and educators. For those who wish to make a career in bioethics, many of our leading universities provide postgraduate degrees in the field, with graduates becoming consultants to nursing homes, HMOs, hospital organ procurement centers, and as scholars in think tanks.
Moreover, the influence of bioethicists has grown in the years since this book’s first edition. Bioethics is now an international movement, its advocacy pursued in virtually every developed country.
I was certainly not the first critic of the movement. Years before I entered the fray, the late philosopher and theologian Richard John Neuhaus succinctly described this oozing of bioethics into every nook and cranny of the West’s institutions when he wrote: “Thousands of ethicists and bioethicists, as they are called, professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable, until it is finally established as the unexceptional.”26
It is worth reflecting upon what has become unexceptional in contemporary medicine and public policy since Neuhaus wrote those words in 1988. Then, most people would have found it unthinkable to dehydrate cognitively devastated people to death by removing their feeding tubes. It might even have been criminal. Today, due in large part to vigorous advocacy by bioethicists, which in turn led to court cases27 and then to new laws permitting the practice, withholding “artificial nutrition and hydration” has become routine—and not just for those diagnosed as unconscious.
In 1988, assisted suicide was illegal in every country. Today, euthanasia is administered to an ever-widening cohort in the Netherlands, Belgium, and Luxembourg. It is legal in Quebec and was transformed by the Canadian Supreme Court into a Charter right in 2015. In the USA, assisted suicide has been legalized by statute in California, Oregon, Washington, and Vermont—with new legislative proposals pouring forth with the start of every state legislative session.
It was once unthinkable to procure organs from someone in a persistent vegetative state. Although that is not being done—yet—some of the most mainstream bioethicists and physicians in the organ transplant community dispassionately debate doing just that, in essence advocacy to permit killing for organs.28
Ironically, the medical ethics, public policies, and philosophical beliefs that mainstream bioethics espouses are being imposed on a public that does not share many of the underlying values upon which they are based. This results in a distinct and oppressive disconnection between the medical protocols and public policies forged by bioethics advocacy and the people impacted directly by them. Kass explains: “There is a kind of condescension toward the views of the general public [within bioethics] and a considerable divide about core moral views. The American people, as a whole, are a religiously affiliated or God believing people and it is on the basis of the wisdom of these traditions that they express their fears about the threats to sanctity of human life and to human dignity.” Kass further warns: “There is the very real danger that what constitutes a ‘meaningful life’ among the intellectual elite [who make up much of the bioethics establishment] will be imposed on the people as the only standard by which the value of human life is measured.”29
John Keown, former University of Cambridge law professor and current Rose F. Kennedy Professor of Christian Ethics at Georgetown University’s Kennedy Institute of Ethics, accurately identifies this fundamental conflict:
Traditional common morality, as its name suggests, comprises ethical principles common to civilized cultures. The notion that that there are certain objective principles which societies must respect if they are to quality as civilized, has been expressed in the West in the Hippocratic Oath in Judeo-Christian morality, the prohibition against killing the innocent, and in the common law. . . . [But] much of modern bioethics is clearly subversive of this tradition of common morality. Rather than promoting respect for universal human values and rights, it systematically seeks to subvert them. In modern bioethics, nothing is, in itself, either valuable or inviolable, except utility.
Much damage has already been done. Indeed, society is only vaguely aware of the extent to which their most basic presumptions about health care have been undermined.
CREATING A HIERARCHY OF HUMAN LIFE
“The traditional Western ethic,” a California Medicine editorial opined in 1970, “has always placed great emphasis on the intrinsic worth and equal value of every human life.” This “sanctity of life ethic,” the editorial continued, has been “the basis for most or our laws and much of our social policy” as well as “the keystone of Western medicine. . . . This tradition ethic is being eroded at its core and may eventually be abandoned. . . . Hard choices will have to be made . . . that will of necessity violate and ultimately destroy the traditional Western ethic with all that portends. It will become necessary and acceptable to place relative rather than absolute values on such things as human lives.”30
These chilling words were prescient. In the nearly fifty years since, that is exactly what has happened. Rather than believing in inherent human equality, most contemporary bioethicists measure the value of human life subjectively. Instead of embracing the human community—which means all of us—most bioethicists are concerned with the “moral community,” which in theory and often in practice excludes some of us. For most bioethicists, human rights—assuming they exist; not all believe in them—are not inalienable but must be earned based on criteria they created—and, as we shall see, may include animals. Thus, equality ceases to be a universal vision.
If these words seem harsh, consider the thinking of an influential philosopher, the late Joseph Fletcher, whose ideas had enormous impact on the West in the second half of the twentieth century. Fletcher is most famous for creating “situational ethics,” which emphasizes “cutting loose from moral rules” and “reasoned choice as basic to morality.”31 Applied to medical ethics and health care, situational ethics—along with Fletcher’s writing and pronounced persuasive skills—made him, in Albert R. Jonsen’s term, “the patriarch of bioethics.”32
Fletcher was a radical utilitarian whose stated goal was to maximize happiness and minimize suffering. That sounds good in the abstract, but once he had freed himself from “moral rules,” Fletcher developed a worldview that was paradoxically both anarchic and totalitarian. Thus, in the name of human freedom, he enthusiastically endorsed the wildest ideas, such as the manufacture of chimeras (part human, part animal) through genetic engineering.33 Yet individuals per se actually counted for little in his thinking, and those he perceived as interfering with the general pursuit of happiness were expendable.
Early on, Fletcher dismissed the traditional medical “reverence for life,” sniffing that “nobody in his right mind regards life as sacrosanct.” Developing his thesis from the then newly crafted right to abortion, Fletcher distinguished “human life” from what he called “personal life.” “What is critical,” he wrote in 1973, “is personal status, not merely human status.” He created a list of “criteria or indicators” that he hoped could be used to divide society between those individuals who possessed “humanhood” and those who did not—between “truly human beings” whom he saw as deserving of great moral concern and the “subpersonal,” or humans he deemed of scant consequence.34 He used the terms “humanhood” and “truly human” not as biological descriptions but as subjective terms to connote moral value.
The immediate problem facing Fletcher and those contemporaries who agreed with him was to devise a method for culling the human herd to prove that “we mean business.”35 Toward that end, Fletcher proposed a formula to gauge the quality of a human life “for the purposes of biomedical ethics.”36 These included a list of fifteen “criteria or indicators,”37 among which were:
• Minimum intelligence (score too low and one is deemed “mere biological life”);
