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Family Values comes to medical ethics--Conservatives, do not fall for this

The invaluable Wesley J. Smith, who is now on a well-deserved vacation, posted just before he left a link to this sickening little article on the site of The Hastings Center. In the course of discussing it, Smith alerts me to something I'd never heard of before: The culture of death in medical ethics is now trying to pass itself off as "family values" in ethics.

Reading the Hastings article, I see the rhetoric. There's a reason why Socrates hated the sophists so much. I imagine they were very effective in their day and in their way. And conservatives, especially conservatives of a particular sort who regard themselves as anti-individualist, may be especially vulnerable to the kind of snake oil being peddled here.

Let me explain:

The article begins with a scenario that the author, Hilde Lindemann, overheard some fellow bioethicists discussing. Evidently this is a true story, though I can't be absolutely sure of this. In the story, a couple have a 20-year-old mentally disabled daughter. She is their only child and will never marry, and they are all upset that their family will die out with themselves. So they try to convince doctors to hyper-ovulate their mentally disabled daughter so that her eggs can be harvested, so that her eggs can be fertilized with donor sperm, so that the resulting embryo(s) could be implanted in a rented womb, so that the parents could "have" a grandchild and raise it.

There are so many things wrong with this that one hardly knows where to begin, but Lindemann's colleagues at least happened to notice that this would involve instrumentalizing the disabled daughter, using her as a mere means to an end, and putting her through an unpleasant (and even possibly dangerous) medical procedure without any benefit or indication for her, making her into a mother, and doing all of this without the least vestige of consent from her. Considering her intrinsic value as an individual (though they didn't actually use the word "intrinsic value"), it is obvious that this is unethical. And so they concluded.

Lindemann isn't happy. In fact, Lindemann says that this conclusion means that her colleagues just don't get how families work. Y'know, how individualistic of them. How Hobbesian! Don't they understand (cue suggestively waving hand motions) how families constitute this whole interconnected web? How they work together? What's the matter with these people? When they leave for work in the morning, do they just forget what it's like living in a family together and how we all make sacrifices for each other? After all, if the parents have taken care of this girl all these years, they've made sacrifices for her. Maybe it's time she made some sort of sacrifice for them, huh?

Yep. That's right. That's what it means to believe in the interconnectedness and interdependence of families, in the love and sacrifice between the generations. That's just how families work--hyperovulating their mentally disabled children so they can get grand-babies from them. Sounds like real family life to me!

This is, I say in all seriousness, like saying that cannibalism isn't so bad, because it shows the dependence of all people on one another. It is a despicable abuse of the notion of the interconnectedness of families, and it must not take in anyone else who likes to talk about the evils of individualism. There are people who like to talk about the evils of individualism who don't mean anything evil, even if I happen sometimes to disagree with them on economic issues. But this is a whole different matter altogether. Because when it comes to the treatment and use of the human body, then the value of the individual, the intrinsic value of the individual, becomes of paramount importance, and in that sense our medical ethics absolutely should be individualistic.

Smith points out that Lindemann's use of the notion of "family ethics" is not unique to her. John Hardwig (of "duty to die" fame) has this long article in which he muses about troublesome problems like the burden it puts on families if a newborn with a disability happens to live, the burden it puts on a wife if her husband with Alzheimer's happens to live, and the like. He concludes that doctors' treatment decisions should be based not on what's best for the patient (as a mere "individual," after all) but on what's ostensibly best for the family, where this includes considerations like the burden of bothersome lives.

So, let's hear it for individualism in bioethics. Everything has its place.

Comments (21)

While concurring in the judgment that this is ghoulish and unethical in extremis, I profess mystification as to what this has to do, even potentially, with anti-individualism, which by no means entails that the individual is to be reduced to an instrument of the desires of others, regardless of the relation in which she stands to those others. Inasmuch as such manipulations would be contrary to the good of the girl, and contrary to the natural obligations of parents, one might argue that it is an instance of postmodern hyperindividualism for the parents to impose such a demand upon the medical system; their I wants (and I have in mind the William Blake etchings...) in this case should be the tip-off: they seek to overrule the good of their daughter in the name of their desires. That is what individualism typically does: overrule the goods of concrete persons or relationships in the name of willed objects, usually desires. They might argue that they have in mind the collective good of a family lineage, but such things are good only in and through the goods of persons and the relationships of persons, both of which are being violated in this case.

