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[tvoivozhd <tvoivozd AT infionline.net>]

", I do not believe that modern democracies will ultimately tolerate the 
death of children in the name of embryos. " Life is a series of choices 
between things of conflicting but relative value---The Bush choice of 
choosing a zygote over hundreds of thousands of infants in a children's 
hospital is morally reprehensible---evil is more accurate. His decision 
will go the way of slavery as did the notion that slaves were more 
valuable to society than their right to be free.


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Click here for a print-ready version of this article. 
<http://www.thenewatlantis.com/archive/7/cohenprint.htm>

*The Tragedy of Equality*

*/Eric Cohen/*

In a recent issue of /Stanford Medicine/, there is a cartoon with two 
individuals on different sides of a precipice: one is a scientist in a 
white lab coat, holding a test tube; the other is a preacher with a 
Bible, looking up to the heavens. The picture suggests that the 
embryonic stem cell debate is a clash between religion and science, an 
irreconcilable conflict between two different conceptions of reality. 
And indeed, many scientists, religious believers, and policymakers see 
it this way. Certainly many advocates for embryonic stem cell research 
see President Bush and his ilk as religious zealots, and see themselves 
as a thousand persecuted Galileos. And many religious believers worry 
about “man playing God,” and about scientists usurping the divine order.

But framing the embryo question as a clash between religion and science 
glosses over many important complexities. It is far too easy to presume 
that religious opposition to embryo research is not rational, but just 
sectarian piety. And it is far too easy to presume that the public case 
for embryo research is the most rational case, grounded in the best 
scientific evidence.

But matters, of course, are not so simple. Religious opponents of embryo 
research make their moral argument by appealing /rationally/ to the 
facts of modern embryology. And rational scientists make their moral 
case by appealing /emotionally/ to the hardships of loved ones suffering 
from dreaded diseases. To understand the embryo research debate and the 
larger human ideals at stake within it, we need to explore more 
precisely what it means to be “rational.” We need to explore the nature 
of human reason and the limits of human reason. And we need to confront 
the fact that reason alone cannot fully explain why things happen the 
way they do, or why we should believe in the first principles—like human 
equality—that we hold so dear.

*The Absurdity of Disease*

*O*ne must begin with the experience of suffering and disease that 
drives many scientists to engage in embryo research in the first place. 
Disease is not entirely rational, of course. Every day, parents shuttle 
their sick children to the hospital, and some of these children are 
diagnosed with the flu and others discover that they have incurable 
cancer. In the age of modern biology, we can rationally explain /how/ 
their situations are different. We can explain how the relevant genes 
and cells and proteins work or fail, at least within the limits of 
current medical knowledge. But we cannot really explain /why/ one child 
gets deathly ill and another does not. Now, if two people walk toward a 
cliff, and one jumps off and the other does not, we can explain 
rationally why one dies and one lives; we can grasp the connection 
between human will and the laws of gravity, and perhaps even the 
circumstances that led to the decision to jump in the first place. And 
for people who die of lung cancer, we can describe the lifestyle that 
put them at extra risk (though of course, many people lead high-risk 
lives and suffer no consequences). But often, sickness is guiltless. It 
is not jumping off a cliff but being struck by a bolt of lightning. To 
blame bad genes does not answer the fundamental existential question: 
Why are my genes bad, and not his? Or why am I still alive, and not my 
child? The biologist has no real answers to these questions. He can 
explain how the disease happened, but not why it happened.

In the age of modern science, therefore, we must confront the fact that 
nature is both /orderly/ and /absurd/: Nature is orderly, in the sense 
that we can understand how many biological systems work and how they 
fail, and we can often use this rational knowledge to fix them. But 
nature is absurd, in the sense that sickness strikes some individuals 
and not others for no apparent reason—a fact made dramatically clear by 
the young faces in the cancer ward. Disease does not strike bad children 
and spare good children. Disease simply strikes. Nature is amoral, and 
seemingly immoral. All of us—but especially doctors, who are trained in 
the most rational techniques—are thrown into a world that is often 
irrational. We must live with the absurdity of disease, especially the 
absurdity of the sweet, sick child. And the sick child is the best 
reason to engage in embryo research, if not finally a morally compelling 
reason to treat and destroy nascent human life as an experimental resource.

*Medicine’s Quest for Justice*

*T*o most people, it seems like common sense that we should try to cure 
the sick, especially those likely to die before their time. The virtues 
of healing are so obvious that we rarely examine the /nature/ of our 
desire to heal. But is the desire to heal really a “rational” desire? 
Surely it is a moral desire. We are a compassionate civilization—a 
civilization that feels the pain of others, and wants to make it go 
away. And surely the means of seeking and delivering cures—such as 
embryonic stem cells—are rational means. A doctor who treated every 
patient by praying for a miracle would be engaged in medical malpractice.

