John Keown, former University of Cambridge law professor and current Rose F. Kennedy Professor of Christian Ethics at Georgetown University’s Kennedy Institute of Ethics, accurately identifies this fundamental conflict:
Traditional common morality, as its name suggests, comprises ethical principles common to civilized cultures. The notion that that there are certain objective principles which societies must respect if they are to quality as civilized, has been expressed in the West in the Hippocratic Oath in Judeo-Christian morality, the prohibition against killing the innocent, and in the common law. . . . [But] much of modern bioethics is clearly subversive of this tradition of common morality. Rather than promoting respect for universal human values and rights, it systematically seeks to subvert them. In modern bioethics, nothing is, in itself, either valuable or inviolable, except utility.
Much damage has already been done. Indeed, society is only vaguely aware of the extent to which their most basic presumptions about health care have been undermined.
CREATING A HIERARCHY OF HUMAN LIFE
“The traditional Western ethic,” a California Medicine editorial opined in 1970, “has always placed great emphasis on the intrinsic worth and equal value of every human life.” This “sanctity of life ethic,” the editorial continued, has been “the basis for most or our laws and much of our social policy” as well as “the keystone of Western medicine. . . . This tradition ethic is being eroded at its core and may eventually be abandoned. . . . Hard choices will have to be made . . . that will of necessity violate and ultimately destroy the traditional Western ethic with all that portends. It will become necessary and acceptable to place relative rather than absolute values on such things as human lives.”30
These chilling words were prescient. In the nearly fifty years since, that is exactly what has happened. Rather than believing in inherent human equality, most contemporary bioethicists measure the value of human life subjectively. Instead of embracing the human community—which means all of us—most bioethicists are concerned with the “moral community,” which in theory and often in practice excludes some of us. For most bioethicists, human rights—assuming they exist; not all believe in them—are not inalienable but must be earned based on criteria they created—and, as we shall see, may include animals. Thus, equality ceases to be a universal vision.
If these words seem harsh, consider the thinking of an influential philosopher, the late Joseph Fletcher, whose ideas had enormous impact on the West in the second half of the twentieth century. Fletcher is most famous for creating “situational ethics,” which emphasizes “cutting loose from moral rules” and “reasoned choice as basic to morality.”31 Applied to medical ethics and health care, situational ethics—along with Fletcher’s writing and pronounced persuasive skills—made him, in Albert R. Jonsen’s term, “the patriarch of bioethics.”32
Fletcher was a radical utilitarian whose stated goal was to maximize happiness and minimize suffering. That sounds good in the abstract, but once he had freed himself from “moral rules,” Fletcher developed a worldview that was paradoxically both anarchic and totalitarian. Thus, in the name of human freedom, he enthusiastically endorsed the wildest ideas, such as the manufacture of chimeras (part human, part animal) through genetic engineering.33 Yet individuals per se actually counted for little in his thinking, and those he perceived as interfering with the general pursuit of happiness were expendable.
Early on, Fletcher dismissed the traditional medical “reverence for life,” sniffing that “nobody in his right mind regards life as sacrosanct.” Developing his thesis from the then newly crafted right to abortion, Fletcher distinguished “human life” from what he called “personal life.” “What is critical,” he wrote in 1973, “is personal status, not merely human status.” He created a list of “criteria or indicators” that he hoped could be used to divide society between those individuals who possessed “humanhood” and those who did not—between “truly human beings” whom he saw as deserving of great moral concern and the “subpersonal,” or humans he deemed of scant consequence.34 He used the terms “humanhood” and “truly human” not as biological descriptions but as subjective terms to connote moral value.
The immediate problem facing Fletcher and those contemporaries who agreed with him was to devise a method for culling the human herd to prove that “we mean business.”35 Toward that end, Fletcher proposed a formula to gauge the quality of a human life “for the purposes of biomedical ethics.”36 These included a list of fifteen “criteria or indicators,”37 among which were:
• Minimum intelligence (score too low and one is deemed “mere biological life”);
• Self-awareness (“essential to the role of personality”);
• Self-control (i.e., if someone is not control of him or herself, “the individual is not a person”);
• A sense of futurity (“subhuman animals do not look forward in time”);
• Memory (“It is this trait alone that makes man . . . a cultural instead of instinctive being”);
• Concern for others (“The absence of this ambience is a clinical indication of psychopathology”);
• Communication (“Disconnection from others, if it is irreparable, is dehumanization”); and
• Neocortical function (“In the absence of the synthesizing function of the cerebral cortex, the person is non existent. Such persons are objects, not subjects”).
Fletcher also fashioned five “negative” points that he believed indicated true humanhood. For example, he claimed that man is not “anti-artificial.” To the “anything goes” Fletcher, “to oppose technology is self-hatred.” Thus, “a baby made artificially by deliberate and careful contrivance, would be more human than one resulting from sexual roulette—the reproductive mode of subhuman species” (my emphasis).38 Fletcher also dismissed the notion of innate human rights: “The idea behind this is that such things are objective, pre-existent phenomena, not contingent on biological or social relativities.”39 In other words, Thomas Jefferson was all wet.
To understand how dangerous that thought of bioethics’ “patriarch” really is, one need only read Fletcher’s 1975 essay, “Being Happy, Being Human,”40 in which he describes participating in a panel discussion of the treatment of babies born with serious birth defects. A physician who cared for a profoundly mentally retarded boy reported that while he possessed a very low IQ, the lad was clearly happy and clearly a human being. Fletcher coldly dismissed the human worth of this defenseless child—and that of many other developmentally disabled people: “Idiots are not, never were, and never will be in any degree responsible [because they cannot understand consequences of action]. Idiots, that is to say, are not human. The problem they pose is not lack of sufficient mind but of any mind at all. No matter how euphoric their behavior might be, they are outside the pale of human integrity. Indeed, sustained and ‘plateau’ euphoria is itself prima facie clinical evidence of mindlessness.”41
Such a provocation had a purpose: to gain support for the notion that killing “idiots” could, depending on the facts of each individual case, be ethical and right—decisions that Fletcher described as a merely “clinical” matter.42 In the case of disabled infants, he wrote elsewhere that killing should simply be considered “postnatal abortion.”43 As I will describe later, calls within bioethics to permit infanticide have proliferated in the years subsequent to Fletcher’s advocacy.
Not every bioethicist agrees with all of Fletcher’s ideas. Nor will every radical policy Fletcher promoted eventually become culturally or medically acceptable—although many of them, such as dehydrating to death cognitively disabled people, which Fletcher proposed as early as 1974,44 already have. But it is particularly telling that Fletcher was not dismissed by the fledgling bioethics movement as some fanatic kook when he advocated infanticide,