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Protection of Conscience Project

Service, not Servitude

'Bioethics' -- What It Really Means for Prolife Nurses

Presentation to the National Association of Pro-life Nurses Annual Meeting1
Hyatt Regency in Crystal City, Washington, D.C. Copyright July 2, 2004
Reproduced with permission

Dianne N. Irving, M.A., Ph.D. *
I. Introduction

THIS is what "bioethics" means . . . It is not "ethics per se", but rather "federal ethics". It is neither "neutral", nor just a "communal conversation". It is incapable of resolving conflicts among its very curiously defined, utilitarian "principles", and even its Founders agree that it just can't work. It is, instead, a "will to power". . .

I'd first like to thank the National Association of Pro-life Nurses very much for inviting me to be here with you this evening. It is an honor to have been invited, and to be able to share with you some thoughts that concern me about the difficult struggle you find yourself in as vital members of the "healing professions".

To begin, let me share with you something recently said to me by a very special prolife nurse - we'll just call her, "Jennifer":

"Nurses are by their very nature, compassionate people. But it is difficult to keep that in focus with ethical issues when we see suffering up close and personal, sometimes on a daily basis."

Quite a very perceptive statement this good nurse made, and it probably reflects to some extent the sentiments of each of you good nurses here this evening. Her reference point was the direct killing of human patients under the guise of what is known as "mis-placed compassion". But what I see in her concern and confusion really goes much deeper -- a deep-seated tension between her personal and her professional lived-experiences on the one hand, and "ethics" on the other. And herein is the exact problem I want to talk with you about this evening. When you find yourself in a situation where you and your deepest gut instincts are so pitted against some "theory" - any "theory" - then perhaps it is time to stop and to question this "theory"? The specific "theory" in question here is not really "ethics", but, I would suggest -- "bioethics".

What is bioethics? How did it come about? How sound is this "theory"? What impact has it had on the practice of medicine and medical research, especially its influence on medical professionals - at the bedside, up-front and personal? How has bioethics attacked the fundamental concept of "personhood", especially as formulated in bioethics as "preference" utilitarianism? How has it so profoundly affected our understanding of who is a person to the extent that we don't even know one when we're staring one in the face - at the bedside?

II. Different ethics, different conclusions

First, just what IS "bioethics"? Most people would say that it IS "ethics" -- just the application of traditional philosophical and theological principles to current technological issues in medicine and medical research, right?

Not really. There is no such thing as "ethics per se". In the real world there are dozens of different ethical theories, using very different ethical norms and principles, thus arriving at fundamentally and even contradictory ethical conclusions - and thus different "medical ethics" and "research ethics" conclusions. Consider that the traditional Hippocratic medical ethics focuses on the physician's duty to the individual patient, whose life and welfare are always primary. The focus of bioethics is fundamentally utilitarian, centered on "maximizing total human happiness", or, as we shall see, maximizing total "preferences" and "interests" for society is primary.

To put my endeavor into sharp focus, consider for a moment the strikingly different conclusions reached by secular bioethics and those of a traditional medical ethics on an array of issues. Secular bioethics generally considers the following as "ethical": abortion, contraception, the use of abortifacients, prenatal diagnosis with the intent to abort defective and disabled babies; destructive human embryo and human fetal research; human cloning; the formation of human chimeras (cross-breeding with other species); human embryonic and fetal stem cell research; "brain birth"; purely experimental high risk research with the mentally ill; euthanasia; physician-assisted suicide; and living wills documenting absolute "autonomous" consent to just about anything. In contrast, traditional medical ethics considered all of these unethical.

Therefore, there is no such thing as a "neutral" ethics -- including bioethics. All ethical theories are normative -- i.e., they take a stand on what is right or wrong. Wouldn't it make common sense, therefore, to wonder why any "ethical theory" should be forced on any members of a pluralistic, multicultural, democratic society as the basis for public policy making?

III. The transition from traditional medical ethics to bioethics

Given the startling differences between traditional Hippocratic medical ethics and current bioethics, how did we get here - historically? Well, just after World War II, new medical research and technologies began to complicate patient care, thanks to massive federal funding of the health sciences. The crucial bonds of the physician-patient relationship were beginning to fray. Traditional Hippocratic medicine was breaking down rapidly, seemingly impotent in the face of pressing new questions brought on especially by advances in science and technology.

