On Testimonial and Argument in Bioethics

We all know, as Steve Phillips reminded us yesterday, that Brittany Maynard took the pills this past Sunday, one day later than she had originally planned.  In the days before that, she appealed to our compassion for her in her suffering—and powerfully at that.  Equally powerful were stories from the likes of Kara Tippetts and, as Steve pointed out, Maggie Karner, two women with terminal brain tumors, one metastatic, the other, like Ms. Maynard’s, primary. 

The medical details matter less than the shared aspects of these women’s experiences, for, indeed, we take it as axiomatic that such shared experience more than deepens the two responses—it is, we tend to think, a necessary prerequisite.  Who can speak to someone without standing in his or her shoes, as the saying goes?  Why should someone in present good health presume to be able to speak into the experience of another who is suffering?  How can anyone not facing death dare to speak to a terminally ill person, much less lecture her, about physician-assisted suicide?  To even address the topic on the grounds of principled argument sounds insensitive, like screaming at another from the depths of an unloving heart.

As a case in point, look back, for example, at Ezekiel Emanuel’s 2012 New York Times blog post, “Four Myths about Doctor-Assisted Suicide.”  Look especially at the comments that were posted.  (Note that the comments section has long since been closed.)  Many of them take the tone of, “Dr. Emanuel, how can you be so cruel?”  Now, some, including your current correspondent, think that Dr. Emanuel is often guilty of trying to tell us how our lives should be run, but in this case, his arguments were temperately, even eloquently, made, and I think one is hard pressed to find a mean spirit in them. 

The real complaint runs deep—autonomy and personal experience are taken to be normative.  But our experiences are embedded in a much broader context, a much larger reality.  And that reality demands thoughtful reflection and logical argument to which we subject our individual experience.  And, in this case, reflection and argument remind us—as we have been discussing on this blog for a some time now—that dignity in dying calls for care of the whole person but not giving that person a push into the hereafter; that dignity in dying must not be misconstrued into a reason to open doors to much darker scenarios.

Substitution of testimonial for argument may seem like a tempting ethical method in general.  As a further example, last month the online Bloomberg Politics ran a story about a project by Planned Parenthood to promote support for abortion on demand by taking a page from the same-sex marriage advocacy playbook and having women who have had abortions canvas, door to door, to tell their stories in the belief that they, and by extension the practice of abortion, will be viewed in a more favorable light.  And perhaps that will happen in some cases.  Or perhaps they will be received like Jehovah’s Witnesses at the door.  But the process cannot negate over 40 years of recent history’s thoughtful—albeit pitched, to be sure—discussions of the matter.  Nor should it.  And I wonder whether the approach will “travel” in the case of abortion.   After all, there is a substantial precedent of “counter stories” from women who decided they would choose life in the moment, or, as a result of changed convictions, in the future.  And there is no testimony from the silent, unborn one.  And the appeal would be in support of something that the appealer already has, after Roe.  And so on.

Individual stories are precious, always to be respected, but not entirely normative.  And the “retail politics” of those stories is a poor ethical method.

 

Who cares about the well-being of women who have abortions?

Currently the states of Texas and Louisiana have laws about the regulation of abortion clinics that are being disputed in the federal courts (see articles by CNN and The Christian Science Monitor). These are not laws about banning abortions. They are laws about safety regulations for abortion clinics. Within the past week federal judges have blocked the implementation of a law in Louisiana that would require physicians performing abortions to have admitting privileges in a hospital within 30 miles of the clinic. Abortion supporters have taken the state to court because they say that the law would result in the closing of all five of the abortion clinics in Louisiana. A federal judge in Texas has blocked the implementation of a law that would require that abortion clinics meet the safety requirements of an ambulatory surgical center. Abortion supporters have claimed that this law would result in closure of 14 of the 20 abortion clinics in the state. The same judge previously blocked the implementation of a law in Texas requiring abortion providers to have admitting privileges at a hospital within 30 miles of the clinic, but an appeals court overturned that ruling and the law has been implemented. There were 40 abortions clinics in Texas prior to the implementation of that law and there are now 20.

