Transcript Challenges to Human Dignity in Secular Bioethics

Challenges to Human
Dignity in Secular Bioethics
14th AFCMA Congress 2008
Human Dignity in Medicine
Catholic Diocese Center,
Hong Kong
Fr. Joseph Tham, L.C.
B.Sc., B. Phil., B.Theo., M.D., M. Bioethics, Ph.D.
Outline
• Traditions of Human Dignity
• Secular approaches to Bioethics
– Against Human Dignity
– In favor of Human Dignity
• Our post-human future?
Traditions of Human Dignity
• Greeks: Stoics (Aristotle, Plato): acquired
– Excellence, aristocratic, elitist?
• Christian: intrinsic
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Image of God, Redeemed
Equality as creatures, not creator
co-creators
Lower than the gods and higher than the beasts
• Modern philosophy (Kant):
– Reason, autonomy, freedom
– Man not treated as means but as an end.
– But too abstract, not existential enough (courage)
• Human Nature  Human Dignity  Human Rights
Secular Bioethics
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No to tradition: Hippocratic Oath, authority
No to Metaphysics
No to Natural Law
No to Human nature vs culture (nurture)
No to Religion
No to Reason
Outline
• Traditions of Human Dignity
• Secular approaches to Bioethics
– Against Human Dignity
– In favor of Human Dignity
• Our post-human future?
Secular Bioethics against Human
Dignity
• Scientific positivism
• Scientific materialism
– Darwinism
• Against human specificity (exceptionalism)
• Human reason (soul) is mechanical, not spiritual
– Transhumanism
– Neuroscience and neuroethics
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Contractualism
Utilitarianism
Liberalism
Pragmatism
Relativism and Nihilism
Scientific Positivism
• Comte: Scientism, Scientific positivism
– Science (empirical data) is the only source of
knowledge
– Progress is infinite
– No limits to research, technological imperative
• Stem-Cell Hypocrisy: “The Christian right’s
wrongheaded invocation of religion to restrict
stem-cell research ranks up there with the
medieval sanctioning of Galileo because his
scientific views conflicted with church
doctrine.”– Newsweek 5/27/2005
Scientific Materialism
• Descartes
– Dualism: Body and soul two different substances.
• Hobbes
– Material universe, no human souls
– Human behavior is a stimulus-response of “appetites
and aversions”
– Animals = humans
• Skinner, behavioral scientist
– ‘animal’ is a pejorative term only because ‘man’ has been
made spuriously honorific…
– “How like a dog! …like a dog he is within range of
scientific analysis.”
Scientific Materialism
• Joseph Fletcher’s 4 indicators of Humanhood
– Minimal intelligence, Self-awareness, capacity to
relate to others, neo-cortical function
– Not non- or anti-artificial, not essentially parental,
not essentially sexual, not a bundle of rights, not a
worshipper
Scientific Materialism
• As far as the scientific enterprise can determine. . .
[h]uman capabilities appear to differ in degree, not in
kind, from those found among the higher animals.
• Humanity's rich repertoire of thoughts, feelings,
aspirations, and hopes seems to arise from
electrochemical brain processes, not from an immaterial
soul that operates in ways no instrument can discover. . .
• Views of human nature rooted in humanity's tribal past
ought not to be our primary criterion for making moral
decisions about cloning. . . .
• The potential benefits of cloning may be so immense
that it would be a tragedy if ancient theological scruples
should lead to a Luddite rejection of cloning. --Francis
Crick and E. O. Wilson
Darwinism
• Human is just a part of nature, no special
dignity.
• Coll: Animals, plants or nature has dignity.
• Animal Rights
– Peter Singer: Speciesism (racism)
• Chimpanzees and humans share 97% genetic info
• Animal culture? Dominance structure and helping
behavior
• Chimpanzee Justice: “abandon the assumption that ethics
is uniquely human.”
– Spain’s Great Ape Project: the rights to life, liberty,
and freedom from torture to great apes and devolve
humans into a "community of equals" with
chimpanzees and gorillas.
Darwinism
• Plant’s rights
– Switzerland’s constitution amendment established the
intrinsic dignity of individual plants, based on the many
similarities they share with us at the molecular and cellular
levels.
