So, what argument does Pinker give against making use of dignity in discussing issues of bioethics? He writes,

First, dignity is relative. One doesn’t have to be a scientific or moral relativist to notice that ascriptions of dignity vary radically with the time, place, and beholder. In olden days, a glimpse of stocking was looked on as something shocking. We chuckle at the photographs of Victorians in starched collars and wool suits hiking in the woods on a sweltering day, or at the Brahmins and patriarchs of countless societies who consider it beneath their dignity to pick up a dish or play with a child.

Pinker fails to realize that autonomy is also relative. Kant, the originator of the contemporary emphasis on autonomy, considered it always contrary to autonomy, the self-given universal law of practical reason, to commit suicide or to have sexual activity of any kind outside of a marriage between one man and one woman. Contemporary advocates of using autonomy as the basis for ethics reject these positions with scorn. Now autonomy is used to attempt to justify physician-assisted suicide as well as freedom of “sexual expression.” So, if dignity cannot be used in bioethics because it has been understood in various ways over the ages, this standard likewise excludes appealing to autonomy in bioethical disputes.

Second, Pinker notes that dignity is fungible:

The [President’s] Council and [the] Vatican treat dignity as a sacred value, never to be compromised. In fact, every one of us voluntarily and repeatedly relinquishes dignity for other goods in life. Getting out of a small car is undignified. Having sex is undignified. Doffing your belt and spread-eagling to allow a security guard to slide a wand up your crotch is undignified.

But Pinker’s premise also renders autonomy problematic, since autonomy too is fungible. Soldiers give up autonomy when they enlist for military service. Employees give up autonomy when they sign contracts agreeing to perform certain services and refrain from doing other activities that constitute a conflict of interest. Police officers, FBI agents, and politicians relinquish autonomy when they swear to enforce the laws of our nation. Lawyers and psychologists give up autonomy in speech in preserving client or patient confidentiality. Do the actions of these people reveal that autonomy is a trivial value, well worth trading off for money, public order, confidentiality, the good of raising children, or health?

Third, Pinker argues that dignity can be harmful. He writes,

In her comments on the Dignity volume, Jean Bethke Elshtain rhetorically asked, “Has anything good ever come from denying or constricting human dignity?” The answer is an emphatic “yes.” Every sashed and be-medaled despot reviewing his troops from a lofty platform seeks to command respect through ostentatious displays of dignity. Political and religious repressions are often rationalized as a defense of the dignity of a state, leader, or creed: Just think of the Salman Rushdie fatwa, the Danish cartoon riots, or the British schoolteacher in Sudan who faced flogging and a lynch mob because her class named a teddy bear Mohammed. Indeed, totalitarianism is often the imposition of a leader’s conception of dignity on a population, such as the identical uniforms in Maoist China or the burqas of the Taliban.

However, it is even more obvious that autonomy can be harmful. Consider the case of Desmond Hatchett who, before the age of thirty, exercised his sexual autonomy by fathering twenty-one children with eleven different women. Exercising her reproductive autonomy in similarly irresponsible fashion, Nadya Suleman, unemployed and unmarried, used in vitro fertilization to add eight more babies to join her other six young children at home. Drug abusers exercise their autonomy in harming themselves physically and mentally, often to the point where they become a drain on society. Politicians regularly exercise their autonomy in such a way as to cause unreasonable taxes, unfair laws, and unjust wars for their own political gain. Indeed, misuse of autonomy causes more harm, arguably much more harm, than misuse of dignity.

A fourth and unoriginal argument from Pinker for abandoning dignity echoes Ruth Macklin, who highlights the ambiguous ways in which the term “dignity” has been used in bioethics. The ambiguity of the term is an important issue that deserves serious consideration, something that Pinker himself fails to offer. He also fails to notice that “autonomy” is used in a variety of ways, so the difficulty of ambiguous terms is not unique to the term “dignity.” Does “autonomy” mean anything actually desired by the agent, even if the agent is brainwashed or under the influence of drugs? Does autonomy mean “informed consent” (which itself is a term used in various ways)? Does autonomy means rational, self-given law, so that an irrational request cannot be considered autonomous? Indeed, there is no term that cannot be used ambiguously. Admittedly, “dignity,” in the contemporary discussion, is even more prone to ambiguous usage than “autonomy,” but this is hardly ground for dismissing it entirely or for prejudicially abandoning attempts at disambiguation.

Disambiguation of the term dignity is done quite well by Daniel P. Sulmasy, in the very book Pinker criticizes. Sulmasy distinguishes dignity as attributed, dignity as intrinsic worth, and dignity as flourishing. Dignity as attributed is the worth human beings confer on others or on themselves. Attributed dignity comes in degrees and is at issue in some of the examples raised by Pinker in his argument that dignity can be harmful. Dignity as intrinsic worth is understood by Sulmasy as “the value that human beings have simply by virtue of the fact that they are human beings” rather than in virtue of performance, health, wealth, location, or social status. Dignity as flourishing is understood as the excellence of a human life consistent with, and expressive of, intrinsic dignity.

This simple disambiguation removes the alleged contradictions seen by Pinker. Slavery and degradation are morally wrong because they take away someone’s dignity as flourishing. Nothing you can do to a person, including enslaving or degrading him, can take his intrinsic dignity away. Dignity as attributed reflects excellence, striving, and conscience, so that only some people achieve it by dint of effort and character. Everyone, no matter how lazy, evil, or mentally impaired, has intrinsic dignity in full measure, but not dignity as flourishing or as attributed.

Even if we can successfully disambiguate the term, why is dignity important? The concept of dignity does a better job than autonomy in describing and accounting for the intrinsic value of every human being. We are valuable not simply because of our choices, and still less do we have value only while we are exercising our autonomy. We have value even when we are not choosing or cannot choose. In his 2009 Tanner Lectures at UC Berkeley, “Dignity, Rank, and Rights,” Jeremy Waldron pointed out that in ancient times dignity was accorded in particular to persons regarded as royalty or nobility. Noble persons were accorded rights, privileges, and immunities that accorded with their elevated rank. Contemporary society at its best does not reduce the noble but elevates the commoner, making every single human person equal in rank to the Duke or Lady. Although these ideals are often imperfectly realized in our society, still Waldron has a point when he writes, “we are not like a society which has eschewed all talk of caste; we are like a caste society with just one caste (and a very high caste at that): every man a Brahmin. Every man a duke, every woman a queen, everyone entitled to the sort of deference and consideration, everyone’s person and body sacrosanct, in the way that nobles were entitled to deference or in the way that an assault upon the body or the person of a king was regarded as a sacrilege.” The term dignity better captures than most, if not all, other terms the elevated status of the human person.

Do we have any reason for ascribing to all human beings such intrinsic dignity? In an earlier essay, I suggested that there are a number of ways to argue for the proposition that all human beings are endowed with intrinsic dignity and certain inalienable rights. The first is that our dignity should be based on who we are, the kind of being that we are, rather than on how we are functioning in the moment. Dignity should be based on our membership in the human family, rather than on any particular performative activity in which we could engage. Our functioning, whether it be understood in terms of our ability to experience pleasure and pain, or our consciousness, or our intelligence, comes in many degrees. If we think that our value as persons is based on a degreed characteristic, an accident in terms of Aristotelian metaphysics, then we cannot secure equal basic dignity and equal basic rights for all persons. We should therefore base our fundamental ethical judgments on the substantial identity of who we are rather than on any accidental degreed quality. Since all human beings are endowed with the same nature, members of the same kind—homo sapiens—they all share equally basic rights and dignity.

Christopher Kaczor is Professor of Philosophy at Loyola Marymount University and the author of The Ethics of Abortion: Women’s Rights, Human Life, and the Question of Justice (Routledge 2011). This piece is adapted from his remarks delivered at the conference “Radical Emancipation” sponsored by the Notre Dame Center for Ethics and Culture on the campus of the University of Notre Dame on November 10-12, 2011, and an article in the National Catholic Bioethics Quarterly.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2012 the Witherspoon Institute. All rights reserved.

It is almost too much to contemplate: the prospect that we are living in the midst of, and accepting (to various degrees) one of the greatest human holocausts in history. And so we don’t contemplate it. Instead, we look for ways to deny this grim reality, minimize it, or explain away our complacency—or complicity.

It is important, however, to view reality with eyes wide open, focus clear, and gaze not averted. On this thirty-ninth anniversary of Roe and Doe, I would like simply to set forth what Roe and Doe held, in as clear-headed and straightforwardly descriptive legal terms as possible, and to lay out its human and moral consequences. My brief tour of Roe’s unbearable wrongness begins with Roe’s radicalism—its extreme holding creating a plenary right to obtain or commit abortion—proceeds with Roe’s legal untenability, and concludes with Roe’s immorality and the moral problem of our seeming passivity and quiescence in response to the greatest legal and moral wrongs of our age.

Roe’s Radicalism

Start with Roe’s radicalism, a radicalism that we may no longer grasp because it has become so familiar. Roe created a constitutional right to obtain or commit an abortion of a human life—that is, to terminate the life of a human embryo or fetus. It is important to be clear-sighted about this: abortion kills a living human embryo or fetus. What distinguishes “abortion” from (say) miscarriage is the specific intention to kill a living fetus. What was alive before has been deliberately killed. Abortion takes a life. Further, the life taken is human life. There is really no doubt about that as a matter of biology. The embryo or fetus belongs to the species homo sapiens. It is a separate, living human being that is killed by abortion.

To be sure, that human being is killed at an early stage in its life cycle, and for a substantial part of that time could not live without direct biological connection to his or her mother (the person in whom Roe vests the right to terminate that human life). But that does not make the human embryo any less alive, any less human, or any less a separate life from the mother. It just makes the unborn baby more vulnerable and dependent.

The right created by the Supreme Court in Roe is a constitutional right of some human beings to kill other human beings. I do not mean for my description to be provocative, but simply direct—blunt about facts. One need not presume that the human fetus has a right not to be killed in order to recognize that, as a descriptive matter, Roe creates a right for one class of human beings to kill other human beings.

Roe, coupled with Doe, creates a plenary right to kill the embryo or fetus for essentially any reason, at any time throughout all nine months of pregnancy. Distilled to its essence, Roe created a “trimester” framework for abortion. In roughly the first three months of pregnancy, the right of abortion is avowedly plenary: abortion may be had for any reason. In the second three months, government may regulate abortion to protect the life or health of the mother, but again the right to have an abortion remains plenary. In the final three months—after the point of “viability,” when the human fetus could live on his or her own outside the mother’s womb—Roe says that abortion can be restricted or prohibited . . . except where abortion is necessary to protect the “life or health” of the pregnant woman.

This is a big exception. And here is where Doe steps in. On its face, Roe might appear, to the unwary or uninitiated, “moderate”—its trimester-balancing framework a measured, reasonable-sounding, proportionate act of judicial legislation concerning abortion. It is Doe that does a lot of the work, through an indirect and ultimately disingenuous definition of the “health” reasons that always may justify a woman’s decision to have an abortion and trump any interest of society in protecting fetal human life, even when the child could survive outside the mother’s womb. Doe holds that relevant “health” considerations justifying late-term abortions include “all factors—physical, emotional, psychological, familial, and the woman’s age—relevant to the well-being of the patient. All these factors may relate to health.” (Doe’s understanding of “the patient” did not include the fetus; Roe held elsewhere that the human fetus has no legal rights that any person is bound to respect.)

Roe then cross-referenced Doe’s stylized definition of health and incorporated it into the main holding. The result is that an abortion may be had, under Roe and Doe, for essentially any reason, throughout all nine months of pregnancy, up to the point of birth.

Nothing in any of the Court’s later abortion cases alters this definition of “health” or the right to abortion throughout pregnancy. Planned Parenthood v. Casey, the 1992 case reaffirming Roe, tinkered slightly with the trimester framework and the point at which “viability” occurs but did not change Roe’s (and Doe’s) holding that abortion may be had for any reason, before viability, and for any “health” reason throughout pregnancy. The partial-birth abortion cases carried this understanding forward, holding that the state may not prohibit the abortion method of inducing birth and killing the fetus on the way out of the birth canal (Carhart I [2000]), unless an equally effective, equally “healthy” method of killing the fetus is available (Carhart II [2007]).

I suspect that if more people understood Roe’s and Doe’s actual holding fewer would support that constitutional regime. Roe was a truly extreme decision, creating an effectively unrestricted constitutional right to abort a living human being for any reason the mother might have, throughout pregnancy right up to the point of birth.

Roe’s Legal Untenability

This brings us to Roe’s utter indefensibility as a matter of constitutional law. If the U.S. Constitution actually protected such an extreme personal legal right to kill the human fetus, that would be troubling enough, but the trouble would be with the content of the Constitution. The further problem with Roe is that it has absolutely no basis in the text, structure, or history of the Constitution. No rule or principle of law fairly traceable to the text, discernible from its structure, or fairly derived from evidence of intention or historical understanding of an authoritative decision of the people, remotely supports the result reached in Roe. In terms of fair principles of constitutional interpretation, Roe is perhaps the least defensible major constitutional decision in the Supreme Court’s history.

Roe’s reasoning, distilled to its essentials, is that the Constitution creates a “privacy” right to abortion, on the premise that the right not “to bear” a child is protected by the Fourteenth Amendment’s Due Process Clause. No serious constitutional law scholar thinks this is a plausible reading of the Due Process Clause. That clause forbids government to “deprive any person of life, liberty or property, without due process of law.” Without due process of law are crucial words. The Due Process Clause does not say that government never may deprive a person of life, liberty or property. It only says that government may not do so “without due process of law”—that is, arbitrarily, lawlessly, not in conformity with duly enacted laws and accepted procedures for their application.

Many nonetheless support Roe’s holding as a policy matter and therefore seek to rationalize the holding some other way. Perhaps the goofiest is the suggestion advanced by a few law professors, in apparent seriousness, that abortion restrictions violate the Thirteenth Amendment’s ban on slavery. Saner, but in the end still unsound as a legal matter, is the notion that abortion laws discriminate on the basis of sex and thus deny “equal protection of the laws.” The defect in this argument is that abortion laws do not classify on the basis of sex or gender and are not disguised attempts to do so. Rather, they aim at conduct—obtaining or committing an abortion—when engaged in by persons of either sex. Abortion restrictions do not restrict acts of women because they are women; they restrict acts committed by men or women because they kill human fetuses. Further, ask a “pro-choice” “feminist” whether abortion should be permitted for reasons of sex-selection—that is, because the unborn child is a girl—and the sex discrimination argument begins to turn back on itself. All but the most blindly pro-abortion ideologues abandon the argument that abortion rights are required for gender equality, if that means abortion can be chosen for gender-selection of boys over girls.

In Planned Parenthood v. Casey, the Supreme Court rested the right to abortion back where Roe purported to find it, in the Due Process Clause. Recognizing the embarrassments created by this view, Casey added another prop: the doctrine of precedent or “stare decisis,” which is essentially all that is left to support Roe. But Casey’s invocation of the doctrine was transparently disingenuous: Because the public expects the Court to adhere (usually) to its past decisions, because the Court had staked its authority on Roe, and because the Court might be viewed unfavorably by some of the public if it reversed itself in such a case, the Court said that it had decided to adhere to Roe “whether or not mistaken.” Thus, what Roe held to be required by substantive due process Casey held to be required by stare decisis, even assuming Roe to be wrong.

If Roe was radical, Casey was craven. A majority of the Supreme Court apparently believed that Roe was wrongly decided, fully understood the moral and human consequences of the decision, and deliberately adhered to it anyway. Stare decisis has never been thought required by the Constitution, before or since. Brown v. Board of Education (1954) famously repudiated Plessy v. Ferguson (1896) on the question of whether racial segregation was consistent with “equal protection of the laws.” The Court has overruled scores of its own precedents. Indeed, it overruled two cases in Casey. Casey’s reaffirmation of Roe, in the name of stare decisis, was a sham—perhaps the most transparently dishonest major judicial decision since Dred Scott.

Roe’s Immorality

Finally, there is Roe’s immorality—the abortion holocaust it unleashed—and the problem of our response to it. Roe is a radical decision and a legally indefensible one. But what really makes Roe unbearably wrong is its consequences. The result of Roe and Doe has been the legally authorized killing of nearly sixty million Americans since 1973. Roe v. Wade authorized unrestricted private violence against human life on an almost unimaginable scale, and did so, falsely, in the name of the Constitution.

It is hard to escape this conclusion, but not impossible—and many certainly try. I will not here belabor the question of whether the intentional killing of innocent, dependent, vulnerable human children is a grave moral wrong. My concluding point concerns the lengths to which we will go to deny the reality of this holocaust, because it is almost unbearable to contemplate and still go on living life as if nothing is terribly wrong. The cognitive dissonance is simply too great. And so we have become, in effect, a nation of holocaust deniers.

Here is the problem, undressed: If human embryonic life is morally worthy of protection, we have permitted sixty million murders under our watch. Faced with this prospect, many of us—maybe even most—flee from the facts. We deny that the living human embryo is “truly” or “fully” human life, adopt a view that whether the embryo or fetus is human “depends,” or can be judged in degrees, on a sliding scale over the course of pregnancy; or we proclaim uncertainty about the facts of human biology; or we proclaim moral agnosticism about the propriety of “imposing our views on others”; or we throw up our hands and give up because moral opposition to an entrenched, pervasive social practice is not worth the effort, discomfort, and social costs. The one position not on the table—the one possibility too hard to look at—is that abortion is a grave moral wrong on a par with the greatest human moral atrocities of all time and that we passively, almost willingly, accept it as such.

All of this should tell us a few more sobering things. It should tell us that, much as we would like to believe that human beings have become more morally conscious, more sensitive to injustice and intolerant of clear evil, it remains the case that we often either fail to recognize it in our midst, or refuse to respond to it decisively, out of self-interest or cowardice. It should tell us that, much as we would like to think that we surely would have stood bravely against slavery, even if embedded in a nineteenth-century society that tolerated and accepted it as a legal right, we might have acquiesced or been tepid in our condemnation. It should tell us that, much as we would like to think we would never have put up with what transpired in Nazi Germany in the 1930s and the 1940s, the evidence of our lives in twenty-first century America is that we might have put up with quite a lot.

And it should tell us finally, that, as much as we may claim to admire our governmental and constitutional system, the decisions of the Supreme Court in the abortion cases expose the Court—at least on this matter of life, death, and law—as a lawless, rogue institution capable of the most monstrous of injustices in the name of law. The Court has, with its abortion decisions, surely forfeited its legal and moral legitimacy as an institution. It has forfeited its claimed authority to speak for the Constitution. It has forfeited its entitlement to have its decisions respected, and followed, by the other branches of government, by the states, and by the people. Yet the docility of the American people with respect to Roe and abortion rivals the pliancy of the most cowardly, servile peoples toward ruinous, brutal, anti-democratic regimes throughout world history.

The Supreme Court is empowered by the Constitution to faithfully interpret the Constitution. But it is not alone in that power, and when it exceeds it and violates it, it is the responsibility of other actors in our system to check the abuse. As James Madison wrote in The Federalist No. 49, “the several departments being perfectly co-ordinate by the terms of their common commission, neither of them, it is evident, can pretend to an exclusive or superior right of settling the boundaries between their respective powers.” Moreover, it is “the people themselves” who are “the grantors of the commission” and who “can alone declare its true meaning and enforce its observance.”

The Court’s decision in Roe v. Wade should not be accepted as law, in any sense. It should be resisted by legislatures and it should be refused enforcement by executive officials because it is not the law. It should be resisted by all citizens, with all the resources at their disposal, and perhaps even with resources not (yet) at their disposal. Anything less is holocaust denial.

Michael Stokes Paulsen is University Chair and Professor of Law at the University of St. Thomas, in Minneapolis, and co-director of its Pro-Life Advocacy Center (PLACE).

