The ultimate amorality of the Georgetown Mantra is amply illustrated by an article written by K. K. Fung, PhD, in the American Journal of Economics and Sociology entitled “Dying for Money.” Fung, a professor of economics at Memphis State University, recommended allowing seriously ill and disabled people to convert their health insurance benefits into a lump-sum cash payment—at less than the market exchange rate—if they agree to commit assisted suicide. How did Fung justify such an odious, exploitative proposal? Why, with the Georgetown Mantra:
Benefit conversion coupled with dignified death go a long way towards resolving these conflicting principles [of the Mantra]. Because resources released from one patient’s refusal of medical treatment (autonomy) can be specifically requested to be used for other patients or beneficiaries with greater need (full beneficence), autonomy and full beneficence need not conflict. Once the patient is allowed to choose death, the caregiver does not have to impose treatment for fear of malpractice liability. Thus, patient-centered beneficence is satisfied. Since benefit conversion is equally available to all who are insured, and the amount of converted benefits varies only with the severity of the illness, justice is also served. All that remains to be done is to educate the terminally or chronically ill how to allocate their converted benefits once death is chosen. Because these four ethical principles [of the Mantra] are largely taken care of, the sense of tragedy connected with the death and denial of treatment to the hopelessly ill can be mitigated.116
As to the abuses that even Fung admits would follow if his proposal were accepted, they are of little concern. Proving that economists can be as amoral as bioethicists, Fung shrugs, “the world is full of slippery slopes.”117
Bioethicists are fond of pointing out that there is no going back to the era when the West was culturally homogenous and primarily Judeo/Christian in outlook, or to a time in which health care decisions were relatively simple. They note correctly, the United States, Canada, and Western Europe are now fundamentally heterogeneous societies, racially and culturally mixed, and fundamentally secular in civic and public policy outlook. Moreover, they argue, the era in which medicine was primarily concerned with keeping people alive for as long as possible and public health policy sought essentially to uphold a (misapplied) religious approach to the sanctity of human life is archaic in a Darwinian world in which too many people compete for too few resources.
The purposes of modern medicine have indeed expanded beyond preserving life, treating maladies, and promoting wellness. Healthcare is now deemed to achieving individual life goals and fulfilling personal desires. And, yes, we now contend with more complicated ethical issues than our forbears faced: cloning, genetic medicine, the societal and individual consequences of increased life expectancies, the impact of permitting wide latitude in individual medical choices, and the difficulties imposed by limited resources.
But this doesn’t mean that ethical analyses need to be as complex as bioethicists make them, nor that contemporary bioethics ideology has the best answers to these emerging moral problems. In a question that evokes the case of the emperor’s new clothes, Anne Maclean cogently asks, “Why should we attach more weight to the pronouncements of philosophers on moral issues than to those of other people?”118
“Three generations of idiots is enough,” United States Supreme Court Chief Justice Oliver Wendell Holmes declared in authorizing the involuntary sterilization of Carrie Buck, age twenty-one, in Virginia.1
What had Carrie done to deserve this cruel fate? She was born poor and powerless, the daughter of a prostitute. In 1924, at the age of seventeen, she became pregnant out of wedlock, apparently after being raped by a relative of her foster father. To cover up this heinous act, Carrie’s foster family had her declared morally and mentally deficient, after which she was institutionalized involuntarily in an asylum.
Adding to Carrie’s woes, in 1924, the state of Virginia enacted a law permitting “mental defectives” to be involuntarily sterilized to better the welfare of society. Asylum doctors, believers in the pernicious theories of eugenics, decided that Carrie was a splendid candidate for sterilization. She was, after all, “a human defective.” Her mother was institutionalized and Carrie’s baby, aged seven months, did not look “quite normal” either.2 Best for society that Carrie’s genes be removed from the human race.
Carrie’s guardian tried to stop the involuntary surgery in court—although he may have been in collusion with those who wanted her sterilized. In any event, the trial judge ordered the sterilization to proceed, relying on “experts” who testified that Carrie had unfit genes. The case was eventually accepted for decision by the United States Supreme Court, where Chief Justice Holmes and seven of his colleagues sealed Carrie’s reproductive fate with but one lonely dissent, after which she was quickly sterilized and released. (Carrie’s daughter died in the second grade of an intestinal ailment. Her teachers considered her very bright.3 During her life, Carrie married twice, sang in the church choir, and took care of elderly people. She always mourned her inability to have more children. She died in 1983.4)
Carrie Buck’s fate—and that of approximately 60,000 other “defective” people involuntarily but legally sterilized in the United States between 1907 and 19605—was sealed by advocates of a pseudoscience in the scientific, artistic, and progressive political communities known as eugenics. The history of eugenics, its fundamental precepts, the manner in which it was imposed on society and in law, and the horror that flowed from its popular acceptance, are highly relevant to our exploration of modern bioethics. First, its history shows the inhuman consequences that invariably follow when the equality/sanctity of human life is disregarded in science, medicine, law, and greater society. Second, striking and disturbing parallels exist between the manner in which eugenic theories were developed and put into practice and the way in which bioethics ideology is coming to dominate the ethics of medicine and the laws of health. Third, modern bioethics, like eugenics before it, creates hierarchies of human worth intended to justify medical discrimination. Now, after decades of quiescence, eugenics itself is making something of a comeback as a result of the development of new genetic technologies and futuristic ideologies such as “transhumanism.”6 (We will look more closely at this movement later in the book.)
Eugenics originated with the English mathematician and statistician Francis Galton. A cousin of Charles Darwin, Galton believed that heredity “governed talent and character” just as it does eye color and facial features.7 Profoundly influenced by Darwin’s theories of natural selection and Gregor Mendel’s pioneering genetic experiments, Galton proposed, in 1865, that humans assume responsibility for their own evolution by using selective breeding techniques to improve society’s physical, mental, cultural, and social health. In 1883, Galton coined the term “eugenics” to apply to his theories, a word he derived from the Greek meaning “good in birth.”8
Eugenics took the same path to acceptability as bioethics would nearly one hundred years later. It first became the rage in the academy and then spread rapidly in the early years of the twentieth century among the cultural elite and the intelligentsia of the United States, Canada, England, and Germany.