Theories of an Ethical Death

By Stella Baer | Monday, March 12, 2001

'Unbeknownst to most Americans, a small but influential group of philosophers and health care policy makers are working to transform our nation's medical practice and heath care laws.'

Thus begins Wesley J. Smith's calm, yet fervent attack on modern bioethics in Culture of Death: The Assault on Medical Ethics in America. Brimming with disturbing anecdotes and keen observations, Culture of Death explores the history of medicine and bioethics in the United States and reaches some horrifying conclusions. While there are not necessarily clear-cut answers to the problems Smith identifies, Culture of Death does reveal the trajectory of today's biomedical ethics, and the movement's frightening destination.

Smith's concern is that the Hippocratic Oath—'do no harm,' which has been the 'cornerstone of medicine' for millennia—has been supplanted with 'a stark utilitarian system that would legitimize medical discrimination against—and even in some cases, the killing of—the weakest and most defenseless people among us.' Worried that highly influential utilitarian bioethicists have plunged off the deep end, Smith believes that the new bioethics is leading the medical profession to 'reject what until now has been the core value of Western civilization: that all human beings possess equal moral worth.'

The abandonment of a 'sanctity-of-life ethic' has already transformed medical practice in America. Presently, 'desired medical treatment is refused in hospitals and nursing homes around the country to patients who are dying or disabled' and such mistreatment is 'justified as ethical under a new theoretical construct known as Futile Care Theory.' Essentially, Futile Care Theory proclaims the right of doctors—not patients or their families—to determine whether or not their patients deserve treatment.

Furthermore, doctors and nurses around the country often urge the relatives of brain-damaged patients to have loved ones dehydrated or starved to death through the removal of tube-supplied water and food. Even more alarming, research animals currently enjoy greater legal protection of their welfare under federal law than many men and women who participate in medical experiments. And in Oregon, assisted suicide is covered by Medicaid—while treatment of late-stage cancers and very low birth-weight babies is not.

This 'culture of death,' as Smith aptly calls it, is promoted as 'a compassionate response to the trials and tribulations of illness and a necessary adjustment to an obsolete, religiously based ethical system.' The result? 'Traditional morality and medical ethics are crumbling before our very eyes.'

While many bioethicists view their work as progressing towards a universal 'morality of medicine that will define the meaning of health, determine when life loses its value, and forge the public policies that will promote a new medical and moral order,' Smith recognizes bioethics as a social reform movement—and as Smith himself asks, 'has there been any social movement that was not predicated, at least to some degree, on ideology?' Historian Albert R. Jonsen, a bioethicist himself, admits that 'the final factor of great importance' in bioethics winning social acceptance was the 'emergence of a form of bioethics that dovetailed nicely with the reigning political liberalism of the educated classes in America.'

Smith also quotes sociologist Howard L. Kaye, who explains that many bioethicists firmly believe 'that there needs to be a radical transformation in how we live and how we think based on new biological knowledge because our values, our ethical principles, our self conceptions are based on outmoded religious ideas or philosophical ideas that they think have been discredited.' The fact that noted bioethicists are mostly atheists while the majority of American people—the supposed beneficiaries of bioethics—are religiously affiliated is no minor point. As Smith concludes, 'the ultimate bioethics agenda is startlingly radical: dismantling traditional Western values and mores and forging a new ethical consensus based on values that most people do not presently share.'

But is this really a cause for immediate concern? According to Smith, 'bioethics advocacy is pervasive within the nation's most important institutions. In the last thirty years—financed by billions of dollars in foundation grant money—bioethics ideology has spread throughout the depth and breadth of the educational, medical, legal, business, and governmental establishments to become one of the most influential cultural forces in the country.'

Bioethicists help make laws, testify as expert witnesses in groundbreaking lawsuits, and even advise important politicians—all the way up to the President of the United States. Bioethics is taught to all medical school students, as well as postgraduate students on their way to becoming lawyers, business executives, government policy makers, and educators. Bioethicists are doing nothing less than shaping the moral values of those best suited to direct the future of American society.

As Smith sounds his clarion call to resistance, the arrival of a new volume from perhaps the most prominent and influential bioethicist illuminates the emerging trends. In Peter Singer's new collection of essays, somewhat ironically entitled Writings on an Ethical Life, Singer argues that because Christianity (pure 'mumbo jumbo') is the basis for most of our moral intuitions, we can now conclude that many of our 'moral teachings just hang in the air, without foundations.' He also concedes that 'ethical ideals, like individual rights, the sanctity of life, justice, purity are incompatible with utilitarianism,' which is Singer's ethical framework and that of most bioethicists.