Are the supporters of abortion in Louisiana saying that they cannot find even one physician to do abortions in that state who is able to obtain admitting privileges at a local hospital? If so how qualified are the current providers who cannot get hospital privileges? How safe are the women they are treating? I have served on enough hospital committees to know how difficult it can be to fulfill requirements for accreditation and meet state and federal safety requirements, but it can be done, and it is the best way we have to be sure that facilities are focusing on patient safety. Are the supporters of abortion in Texas saying that the majority of the current abortion clinics in the state are incapable of meeting the safety standards required to do procedures such as D&Cs, endoscopies or arthroscopies? A surgical abortion presents at least as much risk to the woman being treated as those outpatient procedures and her safety should be as important as the safety of patients having those procedures. How safe are the women being treated in abortion clinics that are incapable of meeting the safety requirements for other ambulatory surgical procedures?

I’m old enough to remember the debates about abortion before it became legal in the US. One of the strongest arguments for legalizing abortion was that there would be women who would have abortions whether they were legal or not and that legalizing abortion would make it safer for women who chose to have abortions. If the overriding concern is the well-being of women why are those who advocate for abortion not seeking to make the abortions that are done as safe as possible? The fight against safety measures for women who obtain abortions suggests that the well-being of women with unwanted pregnancies is not the primary concern of those advocating for abortion in the US.

“Release to Elsewhere” and (vs?) the Reality

World magazine suggests that the movie version of Lois Lowry’s youth novel The Giver is an important entrée to discussions about human dignity, abortion, and euthanasia.

My wife and I saw it last weekend.  Our response to the above:  Maybe, but probably not.

The overwhelming message of the movie seems to be about human freedom:  If people have freedom, they will make bad choices, but take that freedom away, and the results are far worse.

Certainly a fully engineered, totalitarian society can be expected to commit crimes against human dignity.  But the world of The Giver seems so totalitarian-over-the-top that the viewer has an out:  nobody would ever stand for that.  And indeed, nobody would.

What we are standing for seems rather more insidious, until one steps back and looks at it:

  • Autonomy run amok, spreading the assumption that anyone properly holds the authority to determine what lives should end, when;
  • Pressure for choice to serve a false sense of what constitutes an “optimal” human being, and applying management principles to those choices in a pseudo-scientific or pseudo-objective fashion, as Dr. Susan Haack pointed out in her outstanding August 23 post on this blog;
  • Treating “physician aid-in-dying” as a public health good;
  • Pressure to push people to starve themselves;
  • Withholding efficacious treatment to save a few bucks;
  • Reprimanding a euthanasia clinic for not following the bureaucratic process;
  • And yes, unilateral DNR orders at a major academic hospital, something I’m investigating in further detail.

Little of this is being forced on us by a tyrannical government.  We’re asking for it or acquiescing in it.

I will admit that The Giver’s “release to elsewhere” euphemism fits much of what is going on in our actual world.  But I’m not pushing people to see the movie.  Rather, I’m telling them that, if they see it, not to let the otherworldliness lull them into a false sense of security.

Breast Cancer, BRCA Mutations, and Attitudes about PGD

If you knew you had a gene mutation that confers a high risk of cancer, would you use IVF and preimplantation genetic diagnosis (PGD) to prevent passing on the mutation to your offspring?

That is the question that cancer doctors at MD Anderson Cancer Center in Houston put to 155 young women, still of childbearing potential, with breast cancer.  The doctors actually asked their patients a number of questions related to childbearing after their cancer diagnosis; I’m focusing here on the PGD question.

As you read on, keep in mind that the majority of patients would have been Texans—that is, residents of a “conservative” state.

Infertility is a serious complication of treating cancer in young people.  For decades, sperm banking has been an option for young males with cancer who might want to conceive in the future.   Various technical advances in assisted reproduction technology (ART), including oocyte cryopreservation (freezing eggs), have opened up options for young females whose cancer therapy impairs if not frankly eliminates their ability to ovulate.  To be sure, these options generally require in vitro fertilization (IVF), be it with a woman’s own or donated eggs.

