Bioethics and the Human Goods

An Introduction to Natural Law Bioethics

Alfonso Gómez-Lobo, John Keown

• Editorial: Georgetown University Press
• Año: 2015
• ISBN:
  9781626161641
• Categoría: Medicine
• Categoría: Ethics in Medicine

Bioethics and the Human Goods offers students and general readers a brief introduction to bioethics from a "natural law" philosophical perspective. This perspective, which traces its origins to classical antiquity, has profoundly shaped Western ethics and law and is enjoying an exciting renaissance. While compatible with much in the ethical thought of the great religions, it is grounded in reason, not religion. In contrast to the currently dominant bioethical theories of utilitarianism and principlism, the natural law approach offers an understanding of human flourishing grounded in basic human goods, including life, health, friendship, and knowledge, and in the wrongness of intentionally turning against, or neglecting, these goods.

The book is divided into two sections: Foundations and Issues. Foundations sketches a natural law understanding of the important ethical principles of autonomy, non-maleficence, beneficence, and justice and explores different understandings of "personhood" and whether human embryos are persons. Issues applies a natural law perspective to some of the most controversial debates in contemporary bioethics at the beginning and end of life: research on human embryos, abortion, infanticide, euthanasia, the withdrawal of tube-feeding from patients in a "persistent vegetative state, " and the definition of death. The text is completed by appendices featuring personal statements by Alfonso Gómez-Lobo on the status of the human embryo and on the definition and determination of death.

Part I

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Foundations

Chapter 1

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Bioethical Thinking

Stella, a research scientist, arrives at work early in the morning and changes into her white lab coat. She opens the freezer and removes a container. Inside the container are six human embryos that have been shipped from a fertility clinic the day before. They are so-called spare embryos, left over from fertility treatment at the clinic. Fred and Sandra, who had been trying without success for two years to have a baby through sexual intercourse, had gone to the clinic to seek help, and the clinic had recommended in vitro fertilization (IVF). Ten embryos were created by mixing Sandra’s eggs with Fred’s sperm. All ten were examined under a microscope. Two were judged defective and left to one side to die. The other eight were judged to be of adequate quality, and two of those embryos were implanted into Sandra’s womb. Fred and Sandra asked for the remaining six, the “spares,” to be donated for scientific research, as they were “surplus to requirements.”

Stella is engaged in a research project into embryonic stem cell research. These cells are special: they have the power to differentiate into other types of cells, such as skin cells and liver cells. Stem cells can be found in early embryos and in adult human beings.¹ But Stella’s research involves stem cells taken from embryos, not adults. Stella hopes that by studying embryonic stem cells, she, together with other scientists involved in such research, will eventually be able to help doctors use them to treat patients who suffer from diseases like diabetes or cancer or Alzheimer’s. But the research inevitably involves the destruction of the human embryos. Should Stella, as part of her research project, proceed to disaggregate the embryos in order to extract their stem cells even though this will destroy the embryos? Some will reply that she should proceed because what she is about to do is morally permissible. Others, however, will answer that it is seriously immoral. How can one decide with some degree of confidence which of these two answers is correct? We need first to analyze the action itself and then assess it from a moral point of view.

The analysis of the action can be said to be an exercise in—or application of—what philosophers call the “theory of action” or “action theory.” This is a descriptive discipline that attempts to make an action intelligible by identifying the person who is acting (the agent), the point of the action, the intention of the agent, and the circumstances in which it is performed (Gómez-Lobo 2002, chap. 5). If we do not know who performs a certain action or what exactly it consists in, we may very well fail to understand it. Likewise, knowing what the agent intends and when and where the action is performed may also be crucial in reaching a correct understanding of what, precisely, is being done.

These inquiries (Who? What? Why? In what circumstances?) do not tell us that an action is right, acceptable, or permissible; that it is desirable; or that it is good that it be performed. In action theory we do not pass judgment, and we do not assign blame or praise. We dissect a whole and divide it into its constituent elements in order to understand it. It is simply an attempt to grasp what is or has been done. Action theory certainly involves more abstract ingredients because it presupposes some general understanding of what it is to be an agent (and not just someone advising an agent or following orders from an agent); of what constitutes in general the core of an action (as opposed to its peripheral elements); and, above all, of what it means for an agent to intend and not merely to foresee the consequences of his or her action.

In bioethics it may not be necessary to explore the abstract ingredients of action theory so long as we can successfully accomplish what is needed at the more particular level. In the example at hand we understand that the agent, Stella, is the researcher (and not one of the lab assistants or lab cleaners); that the action is the dismantling of human embryos; that the agent intends to extract embryonic stem cells with the further goal of making progress in biomedical research (and not for frivolous reasons), and that she is in the appropriate setting for doing the work (she is not engaged in rogue experiments in her garage without institutional approval). None of these observations settle the bioethical question. Indeed, we may ask: What is the bioethical question in the first place? Insofar as it is an ethical question it is twofold: it is a question about an action, and it is a question about an agent.

