That is not to say that there was no intellectual resistance within the early bioethics movement to the steady growth of this sort of secularist, radically utilitarian thinking. A strong countermovement led by theologian Paul Ramsey provided a significant challenge to the Fletcher school for many years.
Ramsey believed that people owed each other a duty of fidelity based upon “covenant responsibilities” based in “justice, fairness, righteousness, faithfulness, canons of loyalty, the sanctity of life, hesed, agapé [steadfast love], or charity.” This meant, according to Ramsey, that there is “sacredness and in ‘bodily life’ from which flow our mutual duties to care for each other, including the most weak and vulnerable among us.”47
Where Fletcher’s approach was a bioethical version of anything goes, Ramsey stood firmly against the idea that the ends justify the means. Where Fletcher sought to create invidious divisions among people based on purported humanhood criteria, Ramsey explicitly rejected the entire approach as immoral: “Fletcher is simply a sign of the times,” Ramsey worried, as he asserted that creating criteria to judge how people should be treated in health care is wrong because it was to “play God as God plays God.”48 “To use such indices in the practice of medicine is a grave mistake,” Ramsey warned, because it would lead to inequality and “add injustice to injury and fate.”49
Gilbert Meilaender, the theologian and ethicist who has been a part of this struggle for decades, characterized this internal struggle for the soul of bioethics as a three-decade war. To make a long story short, the amoral Fletcher school (my term) prevailed over traditional moralists such as Ramsey, illustrated by the sad fact that few of Ramsey’s books remain in print while most of Fletcher’s books and articles are readily obtainable. In the end, Fletcher, not Ramsey, became the “patriarch” of modern bioethics. It is Fletcher’s views that predominate within the field. Fletcher, not Ramsey, was the one who “articulated where bioethics was heading well before the more fainthearted were prepared to develop the full consequences of their views.”50
Once Fletcher secured a beachhead, it was only a matter of time before someone like Peter Singer would stage his much-publicized landing in bioethics. If this were a movie, Singer’s appearance would be entitled “Son of Fletcher.” Beginning in the mid-1970s, Singer rose quickly in prominence to become one of the world’s most influential contemporary utilitarian bioethicist/moral philosophers. But being the radical that he is, Singer took Fletcher’s original formula and extended it to even more subversive ends. Where Fletcher sought to determine who had moral value strictly for the benefit of humans, Singer expanded the “moral community” into the world of animals.
Singer contended that being human in and of itself is irrelevant to moral status; what counts is whether a “being” is a “person.” Toward creating a formula to make this determination, Singer simplified Fletcher’s multi-point formula to “two crucial characteristics” that earn human being or animal the status of “person” (e.g., “rationality and self consciousness”).51 Species membership is irrelevant, Singer claimed. Indeed, he asserted that some animals are persons, including “whales, dolphins, monkeys, dogs, cats, pigs, seals, bears, cattle, sheep, and so on, perhaps even to the point which it may include all mammals.”52 On the other hand, some humans would not qualify, including newborn human infants (whether disabled or not), people with advanced Alzheimer’s disease or other severe cognitive disabilities—since Singer claimed they are not self-conscious or rational—along with other nonpersons that exhibit similar relevant characteristics (e.g., clams or sardines).
Yes, Singer explicitly made a moral comparison between some people and fish, writing, “Since neither a newborn infant nor a fish is a person the wrongness of killing such beings is not as great as the wrongness of killing a person.”53 Thus, to Singer, a newborn infant is the moral equivalent of a mackerel and an advanced Alzheimer’s patient is comparable to a pigeon. As we shall see later in the book, Singer, like Fletcher, asserted that his theories justify infanticide and non-voluntary euthanasia of cognitively disabled people.
In another world and time, Singer’s advocacy would make him an intellectual outcast. He actually is in bad standing in Germany and Austria, where he cannot speak without generating angry protests from people who consider his opinions Nazi-like.54 But many in academia and bioethics embrace him, or at least respect his intellectualism (and perhaps admire his radicalism). Far from being a fringe character, Singer is invited to present at seminars, symposia, and philosophy association conventions throughout the world. His 1979 book, Practical Ethics, which unabashedly advocates infanticide and euthanasia, and also decries “discrimination” based on species (a bizarre notion Singer labels “speciesism”), has become a standard text in many college philosophy departments. Singer is so mainstream that he even wrote the essay on ethics for the Encyclopedia Britannica. Most disturbingly, in 1999, he became a permanent member of the Princeton University faculty, where he is the Ira W. DeCamp Professor of Bioethics, a prestigious, tenured academic chair at the university’s Center for Human Values.
The person/nonperson moral distinction is generally accepted throughout bioethics and increasingly applied to animals, as Singer has advocated. Writing in the influential Kennedy Institute of Ethics Journal, British academic John Harris, the Sir David Alliance Professor of Bioethics and Director of the Institute of Medicine, Law, and Bioethics at the University of Manchester, England, defines a person as “a creature capable of valuing its own existence,” which he opines could include people, animals, extraterrestrials, and machines but does not include some humans, including infants “during the neonatal period.” To Harris, only the lives of persons are morally important. It is not wrong to kill nonpersons or fail to save their lives:
[T]o kill or to fail to sustain the life of a person is to deprive that individual of something that they value. On the other hand, to kill or to fail to sustain the life of a nonperson, in that it cannot deprive that individual of anything that he, she, or it could conceivably value, does that individual no harm. It takes from such individuals nothing that they would prefer not to have taken from them. . . . Nonpersons and potential persons cannot be wronged in this way [killing them against their will] because death would not deprive them of anything they can value. If they cannot wish to live, they cannot have that wish frustrated by being killed.55
Similarly, Georgetown University’s Tom L. Beauchamp, co-author of The Principles of Bioethics, similarly asserts in the Kennedy Institute of Ethics Journal that personhood and nonpersonhood designations may soon inform us whether we can use people as objects of exploitation in the ways that are presently restricted to our treatment of animals: “Because many humans lack properties of personhood or are less than full persons, they are thereby rendered equal or inferior in moral standing to some nonhumans. If this conclusion is defensible”—and Beauchamp clearly thinks it is—“we will need to rethink our traditional view that these unlucky humans cannot be treated in the same ways we treat relevantly similar nonhumans. For example, they might be aggressively used as human research subjects and sources of organs.”56
Making instrumental use of humans denigrated as having lesser value based on their capacities is definitely on the bioethics table. In 2010, British bioethicist Alasdair Cochrane eloquently identified the stakes in the debate over whether “intrinsic dignity” is an inherent human characteristic: “Under this conception, the possession of dignity by humans signifies that they have an inherent moral worth. In other words, because human beings possess dignity we cannot do what we like to them, but instead have direct moral obligations toward them. Indeed, this understanding of dignity is also usually considered to serve as the grounding of human rights. As Article 1 of the Universal Declaration of Human Rights states, ‘All human beings are born free and equal in dignity and rights.’”57 He also stated: “If all individual human beings possess dignity, then they should not be viewed simply as resources that we can treat however we please. To take an example, it may be that we could achieve rapid and significant progress