Philanthropy's Brave New World: Will those who give decide who should live?

Wesley J. Smith
Writer and Author

During the first three decades of the 20th century the eugenics movement thrived in the United States and throughout much of the Western world. Meaning “good in birth,” eugenicists believed that society could improve the physical, mental, cultural, and social health of humanity through selective breeding techniques that would eventually eliminate feeblemindedness, epilepsy, criminality, insanity, alcoholism, and pauperism.

This utopia was to be created through a two–pronged approach to procreation: first, by promoting eugenically correct marriages, the so–called “positive eugenics,” and second, by preventing the “unfit” from procreating at all, known as “negative eugenics.”

Of course, it all ended horribly. Indeed, how could it not have? The movement was, after all, based on the pernicious premise that some people are better than others. When inequality is the basis for public policy, oppression inevitably follows. In the United States, eugenics oppression took the form of 60,000 “undesirables” being involuntarily sterilized between 1907 and 1963. In Germany, it paved the way for the Holocaust.

What does all of this have to do with philanthropy? The answer is: it takes money.

It takes money to change a nation's morality and public policies from the top down: research must be funded, academic chairs established, issue advocates supported, studies commissioned, articles in academic and medical journals underwritten, advertisements paid for, the popular culture influenced in myriad ways.

Sadly, eugenics from the start was substantially supported by some of the nation's richest and most influential foundations. The Rockefeller Foundation, for instance, began supporting eugenics before World War I, and one of the first major donations made by the Carnegie Institute of Washington went to provide seed funding for the Cold Spring Harbor Laboratories Station for Experimental Evolution, for many years the nation's most influential eugenics research center.

Everything Old Is New Again

The popularity of eugenics declined in the 1930s and all but died out after the Holocaust — although sterilization laws remained on the books in some states well into the 1960s. But now, nearly a century after eugenics' heyday, a new social movement is spreading among members of the elite professions of law, medicine, government, and the academy.

As with eugenics backers before them, movement adherents are busily about the business of culling humanity into favored and disfavored categories and proposing public policies that would, if implemented, medically discriminate against the most weak and vulnerable among us. And proving that the more things change the more they stay the same, private philanthropy is generating much of the steam behind the movement's forward momentum.

The movement has a name — bioethics — an abstruse branch of analytical philosophy practiced primarily by an elite group of academics, philosophers, lawyers, and physicians, known generically as bioethicists.

Bioethicists are best known for arguing intensely among themselves in arcane journals and academic symposia about how best to solve the moral dilemmas created by medical and scientific breakthroughs. But while their enterprise is intellectual, it is freighted with practical implications for the rest of us. The bioethics project aims at nothing less than remaking the laws of public health, the ethics of clinical medicine, and indeed, the morality of society in its own ideological image.

At this point, many bioethicists would no doubt object, claiming that bioethics isn't an ideology and doesn't have a unified goal. “Bioethics isn't a monolith,” says Madison Powers, director of the Joseph and Rose Kennedy Institute of Ethics, a bioethics academic center affiliated with Georgetown University in Washington D.C. “People's opinions are all over the map.” Which is true as far as it goes. Any movement worthy of the name will see disagreements within the ranks — but almost all occurring within the context of a mutually accepted overarching belief system. Thus, just as Baptists and Catholics have their theological disagreements in the context of a shared Christian faith, so too do bioethicists' differing opinions mostly spring from how to apply moral beliefs that are generally shared.

What makes this so worrisome is that the predominant moral assumptions of bioethics differ so dramatically from those of the very populace the movement presumes to serve. For example, most people believe in the “do no harm” values of Hippocratic medicine. Bioethicists generally dismiss Hippocratic medicine as “paternalistic.”

Similarly, most people believe in — even if they don't always adhere to — the equality of life⁄sanctity of life ethic, the moral pillar of Western Civilization that grants to every human equal objective moral value. But long ago the mainstream bioethics movement reached a consensus that human life is neither sacred nor equal. Indeed, bioethics ideology holds that membership in the human species per se is irrelevant to any individual's moral worth. What matters in predominant bioethics thinking isn't the human community but the moral community, which does not include everyone. Bioethics determines who qualifies as a member of the moral community via a so–called “quality of life” standard that bases human value upon whether an individual possesses sufficient cognitive abilities to be deemed a life of moral consequence. Those who pass muster are generally called “persons.” Those who do not are labeled “non–persons.” Persons enjoy maximum legal and moral rights, including the right to life. Non–persons do not.

