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Pushing a Dangerous Anti-Human Exceptionalism “Undignified Bioethics”
Tuesday, January 5, 2010, 1:22 PM
Wesley J. Smith

A bioethicist named Alasdair Cochrane, who is, ironically, a deep thinker at the Centre for the Study of Human Rights in the UK, argues against intrinsic human dignity as a basis for establishing bioethical policies.  He attacks various theories that promote human dignity, e.g., “as virtuous behavior,” Kantian dignity, and as species integrity.  But my concern is his denial  of human exceptionalism and denigration of the concept of “inherent moral worth.”  From his article “Undignified Bioethics” published in the journal Bioethics (link to abstract):

The second important conception of dignity that we need to consider does not see dignity as a form of behaviour, but as a property. 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 towards them. Indeed, this understanding of dignity is also usually considered to serve as the grounding for 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.’

Do you now see the stakes in the debate over human exceptionalism? Cochrane hits the nail: If humans do not have intrinsic equal moral value, the philosophical bases of the U.S. Declaration of Independence (“We hold these truths to be self evident, that all men are created equal…”) and the UN Declaration of Human Rights, are rendered impotent, and universal human rights becomes impossible to sustain. Moreover, if we deny intrinsic human dignity, we open the door to using human beings as objects and mere natural resources.  Cochrane see this:

This conception of dignity as inherent moral worth certainly seems coherent enough as an idea. Indeed, we can also see why this conception of dignity is employed in certain debates around bioethics. For 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 then, it may be that we could achieve rapid and significant progress in medical science if we were to conduct wide-ranging medical experiments on groups of human beings. However, because human beings have dignity, so it is argued, this means that they possess a particular quality that grounds certain moral obligations and rights.

Alas, that crucial matter doesn’t matter to him, because he would rather judge each individual’s characteristics rather than the inherent attributes of our species:

If all human beings possess dignity–this extraordinary moral worth–we need some explanation of what it is about the species Homo sapiens that makes them so deserving. When we start looking at particular characteristics that might ground dignity – language-use, moral action, sociality, sentience, self-consciousness, and so on – we soon see that none of these qualities are in fact possessed by each and every human. We are therefore left wondering why all human beings actually do possess dignity.

Those individuals who happen to lack those attributes have either not developed them yet (embryos, fetuses, infants), or have illnesses or disabilities that impede their expression.  But those attributes are unique to the human species, they are uniquely part of our natures. That some have not developed, or have lost, them, is irrelevant–particularly given the stakes.  Indeed, judging the moral worth of individuals returns us to the pernicious thinking of eugenics and social Darwinism.

He claims, wrongly, that only Christian religion and its concept of the soul could justify human exceptionalism, which he denies as arbitrary and “controversial.” In place of human dignity, he argues a concept of “moral status:”

Obviously, given controversies over abortion, stem cell research, genetic interventions, animal experimentation, euthanasia and so on, bioethics does need to engage in debates over which entities possess moral worth and why. But these are best conducted by using the notion of ‘moral status’ and arguing over the characteristics that warrant possession of it. Simply stipulating that all and only human beings possess this inherent moral worth because they have dignity is arbitrary and unhelpful.

Hardly arbitrary, given the consequences of rejecting it and the uniqueness of human beings as the known universe’s only moral species.  Unhelpful, perhaps–in that it would prevent fetal farming, killing for organs, using human being as lab rats, and other utilitarian horrors.  But if we want universal human rights as a primary goal of society, intrinsic dignity is absolutely essential. He concludes his essay:

I urge for an undignified bioethics.

If we have an undignified bioethics, that is precisely the way we will treat the most vulnerable and defenseless among us.  In this sense, we can see how radically bioethics is straying from true liberalism based on the ideal of universal human equality.

This is why bioethics matters.  As proposed by Cochrane, bioethicists could become court apologists for tyranny. As we have seen in history, such advocacy by the intelligentsia opens the door to the most vile evil of which  man is capable.


