The Value of Life

An Introduction to Medical Ethics

John Harris

• Publisher: Routledge
• Year: 2006
• ISBN:
  9781134954209
• Edition: 1
• Topic: Philosophy
• Subtopic: Philosophy History & Theory

First published in 1985. Medical ethics is a vitally important subject and currently a highly controversial one. Recent cases have highlighted both the intellectual and moral challenges posed by the dilemmas of modern medicine and their significance for us all. John Harris fives a fully up-to-date survey of the issues in this crucial field of applied ethics, including in vitro fertilisation and experimentation on human embryos.

1 Beings, human beings and persons

The ultimate question for medical ethics, indeed, for any ethics, is also in a sense the very first question that arises when we begin to grapple with moral problems. The question is simply: what makes human life valuable and, in particular, what makes it more valuable than other forms of life? There is of course no doubt that we do value human life supremely, we think it important to save a person rather than a dog where we cannot save both, and we think it right to do so. We do not regard a preference for human life as a mere prejudice in favour of our own species. But what is the basis of this belief, what justifies it and what, if anything, makes it more than mere prejudice in favour of ourselves and our own kind?

This question—what makes human life valuable—may seem excessively abstract, a purely philosophical question, interesting perhaps, but too difficult and controversial to be of help in solving the practical problems that every day face health care professionals. Ironically, many of the day-to-day decisions taken in medical practice presuppose particular answers to this question. Abortion, for example, could be permissible only in cases where there is no danger to the mother and where the foetus is normal on the assumption that it is somehow less valuable than adults, and so lacks the protections and rights that adults have. Most people would not, I suppose, think that mentally or physically handicapped individuals are somehow less valuable than others, and yet anyone who thinks that the detection of handicap in the foetus is a good reason for abortion, must accept that such an individual is, or will become, less valuable than one without such handicap, less valuable because less worth saving or less entitled to life. The same issue of value arises at the other end of the continuum, where questions are raised as to whether we should continue to devote resources to the rescue and resuscitation of the aged or the terminally ill, or those in a permanent coma, and so on. If we decide against resuscitation, or divert resources to more ‘worthwhile’ cases, or types of cases, we are treating these lives as less valuable, less worthy of preservation than the others whom we choose to help.

The new techniques of in vitro embryology, which make possible the growing of embryos to provide tailor-made human tissue,¹ give us further reasons for being clear about the relative value of the embryo and the adult. Many people think the answer to this question could be settled if we could be sure about the answer to the related question ‘when does life begin?’, and, returning to the other end of the continuum, that our problems about the management of those in a persistent vegetative state would be resolved if we had an adequate definition of death. I shall argue that both these questions are misconceived even if they could be given determinate answers, and that what we need to know is not when life begins, but rather when life begins to matter morally. And the correlated question is not ‘when does life end?’ but rather ‘when does life cease to matter morally?’ In short, when does life begin to have that special value we believe attaches to human life and when does it cease to have that value?

What do we mean by ‘value’?

When we ask what makes human life valuable we are not concerned with what might make for differences in value between individuals, but with what makes individuals of a particular kind more valuable than others. So, we are not concerned with any of the sorts of considerations that might figure in a balloon debate, where reasons are given why each person in the balloon is more worthy and valuable than the others and so should be the last person to be thrown out to prevent a crash.² Rather we are interested in why and whether people have a particular significance and value simply because they are people and have whatever it takes to be a person, and are not quite different sorts of beings, animals or plants perhaps, which do not have what it takes.

To put this point another way, to believe that people are valuable in this sense is to accept that they should be treated as equals, that is as if they had equal value, quite irrespective of any reasons we might have for showing preferences between them for particular purposes. This is sometimes expressed as the view that there are basic human rights possessed by all people in virtue of their humanity, or as a belief in equal rights, or as the view that all people should be treated as equals.³ It is the assumption behind a belief in equality before the law, and it underlies the view that all are equally entitled to the care and protection of the state, including its medical care and protection. So, to hold that life is valuable in this sense is to believe that the individual whose life is valuable is entitled to the same concern, respect and protection as that accorded to any other individual.

When we ask what makes human life valuable we are trying to identify those features, whatever they are, which both incline us and entitle us to value ourselves and one another, and which license our belief that we are more valuable (and not just to ourselves) than animals, fish or plants. We are looking for the basis of the belief that it is morally right to choose to save the life of a person rather than that of a dog where both cannot be saved, and our belief that this is not merely a form of prejudice in favour of our own species but is capable of justification. So the features we are looking for, although they will be possessed by normal adult human beings, will not simply catalogue the differences between such beings and other creatures. Rather they will point to features which have moral relevance, which justify our preference for ourselves and our belief that it is right to treat people as the equals of one another and as the superiors of other creatures.

