How to make Nazi doctors

Most people who go into medicine have as at least part of their motivation the desire to help other people. I’m sure this was as true in 1930’s Germany as anywhere else. So how did a cadre of Nazi doctors come not only to commit crimes against humanity, but also to defend the moral correctness of their conduct when placed on trial for those crimes? The answer is complex, but one way was through the teaching of medical ethics.

An article in the April 18th Annals of Internal Medicine tells a cautionary tale for teachers and learners of bioethics. Entitled “Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism,” the article details how the Nazi party developed a curriculum for teaching ethics in medical schools that “was intended to explicitly create a ‘new type of physician’ . . . trained to internalize and then implement the Nazi biomedical vision . . . shifting the focus of ethical concern and medical care away from the individual patient and toward the general welfare of society or the people.” The curriculum included lectures in racial hygiene, the science of heredity, population policy, military medicine, and the history of medicine. Only long-standing members of the Nazi party were appointed lecturers. The lecturer at Berlin University, Rudolf Ramm, wrote the ethics textbook used in the curriculum, which emphasized physician paternalism in practicing their moral obligation to rid society of certain groups, and asserted that every (Aryan) person in Germany had a moral duty to stay healthy.

The article’s authors write, “The Nazis neither ignored nor abandoned medical ethics. Instead, they implemented their own version of it in order to substantiate their health policies and secure physicians’ allegiance. . .  an ethic that turned away from the individual and instead emphasized the well-being of the community. . . [They] reinterpreted the Hippocratic Oath for their purposes . . . [drawing] an analogy between the German people and a sick patient . . . so that the Hippocratic Oath seemed to fit with Nazi medical ethics: Exterminating Jewish persons, disabled persons, or patients with hereditary diseases was acceptable in order to heal the organism of the German people.”

The article’s authors draw the conclusion that “we should not rely on the existence of ‘eternal’ or ‘universal’ values in medicine because it is not the medical profession alone that determines the medical ethos but also the moral climate in society, the system of government, and its political goals.” However, this seems to me backwards; it is precisely because society, government, and politics are so fickle that it is vitally important that the practitioners of this art cling tenaciously to the universal values stated so simply and starkly in the Hippocratic Oath: I will not kill, whether in the womb or out of it. I will protect patient privacy.  I will treat everyone with the same regard, regardless of their status. Real Hippocratism should have been a resistance movement against Nazism; it should be again now against the forces that are threatening to deform the medical ethos. If we do not hold fast to these values and teach subsequent generations of doctors to do the same, we will find — we are finding — that we are playing variations on a Nazi theme: for the eugenic ideals inherent in Nazism, the idea that it is morally acceptable to kill some (unborn) people to benefit others, and the belief that there are lives which are not worth living, ideas which have “laid the groundwork for medico-ethical transgressions in the past, remain in play across time.”

Oh, Those Darned Terms!

In a recent post Jon Holmlund cited Thomas B. Edsall’s op-ed in the New York Times, “The Republican Conception of Conception.” Edsall was referring to the concept that life begins at conception. It is his hope that Republicans either stake a consistent position regarding the morality of post-conception “contraception” and incur the disfavor of the electorate, or abandon their “moral purity” in favor of “pragmatism” and agree that post-conceptional interventions are acceptable.

Edsall’s states it thus:

By this logic, a presidential candidate seeking to live up to the standards set by Sedlak and others in the anti-abortion community must then agree that the IUD and morning after pill cause abortions.

The problem is that Edsall challenges GOP candidates to take an informed and consistent position, while depending on the electorate not to. His strategy relies on manipulative use of terms to produce the opposite of clarity in moral reasoning. First, he speaks of medical interventions described as “contraceptives” that act in ways beyond merely preventing conception. But he does not give them the label “abortifacient” (the proper term for an IUD should be “contraceptive-abortifacient”); the term is simply omitted. That is the best way, of course, to ensure that users of devices such as the IUD are unaware that it may act after creation of an embryonic being.

Such a position is facilitated by ACOG’s definition of pregnancy as beginning at implantation, which Edsall also hangs his hat on. This is a willful dodge. “Pregnancy” refers to the state of the woman. To claim that pregnancy doesn’t begin until implantation fails to refute the notion that an embryonic human being is in existence before then. So the woman isn’t “pregnant”….the human being is still alive, moving toward implantation. And, if the woman isn’t “pregnant” during the time after the embryo is fertilized and before it is implanted, what is her state? Is it not different than before she conceived? Does that not deserve a name? The absence of a name for such a condition is no accident, because the unnamed state is far more difficult to assign a moral status to.