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2012 the Witherspoon Institute. All rights reserved.

Equally important is the Society’s affirmation of its commitment to palliative care. The policy, according to Young, expresses “support for patient dignity and the alleviation of pain and suffering at the end of life,” and encourages physicians “to contribute to the comfort and dignity of the patient and the patient’s family.” As the Society acknowledges, palliation is an important part of the doctor’s vocation. Doctors rightly provide comfort to the dying, even when they know that death inevitably approaches. Unlike assisted suicide, palliative care is not inconsistent with the physician’s commitment to life and health.

Physicians in Massachusetts thus grasp a fundamental distinction that proponents of assisted suicide elide. That is the difference between choosing to cause death and choosing instead to provide comfort, knowing, but not intending, that death might be hastened as a result.

Proponents of assisted suicide obscure this distinction by focusing exclusively on consequences and ignoring purpose and intent. They observe that a terminally ill patient, who qualifies for physician-assisted suicide in those states that now allow it, is going to die no matter what. Why should it matter whether that death comes about as a result of a deliberate act or rather in the natural progression of the disease? Indeed, they insist, it is uncaring not to help the patient kill himself, to leave the patient exposed to the pains of a debilitating illness.

The choice between suicide and suffering is a false choice. Physicians do and should act with a purpose to relieve pain. Palliative care expresses respect for the lives of suffering patients, including those patients who are about to die. To acknowledge that death is inevitable is not to choose death; the fact that death occurs is not itself morally significant. But whether we choose death or not is morally significant.

A physician who helps her terminally ill patient live out his last days with as little pain as possible, even if this means hastening death, has not failed morally. Her action is every bit as reasonable as an act of self-defense, prosecution of a just war, or any other act that results in death, where the death is a foreseen consequence but is not intended. In other words, the principle of double effect applies to healthcare providers, just as it applies to everyone else.

By contrast, one’s purpose with respect to death is extremely important. It is the choosing of death, acting with a purpose that death will result, that is morally problematic. Death is not something to be chosen, least of all by doctors. A physician who adopts the death of her patient as the purpose for her action has become a different kind of physician. Indeed, she has become a different kind of person. She has become a person who chooses death over life.

A person who purposely chooses to cause death, who makes death a reason for his actions, is not oriented toward the good. This is because choosing has a creative, self-making significance. To adopt by free choice a reason for one’s action is to make that reason part of one’s projects and commitments. By choosing life, one becomes a person oriented toward life. By choosing death, one becomes a person oriented toward death.

A person who is oriented toward life is going to act very differently than a person who is oriented toward death. Once one has adopted death as his purpose, death becomes a potential reason for action in later instances. One who considers purposeful death as an option will consider it reasonable to weigh the deliberate destruction of life against more costly alternatives, such as extended palliative care. If death itself is a reason for action, then nearly any hardship in life is sufficient to justify death. Addressing the underlying cause of the hardship is viewed as merely one option, and self-murder is often a less costly alternative.

For these reasons, the availability of assisted suicide is the enemy of palliative care. Perhaps this is why some have found that palliative care is declining in Oregon, where physician-assisted suicide has been permitted for several years. Indeed, there is good reason to believe that opposition to assisted suicide and concern about patient suffering, far from being enemies, actually go hand in hand. Respect for the intrinsic value of life provides a motivation to alleviate pain at the end of life. And a commitment to improving palliative care might eradicate demand for assisted suicide.

Human beings have value simply by virtue of their being alive. This does not mean that the value of life is absolute, that measures should always be taken to prolong life, or that one should never take any action that might hasten death. But we should not ask physicians to act with a purpose to bring about the death of their patients. We could not so alter the role and character of physicians without causing serious harm to their profession and to those whom they serve.

Adam MacLeod is an Associate Professor at Faulkner University’s Thomas Goode Jones School of Law.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2012 the Witherspoon Institute. All rights reserved.

To a Sanger supporter, the accusation of eugenics touches a nerve. To understand this, one must grasp the subconscious syllogism underlying the emotional reaction: Margaret Sanger and Planned Parenthood are progressive feminist institutions. Progressive feminism cannot coexist with eugenics, which is a malady of the right-wing. Therefore, Margaret Sanger and Planned Parenthood are free of eugenic contamination. QED.

Something new has happened over the last ten years, however, that challenges such easy assumptions, and both Cain’s and Clinton’s language reflected it. No one with any command of the facts can deny any more that Sanger was in some way a eugenicist.

First, scholars of women’s history have begun examining the feminist movement with more objectivity, producing a new literature that is less afraid to detail the unsavory aspects of feminist history. Historical work on eugenics has also begun to shift: Historians of the subject have long recognized Sanger’s involvement in eugenics, but had not sufficiently acknowledged her importance for the movement.

Second, as positive as these improvements in scholarship are, probably the most crucial factor in bringing about a more realistic and balanced assessment of Sanger and eugenics has been the internet. Sanger’s own words are more accessible than ever (a process aided by the multivolume edition of The Selected Papers of Margaret Sanger). Planned Parenthood is simply unable to deny convincingly the truth about its founder.

And what is that truth? Margaret Sanger was many things admirable: a vibrant personality, a brilliant organizer, a canny reader of the temperature of the times, a woman who built powerful institutions in a man’s world. But she was also many things ugly and even despicable: an egotist who frequently clashed with others; a free-love advocate who had a dizzying number of affairs and who hurt many men as a result; and a eugenicist who argued that “birth control is nothing more or less than the facilitation of the process of weeding out the unfit, of preventing the birth of defectives or of those who will become defective.”

In light of this reality, Jean H. Baker’s book, Margaret Sanger: A Life of Passion, is a bit of a scholarly throwback. While it is readable, lively, and in many ways realistic about its subject, it is deeply unsatisfying as an ideological analysis.

Even Planned Parenthood has had to drop the denials of Sanger’s commitment to eugenics and now urges us all instead to avoid judging those of another historical era. After all, as Hillary Clinton basically said in 2009, Thomas Jefferson owned slaves, and he still did some pretty nifty things. Take what you like and leave the rest, that’s the new approach to Sanger.

So Baker cannot simply ignore the fact of Sanger’s eugenic preoccupation, but she doesn’t seem to feel obliged to try to make much sense of it. Instead, she seeks that convenient refuge of the relativist: “nuance.” Critics of Sanger (this reviewer included) are chastised for not having “a more nuanced view of her perspectives and the reasons she accepted aspects of a mainstream movement dedicated to improving human beings.”

Well, fine. While it’s hard to find “nuance” in a worldview that calls organized charity “a malignant social disease,” it would at least be entertaining to read someone trying to do so. Instead, regarding eugenics, what we get with Baker is an exhortation to nuance (in the Introduction) and then an avoidance of the issue for most of the remaining 300 pages. When she does address eugenics, she does so superficially. She acknowledges that Sanger was a “promoter” of eugenics, yet, in describing her motivation, the most she can muster is a variation of the mere-pragmatics  defense: “In an effort to gain support, [Sanger] signed on to negative eugenics.”

Baker further tries her hand at nuance by claiming that Sanger rejected the “standard eugenic proposition that heredity was absolute.” Unfortunately for Baker, there was no such standard eugenic line. Only the most unsophisticated eugenicist would have claimed such a thing, while most scholarly eugenicists (such as Frederick Osborn) knew very well by the 1920s that nature and nurture interacted in the production of human traits. Ironically, in her Introduction, Baker accuses Sanger’s critics of an inadequate knowledge of the eugenics of Sanger’s day, a defect that she herself exhibits in spades.

The book’s treatment of the population-control movement reveals a similar failure to understand the history of eugenics. Baker writes that by the late 1920s, Sanger “had determined that population experts, like eugenicists, were emerging as an expanding pool of potential supporters.” In fact, population experts were eugenicists, plain and simple. Beginning with the first to use the term “eugenics,” Francis Galton (1822–1911), down through the eugenicists with whom Sanger worked in the 1920s through the 1960s, all early population “experts” were eugenicists. The discipline of demography was shot through with eugenic assumptions. As feminist and Marxist historian Linda Gordon observed, “The eugenics people slid into the population control movement gracefully, naturally, imperceptibly … There was nothing to separate the two movements because there was no tension between their two sorts of goals.”

Why were the two movements so closely aligned? The key can be found in a popular slogan of the eugenics/population-control crowd: “Quality, not quantity.” Eugenicists believed that, in order to improve the race, fewer people (only the so-called “fit”) should reproduce. In its 1927 Buck v. Bell decision, written by Oliver Wendell Holmes, Jr., the Supreme Court ruled that compulsory sterilization of the “unfit” was allowable under the Constitution, enabling American states to sterilize, on a far greater scale, those citizens deemed unfit, without their consent and sometimes even without their knowledge. (In the end, a majority of states allowed for involuntary sterilization, leading to over 60,000 sterilizations by 1967.) Between birth control and involuntary sterilization, the eugenics movement had a plan for dealing with the “unfit” in America.

But what to do about the great mass of people outside her borders? As Sanger confided in a letter to Clarence Gamble in 1940, India was “a bottomless sink … They need birth control on a large scale and it should be continually prodded into the national consciousness daily, hourly, for at least five years.” The Rockefeller family, deeply immersed in eugenics, financially supported the earliest eugenic population-control organizations, such as the Population Council. This was done quietly, however; as Frances Hand Ferguson, a former president of Planned Parenthood in America, observed, “Certainly the Rockefellers didn’t want to be known as a family who was telling little brown Indians not to have babies.” Population control was a gussied-up eugenics—with a passport.

Baker’s neglect of this history makes her treatment of eugenics and population control relentlessly shallow and unreflectively ideological. For example, she states confidently that “too large a population blocked opportunities for growth and stalled industrialization in what was now dubbed ‘the Third World.’” This is the language of someone who takes the formulations of eugenic demographers at face value instead of questioning how their ideological agenda might have compromised their scientific endeavors. In fact, as recent articles in Public Discourse have observed, the world is well able to absorb its roughly seven billion people. Economists such as Julian Simon have argued that the healthy population growth of India is one reason why its economic growth has been so robust. Of course, the point of Margaret Sanger: A Life of Passion is not to give a course on contemporary theories of population economics, but a nod of acknowledgment toward these larger issues would have greatly deepened the book’s analysis.

Disappointing as these defects are to the informed reader, the most unsatisfying aspect of the book is its naïveté about Sanger’s model of sexual liberation. Baker, who earned her B.A. in 1960, has ideas about sexuality that seem not to have budged from a sunny, 1960s-era cluelessness about the glories of uncommitted sex. This, despite the divorce revolution, HIV/AIDS, pornification, the sexualization and abuse of children: in short, the sum total of physical and emotional devastation wrought by the sexual revolution. Instead, the reader gets platitudes about Sanger’s affairs as a “life-affirming inspiration” or as “spontaneous, self-affirming alliances with men.” Baker is too good a historian to overlook the heartache that such behavior caused Sanger’s two husbands, but she seems unable to grasp how promiscuity harmed Margaret Sanger herself. The lonely woman at the end of her life, addicted to Demerol and resentful of the loss of celebrity, is the result of a life spent using people and, in turn, being used.

In sum, Baker cannot think outside the liberal academic box. She makes the utterly conventional assumption that eugenics was not what it in fact was: a progressive movement through and through. She does not understand that eugenics is all about one thing: control, the control of benighted masses by an enlightened elite. As Baker correctly emphasizes (but does not understand), Sanger insisted that contraception be called not family planning but birth control. Margaret Sanger’s was an ideology of control: birth control (baited with promiscuity), enabling a eugenic control of population—the progressive application of biopower. It is an ideology that tempts totalitarian elites—wherever they might be found on the political spectrum.

Angela Franks, Ph.D., is the author of Margaret Sanger’s Eugenic Legacy (McFarland, 2005) and the Director of Theology Programs for the Theological Institute for the New Evangelization (TINE) at Saint John’s Seminary in Boston.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2012 the Witherspoon Institute. All rights reserved.

On October 17, 2011, Sequenom, a San Diego–based testing company, rolled out “MaterniT21” in twenty major cities across the United States. Using a technique called “massively parallel shotgun sequencing,” the test identifies fetal DNA in a sample of the mother’s blood and sequences it. The test detects whether the fetal DNA is positive for Trisomy 21, the most common cause of Down syndrome, with the lowest false positives and false negatives of current screening tests.

In reporting on the new test, headlines (for example, here and here) have highlighted how the new test is a “safer” prenatal test for Down syndrome. This is incorrect.

In 2007, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that all women be offered screening and diagnostic prenatal testing for Down syndrome. Noninvasive screening tests for Down syndrome have existed since the 1980s. Like MaterniT21, they use a mother’s blood sample and are just as safe, though less accurate in assessing a fetus’s likelihood of having Down syndrome. In this initial roll-out, Sequenom is only offering its testing to those mothers considered “high risk” due to advanced maternal age, having a family member with Down syndrome, or having already received a “positive” screen result from the existing screening tests. The only way to know for certain whether a pregnancy is positive for Down syndrome, even after receiving a MaterniT21 result, is through invasive testing, usually an amniocentesis or chorionic villus sampling (CVS). Because invasive testing involves inserting a needle into the womb, it has a risk of miscarriage. MaterniT21 does not make invasive testing any safer—if anything, it might increase the risk.

The journal Genetics in Medicine published a Sequenom-funded study on the eve of the new test’s launching. Jacob Canick, one of the study’s leaders, explains how the test is “safer”: “It is possible that with the availability of this new DNA-based test, more women will opt for screening because of the increased safety resulting from far fewer amniocentesis and CVS procedures being performed.” This is the clinical reason cited as justification for introducing the new test: that it will drastically reduce miscarriages from invasive testing. As Dr. Glenn Palomaki, the study’s lead author, put it, “nearly all women with a normal pregnancy could avoid an invasive diagnostic procedure and its associated anxiety, cost and potential for fetal loss.” This quote deserves to be unpacked.

First, “nearly all” pregnancies currently do avoid invasive diagnostic testing. There are millions of pregnancies each year, with 750,000 being considered high risk for Down syndrome, but only 200,000 invasive procedures each year. ACOG made its 2007 recommendations because studies had found that the risk for miscarriage was lower than historically reported when invasive testing was performed at experienced facilities by experienced practitioners. If Sequenom’s goal of reducing the number of invasive tests is achieved, there also will be fewer experienced facilities and practitioners, thereby potentially increasing the risk of miscarriage for those undergoing invasive testing.

Dr. Palomaki’s assurance that “nearly all women with a normal pregnancy could avoid an invasive diagnostic procedure” also deserves consideration. Most parents of children with Down syndrome would object to the crass labeling of their sons and daughters as abnormal. Putting that aside, Down syndrome is but a small fraction of the baseline risk every pregnancy has for what is commonly considered a birth defect. Further, Down syndrome represents only about half of chromosomal conditions identified through invasive testing. This means that for each woman who opts for invasive testing following a positive MaterniT21 result, there could be another woman falsely reassured by a negative result that her child will not have a chromosomal condition.

Sequenom’s test has also been called safer because it can be performed earlier than ever in a pregnancy, as soon as ten weeks. This, however, is another reason for concern.

MaterniT21 can be performed any time from ten weeks forward in a pregnancy. In the research study, half of the samples were from the second trimester, but the test is offered earlier in the pregnancy specifically because it allows for earlier termination. Matthew Rabinowitz is CEO of Gene Security Network, a company developing its own noninvasive prenatal test for Down syndrome. Commenting on Sequenom’s new test, he clinically and candidly stated, “If a couple finds an abnormality, and chooses to terminate the pregnancy, it’s better to do it earlier.” Considering that the majority of women currently receiving a prenatal diagnosis of Down syndrome do opt to terminate, Sequenom’s new test is definitively not safer for the fetus.

For this reason, Sequenom’s product name for the test is rather Orwellian. “MaterniT21” recognizes that the test is for a mother, but provides the opportunity for most women to end their maternal status through abortion.

Sequenom’s justification for its testing is as misleading as the test’s name. In a press release, Harry F. Hixson, Jr., Sequenom’s CEO, said, “We believe that the MaterniT21 LDT will provide physicians and their patients with critical new information to help them make better informed decisions about the patients’ healthcare and pregnancies.” In the study Sequenom funded, however, it noted as an implementation issue that “educational materials for both patients and providers need to be developed and validated to help ensure informed decision making.” This long has been recognized, based on the current administration of prenatal testing.

Study after study has found that a significant number of expectant mothers and their partners do not understand the probability assessments of screening tests, did not expect they would have to make a decision about invasive testing, and, after a positive diagnosis, often are unexpectedly counseled about termination for the first time and rarely informed of the option of adoption. This has led one researcher to conclude that the current administration of prenatal testing does not respect a woman’s right to choose because so many make uninformed decisions. In response, just this summer, both the National Society of Genetics Counselors (NSGC) and the American Academy of Pediatrics (AAP) published new guidelines specifically calling for the delivery of accurate, up-to-date written materials about Down syndrome and referral to parent support organizations when a patient receives a prenatal diagnosis. The NSGC even listed the educational materials that should be provided to patients, but Sequenom has yet to invest in these equally important information resources for expectant mothers undergoing its testing.

Now, other prenatal testing companies have launched testing without providing the balancing resources, but Sequenom has recognized that these resources are needed from the outset of its testing and still does not provide them. Dr. Hixson’s statement simply makes Sequenom one more purveyor of the “prenatal testing sham” that I wrote about earlier this year—justifying prenatal testing as simply providing information while failing to provide all of the needed information. But Sequenom’s motivation for rolling its tests out without the accompanying educational materials makes its actions particularly unconscionable.

Sequenom had intended to launch its test in 2009, when it was being promised as a diagnostic test. On the eve of going to market, however, it had to admit it had manipulated its data. Its stock price plummeted, a shareholder lawsuit followed alongside an SEC investigation, and its research official pled guilty to conspiracy to commit securities fraud. Competitors, such as Gene Security, also are promising similar testing as soon as next year. Sequenom patented its methodology, promising patent battles should these competitors try to roll their tests out. With the launch of its new test, Sequenom’s stock price increased by 4.5 percent.

So, Sequenom having suffered a hit to its reputation and finances, with competitors poised to offer similar testing, pushed MaterniT21 to be the first available test, justifying it on the premise that it was “safer” and would help mothers make informed decisions, but implementing it without the needed educational resources called for by its own paid-for study.

With a potential market of up to 750,000 “clients” initially, and millions if its testing can be shown to be reliable for even low-probability pregnancies, Sequenom stands to reap billions of dollars in revenue. Yet it has not invested even a small fraction of this revenue into the educational materials it recognizes are needed for physicians and patients to make informed decisions about prenatal testing and following a prenatal diagnosis. In offering its testing with the business interest of most women accepting it, and knowing that most will choose to abort, without having been properly informed, Sequenom is participating in the reckless elimination of Down syndrome.

As a laboratory-developed test, MaterniT21 currently is not regulated by the Food and Drug Administration. Therefore, absent public pressure, a lawsuit, or shareholder demands, there is no compulsion for Sequenom to fund the educational resources it recognizes are needed to inform expectant mothers’ decisions. One hopes its leadership will recognize that its current offering of MaterniT21 is reckless, and that investing in the educational resources is a small price to pay for a clear conscience.

Mark W. Leach is an attorney from Louisville, Kentucky, and a Master of Arts in bioethics candidate.  

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

He proposed this solution in a New York Times column that will likely be studied by journalism students for decades—as an example of what happens when the last Fact Checker at a “newspaper of record” is asleep on the job.

It took only a 30-second Google search to demolish Kristof’s principal thesis—that the birth of the world’s 7 billionth person is the result of too much unprotected sex that contributes to all these ills.