– Vegetation has an inherent value and that it is immoral to
arbitrarily harm plants by, say, "decapitation of wildflowers at
the roadside without rational reason."
– Dr. Keller recently sought government permission to do a
field trial of genetically modified wheat that has been bred to
resist a fungus. He first had to debate the finer points of
plant dignity with university ethicists. Then, in a written
application to the government, he tried to explain why the
planned trial wouldn't "disturb the vital functions or lifestyle"
of the plants. He eventually got the green light.
Darwinism
• Nature
– Ecuador’s constitution, “Nature or Pachamama [the Goddess
Earth], where life is reproduced and exists, has the right to
exist, persist, maintain and regenerate its vital cycles, structure,
functions and its processes in evolution.” Every virus,
bacterium, insect, tree & weed has constitutional rights
– Paul Taylor: all living beings have moral worth (dignity). “We
can think of the good of an individual nonhuman organism
as consisting in the full development of its biological powers.
Its good is realized to the extent that it is strong and healthy.”
– Alan Gregg: “The world has cancer and the cancer is man”
Transhumanism
• Solutions are to be found in future science and
technology.
– AI, cybernetics, Nanotechnology, regenerative medicine, stem
cells, cloning, hybrids, chimeras…
• Self-directed evolution to some better form of life and
overcome present limitations.
– Why not seize this power? Why not control what has been
left to chance in the past? Indeed, we control all other
aspects of our children’s lives and identities through powerful
social and environmental influences and, in some cases, with
the use of powerful drugs like Ritalin and Prozac. On what
basis can we reject positive genetic influences on a person’s
essence when we accept the rights of parents to benefit their
children in every other way? --Lee Silver, geneticist
Transhumanism
• Joseph Fletcher: Specialize capacities of people
– By cloning, constructive genetic engineering, bio-engineer or
bio-design para-humans or “modified men”—as chimeras
(part animal) or cyborg-androids (part prostheses).
– I would vote for cloning top-grade soldiers and scientists, or
for supplying them through other genetic means, if they were
needed to offset an elitist or tyrannical power plot by other
cloners—a truly science-fiction situation, but imaginable.
– I suspect I would favor making and using man-machine
hybrids rather than genetically designed people for dull,
unrewarding or dangerous roles needed nonetheless for the
community’s welfare—perhaps the testing of suspected
pollution areas or the investigation of threatening volcanoes
or snow-slides
Transhumanism
– Testes and ovaries are social by nature and it would appear
ethically that they should be controlled in the social interest
– Hybrids could also be designed by sexual reproduction, as
between apes and human. If interspecific coitus is too
distasteful, then laboratory fertilization and implant could do
it. If women are unwilling to gestate hybrids animal females
could. Actually, the artificial womb would bypass all such
repugnancies.
Neuroethics
• Steven Pinkers, Harvard psychologist
– Morality is biologically based. could be reproduced
if complex enough
– The brain is a very complex computation machine,
but a machine nonetheless.
– Morality is simply a function of the brain, and that if
one rewired the brain, morality would change. So, for
example, people might be rewired to crave incest and
to have a taste for eating dirt.
Neuroethics
• Unfortunately for that theory, brain science has shown
that the mind is what the brain does. The supposedly
immaterial soul can be bisected with a knife, altered by
chemicals, turned on or off by electricity, and
extinguished by a sharp blow or a lack of oxygen.
Centuries ago it was unwise to ground morality on the
dogma that the earth sat at the center of the universe.
It is just as unwise today to ground it on dogmas
about souls endowed by God.
Neuroethics
• Richard Dawkins, The Selfish Gene
• Evolution of morality
– Morality is a product of learning and convention, like toilet training,
social justice may be modified—revised, augmented, deepened.
– Morality has evolved from animal behaviors to more complex human
ones.
– Darwin, “A tribe including many members who, from possessing in high
degree the spirit of patriotism, obedience, courage and sympathy, were
always ready to aid one another and to sacrifice themselves for the
common good would be victorious over most other tribes; and this would
be natural selection.”