The Conferences

The "hot" questions we debate today in bioethics are not that new. Starting in the 1960's there were a series of conferences around the country on pop control, thought control, sterilization, cloning, artificial insemination, and sperm banks. One of the first, the "Great Issues of Conscience in Modern Medicine Conference" at Dartmouth College in 1960, hosted an array of scientific and medical savants, including the microbiologist Rene Dubos of the Rockefeller Institute, the physician Sir George Pickering of Oxford University, and Brock Chrisholm, a leading medical light of the World Health Organization, together with such famous humanists as C. P. Snow and Aldous Huxley.

The hottest topics then too were genetics and eugenics. Dubos declared that the prolongation of the life of aged and ailing persons and the saving of lives of children with genetic defects -- two benefits of post-World War II advances in medicine -- had created "the most difficult problem of medical ethics we are likely to encounter within the next decade." Geneticists worried that the gene pool was becoming polluted because the early deaths of people with serious abnormalities were now preventable. The Nobel Prize-winning geneticist Muller offered his own solution to that problem: a bank of healthy sperm that, together with "new techniques of reproduction," could prevent the otherwise inevitable degeneration of the race that might ensue thanks to medical advances that allowed the defective to reproduce."

At another conference, "Man and His Future," sponsored by the Ciba Foundation in London in 1962, the luminaries included Muller; Lederberg, winner of the Nobel Prize in medicine; the geneticists Haldane and Crick, and the scientific ethicist Bronowski. As at Dartmouth, concerns about human evolution, eugenics, and pop control were primary. The biologist Sir Julian Huxley declared, "Eventually, the prospect of radical eugenic improvement could become one of the mainsprings of man's evolutionary advance." Huxley proposed a genetic utopia that would include strict government controls over physiological and psychological processes, achieved largely by pharmacological and genetic techniques. They would also include cloning and the deliberate provocation of genetic mutations "to suit the human product for special purposes in the world of the future."

Other conferences of the 1960's delved further into the implications of science for medial ethics. One was a series of Nobel meetings in Minnesota in which many Nobel Prize winners participated. At the first of them, in 1965, whose theme was "genetics and the Future of Man," the Nobel physicist Shockley presented his maverick views on eugenics. He suggested that, since human intelligence was largely genetically determined, scientists would embark on serious efforts to raise the human race's "collective brainpower" by various means, including sterilization, cloning, and artificial insemination.

Also evolving during this time were new concepts of scientific and of medical ethics - "secular" ones that would be arrived at by "consensus" for purposes of public policy making - as if "consensus" would be somehow "neutral" and thus useful in our pluralistic, multicultural democratic society. This sort of thinking would become a major characteristic of the new field of bioethics yet to be formalized.
The think tanks

As the 1970's approached, the debates and their participants moved from conferences at universities to permanent think thanks. Callahan and Gaylin set up The Hastings Center outside New York City in 1969. There, such pioneers of bioethics as Dubos, Ramsey, Gustafson, Renee Fox, Arthur Caplan, Robert Veatch, even Senator Mondale and New York Times journalist Peter Steinfels brainstormed.

The first "research groups" at The Hastings Center likewise addressed such issues as death and dying, behavior control, genetic engineering, genetic counseling, pop control, and the conjunction of bioethics and public policy. In 1971, the first volume of the Hastings Center Report appeared, a publication that was to become "the Bible" of secular bioethics, just then acquiring its name. As Al Jonsen, a pioneer of bioethics, noted in his 1998 book, The Birth of Bioethics (Oxford), "The index of the Hastings Center Report over the next years defined the range of topics that were becoming bioethics and constituted a roll call of the authors who would become its proponents."