The 30-second search confirms that population growth is not fueled by an excess of babies, as Kristof contends; it is fueled by more folks living longer than ever. The demographic evidence comes straight from the United Nations Population Division (UNPD). Using UNPD data, a Population Reference Bureau demographer compared population trends in the 0-4 age group and the 65-and-over age group. For simplicity, I’ll refer to these groups as Toddlers and Elders. Here’s what the UN’s data show.

In 1950 there were 335 million Toddlers worldwide and only 131 million Elders. Due to very low birthrates in developed countries and declining birthrates in most developing countries, today Elders are rapidly closing the gap. After Toddlers peak at about 650 million, sometime between 2015 and 2020, “for the first time in history, the [number of Toddlers] will decline” while Elders keep growing in number, reaching 714 million in 2020. By 2050, there will be 2.5 times more Elders than Toddlers—a complete reversal of the 1950 demographics.

Greater longevity is a good thing—the result of scientific and technological breakthroughs in agriculture and nutrition, in medicine, in water purification, and in improved sanitation.

But it’s the Toddlers on whom the future of humanity depends. When they reach adulthood, they will join the workforce, contributing to the nation’s wealth and tax revenues for roughly four decades, revenues sorely needed to fund Social Security and Medicare. It’s the cohort of former Toddlers who’ll be buying the cars, homes, and pricey electronics that keep an economy humming.

It is only right to provide a safety net for the elderly poor, from pure compassion, as well as in recognition of their contributions and sacrifices. But countries in the European Union are already reeling from the crisis of having too few workers to sustain the cradle-to-grave welfare state, even as the number of retirees explodes. Demographically, America is not far behind.

A good Fact Checker might also have questioned Mr. Kristof’s faith in the theoretical modeling exercises of the Guttmacher Institute, which purport to show that an X increase in access to and use of contraception will reduce unplanned pregnancies by Y, and abortions by Z.

The evidence simply doesn’t back this up. Empirical data of the last fifty years overwhelmingly show that with increased access to and use of contraception, unplanned pregnancies and abortions very often rise, or at best, stay about the same (an exception being found among women in former Soviet bloc countries, whose lifetime abortions often numbered well into double digits). Guttmacher and others have published numerous papers describing this apparent paradox.

Spain provides a recent example of this phenomenon: Between 1997 and 2007, contraceptive use among women rose 63 percent, while the rate of elective abortion in Spain more than doubled (108 percent).

In Sweden, teen abortion rates dropped 40 percent between 1975 and 1985, and teen childbearing also fell. Later the government increased pregnancy prevention efforts—providing free contraceptive counseling, subsidized oral contraceptives (OCs) and condoms, and over-the-counter emergency contraceptives. Between 1995 and 2001, teen abortion rates in Sweden increased by almost one-third—from 17 to 22.5 per 1000.

Duke University economics professor Peter Arcidiacono writes: “Our results suggest that increasing access to contraception may actually increase long run pregnancy rates. … On the other hand, policies that decrease access to contraception, and hence sexual activity, may lower pregnancy rates in the long run.”

Key studies with full citations are summarized in a fact sheet titled “Greater Access to Contraception Does Not Reduce Abortions.”

Why do contraceptives fail to live up to their name and their advertising? Many factors contribute to lack of effectiveness in preventing pregnancies (and STDs), especially among teens: method and user errors, the phenomenon of “risk compensation,” age-related fertility, and frequency of intercourse. Guttmacher’s Family Planning Perspectives reports the following 12-month pregnancy rates for sexually active OC users: 3.3 percent for middle-income married women age 30 and above; 13 percent for low-income single teens; and 48.4 percent for low-income cohabiting teens.

Among sexually active women whose partners use condoms as their primary method of birth control, 12-month pregnancy rates are as follows: 6.2 percent for middle-income married women age 30 and above; 23.2 percent for low-income single teens; and 72 percent for low-income cohabiting teens.

If it were just a matter of hormonal birth control not being 100-percent foolproof, and putting aside the moral questions involved in casual and contraceptive sex, some might argue for its use by disciplined, meticulous adults, in a stable relationship, willing and financially able to raise the potential “unplanned” baby.

Hormonal contraceptives are not benign, however, as any Fact Checker would learn from drug labels on the FDA’s website (even without perusing the voluminous Adverse Events data).

The link between hormonal contraceptives and breast cancer has been known for over thirty years. The World Health Organization (WHO) classifies the synthetic estrogen and progestin in contraceptives as carcinogenic to humans. The largest metanalysis (54 studies with over 150,000 women) found that women who use OCs before age 20 have almost double the risk of developing breast cancer before age 30, compared to women who did not use OCs as teens.

Until 2002, hormone replacement therapy (HRT), using hormones similar to those in combined OCs, but in lower doses, was standard treatment for menopausal symptoms. As HRT use increased, breast cancer rates rose by over 40 percent from the early 1980s through 2001. In 2002, the Women’s Health Initiative HRT trials were abruptly halted due to findings of increased risks of breast cancer, heart disease, blood clots, and stroke. As prescriptions plummeted, breast cancer rates in women over age 50 dropped 8.6 percent between 2001 and 2004. WHO now classifies HRT as carcinogenic in humans.

A Fact Checker could have told Mr. Kristof that there is, in fact, a way to slightly reduce population growth through contraceptive use, but not what he had in mind: Contraceptives can kill adults and teens.

In addition to having an increased risk of dying from breast cancer, women using hormonal contraceptives and their partners are dying at higher rates from incurable STDs, like HIV/AIDS, because hormonal contraceptives can double the risk of STD acquisition.

Women continue to die from high levels of synthetic hormones. For example, about 130 deaths have been linked to the Ortho Evra patch from blood clots resulting in heart attack, stroke, or pulmonary embolism.

Three new studies show a higher risk of lethal blood clots or gallbladder disease in women using birth control pills like Yaz. The manufacturer, Bayer, is already facing “6,850 lawsuits alleging that Yaz’s drospirenone ingredient is more dangerous than those used in competing pills. About 190 deaths from heart attack, stroke or pulmonary embolism have been associated with Yaz and similar pills.”

The manufacturer of NuvaRing® now faces 730 lawsuits in the U.S. for blood clot-related injuries and deaths associated with its use. About 40 deaths linked to NuvaRing® use have been identified to date in the FDA adverse event database.

A good Fact Checker could have given Mr. Kristof these hard truths and spared him from looking foolish. But where are all the good Fact Checkers when you need them? Not at The New York Times.

Susan E. Wills, Esq., is assistant director for education and outreach at the U.S. Conference of Catholic Bishops’ Secretariat of Pro-Life Activities.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

Last year I had the good fortune to read Eric Metaxas’s wonderful book, Bonhoeffer. It’s a biography of the great Lutheran theologian, Dietrich Bonhoeffer. I’ve quoted Bonhoeffer’s work many times over the years. The reason is simple. I admire him. He could have been a professor. Instead he chose to be a pastor. He could have had a sterling academic career of lecturing about his ideas and his faith. Instead he chose to put them into action and to immerse himself in people’s lives. He was a man not of “values” in the meager modern sense, but of virtues in the classical and religious sense—the virtues of justice, courage, and love, all grounded in the deep virtue of faith in a loving God.

The Third Reich hanged Bonhoeffer for his resistance activities just a few weeks before the end of the Second World War. Today we see him—rightly—as one of the great moral witnesses of the last century; a man who fought for the good, in the face of very grave evil, at the cost of his life.

Another great moral witness of the twentieth century was the writer Aleksandr Solzhenitsyn, who began as an atheist but ended Russian Orthodox. His history of The Gulag Archipelago, in its indictment of Marx, Lenin, Stalin and the brutality of Soviet repression that grew naturally from their thought, is a masterpiece of modern literature. Like Bonhoeffer, Solzhenitsyn wrote from direct experience of imprisonment and organized inhumanity. Unlike Bonhoeffer, Solzhenitsyn survived the war, survived years in prison camps, and was eventually exiled to the West.

In 1978, four years after Solzhenitsyn left Russia, Harvard University asked him to speak to its graduating students. What Harvard may have expected was praise for Western abundance, freedom, and diversity. What it got was very different.

Solzhenitsyn began by noting that Harvard’s motto is Veritas. This is the Latin word for “truth.” Then he added that “truth is seldom pleasant; it is almost invariably bitter.”

Then he spent the next 6,000 words saying what nobody wanted to hear. He methodically criticized Western cowardice and self-indulgence; the vanity and weakness of America’s intellectual classes; the “tilt of freedom in the direction of evil;” the right of people “not to have their divine souls stuffed with gossip, nonsense [and] vain talk” by the mass media; a pervasive Western atmosphere of legalism and moral mediocrity; and the rise of a destructive individualism that now forces decent people “to defend not so much human rights as human obligations.”

Some of Solzhenitsyn’s hard words came from his suffering. Some flowed from loneliness for his own country. But while Solzhenitsyn was harsh in his comments at Harvard, he also was accurate in at least some of what he said. Speaking of his Russian homeland he said, “After suffering decades of violence and oppression, the human soul longs for things higher, warmer and purer” than anything offered by the practical atheism now common in the West.

The reason for the problems of the West, said Solzhenitsyn, is found “at the root, at the very basis of human thinking in the past [several] centuries.” Our culture has fallen away from our own biblically informed heritage. We’ve lost the foundation for our moral vocabulary. This loss has starved our spirit, debased our sense of any higher purpose to life, and destroyed our ability to defend or even to explain any special dignity we assigned to the human person in the past.

Now I’ve said all of this to give a context for four simple points I’d like to share. I’ll be brief.

Here’s my first point. We remember Bonhoeffer, Solzhenitsyn, and other men and women like them because of their moral witness. But the whole idea of “moral witness” comes from the assumption that good and evil are real, and that certain basic truths about humanity don’t change. These truths are knowable and worth defending. One of these truths is the notion of man’s special dignity as a creature of reason and will. Man is part of nature, but also distinct from it.

The philosopher Hans Jonas said that three things have distinguished human life from other animal experience since early prehistory: the tool, the image, and the grave. The tool imposes man’s knowledge and will onto nature. The image—man’s paintings and other art—projects his imagination. It implies a sense of beauty and memory, and a desire to express them. But the greatest difference between humans and other animals is the grave. Only man buries his dead. Only man knows his own mortality. And knowing that he will die, only man can ask where he came from, what his life means, and what comes after it.

The grave then is an expression of reverence and hope. When Christians and other people of good will talk about “the dignity of the human person” and “the sanctity of human life,” they’re putting into words what we all instinctively know—and have known for a very long time. Something elevated and sacred in men and women demands our special respect. When we violate that human dignity, we do evil. When we serve it, we do good. And therein lies one of many ironies. We live in a society that speaks persuasively about protecting the environment and rescuing species on the brink of extinction. But then it tolerates the killing of unborn children and the abuse of human fetal tissue as lab material.

This leads me to my second point. The University of Pennsylvania is one our country’s premier research universities. That’s a great gift to the Philadelphia community. It’s also a great privilege for all of you as students, especially those specializing in the sciences. Science and technology have expanded human horizons and improved human life in vital ways over the last century. They’ve also, at times, done the opposite.

Part of a good education is learning the skill of appropriate skepticism. And that skepticism, that healthy wariness, should apply even to the methods and claims of science and technology. When a distinguished and thoroughly secular scholar like Neil Postman writes that “the uncontrolled growth of technology destroys the vital sources of our humanity. It creates a culture without a moral foundation. It undermines certain mental processes and social relations that make human life worth living” —then we need to be concerned.

There’s a proverb worth remembering here: “To a man with a hammer, every problem is a nail.” If modern man is scientific man, technology is his hammer. But every problem isn’t a nail. Knowledge without the virtues of wisdom, prudence, and, above all, humility to guide it is not just unhelpful. It’s dangerous. Goethe’s poem, The Sorcerer’s Apprentice—which some of us probably know from the Mickey Mouse cartoon based on it—sticks in our memories for a reason. We’re never as smart as we think we are, and we have a bad track record when it comes to preventing the worst uses of our own best discoveries.

Science involves the study of the material world. But human beings are more than the sum of their material processes. Trying to explain the human person with thinking that excludes the reality of the spiritual, the dignity of the religious, and the possibility of God simply cripples both the scientist and the subject being studied—man himself. To put it another way, we can destroy what we mean by humanity while claiming, and even intending, to serve it.

We might wisely remember one other fact about science. Eric Cohen observed that “From the beginning, science was driven both by democratic pity and aristocratic guile, by the promise to help humanity and the desire to be free from the constraints of the common man, with his many myths and superstitions and taboos.” In other words, scientists too often have a divided heart: a sincere desire to serve man’s knowledge, and a sincere disdain for what they see as the moral and religious delusions of real men and women. If this doesn’t make us just a little bit uneasy, it should. Both faith and science claim to teach with a special kind of authority. One of the differences is this. Most religious believers accept, at least in theory, that they’ll be judged by the God of justice for their actions. For science, God is absent from the courtroom.

This leads to my third point. God also is absent from the U.S. Constitution—but not because he’s unwelcome. In effect, God suffused the whole constitutional enterprise. Nearly all the Founders were religious believers, and some were quite devout. Their writings are heavily influenced by biblical language, morality, and thought.

America could afford to be secular in the best sense, precisely because its people were so religious. The Founders saw religious faith as something separate from government but vital to the nation’s survival. In his Farewell Address, Washington famously stressed that “religion and morality are indispensable supports” for political prosperity. He added that “reason and experience both forbid us to expect that national morality can prevail in exclusion of religious principle.” For John Adams, John Jay, James Wilson, Alexander Hamilton, Charles Carroll, George Washington, and most of the other Founders—including Thomas Jefferson and Benjamin Franklin—religion created virtuous citizens. And only virtuous citizens could sustain a country as delicately balanced in its institutions, moral instincts, and laws as the United States.

Here’s my purpose in mentioning this. The American Founders presumed the existence of natural law and natural rights. These rights are inalienable and guaranteed by a Creator; by “nature’s God,” to use the words of the Declaration of Independence. Such ideas may be out of fashion in much of legal theory today. But these same ideas are very much alive in the way we actually reason and behave in our daily lives.

Most of us here tonight believe that we have basic rights that come with the special dignity of being human. These rights are inherent to human nature. They’re part of who we are. Nobody can take them away. But if there is no Creator, and nothing fundamental and unchangeable about human nature, and if “nature’s God” is kicked out of the conversation, then our rights become the product of social convention. And social conventions can change. So can the definition of who is and who isn’t “human.”

The irony is that modern liberal democracy needs religion more than religion needs modern liberal democracy. American public life needs a framework friendly to religious belief because it can’t support its moral claims about freedom and rights with secular arguments alone. In fact, to the degree that it encourages a culture of unbelief, liberal democracy undermines its own grounding. It causes its own decline by destroying the public square’s moral coherence.

That leads to my fourth and final point. The pro-life movement needs to be understood and respected for what it is: part of a much larger, consistent, and morally worthy vision of the dignity of the human person. You don’t need to be Christian or even religious to be “pro-life.” Common sense alone is enough to make a reasonable person uneasy about what actually happens in an abortion. The natural reaction, the sane and healthy response, is repugnance.

What makes abortion so grievous is the intimacy of the violence and the innocence of the victim. Dietrich Bonhoeffer—and remember this is the same Lutheran pastor who helped smuggle Jews out of Germany and gave his life trying to overthrow Hitler—wrote that the “destruction of the embryo in the mother’s womb is a violation of the right to live which God has bestowed on this nascent life. To raise the question whether we are here concerned already with a human being or not is merely to confuse the issue. The simple fact is that God certainly intended to create a human being and that this nascent human being has been deliberately deprived of his life. And that is nothing but murder.”

Bonhoeffer’s words embody Christian belief about the sanctity of human life present from the earliest years of the Church. Rejection of abortion and infanticide was one of the key factors that set the early Christians apart from the pagan world. From the Didache in the First Century through the Early Fathers of the Church, down to our own day, Catholics—and until well into the twentieth century all other Christians—have always seen abortion as gravely evil. As Bonhoeffer points out, arguing about whether abortion is homicide or only something close to homicide is irrelevant. In the Christian view of human dignity, intentionally killing a developing human life is always inexcusable and always gravely wrong.

Working against abortion doesn’t license us to ignore the needs of the homeless or the poor, the elderly or the immigrant. It doesn’t absolve us from supporting women who find themselves pregnant or abandoned. All human life, no matter how wounded, flawed, young or old, is sacred because it comes from God. The dignity of a human life and its right to exist are guaranteed by God. Catholic teaching on abortion and sexuality is part of the same integral vision of the human person that fuels Catholic teaching on economic justice, racism, war, and peace.

These issues don’t all have the same content. They don’t all have the same weight. All of them are important, but some are more foundational than others. Without a right to life, all other rights are contingent. The heart of the matter is what Solzhenitsyn implied in his Harvard comments. Society is not just a collection of sovereign individuals with appetites moderated by the state. It’s a community of interdependent persons and communities of persons; persons who have human obligations to one another, along with their human rights. One of those obligations is to not intentionally kill the innocent. The two pillars of Catholic social teaching are respect for the sanctity of the individual and service to the common good. Abortion violates both.

In the American tradition, people have a right to bring their beliefs to bear on every social, economic, and political problem facing their community. For Christians, that’s not just a privilege. It’s not just a right. It’s a demand of the Gospel. Obviously, we have an obligation to respect the dignity of other people. We’re always bound to treat other people with charity and justice. But that good will can never be an excuse for our own silence.

Believers can’t be silent in public life and be faithful to Jesus Christ at the same time. Actively witnessing to our convictions and advancing what we believe about key moral issues in public life is not “coercion.” It’s honesty. It’s an act of truth-telling. It’s vital to the health of every democracy. And again, it’s also a duty—not only of our religious faith, but also of our citizenship.

The University of Pennsylvania’s motto is Leges sine moribus vanae. It means “Laws without morals are useless.” All law has moral content. It’s an expression of what we “ought” to do. Therefore law teaches as well as regulates. Law always involves the imposition of somebody’s judgments about morality on everyone else. That’s the nature of law. But I think the meaning of Penn’s motto goes deeper than just trying to translate beliefs into legislation. Good laws can help make a nation more human; more just; more noble. But ultimately even good laws are useless if they govern a people who, by their choices, make themselves venal and callous, foolish and self-absorbed.

It’s important for our own integrity and the integrity of our country to fight for our pro-life convictions in the public square. Anything less is a kind of cowardice. But it’s even more important to live what it means to be genuinely human and “pro-life” by our actions—fidelity to God; love for spouse and children; loyalty to friends; generosity to the poor; honesty and mercy in dealing with others; trust in the goodness of people; discipline and humility in demanding the most from ourselves.

These things sound like pieties, and that’s all they are—until we try to live them. Then their cost and their difficulty remind us that we create a culture of life to the extent that we give our lives to others. The deepest kind of revolution never comes from violence. Even politics, important as it is, is a poor tool for changing human hearts. Nations change when people change. And people change through the witness of other people—people like each of you reading this. You make the future. You build it stone by stone with the choices you make. So choose life. Defend its dignity and witness its meaning and hope to others. And if you do, you’ll discover in your own life what it means to be fully human.

Charles J. Chaput, O.F.M. Cap., Roman Catholic Archbishop of Philadelphia, is the author of Render Unto Caesar: Serving the Nation by Living our Catholic Beliefs in Political Life. This essay is adapted from a lecture Archbishop Chaput delivered last night at the University of Pennsylvania.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

The new research reports the findings of three surveys in which thousands of parents and hundreds of siblings and individuals with DS themselves, were questioned about what it is like to be affected in one way or another by DS. Ninety-nine percent of parents said they loved their child with DS and 97 percent were proud of them; only 4 percent regretted having their child. While 4 percent of siblings would “trade their sibling” with DS, 96 percent indicated that they had affection toward their sibling with DS, with 94 percent of older siblings expressing feelings of pride. Finally, although 4 percent of individuals with DS expressed sadness about their lives, 99 percent said they were happy with their lives and 97 percent liked who they are.