While there are several ethical issues related to childbearing after cancer treatment, the researchers in this case were concerned about the patients’ attitudes, and whether those were affected by learning, from a genetic test, whether they carried cancer-susceptibility mutations in the “BRCA” genes.  For my purposes here, the upshot:

  • About 1 in 4 women said they were likely to pursue PGD or prenatal diagnosis (PND, through amniocentesis or chorionic villus sampling) as part of their decision-making.
  • Knowing the results of the genetic testing didn’t change that number much at all.
  • Perhaps a slightly higher number of the women—closer to 30%–would consider PND rather than PGD.
  • About 2 in 5 said they would be unlikely to pursue PGD or PND.
  • About 1 in 3 were undecided.
  • About 80% thought that, irrespective of their own personal preference, PGD and PND ought to be available to families with BRCA gene mutations or other inherited cancer syndromes.

I read this as fairly widespread acceptance of PGD or PND to prevent the birth of some children with cancer-susceptibility gene mutations.  Surely no one desires to pass on significant risk of serious disease to his or her progeny, but I find the acceptance of PGD or PND troubling nonetheless.  If you accept that PGD may be used in limited cases, to prevent the birth of infants with devastating disease, where do you draw the line?  Where will societal, economic, and government pressures draw the line?  And does making PGD and PND “available” mean that others have a duty to support it?  Is there a place for religious exceptions?  All standard questions, to be sure.

The study in question was published in the August 2014 issue of The Oncologist.  It can be accessed free online (registration required) here.

Is complicity important in Hobby Lobby decision?

Written by Jay Hollman, MD

The ethical issue for a pro-life employer (as discussed in the majority opinion) is that of complicity. The issue of complicity is a subject often surfacing in the charity clinic in which I work. As I discuss the reasons for patients to stop using illegal drugs we discuss health risks if applicable. This is unconvincing to some who regard marijuana as no more dangerous than alcohol. But as we discuss complicity with the drug trade and how drug use has made many Mexican border towns effectively war zones with thousands killed, many of innocent bystanders, they get the concept of complicity. If all Americans stopped using illegal drugs, we would not only reduce crime in the U.S. but also in Latin America. Since most of our patients live mostly in dangerous neighborhood where violent crimes are common, they can easily understand how buying drugs can make life difficult for many innocent people.

With their understanding of four of the twenty mandated contraception methods, the owners of Hobby Lobby believe that by purchasing group insurance that offering these options might facilitate one of their employees to engage in an immoral act. But if Hobby Lobby did not offer these 4 contraception methods they would be subject to fines of almost 20% of their annual sales, an impossible burden. It is presumptuous and arrogant for any one group in our pluralistic society to think that they know the moment when human life begins. It is not unreasonable for a person to believe that human life begins at conception. If this is believed then it is wrong to fund methods of birth control that would act to end nascent life.

An American capitalist might disagree with his daughter who believes that it is unethical for her to purchase certain products from China because these companies are excessively polluting the Chinese water and air. But he should be tolerant of her view and, if indeed, there is some truth to the pollution claim, he should be proud that his daughter is willing to forgo certain products or pay a higher price to obtain the product from a less polluting company. In the same way, if we desire a strong pluralistic society, we should laud individuals and companies that are determined not just to the correct thing themselves but are also striving to help others do the correct thing. Hobby Lobby demonstrates that the owner’s religious convictions by not being open on Sundays which cost the company millions.

The tone in the media following the Hobby Lobby has been strident. If this is continued, likely nothing positive will happen in health care reform in the current Congress. Most in health care are ready for some real health care reform. Physicians are struggling with electronic medical records systems that decrease their efficiency and invite fraud. All providers and hospitals are strapped with complex regulations that defy common sense. Millions are still uninsured. Most of the patients in my charity clinic cannot afford even the cost of Bronze Plans on the Exchange. All the while we are wasting an estimated $910 billion dollars per year on medical diagnoses, treatments and overhead that do not provide any benefit. Reduction of waste should be a high ethical priority upon which we all should agree. The ACA has started the process of reform by such measures as eliminating lifetime caps on health insurance, allowing young adults to remain on their parent’s health plan and eliminating the pre-condition clause that made insurance unaffordable for those with chronic conditions.

