troubled about creating a human/non-human hybrid, and if so, why?  Would a super-intelligent robot, if there could be such a thing, potentially be a rival of “natural” humans in competing claims for concern?

I tried this out on a prominent Christian emergent dualist at the conference, and he quickly dismissed my objections.  To be fair, I hit him with a “drive by” on the coffee break, but as it happened, when I pushed, he responded, in effect, we can’t base all our moral appeals on rational argument.  Sometimes we have to just demonstrate the truth of the gospel, and show people the choice between worldviews and their consequences, and ask them what do they really prefer?  And, as unfairly as this brief post may be posing the issues, that kind of rejoinder worries me.

Ultimately, some appeal to a “givenness” of human nature is necessary to defend boundaries in bioethics.  We might indeed appeal to the naturalist by counseling caution—evolution has, over millions of years, presented us with ourselves, including our common intuitions—and we ought to have a “default” position of “no-go” on the most “out there” ideas.  We might indeed present a “two views” picture, and ask people to choose what kind of world they really want and what sort of people they ought to be.  We might argue, as I take the German philosopher Jürgen Habermas to argue, that the interplay of human autonomy, human language, and human social relationships lead us to conclude that some technological interventions would tend fundamentally to destroy who we are in community, and so ought to be avoided.  But I think it’s harder to identify, on emergent dualist grounds, what if any specific maneuvers ought to be proscribed with “thou shalt not,” or words to that effect.

The emergent dualists might be right.  (I tend to agree with Moreland that the position is unstable, tending toward either his dualism on the one hand or functionalism on the other.)  If so, we should, as the philosopher I challenged told me, follow the inquiry where it leads.  (One approach that could be called into question is Francis Schaeffer’s approach of asking whether one can live with the consequences of one’s philosophy.)  But my efforts, at least, are still awfully preliminary.

Conscience, Data, and the Burden of Proof

Dr. Susan Haack’s recent posts on conscience, and the ongoing struggle over the HHS regulations on mandatory insurance coverage for contraception under the Affordable Care Act, demand more careful further reflections than will fit in a blog post, but I will dare to stick a toe in nonetheless.

In The Line Through the Heart: Natural Law as Fact, Theory, and Sign of Contradiction, J. Budziszewski argues (see pp 8-15, for example) that “deep conscience,” which is “rooted in the constitution” of all humans, is a cardinal indicator of the existence of a natural moral law.  Deep conscience “remembers” general moral norms (including, he argues, the Decalogue).  I’d take this to be Dr. Haack’s “antecedent” function of conscience.  Budziszewski then distinguishes three “modes” of conscience:  cautionary, accusatory, and (for lack of a single term) confession/reconciliation-seeking—the “consequent” functions Dr. Haack mentions.  He would certainly agree with Dr. Haack (as do I) that conscience points to a transcendent authority.

Presumably (me talking now, not Budziszewski), we form correct moral convictions by agreeing with deep conscience about moral truth.  However we arrive at those convictions, we can argue that they too have “antecedent” functions in that they are, if properly understood, sufficient to motivate ethical behavior.  (I just glossed over a major discussion in ethical philosophy that I ask the reader to accept for the sake of argument here.)  Convictions do not, however, produce a sense of guilt, accountability, or of a need for reconciliation.   Conscience does that.   Whether we recognize it or not, conscience is witnessing to our accountability before God.  People who deny God’s existence, however—and who may well also interpret “guilt” to mean a response to bad-faith intimidation by the organized church—can still coherently claim, it seems to me, to act out of conviction with accountability to the community, as long as the standard is some sort of community-recognized norm.  In a pluralistic society, one can appeal to positive law or what we can agree on; or, alternatively, one can appeal to the shared understanding of what it is to be an autonomous moral agent (as I take the German philosopher Jürgen Habermas to do).  Just don’t plead metaphysics.  But the appeal to convictions is not ripped from its community connections—it depends on them, just in a different, but critically different, way.

