Briefing papers The new Grim Reapers Practitioners of bioethics say who should live - and who should die. Wesley J. Smith Is all human cloning wrong? Should doctors be allowed to kill people in permanent comas and harvest their organs? Would it be moral to deny expensive medical procedures to the seriously ill and disabled in order to provide health coverage for the uninsured? Do elderly people have a duty to die to spare their families and communities the financial and emotional costs of their care'? These and even more provocative questions are the grist of bioethics, a relatively new field of philosophy that grapples with issues of morality in the context of health care and biotechnology. In this era of high-tech medicine, when genetic researchers aspire to seize control of human evolution, bioethical issues may seem beyond the comprehension of mere mortals. That is why the practitioners of bioethics have gained so much influence: They claim to have the answers. They advise presidents about controversial health-related policies. They testify in front of state and federal legislative committees. They appear in courts as expert witnesses. They consult with biotech companies engaged in research into human cloning. University bioethicists teach ethics to the doctors and nurses of tomorrow. They are deemed experts in matters of morality simply because they claim to be experts. Unlike lawyers, physicians, or for that matter, hairdressers, it takes no formal education, training or licensing to become a bioethicist. The status is achieved through a bootstrapping process of studying or teaching bioethics, being published in professional journals, writing books or lecturing - and then being quoted by others engaged in the same endeavours. Bioethicists often state that bioethics has no ideology or generally agreed-upon world view. But that isn't true. While bioethicists certainly do argue with each other - sometimes quite vehemently - their disputes are usually about how to best apply an agreed-upon set of moral values to a given bioethical issue rather than over what the values of bioethics should be. In this regard, bioethics discourse is more akin to Catholics arguing with Baptists than to Catholics or Baptists arguing with atheists - the disputes are generally about details and emphasis, not fundamental beliefs. What makes bioethics scary is that the prevailing thinking in the movement rejects the fundamental principle necessary for true freedom: a belief in universal human equality. This point is clearly visible in an essay published in the influential Kennedy Institute of Ethics Journal in September 1999. John Harris, director of the Institute of Medicine, Law and Bioethics at the University of Manchester, England, a leading voice in the bioethics movement, wrote: "Many, if not most of the problems of health care ethics presuppose that we have a view about what sorts of beings have something that we might think of as ultimate moral value. Or, if this sounds too apocalyptic, then we certainly need to identify those sorts of individuals who have the highest moral value or importance (emphasis added): a moral value or importance comparable to that to which we believe ourselves entitled." Ponder these words for a moment. Had Harris written that health-care ethics presupposes a view about "which race has the highest moral value or importance," he would be dismissed as a mindless bigot. Mainstream beliefs in bioethics are just as discriminatory - they merely threaten different victims. Here's the nub of the problem: Many bioethicists believe that basing moral value and legal rights solely upon being human is capricious, religion-based and irrational. Many go so far as to contend that granting special status to humans simply because they are human is itself an act of discrimination against animals, a concept that has been given the bizarre name "speciesism." For example, Princeton University's Peter Singer - probably the world's most famous bioethicist - wrote in "Animal Liberation" that determining moral worth based on species "is no more defensible than racism or any other form of arbitrary discrimination." To avoid the odour of speciesism, bioethicists often assert that what counts morally is not being "human" but being a "person", a status earned by possessing identifiable mental capabilities such as being self-aware or having the ability to engage in rational behaviour. While the exact criteria for determining who is and who is not a person are still being debated, most bioethicists agree that there are human beings who are not persons. So who are they? Generally, such unfortunates include all embryos and foetuses, because they are not capable of rational thought. But other forms of human life, such as infants, are also denigrated as non-persons for the same reason. (Some bioethicists call infants "potential persons.") Other designated human non-persons include advanced Alzheimer's patients, people with serious cognitive disabilities, such as the comatose and those in near-coma, and those having significant developmental incapacities. At the same time, some bioethicists - and this is where it really gets weird - believe that intelligent animals, particularly chimps, apes, dogs, dolphins, elephants and pigs, are persons. According to this view, these animal-persons have greater moral value than do human non-persons. This means some animals should be