“Toward a Bioethics of Love”
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With JL, let me heartily recommend my friend Helen Rittelmeyer’s initial sketch of a bioethics that “sees love, not autonomy, as the basis of human dignity”. It’s a challenging read, but well worth the work. Perhaps due to what I’ve been blogging about of late, this paragraph was probably my favorite:
There is a strong temptation to say, very simply, that these sorts of decisions are family affairs and none of the public’s business. However, the answer is not as simple as recognizing a family’s right to privacy, as the case of elective abortion makes clear. The decision to carry a disabled child to term means something very different depending on how ordinary or extraordinary the decision is. The public’s attitude towards children with Down Syndrome is not the same when 15 percent of women choose to abort such children as when 90 percent do. (The exact figure in the United States is 91 percent.) If elective abortion continues to be the overwhelming norm, the child’s disability will come to be seen as something the mother brought upon herself rather than as something she simply accepted. The assumption will be that no normal woman would have borne the child since, after all, normal women don’t. This same shift—from seeing disability as a family’s fate to seeing it as a self-inflicted burden—will naturally follow if more quadriplegics follow the example of Daniel James, the British rugby player who ended his life at the Swiss clinic Dignitas after an injury left him paralyzed. (Dignitas has ended the lives of more than a hundred Britons since it opened ten years ago, and, in that time, not a single spouse, relative, or friend has been prosecuted for the legal crime of assisting them.) The difference between ordinary and extraordinary measures is an important moral one; it determines the moral—and therefore legal—expectations we have of our neighbors and ourselves. These private decisions have public consequences.
Read the whole thing.
Filed under: abortion, conservatism, morality
Individual autonomy is a strong component of the American character, reflected both in our myths (cowboys, immigrants) and in our Constitution, esp. the 5 and 14th amendments.
What I find astonishing about certain kinds of social conservatism is the whiplash-inducing changes in the role of the state.
“These private decisions have public consequences,” writes Ms. Rittelmeyer, regarding assisted suicide and abortions following DS diagnoses.
Therefore?
That question is unanswered. But the author later states that by resenting self-discipline our society will become painless and pointless.
Well, since that’s unacceptable, something need to be done! But what? What should the state do? The better question is why nominal conservatives want the state to play any role at all.
Also, the concept of autonomy does not get fairly addressed in the piece, especially in the examples of assisted suicide and juvenile deafness.
When a person is denied the opportunity to assist in a suicide, the state is depriving two competent adults of their autonomy — the person seeking death and the person offering assistance. The beneficiaries of that decision are unclear; they appear to be an amorphous group of largely devoutly religious people who believe that the decision belongs to a god along with people, like the author, interested in disability issues who believe that the choice of suicide harms those who want to live with that condition.
“We love you so you can’t be allowed to have help killing yourself” is a pretty thin thread on which to hang the argument for state intrusion into the issue of suicide.
As regards the issue of cochlear implants, forcing a person to wait until he’s 18 to have the right to decide for himself whether he wants to participate in the community of the hearing is a life-changing decision. We wouldn’t allow a blind family to actively blind a normally sighted infant. Nor do we permit female genital mutilation on a child. Yet in both those cases, “without it, the child would grow up a stranger in his own family.” Is active vs. passive a strong enough basis to make this distinction?
Put simply, across America we deprive parents of their rights to limit their own children’s autonomy all the time. And the reason that we do it is that over the years, as these kids hit adulthood they went to their legislatures and asked a simple question: “How could you let my parents do that to me? Where was my right as a juvenile citizen to have the chance to live a normal life?”
(see, eg, Ireland.)
Sacrifice, we are told, is a good thing. But too much of the post is about the author deciding what sacrifices other people should make, so that she feels better about her relationship with her sister.
If sacrifice is so important, she should be willing to sacrifice her own desire to be seen as a hero, and let everyone else have the life that they want.
My goodness, where did the essay-length comments start coming from?
In the first place, Helen’s essay is about ethics, not law; secondly, though, her claim about the likely social effects of widespread selective abortion or assisted suicide strikes me at least as, if true, articulating a rather compelling consideration in its favor.
Again, though: bioethics.
Can you relink to the article with the 91 percent statistic – I keep getting an error message.
RG: Funny – I think the link in the article is broken; I’ll let Helen know. I’ve been looking for a solid link on that statistic, but the best I can do so far is this 1995 George Will column (I know, I know), which puts the number at 80%: http://www.washingtonpost.com/wp-dyn/articles/A51671-2005Apr13.html. Statistics in the 90% range are widely reported by pro-life groups, but Helen’s link appeared to be to an academic paper – let me see what I can do to track it down.
