The Impact of International Bioethics on the 'Sanctity of Life Ethics', and the Ability of OB Gyn's to Practice According to Conscience

Dianne N. Irving, M.A., Ph.D.
International Conference: The Future of Obstetrics and Gynaecology...
International Federation of Catholic Medical Associations (FIAMC)
and MaterCare International
Rome, Italy, June 18, 2001.
Edited August 28, 2001
Reproduced by permission

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“A small error in the beginning leads to a multitude of errors in the end.”
Thomas Aquinas, De Ente Et Essentia Aristotle, De Coelo

I. Introduction

It is a great honor and privilege to be able to participate in this much–needed conference on the future of Obstetrics and Gynaecology, and on the fundamental human right to be trained and to practice according to conscience.1 Tremendous discrimination and pressures now exist world–wide, with dire consequences on the Church's health care ministry and entire societies of people globally — to which the participants at this conference have come to testify.

One of the most urgent yet least discussed medical dilemmas today is access to the correct basic scientific information regarding the human embryo — scientific information which demonstrates empirically that normally every human being begins to exist at fertilization in the woman's fallopian tube as a single-cell embryo, the zygote.2 Indeed, fertilization is the beginning of the existence of the human being, the human embryo, the human organism, the human individual, and the “embryonic period.” Without this correct scientific information we are all precluded from forming our consciences correctly or making morally correct medical decisions about abortion or other related current medical and scientific issues. The use of the correct science is the starting point for thinking about all of this.

To know that the human embryo is a personal human being is central to forming our consciences correctly, and therefore to knowing what actions are right or wrong in a specific medical or research situation. While conscience is the subjective norm in philosophical natural law theory, it must be a correctly formed conscience one in accord with objective reality and objective truth — starting with and including this objective scientific truth. Any scientific error or scientific mis–information in this regard precludes us from forming our consciences correctly or making morally correct medical decisions.

Although we are here this week to discuss and examine the more obvious causes of the pressures and discriminations against ObGyn's to practice medicine according to their consciences, my purpose is rather with identifying the “larger picture”, i.e., the more subtle but pervasive pressures and discriminations that stem from the structures and politics informed by international bioethics. These structures are preventing acquisition to and dissemination of the accurate scientific information regarding the full humanity and personhood of the early human embryo.

More specifically, I want to focus: (1) on the profound global impact of the recently formalized and inherently anti–life philosophy of “international secular bioethics” on political and governmental structures; (2) on the long–articulated attack by international bioethics on the “sanctity of life ethics”, especially as formulated in bioethics as “preference” utilitarianism; and (3) on the incorrect science propagated historically and currently in international bioethics debates on human cloning, human embryonic, and human fetal stem cell research.


A. Different Ethics, Different Conclusions:

First, I would like to historically identify the anti–life philosophy inherent to international bioethics by sketching quite briefly the recent formal “birth” of bioethics in the USA. Just what IS “bioethics”?3 Most people would say that it is just the application of traditional philosophical and theological principles to current technological issues in medicine and medical research — e.g., cloning or experimenting with new AIDS drugs, right?

Not really. The philosophical underpinnings of bioethics are completely different — even contradictory to — the philosophical underpinnings of traditional secular medical ethics or Roman Catholic medical ethics. Traditional medical ethics focuses on the physician's duty to the individual patient, whose life and welfare are always sacrosanct. The focus of bioethics is fundamentally utilitarian, centered on “maximizing total human happiness”, or, as we shall see, maximizing total “preferences” and “interests.”

To put my endeavor into sharp focus, consider for a moment the strikingly different conclusions reached by secular bioethics and Roman Catholic medical ethics on an array of issues. Secular bioethics generally considers the following as ethical: abortion, contraception, the use of abortifacients, prenatal diagnosis with the intent to abort defective babies; surrogate motherhood; human embryo and human fetal research; human cloning; the formation of human chimeras (cross–breeding with other species); human embryonic and fetal stem cell research; “brain birth”; purely experimental high risk research with the mentally ill; euthanasia; physician–assisted suicide; and living wills documenting consent to just about anything.4 In contrast, Roman Catholic medical ethics considers all of these unethical.5

How is it that these two different ethical systems lead to such opposite and contradictory ethical conclusions? The answer is rather predictable. Every academic ethical theory has its own idiosyncratic ethical principles. Deducing from different ethical principles necessarily leads to different ethical conclusions. For example, Roman Catholic medical ethics is grounded in the ethical principles embedded in the Moral Law (a combination of natural law philosophical ethics, Divine Revelation, and the teachings of the Magisterium).6 Secular bioethics, as predominantly understood and applied, is grounded in the National Commission's three ethical principles as articulated in their Belmont Report.7 Deducing from these two very different sets of ethical principles leads inexorably to these different ethical — and therefore medical ethical — conclusions. Nor is there any such thing as a “neutral” ethics, including bioethics. All ethical theories are normative — i.e., they take a stand on what is right or wrong.8 Therefore no “ethical theory”, it would seem, should be forced on any members of a pluralistic, multicultural, democratic society!