This same “reasoning” behind the proposed bill in the California State Legislature  also recently mentioned in this blog by Jon Holmlund:

“The bill would provide that nothing in its provisions is to be construed to authorize ending a patient’s life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, among other things, suicide or homicide.”

So, according to this draft bill, one can take one’s own life and not commit suicide. The attempt to separate the actions that this bill would legalize from the term “suicide” is to attempt to prevent citizens from properly interpreting those actions using the moral values they have already acquired.

Are moral discussions about conception, contraception, abortion, and assisted suicide too painful for our electorate, having what Edsall describes as “its complex views and…pragmatism”? For many, yes, as proven by our unwillingness to clarify the terms needed to elucidate the moral issues regarding medical interventions blocking implantation. However, such discussions are not unwanted by all, but simply unknown to them. Remaining uninformed by the medical profession of the mechanisms of action of “contraceptives,” they are never given a chance to make an informed moral decision. Edsall (to achieve his desired virtue of consistency) would more properly make his challenge to all of us, to demand that each voter take a stance on the morality of embryocidal interventions. It is only then that they could properly interpret the candidates’ responses that Edsall so fervently desires.

The Physician’s Imprimatur

In a previous blog response about physician-assisted suicide (PAS), Mark McQuain asked, “Why involve physicians at all?” That question gets too little attention.

There are some easily discernible (and perhaps expressed) reasons why physicians are chosen to be the agents of assisting suicide. First, they have access to pain- or consciousness-relieving pharmacologic measures that also have the (in this case) desirable effect of stopping breathing when given in high enough doses. Second, by their professional ethic, physicians should approach patients with compassion, which, as mentioned previously, is the catchword that is quite deliberately attached to the act of assisting suicide by those who promote it.

But as Dr. McQuain suggests, access to painless methods for killing need not be restricted by to physicians, just as compassion is not; there is no law of physics that prevents others from assuming this role. To limit the methods and the responsibility to physicians is a willful act by society.

This leaves one main reason for committing the responsibility of assisting suicide to physicians: involvement of physicians gives it a much-desired moral certification, or imprimatur. Here is the logic, unspoken as it is:

  • Physicians have moral standing;
  • If physicians are involved,
  • Then the act has moral basis

But this gets it backwards. Physicians have moral standing based on what they do and what they refrain from doing. Edmund Pellegrino wrote often of the “intrinsic morality” of medicine which depended on the nature of the physician-patient relationship. Such morality stems as much from what is not done as from what is done.

We need not agree upon any particular bioethical issue to realize the significance of the tactic, in how it can could be used by proponents of various acts to enlist, and yes, even pressure or legally mandate, the involvement of physicians. Or, for that matter, the involvement other people whose life work is viewed by society as having moral standing.

If PAS were to be legal across the US, would physicians buy into the idea that it is consistent with the underlying ethic, or intrinsic morality, or their practice? I predict that most would not. Recall the vision of abortion (when first made legal by judicial decree) being done by the patient’s family physician, which presumed a longstanding benevolent and wise relationship. This of course failed to happen, and abortions have since become centered in facilities where patient and doctor remain, by no accident, strangers. Most physicians do not want to be associated with abortions ( and none of the many family physicians I’ve met) because they know that there is a quality to the act that impacts them; it would not be benign simply because they did it. And it is not consistent with the underlying moral and ethical basis for their medical practice.

So it will be with physician-assisted suicide. The strategic involvement of physicians will most certainly mean that some will be involved. But most who could be involved will decline, knowing, or at least sensing, the inverted logic behind how physicians got pulled into the affair to begin with.

In Memoriam

Memorial Day serves as a holiday so that, we might hope, we pause to remember those who gave the ultimate sacrifice for our freedom. We might take a holiday from thinking about things bioethical as well. But could this day hold a lesson for the field of bioethics?

To set aside a day to remember those who died in defense of freedom is not simply to make some gesture for the fallen; what we do today is of course meaningless to them. To think upon those who have passed away, especially those who died for our freedom, is to set aside time to wonder what that means for how we should live. There is no better incentive for a man to ponder what he ought to do with his life then to be reminded how easily it is lost. And if someone dies for us, then we must ask—was it worth it? What features of character and conduct must we have to merit such a sacrifice?

