We have seen how anti-immigration policy supports depopulation policies. The Johnson Act passed by the eugenics movement in the 1920s kept out Jewish fugitives when Hitler was preparing to kill them. Anti-immigration laws today support the Chinese one-child-only population policy.Bioethics is a new discipline. The word first appeared in the late 1960s, and it has been used in two ways. Van Rensselaer Potter was probably the first person to put the word in print, in his book Bioethics: Bridge to the Future (Prentice-Hall Biological Science Series: Englewood Cliffs, 1971). Other people began using the word at about the same time, and it is interesting to look at the different ways they used the word.Bioethics functions in a way that is similar to anti-immigration policies. Just as anti-immigration policies support population control (negative eugenics), so bioethics defends "positive" eugenics in the area of genetics and reproductive technology.
Potter's concern was Malthusian. He did not see how the world could survive if mankind continued to populate and pollute at a great rate, and wanted a way to talk about the problem. He was looking for an ethical framework that would incorporate the new insights of biology. But more, he wanted an ethical scheme that would pay attention to all life, pay attention to life as a unity, pay attention to the future of the whole planet with its precious but fragile veneer of life spread in a thin layer over the surface.
Traditional ethics did not take account of the needs and rights of the entire biosphere, the whole web of life. Potter saw a need for a new ethical framework that would develop ways to talk about such questions.
Another group of people began using the word at about the same time, including the bioethics pioneers who began work at an institute called the Hastings Center to explore the new field. This group included Daniel Callahan, Willard Gaylin, Robert Veatch, Marc LappÈ and many others.
It is not easy to characterize the views of such a group; they were all intelligent and complex individuals, taking different approaches. But in general, they were interested in developing a new discipline called bioethics because they wanted to find ways to handle new ethical questions raised by progress in biology and medicine. For example, respirators and other sophisticated new equipment made it possible for hospitals to keep a heart beating and lungs going after the brain shut down and the patient appeared to be dead. If you could keep a heart pumping after a person died, or even outside the body, then you could not say that a person is dead when the heart stops. So when is a person dead? How do you define death? That question did not vex philosophers in past centuries. Advances in medicine brought new ethical questions. Bioethics was supposed to provide the tools to deal with the new questions.
Getting rid of anomie... It reminded me of a conversation more than 30 years ago with Harry McPherson, a wise Washington lawyer, then on Lyndon Johnson's White House staff. I asked him about the criticism that the "War on Poverty" was was not getting at the fundamental dysfunction that trapped families in blighted neighborhoods. Employing a single-word definition from sociological literature for "a breakdown or absence of social norms and values," McPherson replied, "If you think it's hard to eliminate poverty, just try getting rid of anomie."
David S. Broder, Washington Post, |
The questions that the early bioethicists wrestled with included abortion, coercive birth control, genetic engineering, organ transplants, artificial insemination, euthanasia, and many other similar matters. Population was among the concerns of the Hastings Center group, although it was not the starting point for them, as it was for Potter.
When you look through the articles and papers written in the first years of bioethics, there are two striking characteristics about them. First, the issues that they were discussing were all issues that mattered within the eugenics movement, with only one significant exception. The exception is truth-telling, the limits of what a physician was ethically required to tell a patient: this question runs through bioethics literature, but not previous eugenics literature.
Second, very few of the new bioethicists asserted traditional ethical conclusions like the Hippocratic Oath with any vigor. You can't say that every bioethicist parroted the views of the eugenics movement. But what you can say is that bioethics did not offer any serious resistance to any evil that developed within the eugenics movement. Bioethicists would quibble and caution and wring their hands and especially "develop new safeguards," but "stop it" was not in their vocabulary.
Bioethicists have been able to say no when things have stopped already. For example, in the 1990s, bioethicists at Johns Hopkins University put together an excellent study of the ethical problems in a radiation study conducted by the military in the 1950s. When the United States was developing nuclear weapons, some soldiers were deliberately exposed to radiation so that researchers could study the problem. The soldiers who were used as guinea pigs were not told what the experiments were. The research was inexcusable, and 40 years later some bioethicists said so, firmly.