It also must be remembered that ACA is, from its very beginning, a partisan act. Continued litigation will not unite the country but compromise can. Forcing individuals and their companies to act against deeply held religious belief should not be done and will only inflame partisan rancor. This issue in itself is small compared to the large task of completing health care reform. One could hope that both sides might see this decision as an opportunity to change the rhetoric and sincerely work on a compromise plan that would extract waste from our current system and make health care available and affordable to all.

Bioethics @ TIU guest author Jay Hollman teaches at LSU Health Science Center and cares for mostly indigent patients. Dr. Hollman is a 2012 graduate of Trinity’s MA in Bioethics program.

Burwell v. Hobby Lobby: A thin margin indeed

The recent Supreme Court decision, Burwell v. Hobby Lobby, has been hailed as a victory for religious rights, but in the Supreme Court’s majority opinion there are ominous signs for bioethics.

First, no commentator so far has mentioned that the Supreme Court decision implies that the only legally viable objection to underwriting abortifacient interventions must be religious in nature. The thin margin of decision by a majority that repeatedly referred to the Religious Freedom Restoration Act indicates that anything less compelling than a “sincere Christian belief” would be insufficiently persuasive. The belief at issue was that life begins at conception.

Thus there seems to be no legal room for a secular argument against funding abortifacients in Hobby Lobby’s situation. But what if someone held a purely scientific belief that life begins at conception? Would we not hope that such a person, who came to such a conclusion based on scientific evidence, would then have deeply held moral views about abortifacients? And if so, shouldn’t there be any an equal legal respect for such views?

In fact, what is specifically “Christian” is not the belief that life begins at conception. That is a scientific fact; what the Christian then does is conclude that there is moral consequence to the fact. He then has conviction to act based on this belief.

There are serious concerns here—one is that these events indicate that in our society those without religious beliefs are failing to demonstrate the moral conviction to act on the scientific fact that life begins at conception. The second is that should such secular moral conviction occur, the legal system would fail to grant legal standing to it. The Supreme Court majority made no attempt to accommodate a nonreligious belief; certainly the minority would not do so either.

A third concern is that there is ample evidence that many who support abortifacients deny the scientific facts altogether. They create arguments that what is being destroyed by abortion and abortifacients is not yet actually human life. In these instances they reveal that while they retain a moral sense that ending human life is wrong, they decide to override it with fanciful and convoluted cogitations in order to justify other desires. They simply lack sufficient moral conviction that respecting human life is paramount; both truth and the embryonic human become expendable.

The outcome of Burwell v. Hobby Lobby certainly could have been worse. But as it is it bodes poorly for the state of modern bioethics, for it is shows that there is no active nor legally viable line of defense against assaults on nascent human life than a Christian community increasingly marginalized by its own government.

Musing About the Hobby Lobby Decision

I am in the camp that applauds this week’s Supreme Court decision in the Hobby Lobby case.  But of course others disagree, and I was not surprised to see that there is alarm on the pages of the New England Journal of Medicine.   A “Perspectives” article written by two attorneys (one with a bioethics degree) and one M.D. includes two graphs, in particular, that I think are key.

The first:

[I]n the wake of Hobby Lobby, we may anticipate challenges to other medical services that some religions find objectionable, such as vaccinations, infertility treatments, blood transfusions, certain psychiatric treatments, and even hospice care. Hobby Lobby‘s implications may also extend into civil rights law, with employers asking to “opt out” of laws intended to protect people from employment and housing discrimination based on religion, race, sex, national origin, or pregnancy status. Although the majority deemed these slippery-slope concerns unrealistic, the dissent expressed serious concerns.