Under the leadership of the Dutch fetal-development researcher Andre Hellegers, the Kennedy Institute of Ethics opened at Georgetown University in 1971 (originally named the Kennedy Center for the Study of Human Reproduction and Development). [[I walked through its doors in 1979, as a member of the First Generationers - the first graduate student class in bioethics.]] Its mission was to study the ethical issues involved in reproductive research in a Catholic context. Such scholars as Richard McCormick, and later, Ed Pellegrino, worked out of the Kennedy Institute at various times. Also in the 1970's, a Protestant counterpart to the Kennedy Institute opened, the Institute on Human Values, sponsored by the United Ministries in Education, a partnership of the Methodist and Presbyterian churches - with Pellegrino serving as its first Director.

Many of the conference participants of the 1960's and the think-tank scholars of the 1970's were among those testifying before the Mondale and Kennedy congressional hearings that led to the passage of the National Research Act of 1974. Many in this army of secular scholars also sat on the committee that later issued the Belmont Report with its three bioethics principles. Those scholars were indeed, as Jonsen puts it, the midwives at the formal "birth of bioethics" that the 1974 congressional act had mandated. They were also the first formally designated "bioethicists."

IV. The formal birth of bioethics

Bioethics as understood and practiced today was actually "created" out of thin air by a Congressional mandate, with the passage of that National Research Act of 1974. The Act mandated that the Secretary of DHEW appoint a National Commission to: [1] "identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects", and [2] to "develop guidelines that should be followed in such research." As Jonsen, a member of that National Commission, later perceptively noted, "No legislation had ever before charged a government body to identify basic ethical principles as did Public Law 93-348."

Thus, in 1974, Secretary Weinberger appointed an eleven-member National Commission that in 1978 issued a document called The Belmont Report, which identified and defined these "ethical principles": respect for "persons" (immediately deconstructed to mean absolute "autonomy"), "justice", and "beneficence." To this day, those principles are called "the Belmont principles", the "Georgetown mantra", "principlism", "federal ethics", or simply "bioethics." Obviously, as we have seen, deducing from these different normative ethical principles of autonomy, justice and beneficence - especially as so curiously defined in The Belmont Report-- will lead to quite different conclusions about what is right or wrong in health care, as compared to deducing from other ethical principles.

Also, as Congressionally mandated, in 1981 the Belmont Report immediately became the explicit foundation for the guidelines that the U.S. federal government was to use when assessing the ethics of using human subjects in research. These Belmont principles, as originally, and curiously, defined, also underlie a host of other federal regulations and guidelines for medicine and medical research, and have worked their way into the private and international sectors as well.

V. Evaluation of Bioethics

There are several misconceptions about bioethics I would like to clarify.

1. First, bioethics is not really just the "general moral consensus of the people", but rather it is an idiosyncratic systematic academic theory of ethics alongside many other such academic ethical theories or systems competing for recognition in the universities -- bioethics simply being the one that was recently made up by an 11-member, politically appointed National Commission.

2. Second, bioethics should not be equated with the entire field of "ethics" per se, as often seems to be the implication today, but again, it is only a sub-field of ethics.

3. Third, bioethics is not a "neutral" ethical theory at all, but defines itself as "normative" - i.e., it takes a stand on what is right or wrong. In fact, there is no such thing as a "neutral" ethics - and that includes utilitarianism, consensus ethics, Kantianism, cultural relativism, emotivism, casuistry, communitarianism or any religious-based "ethics" as well.

4. Each of the three principles of the new bioethics was defined by bioethics as prima facie: i.e., no one principle could overrule any of the other two. However, bioethics theory itself does not provide a way to resolve any conflicts that arise among its principles. In dealing with real-life medical and scientific problems, the bioethicist was supposed to reconcile the values of all three principles.

5. Because the Belmont principles were derived from bits and pieces of fundamentally contradictory philosophical systems, the result was theoretical chaos. More problematically, when people tried to apply the new theory to real patients in medical and research settings, it didn't work because, practically speaking, there was no way to resolve the inherent conflicts among the three principles - other than arbitrarily.