It would be easier to take bioethics at Johns Hopkins seriously if they were able to speak as forthrightly about more recent problems. It would be especially useful if bioethicists at Johns Hopkins could examine grave bioethical abuses right at their own institution.
In the 1960s, when population control groups were developing and promoting IUDs, scientists associated with Johns Hopkins worked on a new design. They came up with an IUD that resembled a louse, called the Dalkon Shield. The Dalkon Shield was introduced in January 1971, and about 2.2 million women used it over the next four years. But the device turned out to be deadly, not only for tiny embryos but also for women. Thousands were hurt, and some died. The women sued, and in the end the class action suit had 334,863 claimants. The manufacturer, A. H. Robins, went bankrupt.
The complaints against the Dalkon Shield drove it off the American market in 1974, but population control groups continued to use it overseas.
Researchers at Johns Hopkins had a role in the development of the Dalkon Shield, and in the distribution overseas. But what was their role, exactly? Did anyone at Johns Hopkins make any effort to pull the Dalkon Shield, at least, off the shelves in developing nations? There are many tough questions, still unanswered, about the scandal.
Joseph Fletcher and Situation Ethics
Bioethics is based at least in part on situation ethics, developed by Joseph Fletcher (1905-1991). Fletcher taught ethics at Episcopal Theological School and at Harvard Divinity School from 1944 to 1970, and then at the University of Virginia until 1977. He was a member of the American Eugenics Society, and also of a series of groups promoting various parts of the eugenics agenda, including three euthanasia societies (he was president of the Society for the Right to Die from 1974 to 1976), two abortion societies, and one sterilization association.
During his academic career, Fletcher became increasingly concerned about legalism, an excessive concern about the letter of the law. In his book Situation Ethics he argued that the only rule that really matters is love, a serious commitment to love. An ethical person should examine each unique situation, and try to figure out the loving thing to do, without applying rigid rules. He argued that all efforts to formulate unchanging moral laws have failed. Obviously, he had to address the Ten Commandments in some way, and he attacked each and every one of them, showing that there are always some circumstances in which all reasonable people would agree that the law should be set aside.
Jesus of Nazareth, whom some believe to be the son of God and all consider a great moral teacher, also spoke about summing up the whole Law briefly. His brief summary had two commandments: love God with your whole heart and soul and strength and mind, and love your neighbor as you love yourself. Fletcher went a step beyond Jesus, and reduced the law to a single principle: love. And indeed, withing a few years after the book came out, Fletcher renounced his belief in God.
To understand the new term bioethics, look at some other words with the prefix bio-.
|
It is interesting to note that his first concrete example is abortion, and his concluding example is the use of nuclear weapons. He justified both, in certain circumstances — abortion in the case of rape, and nuclear weapons in Hiroshima. The book was published in 1966. The previous year, the Roman Catholic Church, Fletcher's chief adversary, had concluded the Second Vatican Council, a long meeting of all the bishops, and had released a number of documents stating the teaching of the Church. One was called Gaudium et Spes [Joy and Hope], or The Church in the Modern World. In general, the Council was very upbeat, and so is this historic document. But it does contain two statements that contrast sharply with Fletcher's methods and conclusions. In section 51 of Gaudium et Spes, the Pope and bishops together taught that "abortion and infanticide are unspeakable crimes." In section 80, they declared, "Any act of war aimed indiscriminately at the destruction of entire cities or of extensive areas along with their population is a crime against God and man himself. It merits unequivocal and unhesitating condemnation."
The Belmont Principles
In 1974, just a few years after the field of bioethics began to organize, the Federal government financed a huge bioethics project. The Department of Health, Education and Welfare (or HEW, later called the Department of Health and Human Services, or HHS) put together a commission to think about how to protect people used in research. The group was called the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.
The Commission met and studied and exchanged ideas for some years, and in 1979 they released a paper, "Ethical Principles and Guidelines for the Protection of Human Subjects of Research," or more simply the "Belmont Report." The name was taken from a conference center in Elkridge, Maryland, where the commission thrashed out some ideas during four days of intensive discussion in February 1976.