I actually agree with you, but it's the bioethicists who are saying that they are being anti-individualistic here. I'm just reporting that this is the sophistical line being taken. They seem to have in mind some sort of bizarre utilitarian vector sum of the needs, desires, health, whatever, of all the people in the family. That's their idea of being oriented to the good of the collective rather than the individual. Sort of some weird idea of weighing the _relatively_ minor discomfort and risk to the girl against the distress of the parents at having no grandchildren, etc. Sort of a miniature utilitarian system with "greatest good for greatest number" applied thereto.

If you read the Lindemann article, I think you'll see what I mean. She tries to strike a communitarian note. Says her colleagues' condemnation of the procedure arises from their viewing the world as a Hobbesian "war of all against all." It's very bizarre. It's like communitarianism entirely divorced from natural law.

Maybe it's time she made some sort of sacrifice for them, huh?

Maybe - but then she should be the one to decide (which apparently she is incapable of doing). Otherwise, she is not making a sacrifice, she is being sacrificed.

Says her colleagues' condemnation of the procedure arises from their viewing the world as a Hobbesian "war of all against all."

Utilitarians and other consequentialists always say this whenever their desires are being impeded or thwarted; it's the way they attempt to draw a veil over the base sacrificialism, the holocaust-of-the-particular core of their "thought": this person, or these people, must sacrifice/be sacrificed so that I can get whatever I want. I'm quite certain that the hierophants of ancient pagan cults of sacrifice articulated similar arguments, to the effect that the victims should cooperate in dying for the good of the community, as opposed to positioning themselves over against the authoritative people with knives or furnaces, in a "war of all against all". Just go quietly.

Yes. It is expedient that one man should die for the people.

What was new to me here was that instead of saying "the good of society" they are saying "the good of the family." That's a new one on me. And it turns out that "the good of the family" in Lindemann's world means, "Exploit your disabled daughter" and in Hardwig's world means, "Kill your mother" (as Chesterton might have said).

I wonder what they think of child labor laws. It would be a lot more natural if we were contemplating a Dickensian situation where the 8-year-old son goes out and sells newspapers all day in the winter because his family is so poor and needs the money.

Being currently halfway through a Bioethics course, I'm starting to think that perverse ethical opinions such as Lindemann's are not so rare. On the contrary, the field seems to be littered with them.

Zach, their name is legion. And the more "transgressive" among the ideas (e.g., forced organ donation, to name just one) are becoming more mainstream by the day.

Lydia:

There are so many levels of wrong in Lindemann's analysis, I am nearly speechless.

A family's "good" is not advanced by surgically raping its retarded member as part of a conspiracy between medical personnel and her parents in order to provide the latter a fatherless infant they may call "grandchild."

And, if anything, Lindemann's analysis is "Hobbes on steroids," individualism run amuck. In this scenario, the only individuals whose autonomy counts are the parents, since they are healthy and have their faculties. The retarded daughter and the unborn child--because they lack certain qualities--are just not up to snuff. Thus, they can be used in order to perpetuate a particular family's DNA in the interest of its only two autonomous members who are working in concert for this end. It's genomania, the opposite of "genocide."

That's not how families work, unless its members names are Short, Nasty, and Brutish.

Frank, you have an inimitable way of putting things. I couldn't have said it better myself.

It's pseudo-family values. I wonder why she doesn't think people will see that? I was thinking about this last night: It's like people think the world is run on slogans. Anybody remember fifteen years ago when the phrase "outcome-based education" came out? I think they even called it "education for mastery." It sounded really good. But already I was learning not to take things at face value. But I guess a lot of people do, and if you say to people in a soothing voice, "We're concerned about the good of the family," they'll think, "Yeah." Especially if it means they can do whatever they want and feel good about it.