Perhaps the best-known modern portrayal of this idea is in the movie, “Saving Private Ryan.” As he lay dying, Tom Hanks’ character utters the words to Matt Damon’s character, Private Ryan: “Earn it.” The movie then shows the older version of Private Ryan in sorrowful remembrance, asking if he had in fact done so.

If we think about various issues in the field of bioethics, we can recognize that there are those who have made the ultimate sacrifice as well. We could consider victims of medical experimentation, perhaps. We might also consider the nearly invisible—the human embryos also sacrificed for experimentation or convenience. But there is one group whose ultimate sacrifice comes foremost to mind this Memorial Day—the aborted. These millions are far more numerous than any other group of Americans that has lost their lives for our freedom.  Of course, we could argue whether this is truly “freedom” that abortion has provided, but that is how it is justified to us.

So what features of character and conduct would render us worthy of that which has been sacrificed? It is impossible to come up with any that are consistent with nature of the act of abortion itself. For to be a people of such character to have earned the “freedom” that the aborted have given us would be to be a people who would not do the procedure at all.

Good Ethics Requires Bad News

Some bad news took me by surprise this week, taking the form of an article in the Annals of Family Medicine entitled, “Why Medical Schools Are Tolerant of Unethical Behavior.”  The authors described a medical school graduation ceremony in which the speaker thanked professors and healthcare professionals not just for competent and humane care, but for providing examples of “pure unethical behavior.”

I wondered if my surprise at these circumstances was a bit of bad news in itself. Either I was blessed to be away from such an environment, or ignorant of similar problems around me. To some relief I found (after looking quickly) that the authors were from Brazil, but a book by an American author is but the most recent reminder that the problem resides between our shores as well.

The authors themselves seemed surprised by the audience’s lack of unease or objection to the allegation, and concluded that the professional environment must be tolerant of the behaviors. They asked why, and described these possible reasons:

  1. Barriers to reporting, due to fear of retaliation, lack of anonymity, and complaining seen as a sign of weakness;
  2. Leaders turning a blind eye to problems;
  3. “Systemic disrespect,” that is, widespread problems of the healthcare system that produce long waiting times for patients, excessive staff workloads, and a culture where mistakes are not acknowledged and apologies not made;
  4. Lack of accountability by accrediting organizations for ethical behavior.

They go on to discuss conflicts between explicit and implicit values, with the implicit ones being “culturally appropriate” yet far from admitted publicly. Such conflicts produce a systemic delusion, as well as cynicism in the young and developing healthcare professional.

That such a situation exists merely highlights how critical the truth is to ethical behavior. Organizational dishonesty, in whatever form, corrodes the integrity of individuals and provides fertile ground for unethical behavior. Integrity requires a willingness both to hear bad news and to give it. Values greater than one’s personal image, comfort, or success must be paramount, or else bad news becomes a problem unto itself, as opposed to a useful and necessary tool for ferreting out problems and making organizations better.

We can’t find such integrity from purely utilitarian arguments. The authors cite, unfortunately, only utilitarian arguments for building a professional ethic (increased costs, medical errors, etc.), reminding me how the language of virtues has long ago faded from modern societies. They do note utilitarianism’s inadequacies in the problem of “administrative evil,” in which “standard operational procedures within an organization inflict harm or suffering on individuals by blindly following a cold bureaucratic rationality committed for the ends but not the means to those ends.”

It is virtue ethics that is required to fight the corrosive effect of pure utilitarian thinking, for it reminds us that one of the ends produced when disregarding means is that one becomes the sort of person who uses those means. This requires an understanding of virtues and the central nature of the character of man to any ethical system.

I am not confident that modern society is ready to recover the lost language of virtue. Virtue, it seems, must not be spoken of, lest the speaker be subject to the vitriol as experienced in the strident denunciations of Christianity we hear more and more about. To escape our mean state, however, we must venture to do so.

To discuss virtues, in turn, requires that we articulate a robust vision of the telos—the purpose and ends—of the practice of medicine. A description of a state of being greater than our common existence, greater than mathematical calculations of gains and losses, would give direction and meaning to our efforts. It would enable us to see beyond self-interest, to make the necessary sacrifices for the truth, to move ourselves and our organizations along the road to that greater goal. For such a journey, bad news becomes not an impenetrable wall or obstacle to avoid, but merely a stepping-stone.

Speaking about dignity

Several years ago, while on the verge of delivering the baby of a seventeen year old, I was taken aback by the number of friends that she had asked to accompany her at the event…an event formerly considered far more private than one in which fifteen or so friends might attend (it was a large delivery room). And speaking of private, the wording and location of her tattoo demonstrated further that private areas had lost their former distinction.