So the slippery slope is a fallacy, except when it isn’t.  This paragraph sounds like Justice Ginsberg’s dissent, which commentators much more qualified than I have found over the top.  But grant that this decision may not—and I guess I should say, probably will not—stop with this case.  How plausible is the list above?

  • Vaccinations?  I think that a challenge would fail because the government’s interest is too compelling—although as I understand it the Court majority did not invoke this line of reasoning in Hobby Lobby. Parents already “opt out” of vaccinations for their kids—a poor decision, in my view.  And maybe a separate government initiative to insure that vaccinations are paid for would be a good idea.  I don’t think this one is a likely problem.
  • Infertility treatments?  Legitimate point.  I might see religious objections to providing insurance that pays for IVF—and I believe such an objection should be honored.
  • Blood transfusions?  I wouldn’t rule out a challenge, but I doubt it would succeed.  Too interwoven in too much of medicine and surgery, and too compelling an interest to allow an opt out under the Religious Freedom Restoration Act (RFRA).  (I suppose if we had single payer, that would be an alternative for the government…)
  • “Certain” psychiatric treatments?  I guess I’m not sure what is meant here.  Perhaps some reader can fill in the blanks.  On the other hand, the government might try to block insurers from providing access to “certain” counseling treatments deemed illegitimate by them but allowed by some religious groups.  I suppose.
  • Hospice care?  No way.  Unless a secular business owner wanted to prefer coverage of physician-assisted suicide/physician-aid-in-dying.  I’d expect religiously devout people to want to protect hospice care out of concern for human dignity.  Perhaps a Christian Scientist would object under the umbrella of not wanting to provide access to medical care—but couldn’t such a person decline to insure employees at all and choose to deal with the consequences under the provisions of the ACA?  Or wouldn’t we expect a broad challenge on religious grounds to fail, again because the government’s interest is too compelling?
  • “Opt outs” that are really forms of civil discrimination?  I thought that was specifically excluded under RFRA.

The second key graph:

Though the decision applies only to closely held, for-profit corporations, it sets a precedent for religious exemptions that could have sweeping implications — and reflects the Supreme Court’s great potential impact on U.S. health care. Yet the Court was applying Congress’s statute, and Congress could, if it chose, scale back the protection offered to religious objectors — a good reason to share public reactions to the decision with our elected representatives.

This sounds like a fair point and fair warning.  The struggle for religious freedom continues.

I can’t resist adding that, if people could freely buy their own individual insurance, and not have to depend on employers providing it, maybe the range of choice could be more easily accommodated.  Our employers don’t tell us what our auto insurance options are.  They may offer life and disability insurance, but we can buy more, or different, coverage.

As a long-winded pastor used to say, “This and I’m through”—Justice Alito’s discussion of what it means to incorporate pointed out, if I am getting it right, that forming a corporation is one way for human beings to associate to achieve ends that are not limited to profit.  That, of course, is the hard thing for medical-related enterprises to keep in focus and put into practice.  But it is clearly true.  As organizations get bigger and more far-flung, however, the interests of the human beings become less commensurate, and we slip into money being the sole reason for existence.  But it is not.  Most of the people who work for a drug company, for example, may not be bound to the Hippocratic Oath, but the company works, as it were, under a “Hippocratic umbrella” where the needs of the patient, or patients—and I would distinguish this from the population—dictate the rewards for all other actors in the system.

“The Power of Three”

That is the title of a news piece accessible at Nature’s website this week.  It refers to something that Steve Phillips and I posted on back in February; to wit, the potential for “three parent babies” resulting from the transfer of a nucleus (and its genetic material) from a diseased mother’s egg cell into the enucleated egg from a healthy donor.  (I am skipping important technical nuances with that description; see the Nature article for at least a partial description.) The disease(s) in view are mitochondrial diseases, rare but devastating disorders resulting from abnormal mitochondrial genes, of which there are all of 37, compared with on the order of about 20,500 human genes overall.   Human sperm transmit no mitochondria to offspring, so mitochondrial diseases are inherited from the mother.