Caplan believes that most mothers will still abort, even after this research has been released, simply because it is a fact that, currently, most mothers do abort following a prenatal diagnosis. This fact, however, does not support Caplan’s callous conclusion that “Down syndrome is almost universally seen as something to be avoided.”

The most recent studies find that there are more babies than ever being born with DS in the United States. Moreover, there are hundreds of families on waiting lists to adopt a child with DS. As for the high percentage of mothers who terminate, that does not support the conclusion that they are seeking to avoid DS.

Certainly some are, but study after study has found that up to half of all women accepting prenatal testing did so without making an informed decision, and that half did not expect they would have to decide whether to abort following a prenatal diagnosis. To his credit, Caplan recognizes that prenatal testing can result in uninformed and unexpected decisions to terminate, due to medical professionals and general society often having “nothing good at all to say” about DS. Indeed, one study has found that almost a quarter of physicians actively urge abortion, or emphasize the negatives about DS in order to encourage it. Even for those committed to non-directive counseling, a majority of physicians and genetic counselors have said that they would abort following a prenatal diagnosis for DS, which no doubt affects how a diagnosis is presented. Other recent studies also have found that a significant percentage of adults, youths, and physicians still hold outdated views about DS and would prefer that children with DS were segregated from, rather than included in, the community and typical classrooms. Therefore, those who choose to abort often are seeking to avoid an inaccurate, uninformed, and overly negative view of a life with DS, which is not supported by the current research.

Caplan laments that this “climate for having kids with Down syndrome, happy though they may be, is not good.” But Caplan’s own words contribute to maintaining this lamentable climate.

Caplan writes as though aborting a fetus somehow avoids Down syndrome. An abortion will prevent a child from being born, but it will not prevent that child from having DS; DS occurs at conception. Caplan ends his column by stating that “an abortion for medical reasons is a highly personal decision.” Yet, there is not a medical reason for aborting because of a prenatal diagnosis for DS. DS does not pose a risk to the health of the mother or the child. (Caplan refers to heart and stomach defects that some children with DS have, but these can now almost always be treated surgically.)

Nevertheless, the climate of ignorance about, and prejudice against, DS does exist, which is why this new research needs to be shared with the medical community and with expectant parents. While Caplan calls for this, he is simply wrong to assume that sharing this information will not make a difference. The most influential information an expectant mother receives is from her physician and from written resources. Physicians should be well-informed about DS and provide accurate written materials to their patients. Ignorance and prejudice persist, however: over 80 percent of medical students are not trained in working with individuals with intellectual disabilities, and almost 60 percent of medical school deans do not believe they should be. Further, while most physicians now offer prenatal testing to all expectant mothers, less than a third provide them with educational materials.

This pervasive, self-imposed ignorance in the administration of prenatal testing for DS is contrary to ethical medical practice because it denies expectant parents the information they need to make informed decisions. The same studies that identified the pervasiveness of outdated views about DS also found that those who knew someone with DS were more accepting of DS, and that was true as well of physicians who knew someone with DS, as compared to those physicians who had not known any. Despite their rising birth rate, those with DS remain an incredibly small minority population. This is precisely why providing information about these new studies is so important, for most expectant parents and their physicians will not otherwise have or understand the positive experience of getting to know a person with DS.

The further significance of the new research is that it addresses the concerns of mothers who have aborted following a prenatal diagnosis. These mothers were concerned that the condition would be an excessive burden on them and their other children, and that DS may be too much of a burden for the child him- or herself. The three new studies directly counter these concerns and more, as they reveal a truth not often considered: a child with DS will almost always be a positive force in the lives of his or her parents and siblings. The studies found that 79 percent of parents felt that their outlook on life was more positive because of their child with DS. For siblings, the response was even greater, with 88 percent feeling that they were better people because of their siblings with DS.

The most recent practice guidelines call for sharing positive stories about DS, and the new research provides physicians with those positive stories. These stories do indeed matter. Kathryn Lynard Soper is the author of Gifts: Mothers Reflect on How Children with Down Syndrome Enrich Their Lives, which is an approved resource by the National Society of Genetic Counselors’ practice guidelines. The introduction to the book’s sequel, Gifts 2, presents compelling evidence of how sharing positive stories can and will make a difference. Soper writes of co-hosting a new parents’ workshop at the National Down Syndrome Congress convention. A woman holding a baby started the Q&A time with the following comment: “This is Grace. I just wanted you to know that if I hadn’t read your book, my daughter wouldn’t have been born.”

Contrary to Caplan’s opinion, DS is not something almost universally sought to be avoided. Moreover, sharing accurate information about DS, the newest of which is overwhelmingly positive, can and will change expectant parents’ views following a prenatal diagnosis. This is in the best interest not only of those who are conceived with Down syndrome, but also of those who are blessed to know them.


Mark W. Leach, Esq., is an attorney in Louisville, Kentucky, where he is pursuing a Master of Arts in Bioethics. He is the founder and chair of the Informed Decision Making Task Force for Down Syndrome Affiliates in Action and was a contributor to Gifts 2. The views expressed are entirely his own.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

1. Mandate for Abortion and Contraception

The jointly issued “interim final rule” regarding “preventive health services” requires nearly all private health plans to include coverage for “all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,” without co-pays or other cost-sharing— no matter whether the insurer, the employer or other plan sponsor, or even the woman herself objects to such coverage on the basis of religious or moral principles. Women may not receive, and insurers, employers and other plan sponsors may not provide, health coverage that is exclusive of such “services.” Never before has the federal government required private health plans to include such coverage.

Among the FDA approved “contraceptive measures” are drugs that, under certain circumstances, terminate the life of a human being at the embryonic stage of development. At least two of the drugs approved by the FDA under the rubric of “contraception” so function in some cases. They are more accurately labeled abortifacients.^[1] As a matter of basic embryology, the life of the human organism begins with the fusion of gametes—egg and sperm. And according to FDA labeling, “Plan B emergency contraception” (levonorgestrel, also known as “the morning-after pill”)—“may inhibit implantation by altering the endometrium.” In other words, Plan B may make it impossible for the newly conceived human being to embed herself into her mother’s uterine lining—a necessary condition of life support for the unborn child. In such cases, the embryo is destroyed prior to implantation.

Another FDA-approved form of “contraception” known as “Ella” (ulipristal, or the “5 day-after pill”), seems to pose an even greater danger to newly-conceived or even newly-implanted embryonic human beings. Ella is a “selective progesterone receptor modulator.” It may function pre-implantation by rendering the endometrium inhospitable to implantation for a newly-conceived embryo (like Plan B); it may also function post-implantation by depriving a living embryo of progesterone or by destroying the maternal component of the placenta. In both of these manners, Ella functions as an early abortifacient. Indeed, the FDA labeling for Ella states that the drug is contraindicated during pregnancy, citing animal studies showing its capacity to terminate a pregnancy. Furthermore, there is nothing to prevent the off-label prescription of Ella (or its purchase, should it become available, like Plan B, for sale over-the-counter) for purposes of terminating a known pregnancy. In short, the new “preventive services” mandate includes coverage for drugs used to kill an unborn child both before and after implantation. Many institutions and individuals (religious and secular) rightly condemn such killing as a grave injustice.

2. The Religious Exemption

The rule includes a very narrow religious exemption. Houses of worship are almost certainly protected, but all other religious ministries and institutions are almost certainly not. The exemption covers only: a “religious employer” that has the “inculcation of religious values” as its purpose; “primarily employs persons who share its religious tenets”; and primarily “serves persons who share its religious tenets.” Further, the employer must qualify as a church organization under two narrow provisions of the tax code. Religious institutions such as colleges and universities, as well as hospitals and charitable institutions that employ and serve the public (versus only co-believers) will be ineligible. Individuals, and religiously affiliated health insurers are also outside of the scope of the exemption.

Others have made the case to HHS that the religious exemption in the proposed regulations is unprecedented in its narrowness. Indeed, it is. Though copied largely from state laws requiring insurance plans to include prescription contraception, the proposed federal mandate is much more sweeping than any comparable state program. When you add to this picture that the new proposal would include “contraceptives” that act as abortifacients, then the radical nature of this looming invasion of religious liberty finally comes into full view.

The U.S. Catholic bishops—sponsors of the nation’s largest private charities—correctly observe that the new mandate “poses an unprecedented threat to individual and institutional religious freedom.” We would add that not even a Catholic parish’s grade school would be exempt from the new mandate to carry insurance that pays for some early abortions. These schools do not always “primarily serve persons who share [the employing religion’s] tenets.” Particularly in urban cores, Catholic schools might enroll a majority of non-Catholic students, often children from the most vulnerable racial and socioeconomic groups. Further, Catholic schools’ “purpose,” as required by the proposed regulation, is not solely “the inculcation of religious values.” That is one purpose of a Catholic school. But the main or “primary” purpose of a Catholic school is the same as that of any other school: providing an education. Other religious institutions, universities in particular, regard it as part of the core of their mission and identity to be and act in the world as a witness and servant to others, all others, regardless of their beliefs, circumstances, or station in life. This almost always results in the employing and serving of persons who do not share the same faith as the institution’s founders. This vision of ministry and identity, under the proposed rule, would disqualify a religious institution from taking advantage of the religious exemption.

Yet throughout American history, religious institutions have been the leading private providers of charitable, educational, and medical services to the poor, always serving those they felt were the most marginalized populations of their day—whether slaves or freed slaves, new immigrants, Native Americans, prisoners, or persons with AIDS. The quality and efficiency of their care, and the compassion with which it has been delivered, are often noted. Regularly, the populations served did not share the faith of the religious institutions who took up their cause

Given their solidarity with the dispossessed, religious leaders of every denomination have, throughout American history, also effectively led a variety of human rights’ movements, including the movements for abolition of slavery, for civil rights, for campaigns to end poverty, and for justice for immigrants, the elderly, those with disability, and the unborn. The presence of religious leaders and religious institutions in the public square—and not behind the walls of their monasteries, churches or homes—is an inescapable aspect of America’s history of progress and prosperity.

The proposed exemption disregards this history by limiting its application to employers who do little (or nothing) but preach to the convinced. This, apparently, is what the authors of the new regulations intended when they adopted the stringent definition of “religious employer,” drafted by the American Civil Liberties Union (ACLU) in connection with California’s contraception mandate. This is the very same ACLU that recently urged HHS to force all Catholic hospitals to perform abortions under the guise of necessary “emergency treatment.” Recent history demonstrates that many religious employers will exit from the marketplace rather than abandon their mission to offer faithful witness in the course of providing service. Those behind the new regulations must be willing to accept this effect, and perhaps even desire it.

This is revolutionary. Never before in American history has any administration—state or federal—been so willing to force religious institutions out of business. In fact, at our founding, and for a long time thereafter, most education, healthcare, and social services were provided by the churches, not by the government. In most cases public authorities assisted the churches by some form of financial or material aid. Even when, after the Civil War, governments began more earnestly to set up their own schools and to provide some other charitable services directly, the norm remained what it had been: a productive partnership between religious and civil providers, with no preference for any religion and with coercion of no one’s conscience, all directed to the achievement of the common good. This was surely the pattern up to and beyond World War II.

In fact, it was not until the 1960s, and then largely under the influence of Supreme Court decisions imbued with a rabid secularism, that this long partnership came in for wholesale criticism. Only then did American elites begin to think of systematically privatizing religion, of shutting up faith within the walls of family, home, and church. Only in the 1960s did significant numbers of people begin to think that everything public—that is, all that is properly in the civil sphere—should be governmental.

With these proposed regulations, the Obama administration would turn back the clock, not only to this discredited intolerance, but beyond, and toward a repudiation of our whole constitutional and political tradition. The administration would restrict the public square to the government to an extent that would be anathema to the founders, and undreamt-of by any important public figure since.

3. Sexual Expression: The Elephant in the Room

It seems more than a little likely that the degree to which this administration is willing to silence or privatize religion is proportionate to its passionate commitment to the population and sexual freedom agendas of one of the administration’s closest allies, the Planned Parenthood Federation of America (“Planned Parenthood”)—the largest single abortion provider in the United States. It is Planned Parenthood that lobbied strenuously for precisely the coercive outcome represented by these proposed regulations. It is Planned Parenthood whose leadership is closely intertwined with the authors of the Institute of Medicine (IOM) report upon which these regulations are based. And it is Planned Parenthood’s former research affiliate, the Guttmacher Institute, that issued several of the studies cited in the IOM report as the basis of its false claims that easier access to birth control has reduced and will reduce our national rates of unintended pregnancies and abortions. It is also Planned Parenthood that—at a time of national economic crisis—has just received new federal dollars to replace the dollars recently taken from them by state legislatures wary of supporting such a prominent abortion provider.

It is well known that the various religious institutions sponsored by the Catholic Church do not provide contraception to their employees or their clients. The Catholic Church in the United States is also the most persistent and powerful voice against the legalization and normalization of abortion in America today. Its witness on these matters earns scorn from those “true believers” who continue to insist that abortion and contraception are the best response to high rates of nonmarital births and abortions, in the teeth of compelling evidence that both policies are associated with even higher rates of nonmarital pregnancies and abortions due to the manner in which they change the “markets” for sex and marriage. (See, Helen M. Alvaré, Abortion, Sexual Markets and the Law, in Stephen Napier, ed., Persons, Moral Worth, and Embryos: A Critical Analysis of Pro-Choice Arguments, 255, 261ff (2011)). Planned Parenthood is preeminent among such “true believers.”

With these new regulations, the administration has placed itself on the side of the Planned Parenthood worldview: an irrational commitment to unrestrained sexual expression, “insured” by easy access to contraception and abortion, no matter the cost to religious freedom or to the well-being of the adults and children involved. These regulations would enclose behind the walls of sanctuaries any and all dissenting religious voices on the matter of sexual restraint and respect for vulnerable human life. Those who today speak common sense on the matter of sexual restraint—backed by current and credible data—are the very persons and groups who would be silenced. Their reasoned arguments, and the witness of their lives, would no longer be available to those who do not already share their faith. Consequently, while religious institutions will suffer should the current “preventive” health care mandate take effect without amendment, there is a group that will arguably suffer even more: those Americans most in need of viewpoints dissenting from this new federal orthodoxy concerning human sexuality and the value of vulnerable human life.


Helen Alvaré is an associate professor at George Mason University School of Law and a senior fellow of the Witherspoon Institute. Gerard V. Bradley is professor of law at the University of Notre Dame Law School. O. Carter Snead is professor of law at University of Notre Dame Law School. They write on behalf of the Witherspoon Institute’s Task Force on Conscience Protection.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

People quite naturally recognize that life is better than death, that the deliberate destruction of life is an evil to be avoided, and that the state has a role to play in preventing suicides. It follows logically from these uncontested (and incontestable) observations that state laws prohibiting euthanasia and assisted suicide are just and efficacious. But, like magicians who use distractions to remove the important object from view, proponents of legalized death have shrouded the inviolability of human life in a mist of confusion. Exposing their ploys is the first step in defeating their efforts to advance the culture of death. Below are three arguments that are likely to be advanced for legalization in Massachusetts. All three are designed to distract and to deceive.

The Alleviation-of-Suffering Ploy

In public, proponents of assisted suicide most commonly characterize assisted suicide as the only hope of relief for “suffering patients” who are afflicted with serious illnesses. This plea is of course designed to appeal to voters’ (rightful, natural) sense of compassion for those unfortunate souls in whose shoes none of us would choose to walk. None of us likes to contemplate what it would be like to be told by a doctor that one has just a few months to live, and that one’s most prominent experience during those final months will be unrelenting pain. And we cannot bring ourselves to judge our neighbor who is forced to face such grim prospects. Who are we to tell the terminally ill patient that she must not end her life a few weeks early, and that she may not avoid the suffering and indignity that attend such horrible illnesses?

Thus, cleverly, assisted suicide proponents use voters’ natural aversion to death and suffering to build support for legalized death. To be against suffering is to be against laws that unnecessarily prolong a life of suffering, the argument runs. To celebrate life is to celebrate what is good and enjoyable in life, not to burden the terminally ill with a dark and unendurable coda.

This is an effective ploy, but it rests upon a bold deception. Assisted suicide is neither necessary, nor actually used, for the alleviation of pain. Indeed, the data show a wide gulf between the public justifications for assisted suicide and its actual use in practice. Oregon was the first state to legalize assisted suicide, implementing its program in 1997. The state’s annual reports consistently reveal that, of those who seek and obtain assistance in suicide, only a small fraction cite “inadequate pain control or concern about it” as a reason for their choice. Indeed, hauntingly, more patients are worried about being a “burden on family, friends/caregivers” than are concerned about pain.

Even these data do not tell the whole story; Oregon lumps those who are in pain with those who are merely concerned that they might be in pain at a future date. But few terminally ill patients need to resort to suicide in order to alleviate actual pain. Tragically, legalization in Oregon appears to have decreased patient access to palliative care. Of the initial 142 cases of assisted suicide in Oregon, only 13% were referred for palliative care consultations, and studies reveal that the quality of palliative care in Oregon has declined since assisted suicide became legal.

A much more common motivation than pain management appears to be simple clinical depression. In 2006, the Royal College of Physicians released a statement revealing that patients who want to die will change their minds—will choose life—after they are treated for depression in 98% to 99% of cases. Two researchers writing in the Michigan Law Review also concluded that when patients are treated by physicians who listen to them, treat their depression, and manage their pain, “their wish to die usually disappears.” In light of these facts, it is striking that only one of the sixty-five assisted suicide patients in Oregon in 2010 was referred for psychiatric evaluation. In 2009, none was referred.

The Unnecessary Prolongation Ploy

A second favorite ploy, related to the first, is to conflate prohibitions against assisted suicide with extreme measures to keep people alive. Though legalization proponents trade on fears of being artificially sustained after one’s time has come, prohibiting assisted suicide is not the same as forcing people to live beyond their time. To affirm that life is always worth defending from attempts to destroy it is not to claim that one should always make efforts to lengthen life.

Nor does respect for human life entail that the terminally ill must bear up stoically under extreme pain. Showing respect for all persons regardless of their condition or circumstances means providing needed medical care, including palliative care, when the terminally ill are in their final weeks and hours. That some forms of palliative care hasten impending death is not a reason to condemn its administration. The purpose of administering palliative care is not to kill but to relieve pain. The physician who administers palliative care is no more culpable than the physician who attempts to save a life by performing a risky surgery.

Medical practice involves risk and, sometimes, death. The line that we must ask a physician not to cross is the line at which he adopts the patient’s death as his purpose. That action is inherently different from performing a risky medical procedure; it makes the physician a different kind of person, one who is unfit to practice medicine and who harms himself as well as others.

The Personal Autonomy Ploy

The most common motivation for assisted suicide patients is a desire for personal autonomy, to control the time and manner of one’s own death. In Oregon, this is the most commonly cited concern of assisted suicide patients, and many scholarly advocates of assisted suicide admit that this is the real justification for legalization. The desire for control is understandable, but suicide is a means of control that causes real harm not just to the person who destroys his own life but also to all those with whom he is in community.

Proponents of legalization invoke a radical conception of personal autonomy. The idea is that each individual person makes the value of her own life by choice. When an individual ceases to value her own life, when she no longer prizes those treasures that life enables her to enjoy, she ought to be free to end her life.

People do not make their lives valuable merely by choosing to live. If this were the case, then the lives of small children and senile adults would have no value and would be unworthy of protection in law. As a matter of fact, myriad laws protect human life at various stages of human development, even in states—Oregon and Washington—that permit assisted suicide for the terminally ill. These laws do not discriminate against the very young or the very old, or against those who ascribe the least value to their own lives. States invest resources in suicide prevention and privilege citizens to prevent suicidal acts, by force if necessary. None of these laws provides for weighing the instrumental value of the life being saved.

