The Right to Life is not an Achievement

English: Personhood NOW banner flies in front of the United States Supreme Court during the 2009 March for Life (Photo credit: Wikipedia)

Today I saw another cartoon defending women’s so-called “reproductive rights,” asserting that they concern a woman’s own body and no one else. Besides being based on a radically individualistic premise, the claim begs the question regarding the status of the fetus (“fetus” is used here as shorthand to refer to any stage between conception and birth). Slogans–on both sides of the abortion camp–hide the real issue of the personhood status of the fetus. Moral rights apply to persons. Thus, removing a human being from the category of human personhood serves to deny it the moral right to life. With no moral right to life, there need be little or no protection for the human being who lacks personhood.

The problem with such views of personhood derived from Locke’s view that human personhood supervenes over the human being is that these positions are based on the notion that a human being accrues personhood as the result of an achievement of some kind. Some deny personhood to the fetus until the possibility of twinning and other divisions of the fertilized egg into multiple organisms. Bonnie Steinbock believes that personhood supervenes on the human being when the nervous system reaches the level of sophistication to allow sentient experience in the fetus. Justice Harry Blackmun in Roe v. Wade placed the point of personhood at viability, when the fetus can survive outside its mother’s womb. Judge John Noonan considers the fertilized egg to be only a potential person, but with such a high degree of probability of becoming a person that it deserves legal protection. Mary Anne Warren believes that some ability to reason is essential before a human being can be labeled a “person.” Peter Singer and Michael Tooley hold that personhood only begins after the child is born and has lived a few years.

It is interesting that those who propose an achievement view of human personhood disagree so radically with one another on the nature of the person-granting achievement. Despite over forty years of debate, this issue remains unresolved. The answer given depends on what the philosopher him/herself values as being important in human life. For Singer and Tooley, the ability to reason and consider alternative courses of actions is what makes a person a person. Steinbock, following Bentham, holds that sentience, the ability to feel pleasure or pain, is what is essential to personhood. How can those positions be reconciled? How much achievement is necessary before a human being becomes a human person? Given such radical disagreement, would it not be safer to follow the most conservative position possible in order to avoid the chance of killing a human person?

It is also important to point out that the achievement view can be applied at any point in life, since a person can be injured and lose the ability to reason or the ability to have sentient experience (though it is difficult to know when these properties have been lost given our ignorance of the subjective conscious experience of the injured individual–some would argue it is practically impossible to determine level of consciousness, sentience, or reasoning ability, especially since some individuals have normal cognition with only a small amount of brain tissue [see the link at http://www.flatrock.org.nz/topics/science/is_the_brain_really_necessary.htm%5D). Thus if a person loses the ability to reason, then on a Singer/Tooley/Warren account, the individual loses personhood as well. But then we are thrown back to the intractable debate over which achievement is the person-granting one–and taking the most conservative position possible is best to avoid killing someone who may well be a human person.

Now if the person is constituted by a formed, functioning organic body, as Aristotle and Aquinas believed (note that both matter and form–form being the “soul” of a living thing, are essential, and the organism is a soul-body unity), then human personhood begins from the first moment of a formed organic body. That takes place at conception in which a new genetic code is formed and a new organism comes to be. Growth and development are filling in the patterns already found in the form through protein coding by genes. If someone argues that there is not a true organic body until a short time after conception, it is still best to take the most conservative position possible and affirm that human personhood begins at conception and that killing a zygote is as much murder as killing an innocent adult. If that is the case, then a fetus is not merely a part of a woman’s body, and the rhetorical argument based on the woman’s rights to her own body fails.

 

Newspapers and Stillborns

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Before I read Robert Kastenbaum’s textbook on death and dying, I was not aware that some U. S. newspapers refuse to print the obituaries of stillborn infants. I had to read the statement twice to believe it was there–to be fair to Kastembaum, he does not like that fact any more than I. Although my fraternal twin brother, Jeffrey, was not stillborn, he died two hours after birth of severe bilateral pulmonary hemorrhage. The tendency in society is to downplay the import of such losses and downplay the parents’ grief. “The child really didn’t get a chance to live.” Granted, the child’s life was short, but what follows from that? Is a mother or father’s love somehow missing because a baby was stillborn or died shortly after birth? What gives a newspaper a moral right to deny the existence of such infants to the point of refusing to print their obituaries? I wonder if a society that allows abortion through the ninth month of pregnancy (provided, during that last trimester, that a woman has a doctor certify that the fetus is a threat to her physical and/or “mental” health) can properly value stillbirths or infants dying shortly after birth. Those newspapers that forbid such obituaries are reflecting the values of moral liberals in the wider society, liberals who do not admit the intrinsic value of human life from conception onward. Such an attitude is reflected in bioethicist Peter Singer’s statement that “An adult chimpanzee is of more moral worth than a newborn human infant.” He would go as far as to deny personhood to a newborn until the baby is a week old, and even then Singer does not believe that true moral personhood is present until the child is several years old. American society may not be quite that radical, but when children are considered to be burdens rather than gifts, a stillborn infant can be relegated to secondary status–or perhaps to tertiary status, lower on the scale of value than nonhuman animals.

