A Matter of Life and Death : Provocative work suggests that medical advances require reconsideration of some cherished ethics : RETHINKING LIFE AND DEATH: The Collapse of Our Traditional Ethics, <i> By Peter Singer (St. Martin’s Press: $22.95; 256 pp.)</i>
The miracle of modern medical technology is accompanied by a curse, just as every silver lining has its cloud. Consider, for example, poor Anthony Bland. At the age of 17, this British schoolboy was almost crushed to death during a stampede at a football stadium in which 95 people lost their lives. Since most of his brain was destroyed by oxygen deprivation, Tony Bland was arguably the 96th victim.
He was left comatose, without hope of regaining consciousness, but his oblivion did not seem peaceful. He was fed by a tube through his nose to his stomach; his bladder was emptied by a catheter, which sometimes became the site of infection. Because his joints stiffened, he lay rigidly contracted into a fetal pose, sometimes vomiting from reflex movements in his throat.
Neither his parents nor his doctors believed this was much of a life, but modern medical practices permit him to be kept in this state for years, even decades.
When, if ever, do lifesaving advances wrongly prolong death? When is it permissible to end the life of a patient in a persistent vegetative state?
Such knotty ethical questions are considered in “Rethinking Life and Death.” This ambitious broadside by Peter Singer, a professor of philosophy, social reformer and one of the founders of the animal-rights movement, takes on the traditional ethic concerning life and death, proposes a new one, then shows how this ethic fits in the great moral scheme of things. Singer’s argument is clear, passionate and short, although many readers will find it nasty and brutish.
At issue is the conventional Judeo-Christian doctrine that all and only human life is intrinsically valuable; that it is invariably wrong to take innocent human life, including your own, regardless of its quality, and invariably right to be fruitful and multiply. So goes the reasoning of the opponents of abortion, suicide, euthanasia and, most recently, the use of anencephalic infants as organ donors.
Singer holds that the doctrine of the sanctity of life is pompous anthropocentric nonsense, which, when applied, produces paradoxical results: We are obliged to bring unwanted children into an overpopulated world and to force unwanted life on those who choose to die. And it necessitates grotesque science-fiction scenarios of brainless infants and the permanently comatose kept alive at no benefit to themselves and great cost to others, particularly their families.
Using nitty-gritty legal case studies drawn from the United States, Britain, Germany and his native Australia, Singer shows how this view has broken down in the world of respirators and in-vitro fertilization.
In the case of Tony Bland, the House of Lords ruled that his doctors could lawfully end his tragic life; it was a landmark decision. In many similar situations, physicians who choose to withhold food or treatment from comatose patients disguise their intentions by using sophistical distinctions to bring their practice into line with what the doctrine commands. Thus ordinary measures such as tubal feeding and the use of respirators and antibiotics are deemed “extraordinary” when the patient’s condition is hopeless; and doctors who cannot voluntarily hasten death can administer drugs intended to relieve pain with “the unintended but foreseen consequence” of hastening death.
We’ve even redefined death itself, Singer notes, to avoid hospitals filled with people who will never regain consciousness and to enable some of them to donate their organs. Once respiration and circulation cease (the condition formerly known as death), some organs become unsuitable for transplantation. But if we stipulate that the irreversible loss of all brain function marks death, it becomes possible to remove life supports and organs from a warm and breathing being. This fiction is so useful that no one objects to it, even though no one really believes that the brain dead are dead, only that they ought to be. As Singer points out, brain death is an “ethical choice masquerading as a medical fact.”
Such intellectual contortions are necessary, Singer maintains, because the theoretical center will not hold. He compares these ratiocinations to the complicated epicycles devised by the Ptolemaic astronomers, who were unable to predict planetary motions while they assumed that the sun revolved around the earth. Similarly, Singer believes that we cannot develop a serviceable ethic until we have what amounts to a Copernican revolution in morals: Man must remove himself from the center of the ethical universe.
Singer takes science as seriously as conventional moralists take religion. He dismisses the Old Testament account of man as a special being created in God’s image, with dominion over the rest of nature. Instead, Singer bases his ethic on a Darwinian view of man as one among other animal species, one who shares many emotional and psychological features with his fellow creatures, and who is a part of nature rather than its conqueror. “The more intellectually sophisticated non-human animals have a mental and emotional life that in every significant respect equals or surpasses that of some of the most profoundly intellectually disabled human beings,” he writes. “Only human arrogance can prevent us seeing it.”
Emphasizing that we are more closely related to the chimpanzee than the chimpanzee is to the gorilla, Singer says non-humans have a right to ethical treatment insofar as they possess morally relevant characteristics such as consciousness, self-awareness and rationality. The worth of human life varies too, in his view, and depends on such factors as the capacity for physical, social and mental interaction, the conscious preference for continued existence and the capacity to enjoy it.
Singer’s set of new commandments includes respecting a person’s wish to live or die, and, when deciding such issues, accepting responsibility for the consequences of what we fail to do as well as what we do. Instead of urging us to be fruitful and multiply, he asks us to bring only wanted children into the world.
Not everyone will welcome this radical shift in perspective, which some may perceive as a demotion for humankind. Speciesism, as Singer describes it, is analogous to racism, and will doubtless prove as difficult to eradicate as to pronounce. Many people may resist treating fish and fetuses as moral equals or balk at regarding infanticide as more ethically acceptable than meat eating. Yet there is no denying the profound logical and emotional appeal of animal rights, a movement that has already made significant inroads on conventional behavior.
Whatever the fate of his own ethic may be, Singer is certain that the old order is on its way out, and predicts that the next major battle will be for the legalization of voluntary euthanasia or medically assisted suicide, which have been obtainable for some time in the Netherlands.
These ideas are controversial and have as many natural enemies as all of Darwin’s children. But they are coherent, lucid and fresh, and presented in a non-didactic voice that resonates with goodwill. “There may be better ways of remedying the weaknesses of the traditional ethic,” Singer writes. “The title of this book suggests an ongoing activity: We can rethink something more than once. The point is to start, and to do so with a clear understanding of how fundamental our rethinking must be.” Amen.