So even in states that permit assisted suicide, the law reflects our understanding that life has value, regardless of the conditions in which it is lived. Laws preventing suicide preserve the communities of which the suicidal person is a part. The personal autonomy ploy rests upon the deception that suicide affects only the one who commits it, and that this individual alone should have a say in the matter. But suicides are not purely autonomous acts. Just as the family and neighbors of each person recognize the intrinsic value of that person, the family and friends of a suicide realize the irremediable loss that suicide causes.

Suicide should not be inflicted upon anyone. To assist its commission is to do violence to the very fabric of civil society. For the sake of doctors, their sick patients, and the communities in which doctors and patients live, Massachusetts and Montana should strengthen their legal commitments to protect the sick and suffering.

Adam MacLeod is an Associate Professor at Faulkner University’s Thomas Goode Jones School of Law.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

Discussions of HHS’s new regulation have focused on the required availability of free contraceptive services under the Patient Protection and Affordable Care Act (PPACA). The regulation is the result of HHS’s adopting, in its entirety, the Institute of Medicine’s (IOM) report on Clinical Preventive Services for Women. Buried in the IOM report is the recommendation for no-cost well-woman visits; these visits include prenatal care—and thus prenatal testing for “genetic or developmental conditions.” The regulation was issued as part of the PPACA’s coverage of preventive services. This prompts the question, how does prenatal testing prevent Down syndrome?

The IOM report defines preventive services “to be measures . . . shown to improve wellbeing, and/or decrease the likelihood or delay the onset of targeted disease or condition.” Down syndrome occurs at conception. Prenatal testing simply identifies whether a pregnancy is positive for Down syndrome—a prenatal diagnosis after which most women choose to terminate their pregnancy. A prenatal test does not decrease the likelihood of Down syndrome in a person; it does allow for a decreased likelihood of a person with Down syndrome surviving beyond the womb. If this is how HHS is justifying prenatal testing for Down syndrome as preventive care, then HHS has ushered in a program meant to target future children like Juliet.

The targeted elimination of people with Down syndrome is, in fact, the goal of other countries that have adopted nationwide prenatal testing programs—a goal some other countries are now realizing. Indeed, according to the Copenhagen Post, Denmark “could be a country without a single citizen with Down’s syndrome in the not too distant future,” due to its nationwide prenatal screening program, in place since 2004.

Perhaps the HHS is not purposefully trying to sneak in a modern-day eugenics program to eliminate Down syndrome by regulation. It is likely that the IOM report relied on professional guidelines that recommend the offering of prenatal testing for Down syndrome. Actual experience, however, has shown that such tests do not “improve wellbeing”—certainly not for the aborted child, but also not for the expecting parents.

Robert Resta, a Genetic Counselor, notes in August’s American Journal of Medical Genetics that “there is very little empirical evidence that prenatal knowledge improves medical, developmental, emotional, or adaptational outcomes.” Further, studies have found that prenatal testing increases the mother’s anxiety, regardless of the test results; that women often do not make informed decisions about accepting prenatal testing or decisions made after a diagnosis and that, when abortion is the chosen response, a significant number of women experience post-traumatic stress.

The lone dissent to the IOM report by a committee member makes the point that clinical guidelines “were never intended to provide a basis for insurance coverage determinations; they are intended as guides to physician practices.” Yet, if the IOM’s incorporation of such guidelines is the HHS’s justification for covering prenatal testing, then why does HHS not provide for the other information required to accompany prenatal testing?

The IOM report states that informed decision-making “is structured to give an individual all the information needed to choose from among different clinical options, such as whether to undergo genetic testing.” Professional guidelines require that physicians be well-informed about Down syndrome, offer accurate information, and recognize that parent support organizations can be very helpful. This summer, the National Society for Genetic Counselors and the American Academy of Pediatrics required that this balancing information be part of prenatal care. Both further note that families “benefit from hearing a fair and balanced perspective, including the many positive outcomes of children with Down syndrome and their effect on the family.”

The need for this information is so apparent that, in 2005, two senators from opposite sides of the abortion issue, Senators Ted Kennedy and Sam Brownback, co-sponsored legislation that recognized the need to provide accurate, balanced information and support by parent organizations. In 2008, the Prenatally and Postnatally Diagnosed Conditions Awareness Act was signed into law, but it has yet to receive any appropriations. Similarly, the HHS regulation only requires coverage of the testing itself, but says nothing about covering the provision of proper training, accurate written materials, or support to or through parent organizations—things that could, in fact, improve the parents’ and child’s wellbeing after receiving a prenatal diagnosis.

It seems hard to believe that Congress and the President meant for the PPACA to institute a national prenatal screening program that targets Down syndrome and also fails to provide all of the required information to expectant mothers. Sen. Mikulski introduced the provision for preventive services for women, yet she was also the lead sponsor of Rosa’s Law, a law that replaces “mental retardation” with “intellectual disability” in federal publications. Rosa’s law was named after one of her constituents, who, like Juliet, happens to have Down syndrome. Further, given that HHS’s regulation not only encourages prenatal testing’s discrimination against Down syndrome, but also disrespects a woman’s exercise of informed choice, it is unlikely that members of the bipartisan Congressional Down Syndrome Caucus would allow the regulation to remain in effect.

Prenatal testing for Down syndrome should not be labeled as preventive medicine—an inaccurate and misleading description of a procedure that may prevent Down syndrome births, but certainly does not prevent Down syndrome. A regulation should not be allowed to target a portion of our society for elimination without public debate by accountable elected officials. If the regulation is to remain in place, then additional funding should be provided for all the information required to respect a woman’s choice following a prenatal diagnosis. The President and the Congress should see that the new HHS requirements for preventive care expressly exclude coverage of prenatal testing for Down syndrome unless and until there is public debate and balanced funding for the needed resources. You can help them do that by leaving a comment on this new regulation here.

Mark W. Leach is an attorney from Louisville, Kentucky. He serves on the Board of Directors for Down Syndrome of Louisville and Down Syndrome Affiliates in Action, a trade association of local parent support organizations. The views expressed here are entirely his own and not to be attributed to any associated organization.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Support the work of Public Discourse by making a secure donation to The Witherspoon Institute.

Copyright 2011 the Witherspoon Institute. All rights reserved.

After the Second World War, when various Muslim-majority countries gained their long-sought independence, their new autonomy generally did not lead to a greater level of freedom for their citizens. Instead, authoritarian figures quickly took over the newly independent states, often ruling with an iron fist.

From Indonesia, the most populous Muslim-majority country, to Nigeria, with its less substantial Muslim majority, military officers seized power and sidelined popular political leaders, severely restricting religious and intellectual freedom as well as political freedom. The ascendency of strong military men in Muslim governments, exemplified by such figures as Soeharto, Muammar Qaddafi, Gamal Abdel Nasser, Zia ul Haq, and Saddam Hussein, was evident in the 1960s, ’70s, and ’80s. Since the two Cold-War superpowers took negligible interest in supporting greater levels of freedom, whether in the form of political freedom, democracy, or human rights, they in fact facilitated authoritarian dominance.

The disintegration of the Soviet Union, the fall of the Berlin Wall, and the subsequent increase of freedom in much of Eastern Europe were just a few of many events that impacted people in Muslim-majority countries as well. As the wave of freedom across the world began to shake the foundations of authoritarianism, the military men and other autocrats who, until then, had felt comfortably supported in their fiefdoms by one superpower or the other became suddenly aware that their positions were no longer secure.

During the past decade we have begun to see slow but real change in the political landscape of Muslim-majority countries. In the Arab world, despite some promising advances, such as the overthrow of Saddam Hussein, what appeared to be the Arab resistance to liberty remained an exception to the general trend to democratization until the beginning of this year’s Arab “spring,” when the masses in Tunisia, Egypt, Yemen, and other countries challenged aging but powerful strongmen and began to topple them. Elsewhere in the Muslim world, Soeharto and Musharraf, for example, are now gone, and countries from Indonesia to Turkey are beginning to embrace democratic principles and promote greater freedom.

Even the much-maligned “global war on terror” is playing a significant part in this call for freedom in the Muslim world. While for a brief period the strongmen used their alleged efforts against extremism and in support of the “global war on terror” as a pretense to restrict their citizens’ freedoms further, many people soon realized that they were being deceived. Authoritarianism was, in fact, fueling the very extremism that was a key target of the “war on terror.” Fighting extremism, therefore, also meant fighting authoritarianism and supporting greater freedom, democracy, and human rights for Muslim societies. This further weakened the foundations of despotism, forcing these regimes to introduce a series of political reforms, even if only half-heartedly.

Restrictions on Muslim women is another pillar of repression under threat. While many Muslim societies still have a long way to go in allowing women’s full civic participation, the trend in even some of the most conservative societies is extremely encouraging. In the Gulf, for example, one of the most conservative regions of the Muslim world, the rising level of women’s education and the large number of women who are receiving higher education is a strong indicator that the pillars of authoritarianism are weakening. Only 40 or 50 years ago, controversies existed in places such as Saudi Arabia about whether girls should even attend primary school, and yet current evidence from the region indicates that even at the university level female students’ numbers are higher than those of their male counterparts: they perform better overall, and they earn better grades. More importantly, these women’s economic power appears to be growing substantially.

While many Muslims still do live in extremely repressive societies, a substantial number of those in Muslim-majority countries are enjoying a level of freedom comparable to that in the West. With such freedom, Muslims have been able to discuss, promote, and propagate ideas about intellectual, political, and religious freedom, topics that were taboo until recently. Debates on human rights are taking place on internet sites and blogs, as well as in academia. Even the most controversial issues, including religious freedom, apostasy, and blasphemy, are being openly discussed.

State censorship of writing and speeches, which managed to successfully eliminate any public call for freedom, is no longer as pervasive, and where it still exists, it is no longer as effective. People’s greater freedom to express themselves has resulted in an ever-rising level of intellectual output, in books, television programs, discussions, debates, and on the internet, which has further weakened the despots’ hold over Muslim societies.

The use of such platforms of communication is important for encouraging grassroots support for freedom. For a discourse to have legitimacy, it must occur at various societal levels, and such multi-level debates are happening in the Muslim world right now. The internet has provided a particularly valuable forum for the open discussion of ideas about freedom, especially for Muslims who live in countries where public debate may not be possible. Many Muslims are effectively using web-based forums to inject new ideas about freedom into the public domain. Such new media, as well as global television networks, have helped to provide the mechanism for promoting freedom without being subjected to state control.

Repression in Muslim societies is not necessarily a byproduct of a lack of support for freedom in the Islamic tradition. In fact, with Michael Novak, I believe that Islamic theology and thought do indeed provide resources that promote freedom. The diversity of the Islamic tradition means that it naturally includes a wide range of views on all theological issues, but the broad thrust of the Qur’an as well as the traditions of the Prophet strongly emphasize personal liberty. Personal liberty is the Qur’an’s core message, for each individual must choose to believe in God for himself or herself: it is free and genuine personal conviction that is the basis of salvation. No one—not community, family, clan, tribe, or state—may require or impose this belief. A freely chosen, personal relationship with God is fundamental to who Muslims are. Very early in its history, the Islamic tradition also developed tenets about the proper limitations of political rule: rulers are subject to God’s law and not above it, and people should have the necessary freedom to function as citizens. Though many rulers simply ignored these ideas in practice, the resources are there, and they can be used to offer theological justification for greater levels of freedom today.

Even as far as religious institutions and authorities are concerned, the Qur’an does not tolerate religious authoritarianism. Religious leaders are not there to mediate between individuals and God, and people are free to relate to God without any intermediary. The Qur’an declares that religious establishments should not play the role of God, and it stipulates that people should be free to believe in God, to relate to God, and to be connected to God without restrictions. It does not support religious authoritarianism, describing such rule as akin to the greatest sin of idolatry.

Many factors are fueling the move towards broader freedom in the Muslim world, including the overall political situation in the world today, our greater interconnectedness, technological advances, the efforts of Muslim scholars and thinkers to present new ideas and arguments publicly, and grassroots engagement in Muslim-majority countries. Freedom is expanding in Muslim societies at the political, religious, and intellectual levels, and the momentous changes that these societies are experiencing, most recently in the Arab spring, are unlikely to be reversed. I think that Michael Novak will prove to be right in his assessment of the potential for greater freedoms in Muslim societies. All the achievements discussed above, grounded not just in theory but also in practice, provide the basis for freedom’s further expansion in the Muslim world.


Abdullah Saeed is the Sultan of Oman Professor of Arab and Islamic Studies and the Director of the National Centre of Excellence for Islamic Studies at the University of Melbourne, Australia. This summer he will be leading the Witherspoon Institute’s Islam and Religious Freedom Seminar.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Copyright 2011 the Witherspoon Institute. All rights reserved.

Advocates for life have formulated many well-known theoretical responses to these claims (some of which can be found in the book I co-authored with Robert P. George, Embryo: A Defense of Human Life). As these debates continue, it’s worth turning to another important source for our reflection on these claims: the experience of those who care for human beings who are in a persistent vegetative state, or are yet unborn. In an especially vivid form, the way we treat the radically dependent or disabled gives important testimony to our ability to situate these beings within a common framework of goods, a framework essential for thinking of these beings as persons united in a moral community with those of us who are, at least at the present moment, fully functioning.

The implications of the No Benefit view are immediately, coldly clear: if it is impossible to benefit someone, then it is also impossible to harm him by taking his life. Further, if someone becomes convinced that they cannot benefit their disabled child, or dependent grandparent, they have no reason to tend to or care for that person. Why, after all, should we take care of someone else, sometimes at great cost to ourselves, if our care can do no real good? Indeed, the No Benefit view goes naturally hand in hand with the denial of the human dignity of the unborn and the radically disabled.

Those who care for the radically dependent or disabled are motivated in part because they want to avoid a future in which their charges are ignored, abandoned, mocked, or starved. Rightly, they recognize all these possibilities as bad for their charges. Instead, they attempt to preserve the patient’s life in a loving way, in an attractive environment, surrounded by loved ones, in an atmosphere of at least some joy, laughter, and music. Even if their charge has no active ability to reason, the caregiver still recognizes the attractiveness of this possible future, and the possibility that it is a real benefit not only to the caregiver, but also to their loved one.

This insight about the good is justified by the earlier thought about what would be bad for the loved one. If it is bad, say, to mock a permanently unconscious patient by dressing him as a clown, or using him as a door stop (and few would deny this), then it would therefore be good to pursue the very same goods—treatment with respect and solidarity—that those bad forms of treatment would destroy.

Similarly, pregnant mothers can readily imagine a situation in which their unborn children are unloved, unprepared for, and done violence to; and in all such cases, they can recognize a deficiency of goods for the child, not just for themselves. The active ability to exercise the powers of reason on the part of the unborn again does not seem necessary to act for a shared good in the person of that child. Even the horrific reason that is sometimes given to justify abortion, that it is for the good of the unborn child, shows at least this ability to recognize possibilities as good and bad for the unborn, even if there is terrible error as to which possibilities are good, which bad.

But isn’t the treatment of the unborn in this case entirely anticipatory? According to this objection, the goods sought are not goods now for them, but only will be goods for them later. The problem with this view is that it fails to explain the actions of mothers (and fathers) who care for their in-utero child in a loving way even when they know that their child will die shortly before or shortly after birth. Moreover, many parents identify a time in utero, perhaps even the moment they first heard they were expecting, as the real beginning of their relationship to their child.

By contrast, consider a more obviously anticipatory case. Suppose that right now I do not have friends, but am preparing in various ways for the possibility—moving to a more populated place, working on my personal grooming, and developing virtuous habits. These preparations are truly only anticipatory: they do not themselves begin any friendship, and when I do make friends, I will date the beginning of that good in my life from the time of the friend’s first presence, not the time of what was done in advance.

No Benefit theorists are also likely to argue that person-oriented treatment of the radically impaired at the end of life is entirely symbolic. What is performed is done only in recollection of a person who was once present, but is no longer; at the extreme, such theorists could hold that there is even a form of disrespect involved in treating what is no longer a person as if it still were one. And whereas many people see themselves as benefiting by maintaining solidarity and commitments to a permanently unconscious patient, such as a spouse or parent, a No Benefit theorist might think this benefit entirely illusory.

But adult children, siblings, and spouses often see themselves as maintaining a previously existing relationship with a patient, not simply honoring, in a symbolic way, a relationship that has in fact ended. Putting flowers on a gravestone is likely to be seen as a symbolic act done in remembrance; but bringing flowers, perhaps of a favorite kind, to the room of one’s permanently unconscious spouse is likely to be seen as a loving, not a remembering, act. Similarly, feeding a patient in a persistent vegetative state appears to be one thing, while leaving a piece of cake on the grave of a deceased loved one is something altogether different. And spouses who maintain fidelity to their unconscious loved ones are true to the goods of a marriage that continues to exist.

Our very practices thus reveal the implausibility of the claim that we are unable to benefit—and therefore also to harm—those not yet, or no longer capable of, acting for themselves. Yet the No Benefit view does highlight the reality that human beings, and their pursuit of human goods, have an important temporal aspect to them.

At a most general level, we are beings who live in time, who go through temporal phases of development and decay, and who are not, at various points, actively able to do all that we one day will, or one day did. Recognition of this is essential, or we are likely to think that a snapshot image of a human being will tell us everything about what that being is. Yet it is absurd to think that a snapshot of, for example, an infant tells us everything about that child’s capabilities or goods, in abstraction from how human beings typically develop through time. Indeed, to treat a child in accordance with such a snapshot idea would require that we abandon practices that make no sense from that perspective, such as talking to children who do not yet understand what is being said; yet these practices contribute in essential ways to the development of our children’s capacities.

Looking backwards, an understanding of how a particular human being has lived through time is essential to understanding the way in which certain goods will, and will not, be of benefit now for that person. In the context of established relationships with others, how a good must be pursued in order to fully benefit another takes a specific shape: given the contours of a marriage over time, for example, husbands typically know that certain gifts will please, and certain forms of respect will be appreciated by, their wives, while other forms, acceptable for a different couple, would be experienced as strange and alienating.

This temporally specific quality to the pursuit of goods with and for another suggests that our treatment of those who have lived among us, but are now radically impaired, should be affected by the shape of those previously existing relationships. The way of life lived by a person now in a persistent vegetative state—a life that typically will have been lived with others, within a certain family-specific “culture”—might have consequences for the forms of good his caregivers should now pursue for him. Why, for example, would family members play music of a form detested by the patient in his presence, or decorate his hospital ward in a way known to be disliked?

On the other hand, particular ways of showing affection, developed through time with the patient, might still be especially appropriate even when the patient cannot actively respond to those gestures. A family-specific way of life, for example—styles of dress and decoration, forms of communication, jokes, religious symbols, and the like—should perhaps be extended as much as possible into the life of a no-longer conscious patient. Thus parents of a PVS child will hope to bring friends to visit, and to take meals, celebrate holidays, and pray together in the presence of their unconscious child, and even, if possible, to care for the child in the home. If this suggestion is correct, then the form that the general good of sociality and solidarity should take would thus be specified by the patient’s and the family’s past.

We must be able to situate human beings in their presently existing condition, and to situate their present opportunities for goods, into a larger temporal frame that includes their past and future. This is essential if we are to recognize that those human beings are a part of our human community, and that they can, like more active members of that community, be really benefited and really harmed by our choices. And these abilities are evidenced by our lived experience, and, in particular, by the practice of parents, husbands, wives, children, and friends who realize, in the lives of their charges, the goods of life, play, beauty, justice, and solidarity from conception to natural death.