Recent research on grief suggests that parents, especially mothers, mourn deeply over stillbirths and over infants who die shortly after birth. The least a newspaper can do is to acknowledge their loss by printing their child’s obituary. To do otherwise is to exhibit a fundamental lack of respect for the dignity of the stillborn infant or of the infant who dies shortly after birth. To do otherwise says that the severe grief felt by parents over the infant’s death is misguided. I suggest that it is not the parents who are misguided; it is newspaper editors who refuse to respect the dignity of all human persons, born, stillborn, or unborn.

The Fundamental Goal of Medicine

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The fundamental goal of medicine is the patient‘s good. Edmund Pellegrino and David Thomasma both focus on that point in their 1981 book, A Philosophical Basis of Medical Practice, the book that has most influenced my approach to medical ethics. All other goals–having an up-to-date facility, having the best equipment at a clinic or hospital, turning a profit, and efficiency in finances, must be subsumed under that primary goal. The good of the patient may involve curative care, or it may involve palliative care in the case of a dying patient. The human person is a whole, body and soul, so medical practice must focus on the good of the whole person and not just on body parts and diseases. The good of the patient may include physical good, but it may also include psychological and spiritual good. Recognizing the complex dimensions of personhood and treating a patient as a person, not as a thing, will do more for the good of the patient than merely diagnosing and treating a physical disease. Even a “physical disease” contains a psychological component, since the patient’s mood can influence the course of the disease for good or ill. Sometimes a physical disease can be triggered by psychological stress. Extreme emotional stress can activate the HIV virus so that a person gets full-blown AIDS. Other diseases may be activated by stress: cardiovascular disease, cancer, rheumatoid arthritis, lupus, infectious diseases. Part of a medical practitioner’s job is to recognize when a patient is having a great deal of emotional stress and encourage the patient to deal with that stress.

Treating the patient as a person implies that assembly line medicine is not ideal. Despite massive debt that young physicians often try to pay off with a high volume of appointments, at some point a provider is spending too little time with patients and comes across an uncaring. Constantly looking at one’s watch does not help. Talking to a patient in a real conversation does. Of course any doctor, PA, or nurse practitioner must have some limitations on patient appointments in order to receive all those in need. Finding the correct balance is not subject to exact rules and is a matter of prudence. Prudence is the ability to make a good decision in both routine and in more troublesome and complex situations. It is an essential virtue, necessary for both everyday medical, as well as for moral, decision making. A list of absolute rules to follow will not help in ethical dilemmas in which rules conflict and are only prima facie, which higher-level rules may supercede.

The fundamental end of medicine implies the principles of benevolence, nonmaleficence, and justice. Autonomy is trickier, since it is an enlightenment concept that may be conditioned by contemporary Western Culture. Kant himself thought we would autonomously give ourselves the moral law, but the term is used today for “the right of every adult to make choices based on their own value systems.” In practice, there is limited autonomy in medicine; not everyone can practice medicine, and drugs must pass FDA approval before being placed on the market. These limitations are so patients will not be misled by quacks or those pushing an untested, ineffective, and perhaps dangerous, drug. Autonomy in patient decision making recognizes that it is the patient’s body who is being affected by medical treatment, and that the patient’s values are not necessarily the physician’s values. I think of respecting autonomy in terms of respecting the free will of patients to make their own decisions regarding health care.  This helps preserve the dignity of the patient in a setting in which the sick patient, feeling powerless, tends to lose a sense of dignity.

There are a number of controversial issues in medical ethics that focus on the nature of the patient’s good, or even if there is a patient present to whom the health care provider does good or harm. The abortion issue is one of these–if the fetus is a patient, then abortion amounts to murdering a living human person. If the fetus is not a patient because he is not a person, then the opposite conclusion seems stronger. My own view is that personhood begins at conception, so that any doctor or health care worker helping with an abortion is violating the fundamental end of medicine. The same would follow for euthanasia and for physician-assisted suicide. Many people will disagree with these positions, and I welcome rational argument on any position I set forth in this blog.

Most issues regarding the fundamental good of medicine are more mundane that the large scale bioethical issues often discussed in undergraduate medical ethics courses. Usually the practical everyday issues involve the amount of time spent with patients, dealing with difficult patients, keeping information confidential, keeping medical records accurate instead of falsifying “the little stuff,” and so forth. All these issues involve remembering that the patient is a human person with feelings, with a life, with loved ones, just like the health care provider–and that providers can help a person leave better than when he arrived.