And that, of course, is the problem.  People like me are making a metaphysical argument (actually, I want to argue for a form of natural law) in a positive law world.  Some of the “positive lawyers” claim that their convictions are objective, not relativistic, because they are available to observation, as in the natural sciences, so we can agree on them, revising our understanding as we get new information.  We are left with a sort of “naturalist’s natural law.” I think that is irredeemably relativistic, in the end—if God is dead, nothing is out of the question.   I understand Budziszewski to agree.  He criticizes the “positive/natural lawyers,” if you will, of pursuing a “second-tablet project”—that is, isolating the “second [stone] tablet” of the Decalogue (Commandments 5-10) from the more explicitly God-directed first 4 commandments of the “first tablet.”

So what?  First, I would submit that the “conscience/convictions” argument doesn’t help all that much in cases like the HHS mandate.  The issue is how much room to give to particular metaphysical stances—the public/private square problem.  Pluralistic norms vs religious freedom is still the battle.  And it will not do to say that profit-seeking makes the moral application of metaphysical commitments illegitimate.  To put the fine point on it, Hobby Lobby’s owners ought to be accorded the same freedom of conscience as are the Catholic Church, or a church-run hospital, or Wheaton College (for example).  I worry, perhaps too much, that bioethicists in particular worship at the altar of non-profit status in ways that risk serious mistakes.

Second (and cf. the recent post by Dr. Joe Gibes), statements like “[The] lack of any substantial evidence for post-fertilization effects [of emergency contraceptives] may significantly weaken conscience claims, and may militate against refusals to dispense or to refer,” [Lewis and Sullivan, Ethics & Medicine 28:113-120, 2012] will not do.  Failure to prove is not disproof.  Absent definitive data, prohibition of emergency contraceptives may be weakened.  But without definitive data—which may not be accessible by ethical experiments—sufficient to free the conscience of concerns, conscience claims of someone with a reasonable doubt about what the data mean ought to be vigorously defended, even against a strong majority consensus.   We should not let a prevailing tide of naturalistic, “data-driven” ethics confuse our use of the data in service of true moral precepts.

Is emergency contraception abortion?

Emergency contraception (EC) — the “morning-after pill” — is taken by a woman after an episode of unprotected intercourse in order to try to prevent pregnancy.  It contains a hormone that acts to prevent pregnancy by preventing ovulation (the release of an egg from the ovary). However, theoretically, if ovulation has already occurred, EC might prevent pregnancy by preventing implantation, the attaching of an already-fertilized egg to the lining of the uterus. This second, conjectural mechanism raises ethical problems for those of us who consider that life begins at the moment of conception, since preventing the implantation of a fertilized egg could be viewed as inducing an abortion. Should we oppose EC because it might in theory cause an abortion?

The authors of a review article in the Fall 2012 issue of Ethics & Medicine address just this question. They review the best available scientific evidence and conclude that  there is “sufficient motivation” to believe that EC does not prevent implantation, and therefore does not cause abortion. (p. 116)

Good ethics begins with good facts. But our understanding of scientific facts is constantly changing; so even though we use the same moral reasoning (“It is wrong to deliberately take a human life, so one should not use a medication to cause an abortion”), our ethical conclusions may change as our understanding of the facts progresses  (i.e., if the facts indicate that EC causes abortion, we should not advocate its use; on the other hand, if the best data indicates that EC does not cause abortion, it may be ethically justifiable to use in certain circumstances ).

In a fallen world, our knowledge of the truth will always be imperfect; but it is the best we have to work with. Given the current state of knowledge, it appears that EC is not tantamount to abortion, and that I should not use “It might cause an abortion” as a reason not to prescribe it in certain circumstances (such as rape). I am open to changing this stance as knowledge grows and changes; what I am not willing to change is my commitment to not deliberately take a human life.

(See my post here for more on this topic.)

Professionalism vs. commercialism in medicine (or, Yet another Black Friday special!!!)

Some thoughts on medicine and commercialism on this, the high holy day of the gods of commercialism:

The understanding of medicine as the satisfaction of consumer wants is corrosive to the practice of medicine as a profession.

“The practice of medicine is not a business and can never be one . . . Our fellow creatures cannot be dealt with as a man deals in corn and coal; the human heart by which we live must control our professional relations.” (Sir William Osler, 1903)

A profession involves the freedom if its practitioners from the simple market reduction of the work to that of the tradesman. It is fundamentally an ethical and moral endeavor. It entails independence of judgment, a degree of self-regulation, a covenantal commitment to patients, the bearing of a characteristic set of responsibilities, and adherence to a distinctive ethical code.