– Ethics is rooted in social instincts supplied by our genes
• No universal morality, multiculturalism = moral relativism
• Determinism, no free will
Secular Bioethics against Human
Dignity
• Scientific materialism
– Darwinism
• Against human specificity (exceptionalism)
• Human reason (soul) is mechanical, not spiritual
– Transhumanism
– Neuroscience and neuroethics
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Contractualism
Utilitarianism
Liberalism
Pragmatism
Relativism and Nihilism
Contractualism
• Consensus but not truth:
– Principlism, Rawls, Nussbalm, etc
• Hobbes’ Leviathan: The Value or worth of a man, is,
as of other things, his price; that is to say, so much as
would be given for the use of his Power; and therefore
it is not absolute; but a thing dependent on the need
and judgment of another…. The publique worth of a
man, which is the Value set on him by the
Commonwealth, is that which men commonly call
dignity.
• Reason unable to find consensus: Engelhardt
Utilitarianism
• Quality of Life, ends justifies means, $$
• Peter Singer
– Australian, Princeton Chair of Human Ethics since
1999
– All and only beings that can (now) experience
suffering or enjoyment have interests; and therefore
have moral status.
• Voluntary euthanasia, Non-voluntary euthanasia of “nonpersons”, Experimentations on brain-damaged humans,
Eugenics, Infanticide
Utilitarianism: Infanticide
• “Since neither the neonate nor the fish is a person,
killing these beings is not morally as negative as killing a
person.”
• “In modern era of liberal abortion laws, most of those
not opposed to abortion have drawn a sharp line at
birth. If, as I have argued that line does not mark a
sudden change in the status of the foetus, then there
appear to be only two possibilities: oppose abortion or
allow infanticide. In our book Should the Baby Live, we
suggested that a period of 28 days after birth might be
allowed before an infant is accepted as having the same
right to life as others. This is clearly well before the
infant could have a sense of its own existence over
time, and would allow a couple to decide that it is better
not to continue with a life that has begun very badly.”
Utilitarianism: Infanticide
• Among philosophers and bioethicists, the
view that I was to defend is by no means
extraordinary; if it has not quite reached the
level of orthodoxy, it, or at least something
akin to it, is widely held, and by some of the
most respected scholars in the fields of both
bioethics and applied ethics.
• Harvard, Yale, Princeton, Oxford, Tufts,
Texas, etc.
Utilitarianism: Infanticide
• Joseph Fletcher, (1905-1991) Co-Founder, Program in Biology and
Society, first professor of medical ethics University of Virginia; Professor
of Christian Ethics, Harvard Divinity School
• Dan W. Brock, Frances Glessner Lee Professor of Medical Ethics and
director of Medical Ethics, Harvard University, and previously director of
the Center for Biomedical Ethics, Brown University
• Norman Daniels, Mary B. Saltonstall Professor of Population Ethics,
Harvard University, and former Goldthwaite Professor of Philosophy and
Medical Ethics, Tufts University;
• Shelly Kagan, Clark Professor of Philosophy, Yale University and former
Henry R. Luce Professor of Social Thought and Ethics;
• Michael Sandel, Anne T. and Robert M. Bass Professor of Government,
Harvard University.
• Ronald Dworkin, Emeritus Professor of Law, Oxford University,
Professor of Philosophy and Frank Henry Sommer Professor of Law,
New York University.
Utilitarianism: Infanticide
• Jonathan Glover, director and professor, Centre of Medical Law and
Ethics, King’s College, London
• R.M. Hare (1919-2002), the late White’s professor of Moral
Philosophy at Oxford University.
• Julian Savulescu, director of Oxford’s Uehiro Centre for Practical
Ethics, head of the Melbourne-Oxford Stem Cell Collaboration, and
editor of Journal of Medical Ethics.
• James Hughes, Professor of Health Policy, Trinity College, Hartford
Conn.
• John Harris, Sir David Alliance professor of bioethics, University of
Manchester, England
• Helga Kuhse, senior research fellow at Centre for Human Bioethics at
Monash University, Australia
• Tom Beauchamp, Professor of Philosophy and Senior Research
Scholar, Kennedy Institute of Ethics, Georgetown University.