6. The very definition of the bioethics principles is problematic. For example, while the Belmont Report gave a nod to the traditional Hippocratic understanding of BENEFICENCE as doing good for the patient, it also included a second definition of beneficence that was essentially utilitarian: doing "good for society at large." The report even declared that citizens have a "strong moral obligation" to take part in experimental research "for the greater good of society". This obviously contradicts the Hippocratic interpretation of beneficence, and it also violates time-honored international research guidelines, such as the Nuremberg Code and the Declaration of Helsinki, which bar physicians from experimenting on their patients unless it is for the patient's direct benefit.

The Belmont principle of JUSTICE was also defined along utilitarian lines, in terms of "fairness": i.e., allocating the benefits and burdens of research fairly across the social spectrum. This Rawls-influenced definition is obviously very different from the classic Aristotelian definition of justice as treating people fairly as individuals.

Even the Belmont principle of respect for persons - or AUTONOMY -- ended up serving utilitarian goals. Supposedly derived from Kant's respect for persons in which respect for the individual is absolute, the Belmont Report blurred that idea with Mill's utilitarian views of personal autonomy. In Mills' view, only "persons" -- that is, fully conscious, rational adults capable of acting autonomously -- are defined as moral agents with moral responsibilities. However, those incapable of acting autonomously -- infants, the comatose, those with Alzheimer's - were to become defined in bioethics theory as non-moral agents -- and thus as "non-persons", with quite different "rights" than "persons. It is only a short step from this kind of reasoning to that underlying Princeton ethicist Peter Singer's "preference" utilitarianism, in which animals have more rights as persons than young human children, and non-person humans can be used as objects for the greatest good of society.

Eventually, discontent began to smolder within the brave new discipline. Even the founders of bioethics have recently admitted that the Belmont principles present grave problems as guidelines for health care workers and researchers. The Hastings Center's Callahan baldly conceded that after 25 years, bioethics simply has not worked. But not to worry, he said, we'll try communitarianism now (yet another utilitarian theory): "The range of questions that a communitarian bioethics would pose could keep the field of bioethics well and richly occupied for at least another 25 years", Callahan cheered! Gilbert Meilaender has noted "how easily the [reality and worth of the individual human] soul can be lost in bioethics." National Commissioner Al Jonsen recently wrote that principlism should now be regarded as "a sick patient in need of a thorough diagnosis and prognosis." And, I would argue that until that is accomplished, our sick culture will remain confusing and contradictory.

7. Another reason for the theoretical and practical chaos surrounding bioethics these days is that almost anyone can be a bioethicist - slightly irritating to we bioethics graduate students who had to pass at least 60 graduate credits with an "A" average, pass three 8-hour written comprehensives, and write a doctoral dissertation defended university-wide! Few "professional" bioethics experts -- the doctors, researchers, and lawyers who sit on hospital and government bioethics committees -- have academic graduate degrees in the discipline, and even for those very few who do there is no uniform or standardized curriculum to which their degrees conform. Most professors of bioethics have only taken a community seminar or two, don't know the historical or philosophical roots of the subject they teach; the courses vary wildly from institution to institution; there are no local, state, or national boards of examination for bioethicists; and there are no real professional standards. There is not even a professional code of ethics for bioethicists.

Because of these criticisms, many nervous bioethicists now prefer to say that their field is more a form of "public discourse" than an academic discipline, a kind of "consensus ethics" arrived at by democratic discussion rather than by formal principles. The problem with this line of reasoning is that (1) there is no "level playing field" out there, and (2) the ethical principles used in the "discourse" are still exactly the same bioethics principles with the same curious definitions, and those who typically reach the "consensus" are the bioethicists themselves, not the patients, their families, or society at large, so the process is not exactly neutral or democratic. And if bioethics is just a "discourse," then why are its practitioners regarded as "ethics experts" - even in the court rooms?

VI. Erroneous science used by early bioethics

8. The use of false science propagated in bioethics pervades many medical ethics and medical research issues as well, and surely precludes health care workers from accurately forming their consciences about abortion, the use of abortifacients, genetic pre-selection, euthanasia, and a host of other related issues. Right from the start bioethics has propagated its own "science" and "medicine" in order to advance its own agenda. If the facts don't fit the agenda, just change the facts. Indeed, it is the erroneous "science" used so successfully in the issues at the beginning of life that grounded their erroneous concept of "person" - which concept was then simply transferred without fanfare to issues involving adults at the end of life. In order to prevent public scrutiny of this "conceptual transfer", bioethics relied brilliantly on the political strategy of making any and all public or academic discussions and debates on the "abortion" issue politically incorrect - off-base. No debates, no scrutiny, no problems. But the disturbing issues concerning the end of life simply cannot be thoroughly addressed without at least taking a look at this "conceptual transfer".