The Belmont principles are not supposed to be about the whole of life, like the Decalogue from Mount Sinai; they are limited to a specific need, protecting human subjects in research. Still, to understand bioethics and modern eugenics, you must understand the Belmont principles.
First, it is noteworthy that the Belmont Report speaks of "principles and guidelines," not rules. This is the language of Joseph Fletcher. Further, the principles are supposed to "assist in resolving the ethical problems," rather than "resolve the problems." This is characteristic of Fletcher's post-Sinai approach.
The Belmont Report identifies three basic ethical principles that are "among those generally accepted in our cultural tradition." In other words, ethical principles depend on social consensus.
The three principles are: respect of persons, beneficence and justice. Some bioethicists have since divided beneficence in two, adding non-maleficence as a fourth basic ethical principle. These words sound impressive, but it is not clear that they convey much meaning.
The first principle, respect of persons, sounds a little like a concern about the overwhelming dignity of each individual. But in 1976, the nation was already torn apart over the question of who is and who (or what) is not a person. The abortion debate was often phrased in terms of personhood: is the child or fetus in the mother's womb a person? In eugenics theory, offspring accumulate value over a period of months, and personhood is a legal status conferred by the State at an arbitrarily set time; in many other world views, personhood is part and parcel of being alive and human, and comes with the beginning of life at fertilization. Is abortion moral? Is it ethical to use human beings in the first days of life for research? Speaking of respect of persons does not begin to answer these key issues of our time.
The second principle, beneficence, is Latin for doing good. No one is opposed to it, but what does it mean? Take, for example, one of the major issues that bioethics tackled, euthanasia. If a person is in pain and you try to relieve it, that certainly sounds like doing good. But if you "relieve the pain" by killing them, that may not be good, especially since you cannot guarantee that a dead person is free of pain and suffering. Throughout the world, throughout history, there have been stories about life after death, including the possibility of eternal suffering. It is not possible here to prove or to disprove theories about life after death, but it is foolish and narrow-minded to dismiss them. Euthanasia may be beneficent if humans are merely smart animals; euthanasia may be eternally harmful if humans are eternal creatures. The second principle of bioethics does not help to resolve this matter.
Non-maleficence is Latin for not doing evil; this is the part of beneficence that some bioethicists use as a fourth principle. But the Report cuts the heart out of the Hippocratic Oath, and even claims that the Oath is a basis for situation ethics, pointing out that the Oath says that physicians should benefit their patients "according to their best judgment." What Hippocrates had in mind, surely, were questions like when to rest and when to exercise, or when to wait and when to operate. But the Belmont Report expands the idea of "best judgment." The original Oath had clear prohibitions, including unmistakable words against abortion and euthanasia. But the Belmont Report refers to a vague beneficence. Further, beneficence can mean doing good for the individual or for society, possibly even harming the individual for the good of society.
The third principle, justice, also turns out to be elusive for the authors. The Belmont Report rounds up a variety of theories about justice, and does not put them together. In fact, the Report poses questions about equality, asking, "Who is equal and who is unequal?" It follows this question by asking, "What considerations justify departure from equal distribution? Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes." But in the United States exactly two centuries after the Declaration of Independence, why did the matter of distinctions based on various conditions lead bioethicists to ask, "Who is equal?"
What did emerge from the Belmont Report was a set of guidelines about informed consent. Before a person is used in research, the person must understand what it is all about, and agree in writing to permit it. This has led to an increase in the paperwork that patients sign when they enter a hospital. At least one member of the National Bioethics Advisory Commission calls the informed consent process "an empty secular ritual," but sticks to it faithfully anyway.
The Role of Bioethics Today
Bioethics is still a new field, but it is well established in universities and hospitals.More than 25 universities offer programs leading to degrees in bioethics, or to degrees in a larger field (such as philosophy or history) with a concentration in bioethics. There are dozens of professional journals in bioethics. Medical schools generally include a variety of bioethics courses in the curriculum. Divinity schools that train pastors also teach bioethics.