*  *  *

From a hypothetical ad in today’s paper:

“Yes, you heard right, it’s our Black Friday special!! Have we in medical practice got a deal for you! Come over to St. Exorbitant’s where today, we’re offering one MRI for the price of two! (Actually, we’ll charge as high a rate as we can and take whatever your insurance company will allow!) Plus, we’ve got all the most-requested procedures of dubious benefit and unnecessary tests for your enjoyment!! (Unnecessary for your care, that is, but they might help finance that new atrium we’re building on to the hospital, which has really helped us attract patients away from our competition!)

“And if you don’t like our Hippocratic™ – brand selection, come on over to our other showroom, where you can peruse some of our less-traditional items! So, you’re not interested in our time-honored offerings of compassion, presence, and comfort? Well, we have a special discount today on Physican-Assisted Suicide (at such a bargain, too — at least, for our medical system which can finally stop paying for all those pharmaceuticals you’re taking!)! Looking for the perfect child? Sorry, we don’t have that yet, but we can test the one you’re carrying to see if she meets your specifications and tolerances! Now how much would you pay? But wait, there’s more! Our technicians can abort, ah, that is, terminate the child you’re carrying if we find something wrong, or for any other reason, or for no reason at all! We’re eager to serve — YOU! Here, the patient is King and Queen! We will do anything — anything — within our power (and your ability to pay) that you want, and if it isn’t within our power yet, don’t worry, we’re experimenting on your embryos to find ways to serve you better!  (We accept many insurances, cash, and all major credit cards!)”

 

Oh, wait — you say you can’t pay? No insurance? Well, well, funny how those market forces work, isn’t it? I’m sorry, we won’t be able to help you today. Why don’t you try the internet? I hear there’s very good care to be had there!

 

Rape, God’s sovereignty, and the value of human life

I live in Indiana, and most of the time I think that is a good thing. This election season I am not so sure. The race for our Senate seat has been one of the ugliest I can remember. It has been so bad I am seriously considering not voting for either candidate. Now a statement made in a recent debate between the two candidates has made the national news and reflects on Christian bioethics. When asked whether abortion should be allowed in cases of rape or incest, Richard Mourdock said during the debate, “I struggled with it myself for a long time, but I came to realize that life is that gift from God. And, I think, even when life begins in that horrible situation of rape, that it is something that God intended to happen.”

Mourdock has been attacked by those who say that if a Christian is opposed to abortion in cases of rape they are saying that God has intended the rape to happen. Christians are divided over whether abortion is permissible in cases of rape. Balancing the value of an unborn human life and caring for the victim of such horrific wrong who is also of great value is a difficult thing to do. Those who address this need to be much more careful than most political candidates in what they say and how they say it.

It can be reasonable from a Christian perspective to take the position that the value of the life of the innocent fetus whose life was begun as a result of rape is such that the life of the innocent fetus should be preserved no matter what his or her origin was. Those who take that position are not saying that rape is not a horrible evil. Rape is evil and the scripture clearly identifies it as evil. Scripture also emphasizes God’s compassion on those are victims of violence and we should have that same compassion. Expressing how we reconcile God’s love and his sovereignty with the evil in the world is something that theologians have struggled with for centuries. From a Christian perspective it is clear that God is not the author of evil, but he is able to use the evil done by human beings in ways that produce something that is good. Even though he did not say it well, that may be the Christian truth behind what Richard Mourdock was trying to say. Rape is evil and God is not the cause of such evil, but God can take something as evil as rape and from it bring an innocent human life that is good. It is when we see the good of the life that came out of what was an evil act that we can see why we should think that such an innocent life should be protected even though his or her origin was in something evil.

Eugenics and the genetic testing of embryos and fetuses

In a recent article in the Australian media Julian Savulescu, a noted Oxford ethicist who is a visiting professor at Monash University in Melbourne, makes the contention that selecting which babies are born by doing genetic testing on embryos or fetuses and only allowing those that are desired to live to birth in the way that it is allowed in Australia shares the moral problems of past eugenics programs that we have rejected. His point is that the current practice in Australia allows selection of embryos by preimplantation genetic diagnosis and fetal testing with selective abortion only for diseases and not for sex selection or other non-disease characteristics. By allowing selection based only on diseases the society is saying that “lives with disability are less deserving of respect, or have lower moral status.” That is why we rejected the eugenics programs of the past.