But is the actual desire to cure a /rational/ desire, a desire grounded 
in reason? Or is this desire grounded in something more primal than 
reason—such as the instinctive will to survive, or the selfless capacity 
for empathy, or the protective instinct of maternal love? This is not an 
easy question, since it is not easy to say whether any human desire is 
really grounded in reason, as opposed to reason shaping, serving, or 
moderating desires grounded in or implanted from somewhere else. Without 
desire, reason is perhaps impotent. But without reason, desire is often 
dangerous. And as Max Weber famously observed, there is a difference 
between “substantive reason” and “instrumental reason,” between the 
reasons we do what we do and the utility of reason in executing what we 
want to do.

When it comes to medicine, some might argue that it is irrational to 
devote so much energy to fighting disease, since in the end all 
victories are temporary and all losses are final. Faced with the 
inevitability of suffering and death, a rational person might pursue 
instead a life of preparation, not resistance—a life spent preparing to 
die, even from childhood. Perhaps such mystic detachment is the most 
rational response to the death sentence that is birth. Perhaps we’d be 
better off spending less money on basic research and more money on death 
education.

But such a dark view of life is not the modern view of life. It 
belittles the many goods of this world to see all of life as one long 
preparation for death. (Though without the urgency of mortality, we 
might put off all that is good and noble in the belief that tomorrow is 
forever.) And the desire to cure can be rationally defended, even if the 
desire itself is not exactly grounded in reason. In the clinical 
setting, doctors just want to help people. They want to make the sick 
feel better. But in a deeper sense, modern medicine is an effort to 
impose rationality on an often irrational world—an effort to meet the 
absurdity of nature with the orderliness of nature; an effort to give 
every child a fair chance to live a full and flourishing life. In this 
sense, science and medicine might be understood as /redemptive/ 
activities: as the restoration of justice in a world where biological 
nature often seems unjust. Doctors want people to get what they deserve, 
and they do not believe anyone deserves to be sick. Medicine is the 
taming of errant nature by human morality, using nature’s laws as its 
instrument.

But the pursuit of health and the rejection of death are not the whole 
of human morality—even if being healthy is, as Descartes claimed, “the 
foundation of all other blessings in this life.” Perhaps no one deserves 
to be sick, but it is also true that no one deserves to live forever. 
And if extending life were the only or highest goal of being human, then 
civilization would be in peril—because we would be too cowardly to 
confront murderous tyrants, or so blood-thirsty for life that we would 
use the dying to save the living, or so narcissistic that we would never 
have children, who are our natural replacements.

As biotechnology improves, medicine will achieve more partial victories 
over nature; we will cure many terrible diseases. But medical science 
will never achieve its ultimate aim of reversing the death sentence that 
comes with being born. And so doctors will continue to play the dual 
role they have always played: they will /cure/ as long as possible and 
they will /care/ when cures are no longer possible. But what happens 
when curing and caring come into conflict? What if caring for people 
with terminal illness interferes with curing people who might yet be 
saved? To put the question more sharply: Why not harvest organs from a 
patient who is dying to save three other patients who have a chance to 
continue living? If the purpose of medicine is to mitigate the absurdity 
of disease as much as possible, is it rational to let a teenager die 
rather than use tissues from a dying sixty-year-old to save him? Should 
the obligation to care for this terminal patient stand in the way of 
finding cures for the many patients who might suffer in the future?

*Reason and Equality*

*A*nd here we see the other side of our existential predicament: While 
the death sentence of nature is often /amoral/, the acceptance of death 
is often necessary in order to prevent being /immoral/, at least as we 
usually understand it. Perhaps it is morally obvious that we should 
accept death rather than harvest organs from the living. Surely there is 
an aesthetic objection to disaggregating those who look like us, even if 
their days are numbered and their lives are miserable. But should we 
accept death rather than harvest stem cells from destroyed human 
embryos, which do not look like us at all? And would accepting death for 
this reason be /rational/ or /irrational/?

To answer this hard question—perhaps the great bioethics question of our 
time—we need to examine the first principles upon which our ideas of 
moral obligation rest. The reason we do not use some individuals as raw 
materials to help others is because we believe that every living person 
possesses equal dignity, including those who are weak, disabled, 
dependent, and dying. We believe everyone possesses an inviolable right 
to be cared for, at least in the minimal sense of not being exploited. 
Even prisoners on death row get medical care, and no civilized society 
would use them as ready sources of organs. This equal dignity is not a 
function of what we /do/, but intrinsic to who we /are/; it is not an 
attribute that can be measured according to our /deeds/, but an 
unchanging characteristic of our very /being/.

