Bioethicists Who Give Ethicists a Bad Name

I remember that when I first heard of Jack Marshall, who blogs at Ethics Alarms, my opinion of him was colored by the fact that he claimed to be a professional “ethicist.” I had a strong negative reaction to that word. It sounded to me like a self-aggrandizing title that someone would make up for themselves in the hope that it would make people take their opinions and moralizing condemnations more seriously. I later realized that my low opinion of ethicists was influenced by my low opinion of some prominent bioethicists. In particular, I was disturbed by the views of bioethicist Leon Kass, who was chairman of the President’s Council on Bioethics during the Bush administration.

I first heard about him in connection with human cloning, which he opposed. There are a number of good practical reasons to oppose human cloning, such as the high likelihood of birth defects, but Kass’s reasons — once stripped of their vague references to nebulous concepts of human dignity — amounted to little more than his vigorous assertion that “it’s icky.” He not only acknowledged this, but even exulted in it, titling his most famous anti-cloning article “The Wisdom of Repugnance.”

We are repelled by the prospect of cloning human beings not because of the strangeness or novelty of the undertaking, but because we intuit and feel, immediately and without argument, the violation of things that we rightfully hold dear. Repugnance, here as elsewhere, revolts against the excesses of human willfulness, warning us not to transgress what is unspeakably profound.

In other words, he doesn’t like human cloning for reasons he can’t really explain rationally, but he’s sure that his personal disgust is the correct reaction. That’s little more than an appeal to ignorance and bigotry. I’m sure that many homophobes “intuit and feel, immediately and without argument” that gay marriage is a violation of things they hold dear. And I have no reason to believe that the folks at Stormfront are lying when they say that they are disgusted by interracial sex. (Although, in both cases, see reaction formation.) But the problem with Kass’s position is not just his disgust, but his attempt to hold up his personal disgust as a higher form of truth.

It’s not just cloning that bothers him. Kass has this to say about the general effort to extend human life:

Laboratory assisted reproduction, artificial organs, genetic manipulation, psychoactive drugs, computer implants in the brain, and techniques to conquer aging — these and other present and projected techniques for altering our bodies and minds pose challenges to the very meaning of our humanity.

[…]

I wish to make the case for the virtues of mortality. Against my own strong love of life, and against my even stronger wish that no more of my loved ones should die, I aspire to speak truth to my desires by showing that the finitude of human life is a blessing for every human individual, whether he knows it or not.

[…]

Confronted with the growing moral challenges posed by biomedical technology, let us resist the siren song of the conquest of aging and death.

That’s not the attitude toward medicine that I want to hear from a man who had the ear of a President.

I do realize Kass is not representative of most bioethicists — he acknowledges as much with his criticism of other bioethicists — and I know that bioethicists give a lot of practical policy advice…but for a while there it seemed like every time I heard the word “bioethicist” in the news, some self-important twit was opposing medical progress or personal medical freedom in the name of vague ethical concerns.

All of which brings me to a story that Jeff Gamso posted about a few weeks ago about a death row inmate named Ronald Phillips who wanted to donate his organs after his execution to help out a sick relative.

This raises a bunch of thorny ethical issues: Is his consent to the donation truly voluntary? Does using organs from executed criminals create an incentive to execute people for their organs? Can the execution procedure and the organ harvesting procedure be combined without violating medical ethics?

Personally, I think that last issue is an insurmountable hurdle, at least the way executions are carried out today. They’d have to find a way to make Phillips so decisively dead that a surgeon would have no ethical reason not to take his organs but not so completely dead that it would damage any of those organs. And this careful killing would likely have to be done in a sterile operating room with medical personnel standing by so that the surgeons can start work immediately after he dies, but no medical personnel could be involved in the killing itself. That’s so different from how executions are done today that I don’t think we could get there from here.

But I’m hardly an expert, and this seems like exactly the sort of issue where bioethicists could make a valuable contribution. If we take it as a given that the state is going to execute Phillips — that he’s going to die regardless of any doctor’s wishes and regardless of what happens to his organs — it seems like there ought to be some way to achieve the entirely ethical goal of saving an innocent life that the condemned man himself wants his organs used to save. Perhaps there’s a way to design a careful protocol for an execution and an organ harvest that would work around the state’s killing and allow the doctors to save a life without contributing to a death. This seems like something a thoughtful bioethics expert could figure it out.

Unfortunately, the bioethicist interviewed for the AP wire story isn’t that thoughtful. He apparently opposes Phillips’s organ donation for the dumbest and most unethical reason I’ve ever heard of:

Medical ethicist Arthur Caplan of New York University said organ donation is incompatible with the goals of punishment.

“It’s unethical because this guy who’s being executed raped and killed a 3-year-old. When you donate your organs, there’s a kind of redemption,” Caplan said. “Punishment and organ donation don’t go well together. I don’t think the kinds of people we’re executing we want to make in any way heroic.”

Phillips wants to donate a kidney and his heart to save two of his relatives. I don’t know what will happen to them if they don’t get his organs. Perhaps they are high enough on the waiting lists that they will get organs from someone else, but that just means that someone else won’t get those organs and will have to wait. Organ transplants are life-saving procedures, and there is a nationwide shortage of both hearts and kidneys, so if Phillips can’t donate his organs, there will be an inevitable cascade down through the waiting lists, and at some point somewhere, two people will die.

That’s an awful high price that Caplan wants a pair of unknown strangers to pay, all because he doesn’t want anyone to mistake a child murderer for a hero. It’s this kind of thinking that makes me cringe when I hear the word “bioethicist.”

(To be fair to Caplan, much of his writing seems thoughtful, and he points out that using untested drugs for execution is arguably a form of human experimentation that likely wouldn’t pass IRB review, which strikes me as a pretty good point. Also, in a more scholarly piece in The American Journal of Bioethics he gives a brief survey of many of the issues related to using prisoners — condemned or not — as sources of organs, and although he mentions the conflict between the goals of execution and organ donation again, he clearly describes it as only one issue among many.)