Utilitarianism: Infanticide
• Baruch Brody, Professor of Philosophy, Rice University.
• Tristram Engelhardt, Professor of Medicine, Baylor College of
Medicine and Professor of Philosophy, Rice University.
• John A. Robertson, Vinson and Elkins Chair in Law, University of
Texas, and Chair of the Ethics Committee of the American Society for
Reproductive Medicine.
• Michael Tooley, professor of philosophy, formerly at University of
Western Australia and presently at University of Colorado.
• Richard Frey, professor of philosophy, Bowling Green State University.
• James Rachels (1941-2003), professor of philosophy, University of
Alabama, Birmingham
• Gregory E. Pence, Professor of Philosophy, Schools of Medicine and
Arts/Humanities, University of Alabama
Utilitarianism: Infanticide
• The Groningen Protocol for Euthanasia
in Newborns
– 22 cases of severe spina bifida in Holland
from 1997-2002
– Newborns with no chance of survival.
– Infants who may survive after a period of
intensive treatment, but expectations
regarding their future condition are very
grim.
– Babies with an extremely poor prognosis
who do not depend on technology for
physiologic stability and whose suffering is
severe, sustained, and cannot be alleviated.
Utilitarianism: Infanticide
• ACTIVELY ending a life can sometimes
be more humane than waiting for a
person to die, and in the desperate cases
where death does not come of its own
accord to end unendurable suffering, the
morally right thing to do is to summon it.
Hilde Lindemann - Marian Verkerk, “Ending the Life of a
Newborn: The Groningen Protocol”, Hastings Center Report
1 (2008), 42-51.
Secular Bioethics against Human
Dignity
• Scientific materialism
– Darwinism
• Against human specificity (exceptionalism)
• Human reason (soul) is mechanical, not spiritual
– Transhumanism
– Neuroscience and neuroethics
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Contractualism
Utilitarianism
Liberalism
Pragmatism
Relativism and Nihilism
Liberalism
• Pro Choice, autonomy: abortion, euthanasia
• Technological imperative
• Human Fertilisation and Embryology Act, UK
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Creation of animal-human embryos,
artificial gametes,
cloning using two maternal egg sources,
germline manipulation,
preimplantation diagnosis for eugenic purposes,
posthumous conception,
removal of the child’s need for a father,
use of tissue without proper consent
Liberalism
• Martha Nussbaum, Professor of Law and Ethics
at the University of Chicago.
– I think we ought to seek political principles that have
a moral content but that avoid contentious
metaphysical notions (for example, the notion of the
soul)…
– Respecting human dignity requires informing people
about their choices, restricting dangerous choices for
children, but permitting adults to make a full range
of choices, including unhealthy ones.
– Prostitution, drug use, killing embryos, abortion,
cloning, suicide and euthanasia okay, but not research
on animals.
Pragmatism
• Ruth Macklin, “Dignity is a Useless Concept,” BMJ 327
(2003): 1419-1420.
– Dignity “is a useless concept in medical ethics and can be
eliminated without any loss of content.”
– Dignity “means no more than respect for persons and their
autonomy.”
– Reducible to autonomy or a Trojan horse for religion.
• Functional reductionism
– Dignity is attributed, not inherent
– Can be absent or lost (embryo, fetus, PVS, etc.)
– E.g., Dignity in Dying, Dignitas
Relativism and Nihilism
• My demand upon the philosopher is known, that he take
his stand beyond good and evil and leave the illusion of
moral judgment beneath himself. This demand follows
from an insight which I was the first to formulate: that
there are altogether no moral facts. Moral judgments agree
with religious ones in believing in realities which are not
realities. Morality is merely an interpretation of certain
phenomena—more precisely, a misinterpretation. Moral
judgments, like religious ones, belong to a stage of
ignorance at which the very concept of the real, and the
distinction between what is real and imaginary, are still
lacking: thus “truth”, at this stage, designates all sorts of
things which we today call “imaginings”. Moral judgments
are therefore never to be taken literally: so understood,
they always contain mere absurdity.