The "progressive" condemns some institution or social arrangement as obsolete and irrelevant. The conservative says "You're destroying something vital and God-given, you idiot," but loses.

Then along comes some reformer who says "Gee, that conservative had a point. We've emptied ourselves of 'something' that's really precious.” Then he tries to recreate that "something" without reference to religion, history and tradition.

The "preciousness" of this fictional reformer is really all he has to go on. Lindemann's argument draws emotional force from the sentimentality, not the substance, of family.

Even the choice of tissue exploits familial sentimentalism. If a kidney or liver lobe transplant were demanded, rather than egg donation, would the writer have been so eager to make her argument?

(As an aside, some pro-natalist Christians especially would be vulnerable to Lindemann’s argument, while Christian traditions with a place for the celibate and the physically barren might be less so.)

I’m glad communitarianism was brought up. Lindemann presents us with Left or secular communitarianism: it encourages sacrifice to and respect for man, but not to God, the giver of life. It endorses bodily sacrifice in a world without the transfiguration and the resurrection of the body. (Is family lineage that important in a world where one’s body will be remade for eternity?)

A skewed communitarian vision also aspires to communion in a world without the Last Supper or the Trinity.

It has the bits and pieces of an older, decayed order but no sense of their interaction and balance.

And do I detect a tribal appeal in Lindemann's argument? While multiculturalism will probably suppress expressions of White ethnic loyalty, its vision of group loyalty may be manifested in family life. Especially if more and more single mothers must fall back on family ties to help raise their children in the absence of spouses and in-laws.

A family's "good" is not advanced by surgically raping its retarded member as part of a conspiracy between medical personnel and her parents in order to provide the latter a fatherless infant they may call "grandchild."

Well said.

Francis has the courage to state the family's "good" dogmatically but Lindemann retreats from this into a classic relative canard. This paragraph is telling

I’d also want to be very careful not to dismiss as unimportant the parents’ longing for the family line to continue. It’s not one of my values, but that’s easy for me to say: I have six children and four grandchildren. I don’t know how I would feel about it if the possibility of grandchildren were ruled out forever by the kind of tragedy this family has had to endure. The point is, though, that my own economy of values is here quite irrelevant.

The oddity of Lindemann's logic is that she wants to claim ignorance of the family's good as a justification at the same time that she takes pains to elaborate a narrow and particular interpretation of family "good." She says "I don't know how I would feel" when all of the previous discussion has extrapolated from a very definite interpretation of the daughter as owing a debt. What happened to the ignorance? Or is it that in ignorance we are always to apply a standard that is repulsive to our own sensibilities, as she supposedly claims the parents' wishes are to her?

Lydia,

This is the first time I have heard the appeal to family good instead of society good as well. Nevertheless, it's logical. There isn't a great philosophic jump here, just a sharpening of the rhetorical tools to elicit a stronger visceral response.

Francis,

The accent in that first sentence was supposed to fall on "courage" not on "dogmatically." Of course I didn't mean that you would be incapable of further elaboration or defense.

Lydia, I wouldn't dream of falling for Lindemann's argument. Only a consequentialist would fall for it, and this conservative has never been a consequentialist.

It's tempting to say that a conservative cannot, self-consistently, be a consequentialist; but it wouldn't be true. The torture debate shows that. Another example would be the support I've heard from many conservatives for the "strategic bombing" the Allies did in WW II, especially that of Hiroshima and Nagasaki. The only justification for that was utilitarian. I agree that such bombing was the only way to induce "unconditional surrender"; but as Elizabeth Anscombe once argued, so much the worse for unconditional surrender as a war aim. Being conservative is no guarantee of a sound or self-consistent moral philosophy.

I once taught bioethics. The central problem, to which its other questions connect like the spokes of a bicycle wheel, is determining when and in what ways being a human being makes one a subject of rights. That's also a general question of moral philosophy. So we won't get our bioethics right if we don't get our overall moral philosophy right. That's a problem for "conservatives" as well as "liberals," even though the latter have wandered much further off the farm.