John – thanks for the link. That was an excellent piece by Ms. Rittelmeyer. Maybe the best article on bioethics I have ever read.
Question for you: I am concerned as to how this argument for a conservative bioethics of love relates to the law. How can our laws focus on anything but autonomy? Isn’t this more of a cultural issue?
Those are great questions, Matt C. I absolutely agree that the pervasive – and insidious – influence of “rights” language on our political discourse makes a proposal like Helen’s seem unworkable: and of course the same goes for the influence of such language on our strictly ethical discourse, too. It’s worth observing, though, that in lots of cases talk of “rights” seems to masquerade as an obligatory framing for what is really a very different set of convictions; hence one could imagine, I think, a sort of “right to love” movement that slyly made the case for convictions like Helen’s. That said: the culture would have to change first, which is why essays like this one are so important.
P.S. Here’s that 91% reference, RG:
John, I am pleased to see you considering bioethics. We can test the limits or our beliefs most readily we examine the possible outcomes of our choices. I am also pleased because it gives me something to write about. :)
I disagree with the both the thrust and the tenor of Helen’s essay. Having that out of the way, an observation and a question.
First the observation – the 91% includes Anencephaly, a truly horrific malformation where there is essentially no head above the eyes and no brain much above the stem. Babies who survive birth live for hours only. I don’t know what the fraction of the total is. Aborting this fetus is entirely appropriate – there is NO expectation of a human life.
Second, the question – if the mothers the 15% suffer some negative prejudice, how do we measure the pain and suffering avoided for the other 85%? Avoided most specifically before the parents or the child had an intellectual and emotional investment in life? I know this question barks right up against the whole right to life position, but Helen posed the question, of a chosen burden.
I think it a fair question, one that provides a deep look into the effects of abortion. If we could choose to eliminate birth defects through selective abortion, should we? I think part of the answer depends upon your individual view of something else Helen said: “Defending the value of one’s own life is, of course, insultingly superfluous.” I agree, but I suspect for different reasons – we have no rights to life at all. None of us is special, though we are unique. Every single one of us could be subtracted from the history of the world, and the world would go on apace. We are not valuable except in the context of those we love, and who love us. If we had never existed, neither would those relationships.
So for me, if a parent chooses to abort a fetus with Anencephaly, that is an acceptable choice. If they decide to abort a child for any other reason, that too is an acceptable choice. We are simply potential at that stage of our life, and that potential is simply closed off, never to return. Other, equal, potentialiites may be realized.
I understand you approach the idea of a potential human from a different pov.
I don’t understand this statement of yours: “I absolutely agree that the pervasive – and insidious – influence of “rights” language on our political discourse makes a proposal like Helen’s seem unworkable:” What is insidious about “rights” language? What is it about the idea of rights with which you disagree?
Thanks for the post.
Jake
You mean aside from the fact that I don’t think they exist? Well, how about the way that conceiving of our moral and political life in such terms tends to set us off against one another like competitors, each with his or her own property and the power to defend it against others. Love and mutual respect strike me as much better foundations for human society than that.
“I think it a fair question, one that provides a deep look into the effects of abortion. If we could choose to eliminate birth defects through selective abortion, should we? I think part of the answer depends upon your individual view of something else Helen said: “Defending the value of one’s own life is, of course, insultingly superfluous.” I agree, but I suspect for different reasons – we have no rights to life at all. None of us is special, though we are unique. Every single one of us could be subtracted from the history of the world, and the world would go on apace. We are not valuable except in the context of those we love, and who love us. If we had never existed, neither would those relationships.”
Well one thing is clear Jake – you are a utilitarian. Good thing you weren’t at the Constitutional Convention.
John, in what sense do rights not exist? I don’t even know if I disagree with you – I simply don’t understand what you mean.
And, Matt, how would my view on rights have affected the Constitution? The Bill of “Rights”? I think a government can grant rights to its citizens. Are those rights inalienable? I don’t believe so.
What rights can possible be inalienable?
Jake
I think that rights are, as MacIntyre puts it, like witches and unicorns; it’s exactly in that sense that they don’t exist. But that’s beside my original point, which is that even if rights to exist they’re an unhealthy way to understand the core principles of moral and political life.
P.S. Not that I think children with anencephaly should be aborted, but I think you’re wrong about that 91% statistic, Jake. The abstract reads:
According to the full text of the paper, the termination rates for anencephaly averaged to 84%, while those for Downs averaged to 92%, spina bifida to 67%, and Turner syndrome to 71%.
John, your correction to 92% is completely correct. I stand corrected.