The Nature piece, while far from complete, is a pretty good introductory discussion of the work for the general reader.  It briefly addresses some, but not all, of the implications.  The subtitle says that this work is “on the verge of clinical use” in the hope that women with mitochondrial diseases might be able to bear unaffected offspring.

I count at least 10 ethical issues raised by this work.  There may be more.  Steve and I touched on several in February, but the Nature article offers the occasion to try to list them briefly.  I don’t pretend the following list is complete, and space prevents me from trying to address them.   Also, there was an excellent piece last year in CBHD’s Dignitas, which I cannot lay hands on, and could not do justice to, here, in any event.

First is the question of risks to any immediate offspring.   It is not clear that the egg modification process will eliminate diseased mitochondria, or avoid further complications, including, conceivably (apparently based on work in mice and fruit flies) other genetic or general disorders not directly related to the mitochondrial defects.  As Steve and I commented in February, these risks are far from fully understood.

Second is the question of informed consent.  The unborn, much less the yet-to-be-conceived or yet-to-be-implanted, obviously can’t provide informed consent.  The intended mother would have to do that.  That’s not necessarily outside the pale.  Presumably a child otherwise destined to be afflicted with these disorders would be willing to take considerable risks to try to avoid them, and in any event existing regulations allow more-than-minimal risk research in pediatric populations if there is a sufficient prospect of direct benefit to the subjects.

Third is the question of whether there would be any risk of inherited disorders to the second generation—the offspring of the “treated” child.  Researchers in the US have followed two generations of monkeys after the sort of nuclear DNA transfer envisioned, and report they appear normal.  Some scientists would want to see many more generations.

Fourth is the possible strategy of sex-selective abortion to try to prevent the concern raised by the third issue.  One presumably would want to have only boys born of these procedures, to try to interdict any subsequent maternal transmission.  This assumes that the boys’ genomes are not adversely affected in the process.

Fifth is the practical fact that, to perfect the nuclear transfer technique, it would be considered advisable to do substantial practice with human eggs and sperm—i.e., create human embryos solely for research purposes, and of necessity subsequently destroy them.

Sixth is the commodification issue.  The eggs developed would be considered a form of cellular therapy, and be subject to strict manufacturing controls.  Presumably each case would be unique, so that buying and selling would be limited to compensation of the healthy egg donor.

Seventh is a form of the “slippery slope” worry—that the technique is broadened to become a treatment for infertility (already actively contemplated).  This is a concern in that it further commodifies reproductive medicine, and that it portends other ambitious extensions of the genetic modification of  humans.

Eighth, and related, are the broader twin concerns of confusions about parentage, and the wisdom of opening the door to introducing heritable changes on purpose into humans.  There is both the more consequentialist perspective on this—do we know what we are doing?—and also the concern that choices about introducing the technician so much more intimately into the outcomes of reproductive choices.

Ninth is the fact that all this is coming with relatively little discussion in the general public.

Tenth is a type of justice issue—this won’t be cheap.  Why this and not some other use of our resources?

Now, a difference of 37 mitochondrial genes is not going to make someone wonder who his mother really is.  Perhaps this would be one thing if we could be assured that we can establish a narrow scope and firm boundaries around this work, in the name of observing the “therapeutic boundary.”  But experience shows that such boundaries do not hold.

Abortion and the personhood of the fetus

In my post last week I addressed the idea that uncertainty about the personhood of a human embryo or fetus should lead us to think that we should refrain from causing harm to any entity that might be a person. Therefore, if we are uncertain about whether a human embryo or fetus is a person we should protect that embryo or fetus in case it is a person.

One of my students, Mark Taylor, wrote a paper this spring in the Medical Ethics class I teach that took a different approach to the disagreement in our society about the personhood of the human fetus in relation to the issue of abortion. In contrast to Judith Jarvis Thomson who took the position that abortion should be permissible even if the fetus is a person, he suggested that there are reasons to consider abortion impermissible even if the fetus is not a person.

