In Memory of Edmund D. Pellegrino

I cannot claim to have had anything more than a casual and intermittent personal acquaintance with Professor Pellegrino, whose passing this last week is a great loss for bioethics, medicine, academia, and the church alike. I did, however, have the privilege of meeting him on several occasions (always at CBHD summer bioethics conferences!), as well as, more recently, the honor of serving as a co-editor of an edited book volume to which he contributed a chapter.[1] In all my interactions with him, he was always the epitome of graciousness and generosity of spirit.

As several other bloggers have noted on this site, one of Pellegrino’s chief contributions was to draw our attention, repeatedly and consistently, to persistent and fundamental questions and concerns that are all-too-often neglected in this age in which the “technological imperative” so frequently carries the day. Questions such as: what exactly are the “ends” of medicine? And how do our present medical practices square with those ends? Concerns such as: what does it mean to be a physician? To be a patient? To encounter one another, as physician and patient, respectively, in the clinical context?

Chief among these concerns was an increasingly countercultural commitment to the notion that medicine, as both an art and a profession, really does possess an “internal” morality—that is, a coherent set of moral principles and ethical guidelines arising out of the nature of the medical practice itself, and embodied in a shared set of assumptions (moral and otherwise) and values to which members of the medical profession are (or ought to be) committed. This contention of Pellegrino’s, central as it was to so much of his work, naturally attracted much criticism—and, to be sure, one cannot help but suspect that, for all practical purposes, medicine as an institution today increasingly looks more and more like a “vending machine” responsive primarily to the vagaries of consumer demand and sociopolitical agendas, rather than the robust, ethically-constrained profession to which Pellegrino continued to call its practitioners throughout his career. To his credit, however, he stayed true to his convictions on this matter, even in the face of opposition—a strength of conviction that is worth emulating in its own right.

Importantly, as a Catholic believer, Pellegrino was both courageous and consistent in his insistence that a proper understanding of medicine as a practice can be attained only in the context of a theologically-informed understanding of reality. For Pellegrino, this meant a continual return not only to the philosophical underpinnings of medical practice, but ultimately, the theological foundations upon which all of human experience—including the clinical encounter—is grounded.

For his rigorous, consistent, and persistent insistence that bioethics be approached from within a philosophical-theological framework that attends to the deep, fundamental “first things,” Pellegrino is to be admired and emulated. For his unfailing personal graciousness, he will be missed. And for his contributions to bioethics, medicine, academia, and the church, he will be cherished.

Rest in Peace, Edmund Pellegrino.

[1] See The Development of Bioethics in the United States (Springer, 2013). Pellegrino’s essay, entitled “Medical Ethics and Moral Philosophy in an Era of Bioethics,” addresses four issues in particular:

First, it examines the sociocultural context that gave birth to bioethics, which is characterized by the rejection of traditional moral authority and the rapid development of biomedical sciences and biotechnology. According to Pellegrino, this particular milieu recast traditional medical ethics outside its philosophical foundation and paved the way for the emergence of bioethics. The second issue relates to the decline of medical ethics as the source for the professional ethics of physicians. Bioethics reconfigured medical ethics within the particular socio-cultural and scientific context of the 1960s. Pellegrino deplores this shift because it redefines the patient-physician relationship in term of social mores instead of the traditional foundations of medical ethics. Third, Pellegrino looks at the meaning of the word “ethics” in the terms “medical ethics,” and “bioethics,” each presupposing different moral visions. Medical ethics, he contends, presupposes rigorous classical philosophical ethics whereas bioethics, in its latest iteration (i.e., “progressivist bioethics”), combines the values of liberalism and pragmatism to advance its socio-political agenda. Pellegrino sees the latter development of bioethics as problematic because it conflates social mores and political ideology with ethics. In his view “ethical discourse must go beyond activism or political ideology,” whether in its progressivist or conservative conceptualization. The fourth and final issue Pellegrino addresses is the plea for a “more rigorous adherence to classical philosophical ethics” to ground ethical reflections in concepts such as the good, the right, and the just, rather than in particular ideologies. To this end, he makes a call for a reconsideration of the potential role of moral philosophy in bioethical and medical ethics debates.

Jeremy R. Garrett, Fabrice Jotterand, and D. Christopher  Ralston, “The Development of Bioethics in the United States: An Introduction,” in J. R. Garrett, F. Jotterand, & D. C. Ralston, eds., The Development of Bioethics in the United States (Springer, 2013), p. 12.

Animal Rights, Part I

I find it rather curious that in my line of work, as a veterinarian in small-animal clinical practice, I have very few conversations that tackle the issue of the rights of my animal patients. Maybe it’s because much of the legal landscape dictates the relationship we have with pets: I am still my dog’s “owner.” Harm that comes to a pet can lead to damages based entirely on the “replacement value” of the pet, not due to pain and suffering, or other subjective factors. Property rights, not moral rights, are where the law speaks.
As I have tried to draw my own conclusions on what rights, if any, animals may have, I largely read books with which I disagree, much to my dismay. Chief among these, of course, are the writings of Peter Singer. His notion of “speciesism,” a pejorative term that equates differentiation of value between humans and non-human animals (heretofore I’ll just call them “animals”) to be a great moral evil akin to racism and sexism, would seem to many to be a crackpot theory from an irrelevant, ivory tower philosophy professor. But the utilitarian idea espoused in Singer’s landmark Animal Liberation that equates the level of moral consideration of an individual, human or animal to be commensurate with the level of pain the creature may feel is probably more accepted in Western society than many of us realize. An entire branch of sociological study is dedicated to the “human-animal bond.” That bond is significant, and often a very positive force for human mental health and animal welfare. But we may have a greater emotional connection with a beloved pet than a dying relative, and unwittingly afford them moral status based on this emotional bond. More troubling, Singer’s radicalism is (surprisingly) fast becoming mainstream as the inherent dignity of human beings is undermined by ethical relativism and limitless personal autonomy.
But, as with many things, the reflexive response is unsatisfying as well. Christians who recoil at the subjugation of human dignity at the altar of animal liberation fail to understand our relationship to the animals God has created (and, indeed, all of creation) by misunderstanding Scripture. Much abuse can be heaped upon the Genesis 1:28 “dominion” mandate. In their view, the moral status of animals is utilitarian, but not Peter Singer’s utilitarianism. Animals were placed here for us, and we should enjoy what they provide for us without much concern for them beyond that.
But that, too, fails to understand the message of “dominion.” We are given power over animals, but that is fraught with responsibility as stewards of creatures that God takes very seriously. Some authors, prominent among them Robert Wennberg, go to lengths to find rights for animals in the Bible, particularly the right not to be eaten as human food. Ultimately, they struggle to find strong scriptural support, rely on extrabiblical sources, and don’t address in a practical way what “dominion” means .
I’ve become convinced that an effective view toward animal rights (one that really holds water) is based on a stewardship ethic that can only be found in Christian thought as put forth in Scripture. This will take some unpacking, and I will attempt to do that over a few blogs.