The only practical option at that time was to ignore the crowd and attend to the imminent delivery, and ensure the newborn’s and mother’s safety. I could only hope that everyone had the sense to stay out of the way if an emergency arose. There was no time for instructions, explanations, or crowd control.

All turned out well. The teenager delivered a healthy baby, and I stayed on duty on labor and delivery. Our paths never crossed again, but I have thought of that brief encounter many times over the ensuing years.

When I think of the struggle to protect human dignity from innumerable external onslaughts, I think of battles such as those over public policy, technology, and cultural trends. But what I have not seen well is how the struggle extends to the hospital bedside, when the most pressing threat is from the patient herself. How much ought we, as physicians, while comforting and testing and treating and advising, take a firm stand and square off with patients, to explain why they themselves are the biggest threat to their own dignity?

Such a stance doesn’t reconcile easily with the current notions of patient autonomy. A sense of patriarchy within the medical profession comes rushing back, and it would be foolish to claim that patriarchy was always done well.

I am hard pressed to think of examples of seeing a physician address such concerns, unless couched in biomedical terms. It is difficult to know which of the numerous behaviors a patient exhibits falls, ethically and practically, within the realm of the practice of medicine. What I can say, with the advantage of some years, is that with the transformation of medicine to an autonomy-centered realm, we have lost sight of the most important defender of each person’s human dignity: the person herself. If we are to claim our dedication to a patient’s dignity, then should we not be more willing to speak the truth about it—even if it shines a light on an area the patient would rather not be seen?

Academic Medicine: In need of an examination?

Being a physician in an academic setting, my attention was drawn to this recent article in Academic Medicine: “Time Well Spent: The Association Between Time and Effort Allocation and Intent to Leave Among Clinical Faculty” by Pollart et al.

I had mixed gut reactions to this topic; ranging from the notion that this is an awesome topic long overdue for attention, to the questioning of why academia is spending its valuable time on such internally focused research.

But I found that there is a significant practical problem facing academic institutions that is driving this and similar research—the ongoing loss of experienced and capable faculty. What the study reports to have found is that the intent to leave an academic institution and academia in general was related mostly to the clinical staff’s impression as to whether the amount of time in a given area (clinical, research, teaching, administration) was too much or too little. The authors proposed that, “academic hospitals can work with individual faculty members to find the right mix of clinical, teaching and administrative responsibilities.” This seems simple enough, but do individual organizations have such flexibility? For example, very few said that they spent too much time in research (@ 1%); the dissatisfaction here was that too little time was spent. I suspect that the demands to produce revenue through clinical duties make it unlikely that all those desiring more time for research can be accommodated.

This first article then led me to a second in Academic Medicine, entitled “Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools,” by Pololi et al.

What was disturbing about the results was the authors’ “central and concerning finding…that faculty dissatisfaction was saliently associated with faculty members’ negative perceptions and distress 
about the nonrelational and ethical culture of the workplace.” The last thing the medical professional needs is such an environment in which medical students acquire their professional values. As the authors point out, “the detrimental culture for faculty members constitutes part of the hidden curriculum for medical students, who often become less altruistic and more cynical through the four years of medical school…” and that “if faculty project that the moral, ethical, professional, and humane values articulated in the formal curriculum are not reinforced in their own experience as faculty (through the medium of the hidden or informal curriculum), the goals of educating and graduating competent, professional, and humanistic physicians may be undermined.”

My academic setting is a smaller hospital and not the large university medical center and school setting, making it impossible for me to perceive the extent of the concerns; the article itself only highlights them, but does not help to clarify the scale of the problem. However, we ought to ask why there is such a questioning of the moral and ethical environment of medical schools, which are the formative environments of our medical profession. Perhaps the practical limits on advancement and the inherent competitive nature of large organizations (filled with driven professionals) prevent development of mutually supportive relationships. Perhaps it is but one manifestation of the consequences of the growth in cost of a highly complex medical system arising out of the advances in science and technology. Our capabilities exceed what we can pay for, and the institutional environment demonstrates the effects of the demands to produce something to justify the cost. Such demands can lead to ethical compromise.

I also wonder if ethical misdirections of our academic centers arise from a shrinking of the ethical foundation of medicine itself, to the narrow principle of autonomy. As the authors state, “[t]he scale of ethical/moral distress
 reflects reactions to the prevailing norms and possible erosion 
of professionalism and increased organizational self-interest.” If we have elevated autonomy to the highest principle, we should be unsurprised when self-interest begins to crowd out other professional motives.