Although, were I a quibbler, I might say, “I never said how the % might change, just that it included Anencephaly!” but of course you read the intent of my statement correctly – I supposed that if you removed the truly horrific, the total % would go down. It did not.
Moral and political life. Are they separate from legal life? I mean legal life in the sense that the Bill of Rights grants us rights, that courts have construed those rights further to include things like Miranda, etc.
I actually base my moral beliefs on the golden rule, so I get what you mean about rights. Nobody “owes” me nuthin’, so to speak.
Now earlier, I believe you spoke of dignity when we were discussing abortion. Is dignity inalienable? Or is that too something granted?
Jake
John, I just wanted to tell you how much I appreciate your allowing me to comment here. It seems that, like FPR, Doublethink would rather I did not comment. So, like FPR, I won’t.
But it makes this place really stand out, I gotta tell ya.
If you ever come to the conclusion you can no longer tolerate my comments, please let me know. I won’t post here, either. I will continue to read.
Thanks,
Jake
I suppose I think that moral and political life are more basic than legal life, and that the law is a product of, and ultimately beholden to, morality and the health of the polis.
Yes.
Can the law operate without the concept of rights? I don’t see how.
Are there other inalienable aspects of being a human being? Or perhaps any being?
Jake
Definition time, so we are sure we speak of the same things:
Dignity – the quality or state of being worthy, honored, or esteemed
Dignity appears to be something granted, at least by definition. This being English we use here, there’s no telling what all else it means.
Perhaps worthy holds a clue.
Worthy – having worth or value.
Hmmm, not much there. Value is definitely something external. Perhaps worth will help.
Worth – archaic, meaning having monetary or material value.
Nope, no help at all.
Could you expand on dignity as something not granted?
Jake
Sure – how about operating with the concepts of “right” and “wrong”?
I’m not at all sure what this question means.
Nor do I understand your objection to the idea that dignity isn’t granted: a person (or other thing) can be worthy of, say, admiration or honor or respect even if no one recognizes that worth as such. What’s so mysterious about that?
If right and wrong are to be your gold standard, how do you determine what is right and what is wrong? If you say stealing is wrong, is that not also a statement that the owner has the “right” to keep his property?
We are back to the golden rule. I agree with you that people deserve something, respect, dignity – something, simply because they are human. But, whatever it is, it is something that you or I choose to grant them because our ethics demand it of us. If you are in an earthquake, there is no dignity, there is no respect. The earthquake grants you nothing, and all that remains is autonomy, for as long as you are alive. That autonomy is truly inalienable. Everything else is granted. And in the end, death will take your autonomy as well – but then, you are no longer a being at that point in time, either, so there is no conflict in terms.
Jake
Well that’s not always easy, but neither is determining what “rights” people have.
If those statements are meant to be equivalent, then fine; though as I’ve said I’m not at all sure what the latter formulation is supposed to gain us, and pretty sure that it obscures quite a bit.
I don’t understand the argument of that last paragraph at all: certainly faceless events don’t “grant” us anything by way of dignity or respect, but who ever said they did? No matter what situation we’re in, we’re obliged – among other things – to treat other persons rightly, which as you suggest requires treating them according to the Golden Rule. But the status that demands that they be so treated isn’t something we “grant”; it’s something they have, and that we’re morally required to acknowledge and live up to. And it’s reasonable enough to say that autonomy is one of the (perhaps “inalienable”) characteristics of human beings, but the question is whether it’s an appropriate basis for ethics (or politics). Helen’s contention, which I’ll whole-heartedly second, is that it clearly isn’t.
John, Helen never got around to making her contention. She made a statement in the title of her essay – and that was it.
If a natural event can take it away from you, then whatever “it” is, it is like a right. In fact, life can be seen in that light. We have no rights to life. It just happens to us, and then age,or accident or disease takes it away. All we ever have that is truly ours, is choice. All we ever truly own, is our choices. All we leave behind, that neither time, nor accident, nor any human act can take away from us, is our choices. Which is just another word for autonomy.
I see that clearly now, and thank you for this discussion.
Jake
What in the world can you mean by that? She explicitly contended that, e.g., DS babies shouldn’t be avoided, it is permissible (if not obligatory) to let certain sorts of disabilities go untreated, etc.
Meanwhile, if your argument that we have no right to life centers on the premise that we can die, then the argument is an abject failure. And by the way, our autonomy – like our “choices” – is obviously taken away from us when we die; what is “left behind” are the consequences of that autonomy … which of course are the consequences of our lives, too.
“DS babies shouldn’t be avoided” is not a bioethics of love. It is a statement of one person’s beliefs about what constitutes love. Her beliefs are sufficient to her. That is good.