Dr. Singer's Opus

The Australian bioethicist Peter Singer is probably the best–known proponent of this view. In his book Practical Ethics Singer contends that “two crucial characteristics” earn a being the status of person: “rationality and self consciousness.”

Since he considers species membership irrelevant, Singer claims that some animals are persons, including “whales, dolphins, monkeys, dogs, cats, pigs, seals, bears, cattle, sheep, and so on, perhaps even to the point which it may include all mammals.” Other forms of animal life are not persons, such as fish and birds. Nor, to Singer, are newborn human infants (whether disabled or not), people with advanced Alzheimer's disease (perhaps Dr. Singer is thinking of Ronald Reagan), or others with severe cognitive disabilities considered persons.

Since non–persons — whether animal or human — don't have the same moral value as persons, they can be killed or exploited in a way that would be wrong if inflicted upon persons. Thus Singer is one of the world's most famous proponents of legalizing infanticide. For example, in his book Rethinking Life and Death, he draws an explicit moral equivalency between ending the life of a baby and, say, that of a sardine, writing, “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.”

Singer believes infants are “replaceable” and thus they can be killed if the act would serve the interests of the family. Toward this end, he has repeatedly advocated that parents be accorded 28 days to decide whether to keep or kill their newborn offspring. More recently, he expanded this timeframe to up to a year — depending on a case–by–case analysis of the child and family's circumstances.

In another time, Peter Singer's advocacy for infanticide would have branded him an intellectual outcast. Indeed, he cannot appear in Germany or Austria without generating angry demonstrations, given those nations' painful memories of the Holocaust, during which more than 250,000 disabled infants and adults perished at the hands of doctors.

But far from being a fringe character within bioethics or the academy, Singer is mainstream and is frequently invited to present papers at seminars, symposia, and philosophy association conventions throughout the world. Indeed, Singer is so conventional that he was asked to write the essay on ethics for the Encyclopedia Britannica.

Yet because Singer was based in remote Australia, his popular influence was once relatively limited. But now, thanks to a couple of philanthropists, he has taken center stage. Almost overnight, Singer has been transformed into a cause celebre in elite opinion. Barely a month goes by without articles by Singer or interviews with him appearing in the popular press. All of this came to pass because Princeton University appointed him the first Ira W. DeCamp Professor of Bioethics at the University's Center for Human Values. Philanthropic giving to Princeton paid for Dr. Singer's transformation. The Center for Human Values was established with money donated by Lawrence Rockefeller, and the Ira W. DeCamp Foundation endowed the chair bearing its name.

How does the Ira W. DeCamp Foundation feel about its money being used to provide Singer with a platform from which to promote his ideas? Do his values reflect the views of the foundation trustees and staff, or are they appalled but silent due to a strong belief in academic freedom?

It's impossible to say, because the Foundation's New York offices did not return repeated calls. But William C. Gallaher, associate director of the Center for Human Values, told me, “We told them [the DeCamp Foundation] about Singer's appointment and gave them much information about him and his views. We haven't heard from them one way or the other but I can only assume they are thrilled.” Thus is the deconstruction of core Western values advanced through unaccountable philanthropic giving.

Looking For Change In All The Wrong Places

Most foundations fund worthy health care initiatives designed to expand access to medical care for the poor and improve end–of–life care for the dying. The Carter Center has brought tremendous relief from suffering in Africa. Here at home, the Robert Wood Johnson Foundation's funding of the Missoula Demonstration Project has helped stimulate worthwhile ideas in improving the care and medical treatment of dying people.

Along these lines, many foundations fund worthy bioethics initiatives designed to broaden access to comprehensive health care for the uninsured. Unfortunately, many of the bioethics luminaries who are working on the problem passionately espouse health care rationing as the best answer to this national dilemma.

Rationing is legally sanctioned medical discrimination of a kind that explicitly sacrifices the health and well being of some in order to benefit others. While it is highly probable that most Americans do not want rationing, the primary argument among bioethicists isn't whether to ration but how to design a “just rationing system.”