In over two dozen essays, Singer spells out why infanticide and euthanasia are entirely acceptable, why apes should be allowed to testify in courts, and why most humans are guilty of 'specieism' ('a prejudice or attitude of bias in favor of the interests of members of one's own species and against those of members of other species'). Singer pushes political liberalism beyond anyone's furthest expectations.

While his descriptions of the merciless torture of baby calves before slaughter are compelling, Singer does not advocate treating animals humanely (such a notion is specieist, as advocating the humane treatment of African American slaves would be racist); he believes animals should have equal rights as humans. The modern meat industry, Singer believes, is far worse than the Holocaust.

At the same time, Singer gives 'pro-choice' a new, chilling definition. He holds that a woman's 'right to choose' pertains after the baby is born, and that it is perfectly 'moral' for a mother to kill her infant if she so desires. The 'two crucial characteristics' an animal or human must possess in order to be a 'person'—that is, a being of moral worth, deserving of legal rights—are rationality and self-consciousness. Species is irrelevant, of course. Thus, while 'whales, dolphins, monkeys, dogs, cats, pigs, seals, bears, cattle, sheep' are 'persons,' human infants and people with brain damage are not.

So while infanticide is permissible, and may be morally required in some cases, pork chops are criminal murder.

It is worthwhile to emphasize that Singer is not writing from the confines of an asylum. In fact, Singer enjoys one of the most prestigious academic posts in the country as the Ira W. DeCamp Professor of Bioethics at Princeton University's Center for Human Values. And he is exactly the sort of 'academic' Smith fears most.

Smith draws a direct comparison between today's bioethics and 'eugenics,' the term Darwin's cousin Francis Galton coined in 1883 to apply to his theories that humans must 'take control of their own evolution by using selective breading techniques to improve society's physical, mental, cultural, and social health.' According to Smith, '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... Modern bioethics, like eugenics before it, creates hierarchies of human worth intended to justify medical discrimination.'

Eugenics was once taught in more than 350 American universities and colleges, and was endorsed in more than 90 percent of high school biology textbooks during the 1920s. Eugenics, Smith continues, became the fuel of Nazism and the Holocaust. What Smith finds so frightening are the similarities between eugenics and modern bioethics: 'Both movements reject equal human moral worth. Both are utilitarian-based, seeking to improve overall human happiness and reduce human suffering—sometimes at the expense of individual human rights. Like today's bioethics theories, eugenics was taught in some of the world's most prestigious universities, and most eugenics societies 'were dominated by professionals such as professors, social workers, lawyers, doctors, teachers and ministers.''

Many might say that Smith goes too far here—that comparing 21st century America to Nazi Germany is ludicrous. But Smith claims that such a view is na've, and complete 'self-deception.' He quotes one of the world's foremost experts on the medical history of the Holocaust, Dr. Leo Alexander, as saying that with regard to the Holocaust:

Whatever proportions [the] crimes finally assumed, it became evident to all who investigated them that they started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of physicians. It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronologically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans.

Smith notes that in Germany and Austria, 'countries with an acute memory of the euthanasia of the Holocaust,' Singer is forbidden to lecture. He also reminds us that 'acknowledging past evils is far easier than recognizing abuses in the present.'

But while the stakes are high, and the picture Smith paints of the present is far from positive, he insists that he is nevertheless optimistic about the future. Smith claims that the modern bioethics movement can be stopped; we won't be able to return to the past, but if we once again embrace a traditional morality we will be able to save future generations from past excesses, as when eugenics went too far.

Smith insists that assisted suicide should be illegal, and that while physicians should always have the right to argue their position in dialogue with patients and families, they must not be allowed to abandon patients based on their personal opinions about the quality of the patients' lives. He argues that we must never come to believe, as Singer does, that those with brain damage or any sort of disability have less of a claim to life than the rest of us do. Moral worth should rest in the fact of being human.

Likewise, while treating animals humanely is certainly commendable, we should not trivialize past injustices by equating animal rights with human rights. 'We must create a vibrant, robust, and influential school of bioethics that can effectively challenge the utilitarian bioethics movement in all venues in which it operates. Such a 'Human Rights Bioethics' would analyze and boldly propose health care public policies upon the foundational belief that each of us is equal.'

While Smith's Holocaust parallel may sound to many of us like a conspiracy theory of sorts, it is difficult to blame him for alarmism when intellectuals like Singer are behind one of the most influential social movements in America. Culture of Death illustrates a society devoid of the governing principles of the past, with the West's foundational tenet—that all human beings possess equal moral worth—abandoned. And it is a grim picture indeed.

Theories of an Ethical Death

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