Bioethics is an expanding area of moral philosophy which in recent years has attracted public attention. Moral philosophers are widely read and consulted on topics such as euthanasia, abortion, and genetic engineering.
But, in the view of the authors of the papers collected in this book, it is the wrong moral philosophers who have won the ear of the political, legal and medical professions. As a result, they claim, ethical decision-making on life and death issues has become dehumanised.
Moral philosophers may be divided into absolutists and consequentialists. Absolutists believe that there are some kinds of actions which are intrinsically wrong and should never be done no matter what the consequences are of refraining from doing them. Consequentialists believe that the morality of actions should be judged by their consequences, and that there is no category of act which may not, in special circumstances, be justified by its consequences. It is consequentialists, not absolutists, who have been forming establishment opinion on bioethical topics. This is because they talk in the cost-benefit terms that technologists and policy makers instinctively understand. The editors and authors of this book seek to redress the balance and to show that bioethics can be done in a non-consequentialist manner, which, without relying on religious beliefs or supporting reactionary political ideals, preserves the respect for human beings which is fundamental to sound morality.
The key essay in the attack on consequentialism is Nicholas Denyer's. He points out that the greatest moral philosophers, and the major religious traditions, have all held absolutist conceptions of morality. He argues that the fundamental assumptions of consequentialism are incoherent. Consequentialism sees morality as essentially the making of decisions about how to spend one's time: of the alternatives open to me, which action will maximise the amount of goodness in the universe? Denyer argues that it is unrealistic to believe that the actions within our power can be partitioned into alternatives in this way. Moreover, states of the universe cannot be ranked or evaluated in the way consequentialism demands. The calculations to decide on the best alternative are quite beyond our power; and even if they were not, it is not necessarily irrational to go for the good rather than the best.
The most famous form of consequentialism is the utilitarianism founded by Jeremy Bentham who thought that the consequence to be sought in action was "the greatest happiness of the greatest number". One question which that formula leaves open is "greatest number of what?". Who gets counted in the reckoning when we are operating the felicific calculus? All humans? All civilised humans? All rational beings in the universe? All living creatures? Prior to Bentham, most moralists had regarded the moral community as consisting of humans, since they alone have the capacity to reason and communicate intelligently. But Bentham, while remarking that a full-grown horse was more rational than a month-old infant, thought that rationality was not the relevant criterion for moral consideration. "The question is not, 'Can they reason?' nor, 'Can they talk?' but, 'Can they suffer?'" While united in their opposition to Bentham's consequentialism, the contributors to this book differ in their attitude to his redrawing of the boundaries of the moral universe. Brian Scarlett, in "The moral uniqueness of the human animal" defends what he calls "The Common View" that non-human animals are inferior forms of life compared with us, and that while it is wrong to treat them cruelly it is permissible to kill them for food and to use them for other human purposes. Stephen Clark, on the other hand, wishes to extend the moral universe well beyond Bentham's limits, and argues that we should live according to such laws as will give all living creatures the best chance possible to live worthwhile lives according to their kinds.
Tim Chappell occupies a position between Scarlett and Clark. While opposing experimentation on animals and arguing for vegetarianism, he claims that human beings occupy a unique position because they alone can balance the conflicting interests of other species. "The ecological niche of Homo sapiens now involves us in being prepared, if necessary, to regulate the relations between the occupants of other ecological niches, eg to prevent the tiger from eating the gazelle into extinction, and to prevent the gazelle from eating itself and the tiger into extinction by overgrazing."
In defending his version of speciesism, Chappell takes as his target Peter Singer, the author of Animal Liberation.
Singer is the bete noire of most of the authors of this book, not so much because of what he says about animals, but because of what he says about human infants. "We should give the same respect to the lives of animals," Singer wrote, "as we give to the lives of those humans at a similar mental level". In exploring the consequences of this principle, he has defended the killing of severely disabled newborn infants. Several of the authors, especially Jacqueline Laing, attack Singer's downgrading of the moral status of infants as incoherent as well as immoral. Grant Gillett savages the utilitarian view that the fundamental objection to infanticide is that it is distressing to parents. If that were the case, how should we deal with parents who abuse their children? If the consequentialist view were correct, we should be morally indifferent between killing the abused child and censuring or punishing the parents.
Consequentialists who equate the moral status of human infants with that of higher animals make the mistake of ignoring the potential for development which exists in children but not in the brightest of adult primates. Here an apparently metaphysical issue - the question of the primacy to be accorded to the actual in comparison to the potential - is shown, by several of the contributors, to be of crucial importance to moral decisions of great moment. "Personism" is the name of the theory here under attack, a moral viewpoint which accords special moral status to creatures with present capacity to communicate and reason. As Laing points out in attacking personism, it is absurd to restrict the protection of morality to those who have the actual and actuated characteristics of adults (eg rationality, autonomy, artistry etc.) "Even the most talented musician must sleep. The most honoured among us were once dependent foetuses and infants."
The wrongness of "euthanasia" for infants would be common ground among the contributors to this book. Douglas Odegaard takes the argument further. He claims that even in the case of voluntary euthanasia for adults a doctor commits an injustice in terminating a life, because the right to life is inalienable and cannot be renounced by a patient.
Other essays concern such issues as the goal of the art of medicine (is it to restore health, or to restore the patient's autonomy?), the principle of double effect and the distinction between intended results and side-effects, and the question whether John Stuart Mill was a consequentialist in the sense of the word defined by Elizabeth Anscombe, who invented the term.
This last may seem esoteric, but the essay is a fitting tribute to Anscombe, whose influence is pervasive throughout. The volume would make an excellent text for an undergraduate or graduate bioethics seminar. It is much to be desired that it will, as its authors hope, provide a counterbalance to the preponderance of consequentialism in bioethics.
Sir Anthony Kenny is warden, Rhodes House, Oxford.
Human Lives: Critical Essays on Consequentialist Bioethics
Editor - David S. Oderberg and Jacqueline A. Laing
ISBN - 0 333 62980 9
Publisher - Macmillan
Price - £40.00
Pages - 244
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