treated with greater respect than some people are. (A minority of bioethicists disagrees with so-called personhood theory. Most of these dissenters come from an explicitly Christian or other religious perspective. Not surprisingly, these bioethicists generally have little influence within the movement as a whole. The secularist Leon Kass, recently appointed by President Bush as the director of the President's Council on Bioethics, also disagrees with those who advocate personhood. Whether his appointment will make a difference in the direction of bioethics remains to be seen.) Relying on personhood instead of humanhood as the fundamental basis for determining moral worth threatens the lives and well-being of the most defenseless and vulnerable humans among us. Here's why: In personhood theory, taking life is only wrong if the being killed was a "person" who wanted to remain alive. Thus, in the same article quoted above, John Harris asserted: "Personhood provides a species neutral way of grouping creatures that have lives that it would be wrong to end by killing or letting die. Persons who want to live are wronged by being killed because they are thereby deprived of something they value. Non-persons cannot be wronged in this way because death does not deprive them of something they can value. If they cannot wish to live, they cannot have that wish frustrated by being killed." Basing public policy on such theories leads to very dark places. Some bioethicists justify the killing of Alzheimer's patients and infants born with disabilities. Others suggest that people in comas can be killed and their organs harvested if their families consent, or used in medical experiments in place of animals. The best-known proponent of such views is Peter Singer. He is world famous (or infamous) for advocating that parents should have a period of time to decide whether to keep or kill their newborn infants. His support for infanticide is founded on personhood theory. Since infants aren't persons, he believes, they are "replaceable" - and hence killable - like all other "non self-conscious animals." Thus, he has written, in "Practical Ethics": "Since neither a newborn infant nor a fish is a person, the wrongness of killing such beings is not as great as the wrongness of killing a person.” To make his view more acceptable, Singer almost always advocates infanticide in the context of a baby born with a disability. Using the example of an infant born with haemophilia, Singer wrote: "When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of the happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if the killing of the haemophiliac infant has no adverse effect on others it would be right to kill him." Consider what this would mean in practice. The distraught teenage mother who painlessly killed her newborn and then threw the infant into the trash would have done nothing more serious than catching a mackerel from the Pacifica pier. In a better world, Singer's advocacy would make him an intellectual outcast. To some degree, he is a pariah in Germany and Austria, where he cannot speak without generating angry protests from those with memories of the Holocaust, in which hundreds of thousands of disabled people were murdered. Certainly not everyone in bioethics advocates infanticide, but Singer's opinions are hardly beyond the pale. Singer is no fringe character. He is invited to speak at seminars and conventions throughout the world. He is a past president of the International Association of Bioethics. He is so mainstream that he wrote the essay on ethics for the Encyclopaedia Britannica. Not only does personhood theory suggest there are people whom we can kill and still get a good night's sleep, but by allowing use of "non-persons" as involuntary research subjects or sources of organs, it threatens to reduce some people to the status of a natural resource akin to timber or cattle. Were such ideas promoted by a hate group, they would be rejected without a second thought. But because they come from an "enlightened" elite, the danger goes largely unnoticed. Bioethicists Bioethicists are, for the most part, good and earnest people striving to improve society. The issues with which they grapple are important and compelling. But it doesn't take a rocket scientist to see where their rejection of universal human equality leads. History teaches us History teaches us that judging human worth based on subjective criteria- race, sex, sexual orientation, tribe, religion, nationality or personhood- invariably results in the oppression, exploitation or even killing of those deemed by the powerful to be less worthy of respect. And considering that many of the people denigrated by bioethics as non-persons, not coincidentally, also happen to be the most expensive to care for in the age of the HMO when cost-cutting is king, bioethics presents an acute danger to the lives, health and well-being of millions of people who are elderly, disabled, newborn and cognitively or developmentally impaired. Since in the end this could include anyone of us, we ignore the threat of bioethics at our own peril. Consumer Advocate and attorney Wesley J. Smith is the author of "The Culture of Death: The Assault on Medical Ethics in America." ©2002 San Francisco Chronicle - reproduced with the author’s permission Published by ALERT 27 Walpole Street, London SW3 4QS. Telephone 020 7730 730 2800. Fax 020 7730 0181.