by Andrew Ferguson –
The disgrace of medical ethics.
On the list of the world’s most unnecessary occupations—aromatherapist, golf pro, journalism professor, vice president of the United States—that of medical ethicist ranks very high. They are happily employed by pharmaceutical companies, hospitals, and other outposts of the vast medical-industrial combine, where their job is to advise the boss to go ahead and do what he was going to do anyway (“Put it on the market!” “Pull the plug on the geezer!”). They also attend conferences where they take turns sitting on panels talking with one another and then sitting in the audience watching panels of other medical ethicists talking with one another. Their professional specialty is the “thought experiment,” which is the best kind of experiment because you don’t have to buy test tubes or leave the office. And sometimes they get jobs at universities, teaching other people to become ethicists. It is a cozy, happy world they live in.
But it was painfully roiled last month, when a pair of medical ethicists took to their profession’s bible, the Journal of Medical Ethics, and published an essay with a misleadingly inconclusive title: “After-birth Abortion: Why should the baby live?” It was a misleading title because the authors believe the answer to the question is: “Beats me.”
Right at the top, the ethicists summarized the point of their article. “What we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.”
The argument made by the authors—Alberto Giubilini and Francesca Minerva, both of them affliliated with prestigious universities in Australia and ethicists of pristine reputation—runs as follows. Let’s suppose a woman gets pregnant. She decides to go ahead and have the baby on the assumption that her personal circumstances, and her views on such things as baby-raising, will remain the same through the day she gives birth and beyond.
Then she gives birth. Perhaps the baby is disabled or suffers a disease. Perhaps her boyfriend or (if she’s old-fashioned) her husband abandons her, leaving her in financial peril. Or perhaps she’s decided that she’s just not the mothering kind, for, as the authors write, “having a child can itself be an unbearable burden for the psychological health of the woman or for her already existing children, regardless of the condition of the fetus.”
The authors point out that each of these conditions—the baby is sick or suffering, the baby will be a financial hardship, the baby will be personally troublesome—is now “largely accepted” as a good reason for a mother to abort her baby before he’s born. So why not after?
“When circumstances occur after birth such that they would have justified abortion, what we call after-birth abortion should be permissible.” (Their italics.) Western societies approve abortion because they have reached a consensus that a fetus is not a person; they should acknowledge that by the same definition a newborn isn’t a person either. Neither fetus nor baby has developed a sufficient sense of his own life to know what it would be like to be deprived of it. The kid will never know the difference, in other words. A newborn baby is just a fetus who’s hung around a bit too long.
As the authors acknowledge, this makes an “after-birth abortion” a tricky business. You have to get to the infant before he develops “those properties that justify the attribution of a right to life to an individual.” It’s a race against time.
The article doesn’t go on for more than 1,500 words, but for non-ethicists it has a high surprise-per-word ratio. The information that newborn babies aren’t people is just the beginning. A reader learns that “many non-human animals … are persons” and therefore enjoy a “right to life.” (Such ruminative ruminants, unlike babies, are self-aware enough to know that getting killed will entail a “loss of value.”) The authors don’t tell us which species these “non-human persons” belong to, but it’s safe to say that you don’t want to take a medical ethicist to dinner at Outback.
But what about adoption, you ask. The authors ask that question too, noting that some people—you and me, for example—might think that adoption could buy enough time for the unwanted newborn to technically become a person and “possibly increase the happiness of the people involved.” But this is not a viable option, if you’ll forgive the expression. A mother who kills her newborn baby, the authors report, is forced to “accept the irreversibility of the loss.” By contrast, a mother who gives her baby up for adoption “might suffer psychological distress.” And for a very simple reason: These mothers “often dream that their child will return to them. This makes it difficult to accept the reality of the loss because they can never be quite sure whether or not it is irreversible.” It’s simpler for all concerned just to make sure the loss can’t be reversed. It’ll spare Mom a lot of heartbreak.
Now, it’s at this point in the Journal of Medical Ethics that many readers will begin to suspect, as I did, that their legs are being not very subtly pulled. The inversion that the argument entails is Swiftian—a twenty-first-century Modest Proposal without the cannibalism (for now). Jonathan Swift’s original Modest Proposal called for killing Irish children to prevent them “from being a burden to their parents.” It was death by compassion, the killing of innocents based on a surfeit of fellow-feeling. The authors agree that compassion itself demands the death of newborns. Unlike Swift, though, they aren’t kidding.
They get you coming and going, these guys. They assume—and they won’t get much argument from their peers in the profession—that “mentally impaired” infants are eligible for elimination because they will never develop the properties necessary to be fully human. Then they discuss Treacher-Collins syndrome, which causes facial deformities and respiratory ailments but no mental impairment. Kids with TCS are “fully aware of their condition, of being different from other people and of all the problems their pathology entails,” and are therefore, to spare them a life of such unpleasant awareness, eligible for elimination too—because they are not mentally impaired. The threshold to this “right to life” just gets higher and higher, the more you think about it.
And of course it is their business to think about it. It’s what medical ethicists get paid to do: cogitate, cogitate, cogitate. As “After-birth Abortion” spread around the world and gained wide publicity—that damned Internet —non-ethicists greeted it with derision or shock or worse. The authors and the editor of the Journal of Medical Ethics were themselves shocked at the response. As their inboxes flooded with hate mail, the authors composed an apology of sorts that non-ethicists will find more revealing even than the original paper.
“We are really sorry that many people, who do not share the background of the intended audience for this article, felt offended, outraged, or even threatened,” they wrote. “The article was supposed to be read by other fellow bioethicists who were already familiar with this topic and our arguments.” It was a thought experiment. After all, among medical ethicists “this debate”—about when it’s proper to kill babies—“has been going on for 40 years.”
So that’s what they’ve been talking about in all those panel discussions! The authors thought they were merely taking the next step in a train of logic that was set in motion, and has been widely accepted, since their profession was invented in the 1960s. And of course they were. The outrage directed at their article came from laymen—people unsophisticated in contemporary ethics. Medical ethicists in general expressed few objections, only a minor annoyance that the authors had let the cat out of the bag. A few days after it was posted the article was removed from the publicly accessible area of the Journal’s website, sending it back to that happy, cozy world.
You’d have to be very, very well trained in ethics to see the authors’ argument as a morally acceptable extension of their premises, but you can’t deny the logic of it. The rest of us will see in the argument an extension of its premises into self-evident absurdity. Pro-lifers should take note. For years, in public argument, pro-choicers have mocked them for not following their belief in a fetus’s humanity to its logical end. Shouldn’t you execute doctors who perform abortions? Why don’t you have funerals for miscarriages?
As one pro-choice wag, writing about the Republicans’ pro-life platform, put it in the Washington Post a few years ago: “The official position of the Republican Party is that women who have abortions should be executed.”
And now we know the pro-choice position is that children born with a facial deformity should be executed too, as long as you get to them quick enough. Unwittingly the insouciant authors of “After-birth Abortion” have shown where pro-choicers wind up if they follow their belief about fetuses to its logical end. They’ve performed a public service. Could it be that medical ethicists really are more useful than aromatherapists?