For a field of such public academic prominence, bioethics has a bad reputation. As Luke Gormally (former director of the British-based Linacre Centre for Healthcare Ethics) once put it, “bioethics is something of a philosophical slum, overcrowded with utilitarian philosophers seeking refuge from the intractable foundational problems that arise from the utilitarian undertaking to reconstruct morality.” Prominent University of Chicago law professor Brian Leiter summed it up by saying that bioethics “has a fairly dim reputation in academic philosophy.”
Such harsh generalizations might be difficult to defend in every particular, but they capture a widespread view. A charitable take would be that the clinical demands of bioethics—training students for work on difficult cases, journal articles offering solutions to issues of the day—leave little room for more and better philosophical work in bioethics. Or, as Gormally’s comment suggests, the rapid rise of bioethics in the latter half of the twentieth century meant that foundational questions in ethics that occupied moral philosophers were often brushed aside. That left the field to unexamined, rough and ready applications of utilitarianism (and proportionalism in theological ethics) or Kantianism, although there have certainly been some exceptional book-length contributions to the field over the past decade—J. David Velleman’s 2015 Beyond Price and Jeffrey Bishop’s 2011 The Anticipatory Corpse come to mind. But even the dominant approach in bioethics that purports to articulate and defend a consistent method for the field through application of a set of principles—appropriately named “principlism” and famously associated with the work of Thomas Beauchamp and James Childress—has been subject to widespread criticism.
Set against this backdrop, O. Carter Snead’s What It Means to Be Human: The Case for the Body in Public Bioethics is a momentous achievement, an agenda-setting work offering a philosophically rich argument moving between important moral concepts and applied issues in bioethics. It is also a rare book from an academic press that is accessible to a general audience as well as to specialists in the field.
Snead’s book has three major components, each executed at a high level and written in a bracing prose style: a historical overview of public bioethics, a diagnosis and critique of the underlying philosophical view in the American law of bioethics, and three “applied” chapters on abortion, assisted reproduction, and end-of-life care.
First, Snead outlines the rise of “public bioethics” from the 1960s and 1970s to the present. In Snead’s engaging recounting of the historical background, public bioethics began with a series of shocking revelations about abuses in research done on human subjects, including the Tuskegee syphilis experiments and the vivisection of aborted fetuses. In reaction to these abuses, hearings, reports, commissions, and legislation ensued to regulate bioethics research and prevent unconsented-to research.
(As an aside, it is interesting to note that the morally responsible position raising concerns about abuses in research began with the efforts of liberal Democratic Senators Edward Kennedy and Walter Mondale, hearkening back to a bygone era when Congress could legislate effectively on controversial matters across ideological divides.)
The philosophical and legal framework for the book is spelled out in Chapter Two. Snead argues, as he puts it, “inductively” from the state of American law on bioethics issues to show that the implicit view of human nature or anthropology throughout is “expressive individualism,” a phrase that came to prominence in Robert Bellah’s Habits of the Heart. Snead characterizes individualism thus: “The premise that the fundamental unit of human reality is the individual person, considered as separate and distinct from the manner in which he is or is not embedded in a web of social relations. Persons are identified with and defined by the exercise of their will—their capacity for choosing in accordance with their wants and desires.” Expressive individualism “holds that individuals thrive insofar as they are able to freely create and pursue the unique projects and future-directed plans that reflect their deeply held values and self-understanding. These projects and purposes emerge from within the self; neither nature, natural givens, nor even the species-specific endowments and limits of the human body dictate the ends of individual flourishing.”
As Snead carefully shows, however, expressive individualism fails to account for human life as it truly is—embodied, relational, dependent, and social. As an alternative to expressive individualism, Snead posits an anthropology of embodiment, marked by themes of remembering, acknowledged dependence, gratitude, openness to the unbidden, solidarity, dignity, and friendship. These pages of the book are too rich and suggestive to do justice in a brief survey, but it is here that one will either be (as I am) persuaded by the diagnosis of the shortcomings of expressive individualism and the power of the alternative of embodiment, or will reject them.
But what Snead’s argument suggests is that the stale and interminable arguments in public bioethics can only be addressed by working through the anthropological or metaphysical questions posed in this book. Every participant in bioethics debates comes with his or her own set of views; Snead is both more thorough than most contributions in so carefully laying out his own, and more perceptive about how expressive individualism and its central themes of unfettered autonomy and freedom compose the default view for almost everyone in the field.