This commitment to equality is not, I should say, the only view of human 
dignity. Aristotle seemed to have little problem leaving deformed 
infants out in the wilderness to die; the dignity he sought to defend 
was the dignity of human excellence, which the disabled could never 
achieve. But the belief in the equality of all human beings is the 
democratic view of human dignity, with roots that trace back to biblical 
religion. And while there is much to learn from Aristotle about the 
nobility we often lack, the democratic idea of dignity is, as 
Tocqueville soberly concluded, more just. So long as we are alive, we 
/are not/ things and we are /more than/ animals—even when our rational 
faculties decline, and even when we behave in beastly ways. This 
democratic belief in human equality can be rationally defended, but it 
cannot be proved by human reason. It is a commandment we obey or a 
proposition we seek to uphold, not an indisputable natural fact like 
gravity.

For those who accept this first principle—the equal dignity of all 
individuals—the embryo research question centers on whether an embryo is 
a person or something less than a person. Now, if deciding this question 
were just a mathematical or even ontological problem—if we were 
interested simply in the best scientific answer, not the answer that was 
most expedient for doing science—then it seems to me that the religious 
opponents of embryo research are the most rational voices in the stem 
cell debate. If the question is—When does an individual life begin?—then 
the conclusion that life begins at fertilization is the most rational 
conclusion. If we trace an individual life backwards biologically—from 
adulthood to adolescence to infancy to birth to the fetal stage to the 
embryonic stage—there is only one bright line that separates being from 
non-being: fertilization. Before fertilization, we have an egg and many 
sperm; we have many possibilities and no person. After fertilization, we 
have an individual human life in-process. I was once a zygote, but I was 
never a sperm or an egg, since the gametes that produced me could have 
produced someone else.

To be sure, there are other key moments in embryological development, 
moments that some people believe are more significant than fertilization 
for conferring human worth: There are the moments when certain 
powers—like brain activity or the capacity to feel pain—manifest 
themselves. There is the moment when the discernible human form first 
becomes visible. But these moments do not mark the arrival of a /new/ 
person; they mark the arrival of certain attributes in an /existing/ 
person. To believe that crossing these hurdles is the prerequisite for 
human dignity is to deny the first principle that all individuals are 
equal. It makes our equality conditional, and thus weakened. But for 
those who really believe that all human individuals have equal 
worth—regardless of size, or intelligence, or level of dependence—then 
the most rational conclusion is the view held by many religious 
believers: the conclusion that life begins at conception. Put 
differently: To oppose embryo research is to act rationally on the 
belief that human beings are inherently equal. This position is strictly 
religious only inasmuch as the belief in human equality is strictly 
religious.

*Scientific Mystics and Liberal Revolutionaries*

*I*t is certainly the case that destroying embryos and harvesting stem 
cells is a very rational activity. It involves testing hypotheses about 
how nature works and seeking to use natural knowledge to develop 
rational techniques. It also involves a goal—curing disease—that can be 
rationally defended. But the moral theories that justify embryo 
destruction—the theories that most stem cell scientists embrace, whether 
implicitly or explicitly—are either /mystical/ or /revolutionary/.

The mystics argue that “personhood” arrives at some murky point along 
the continuum of development. They appeal to our moral sentiments in 
claiming that 8-cell embryos should be available for research while 
8-pound babies should not be. And they assert that somewhere along the 
way usable embryos become inviolable infants, even if we cannot say 
exactly when. But this sensibility—which may be true—is not very 
rational. It is surely not a scientific argument grounded in biology, 
but a moral feeling about who is equal and who is not. The scientists 
are often the mystics, even if they would never admit it.

The more revolutionary defense of embryo research involves the rejection 
of the very principle that all human beings possess equal worth, and the 
assertion that human dignity depends on possessing certain 
attributes—like a developed neurological capacity or a certain number of 
cells. This view does not abandon reason to follow sentiment; rather, it 
attacks the very premise that dignity is intrinsic rather than 
conditional. It attacks the first principle of equality upon which 
modern democracy is based. It dissents from the idea that “all men are 
created equal.”

And why not question this founding democratic faith? After all, the 
belief that all human beings possess equal worth is not the only 
rational conclusion one might draw from lived experience. In many 
important ways, human beings are clearly not equal: some are healthy and 
some are sick, some are on the way up and some are on the way out; some 
are saints and some are knaves; some are self-aware and some lack 
self-awareness; some are independent and some are needy; some are 
excellent and some are average. Is it really so obvious that a retarded 
child or a demented grandparent is equal to the rest of us? Or that 
Einstein is equal in dignity to Einstein’s maid? And is it really so 
obvious that we should sacrifice our plans and projects to care for the 
retarded, the demented, and the terminally ill? Or that we should 
abandon our hopes of medical progress to care for frozen embryos?