Sexism in Baby Death Decision Case–or Cynical Use of Traditionalism?
Monday, November 9, 2009, 5:39 PM
Wesley J. Smith

This is rich: A pediatrician for a hospital wanting to cut off the life support of a baby because he is seriously disabled–although cognitively fine, as discussed here before–says that the hospitals like to follow what mothers want in cases such as this.  From the story:

The parents of the chronically disabled one-year-old, who can only be identified as RB, are locked in a court battle over whether he should be allowed to die. Prof Bush, a world-renowned expert in paediatric care, said both parents were ‘genuine, loving and caring’ and that he respected both their opinions. But he told the court: ‘As a paediatrician I think the views of the mother are something that should always be taken very, very seriously. ‘That’s not to trivialise the views of the father but I think most paediatricians would find it very difficult to overrule the views of the mother, unless there was clear evidence that the mother was unreasonable.’

That seems awfully convenient to me.  How many times have we been told over the last twenty years that there is no difference between the sexes ?  That point aside, I wonder whether–if the mother wanted the baby’s care continued and the father didn’t–we would be hearing that the mother just can’t face the facts because she is so invested in her baby.  We’ve certainly seen doctors and ethicists say that in other cases.  Indeed, futile care cases in Texas, Michigan (Baby Terry) and Washington (Baby Ryan) saw doctors/ethicists testifying to just that point.

Surely, cases such as this, where it is clearly no slam-dunk and one parent wants the child to live, that is where any benefit of the doubt should be honored.  What matters most is the baby’s interests and welfare, and I don’t think we are yet to the point that ethicists will say unequivocally that it is in the baby’s best interest to die when it he or she is cognitively normal and enjoys music, etc.

With this case, the dehydration/ventilator cases are moving from the cognitivey disabled being deemed lives too burdensom to live, to the physical.  It is a very scary time to be a disabled person who is expensive for which to care.


Obamacare: Government Funded Studies Pushing Toward Futile Care Rationing?
Friday, October 16, 2009, 7:57 PM
Wesley J. Smith

I have been warning for nearly ten years that the Medical and Bioethics Intelligentsia were committed to imposing futile care theory on the most weak and vulnerable patients.  Lately, we have been discussing the pronounced threat of health care rationing under Obamacare.  Today, I noticed two new studies in the New England Journal of Medicine that could be abused by health care rationing and medical futility advocates to justify policies that prevent certain patients from receiving wanted life-extending treatment.

One deals with late stage dementia as a terminal illness, and the other with providing kidney dialysis for the frail elderly. Both suggest that a better way to go for the wellbeing of the patient may be to switch from life-extending treatment for these patients to a hospice-style palliative care approach. From the story:

A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal. One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment. Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

“Consider”-yes.  Impose, no.

The palliative option should always be an option for patients nearing the end of their lives.  But the final decision should ultimately be that of  the patient/ family/surrogate–(assuming a patient is not forced off food and fluids based on quality of life judgmentalism).  There comes a time when nature should be allowed to take its course and people have the right to refuse unwanted interventions. They, have the right–not bureaucrats or bioethicists.

But: If these and other studies are used by cost/benefit/best practices bureaucrats to coerce decisions or require that these patients not be maintained, that is a different matter altogether.  It is the difference between a patient treated as an individual, and a patient treated as the member of a category, the latter 0f which profoundly endangers the elderly and people with disabilities–as the as recent horror stories out of the UK about the Liverpool Care Pathway vividly illustrate.  And I fear, based on the italicized language above, that forcing patients off of wanted treatment is precisely how the Obamacare bureaucrats would use studies such as these.  Indeed, the noxious notion that if there is no cure, there is no point to maintaining lives, is growing among the usual suspects.  Indeed, there is an attempt within these circles to deny that life itself is  a benefit–even when those most affected want it to continue–that, hence, the time comes when we can put a patient out of society’s misery.

This is not to say, of course, that these studies should not be done.  Assuming they don’t have secret agendas, they should be conducted and discussed to help professionals know likely outcomes when discussing options with patients and families. But they should not be abused to create policies that take away treatment options and victimize the most weak and marginalized among us.



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