Savulescu points out that “If either the embryo or the fetus has a moral status – then it would be wrong to kill either, whether or not a disability is present. If the embryo or fetus does not have a moral status, it should be permissible to destroy an embryo or abort a fetus for any reason. In this way, paradoxically, allowing testing for diseases, but not for other genes, is eugenic in objectionable ways.”

It would be easy to go from there to saying that genetic testing of embryos and fetuses for the purpose of selecting who will be allowed to be born should not be done based on the principle of the value of all human lives underlies our rejection of eugenics, but he does not go that direction. Instead he moves toward the permissibility of all embryonic and fetal testing by saying that lifting the restrictions on personal liberty imposed by limiting genetic testing of embryos and fetuses to testing for disease would resolve the moral objection that the current policy involves morally impermissible eugenics. He gets there by saying that since most people already accept the testing of embryos and fetuses for diseases, we should not say that all such selective testing is wrong based on the moral status of embryos and fetuses and the way to validate people’s acceptance of testing for diseases is to allow testing for non-disease characteristics.

Savulescu’s means of getting to his conclusion is an interesting and commonly used one to justify things that have previously been understood to be wrong. Rather than giving arguments for why we should believe that a human embryo or fetus does or does not have full moral status, he says we have already accepted a limited practice that would otherwise have been considered immoral, so we should accept a broader version of the same sort of practice. This is the process by which immoral behavior takes over a society, and also the process by which an individual falls into immorality. First justify a very limited violation of morality, and then once that is accepted use that to justify further immorality.
That is why we need to stand firm on basic moral values such as the dignity and value of every human life. Defending the moral status of the weakest and most defenseless human beings is essential to avoid the acceptance of things like aborting fetuses because they are female that currently seem obviously wrong, but may become accepted by a gradual breakdown of moral values.

Eugenics in Our Day

Researchers have now developed a technique for doing genetic testing of a fetus by using cells circulating in maternal blood, avoiding the more invasive and dangerous technique of amniocentesis.   These new technical capabilities hail the dawn of a new age of eugenics, or the pursuit of “good (eu) genes.”  With these new technical achievements, physicians can gain knowledge of the child’s genetic makeup as early as 7 weeks after conception.  This can mean a new opportunity for interventions earlier in the pregnancy for the sake of the health of the child or it may provide doctors with more information to inform a decision to abort the child.

Arthur Caplan helped develop guidelines for organ transplants in the 1980s and has for some time pressed for similar oversight of the “wild west” of reproductive medicine, largely because of its eugenics implications.  He is very aware that genetic testing could be used for selecting athletic ability, eye color, or gender.  Sex selection using abortion is already something practiced in countries like India and China, and genetic testing using maternal blood would only make it easier.  However, Caplan is firmly pro-choice, saying that there are good and bad reasons for an abortion.  As Caplan puts it,“Sexism is not a good reason for ending a pregnancy.”

What is missing in this discussion is our response to those with diseases and abnormalities.  To many, a chromosomal defect like Down Syndrome or a physical abnormality like malformed limbs is a good reason for ending a pregnancy.   Too often our attitude to those with abnormalities and diseases is to consider them as unfortunate mistakes rather than opportunities to live in fellowship with another human being.  We think getting rid of the mistake solves the problem, especially when it involves fetal tissue out of our line of sight.  If our drive for perfection bumps into human autonomy, we back off.  If it does not, we proceed in getting rid of the patient if we can’t get rid of the disease.  This is a serious misunderstanding of the ethos of medicine.  An improvement in our ethical strategies will not come from a new set of protocols to use in the clinic.  It will only come about if physicians adopt a new value system concerning the purpose of medicine and develop their character accordingly.

Henri Nouwen, well-known for living in the L’Arche community for adults with disabilities, articulated  a vision of such an ethic when he said, “When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

Click here for a video of Art Caplan discussing gender selection.