In many hospitals, chaplains have been replaced by bioethicists, who have been trained to help people deal with death. They may or may not believe in life after death, but are ready to talk at length about the feelings that patients have as they approach death, and are ready to help families cope with grief. They are also trained to help physicians, patients, families and hospital administrators make decisions about whether or when to turn off life-sustaining equipment. Such issues include medical and legal complications. Insurance companies and managed-care organizations have more and more influence on decisions about medical care, and bioethicists are trained to help everyone involved to understand each other's needs and interests.
Under President Clinton, bioethics expanded its role in national policy-making. Clinton's predecessors had appointed various ad hoc commissions to advise the government on specific issues, such as protecting research subjects. But in 1996, President Clinton created a new body, the National Bioethics Advisory Commission (NBAC). The idea was to establish a permanent group that would deal with a wide variety of bioethical issues, to replace the temporary groups of previous years.
The NBAC was supposed to advise the government on bioethical issues, but it would also have some power to focus public attention on specific questions and problems. Obviously, in a free country with a vigorous free press, no single institution can end any discussion. But the NBAC would be able to set the agenda for public debate, decide which topics to discuss.
The first chairman of the NBAC was Harold Shapiro, president of Princeton University. There were a total of 18 members, experts in medicine, law and public policy. One member was an expert in comparative religions, but none were priests or rabbis or ministers. This, surely, was among the most bizarre events of the recent history: a nation in which the overwhelming majority of the citizens believe in God and go to church or synagogue assembled a group of experts to give advise on life and death issues — without any clergy.
In the first few months, as the NBAC was just getting itself organized, a scientist in Scotland reported that he had cloned a sheep. For decades, efforts to clone mammals had failed, and the report from Scotland was revolutionary. It raised the possibility of cloning other mammals, including humans. President Clinton turned to his brand-new advisory body and asked for their advice about a national policy on human cloning. This gave the NBAC much publicity, and probably ensured that it would survive.
The NBAC not only sets the agenda for public discussion of issues, but also lays down some of the ground rules. During their meetings on human cloning, they invited representatives from various churches to give their views. But over and over, they asked people to put their views in nonreligious terms, so that they could be understood by everyone in a pluralistic nation. The chairmen of NBAC subcommittees did not ask speakers who offered their ideas in secular terms to rephrase their remarks in religious terms. In other words, it is the view of the NBAC that completely nonreligious language is neutral. The members of the commission did not include clergy, and the language they sought to use was specifically nonreligious.
As we saw in Chapter 16, the NBAC recommended that this nation permit human cloning as long as the cloned embryos were destroyed before they got very large. This "clone-and-kill" recommendation is pure eugenics. It assumes that human beings in the first days of life are less than human or other than human, and that value accumulates over time. But also, the NBAC recommended that cloned embryos should be destroyed because they were likely to be defective in a variety of ways.
It is worth dwelling on this point. Suppose that researchers do succeed in cloning humans, and in a few years there are clinics and laboratories all over the country churning out cloned embryos. The question then is not whether to start cloning, but whether to kill the embryos or to try to keep them alive. What are the arguments for and against implanting cloned embryos in a mother's womb? Infertile parents would want to proceed with implantation. Pro-lifers would demand implantation, since anything else kills a living human being, however tiny. Researchers would be curious about the results. The only argument for hesitating before implanting a cloned embryo is a concern about quality control. And the NBAC adopted this purely eugenic recommendation unanimously.
People who offer themselves as experts on matters like the beginning of life (cloning, human sexuality) and the end of life (euthanasia) are performing some of the functions of a priestly class. Bioethics today functions as the priesthood of the eugenics movement.
1. Identify Joseph Fletcher, and explain the term "situation ethics" briefly.
2. List words that have "bio-" as a prefix. Explain the term "bioethics," giving two different definitions.
3. What are the "Belmont Principles"?
4. What is the role of bioethics today? Who trains bioethicists, and where does a bioethicist work?
5. Identify the National Bioethics Advisory Commission, and describe its initial work briefly.
Discuss: If you try to build an ethical framework in which everyone in your society has a veto over any statement of principles, is there a way to avoid having your statement degenerate into toothless and meaningless platitudes?