-Nietzsche
Outline
• Traditions of Human Dignity
• Secular approaches to Bioethics
– Against Human Dignity
– In favor of Human Dignity
• Our post-human future?
Positive secular attempts
• Jürgen Habermas
– German philosopher, The Future of Human Nature
– Not based on intrinsic dignity of human life of the
human embryo.
– Liberal defense of human dignity based on equality
– Dialogue with Benedict XVI.
• Joseph Cardinal Ratzinger and Jürgen Habermas, Dialectics
of Secularization: On Reason and Religion.
Positive secular attempts
• Francis Fukuyama, Our Posthuman Future
• President’s Council on Bioethics
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Leon Kass, Edmund Pellegrino
On Being Human
Human Cloning and Human Dignity
Bioethics and Human Dignity
• Virtue ethics (e.g. MacIntyre)
• Philosophy of nature (Maritain)
Positive secular attempts
• Human Rights
– Nuremburg trials, slavery
– Preamble to the United Nations’ Universal Declaration of
Human Rights (1945): “All human beings are born free and
equal in dignity and rights.”
– Dignity appears in about four constitutions in the period
1900–1945 and in more than thirty-seven from 1945 to 1997.
– Charter of Fundamental Rights of the European Union: “Human
dignity is inviolable. It must be respected and protected.”
– The German Basic Law: “Human dignity shall be inviolable. To
respect and protect it shall be the duty of all state authority.”
– UNESCO Declaration on Bioethics and Human Rights
Human Rights
• The meaning, content, and foundations of human
dignity are never explicitly defined.
• Political consensus, not a philosophical or moral treatise
on human nature and the rights and dignities attending
human nature
• It is difficult to define what human dignity is. It is not
an organ to be discovered in our body, it is not an
empirical notion, but without it we would be unable to
answer the simple question: what is wrong with
slavery?—Leszek Kolakowski
Human Rights
• Via Negativa: when rights are denied
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Holocaust
Slavery
Genocide
Ethnic cleansings
Political murders of dissidents in totalitarian regimes
Religious coercion
Human trafficking
Torture and degradation of prisoners
Urban slums
Outline
• Traditions of Human Dignity
• Secular approaches to Bioethics
– Against Human Dignity
– In favor of Human Dignity
• Our posthuman future?
Eugenics
Hybrids
Cloning
Embryonic stem cell
Prenatal selection
IVF
Infanticide
Euthanasia
Abortion
Homosexuality
Divorce
Premarital sex
Contraception
Masturbation
Domino
effect
Our posthuman future
• Growth hormone to make children taller;
• Pre-implantation genetic screening to
facilitate eugenic choice and enhancement
• Ritalin and other stimulants to control
behavior or boost performance on exams;
• Prozac and other drugs to brighten moods
and alter temperaments, increase muscle
mass, sexual performance, etc.
Our posthuman future
• Drugs to erase painful or shameful memories
or to simulate falling in love.
• Genes to increase the size and strength of
muscles.
• Nano-mechanical implants to enhance
sensation or motor skills.
• Techniques to slow biological aging and
increase the maximum human lifespan.
• Better children, superior performance,
ageless bodies, and happy souls.
Brave New World
• Aldous Huxley
– Mastery of human nature and human troubles
through technology can issue in a world peopled by
creatures of human shape but of shrunken
humanity—engaged in trivial pursuits; lacking
science, art, religion, and self-government; missing
love, friendship, or any true human attachments; and
getting their jollies from high-tech amusements and
a bottle of soma. --Leon Kass
The Abolition of Men
We reduce things to mere Nature in order that we may
“conquer” them. We are always conquering Nature,
because “Nature” is the name for what we have, to
some extent, conquered... As long as this process
stops short of the final stage we may well hold that
the gain outweighs the loss. But as soon as we take
the final step of reducing our own species to the
level of mere Nature, the whole process is stultified,
for this time the being who stood to gain and the
being who has been sacrificed are one and the same.
C.S. Lewis, The Abolition of Men, 43.
Prospects
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Reconciliation, unity
Renewal
Education, Formation
Religious input
Engagement
Testimony
School of Bioethics
Regina Apostolorum, Rome
[email protected]
[email protected]
www.upra.org