Indeed, some people argue, quite rationally, that it is senseless to 
devote medical resources to individuals who are beyond repair or not 
fully conscious, and that we should focus instead on helping those who 
are sick today but might flourish again in the future. Rather than 
holding the belief that all human beings are inherently equal, this view 
seeks to help as many people as possible to enjoy the fruits of 
equality, while dealing ruthlessly with those who will never enjoy the 
fruits of equality, such as retarded children or people with dementia. 
Such rationalists are at war with nature’s absurdities, but they also 
know when to cut their losses. They know that some cases are futile, 
that nature has won her nasty victory.

If the goal of medicine is to correct nature, then curing must always 
trump caring. The possibility of /making /human beings equal by making 
the sick healthy must always trump /treating /human beings as equals by 
caring for the dependent. And even though embryos are not /beyond 
repair/ but /on-the-way/, their very lack of certain powers (or certain 
experiential miseries) apparently makes them usable, in this view, in 
the effort to restore certain powers to those who have lost them. /This 
is both a radical rejection and a radical pursuit of human equality./ In 
the name of the sick whose inequality we lament, we would become 
inegalitarian supporters of litmus tests for human dignity. In the 
pursuit of medical justice, we would become unjust. This is true not 
only in the case of embryo research, but in the case of 
screening-and-aborting fetuses with genetic disabilities, like Down 
Syndrome. In the name of health, we would discard the sick; in the name 
of gaining strength, we would exploit the weak. Whether this is because 
we cannot see the weak as equal or because we do not believe the weak 
are equal, the result is the same: the pursuit of equality requires the 
sacrifice of equality. The pursuit of a rational world, where nature’s 
absurdities are conquered, requires the retreat from moral reason in the 
name of sentimental science, or the retreat from the inherent equality 
of all human beings in the pursuit of a more egalitarian future.

*The Tragic Choice*

*T*his leaves us with one final question, especially for those who 
believe in the inherent equality of all persons and the rational 
conclusions that follow from it. Let us suppose in the future that 
embryo research or “therapeutic cloning” works as advertised, and that 
parents one day face the choice between saving their sick child by 
destroying an embryo or letting their sick child die because embryo 
destruction is unethical. No parent would ask his doctor to procure 
fresh organs by dissecting one of the babies in the maternity ward. 
Familial love in this case is checked by neighborly love—a premise, for 
now, that everyone accepts. But are embryos our neighbors, in the sense 
of being inviolable? For those who believe that all human beings are 
equal regardless of their attributes, the rational answer is 
unequivocally yes. Even tiny embryos are our neighbors, because each 
tiny embryo is a life in-process.

But on the precipice between a beloved child’s life and death, the 
ethical commitment to reason and equality will be put on trial—a 
modern-day reversal of Abraham and Isaac’s trip up the mountain. Parents 
will face the ultimate existential predicament: the absurdity of a sick 
child, the obligation to treat all human beings equally, and the 
apparent absurdity of letting their child die rather than deliberately 
destroying an embryo to save him. Believing in the “culture of life” 
means accepting the concrete reality of death.

Such an act—the act of letting die—will probably make no sense to the 
world. But it may be what is required to live the commandment of 
equality in a world where nature does not treat us equally, and to 
follow the dictates of moral reason in a world that is often irrational. 
Thrown into a condition that /is/ absurd—being the parents of a dying 
child—neighborly love and moral reason require enduring what /seems/ 
absurd. And perhaps only those who believe in divine redemption—who 
believe that this world’s irrationality will be set right in the next, 
by God rather than science—can endure the painful witness that reason 
and equality may require. Perhaps only religious people can see the weak 
the way God does, and see equality where uncorrected human eyes see only 
a clump of cells.

That said, I do not believe that modern democracies will ultimately 
tolerate the death of children in the name of embryos. The state will 
mandate embryo-based medicine for underage persons. It will force 
parents to act in ways that seem more reasonable. But in doing so, the 
democratic state may cannibalize the very principle of equality on which 
it rests. It will compel people to act in inegalitarian ways. It will 
seek a course that seems more reasonable, but one that requires adopting 
the irrational view that embryos are not persons or the inegalitarian 
view that some persons possess dignity but others do not. And while I 
doubt that I could ever be the parent who lets his child die, even if 
the law still allowed me to do so, I’m not sure I’d want to live in a 
world where the commandment to treat everyone equally has been 
abandoned, and where moral sentimentality trumps moral reason.

These are the hard dilemmas—political and existential—that scientific 
progress has set before us. We would be blind or foolish to ignore the 
stakes, and in the end, we may face a choice between what is hard and 
what is horrible. But in this, at least, our time is not unique.

------------------------------------------------------------------------

/*Eric Cohen* is editor of /The New Atlantis/ and Director of the 
Project on Bioethics and American Democracy at the Ethics and Public 
Policy Center./

Eric Cohen, "The Tragedy of Equality," /The New Atlantis/, Number 7, 
Fall 2004/Winter 2005, pp. 101-109.

Published by the Ethics and Public Policy Center <http://www.eppc.org>, 
Washington, D.C.