(Gun) Violence as a Public Health Issue

In the Summer 2014 edition of Dignitas Greg Rutecki provides a thought-provoking article calling for reframing the gun control debate as a public health issue. He brings attention to the measures taken in Australia following a 1996 mass shooting (35 dead) in 1996, which subsequently appeared to produce a striking drop in homicides, as well as suicides by firearms.

Although we could have reasonable debate as to whether the specific actions taken in Australia would be appropriate here, it is appropriate to consider if current laws are adequate or need revision based on features of modernity such as increasing population and crowding, advances in technology, and so on. The need to balance public safety, or, as Rutecki puts it, public health, and individual freedoms, requires us to find an Aristotelian “golden mean” between unfettered and unregulated gun ownership and excessively strict control.

But we must ensure that our debate is sufficiently circumspect, otherwise we may find ourselves with unintended consequences that cannot be undone.

First, we ought to consider what is meant by “gun violence.” Descriptions and debates in the news of shootings frequently use this term, which seems to create a mental picture of guns wandering independently down streets and shooting innocent people. If “gun violence” is a public health issue, then so is violence in general. Therefore, interventions must include actions to address the social and moral breakdowns producing violence. When violence is an issue, the choice of instrument is but one aspect, and banning guns does not ban the problems that produce violence in the first place. In the absence of guns, there are plenty of other instruments at man’s disposal.

Second, Rutecki cites “dedication” and “commitments” to the Second Amendment. Critique of Second Amendment advocacy paints a picture of unquestioning devotion, as if the right to bear arms was considered, philosophically speaking, a “first truth.” This is too shallow a view, for the foundational principle was not gun ownership but self defense. It was, to the founding fathers, a commitment to individual freedom, a recognition that the tyrannical gather power when their force is unopposed. Gun ownership becomes both symbolic and an actual guarantor of freedom from tyranny.

There are many who consider such concern anachronistic, and are doubtful that 21st Century America needs such guarantees. Are modern dangers sufficient to justify gun ownership, as they were in 18th century America? If one were to say no, I would argue that he could not prove so unless gun ownership were eliminated and the subsequent net loss of life from violence turns out to be less than today’s. It is credible to argue that there are threats we are unaware of because of widespread gun ownership. If Rutecki’s public health analogy is valid, then one must note that this is the nature of the argument for immunization against rare diseases, when confronted by those who argue against immunizations due to vaccine safety concerns.

We must then decide if there is a more modern “disease” from which private gun ownership protects us. In a recent article in National Review   Charles C. W. Cooke brings attention to our own history, and the role of private gun ownership in defending Americans of African ancestry against racially-motivated violence:

In her harrowing 1892 treatise on the horrors of lynching in the post-bellum American South, the journalist, suffragist, and civil-rights champion Ida B. Wells established for her readers the value of bearing arms. “Of the many inhuman outrages of this present year,” Wells recorded, “the only case where the proposed lynching did not occur, was where the men armed themselves.”

That history may still be too remote to convince many of the threats diverted by gun ownership, but world events concurrent with Rutecki’s article provide sufficient evidence to me. To cite but one example—we have heard of an epidemic of the maladies of decapitation and mass execution raging through Iraq and Syria. We could argue whether a well-armed Yazidi populace may have saved many lives; the Kurds need no convincing.

This is not an impossibly remote or nebulous threat to America. It doesn’t take much imagination to figure out how a well-resourced group of people could find their way into the United States. And the question of whether ISIS desires to do so has already been clearly answered.

I would not deny the need to be expansive in one’s consideration of gun laws in the face of gun violence in the United States, whatever its root causes, and the need to seek solutions. But if the goal is to prevent violence, we must consider all sources, and ensure that we do not go so far as to remove a potential preventive measure. In the face of an advancing evil bent on shedding our blood, and considering our inability to protect our borders fully, a well-armed populace is our final defense against the current and advancing public health scourge of decapitation. If violence is a public health problem, then privately owned gun ownership amidst a determined citizenry facing an advancing and depraved evil is simply “preventive medicine.”

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.