Abortion

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As a precocious child, I watched the CBS Evening News with Walter Cronkite from the fourth grade onward. One winter evening when I was in the fifth grade Mr. Cronkite’s lead story was one I did not understand: “The U. S. Supreme Court today in a seven to two vote legalized abortion.” I ran and asked my mother what “abortion” was. She was hesitant to say, as if the term I had used were an obscenity. Finally she said, “It’s killing babies before they’re born.” My mouth dropped and I had a sinking feeling in my stomach. To this day that sinking feeling returns when I consider the great evil Justice Harry Blackmun and his court majority inflicted (via Roe v. Wade) on the American people that day, January 20, 1973.

In considering the morality of abortion, the key philosophical question is when does human personhood begin. Even supporters of abortion would say that the human being begins at conception—the issue is, at what stage does the human being become a human person? Is every human being a human person? Or does a human being become a human person at a particular stage of development. Parents with teenagers may believe that a human being does not become a human person until around age twenty, if even then. Seriously, though, philosophers Michael Tooley and Peter Singer have both argued that a human being does not become a human person until several years after birth. Singer believes that a baby should not be declared a human person until he is a week old; during that time, it is, Singer believes, morally permissible to kill the baby, for example, if it has an incurable disease that would cause it endless suffering. Tooley holds similar views. Bonnie Steinbock believes that sentience, the ability to feel pleasure or pain, is the point at which personhood begins to develop; she argues that this ability is not present until the third trimester. Before then, the human being present does not have the moral rights that a person does.

The separation of human personhood from human being finds its roots in the mind-body dualism of René Descartes (1596-1650). Descartes argued that the mind, defined as consciousness, is the self, and that the body, though closely connected to the mind in this life, is not essential to one’s identity. Although not as dualistic as Descartes, John Locke (1634-1704) explicitly argued that the human being is not the same thing as a human person. For Locke, the human being is the living human body; the human person is the individual consciousness. The continuation of the same person is guaranteed by the continuation of consciousness, and this is revealed by having a stream of memories stretching back through time. Thus, if my consciousness were transferred into Hugh Laurie’s body, the body would remain that of Hugh Laurie, but the personal identity would be that of Michael Potts.

An alternative position holds that the human being and human person cannot be separated; as long as the human being is alive, the human person remains. This view is associated with some followers of St. Thomas Aquinas (1225-74). Philosophers J. P. Moreland and Scott Rae are representatives of this position. They argue that what constitutes personal identity is the soul, defined as the “form of the body,” the informational pattern, encoded in DNA, that makes the person the kind of entity he is. This informational pattern is specific to a particular body, and as long as that body lives, the pattern is present. This is true even if the body does not have all its powers, for example, in a zygote , embryo, or on the other end of the scale, in an elderly person suffering from severe Alzheimer’s Disease. This view, I believe, makes better sense of the embodied nature of human existence than the radical Cartesian separation of mind and body. It recognizes that humans can BE persons without FUNCTIONING as persons, as when a person is in a dreamless sleep or under anesthesia. Thus, as soon as the new information pattern encoded in the genetic code after conception is present in the zygote, a human person is present. Thus, abortion kills a living human person and not just a living human being.

I am aware of arguments regarding twinning and the lack of implantation of around 40-50% of embryos. As far as twinning or other multiple births, the informational pattern for all the births are present in the case of identical twins, triplets, etc., and it would be wrong to destroy the zygote(s) at whatever stage of development it is in. As far as lack of implantation—in the past the child mortality rate was as high or higher than 50%, yet no one questioned the personhood of children.

Even if conception is not when human personhood begins, one could argue we cannot know for sure—would you risk shooting a person if you heard a rustle in the bushes and thought it was a deer? In a similar way, would you risk killing a human person by killing an embryo you are SURE is not a human person. Some confidence can kill.

Men often pressure women into abortions; I have known at least two cases among family and friends in which this occurred. It is ironic that most feminists support abortion when it empowers men to be sexually irresponsible—if the woman gets pregnant, a man can pressure her to kill the evidence.

Morality is not necessarily the same as legality, but if abortion is murder, it should be prohibited. Although abortion due to rape or incest is still murder, most Americans support it being legal—even with that exception, almost all abortions would be illegal. Now I do not think that a constitutional amendment is the answer; overturning Roe v. Wade and putting abortion back into the hands of the states is most consistent with federalism. Then it is up to those on both sides of the issue to make their best cases—and the representatives of the people would decide instead of dictatorial judges.

Although abortion is objectively a grave moral evil, one of the worst mistakes a person can make, the subjective guilt of the woman may be lessened by circumstances such as rape, incest, or threats from a boyfriend. But abortion doctors are, to use a Southern expression, “lower than a snake’s belly” in using medicine to kill instead of to heal. I hope and pray that people will wake up and work to stop the great evil of abortion in American society.