Yet justice proves elusive in many of these schemes because they invariably promote the idea that people should be excluded from care based on personal characteristics. For example, Daniel Callahan, cofounder of the Hastings Center, a nonprofit bioethics think tank (substantially funded by corporations such as Monsanto Company, and by foundations like W. K. Kellogg and Robert Wood Johnson) advocates rationing based on age.

Even as the movement debates the pros and cons of vastly different rationing proposals, Futile Care Theory — the denial of life–extending medical treatment to catastrophically ill and injured people — is already occurring in some hospitals and nursing homes around the country.

Simply stated, Futile Care Theory, also known as “medical futility,” “inappropriate care,” or “non beneficial care," empowers doctors unilaterally to refuse wanted end–of–life medical treatment based on the physician's subjective perceptions about the quality of the patient's life — a depressing complement to the specter of being hooked up to machines and kept alive involuntarily.

As described in the Journal of the American Medical Association, futility–based hospital protocols have already been promulgated by several Houston–area medical centers and exist in other hospitals in the country, including the Alexian Brothers Hospital of San Jose, ostensibly a Catholic institution (Alexian was recently sold to Columbia HCA). A recent issue of Cambridge Quarterly of Health Care Ethics stated that of 26 surveyed hospitals in California, 24 of them had futile care policies in place. What makes Futile Care Theory so dangerous to society — as well as to the individuals upon which it would be visited — is that it would establish the principle that medical care can be withheld or withdrawn over the patient's or family's objections based on a cost⁄benefit analysis of the value of human life. Seen in this light, futility subverts the sanctity⁄equality of human life and our Hippocratic–based health care system, pushing us towards a “new medicine” that rations care based upon subjective quality–of–life standards.

Death By Philanthropy

A recent episode illustrates the role of foundation funding in promoting Futile Care Theory or protecting us from it. Dr. Donald J. Murphy, a Colorado physician and ethics consultant, a prominent proponent of medical futility, believes that “the community” should define when and under what circumstances it is inappropriate for doctors to provide medical treatment.

Murphy once headed a nonprofit organization, the Colorado Collective for Medical Decisions (CCMD), dedicated to crafting formal guidelines it hoped would come to govern when life–supporting medical treatment would be withdrawn from patients — whether or not the patient or the patient's family wanted the treatment to continue.

To promote his organization's agenda, Murphy approached the Colorado Trust, a philanthropic foundation dedicated to funding projects designed to promote “accessible and affordable healthcare programs.”

The Trust granted CCMD $1.3 million to develop its guidelines. “It was a unique grant,” says Nancy Baughman Csuti, senior evaluation officer for the Colorado Trust. “It was not done in response to a Request For Proposals. Dr. Murphy just came in as the leader of his organization and made a strong presentation asking for the money.”

CCMD used the Colorado Trust's donation to convene community focus groups intended to determine — and mold — the public's attitudes towards end–of–life care. Murphy's purpose was to generate so much public agreement with CCMD's proposed guidelines that hospitals, HMOs, and physicians would be emboldened immediately to begin the widespread withholding of “inappropriate” care. To Dr. Murphy's chagrin, “the community” generally rejected Futile Care Theory. “It became clear that people believe that they should be in control of their own care,” Csuti says.

Seeing the writing on the wall, the Colorado Trust ceased funding CCMD and used the information gleaned from the focus groups to help craft a new Palliative Care Initiative, by which it hopes to promote better and more humane medical treatment at the end of life — a program not based on a coercive model.

Why the change? Says Csuti: “Our foundation believes that the community must buy into new approaches to medicine. It became clear that the guidelines would not fly. So, the foundation is now pursuing a different path.” In an ironic postscript to the story demonstrating that groups that live by philanthropy can also die by philanthropy, the loss of the Colorado Trust's funding dealt a deathblow to CCMD. Dr. Murphy has moved on to new endeavors and the organization is no longer active.

The moral wreckage of the eugenics movement should serve as a warning sign against embracing discriminatory policies as proper solutions to social and medical problems.

When making their funding decisions, donors would thus do well to ponder whether their support for a specific bioethical activity would be likely to move the nation forward to a more just and accessible medical system or would, in the name of progress, actually undermine the cornerstone principle of universal human equality. With foundation–funded bioethicists leading us incrementally in the direction of a “new eugenics,” due diligence demands nothing less.