Christopher O. Tollefsen is Professor of Philosophy at the University of South Carolina and a senior fellow of the Witherspoon Institute. His book Biomedical Research and Beyond: Expanding the Ethics of Inquiry (Routledge, 2008) has just been released in paperback. Tollefsen sits on the editorial board of Public Discourse.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Copyright 2011 the Witherspoon Institute. All rights reserved.

AC: In the early days of bioethics, we had these conferences at the Hastings Center, where I began my bioethics career, where Alasdair MacIntyre, Paul Ramsey, Leon Kass would come and talk about issues. And I began to form an idea of what bioethics’ role was—and I still believe it to this day: My philosophical idol is Socrates. He worked frequently in the public sphere. I think as a bioethicist you try to alert the public, you warn people, you push to see what’s true, but at the end of the day, bioethics gets out of the way. You don’t issue final judgment; you must resolve issues in the political sphere. If Robby’s guys get elected all the time, and they ban embryonic stem-cell research, I’ll scream and yell, but if that’s what people decide, that’s what people decide. I favor bioethics commissions that raise issues, clarify them, and then give them to the polity to resolve.

RG: Well, it’s true that President Bush’s council on bioethics, on which I had the honor to serve, sometimes went beyond advising the president of the United States himself. But it’s worth remembering that the Executive Order creating the Council included a mandate to “provide a forum for a national discussion of bioethical issues.” The collected readings we published were an effort at large-scale public education. I think that kind of work can easily be defended, and the best defense is that by doing it under the auspices of a commission, and especially an ideologically diverse commission like ours, it is possible to draw attention to the basic values issues that Americans should think about when they consider bioethical questions. I doubt that it would be possible to do it as well in reports issued by, say, Princeton University, or even the premier center for bioethics here at the University of Pennsylvania. If the commission is not the place, where, then? Because the universities aren’t doing it very well, and perhaps can’t.

AC: So it’s funny you should say that, because I’ve also thought—and I don’t know how to make this happen, exactly—but if I had a politician ask me for advice on something, I’d like to be able to bring Robby in—really—and say, “I’ll tell you my advice, and you can listen to the minority, distorted, bizarro other opinion…”

RG: Soon to be the majority! [Laughter]

AC: But here it is, listen to the other view, and you’ll get more from a conversation than you might from me just talking to you.

RG: Art is absolutely right on this. I was asked by three Republican presidential candidates in the run-up to the 2008 election for briefings on embryonic stem-cell research. Senator McCain, Governor Romney, and Mayor Giuliani. Mayor Giuliani did it differently than the other two. He invited me and an advocate of embryonic stem-cell research from one of the New York-based patient advocacy groups to discuss the question with him. Essentially, it was a debate in front of Mayor Giuliani. And I do think that it was more fruitful than the other two briefings, where I had my little captive audience, but would just give my best answer when they asked, “Well, why do the people on the other side think what they think?”  And I’d try to give the argument, but I think I was probably less effective in giving the argument than someone who actually believed it.

Let’s have one of those exchanges now about a big issue in bioethics: eugenics. You have people like Professor Kass, who are warning that it is popping up again in the availability of certain options for improving the gene pool or selecting for or against early human life that has certain defects and so on—but that the “new eugenics” are disguised as opportunities for practicing autonomy, and that, as a result, they are viewed as morally okay. Do you think that’s happening, as a factual matter? And is even uncoerced eugenics wrong in principle? Was eugenics in the 1930s, say, wrong only because it was coercive, or also because it was eugenics?

RG: You’ve heard me make the argument about human dignity without any appeal to religious authority or biblical revelation or theological premises. But the most vivid expression of that idea is that man is made in the image and likeness of God. Whether or not that’s literally true, I would still hold that human beings have a certain dignity that distinguishes them from other material objects that we know about. There may be other creatures in the universe that possess a rational nature, and I would say that if there are such beings, they too are of inherent and equal dignity and cannot be reduced to the status of mere means or property. In the end, this is really the only reason to oppose something like slavery, or to consider that domination and conquest are a bad thing. So people who oppose these evils have to embrace some notion of the special worth—we can use the word “dignity” or “sanctity”—of a human being. But that means there are some ways you can’t treat human beings. You can’t treat them as instruments, or just the way you treat cows and horses. That is true even when it comes to breeding, or to improving the quality of the race. Or treating them like products—this is what Leon Kass is so worried about. He’s worried about reducing human beings to the status of products of manufacture. And he’s absolutely right to be concerned about that. That is incompatible with our dignity as human beings. Which leads me to think that the problem with eugenics is eugenics itself. It’s not just that the eugenics practiced by the Nazis was coercive. The idea predated the Nazis. The book Die Freigabe der Vernichtung Lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life) was not written by the Nazis. It was written by German progressives in the Weimar period, Karl Binding and Alfred Hoche, who were, respectively (as I recall), a jurist and a medical doctor. And they weren’t thugs like the Nazis; they were well-educated, well-intentioned, polite people—the kind of people that you’d be pleased to have dinner with. But I believe they embraced a very bad idea that was easily taken by the Nazis as a justification for the atrocities that they committed. So I would like to see eugenics itself, and not just the Nazi version of it, relegated to the ash-heap of history. Today we are seeing a revival in eugenics, this time under the cover of (and often in the name of) autonomy.  People say, for example, that so long as it is parents who are choosing to abort a Down syndrome baby, or failing to treat a handicapped newborn, and it’s not the state mandating it, then it’s okay. That, I believe, represents the abandonment of something precious in our civilization and in our polity. And that’s the idea of the equality and dignity of all human beings. This treasure of our civilization is the idea that, in some fundamental sense, all of us are created equal.

AC: So, I think that the coercion is, historically, really what made the Nazis’ position absolutely wrong. They practiced government-mandated negative eugenics. They killed involuntarily as social policy to improve the German genome. So put that aside, that’s just an issue of making sure you know when you’re going to use the metaphor—it’s not just eugenics, it’s that kind of eugenics. So to me, I think that intervening to try to improve health and function is part of what medicine does. And there’s some role for medical engineering and cellular engineering to achieve those goals. I think when you start to slide into the aesthetic and cosmetic improvements—I’m not sure that’s something that society or the public has to fulfill. But do I think we will someday try to alter a genetic message to get rid of certain diseases? Yes. Do I think that we’re likely to see the selection of certain types of gametes that might avoid certain clear-cut disease states? Yes. Do I think that the state has to be in the business of affording the opportunity for everyone to have a 6’5” basketball-playing mathematician? No. For me, there is some role for what I’ll concede as eugenics—if you want to take eugenics as just trying to improve the overall hereditary health of the public. For example, if you could fix the child with Tay-Sachs, I don’t think it takes away from the dignity of the child with Tay-Sachs.

RG: I agree. But would you draw the line at trying to enhance intelligence—

AC: I do. I think intelligence is so complicated that you don’t know what the hell you’re doing. If someone came to me and said, “Well, I’m going to try to enhance memory,” that may be good and that may be bad. It’s tricky business, number one. And number two, that isn’t a disease. So I’ve never been a proponent of allowing sex selection. We don’t allow it at Penn, actually. We could do it instantly. It’s not that hard. And other places do it. But gender is not a disease. If you come to us and say, “Could I use gene therapy”—as I said, “for Tay-Sachs, or to try to improve muscular dystrophy”—I’d be first in line to say, “I think that’s great, and we have to test it, and there may be some risk to that, but I’m okay with it,” even though some in the disability community might say, “Well, then, your goal is to get rid of disability, isn’t it?” And I might concede at that point, “Yes—if I could do it.”

RG: But not by getting rid of the disabled.

AC: Oh, no, no, no.

RG: Because that’s the key distinction.

AC: I agree, but some in the disability community hear inferiority, lack of respect, when you say, “I’d prefer people who could function more.” I’ve heard this with the deaf community. To me, hearing is better than not hearing. And it’s pretty clearly a function you’re supposed to have. It’s true that you can sign, and that there is a deaf community. And I get that there’s Gallaudet College. I’m not proposing to close them; I think you should fund them. But at the end of the day, if I’m the child of a deaf couple, I’d rather be able to hear and sign, and decide what I’m going to do from there. I’m not going to make a deaf baby because the couple says, “We want a kid like us.” No steps should be made to honor that kind of autonomy—things that will harm or set back people. I’m worried for that reason about things like intelligence or athletic ability. You’re narrowing futures, deciding what the kid is going to be, raising expectations, instead of allowing them to be more open. So I favor, if you will, ‘eugenics’ on the disease-elimination front, but I am not so crazy about performance-enhancement or the behavioral meliorism.

So it sounds like both of you have two distinctions you want to draw. One is between enhancement and therapy—

AC: Right. And many say you can’t, but I think you can at the extremes.

And the other is between negative and positive, between destroying life that has the therapeutic problems versus—

AC: Trying to engineer it away. Medicine does that now, right?

RG: I think Art’s reminding us of the ends of medicine: the goal of medicine is the restoration of healthy functioning of the organism and its parts, within the bounds of ethical norms. I mean, you don’t restore health by murdering someone conveniently to get a heart for somebody else who happens to need a heart transplant. We understand that. That’s just a plain violation. But my point is that when we treat medical professionals as people who are supposed to enhance our lifestyle choices—the kind of kids we want to have, whether our kids are good at math, whether they’re basketball players and 6’5”—it causes medicine to lose track of its mission and places at risk its commitment to ethical norms shaped by that mission.

Read the first part of this interview here.


Sherif Girgis is a Ph.D. candidate in philosophy at Princeton University.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Copyright 2011 the Witherspoon Institute. All rights reserved.

People sometimes contrast those who go on evidence, facts, science, and reason, with those who “politicize the science.” But both of you seem to think that besides scientific findings, moral norms have to govern scientific inquiry and medical practice…

AC: That’s why Robby and I can get along. We’re just fighting about the norms. But we both know that you have to have normativity. Bioethics without norms is completely blind!

…and that those norms are not going to come from science.

RG: No. Bioethics is ethics, and ethics is about right and wrong. We know you can’t go about figuring out what’s right and wrong by scientific methods. So the norms have to come from somewhere else. And since we are a democratically constituted people, we are going to have to resolve by democratic procedures disputes about what the norms are, and how they apply in particular cases. Now that, I’m afraid, is politics. Not in some pejorative sense—rather in a good sense, in the democratic sense. Together, we deliberate, debate, and decide. So I think the juxtaposition that you mentioned is just phony. It’s not a dispute between the people “who believe in reason and evidence” and people who “are opposed to science.”

AC: You can pile up evidence to the size of the Jungfrau, but if you don’t have norms, evidence does you no good. But some out there believe that the evidence speaks for itself.

The scientific evidence speaks for itself?

AC: Yes, there are adherents of what might be called logical positivism, or scientism.

They are out there! They believe the facts alone dictate moral choices.

RG: I agree. I would add that it is highly ironic that the scientism that Professor Caplan observes out there, and rightly condemns, is often embraced by people who regard themselves as especially sophisticated and even enlightened.

AC: Yes, yes. As an exemplar, take some of the writings recently of Zeke Emanuel, the doctor who’s been whispering in the ear of Obama. Rahm Emanuel’s brother.

RG: He was the Director of the Bioethics Council under President Clinton.

AC: Zeke and I actually have been arguing more contentiously than Robby and I over the past few years because Zeke is an exemplar of scientism: “If we all collect enough evidence, it will be clear we should do X.”  I disagree. You need normativity to do both ethics and bioethics.

So in light of what you’re both saying, is there a way of separating science and religion—or of walling off the influence of religious views from the settlement of these policy issues, in a country where many get moral guidance from their faith traditions?

AC: That isn’t going to happen. But the religious communities have to engage one another, too. I think what science does, relative to the religious discourse, is it tries to protect its self-interest. So scientists generally have a very strong commitment to freedom of inquiry, no matter what the heck they’re doing. I have to say it’s not quite my view. Freedom of inquiry is a great thing. But most scientists also want NIH money, or tax money. Science needs public funds; it’s a hugely expensive public endeavor. So scientists have to make their case to the public. They’re used to doing what they want, under the idea that freedom of inquiry will bring the public the most returns. They also have an advantage over religion in that they can deliver shorter term but more immediate rewards. You can at least turn on your heater due to physics. Where your soul is in the afterlife…

Jury’s still out. [Laughter]

AC: But at the end of the day, they’ve got to convince the polity and the religious traditions. Sometimes, if you’re trying to make room for scientific advance, you try to play into the divisions of religious opinion. But the most powerful thing that happened in the stem-cell debates was not arguments by Robby or by me. It was patient advocacy groups speaking up. You come in and say, “I’m in a wheelchair, or my child has diabetes…” Very, very powerful. It’s not religion, but let’s call it a normative stance that is enormously forceful. You must help those in desperate need. That’s how things get settled—not science alone.

Let’s talk more about that bioethics debate. Leading up to 9/11, public funding of stem-cell research in which human embryos are destroyed was a huge issue in American politics, and it deeply polarized the country. There was a very long and public deliberation by the president. To some degree it antagonized some people in the scientific community against some people in the religious community. Was it worth the polarization, the social and political costs?

RG: To me, at stake was our fidelity to the principle of the sanctity of human life. So I could not have yielded and said, “Well, that’s not important.” At the level of principle, I think probably both sides would say that it’s a big issue. But my sense is that it got blown enormously out of proportion as far as the practical significance of a policy one way or another was concerned. First, because it became useful politically. It was a way for Democrats to marshal their base against Bush in 2004. Ron Reagan, the late president’s very liberal son, to my mind just wildly hyped the potential therapeutic promise of embryonic stem cells. I think a lot of people were led to believe—and to what extent scientists were responsible for this is an interesting question—that if only the regulations were relaxed, embryonic stem-cell science would be central to our medical research and practice going into the future, and that it would massively alleviate suffering and produce cures for dreaded diseases. But it wasn’t true. Prescinding from the ethical questions, my own view is that there are scientifically interesting things that can come of embryonic stem-cell research, but that even without regulation, it wouldn’t be central. It doesn’t promise anytime soon, if ever, the amelioration of suffering or cures for dreaded diseases.

AC: So far I don’t disagree with that too much. Embryonic stem-cell research was completely overhyped, in terms of its promise. And people knew it at the time. I tried to say so myself at different times myself, even though I support embryonic stem-cell research. But this notion that people would be out of their wheelchairs within a year if we could just get embryonic stem-cell research funded was just ludicrous. Just simply silly.

RG: They knew it at the time?

AC: Yes, those saying it had to know it at the time. The scientists had to have known that. Who has ever delivered a cure in a year from something that’s basically a dish? That’s never happened. Gene therapy was promised as a cure for everything, and it is now starting to cure things, 15 years after the initial gene therapy experiments in dishes were being done. I think embryonic stem-cell research—if it works out, if you can control stem cells derived from embryos, if they don’t revert back… but we don’t know what chemicals to put around them, to get them to become what we want. We don’t know where to put them. But the politics of that issue were abortion politics, meaning that one side had as a principle, “Don’t kill.” The other side had as a principle, “You’ve got to cure.” And that escalated the rhetoric. So I think the science got hyped in response to the politics. Norms drove the debate. Embryonic stem-cell research for me is one of what I might list as 20 scientific frontiers that you might want to pursue. It’s not the frontier, but it’s one of a number of them.

RG: But it sounds to me like a niche.

AC: Oh it’s a niche, absolutely. Bio-banking, synthetic biology, bioagriculture, regenerative medicine at the adult stem cell level… There’s a bunch of areas of science with equal promise—

RG: If scientists knew that what they were doing was hyping it, then—even laying aside the ethical question about the status of human embryos—it seems to be deeply dishonest, clearly wrong.

AC: Here’s an assertion that you hear all the time: “Stem-cell research will help Alzheimer’s.” But stem cell research has no possibility of helping Alzheimer’s. Alzheimer’s is a gunk-up-the-brain disease, where every cell is affected. You can’t fix it by any sort of stem cell research. Model it? Maybe. Cure it? Never.

RG: In 2003 or 2004, a major Washington Post article quoting the central authorities on this made exactly the same point. Now that’s the kind of dishonesty that threatens to alienate the public from science. Because even if the public buys it in the beginning, and the scientists win the political debate, when they can’t deliver on the promises they made, people’s faith in scientists—crucial for the funding of science—is placed in jeopardy.

AC: I think it’s worse. There’s a clinical trial going on in California with private funding, for a spinal cord study. That study is poorly designed, shouldn’t go on—I’ve said so. The model that you want to use on stem cells is in your eyes: if you wreck one, you still have the other, and they’re easy to access. But trying to shoot cells—and you don’t know what they’re going to do—into someone’s spinal cord on the basis of a few rat experiments… If that goes wrong, the hype has been such that when critics come in and say, “it shouldn’t have been done,” it will set the field back to zero. I’ve tried to tell my science colleagues, “If you make a mistake on this first trial, and kill somebody? You can hang it up.”

RG: I think there was a warning that should have been heeded that came as a result of the exposure of the fraud committed by the South Korean scientist Woo Suk Hwang in 2004. If I recall correctly, his paper had been published in Science, and it had been fast-tracked in what seemed transparently to be part of a political effort to sell the public on human cloning to produce patient-specific embryonic stem cells. Since this would serve the political cause, normal checks that would have prevented the publication of a fraudulent paper were not observed, and it turned out to be fraudulent.

AC: And a little less lofty: “Give it to us, because if you give it to, say, Nature, they might slow it down!”

RG: [Laughter] Is that what happened? Well, the cutting of corners for political reasons is such a dangerous thing to do—to science. But when Ron Reagan was trotted out at the 2004 Democratic National Convention to make these preposterous claims about Alzheimer’s, of course you spoke out—but were there others?

AC: There were and there weren’t. Because at that point, I think what happened was that the polarization of the politics got so bad that it was a team philosophy.

So it would look like you betrayed your side if you spoke out with the truth?

AC: Definitely… It’s a little harder to be a moderate in the middle of that. I can give you a parallel: Terri Schiavo. I was vociferous in my insistence that the husband should make the call in the case of Terri Schiavo [about whether to continue her artificial nourishment after her severe brain damage]. But one thing I knew was that she was absolutely permanently vegetative. She had two heart attacks; she wasn’t getting oxygen to the brain. People were saying, “I could hear things in PVS.” Doctors said, “I can make her better.” And no one on the other side would say that was bull. So certain factual claims get laid aside in the heat, when bioethical disputes move up to culture war level. I can moan about this. “Alzheimer’s disease? Really, a systematic disease of the brain? You’re going to replace every cell in the brain with embryonic stem cells?” But you know, the price of entering into that arena is you can lose or be put in the service of what you know to be purely politicized debate.

RG: Art and I disagreed about the Terri Schiavo case, but the fundamental point he is making here is absolutely right. Back on the embryonic stem-cell debate, there were people on my side of the ethical question who contended that there was absolutely no reason to pursue embryonic stem-cell research even if the stem cells could be obtained without destroying embryos, because (they said) everything that could be done with embryonic stem cells could be done with adult stem cells and we knew it. Well, I knew that we knew no such thing. To admit the truth that there very well may be uses for embryonic stem cells—not therapeutic uses at any time soon or perhaps ever, but in basic science, or perhaps in the construction of disease models—one needn’t abandon one’s principled position against the destruction of embryos.


Sherif Girgis is a Ph.D. candidate in philosophy at Princeton University.

Receive Public Discourse by email, become a fan of Public Discourse on Facebook, follow Public Discourse on Twitter, and sign up for the Public Discourse RSS feed.

Copyright 2011 the Witherspoon Institute. All rights reserved.

I dread specialists in power because they are specialists speaking outside their special subjects. Let scientists tell us about sciences. But . . . questions about the good for man, about justice, and what things are worth having at what price . . . on these a scientific training gives a man’s opinion no added value. Let the doctor tell me I shall die unless I do so-and-so; but whether life is worth having on those terms is no more a question for him than for any other man.

