Subject: [Homestead] Killing children in in a chilodren's hospital in the name of morality
Date: Tue, 25 Jan 2005 09:41:42 -0500
", 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.
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.