Ethical questions about the agent who performs an action are questions of responsibility, of blame or praise. A judgment about an agent’s blameworthiness depends on various factors, including what the agent knew, what she intended (in the ordinary sense of what her aim or purpose was), and what she chose to do. Everyone should act according to his or her conscience. This is not to say that because a judgment is made conscientiously it is therefore morally right. Slave owners may have conscientiously thought they were right to own slaves. Nazis may have conscientiously thought they were right to gas Jews. We can still judge that, whether or not the agent was personally blameworthy, her action was wrong. Moreover, an agent may be blameworthy in the way she arrives at her conscientious judgment; for example, she may have overlooked matters she should have taken into account. Many conscientious judgments are carelessly made.

How does one judge an action from a moral point of view? The moral point of view is not the only alternative. We often judge actions (our own and those of others) from a prudential point of view. The prudential point of view is adopted when the primary consideration is the benefit or the interests of the agent. When one parks one’s car, it is imprudent to leave valuables in view. When it is icy underfoot, it is imprudent to wear slippery soles. If Stella, the researcher in our example, is working with funds from a grant awarded specifically to research on embryonic stem cells, it might be imprudent for her to refuse to disaggregate the embryos. Her grant may be withdrawn and she may even lose her job. Whether an action is or is not morally correct clearly does not depend on prudential considerations.² If a person says, “This is correct because it is in my best interests,” she would be giving a justification that few if any would accept. In deciding moral permissibility, the primary criterion is clearly not simply benefit to the agent.

Some philosophers have held that moral permissibility is strictly a function of the features of the particular case. Taken to the extreme, this view entails the claim that one can “see” that this concrete action was right and that the other one was wrong. Sometimes the technical term “casuistry” is used to describe a method in ethics that starts in this manner from “considered opinions” about particular kinds of action, real or imagined, and then makes similar opinions about larger classes of action. This is a “bottom-up” or inductive conception of morality. A person directly observing Stella may instantly reach the conviction that she is doing nothing wrong. She is just extracting stem cells. If other researchers do the same thing, so the thinking goes, they also would not be doing anything wrong. The end step in this inductive way of ethical reasoning would be to make a general claim about actions of this sort: extracting stem cells from human embryos is ethical.

However, this approach to moral reasoning is flawed. The method relies heavily on an analogy with a method of scientific thinking that starts from direct observation. Multiple observations of particular instances of a phenomenon may lead to a reliable generalization, and this is possible because sensible properties are perceptible and for the most part measurable, either directly or by means of instruments. Moral properties, on the other hand, are neither perceptible nor measurable. If X claims that a particular action is “wrong,” X cannot justify that claim by appeal to something X perceives, in the way that X could do if X claimed that something was “hot.” The terms “hot” and “wrong” stand for very different sorts of property. X can justifiably claim that a given object is hot because that is how it affects X’s touch or registers a temperature on a thermometer. But X cannot justifiably claim that an action is wrong because X feels it is wrong or can somehow measure its wrongness. There is no such thing as a moral thermometer. Slave owners felt it was right to own slaves. Nazis felt it was right to gas Jews. Did those feelings make their actions right?

Sometimes observation or consideration of a particular action may be followed by reflection, and the conviction that it was right or wrong may be reached after some time has elapsed. This is what we usually call “a considered opinion.” Although it may seem that a considered opinion has been drawn exclusively from the particulars of the case, in fact a more general ingredient is necessarily involved, for by its very structure a considered opinion is a judgment. To judge, for example, that a particular defendant is guilty of a crime is to hold that on a specified occasion he broke the law, and the law is a set of general rules.

A swift moral judgment may be passed with little or no reflection on the fact that one is subsuming or bringing a case under a rule. In fact, it often happens that the pertinent rule, such as the wrongness of rape, has been internalized long ago through education or because of the prevalence of that rule in the culture, and this contributes to the mistaken impression that the morality of what was done can be “read off” the particulars of the action itself. The fact that judgment may be swift and involve little reflection does not mean there was no judgment at all and that there was merely moral “feeling” or “intuition.”

A good reason to deny that we have such direct intuitions and insights comes from the fact that in our exchanges in real life we demand that allegedly intuitive claims be justified. If X says that it seems to him intuitively correct for Dr. M to treat patient P without consent, you can always ask “Why?” X will probably say, for example, that P has the Ebola virus and treatment is justified to prevent its spread to the community. If X provides some such justification for his intuition, he has gone beyond the particular case. X has made explicit the rule under which tacitly, and even perhaps unconsciously, he subsumed or brought the case. Not to do so would be to misunderstand how we use the terms “right” and “wrong” when we talk to each other. Both terms demand reasoned justification from a general perspective, not just personal feelings or intuitions. It may of course be that our judgments confirm our intuitions, but they may not. In any event, our moral judgments should rest on reason, not feeling.

If the appeal to rules is built into our moral language, then the next step in our ethical reflection about Stella’s research must be to face the following question: Is there a rule or norm that prohibits or allows the dismantling of human embryos? The question is ambiguous. In one sense it asks whether there are accepted moral norms of what philosophers have sometimes called positive morality that bear on this issue. Moral norms do not exist in the same way in which horses exist and centaurs do not exist—that is, as objects in space and time. Norms exist only as rules for action that are thought about, whether with acceptance or rejection, by a particular human community. If we take a narrow view of community and ask whether the natives of a remote area in the Amazon basin have a norm about the proper treatment of human embryos, we embark on a futile inquiry because they have not achieved the technolog...