Much of the book’s argument against expressive individualism and for embodiment draws on such figures as Charles Taylor, Alasdair MacIntyre, and Michael Sandel. Indeed, in some respects Snead’s argument echoes the famous opening chapters of MacIntyre’s After Virtue by showing that notwithstanding a seemingly vibrant field of public bioethics—academic centers, think tanks, bioethics commissions, journals, and newspaper op-eds—the field is beset by deep and enduring disagreements over first principles. This becomes clear in the next three chapters of the book, which take up in turn abortion, assisted reproduction, and end-of-life issues. For each, the law’s implicit commitment to expressive individualism frequently privileges an unencumbered “freedom”—to have an abortion, to create new human beings, or to take one’s own life through assisted suicide. Interestingly, on the last of these issues a recognition of our dependence and concerns about the disabled have caused the American law of bioethics to move more slowly, as both our constitutional law and the law of many states reject a wholesale right to physician-assisted suicide—for now.
These chapters summarize the state of both legal and philosophical arguments about the selected issues, arguments that will be familiar both to those in the field and to the general reader. It is a credit to Snead’s treatment of these issues that although his own pro-life commitments are never hidden, he is scrupulously fair in his account of arguments on different sides. And while the literature on these topics, particularly abortion, is well worn—Judith Jarvis Thomson’s famous article with the thought experiment about a kidnapped violinist and the morality of abortion is fifty years old—by bringing the perspective of the competing anthropological visions of expressive individualism and embodiment to bear on them, one comes to see neglected aspects of these debates.
In addition to these new perspectives on abortion, assisted reproduction, and end-of-life issues brought by the anthropology of embodiment, perhaps the greatest strength of the book is its extensive engagement with the thought of Charles Taylor and Alasdair MacIntyre throughout the argument about the shortcomings of expressive individualism. Both are, of course, among the most prominent living philosophers in the world and have made major contributions to the Catholic philosophical tradition. And while other books (notably Jason Blakely’s 2016 book Alasdair MacIntyre, Charles Taylor, and the Demise of Naturalism: Reunifying Political Theory and Social Science) have attempted to spell out the significance of Taylor’s and MacIntyre’s work across various disciplines, bringing their thought to bear on topics in so-called “applied” ethics has often been a difficult task. This is, one suspects, both because their work is so extensive and occasionally elusive (Taylor’s Sources of the Self and A Secular Age are famously digressive) and because so much of the work in contemporary applied ethics rests, as MacIntyre himself suggested in a 1984 article, on a mistake.
It is no discredit to Snead’s accomplishment in this book that many of the hardest questions posed by the book are left unresolved, and here I wish to highlight those at the level of culture and politics. Culturally, it is not just that expressive individualism has a grip on the law of American public bioethics—it has a hold on the culture more generally and pervasively. As Taylor notes in A Secular Age, expressive individualism is more than just an idea—it forms, in Taylor’s phrase, a “social imaginary” that “is something broader and deeper than the intellectual schemes people may entertain when they think about social reality in a disengaged mode.”
Overcoming the social imaginary of expressive individualism and its implications for thinking through problems in public bioethics (and a host of other topics as well) is not merely a matter of having better ideas about human nature, but of displacing an understanding that permeates our culture. Expressive individualism is also, as Taylor argues, bound up with modern notions of authenticity, which explains why, for all of the shortcomings ably pointed out by Snead, it retains a powerful attraction. Overcoming that beguiling attraction is the work of building a culture that fosters the virtues of an anthropology of embodiment.
And since Snead’s target is public bioethics—that is, the regulation of the three issues of abortion, assisted reproduction, and end-of-life care as a matter of public policy and regulation—this all has profound implications for politics. Snead is persuasive in showing that expressive individualism forms the default anthropological understanding for bioethics today, but he quite appropriately notes at the conclusion of each of the chapters that there is much room for debate about what precisely the right policy solution would be to each. Much work remains to be done with regard to court decisions, legislation, and regulations to move the American law of bioethics away from an anthropology of expressive individualism toward one of embodiment. Altering cultural and political trajectories is no easy task, but we can be grateful that Snead’s trenchant discussion in this book shows the way.