In short, there is really no such thing as just “ethics per se”, as just “medical ethics per se”, or as a “neutral ethics”. There are different kinds of ethics, and therefore there are different kinds of medical ethics — each with its own unique normative ethical principles, subject matter, method, ethical “conclusions”, and squadrons of “experts”. bioethics is just one idiosyncratic ethical theory among many — albeit relatively new.

B. The Formal “Birth of Bioethics”:

As detailed in his extensively referenced new book, The Birth of Bioethics, Albert Jonsen traces the history of traditional medical ethics from the ancient Hippocratic period to post–World War II traditions. He then describes a couple of decades of famous international conferences on the future of medical ethics/research, and the gradual formation of the three major “think tanks” which were comprised of the leading scholars who would play critical roles in the final formal “birth” of bioethics. These “centers” included: The Hastings Center in New York (founded in 1969 by Willard Gaylin and Daniel Callahan as Co–Directors), The Kennedy Institute of Ethics at Georgetown University (founded in 1971 by Andre Hellegers as Director), and the Society of Health and Human Values (founded in 1970 by the Committee on Medical Ethics and Theology of the United Ministries in Education, with its first Chairman of the Board of Directors, Dr. Edmund Pellegrino).9

Bioethics as understood and practiced today was actually “created” out of thin air by a Congressional mandate, with the passage of the National Research Act in 1974.10 The Act mandated that the Secretary of the Department of Health, Education and Welfare appoint a National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to: "[1] identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and [2] to develop guidelines that should be followed in such research."11 As Albert Jonsen, a member of that National Commission, later perceptively noted, “No legislation had ever before charged a government body to identify basic ethical principles as did Public Law 93–348.”12

Thus, in 1974, the Secretary appointed an eleven–member National Commission13 that in 1978 issued a document called The Belmont Report,14 which identified and defined three “ethical principles”: respect for “persons” (immediately deconstructed to mean pure “autonomy”), “justice”, and “beneficence.” To this day, those principles are called “the Belmont principles”, the “Georgetown mantra”, “principlism”, “federal ethics”, or simply “bioethics.” Obviously, as we have seen, deducing from these different normative ethical principles will lead to quite different conclusions about what is right or wrong in health care, as compared to deducing from other ethical principles such as the Moral Law.

Also, as Congressionally mandated, in 1981 the Belmont principles immediately became the explicit foundation for the guidelines that the U.S. federal government's Office for Protection from Research Risks (OPRR)15 was to use when assessing the ethics of using human subjects in research. These bioethics principles, as originally defined, also underlie a host of other federal regulations and guidelines for medical research, and have worked their way into the private and international sectors as well.

C. Short Analysis of Bioethics “Theory”:

What is perhaps helpful for ObGyn's to understand is that bioethics was fatally flawed from the beginning, and therefore it can be easily challenged. The three Belmont Principles — respect for “persons” (autonomy), justice, and beneficence — were supposedly derived from the normative ethical systems of various secular moral philosophers, especially Emanuel Kant, J. S. Mill, and John Rawls (a contemporary influential Harvard University philosopher whose 1971 book, A Theory of Justice,16 was a blueprint for certain liberal legal and social theories of the 1970's).

The fact that each of these theories fundamentally and systematically contradicted each other seemed to be irrelevant to the early “ethics–makers”. In effect, they quite selectively took bits and pieces from different and theoretically irreducible ethical systems and rolled them up into one ball. Furthermore, each of these principles were defined as prima facie,17 i.e., no one principle could overrule any of the others. The way we come to know these bioethics principles is by taking courses, attending seminars, and listening to bioethicists lecture at conferences.

But theoretically and practically it was soon discovered that these bioethics principles simply could not, and would not, work. Because bioethics was derived from bits and pieces of fundamentally different and contradictory theoretical philosophical systems, the result was theoretical chaos, rendering it academically indefensible.

More problematic, when people practically tried to apply the theory, it didn't work because there was no way to resolve the inherent conflicts among these three prima facie principles. Caution concerning this inherent conflict among the three bioethics principles had been voiced at the beginning of the field, e.g., by Paul Ramsey, who noted, “Within the amplitude ... of general ethics, our authors fail to address clearly and rigorously the issue: which of these moral principles has priority (e.g., in the case of conflict)?”18 For example, how could a patient appeal to “autonomy” to have any and every medical treatment regardless of its efficacy or cost without contradicting an appeal to “justice” and the “fair” allocation of scarce medical resources? It couldn't.