Of note, for example, the National Commission used several "odd" scientific definitions in its individual reports, e.g., in its Report on Fetal Research (1975) Even the Commission acknowledged this: "For the purposes of this report, the Commission has used the following definitions which, in some instances, differ from medical, legal or common usage. These definitions have been adopted in the interest of clarity and to conform to the language used in the legislative mandate" [referring to the National Research Act of 1974!]. Among such "unique" scientific definitions used by the Commission was that of the "fetus" as beginning at implantation (i.e., 5-7 days post-fertilization). Before that there was only a "pre-embryo". The terms "human being" and "human embryo" were never defined. Similarly, the OPRR federal research regulations, based explicitly on the Commission's Belmont principles, contain two "unique" scientific definitions. "fetus" and "pregnancy" are both defined as beginning at implantation! Again, no definitions of either "human being" or of "human embryo".

Of course, such "definitions" are rather bizarre, as the single dissenting report by National Commissioner Louisell pointed out. Science has known since the 1880's, with the publication of Wilhelm His' three-volume tome, Human Embryology, that fertilization was the beginning of the existence of the human being, the human embryo, using sexual methods of reproduction. Normal pregnancy also begins at fertilization in the woman's fallopian tube. And the "fetal period" doesn't even begin until the 9th week post-fertilization.

Clearly, such "odd" scientific definitions -- or re-definitions -- in the National Commission's Report and in the OPRR federal research regulations would simply serve the purpose of allowing the removal of "flushed" human embryos, and artificially produced human embryos (through 8-weeks-post fertilization), from any sort of governmental protection or oversight in the future -- especially given the growing interests in viable human embryos as biological materials for use in IVF "research" and "therapy". They would be especially prized for used in human cloning, human chimera, and all human genetic engineering research. But such "odd" scientific definitions would also be used as the basis for bioethics' "conceptual transfer" of "personhood" at the beginning of life to issues at the end of life - and all stages in-between. If, by using such false science, a human embryo or fetus - even a young child - is not a "person", then neither are adult disabled human beings, or those at the end of life.

VII. Erroneous 'personhood' theories used by bioethics

9. The issue of "personhood" is not a scientific, but is rather a philosophical issue. Nurses might keep in mind that the key to understanding any philosophical theory is to identify its "anthropology"-- or definition of "a human being" or "person". Different anthropologies lead to different ethical theories - which lead to different medical ethics theories. Some anthropologies match reality; others don't. Reality check:

Bioethics tries to claim that its theory really has no "anthropology". Bioethics is "just" about "ethics". However, almost all bioethics arguments incorporate a "personhood" claim on issues at both the beginning and at the end of life.

Philosophically, such a claim is per se a claim about "anthropology", and historically a very weak and academically indefensible one at that. It requires, e.g., that the soul and the body are two separate and independently existing substances. But think about it. If there is a real split or gap between the "mind" (or "soul") entity, and the "body" (or "matter") entity -- which is required if there is any "delay" in "personhood" at the beginning of life -- then one simply cannot successfully explain any causal interaction whatsoever between these two separate entities, either before or even after "uniting". Nor is there any scientific data to verify such a "split", nor any such "delay".

A lengthy response is not practical here, but solid arguments to refute such "delays" have been advanced for many centuries. E.g., if, the "rational soul" always contains virtually the sensitive and vegetative powers of the soul; if there is no split among the several powers of the soul itself; if there is no split between the soul and the body; if the body and soul must exist together as one single substance; and if there is scientific evidence that the "vegetative" power of the human rational soul is present immediately at fertilization (which there is), then the whole rational soul must be immediately present at fertilization - when "the matter is appropriately organized.

