Culture of Death. Wesley J. Smith
means that they possess a particular quality that grounds certain obligations and rights.”58
Despite understanding the stakes, Cochrane took the familiar bioethics line, calling for an “undignified bioethics” that views humanhood per se as morally irrelevant and arguing that the ways we treat our fellow humans should depend on each individual’s perceived “moral status”—such as personhood. “Simply stipulating that all and only human beings possess this inherent moral worth because they have dignity is arbitrary and unhelpful,” he wrote.59 Hardly arbitrary, given the stakes and the deep traditions behind this view. Unhelpful, perhaps—it impedes using vulnerable humans as lab rats, prevents raising fetuses for harvest, and argues against other utilitarian horrors—real and proposed—that are the subject of this book.
Not all bioethicists are as candid as Fletcher, Singer, Harris, Beauchamp, and Cochrane. The late Ronald Dworkin, an influential law professor and author whose effect on the Montana Supreme Court I mentioned earlier, argued in his book Life’s Dominion that killing the weak and helpless can actually be a method of upholding the inherent value of human life.60 Dworkin claimed that the argument between those who support abortion or euthanasia and those who oppose these practices isn’t even an argument about whether the sanctity of life is a sound principle. Everyone agrees that it is, he claims: “We disagree so deeply because we all take so seriously a value that unites us as human beings—the sanctity or inviolability of every stage of every human life. Our sharp divisions signal the complexity of the value and markedly different ways that different cultures, different groups, and different people, equally committed to it, interpret its meaning.”61
Yet, in Dworkin’s hands, the meaning of the “sanctity of life” is left to each person to determine individually. Thus, Dworkin says, having an abortion is not denying life’s sanctity to the human fetus but upholding life’s sanctity for the woman who doesn’t want a baby. “It may be more frustrating to life’s miracle when an adult’s ambitions, talents, training and expectations are wasted because of an unforeseen or unwanted pregnancy than when a fetus dies before any significant investment of that kind has been made.”62 Regardless of where one stands in the great pro-life/pro-choice cultural divide, to assert that having an abortion is somehow to embrace “the inviolability of every stage of every human life,” as Dworkin does, is simply ludicrous.
Dworkin similarly asserts that euthanasia isn’t actually a rejection of the sanctity of life but an embracing of it: “People who want an early, peaceful death for themselves are not rejecting or denigrating the sanctity of life. On the contrary, they believe that a quicker death shows more respect for life than a protracted one.” Active killing of people promoted, without a hint of irony, as an embrace of life’s sanctity is to suck all meaning from language. For Dworkin, the “sanctity of life” is not a principle but a mere contingency, defined essentially by where a person stands in his or her life at any given moment. Such a porous concept is incapable of protecting the weak and vulnerable from medical discrimination or killing, and that—as with the distinction between human beings based on personhood criteria—is exactly the point.
Dworkin repeatedly confused feelings with morality, arguing that since the deaths of some people cause more grief and sense of tragedy than do the deaths of other people, it is somehow justifiable to view the inviolability of individual human lives in relative terms: “Most people’s sense of that [death-caused] tragedy, if it were rendered as a graph relating the degree of tragedy to the age at which death occurs, would slope upward from birth to some point in late childhood or early adolescence, then follow a flat line until at least very early middle age, and then slope down again toward extreme old age. . . . [Thus] The death of an adolescent girl is worse than the death of an infant girl because the adolescent’s death frustrates the investments she and others have made in her life.”63
Determining the value of life with such an emotional yardstick is a quixotic enterprise. One could just as easily argue that the newborn’s life is more valuable because it is all potential—a blank slate—while the adolescent has already acquired a character and experiences that limit her range. Such opinions are at best an underwriter’s version of morality and not worth the time it takes to make them.
EUTHANIZING HIPPOCRATES
“To regard life as sacred,” Leon Kass wrote, “means that it should not be violated, opposed, or destroyed, and that positively, it should be protected, defended and preserved.”64 These precepts are especially important in medicine, considering the power accorded physicians to cut, drug, and manipulate the bodies of their patients. Meilaender summarized the obligation as a positive obligation of physicians to “be committed to the bodily life of their patients.”65 A robust belief in the equality/sanctity of human life takes these prescriptions one step further by positing the obligation of physicians to view each of their patients as having equal moral worth. Thus physicians are not free to pick and choose among the patients to whom they will give optimal care. All patients are owed the same level of dedication, excellence, loyalty, and fidelity, regardless of their physical or cognitive condition.
These worthy concepts are famously embodied in the Hippocratic tradition. Indeed, medicine may actually have been the first field in which the underlying principles of the equality of life ethic were recognized as applying generally rather than parochially. The Oath, bearing the name of Hippocrates (approximately 470–360 BCE) was created hundreds of years before the advent of Christianity. It required physicians to “apply dietetic measures for the benefit of the sick according to my ability and judgment,” to “keep them from harm and injustice,” foreswear abortion, and “give no deadly medicine to any one if asked, nor will I make a suggestion to this effect.” The Oath taker promised, “Whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of all sexual relations with both female and male persons, be they free or slaves.” Physicians further pledged to keep patient confidences, holding what the doctor sees or hears “in the course of treatment” to be “shameful to be spoken about.”66 These life- and dignity-affirming doctrines of the Oath are generally summarized by a familiar summarizing phrase: “do no harm” (the exact phrase is not found in the great document itself, although it is discussed in Hippocratic literature). These principles were and are upheld by physicians in myriad ways: by rendering optimal care to each patient; promoting bodily healing; alleviating pain and suffering; respecting patient dignity; refusing to disclose patient confidences, even in a court of law; and refusing to kill patients.
As we move further into the twenty-first century, the Hippocratic tradition is ailing and in acute danger of collapse. “It was when bioethics came on the scene that the Hippocratic tradition of the physician/patient relationship started to fall apart,” philosopher Dianne N. Irving, PhD, a longtime critic of bioethics, told me. “Once it was weakened, bioethics began to replace it with medicine practiced for the greater good of the society rather than the individual patient. That threatens patient welfare and denigrates medicine into a business rather than a profession.”67 Irving’s criticisms find support among many mainstream bioethicists who celebrate their calling as “post professional.”68
A recent study of physician oath taking published in the Journal of Clinical Ethics69 illustrated how far modern medicine has strayed from the traditional values of the Hippocratic Oath. The authors analyzed contemporary medical oaths and compared them to the Hippocratic original. Considering Roe v. Wade, it is not surprising that 8 percent of doctors pledged to forswear abortion, but only 14 percent promised not to commit euthanasia (active killing by doctors). In 1977, only 31 percent of oaths required the taker to “respect life,” and only 43 percent of present-day oaths require physicians to be “accountable to their profession.” There has also been a stunning “nearly complete” disappearance of the proscription against sexual relations between physicians and patients, a key factor in professionalism, since it is a matter “of character and justice . . . and not taking advantage of vulnerable patients.”70
Many of the most prominent doctors and bioethicists could care less. Thus the late author and physician Sherwin Nuland of Yale University School of Medicine wrote