His arguments are based on the idea that the impermissibility of an action is based more on the moral obligations of the person performing the action than on the rights of the object being acted upon. He presented an argument from aesthetics and virtue and an argument from justice that supported the position that abortion is impermissible even if the fetus is not a person. The first argument says that a fetus is a complex human organism which is a thing of beauty which has been created in most cases by an action chosen by the mother which was known to lead to the creation of such a beautiful being. To choose an abortion would be an irrational act that would be wrong in the same way that it would be wrong to create a great work of art only to destroy it. It would also violate the virtue of responsibility by engaging in an action know to add beauty to the world only to destroy that which is beautiful rather that caring for it. This argument only applies to the abortion of pregnancies that result from consensual sex, but those make up the vast majority of abortions. He argues that failure of contraception does not negate this argument since it is know that contraception is not foolproof.

The argument from justice is based on Rawls’ concept of justice as fairness and the use of the veil of ignorance. Central to Rawls’ system is the idea that a just society is one in which a person who does not know what role he or she will play in that society would judge the society to be fair. Taylor argues that one of those roles that the one judging the fairness of the society might assume behind the veil is the role of the fetus. Even if the fetus is not a person, we all go through the stage of being a fetus so just as the person behind the veil might take on the role of a child the role of the fetus should also be considered in whether the society is just. If the role of fetus is one that the one judging the fairness of the society may assume then it would not be concluded that if would be just to allow a fetus to be aborted.

These arguments suggest the possibility of being able to argue for the impermissibility of abortion no matter what position is taken on the personhood of the fetus. If the fetus is a person then the traditional arguments against of killing an innocent person apply. If we do not know whether a fetus is a person then we should refrain from killing an entity that could be a person. If the fetus is not a person there are still reasons why a person would have a duty not to destroy the fetus based on obligations of virtue and justice that are not dependent on fetal rights or personhood.

The implications of uncertainty about personhood

Many times the different parts of my life conflict with each other, but sometimes they come together in interesting ways. Susan Haack’s recent post on the article “The Fetus, the “Potential Child,” and the Ethical Obligations of Obstetricians” from the journal Obstetrics and Gynecology contained a quote that connected with a reference to an article by Christopher Tollefson by one of my students in a recent paper. The authors of the Obstetrics and Gynecology article stated that the issue of whether a fetus has full moral status is “irresolvably disputable” and from that drew the conclusion that the fetus has no independent moral status and subsequently reached the conclusion that abortion is permissible. Tollefson, however, has argued that an inability to decide whether a human being at a certain point in development has full moral status should actually lead to the opposite conclusion.

In his article “Embryos, Individuals, and Persons: An Argument Against Embryo Creation and Research” in the Journal of Applied Philosophy in 2001, Tollefson argued that in order to conclude that destructive research on human embryos is permissible it would be necessary to establish conclusively that the human embryo is not a person. His argument is that if it is uncertain whether an entity is a person or not it would be wrong to intentionally kill it. Therefore, it is wrong to conclude that it is permissible to do destructive research on early human embryos because we don’t know or can’t know whether those embryos have full moral status. The uncertainty about their moral status means that we should avoid the possibility of killing a person if those embryos would happen to be persons. That same idea can be applied to the “irresolvably disputable” issue of whether a fetus has full moral status. If the issue is unresolved then there exists the possibility that a fetus is a person with full moral status and we should not kill a fetus if that possibility exists.

An example that would be readily understandable to many of my rural Midwestern patients and neighbors can illustrate this point. Assume you are a deer hunter in the woods of rural Indiana and you see something move in the underbrush. You are not sure whether it is a person or a deer. It would be morally wrong to shoot at whatever was moving without determining with certainty that it was not a person. In the same way doing embryo destructive research or an abortion is wrong unless you are able to determine with certainty that what is being killed is not a person. Uncertainty about the personhood of the embryo or fetus means that it would be morally irresponsible to kill it.

It would be sad to think that the typical deer hunter has more moral responsibility than a medical researcher or physician.