Personhood must begin when the human being begins. There is no frog, or carrot or tomato produced at fertilization -- and we know that empirically! Nor can this "delay" be legitimately reversed at the end of life - first the "rational" soul leaves, then the "sensitive" -- leaving only a "human vegetable". Empirically there is no such thing as a "human vegetable" - they exist only in bioethics text books.

It is long past time for us to recognize, acknowledge, and deal with the concrete reality that all human beings, at all stages of life, are human persons -- simply by virtue of their inherent human NATURE - not because of the active exercising of adult functions (which, BTW, must be caused by that human nature that is already there).

To choose not to acknowledge or deal with this information has already led to the acceptance, now almost habitual, of a two-tiered caste of human beings -- some of whom are "persons" and some of whom are not. If nothing else, the Nazi "science", rationalizations, propaganda, and concrete experiments -- and the on-going scourge of slavery and genocide -- should have taught us something about the inevitable real life consequences of such a human "caste" system.

The unheralded words of the single dissenting National Commissioner Louisell ring ominously clear: "American society is itself at risk -- the risk of losing its dedication to the proposition that 'all men are created equal.' We may have to learn once again that when the bell tolls for the lost rights of any human being, even the politically weakest, it tolls for all."

VIII. International bioethics' attack on the "sanctity of life ethic"

Although bioethics is unquestionably predominantly a "utilitarian" ethical theory, there are in fact many different kinds of "utilitarianism". Probably the most common in bioethics today is "preference" utilitarianism, actually a deconstruction of the classical utilitarianism of Bentham and Mill. A small sampling of some of the most articulate in the field could serve to indicate, in general, some of the main dogmas they hold in common -- which dogmas nurses currently meet on a daily basis, face to face, as "ethics" - but never recognize their "faces".

In "preference" utilitarianism an action is ethically correct if it satisfies the "preferences" of those affected -- and has the best consequences for the greatest number of "people". Modern utilitarianism, Bernard Williams explains, is supposed to be a system that is neutral (!) among the preferences that "people" actually have -- a "preference" being a reflection of the state of mind of the agent, and not to be judged by some standard of reasonableness other than whether it accords with the best utilitarian theory. Therefore, all preferences go into the melting pot, with no preference to count for more than any other; there must be "equal consideration of interests", as Singer puts it. But of course ultimately, these individual "interests" will be weighed UNEQUALLY against the total "good" or consequences for society as a whole -- a point about any utilitarian theory that is often overlooked or underestimated.

Of interest is the definition of "people" or "person" used in preference utilitarianism. "Persons" are those who have preferences, interests, desires, etc. For these utilitarians, not all human beings are "persons", while some animals are "persons".

Preference utilitarians especially need to attack those who hold the "sanctity of life ethic" ((which states that only human beings are "persons")), as simply prejudiced and racist tenets of "speciecism". As Oderberg explains the origins of this attack: "The charge was made famous by Peter Singer and is leveled by virtually all the followers of Singerian bioethics". They prefer instead a "quality of life" ethic. One way that "preference utilitarianism" attacks the "sanctity of life ethic" is by literally deconstructing or redefining it -- usually by means of "soft", meandering, but very clever "thought experiments" and pseudo "logical dialogues" that supposedly "evaluate" the "pros" and "cons" of the "sanctity of life ethic" - all in order to support a "quality of life" position.
Jonathan Glover:

One of the major theoreticians of "preference utilitarianism" for many decades has been Oxford philosopher/bioethicist/eugenicist Jonathan Glover. In his 1977 book, Glover literally redefines the "sanctity of life ethic" by means of redefining its major premise. Once that major premise is corrupted, of course, then all conclusions which flow from it will be corrupted as well.

The "sanctity of life ethic" is generally correctly stated as: "It is always a morally evil act to intentionally and directly kill an innocent human being." From that major premise it follows, e.g., that since human embryos and fetuses are innocent human beings, and since human disabled and terminally ill adults are also innocent human beings, to intentionally and directly kill them would be morally evil actions per se -- regardless of any "personhood" status, circumstances or intentions.