John, you were the one who said that rights are a pernicious evil. Yet suddenly a right to life springs into the discussion, and from you.
I agree with your first stated position – we have no inalienable rights. Including a “right to life”.
Autonomy is not taken away from us when we die – there is no “us” to lose autonomy. And, yes, the consequences of that autonomy are all that remains of our lives. You said that very well.
Jake
So I meant “aborted” not “avoided”, but what is it with you and “beliefs”? Helen argued that the demands of love – i.e., what she believed were the demands of love, though what else did you want her to appeal to? – required e.g. not aborting babies with Downs Syndrome, and that this was a better basis for bioethics than autonomy (or, I’d venture, “rights”). That’s a bioethics of love if I ever saw one.
Well I certainly never said that. And no, it wasn’t I who (re)introduced the notion of a right to life; it was you, and I was just observing that the surrounding argument was no good.
No, the consequences of our lives are what remain of our lives.
I think aborting disabled children out of convenience is selfishness. Real autonomy would come from accepting the person and loving them. Otherwise it is running away in my opinion.
I think disorders that results in disabilities and imminent death should be cured if the cure is available. I draw the line on “curing” at the idea of designer babies. There is a difference between a parent wanting their child to be happy and creating a trophy to parade around.
John, we all have many beliefs, but only a few can be a basis for ethical behavior. Love can certainly be a component of ethical behavior, but it can also be destructive and self-serving. Beyond that, how should you treat people for whom you feel no love? Helen’s paean to her sister is primarily one of love, but for whom, exactly? For her sister who likely doesn’t know love, but only security and relative comfort? I know, and believe, that love is not something we feel but rather something we do. Even so, how do you apply love? How do determine the difference between self-serving and selfless love?
You need ethics. You have the church to help you. I do not. The rules, if law is to be sourced in them, must apply to and for us equally, though we believe differently.
Let’s look at Helen’s sister from the pov of the golden rule. Did Helen mention what her sister might want, even once? If she did, I couldn’t find it. As it is, her sister couldn’t comprehend the question, much less answer it. But we can imagine how we might feel in her place, what our desires might be were we to become aware that her fate was ours. We might choose to not suffer that fate. Not because we don’t want the that life but because we don’t want to be that burden. We might decide that whatever grace Helen and her parents acheive because of their care for us, the burden of our care is too high a price. And who knows, if we do not burden their life, perhaps they will adopt a deserving child, or bear another one who bring them joy less alloyed with pain.
We actually have a model for such a choice – Do Not Resuscitate instructions and living wills. Here people make judgements about their life, not the life of some other person. In certain situations where the potential for resuscitation is likely to arise, a significant fraction of people choose to not be resuscitated. Is this act of autonomy a selfish or a loving act? It is a loving act, I believe. Not that it matters what I believe.
Were such a thing possible, what would the beings in that 91% have to say? I know what I would say. I would take a pass, thank you. I would not burden those who would come to love me. I have made that decision in my life.
On another note, Doublethink put my comment back up. A perfect example of their name!
Jake
And the same goes in spades for autonomy.
But anyway, it’s not worth pursuing this any further. I find your position repellent, and am genuinely uncomfortable with the fact that you’re willing to sit there and publicly claim that you think my friend’s sister should not be alive, that if she were able to comprehend the question she’d decide that in her present state she’d be too much of a “burden” for her parents and sister. Yeah, I’ll pass on that.
And as for the Doublethink comment, it probably got marked as spam and caught up in a filter. Don’t give yourself too much credit.
So… how about an exceedingly Greek definition of “love” to start with?
Love is desiring and acting towards the Good for another.
On this definition, love becomes an element of ethics driving all other elements insofar as all other elements (including autonomy) are subsumed in the idea of “the Good.”
Also on this definition, we must assume either a fixed and unchanging idea of “the Good,” which applies equally to all human beings regardless of specific identity, or we must assume a non-postmodern view of the individual whereby said individual has fixed characteristics that may make general, abstract principles of “the Good” into concrete desires and actions.
If we assume the latter (as, I think, Miss Rittelmeyer does), then we must make a distinction between those aspects of a human being that are essential and those aspects which are merely accidental. If a disability is so thoroughgoing as to constitute an essential aspect of a person, then loving and even ethical action towards that person becomes impossible if one seeks to undo or prevent that disability.
Acceptance of the essential aspects of a person is the necessary foundation to pursuing the Good for them.
