Friday, June 5, 2009

A Bioethics Rooted In Love

John, at Upturned Earth, pointed me to this essay, Toward a Bioethics of Love by Helen Rittelmeyer at Doublethink Online.

I think this is a valuable discussion. Social conservatives struggle with the whole autonomy thing. I don't know if it's because they can't refute it without resorting to God, or because they believe that God already answered the question and there is no autonomy. Perhaps if they choose the root for bioethics, maybe we can find a way to a common ground that respects the beliefs of each kind of person.

Here is what I had to say:

I think you misstate Autonomy. Autonomy comes to us from ancient Greek: αυτονόμος autonomos, from auto “self” + nomos, “law”: one who gives oneself his/her own law. In modern use in ethics and philosophy, this means self-determination in the context of moral choices. In medicine, for example, this often takes the form of “informed consent” - the autonomous individual chooses for his- or herself. So when you say, “They think so because they believe people are fundamentally autonomous—a strange fiction.” And you are correct, except that you, too, hold some strange fiction that inter-dependence somehow compromises autonomy. It doesn’t. Autonomy is about choice in the context of constraints, external or internal. A person with certain specific disabilities is less self-sufficient than a more or less normally functioning human being, but his or autonomy is not thereby lessened.

In your 91% are included several genetic malformations other than DS. Among them is Anencephaly, a truly horrific malformation where there is essentially no head above the eyes and no brain much above the stem. Babies who survive birth live for hours only. This does not obviate your point about 15% so much as provide a footnote - there may in fact be lives so short and horrific that to not terminate the pregnancy is to insure unimaginable suffering of the parents and the baby.

Science has no vision of the world at all. Some, or even most, practitioners of science do. That vision is as multifaceted as the human beings that hold it. Undoubtedly some human beings, scientists included, envision a perpetually comfortable and easy world. Others hope to reduce disease, or improve the environment, or find some measure of peace for the mentally ill. You have created a straw man, a scientist that may or may not exist for real, but one that surely does NOT hold the view of many, or even most, scientists.

Finally, you have presented no rationale for exchanging love for autonomy as a basis for bioethics. Explain to me how that would work on an informed consent form. Explain to me how an individual making a moral choice could sublet that choice to another, even if love was at the heart of the relationship. Who bears responsibility for the action that follows the moral choice?

As a sketch, this is more of a thin straw. I wouldn’t care that it so were it not that so many conservatives seek just such a straw to which they can cling in their efforts to shut their ears to ethics discussions rooted in autonomy.

There may be such a thing as a bioethics rooted in love. I encourage you to sketch out your thoughts more fully, so that discussion can continue.

I hope she pursues her sketch further. This kind of discussion can only help.


Update - it seems I am not welcome at Doublethink, either. Another post deleted. Such is life!

'Nuther update - Doublethink put the post back. That's thinking twice? Also, read comments for my response (not the only one, just the last one) to John at UE.

1 comment:

  1. John, we all have many beliefs, but only a few can be a basis for ethical behavior. Love can certainly be a component of ethical behavior, but it can also be destructive and self-serving. Beyond that, how should you treat people for whom you feel no love? Helen’s paean to her sister is primarily one of love, but for whom, exactly? For her sister who likely doesn’t know love, but only security and relative comfort? I know, and believe, that love is not something we feel but rather something we do. Even so, how do you apply love? How do determine the difference between self-serving and selfless love?
    You need ethics. You have the church to help you. I do not. The rules, if law is to be sourced in them, must apply to and for us equally, though we believe differently.
    Let’s look at Helen’s sister from the pov of the golden rule. Did Helen mention what her sister might want, even once? If she did, I couldn’t find it. As it is, her sister couldn’t comprehend the question, much less answer it. But we can imagine how we might feel in her place, what our desires might be were we to become aware that her fate was ours. We might choose to not suffer that fate. Not because we don’t want the that life but because we don’t want to be that burden. We might decide that whatever grace Helen and her parents acheive because of their care for us, the burden of our care is too high a price. And who knows, if we do not burden their life, perhaps they will adopt a deserving child, or bear another one who bring them joy less alloyed with pain.
    We actually have a model for such a choice - Do Not Resuscitate instructions and living wills. Here people make judgements about their life, not the life of some other person. In certain situations where the potential for resuscitation is likely to arise, a significant fraction of people choose to not be resuscitated. Is this act of autonomy a selfish or a loving act? It is a loving act, I believe. Not that it matters what I believe.
    Were such a thing possible, what would the beings in that 91% have to say? I know what I would say. I would take a pass, thank you. I would not burden those who would come to love me. I have made that decision in my life.
    On another note, Doublethink put my comment back up. A perfect example of their name!