Whether western liberal democracies have “progressed” in the direction of the “welfare state” that Lewis envisioned in his 1958 essay is a matter of on-going political debate. What is, perhaps, undisputed is that in addition to telling us about science, a new scientific priesthood speaks ex cathedra on the whole range of “questions about the good for man, about justice, and what things are worth having at what price.”

As a recent example of this trend, consider Designer Genes: A New Era in the Evolution of Man, a new book by Dr. Steven Potter, professor of pediatrics in the Division of Developmental Biology at Children’s Hospital Medical Center in Cincinnati. In his book, Potter not only provides a highly accessible, winsome tour of current genetic biology, he also (as one endorsement puts it) “ventures into morality and religious issues and does this with great capability and sensitivity.” Potter’s credentials in genetic research and developmental biology are noteworthy. In addition to his Ph.D. from the University of North Carolina at Chapel Hill and a postdoctoral fellowship at Harvard Medical School, Potter has published in such journals as Nature, Cell, and Science. However, a careful reading of Designer Genes suggests a healthy measure of skepticism is in order about the credibility of Potter’s priestly pronouncements on how we ought to harness the potential of genetic science.

Designer Genes is a panegyric for eugenics. At times, the tone of Potter’s praise for a genetically orchestrated future is almost ebullient. Potter writes:

But if we know our complete DNA sequences then we can be on our guard for this eventuality [genetically inherited disease], perhaps by restricting who we marry, or perhaps more likely by screening embryos through DNA sequencing when the danger of severe genetic disease is present. And in time, as such genetic screens become more common, it might be possible to completely remove such harmful versions of genes from the human population.

Recognizing the tragic history of past eugenic efforts, Potter is cautious to distance himself from the worst abuses of eugenic programs. He makes a distinction between “positive” and “negative” eugenics. The former consisting of “efforts to promote the passage of the best genes from one generation to the next, by positive means” (emphasis added). The latter “is devoted to preventing the reproduction of people with perceived inferior genes,” By “positive means,” Potter seems to have in mind a kind of free-market eugenics based on consumer choice since “we need to be vigilant and avoid state-dictated genetic programming of populations.” After all, he muses, “who wouldn’t want to be the parent of another Michael Jordan? . . . If the technology to produce super-athlete children is available, there will be people who will use it.” And Potter’s proposed positive eugenics would seek to make all of the technological resources available to those parents seeking to avail themselves of it.

To his credit, Potter recognizes that his enthusiasm for future genetic perfection is a source of moral discomfort for some. He candidly acknowledges that the “genetic manipulations described in this book for the creation of babies with desired gene combinations would result in the destruction of human embryos.” Hence, he raises the question of whether such technology is “morally unacceptable” since we might be “committing the murder of some human beings to improve the genetic makeup of others.” However, in keeping with the free-market stance of his “positive” eugenic proposal, Potter asserts that there “are no certain answers to these [moral] questions, only different points of view.” Consequently, we, individual consumers “will reach our own conclusion” about how we ought to proceed in re-engineering future human beings in conformity with our desires.

Potter’s own attempt to wrestle with the morality of destroying human embryos is philosophically, if not biologically, confused from the start. He begins by claiming that “each egg and sperm has the potential to make a person.” Biologically, this is simply false. Gametes, by themselves, have no intrinsic developmental potential for human personhood. Of course, Potter knows this. So his use of “potential” is likely more latitudinarian. Still, three pages later, Potter describes the zygote as having “remarkable potential.” “It can,” he explains, “turn itself into a person.” Ironically, Potter fails to recognize that this potentialist understanding of human personhood is at odds with his rather surprising admission of the embryological facts. Potter writes, “Of course we all began as a zygote. Everyone does.” What is shocking about this concession is what it so obviously entails—an entailment that seems lost on Potter. If I, the human being I am today, “began as a zygote,” then the zygote that began the-human-being-I-am-today was me—i.e., it was a human person. It was not merely a cell with “remarkable potential” to become me. It was me.

Undoubtedly, if pressed on this logical inconsistency, Potter would retreat to his potentialist position, a view that allows for a range of perspectives consistent with the overall thrust of a consumer-oriented ethic. Thus, while Potter is willing to go on record as believing that a late third trimester baby is “clearly” and “indeed a human being and deserving of the right to live,” he conveniently remains non-committal about the point at which a potential person becomes an actual one. The skepticism about this point—“somewhere after conception and before birth”—enables the consumers to decide. Either way, Potter thinks that the potentialist viewpoint absolves those involved in the genetic manipulation of human beings of the charge of complicity in the destruction of human persons.

From the standpoint of rational consistency, Potter’s insistence that a late third trimester baby “clearly” deserves a “right to live” is odd. If the so-called moral status of unborn human beings is something that is conferred, as it seems to be in Potter’s consumer-oriented ethic, then what reason does one have for believing that a human being “clearly” possesses such moral dignity at any point in its development? Though barbaric, the views of Peter Singer have the admittedly small virtue of being logically consistent on this point. Reasonable though it is given his underlying assumptions, Potter, unlike Singer, can’t seem to swallow the infanticide pill.

Of course, this is ultimately because the position upon which Potter’s positive eugenics is based is a-rational. The maximization of consumer choice requires a full range of options over which deliberation is guided by emotion and desire. From this standpoint, Potter’s reticence to sacrifice late third trimester infants in the name of genetic advance makes perfect sense. His moral reluctance is not grounded in a rationally defensible, principled position. It is simply an expression of how he feels.

It is precisely this aspect of the new scientific priesthood that is most disconcerting. It wants science unencumbered by the rigorous demands of rational moral discourse. At the same time, this priestly class recognizes that they serve a populace still very much enthralled by a moral universe they have long since rejected. Consequently, the scientific priests must provide a substitute mythology for traditional, rational moral discourse—one that affords therapeutic solace for the vacuum created by the elimination of the latter. This is achieved perfectly when morality is reduced to emotive preference and science becomes an instrument in the satisfaction of consumer desire.

That Designer Genes aims at a popular audience is telling. It tells a story of the exciting and uncertain future of genetic enhancement in the tradition of Disney’s Jiminy Cricket. However, what guidance it provides comes not from conscience, but from technological possibilities offered in the interest of consumer demand. What passes for moral counsel is mere reassurance that the customer is king. If C.S. Lewis is right to fear scientists who speak as though their technical training as scientists provides grounds for moral authority, one ought to be more fearful of scientists who, speaking out of their scientific expertise, assure us with full moral authority that there is no moral authority. Just relax while the anesthetic takes effect.


Justin D. Barnard is Associate Professor of philosophy and Director of the Carl F.H. Henry Institute for Intellectual Discipleship at Union University in Jackson, Tennessee.

Copyright 2011 the Witherspoon Institute. All rights reserved.

The therapeutic promise of stem cell research rests on using pluripotent stem cells, which can be grown into many of the types of cells found in the human body. Until recently, such cells could be produced only by destroying human embryos and harvesting embryonic stem cells. Opponents of embryonic stem cell research (ESCR) sought a method of producing pluripotent cells without destroying embryos. Their goal was to show that adult cells, rather than embryos, could provide the raw material for stem-cell therapy.

In 2007, scientists demonstrated that they could transform human skin cells into iPS cells, bypassing the destruction of embryos. While opponents of ESCR hailed this announcement as a sign that iPS cells could provide the full therapeutic promise of ES cells, the methods were still in their infancy. It took about a month for the iPS cells to develop, and very few transformations were successful: 99.9% of treated cells failed to transform. Besides being slow and unreliable, the techniques were dangerous. Viruses were used to insert specific genes into the adult cells, which increased the cancer risk for the stem cells and thus for prospective patients receiving stem cell therapy. Without a safer technique, the promise of iPS cell research remained in the future.

That future is now. On September 30, researchers led by Derrick J. Rossi, Ph.D., at the Harvard Stem Cell Institute reported a novel technique for producing iPS cells from adult skin cells that is fast, reliable, and safe. Instead of viruses, Rossi’s team transformed skin cells using messenger RNA (mRNA), producing iPS cells two times faster and one hundred times more reliably than the virus techniques. Most importantly, the mRNA method does not raise the cancer risk for the iPS cells. While there is still room for improvement in the method’s efficiency, scientists in the field view Rossi’s discovery as a major breakthrough. Robert Lanza, chief scientific officer at Advanced Cell Technology, likens it to “turning lead into gold.”

Opponents of ESCR have applauded the discovery as well, citing its potential to render obsolete research methods that destroy embryos. Richard Doerflinger, Deputy Director of the Secretariat for Pro-Life Activities at the United States Conference of Catholic Bishops, commented: “With each new study it becomes more and more implausible to claim that scientists must rely on destruction of human embryos to achieve rapid progress in regenerative medicine.”

With the new mRNA method for producing iPS cells the prospects for iPS cell research are better than ever. In this respect, opponents of ESCR should welcome the news. They should be aware, however, that it is no moral panacea.

To begin with, demand for embryonic stem cells will continue in the near future. In order to determine that the transformations work properly and the cells are safe for therapeutic use, researchers need to compare the iPS cells to ES cells, which means destroying embryos. In the long run, fewer embryos may be destroyed in stem-cell research as research shifts to iPS cells; but this transition may take years.

The moral complications of the new state of the art go even deeper, due to an advance that scientists anticipate within a decade: using iPS cells to create human sperm and egg cells. Scientists will be able to create an entire embryo using ordinary skin cells or other adult cells, without ever using gametes harvested from a person. This method, which we might call gameteless reproduction, makes in vitro fertilization look like child’s play and gives us more control than ever over human reproduction. The prospect of gameteless reproduction not only makes even more pressing the ongoing debate about the morality and legality of human cloning, but also raises moral and legal questions that are not widely known and discussed, even among the staunchest opponents of ESCR.

First, there are the moral issues connected with the procedure itself. Like Somatic Cell Nuclear Transfer (SCNT), the method used to clone Dolly in 1996, gameteless reproduction raises the question of the morality of cloning and other kinds of asexual reproduction, since it allows the creation of an embryo from one or more tissue donors. However, gameteless reproduction has the potential to transform reproduction even more dramatically than SCNT. Unlike SCNT, gameteless reproduction uses easily obtainable adult tissue and does not require donated ova, which can be obtained only through a highly invasive procedure. It will thus be a dramatically cheaper and easier route to asexual reproduction, and may therefore be much more widely used than SCNT. Due to its advantage over SCNT, gameteless reproduction may over time replace IVF as the assisted reproductive technology of choice. Since it allows reproduction without donated sperm or eggs, gameteless reproduction expands the possibilities of reproduction. In principle, young children or deceased persons could become parents of embryos used in research. Moreover, gameteless reproduction may erode the link between procreation and any kind of family context: single persons, for example, could create an embryo using only their genetic material. As a result, children could be increasingly—and tragically—viewed as products, rather than the fruit of a loving relationship. Most importantly, like other non-conjugal methods of conception that sever the procreative and unitive aspects of human sexuality, gameteless reproduction is intrinsically immoral.

Despite the anticipated development of gameteless reproduction and the serious moral questions it raises, this technique (like SCNT) is permitted under federal law. Only six states (Arkansas, Indiana, Iowa, Michigan, North Dakota, and South Dakota) have laws against therapeutic cloning, but only the Indiana law is broad enough to cover gameteless reproduction. We should expand existing prohibitions on cloning to cover gameteless reproduction as well.

Apart from these issues with the procedure itself, gameteless reproduction will also give parents an extraordinary level of control over the genetic makeup of their children. What moral principles govern these choices? Are parents morally required to create the “best” possible children? And should the law prevent parents from choosing to create children with disabilities?

Every human life is worth living, even a life beset by extraordinary hardship or disability. This is the foundation for protecting all human life, including the very young, the very old, and the physically and mentally disabled. It is therefore never wrong, in and of itself, to choose to bring a new human life into existence, though it may be wrong to do so with certain intentions, in certain circumstances, and through certain means. As I said earlier, non-conjugal reproduction is intrinsically immoral, and this is so because it involves an impermissible means of conception. In itself, however, choosing to conceive a child is a fundamentally good act. I therefore reject the view held by Joseph Spoerl (Professor of Philosophy at St. Anselm College), who has argued that choosing to conceive a child is to treat the future child as a means to the parents’ ends, since the child does not yet exist and therefore cannot be benefitted by the choice. On the contrary, in choosing to conceive, parents are taking the necessary first steps for their child to come into existence; provided they are not making these choices for selfish reasons, they are not treating their child as a means only and are acting permissibly. This is a delicate issue, and I firmly agree with Ryan T. Anderson that we need to devote more attention to the intrinsic moral status of reproduction.

In recognition of the goodness of conception in itself, we should protect the choices of parents to have children who share their disabilities. If deaf parents foresee that conceiving a child through a conjugal act would result in a congenitally deaf child, that choice is morally permissible and should be legally protected. It does not follow that deliberately choosing a deaf child through embryonic selection is permissible.

There’s another argument in favor of protecting the reproductive choices of the disabled. The law not only governs our behavior but also expresses our values. Prohibiting parents from knowingly conceiving a severely disabled child, on the grounds that their doing so would lead the child to have a life not worth living, expresses profound disrespect for the value of each human life. Importantly, even if it’s controversial that every life is worth living, it’s arguable that the law should proceed as though it were true because not doing so would dishonor those who live with disabilities. How can society claim to value the deaf, or those with other disabilities, if it requires that their children not resemble them in these respects?

Though it is seldom discussed among opponents of ESCR, there is a further set of issues that gameteless reproduction raises: how should we regulate tissue donation in light of future advances in reproductive technology? Donating tissue for scientific research will soon mean donating tissue that can be used to grow a sperm or egg; tissue donors could then become parents at the whim of the researchers possessing their tissue. While it has always been important for tissue donors to have some control over what procedures are done with their samples—some donors might be comfortable with certain kinds of research, and others might not—informed consent will be more important than ever once a simple cheek swab provides the raw material for someone to be a mother or father. There is disagreement in the courts and legal academy about whether there is a constitutional right not to be a parent; there should be no dispute that it is gravely immoral to make someone a parent (even of the most nascent form of human life, the embryo) without their informed consent.

The current law governing informed consent for tissue donation is woefully inadequate for protecting tissue donors in light of anticipated progress with iPS cell research. Informed consent is required when donating tissue for therapeutic research, in which the patient stands to benefit from the treatment being tested; violating the informed consent requirement is a tort. However, when donors give tissue to non-therapeutic research, in which they will not benefit from experimental treatment, violating informed consent is punished through administrative measures, like denial of federal funding. This minor response is clearly inadequate for the moral gravity of using someone’s tissue to make them a parent without their consent.

Moreover, once the tissue has been donated, there is no further risk of harm to the donor. This means that there is no legal informed consent requirement whenever obtaining a consent waiver is impractical and the tissue can no longer be linked back to the donor. If these two conditions are met, which is not uncommon, there are no restrictions related to informed consent for how researchers can use a donor’s tissue. In the absence of a sufficiently wide ban on human cloning and gameteless reproduction, or a legally protected right not to be a parent, researchers in these scenarios have a legal green light to make tissue donors parents without any kind of consent; this is profoundly immoral and should be a legally actionable tort.

As new advances alter the possibilities of human reproduction, we must develop a morally sound body of law governing stem cell research and tissue donation. Science studies momentum and other physical quantities but it also has its own momentum, which we must harness to promote the common good.


Matthew Hoberg is a Ph.D. student in Philosophy at the University of California, Berkeley.

Copyright 2010 the Witherspoon Institute. All rights reserved.

I should note that my argument is relative to a community in which abortion is legal. If abortion is wrong by virtue of the kind of act it is, namely an act of unjust killing, which I judge it to be, then aborting a fetus knowing that he or she will or might feel pain makes the act worse. But what about a society like ours where abortion is, sadly, legal?

First, pro-lifers and pro-choicers should be able to agree on the principle of full disclosure. If fetuses feel pain, then where abortion is legal, abortion providers should disclose to the gestational mother the effects of her choice on the fetus. We may disagree about whether abortion is wrong, but we should be able to agree that withholding information relevant to making an informed abortion decision would be unfair to women.

Second, if fetuses feel pain, then where abortion is legal, abortion providers should also take reasonable measures to suppress the pain. We should be able to agree that it would be wrong not to try to remove the pain, just as it is when political authority fails to take reasonable measures to remove the pain from the process of legal execution.

If, however, evidence demonstrates that fetuses do not feel pain, then, where abortion is legal, abortion providers obviously have neither the duty to relieve that which does not exist, nor to inform women of what’s untrue.

Our moral analysis then waits upon the settling of the empirical question of whether fetuses feel pain. This settling requires convincing data. But when speculative data is used to direct normative considerations of what ought to be done, the measure of certitude justified by the data is decisive for guiding action.

To clarify my meaning, let me use an example. Some abortion opponents have argued that a secondary effect of the most common drug used in emergency contraceptives—levonorgestrel—is to render the uterine lining inhospitable to an implanting embryo. If at commonly prescribed dosages this is the case, then the drug sometimes acts as an abortifacient. Whether this is the case is an empirical question. If it is the case, it has moral implications for the behavior of anyone concerned for embryonic human life and contemplating the legitimacy of taking the drug.

Let us say for the sake of argument that rigorous data is inconclusive. I am then left with a doubt as to whether or not levonorgestrel might render the uterine lining inhospitable. According to my practical knowledge, informed, let’s say for the sake of argument, by the best available evidence, I might kill an embryo if I use this drug in such and such a way. The possibility that my action will cause a death gives rise to the duty, stemming from the requisites of fairness, to refrain from that action. I would need to be reasonably certain that it will not cause death before purposeful action is justifiable. This reasonable certitude can also be called moral certitude. And reasonable doubt and moral certitude about the same fact are mutually excluding.

Let me propose one more example. If reasonable doubt existed as to whether the new device known as the “Mosquito,” which emits a high-pitched noise to disperse loiterers, not only caused minor auditory discomfort but severe pain, the burden of proof would fall upon the manufacturer to give evidence that it does not before the device should be approved for general use. Proof, of course, would be simple to arrive at: ask those exposed to the “Mosquito.” Since fetuses cannot yet provide self-report in language we cannot simply ask them whether they feel pain.

Yet I think the principle still stands: the burden of proof would fall upon defenders of the “Mosquito” to rule out a reasonable doubt that the device causes severe pain before its common use was approved, or to take action to assure that this possibility is mitigated.

The burden falls on the one who might be doing wrongful harm to rule out reasonable doubt that they are. If you were hunting in the woods and saw something moving in the distance, but were unsure of whether it was a deer or another hunter, you would be bound not to shoot until reasonable doubt was dispelled that what was stirring in the distance was not another hunter. When a doubt of fact bears on settling whether an alternative under consideration is immoral (e.g., it would be immoral to shoot in the face of reasonable doubt), one should withhold choosing till the fact has been settled.

So the question to be settled is whether or not reasonable doubt exists concerning a fetus’s capacity to experience pain. Since empirical certitude is not available, I propose, in light of what I said above, the following principle: that the judgment that fetuses do feel pain need only be a reasonable explanatory hypothesis in light of the settled evidence. Whereas the judgment that they do not requires moral certitude before providing a speculative ground for normative judgments about how to act.

Coming from one who is not a scientific expert on the question, but who has read considerably over the past four months on most all dimensions of the question, I conclude strongly that moral certitude that fetuses do not feel pain presently cannot be reached. In other words, fetal pain experience is a reasonable conclusion from the settled evidence. This evidence includes an appeal to fetal anatomical, neurochemical, physiological, and behavioral features, as well as responses to noxious stimuli (behaviors such as facial grimacing, the withdrawing of limbs, clenching of fists, opening of mouth and even crying).