Report from the ASBH Conference: Julian Savulescu’s Moral Bioenhancement Project

I am in Atlanta for the annual meeting of the American Society for Bioethics and Humanities. Last night’s (Thursday’s) first plenary address was given by Julian Savulescu of Oxford University, entitled “Unfit for the Future: The Need for Moral Bioenhancement.” He argued that “The greatest problems of the 21st century—climate change, environmental degradation, terrorism, poverty, global inequality, mass migration, depletion of resources, infectious diseases, abuse and neglect of children—are predominantly the result of human choice and behavior rather than the result of external threats. They are caused by human moral limitations.”

He detailed some of the contributors to our problems. The first was technological advances, which have led us to do things like develop weapons of mass destruction. He went on to assert that evolution had shaped human moral psychology such that it is “characterized by aggression, restricted altruism, partiality to kin and in-group members, hostility toward and disregard of out-group members, bias toward the near future, and limited cooperation.” These characteristics were (supposedly) evolutionarily adaptive when we were out living in small groups on the African plains. Because we are no longer in that situation, our morals don’t work anymore. Science has shown us that biological factors affect our moral reasoning; therefore, since evolution hasn’t caught up with present realities, we should “look at altering the biological dispositions that contribute to these [moral] limitations, and make research into human moral bioenhancement an urgent priority.”

Savulescu got part of it right. He denied moral relativism. (!) He acknowledged that human depravity is the reason for our problems. Many circumstances, physical and otherwise, affect our moral reasoning: upbringing, social background, whether or not we have a stomach ache, whether we slept well last night. Our inability to deal wisely with or even control our technology is a huge problem.

Therefore, it seems at least a little naive to assume that a new technology, designed and implemented by these same depraved humans whose moral reasoning may be adversely affected by various conditions, will magically solve the problems that technology has posed for us.

As Neil Postman pointed out in Technopoly, every technology carries embedded within itself an idea, a set of assumptions of which we are barely conscious, but which nonetheless directs our thinking and affects how we view the world. Also, while we are quick to consider what we gain from a new technology, we rarely reflect on what we lose. The ideology embedded in Savulescu’s technological project seems to be a materialistic, deterministic, biology-based understanding for human moral behavior. What is lost is a full, complex view of human responsibility, behavior, and motivation, the understanding that although we are fashioned from dust, we are also infused with the breath of life from God.

Savulescu reminded me of the Conditioners in Lewis’s The Abolition of Man. Despite Savulescu’s stated denial of moral relativism, he has chosen particular moral values that he regards as important, and dismissed the rest as evolutionary blind alleys. He embraces a view of humanity and human moral behavior that go well outside what Lewis calls the Tao, the realm of objective value that forms the basis for traditional morality. As Lewis wrote,

For the power of Man to make himself what he pleases means, as we have seen, the power of some men to make other men what they please. In all ages, no doubt, nurture and instruction have, in some sense, attempted to exercise this power. But the situation to which we must look forward will be novel in two respects. In the first place, the power will be enormously increased. Hitherto the plans of educationalists have achieved very little of what they attempted . . . But the man-moulders of the new age will be armed with the powers of an omnicompetent state and an irresistible scientific technique: we shall get at last a race of conditioners who really can cut out all posterity in what shape they please.

The second difference is even more important. In the older systems both the kind of man the teachers wished to produce and their motives for producing him were prescribed by the Tao—a norm to which the teachers themselves were subject and from which they claimed no liberty to depart. They did not cut men to some pattern they had chosen. They handed on what they had received: they initiated the young neophyte into the mystery of humanity which over-arched him and them alike. It was but old birds teaching young birds to fly. This will be changed. Values are now mere natural phenomena. Judgements of value are to be produced in the pupil as part of the conditioning. Whatever Tao there is will be the product, not the motive, of education. The conditioners have been emancipated from all that. It is one more part of Nature which they have conquered. The ultimate springs of human action are no longer, for them, something given. They have surrendered—like electricity: it is the function of the Conditioners to control, not to obey them. They know how to produce conscience and decide what kind of conscience they will produce. They themselves are outside, above. (The Abolition of Man, Chapter 3, para. 7-8)


During the question-and-answer session after Savulescu’s talk, audience members were quite confrontational, asking appropriate questions such as, who determines who gets morally bioenhanced, and on what basis? Is this to be done in a coercive manner? Savulescu’s simplistic explanations for the causes of moral behavior were also vigorously challenged. Savulescu seemed to backpedal a bit under the attack.

The second plenary session, which immediately followed, was a deeply meaningful, moving, at one point tearful, tribute to Edmund Pellegrino. It is difficult to state how great was the contrast between the two sessions.