Furthermore, while the Belmont Report gave a little nod to the traditional Hippocratic understanding of beneficence as doing “good” for the individual patient, it also included a second lengthy definition of beneficence that was essentially utilitarian: doing “good” for society, or, “the greatest good for the greatest number”. The report even declared that citizens have a “strong moral obligation” to take part in experimental research for the greater good of society.19 This obviously contradicts the Hippocratic interpretation of beneficence, and it also violates time–honored international guidelines, such as the Nuremberg Code and the Declaration of Helsinki, in which the “good” of society may never outweigh the “good” of the individual patient. 20

The second Belmont principle, justice, was also defined along utilitarian lines, i.e., in terms of “fairness” — “fairness”, that is, in allocating the benefits and burdens of research fairly across the social spectrum. This Rawls–influenced definition of justice is surely quite different from the classic Aristotelian definition of “justice” as treating people fairly as individuals. Rawl's “theory” of justice also profoundly influenced the theory–makers of bioethics from several other different academic disciplines. For example, it would later be adapted by his student Norman Daniels and applied to health care;21 it began to “creep into law”, e.g., through lawyer⁄bioethicist John Robertson, who quoted from Rawls in influencing the justices' decision in the Saikewicz case — resulting in the still controversial legal concept of “substituted judgement”;22 it has also been applied by Arthur Dyck in international population policy issues.23

Even the third Belmont Principle, respect for persons, ended up serving utilitarian goals. Respect for persons is supposed to be a Kantian notion, in which respect for the individual is absolute. But the Belmont Report blurred that idea with Mill's utilitarian views of personal autonomy. In Mills' view, only “persons” — that is, fully conscious, rational adults capable of acting autonomously — are defined as moral agents with moral responsibilities. Unfortunately, this issue of mere “moral agency and responsibility” was reinterpreted by bioethics to “read” that those incapable of acting “autonomously” — infants, the comatose, those with Alzheimer's or Parkinson's, drug addicts, alcoholics, the mentally ill and mentally retarded, etc. — were “non–moral agents”, and thus “non–persons” with no rights. It is only a short step from this blurred reasoning to that of Princeton's Peter Singer — a “preference” utilitarian who argues that some animals have more moral value than young human children or ill, disabled human adults.

Eventually discontent began to smolder within the brave new discipline. Even the founders of bioethics have admitted that the Belmont principles of “bioethics” present grave problems as guidelines for physicians and researchers. The Hastings Center Dan Callahan has conceded that after 25 years, bioethics simply has not worked.24 Gilbert Meilaender has noted “how easily the [reality and worth of the individual human] soul can be lost in bioethics.”25 National Commissioner Jonsen recently wrote that bioethics should now be regarded as “a sick patient in need of a thorough diagnosis and prognosis.”26 In a scathing article against bioethics, “Leaving the Field”, Renee Fox and Judith Swazey responded in depth and detail to the horrendous ethical dilemmas they considered posed by bioethics public policy making concerning organ transplantation, especially on an international scale.27 Other controversies and battles over the validity of the bioethics principles on many levels are documented and collected in an already classic 1195–page tome edited by Rannan Gillon, in which 99 scholars from around the world jump into the fray over bioethics — by far the majority of them arguing against bioethics “principlism”.28 Bioethics simply cannot be defended, and it does not work.

Another reason for the theoretical and practical chaos surrounding bioethics these days is that almost anyone can be a bioethicist. Few “professional bioethics experts”, the doctors, researchers, and lawyers who sit on hospital and government bioethics committees, have academic degrees in the discipline, and even for those very few who do there is no uniform or standardized curriculum. Most professors of bioethics don't know the historical and philosophical roots of the subject they teach; the courses vary from institution to institution; there are no local, state, or national boards of examination; and there are no real professional standards. There is not even a professional code of ethics for bioethicists! 29

Because of these and other stinging criticisms (especially from within the academy and their own ranks), many bioethicists now prefer to say that their field is more a form of “public discourse” than an academic discipline, a kind of “consensus ethics” arrived at by democratic discussions rather than by formal principles.30 The problem with this line of reasoning is that the ethical principles used in the “discourse” are still defined precisely as defined in The Belmont Report and the early bioethicists, and those who typically reach the “consensus” are the bioethicists themselves (not the patients, their families, or society at large). So the process is not exactly “neutral” or “democratic.” And if bioethics is just a “discourse,” then why are its practitioners regarded as “ethics experts”? Most curiously, if bioethics is a normative ethical theory — i.e., it takes a stand on what is right and wrong — it is thereby not a “neutral” ethical theory — so why should it be allowed to be forced on the citizens of any multi–cultural, pluralistic, democratic society?

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