There is a direct line of compassion, succor, and love from David Tasma in 1948 to the millions of others who have benefited from hospice care since 1967—including my father, who died under hospice care in 1984, and my aunt in 2013. None of this would have happened without the religious values manifesting in the secular milieu of medicine through Dame Cecily, specifically the belief that no matter what our state of health, no matter our age, no matter how much help we need, no matter how we look or smell, we all have equal moral worth.
To promote such values is not to support theocracy. It does not divide a pluralistic society by imposing religion on an unwilling public. Rather, it is a secular application of the sanctity of life. How sterile and harsh the world would be if the values that inspired Dame Cicely were barred from the public square simply because they were founded in religious faith. How dangerous to exclusively base our approach to issues of public health policy and clinical medical ethics on amoral “moral philosophy.” It is true that religion not tempered by secular restraint and rationalism can lead to the tyranny of theocracy. But secularism not enriched by the values inspired by spirituality and religious faith, as this book demonstrates, will lead to the creation of “hierarchies of human worth,”91 the building blocks for a medical culture of death.
BRAVE NEW BIOETHICS
Having rejected the core values and virtues of Western civilization as bases for determining what is moral and good, bioethics turned to secular moral and analytical philosophy for the answers. This approach accepts no moral standard or ethical rule, no matter how deeply valued, as a self-evident truth. Every moral principle must be reassessed and deemed “rational” if it is to pass bioethical muster. Not surprisingly, the people bioethicists deem best able to perform this task are themselves, especially those trained in the arcane schools of secular philosophy. Needless to say, that stacks the deck in favor of those values and approaches to morality that the most influential bioethicists embrace personally. Unfortunately, some critics (me included) find that important human values such as “decency, kindness, empathy, caring, devotion, service, generosity, altruism, sacrifice, and love” are too often omitted from their equations because they are perceived to have little value in determining “what is ethical or moral.”92
Ironically, mainstream bioethics, which explicitly eschews religious values in public policy and medical ethics discourse as well as proudly proclaims itself the epitome of rationality, has itself become something of a secular faith among its adherents. Renée Fox notes, “Bioethics has always been a societal happening, dealing with issues that have religious import and ramifications. It deals with real dilemmas, issues of how society deals with ultimate beliefs. Bioethics uses medicine as a metaphor for discussing with each other issues of ultimate values and belief, questions that are as religious as they are ethical.”93 Adds Leon Kass: “While bioethics is not formally a religion, it is absolutely faith-based and is as equally indemonstrable. They purport to grapple with First Principles. Yet, they step into the public square with no greater claim to wisdom than does someone who believes in the resurrection or in the revelation of the Law at Sinai.”94
Bioethicist Daniel Callahan clearly perceives bioethics in quasi-metaphysical terms. “Above all,” he wrote in 1994, “bioethics needs to develop the capacity to help individuals make good moral decisions in their own lives and to do so in the context of the most basic moral questions: how ought I to live my life? The health of the soul (as they might have put it in an earlier day) is even more important than the health of the body.”95 In the same article, Callahan advocated a bioethics that helps “people shape their inner, private lives, assisting them in knowing how to make good personal judgments…”96 Thus it seems that bioethics didn’t actually “push religion aside,” as Callahan wrote elsewhere, as much as it changed the venue of belief.
We have seen what the new secular faith or ideology of bioethics rejects. But what does it embrace? Again, it is important to concede that the field is not monolithic. Not everyone who claims to be a bioethicist necessarily accepts some or all of the concepts I will discuss below, just like not every Christian adheres to the same tenets of faith. That being duly noted, it is fair to say that predominate bioethics adheres to the following general belief systems with the following dominant features:
Utilitarianism: Whether explicit or implicit—in intent or outcome—bioethics advocacy is predominately utilitarian. “All [leading] bioethicists,” claims author Anne Maclean, accept “some version of utilitarianism.”97 Professor Keown told me similarly, “Much of modern bioethics is largely utilitarian. Utilitarianism is fast establishing itself as the new orthodoxy.”98 Fox and Swazey write, “Since the mid-1970s . . . moral philosophy has had the greatest molding influence on the field,” especially “analytic philosophy—with its emphasis on theory . . . and its utilitarian outlook.”99 That theme has continued since this book was first published, with the emergence of younger voices in the field, such as Julian Savulescu, professor of practical ethics at the University of Oxford, and Thaddeus Mason Pope, director of the Health and Law Institute at Hamline University.100
Generally stated, utilitarians hold that “what people want, is the ultimate measure of right and wrong.”101 Joseph Fletcher was a wild utilitarian, writing that “a moral agent’s business is to maximize good,” which he defined as “happiness”: “Whatever increases human happiness is good; whatever reduces human happiness is evil.”102 Peter Singer, one of the world’s foremost contemporary utilitarians, does not look to happiness so much as whether the “interests” of those affected (which in his view includes animals) are furthered or hindered.103 Peter Singer himself admits that “ethical ideals, like individual rights, the sanctity of life, justice, purity . . . are incompatible with utilitarianism.”104 Thus, to the utilitarian, there is neither objective right nor objective wrong: actions are measured subjectively based on desired or actual outcomes and the ends justify the means. Unfortunately, what the Singers and Fletchers of the world forget is that the means themselves often subsume the ends.
Lacking a firm commitment to the sanctity/equality of human life, utilitarians may justify profoundly dangerous and immoral schemes and not even blush. As described by Anne Maclean in her book The Elimination of Morality,105 bioethicist John Harris—whose views on personhood we have already discussed—proposed a scheme to eliminate the shortage of transplant organs under which the few would be murdered to benefit the many: “[E]veryone [shall] be given a sort of lottery number. Whenever doctors have two or more dying patients who could be saved by transplants, and no suitable organs have come to hand through ‘natural deaths,’ they can ask a central computer to supply a suitable donor. The computer will then pick the number of a suitable donor at random and he will be killed so that the lives of two or more others may be saved.”106
To the radical utilitarian Harris, saving two or more lives at the expense of one murder would bring greater overall happiness than would the suffering caused by the killing of one man or woman. And since under utilitarianism no individual possesses human rights per se, at least if the exercise of such rights would impede the highest overall utility, why not perform the human sacrifice?
Obviously, Harris’s proposal will never become public policy—although it is worth noting here that Belgium and the Netherlands have joined voluntary euthanasia with organ harvesting. (More about that later.) Nor, I hope, will most bioethicists accept his ideas. Still, that Harris’s proposal was presented straight-faced as a respectable point-of-view in an important philosophy primer (Applied Ethics, edited by Peter Singer) illustrates the amorality of utilitarian thought and much of what has gone so dreadfully wrong in bioethics discourse.
The Quality of Life Ethic: As skeptical as mainstream bioethicists are about “the sanctity/equality of life,” they are equally enthusiastic about the “quality of life” ethic. What do they mean by this phrase as applied to health policy and medical practice?