All that should be obvious, but I've observed that it isn't always obvious.

I wonder also, Lydia, if Lindeman's thinking isn't further evidence of the virus-like propagation of that "principle of personal autonomy" trope I've written about before, in which one is said to give consent via proxy. That is, this disabled girl cannot give such consent, but others are empowered to determine what she would have done if she could, which coincides inerrantly with the wishes of those others. E.g., if you can take away a woman's life by withdrawing food and water, why can't you take her egg? After all, that's what she'd want us to do.

It's interesting, though, that Lindeman's colleagues came to a different conclusion. It makes me suspect that when people want to take something from you that isn't theirs, the consequences of not doing so must be more pressing than the absence of grandchildren. So far.

Yeah, the colleagues saw the conflict of interest there and said that therefore the parents couldn't make a proxy decision. I suspect that when it's a matter of killing someone by withdrawing food and fluids,it's become ingrained in the national consciousness that that is what the person would _usually_ want, that that is _normal_ somehow, especially if the patient is disabled. So conflicts of interest in proxy decision-makers tend to be ignored. Taking eggs for grandchildren is sufficiently unusual and bizarre that there isn't the same precedent for assuming that it is what the patient would want, and the conflict of interest in the parents as potential proxy decision-makers stood out to the colleagues like a sore thumb.

Not for the first time that the assault on the family is made under the guise of advancing its betterment.

The "the melancholy long withdrawing roar" of faith brings in its wake "a red-rimmed tide", as the market sets the price and answers the question; what is a human life worth.

We've been gradually accepting our own commodification under many rubrics for some time, and absent the active practicing of the Real Presence, we will give consent to an affordable and convenient self-annihilation.

It's like communitarianism entirely divorced from natural law.
Yup.
I’m glad communitarianism was brought up. Lindemann presents us with Left or secular communitarianism: it encourages sacrifice to and respect for man, but not to God, the giver of life.
Generally, the appropriate term for the kind of disordered hyper-communalism we're seeing here is collectivism, which necessitates the radical dissolution of the individual via a reduction of the human person, in this case, to a rational will. Since the mentally retarded daughter is understood to have a defective will, she is less than an individual human and so is easily dissolved into the collective. Any time one sees collectivism at work, discerning what the human person is being reduced to can often offer insight as to the roots of the disorder. In this light, one can see how individualism and collectivism are actually quite compatible in their shared reduction of the human person to the will, which is why societies in modernity like ours seem to oscillate between the two so-called "poles."

I prefer to reserve the term "communitarian" to describe a better ordered understanding of community. Your description, which touches on the roots of the disorder, is right on.

I wonder also, Lydia, if Lindeman's thinking isn't further evidence of the virus-like propagation of that "principle of personal autonomy" trope I've written about before, in which one is said to give consent via proxy. That is, this disabled girl cannot give such consent, but others are empowered to determine what she would have done if she could, which coincides inerrantly with the wishes of those others. E.g., if you can take away a woman's life by withdrawing food and water, why can't you take her egg? After all, that's what she'd want us to do.
Your example raises one of the dilemmas of the rational choice/will reduction of the human person. If what matters is the competence of the will, how can the "line" demarcating the minimum competence be drawn and held? Won't the lesser (informed) wills eventually be at the mercy of the educated elite managers whose "right" to control the lives of others is justified by the competence of their wills but not restrained and limited by a conception of well-ordered natural relations? It seems this is precisely the trajectory of our managerial State.
It's genomania
First time I've seen that term :)

"First time I've seen that term :)"

It's because I made it up!

No worries here. Those who'll fall victim to this "family ethics" mentality will be those who never had any, anyway--perhaps the mentally disabled daughter is fortunate in that she's spared the capacity to see her parents for the monsters they, essentially, are.

I'd also like to add that this remark has kept me laughing on and off for some time: "...This is, I say in all seriousness, like saying that cannibalism isn't so bad, because it shows the dependence of all people on one another..."

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