But Glover doesn't hold those actions to be "morally evil per se"; besides, he says, that would impede the advancement of global "positive eugenics" and genetic engineering which he, and most preference utilitarians, strongly advocate. So he redefines the major premise of the "sanctity of life ethic" itself as follows: "It is always intrinsically wrong to destroy a life that is worth living." Such a life would not be "mere biological life", but rather, as Glover vaguely describes it, the quality of life of one who consciously possesses preferences, plans, projects, desires, feelings, memories, a sense of identity, etc. -- what later came to be grouped together in bioethics and labeled "rational attributes" and/or "sentience". Only a "person" possesses a life that is worth living. Since unborn, born, and young human children, as well as many ill or disabled adult human beings, do not have this "quality of life", they do not have a "life that is worth living". They are not "persons" -- and therefore the direct and intentional killing of these human non-persons would not necessarily be a morally evil act. Voila! The "sanctity of life ethic" now is the "quality of life ethic"!
R. M. Hare:

Glover, in turn, was the academic mentor of Oxford philosopher/eugenicist R. M. Hare. For Hare, the early human embryo, fetus and even young child are not "persons". They are not "real people"; they are just "possible people" (that is, they don't exist yet) -- and thus have no serious "interests" or "preferences" to be respected. We do, however, have "some" duties" toward "them". So, applying a sort of mathematical trigonometry set theory to the problem, his international public pop policy proposals go like this: "The maximum duty that is imposed is to do the best impartially for all the 'possible people' there might be by having an optimal family planning or population policy, which means necessarily excluding some possible people." Indeed. Hare asserts that the best policy will be the one which produces that set of people, of all "possible sets" of people, which will have in sum the best life, i.e., the best possible set of future possible people." [[And I ask you, would you buy a used car from this man?!]] Hare's bioethics interests lie largely in translating the Gloverian theory of "preference" utilitarianism into British law and global pop policies via the UN. One of Hare's most prominent students at Oxford was Peter Singer.

Peter Singer:

Most bioethicists today -- to one degree or another -- agree that a "person" is to be defined in terms of such "rational attributes" or "sentience". What are really "morally relevant" are "quality of life" characteristics, "preferences", or "interests". So too argues Peter Singer, currently Professor of Bioethics at Princeton University's Center for Human Values. Like Glover and Hare before him, Singer -- the founder and first President of the International Bioethics Institute at the U. N., as well as the founder of "animal rights" -- argues that the higher primates, e.g., dogs, pigs, apes, monkeys -- even prawns -- are persons, because they actively exercise "rational attributes" and/or "sentience". However, some human beings, even normal human infants, as well as disabled and ill human adults, are not persons.

American philosopher/bioethicist Richard Frey, pushing Singer's logic, actually published an article in a major international bioethics and health care textbook that, since many adult human beings are not persons (e.g., Parkinson's patients, the mentally ill and retarded, the frail elderly, etc.), and since many of the higher primates are persons, then these adult human non-persons should be substituted in purely experimental destructive research in place of the higher primates who are persons.

Interestingly enough, Singer - as a preference utilitarian - does not believe in "rights" or "absolute autonomy" - unless their exercise increases the "greatest happiness for the greatest number of people" in the world! For example, Singer "allows" for a couple to "autonomously choose" to kill their unborn or born human child. But if the parents refuse, and if such an autonomous refusal would not be in the interests of "the greatest number of people", then he calls for the government to step in, do its "duty", and legally require them to do so! The same reasoning applies, BTW, to "living wills" and euthanasia.

Recently, Singer applied his form of "preference utilitarianism" to bestiality. He concluded that bestiality can be an "ethically correct" action, as long as it is not cruel, if it satisfies the preferences (e.g., sexual pleasure) of those affected (i.e., the human person and the animal), and if it has the best consequences for the greatest number of people involved (i.e., the total amount of "pleasure" experienced in the world would be increased). And, of course, since Singer defines many animals as "people", then "the greatest number of people" for Singer would include some human beings and some animals. Therefore, bestiality can indeed be "ethical". This is surely "theory" run amok!

Or consider the words of bioethics Founder Tris Engelhart, "Persons in the strict sense are moral agents who are self-conscious, rational, and capable of free choice and of having interests. This includes not only normal adult humans, but possibly extraterrestrials with similar powers."