Although we are not warranted in moving from these features and responses to a certain conclusion that fetuses do experience pain—I realize that fetal consciousness is a central factor in the equation—we are justified in concluding from the evidence—in fact, we are rationally required to conclude—that moral certitude does not exist that fetuses do not feel pain.

Unless and until contrary evidence is presented, we have a duty to act with the presumption that they do. In a territory such as our own where abortion is legal, we have a duty: 1) to inform women considering second- and third-trimester abortions that their actions may cause their babies pain; and 2) to guarantee that suitable analgesics and anesthesia be administered to fetuses during second- and third-trimester abortions.


E. Christian Brugger is Associate Professor of Moral Theology at Saint John Vianney Theological Seminary in Denver, Colorado. This paper is adopted from remarks given at the conference “Open Hearts, Open Minds and Fair-Minded Words,” held at Princeton University October 15^th-16^th, 2010.

Copyright 2010 the Witherspoon Institute. All rights reserved.

The last time I had the opportunity of discoursing on today’s topic was at the American Political Science Association, in 2000, in a debate with the Rawlsian political philosopher Jeffrey Reiman. Reiman is a liberal, but he too, like Peter Singer, doesn’t believe in human equality. Peter must speak for himself, but in his publications around 2000 he agrees, I think, with Reiman that birth has little or no real moral significance. Reiman’s position is clear enough: the baby has no more rights, is no more entitled to respect, in the minutes or hours or days, or weeks, after birth than in the minutes or hours or days, or weeks, before birth. So far he and Peter agree. But then they split; for Reiman the child doesn’t acquire the equal moral status of having rights of its own for several years, when it has started to “consciously care about the continuation of its life”—whereas for Peter the moral status of equality and right to life is to be affirmed (I’m not sure why) a month after birth. (In the debate following this presentation, Singer made clear that his “one month” proposal dates back to 1984 and was intended just as a pragmatic legislative line, and that his basic and present view approximates to Reiman’s.)

So, on Reiman’s view (and I suppose Peter’s), if there is to be a law against infanticide from birth, it certainly doesn’t rest on the moral rights, or moral status, of the young infant—it has none—but only on the feelings and dispositions of adults. And Reiman is keen to add this: since the unborn child, like the born child for quite a while, has no right to life, the mother’s right to an abortion is not a right simply to be relieved of the presence of what is growing in her body, but a right to ensure that it is killed, whether or not it was delivered or expelled alive.

All parts of this view are rejected by our law, and, I want to say, by our civilization. In 2002 both houses of Congress unanimously passed the Born Alive Infants Protection Act, with the stated objective: “to repudiate the flawed notion that the right to an abortion means the right to a dead baby, regardless of where the killing takes place.” This was in response to the Farmer decision of the Court of Appeals of the Third Circuit in 2000 which seemed to mean that even a fully delivered baby could be lawfully killed if the reason for its delivery was abortion. At that time the Supreme Court had declared that if the baby is two-thirds outside and one-third inside, its mother has the right to employ someone to kill it. The doctor who developed this procedure, Martin Haskell, testified to Congress that in his standard version of the procedure (outlawed in 30 states but upheld by the Supreme Court) it would be possible to deliver the baby fully, in perfect health and without injury, if one treated the woman with dilating drugs for longer, but one doesn’t do that, because “the point here is you’re attempting to do an abortion … [The point is not] to see how do I manipulate the situation so that I get a live birth instead.”

Haskell was doing this skull-emptying of a living healthy baby almost fully delivered from a physically healthy mother at 22, 23, 24, 25 or 26 weeks of gestation or pregnancy. My pediatrician daughter treats premature babies of some of these ages. While there can be agonizing problems about the futility or medical benefit of treatment,  no one involved in her practice—mothers, nurses, doctors—has the slightest doubt about the nature of the baby as a human person or, consequently, about its moral status as a bearer of interests and rights, unconscious though it often is for days or weeks. So there are babies born, babies half-born, and babies soon to be born. Since 1973, U.S. constitutional law allows abortion virtually completely freely for a further 11-15 weeks beyond the stage I have just been mentioning.

The first time I debated the rights and wrongs of abortion (which I’m not here to do today, as I am to limit my remarks to the “moral status” of the “fetus”) was in print with Judith Jarvis Thomson, author of the justly famous article about the kidnapped violinist, the first philosophical article to articulate a woman’s right to an abortion, an article whose thesis about the significance of the intimate intertwinement of the mother and the unborn child has been elaborated and extended by Margaret Little. Of course, this was 1971, so Thomson, while most strenuously arguing for this moral right, denied that it includes a right to get the baby dead. (Since then, hearts have hardened.) She had this to say about our topic this afternoon:

I am inclined to think also that we shall probably have to agree that the fetus has already become a human person well before birth. Indeed it comes as a surprise when one first learns how early in its life it begins to acquire human characteristics. By the tenth week, for example, it already has a face, arms and legs, fingers and toes; it has internal organs and brain activity is detectable.

That was 1971 and since then ultrasound makes all this much less surprising. And once Roe v. Wade and even more importantly Doe v. Bolton came along in January 1973, people became more resolute than Judith Jarvis Thomson in denying that what they could see is a human baby, is a human person, or has moral status.

All sorts of stages have been proposed for “becoming a person” or “acquiring moral status”: implantation, development of the primitive streak, brain life, sentience, quickening, viability outside the womb, actual birth, actual birth unless it was an induced abortion, formation of desires, formation of concepts, formation of self-consciousness, valuing your own existence—but these all cancel each other out, and anyway, with the talk of the threshold being desires, or self-consciousness, or conscious concern to stay alive, we are now deep, deep into infanticide territory with Peter Singer and Jeffrey Reiman. These are positions that willy-nilly are incompatible with non-arbitrarily affirming the personhood of adults who are in even temporary unconsciousness. And what is wrong in principle with their positions is that they deny human equality, elevating various subrational animals of their choice above healthy young babies weeks, months, and years after birth, and above the deeply disabled mentally or physically.

The thing about moral status is, if you believe in morality at all, that it is not a matter of choice or grant or convention, but of recognition. If you hear anyone talk about conferring or granting moral status, you know they are deeply confused about what morality and moral status are. The very idea of human rights and status is of someone who matters whether we like it or not, and even when no one is thinking about them; and matters, whether we like it or not, as at bottom an equal, because like us in nature as a substantial kind of being.

This mattering is the immediate basis for respect, including self-respect, and for guilt or remorse when one betrays another. It goes with the territory we call meaning, which transcends times and places, and forces us to speak about mind or spirit, and freedom of choice. If we are thinking alertly to the realities of the realm of sharable interiority, we know what it is to be a developed and conscious person: a being who finds himself or herself to have a rational nature, capacities that combine intelligibility with intelligence. A nature to be recognized and acknowledged, not conferred.

If one asks oneself about one’s own personal origins, one can go back to one’s earliest memories, and then to the earliest photographs, earlier than one’s surviving memories but showing one as a center of personal life; and then to the life before birth that was scarcely or not at all conscious, but is recorded perhaps in those ultrasound photos which show you as you, a white male thumb-sucker, or a vigorous female Chinese thrower of punches, or whatever. Now we are only a couple of months from our conception. But it is certain that we began before.

Unless we are one of the 1% who are identical twins, we began as Louise Brown the first IVF baby began in the discriminating care of Professor Robert Edwards who got the Nobel Prize for it last week: “She was beautiful then” he said at her birth, showing a photo of her at one cell, “and she’s beautiful now.” Edwards gives a lucid account of the dynamic self-directing unity of the embryonic being who even at one cell smaller than a pin-head has scores of millions of molecular components all organized, then and there, to make him or her, well, him, or her, and brown, yellow, black or white, and clever or not so clever, and clumsy or not so clumsy, and much else, by nature.

The key concept here is radical capacity. The early human embryo has the radical capacity to think and laugh and pun; all it (he or she) needs is time and nourishment, no more: the actual and active second-order or radical capacity, written into its molecular and cellular constitution, to develop first-order, promptly usable capacities such as to learn a language here and now.

In the discussion, I put to Singer the following hypothesis, which I owe to Patrick Lee. Suppose that on my return home I am diagnosed with a rare and lethal brain tumor which can be cured only by excision of a part of my brain such that all my memories of life, people, languages, etc. before the operation will be irreversibly expunged, though I will retain the capacity, after nine months of unconsciousness following the operation, to rebuild a new stock of memories, language, skills, affections, etc. Right after this operation, would not my “moral status” or, more relevantly, my reality as a person, be essentially that of the newborn baby and indeed of the early embryo? (Unfortunately, Singer was never called upon to answer my question.) The chairman of the panel, Prof. Arthur Caplan intervened to say that I would not be me (JMF). But of course I denied that completely; I would be JMF before, during, and after the operation, someone who suffered grievous loss in and as a result of the operation, but retained like the embryo and newborn baby the radical capacity for continued life as the one and only person I already am.

But I wasn’t asked to discuss the moral status of the embryo, but of the fetus. You ceased to be conventionally called an embryo 56 days into your life and became in medical parlance—but it’s just a conventional boundary—a fetus, which you remain, for purposes of discourse between doctors: a fetus until delivered. But of course, a website describing ultrasound for expectant mothers doesn’t talk about her fetus but her baby, and so do her doctors unless they’re her abortionists or think she has been or is interested in abortion. So there’s the topic of the moral status of the fetus, and there’s the topic of the moral status of the phrase “the fetus.”

About the moral status of the fetus, it’s clear, I suggest, beyond doubt, after forty years of intense philosophical discussion, that there’s no credible halfway house between, on the one hand, acknowledging that whether we like it or not the fetus—indeed the embryonic baby from the outset—has the same radical equality of nature that we all have despite myriad differences, and on the other hand joining Peter and Jeffrey in denying two things: (1) denying that the primary question is one of fact—shared nature as beings all having or capable of developing (given only food and protection) rational characteristics and activities, and (2) denying equality or ethical or moral entitlement to rights such as life until some time after birth (and here I think Reiman’s position will prove more stably defensible than Peter’s in making that years after birth; but of course neither of them can limit their denial of human equality to conditions of infancy; the denial extends to various sorts of disablement and decay). And each of them goes wrong from the outset in making “moral status” the fundamental predicate in the discussion, instead of predicates of the form “person,” “rational nature,” “kind of being.”

About the moral status of the phrase “the fetus,” I will just say this. As used in the conference program and website, which are not medical contexts, it is offensive, dehumanizing, prejudicial, manipulative. Used in this context, exclusively and in preference to the alternatives, it is an F-word, to go with the J-word, and other such words we know of, which have or had an acceptable meaning in a proper context but became in wider use the symbol of subjection to the prejudices and preferences of the more powerful. It’s not a fair word, and it does not suggest an open heart. Those of you who have an open mind or a fair heart may wish to listen to every speaker at this conference, and see whether they are willing to speak, at least sometimes, of the unborn child or unborn baby, and to do so without scare quotes or irony.

For about 12 weeks after viability some of these little beings are on the outside being tended by the pediatrician and everyone as babies, and some of them are on the inside still intertwined with their mothers, and being cared for, in some cases, by gynecologists who recognize they have two patients, and in some cases, as the mother decides (in America, or the party official in China) being threatened with destruction by her (or the state’s) abortionist as a mere fetus. However extensive the rights in all fairness of the mother, and they are extensive, they are no basis at all for denying to the child she’s bearing during those twelve weeks its proper human name, her baby or child—what an important article of Margaret Little’s calls at one point “being connected to the child in one’s belly.” So, I suggest, listen; this is a litmus test, in words, of this conference’s motto.

Postscript:

Peter Singer has written to me to say that his position is, and has always been, that the question when someone is dead is one of fact, not an ethical issue.  “I have never believed that when a being is dead is an ethical question.  Why would I, given, that, as you know, I think it is sometimes ethically acceptable to kill innocent human beings?”

I am happy to accept that this is his view, and accordingly to withdraw my parenthetical remark “(and I’m sure still wants)”.

But although neither he nor I can lay hands at present on his 1998 Oxford paper, the 1999 version of it which he has dug out amply confirms, in my opinion (though not his), that in 1998/9 he was arguing, against Grisez and Boyle and Pius XII, that establishing the time of death with more precision than the vague traditional concept of death allowed must be an ethical, not a factual issue.  He persisted in that position in 1999, despite my firm and prominent critique of it in Oxford in 1998, and in my opinion he is still in some confusion about it.


John Finnis is Professor of Law and Legal Philosophy in the University of Oxford and the Biolchini Family Professor of Law at the University of Notre Dame. This piece is adapted from his remarks delivered at the conference “Open Hearts, Open Minds, and Fair-Minded Words,” held on the campus of Princeton University on October 15^th and 16^th, 2010.

Copyright 2010 the Witherspoon Institute. All rights reserved.

But a better strategy might be to accept the liberal definition of pregnancy, but reject the conclusions that purportedly follow from it. On three issues—contraception, abortion, and embryo-adoption—I’ll argue that the liberal definition of pregnancy can actually help clarify what sound morality demands.

There are, after all, plausible reasons to think the liberal definition sound. Pregnancy signifies a relationship between the developing human being and his or her mother, but that relationship is not simply the relationship of being the mother of an embryonic child. Mothers of embryos conceived through in-vitro fertilization (IVF), for example, are not pregnant while their children are in Petri dishes. Nor does it seem to be enough simply for an embryo to exist within some part of a woman for the woman to be pregnant. We are inclined to think that in pregnancy the embryo or fetus is connected to the mother in a special way. So, plausibly, a mother becomes pregnant, as liberals think, at the time that the embryo implants in the mother’s womb. At that time, in addition to being a mother of a child, the woman also stands in a uniquely intimate biological relationship of nurturing and sustenance to the developing child, a relationship it makes sense to call “pregnancy.”

But why do liberal proponents of this definition think that it has consequences for understanding the difference between contraception and abortion? The answer, it seems, lies primarily in their misunderstanding of the nature of contraception. For contraception is not a practice whose purpose is the prevention of pregnancy, but a practice whose purpose is the prevention of the conception of a new human being. Consider: someone who prevents an embryonic human being from being implanted in a woman after IVF is not reasonably thought to be contracepting. Someone contracepts only if they intend to prevent a human being from coming into existence—they act contra-conception.

So the questions surrounding whether the so-called “week-after pill” Ella—or the contraceptive pill, or an IUD—operates only as a contraceptive really has very little to do with pregnancy. The real question is whether they work exclusively by preventing possible human beings from coming into existence, or whether they ever work by making it impossible for already existing human beings to continue to exist. If they do the latter, they are not exclusively contraceptive.

What about abortion: is it not a disruption of pregnancy? Interfering with the life of a not yet implanted embryo usually takes the life of that embryo, yet it does not, if we accept the liberal definition of pregnancy, terminate a pregnancy. Does this make it difficult to say that drugs or devices that take the life of a pre-implantation embryo are abortifacient?  One approach to the question of what abortion is might say yes.

This approach identifies abortion, or direct abortion, precisely as the intentional ending of pregnancy. But even apart from the question of how pregnancy is to be defined, this is a bad definition of abortion. Ending a pregnancy seems neither necessary nor sufficient for a procedure to be an abortion. Not necessary, because an embryo or fetus could be removed from the mother, thus ending the pregnancy, precisely to save the child’s life, if, for example, the mother was incapable of sustaining the child in the womb. Not sufficient because an embryo or fetus could be aborted without the mother’s pregnancy ending. This, sadly, is what happens when mothers undergo “selective reduction” of embryos when they are carrying multiple children. These mothers abort, but remain pregnant.

It seems more plausible to think that abortion causes the death of an unborn child, and that a “direct” abortion is an intentional killing of the unborn child. Not only does such a definition avoid the problem cases just mentioned, it draws attention to what is wrong with abortion in a way that the “ending of a pregnancy” definition does not. For while ending a pregnancy is, just as such, a serious matter—under most circumstances, mothers surely owe it to their unborn children to provide them with a uterine home until birth—the wrong of direct abortion is, more specifically, the wrong of intentionally killing one’s unborn child, not the wrong of expelling it from the womb.

Moreover, the distinction allows one to acknowledge that there might be cases in which only the ending of pregnancy was intended, and not the death of the child. Would this justify ending a pregnancy if the intention was not to kill? In almost every imaginable case, no: For to accept the death of one’s own child as a side effect of ending one’s pregnancy is unjust in every circumstance except when otherwise both the mother and child will certainly die. So while direct abortions are always wrong on this account, indirect abortions—the kind that are a result of ending pregnancy—are also wrong in the overwhelming majority of cases. Moreover, it would seem reasonable to adopt, as a convention, the practice of referring to all procedures that take the life of an unborn human being, whether intentionally, or indirectly but unjustly, simply as “abortions”: it would then be fair to say that all abortions are morally impermissible.

And yet, some problem cases will, arguably, be settled in a different way. Consider the use of methotrexate when used to address a tubal ectopic pregnancy (methotrexate is also used for “elective” abortions). Given where the embryo has implanted, if nothing is done both mother and child could die. Methotrexate works by inhibiting the growth of the trophoblastic tissue that connects child to mother. It also inevitably results in the death of the embryo. Its use seems to fall into the category of “intentionally ending pregnancy,” yet not into the category of “intentionally killing an unborn child.” Thus, if a mother’s life is truly at risk, and there is no possible way to save the child, then deliberately ending a tubal pregnancy by use of methotrexate might not be an instance of “direct abortion,” i.e., not an instance of intentional killing of an unborn child, and might, in fact, be an instance of rightly accepting death as a side effect. But this possibility is likely to be overlooked if abortion is equated with the intentional ending of a pregnancy.

Consider a third case: the question of embryo adoption and rescue, a vexed issue among many conservative bioethicists. Sound moralists acknowledge that one should never separate the unitive and the procreative aspects of the marital act; in other words, marital sexual acts should be open to new life; and new life should not be created outside the performance of marital sexual acts. But neither, the philosopher Mary Geach has argued, should the marital act be imitated in respect to either function. And so the question arises whether, when a woman becomes pregnant through the implanting the biological child of another, the allowing of the embryo into her womb imitates a function specific to the marital act, for, in Geach’s words, in both the marital act, and in embryo transfer, the woman performs an act “an act of admission whereby she allows an intromission of impregnating kind.”

Several philosophers have argued, however, that it is the generative significance of conjugal intercourse—the capacity of sexual union to result in a new human being—that is essential to its unitive significance—the capacity of the marital act to make the spouses “one flesh.” It is not, in other words, the “capacity to make pregnant” that makes man and woman one flesh but rather the capacity to generate new life.

In consequence, the transfer of a human embryo to the womb of a woman who is not that child’s biological mother, whether to rescue the child from the absurd fate of cryo-preservation, or as the first step of a process of adoption, does not imitate the marital act in respect of any of its proper functions. The liberal definition of pregnancy helps us see this because it makes clear that generating a child, and being pregnant with a child, are two different realities.

Yet accepting this definition does not result, I have shown, in the false claim that a process that prevents implantation of an embryo is thereby “merely” contraceptive. And this definition can help us see that there are some procedures which end a pregnancy but are not acts which intentionally take the life of an unborn child. Acts of the latter sort are intrinsically wrong and always morally impermissible, but some acts of the former sort may be morally permissible when otherwise both the mother and child will certainly die.


Editor’s note: The original version of this essay incorrectly stated the views of Mary Geach. We apologize for the error.


Christopher O. Tollefsen is Professor of Philosophy at the University of South Carolina and a senior fellow of the Witherspoon Institute. His latest book, co-authored with Robert P. George, is Embryo: A Defense of Human Life (Doubleday, 2008). Tollefsen sits on the editorial board of Public Discourse.

Copyright 2010 the Witherspoon Institute. All rights reserved.