What I see Jake saying is that (1) there is no “the Good,” but merely a myriad of accidental goods. A human being has no interest in life apart from the concrete relationships and essentially transitory pleasures that said human being actually enjoys or desires. Also, (2) ethics are inherently subjective. I take his speech about the Golden Rule to mean that ethical behavior is essentially the imputation one’s own self-interest unto others. Or, to state it differently, the charitable acceptance of others’ right to pursue their own self-interests. For this reason, there need be no fixed identity of persons for the sake of ethics beyond a relatively consistent pursuit of self-interest.
My objections to these ideas that I see Jake putting forward all rest in the fact that they make true intimacy and true love impossible. By “true intimacy,” I mean a real encounter with another human being’s (for lack of a better word) Being (note the capital “B”). By “true love,” I mean the definition I give above. Such love is an end in and of itself.
Jake’s position is essentially solipsistic. All that matters is for ethics is one’s own ethical responsibilities. One may act ethically without having knowledge of what is the Good for another person. One may thus act ethically without pursuing intimacy or love as I have defined them. This in and of itself is enough for me to reject Jake’s position.
Beyond this, the real experience of human beings tells us that the most significant and exemplary ethical actions do not operate on the basis Jake describes. Good parents do not follow Jake’s Golden Rule on behalf of their children. Rather, they seek to obtain some objectively good life for their children in view of the temperaments and characteristics of their children. And this irrespective of many of their own desires and certainly irrespective of their children’s desires.
Mother Theresa was shockingly unconcerned with the autonomy of those she aided. She was a horrifically bad Western liberal. But she was an exemplar of ethical action.
John, I never said, nor implied, that Helen’s sister should not be alive. She IS alive. That is a fact. There are uncountable numbers of possible human beings who are not alive and never will be alive. All beings are contingent – we enter a birth lottery, and we get what we get. I maintain we, as parents, may choose to affect the odds applicable at the birth of our children.
Smiley, there is no fixed person there at all. Not your skin, not your internal organs, not your bones, not your memories. There is only the record of your choices.
Nonetheless, we choose to love people as best we can, however imperfect and inconstant that love may be. Is love acting for the good of another? At least in part, yes. Clearly, we disagree about what constitutes the good of another. I suspect the we differ on Terri Schiavo, for example. I believe acting for her good meant terminating life support in accordance with her expressly stated desires. In my mind, that is loving the woman who was. Acting against her wishes would not be an act of love, it would be an act of selfishness.
Jake
Yes, you did:
That’s implication, at least, and it’s frankly nauseating.
Jake,
“Smiley, there is no fixed person there at all. Not your skin, not your internal organs, not your bones, not your memories. There is only the record of your choices.”
Then how do you account for the fact that (despite our bodies replacing their cells entirely every — what? — seven years or so) every individual displays observable characteristics that subsist over time — even over their entire lives? I include appearance, personality, disabilities, recurring dreams, anything and everything. If we can form some coherent idea of another person’s identity, then doesn’t that mean that enough characteristics of a person remain fixed as to make the idea of a fixed person meaningful at the very least?
I’m not going to quote it again, but I’d also like to address the application of your “Golden Rule” that John takes such exception to.
I disagree with John insofar as I don’t think you’re suggesting that Miss Rittelmeyer’s sister shouldn’t be alive. My problem with that passage is different. My problem is that your method of determining ethical action depends entirely on counter-factuals. You put yourself in someone else’s shoes. but this is a fiction. It’s also self-contradictory with your position regarding the fixedness of identity.
First, by putting yourself in someone else’s shoes, you fail to deal with that actual person. You write your own desires, beliefs, and prejudices onto that person and so ignore the reality that is there. The fact is that Miss Rittelmeyer’s sister does have desires at least (however inferior you judge them to be), and may even have beliefs in a meaningful sense. She enjoys relationships with other people. By effacing all of this, you privilege a fiction rather than facts in making ethical decisions. The fact is that Miss Rittelmeyer’s sister does not feel herself a burden, and she does like being read to and eating Jell-o (or whatever she happens to like). Facts ought to take precedence over self-serving thought experiments made by people with little or no interest in an individual’s life.
Second, if there is no fixed identity of a person, then the thought experiment of “putting yourself in the other person’s shoes” is incoherent. If there is no fixed identity, then, if you were in the shoes of another, you could not predict what desires, etc. you would have. In Miss Rittelmeyer’s sister’s shoes you would want to be read to and have some Jell-o (or whatever the case may be). You would not want to avoid being a burden on your family.
I would like to assert again that there is such a thing as fixed identity of persons, but even if there isn’t, your “Golden Rule” remains a perversely solipsistic method of making ethical decisions. We know enough facts about other human beings to tailor our decisions to what they feel and what they desire. By putting ourselves in their shoes, we overwrite those factual considerations with self-centered fictions.
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