Or, those of Winston Duke in 1972 in an article on the new biology in Reason Magazine:

"It is quite possible that the advances in human biology in the remainder of the twentieth century will be remembered as the most significant scientific achievement of the animal species known as Homo sapiens. But in order to become a part of medical history, parahuman reproduction and human genetic engineering must circumvent the recalcitrance of an antiquated culture. ... Fit the parts of the puzzle together: nucleus transplant, test tube growth to blastocyst and uterus implant -- the result is clonal man. ... An Eugenic Age is just around the corner. ... Under scientific management, the result can be human parts-farming: the methodical production of precious organs such as eyes, hands, livers, hearts, and lungs. ... The foremost philosophical problem presented by the new biology is semantical: What is a human being? ...Humanity per se is based on cognitive abilities. A philosophy of reason will define a human being as one which demonstrates self-awareness, volition and rationality. Thus it should be recognized that not all men are humans. The severely mentally retarded, victims of lobotomies, the fetus, blastocysts, androids, etc., are not human and therefore obtain no human rights. ... It would seem ... to be more "inhumane" to kill an adult chimpanzee than a newborn baby since the chimpanzee has greater mental awareness. Murder cannot logically apply to a life form with less mental power than a primate. ... It certainly follows that the practice of abortion is not immoral. And it is furthermore conclusive that experiments with fetal material and the engineering of non-thinking Homo sapiens tissues are not immoral. A clear definition of humanity in terms of mental acuity, rather than physical appearance, should be encouraged. And libertarians should continue to defend as absolute the prerogative of humans to conduct their own lives independent of societal norms, whether that conduct involves euthanasia, suicide, abortion, organ transplant, or ownership of genetic material. ... Likewise, the incentive for developing a rational philosophical framework including a psychology of self-esteem will be magnified. ... [I]t would be increasingly obvious that a philosophy of reason is needed to meet the test of present day living, and that it is the only orientation able to readily absorb the ever developing spectrum of scientific discovery."

Finally, hear Dan Wikler, as representative of the World Health Organization, declared that "The state of a nation's gene pool should be subject to government policies rather than left to the whim of individuals, ... The completion of the human genome project would also make it possible to promote some genetic qualities such as intelligence and lower the incidence of others. ... It may be conceivably required by justice itself," - i.e., "justice" as defined for bioethics by John Rawls.

IX. What bioethics means to prolife nurses

THIS is what "bioethics" means - or should mean - to prolife nurses. It is not "ethics per se", but rather "federal ethics". It is neither "neutral", nor just a "communal conversation". It is incapable of resolving conflicts among its very curiously defined, utilitarian "principles", and even its Founders agree that it just can't work. It is, instead, a "will to power", an evolution from eugenic-minded post-war savants of science, to eugenics we now hear echoed daily around the world as "global health care" by like-minded bioethicists. It advocates the violation of just about everything traditional medical ethics held dear, and for the deconstruction of our most genuine inherent human rights - including, and especially, the right to life of even the most vulnerable. Indeed, many have argued that "bioethics" per se is not "ethical"!

Yet THIS is the "ethics" that greets prolife nurses at the bedside - up-front and personal, on a daily basis --, the "ethics" that informs them which medical actions they take are right or wrong - or "compassionate" -- for their individual patients. It sanctions physician and even nurse killing of the terminally ill in the name of patient autonomy, the use of the mentally ill in high risk destructive medical research in the name of "beneficence", and pop control, involuntary sterilization and abortion in the name of "justice" - whichever principle works - and because none of these humans are "persons". And this is "compassion"???

No wonder you are confused and conflicted, "Jennifer" - but the problem is not you. It is the "ethics" that is being forced on you against your deepest intuitions.

Listen ..... to ..... them.

Thank you.


1. Based on Irving, "What is 'bioethics?'", UFL Proceedings of the Conference 2000, in Joseph W. Koterski (ed.), Life and Learning X: Proceedings of the Tenth University Faculty For Life Conference (Washington, D.C.: University Faculty For Life, 2002), pp. 1-84.




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