Thursday, July 29

The Hazards — And The Necessity — Of Playing God

In a recent “Skeptic’s Collection” column, I asserted the following regarding biasing abortion decisions in favor of the woman’s welfare, even at the expense of her fetus. I counseled caution toward the status of the fetus – which status, I repeat once more, I do not profess to know – because, while we can be certain the woman is a person, we do not have an analogous level of certainty about the ontological status of the fetus. So, in that column, I said:  

8-day-old human fetus

So why not err on the side of caution toward the woman? Good question. This is my answer: because I am sure the woman is a human being. I do not have a similar degree of certainty about the fetus. So the fetus is more deserving of the benefit of caution. If I were as uncertain about the “ontological” status of the woman as I am about her fetus, this would be a compelling objection. But the situation is not nearly as "symmetric" as the above boldface question suggests.

I stand by that principle. But I think that paragraph above is a pointer toward a more general principle in dealing with all life issues, not just abortion, e.g., the use of embryonic tissue for stem cell implantation and research concerning same, the “harvesting” of organs from people with no discernible cortical activity, etc., etc. – basically any situation where there are two parties involved, one of whom is undeniably a person, and the other of whom is of debatable ontological status.

The principle is very simple to state, though, as I concede below, it would undeniably be subject to detailed points of honorably debatable ambiguity in practice:

Always err in favor of the party whose personhood is ontologically indisputable.    

There are cases where there is no ambiguity, of course. People who have died in accidents or as the result of unsuccessful surgical procedures are … well … dead. As I said in that “Skeptic’s Collection” column I cited in the first paragraph, they are – if you will forgive my brutal candor – cadavers, i.e., human-shaped pieces of meat phenotypically – and even genotypically, since their cells, at least prior to complete decomposition, still possess fully articulated genomes -- but otherwise just pieces of meat. (See that previous “Skeptic’s Collection” column for the definition of the terms “phenotype” and “genotype”.) Whatever personhood there was is only in past tense:  they were fully persons in the past, but not in the present.  Whatever it was that made them persons, that made them more than just meat plus genetics – soul, spirit, sentience, elan vital … choose your own term – is now demonstrably gone. If, when alive and mentally competent, they granted permission for their organs to be donated to others, it is now permissible to do so.

Not every case is that clear-cut, of course. What of people in a persistent vegetative state? I am referring now to people like the character Shelby, the daughter of M’Lenn and Drum Eatonton in the unforgettable movie Steel Magnolias? Shelby, a diabetic, had received a kidney donated by her mother, but a few weeks after surgery, having received M’Lenn’s kidney, her condition radically deteriorated to the point that she showed no response to external stimuli, no brain activity, i.e., none of the usual signs by which we customarily judge personhood. To all appearances, Shelby was just a biologically animated piece of meat – and artificially animated at that, with respirators and the entire panoply of medical technology families with loved ones in a similar situation are all too tragically acquainted with.

Question now:  is Shelby, and her non-fictitious brothers and sisters, still a person or not? 

If she had given permission for her organs to be donated, would it be morally – never mind legally – permissible for Shelby’s organs to be harvested? In asking that question, I am quite aware that there are allegedly anecdotal instances of cases where people in essentially the same condition as Shelby – this is my non-medical layman’s understanding – suddenly regained consciousness and were, at least to some significant degree, sentient and conscious.  My honest answer in this case:  I do not profess to know, and I pray  to whatever deities may be that I am never in a position where I have to make such a decision. I know no more about the ontological character of the Shelbys of the world than I know about the ontological character of the fetus in the uterus.

All of which brings us to what is arguably the most salient issue of all:  the use of embryos in stem-cell treatment and research. My response here is essentially the same as my response to the issue I cited in the above hyperlinked “Skeptic’s Collection” column:  the only thing I am categorically certain of is that the person suffering from, e.g., Alzheimer’s or any analogous neurological Hell-on-Earth is indisputably a person, ontologically. Denying this estimate of the personhood of, e.g., Alzheimer's victims or severe autism would constitute an off-ramp from the Bioethical Freeway which would perforce terminate in full-up Naziism and from thence to wholesale fascist eugenics, a slippery slope to be avoided at all cost.   

What I am much less certain about is the ontological status -- i.e., the personhood -- of the embryo from which ... whom? ... the stem cells would be taken ... harvested? ... Is the embryo a person, ontologically? My answer -- the answer of a non-biologist, non-ob/gyn -- is "No, but only up to a certain point." Here I must take ownership of my own biases vis a vis the definition of personhood: I would personally -- and speaking only for myself -- not countenance harvesting stem cells from any embryo that showed signs of cognitive activity, of sentience, if you will. However -- this is my understanding of the process of fetal development -- an embryo that showed such signs would no longer, technically speaking, be an embryo. An embryo evincing signs of cognitive ability, and certainly of sentience, would -- again, in my mind, and speaking only for myself -- have crossed the biological Rubicon from embryo into personhood, adopt whatever technical terminology you will, and could and should therefore thereafter not be thought of as a kind of stem-cell ATM. At that point, we would be dealing with a person, not just a piece of pragmatically useful meat.

But, at this point, I freely admit that I run afoul of the very issue I adumbrated in the sequel to the "Jumping the Abortion Shark" column: the temptation to give "digital" answers to "analog" questions. Sentience, cortical activity -- for all I know, even personality -- is a smooth, continuous coming-of-the-dawn phenomenon quite different from turning on a light switch. I.e., achieving the level of sentience that would mark an embryo or fetus as a person, and therefore possessed of rights and not subject to exploitation for her / his genetic material, is not a binary, 1 / 0 process. And it is useless to ask at what point does that transition occur, because the very word "point" betrays a fundamental misunderstanding of the issues involved. In actuality, there is no "point". There is only a continuum.

Ultimately, my hope is that, in the intermediate future, say within a generation, genetic technology will have evolved to the point that any given cell in the human body can be "un-specialized" and turned into a "virtual stem cell," i.e., capable of becoming any kind of cell needed for any therapeutic purpose, at which point the newly un-specialized cell -- the "virtual stem cell," if you will -- could be repurposed to some new end-in-view. At that point, the whole ethics of stem-cell research and therapy will become blessedly moot.

Until then, I give my usual answer to such questions: it beats-a hell outta me!

James R. Cowles

Image credits

Pro-life Planned Parenthood signs … Charlotte Cooper … CC BY 2.0
Dawn … … Public domain
Human embryo … Lunar Caustic … CC BY-SA 2.0
Sperm … Karl-Ludwig Poggemann … CC BY 2.0
Human embryonic stem cells … Nissim Benvenisty … Creative Commons Attribution 2.5 Generic
Ocean wave ... ... Public domain

Leave a Reply