Humans and persons

In identifying the things that make human life valuable we will be pointing to the features that would make the existence of any being who possessed them valuable. It is important to have a word for such beings which is not simply anthropocentric or species-specific. I shall use the term person to stand for any being who has what it takes to be valuable in the sense described, whatever they are otherwise like. Although in normal use ‘person’ is just another (and usefully gender-neutral) term for ‘human being’, as I shall use it from now on it will also be species-neutral as well. This does not put as great a strain on our normal understanding of the word as may be imagined. For example, the question of whether or not there are people on other planets is a real one. If there are, we need not expect them to be human people (it would be bizarre if they were!), nor need we expect them to look or sound or smell (or anything else) like us. They might not even be organic, but might perhaps reproduce by mechanical construction rather than by genetic reproduction. But if we are able to answer the question in the affirmative, we will be distinguishing between people on other worlds and animals, plants or machines on those worlds. We will be deciding whether an appropriate response to them would be to have them for dinner in one sense or in the other. And if the people who we find (or who find us) turn out to be technologically very much our superiors, we may hope to persuade them that we are also people, not just like them maybe, but enough like them to be valuable, and to warrant being accorded the same concern, respect and protection as they would show to each other. And, if the boot is on the other foot, to warrant our according to them the same concern, respect and protection as we accord to one another. But in what respects must we be like them or they like us?

If we can answer this question, we will have sketched a concept of the person, and of what makes such creatures valuable, which we can apply to the dilemmas which face us every day and do not merely await us in some science fictional future. To begin our attempt to arrive at such an account we will start at the beginning.

I When does life begin?

Many people have supposed that the answer to the question ‘when does life begin to matter morally?’ is the same as the answer to the question ‘when does human life begin?’ The moment of conception may seem to be the obvious answer to the question of when life begins. Over any rival candidates it seems to have the decided edge that it is an identifiable event from which point the egg begins the continuous process that leads to maturity. But of course the egg is alive well before conception and indeed it undergoes a process of development and maturation without which conception is impossible. The sperm, too, is alive and wriggling. Life is a continuous process that proceeds uninterrupted from generation to generation continuously (or at least sporadically) evolving. It is not, then, life that begins at conception. But if not life, is it not at least the new individual that begins at conception?

A number of ‘things’ may begin at conception. Fertilisation can result not in an embryo but in a tumour which can threaten the mother’s life. This tumour, called a hydatidiform mole, would not presumably be invested with all the rights and protections that many believe spring fully armed into existence at fertilisation.

Even when fertilisation is, so to speak, on the right tracks, it does not result in an individual even of any kind. The fertilised egg becomes a cell mass which eventually divides into two major components:

the embryoblast and the trophoblast. The embryoblast becomes the foetus and the trophoblast becomes the extraembryonic membranes, the placenta and the umbilical cord. The trophoblastic derivatives are alive, are human, and have the same genetic composition as the foetus and are discarded at birth.⁴

A further complication is that the fertilised egg cannot be considered a new individual because it may well become two individuals. The fertilised egg may split to form twins and this can happen as late as two weeks after fertilisation.

Life, then, is a continuum and the emergence of the individual occurs gradually. At this point it is commonly argued that if life does not begin at conception and if it cannot be said that a new individual human being begins there, at least the potential for a new human being is then present complete with its full genetic make-up and with all its uniqueness and individuality. And since the fertilised egg is potentially a human being we must invest it with all the same rights and protections that are possessed by actual human beings. This we may call ‘the potentiality argument’.

The potentiality argument

There are two sorts of difficulty with the potentiality argument which are jointly and severally fatal to it. The first is that the bare fact that something will become X (even if it will inevitably become X, which is far from being the case with the fertilised egg and the adult human being) is not a good reason for treating it now as if it were in fact X. We will all inevitably die, but that is, I suppose, an inadequate reason for treating us now as if we were dead.

The second difficulty is that it is not only the fertilised egg that is potentially a human being. The unfertilised egg and the sperm are equally potentially new human beings. To say that a fertilised egg is potentially a human being is just to say that if certain things happen to it (like implantation), and certain other things do not (like spontaneous abortion), it will eventually become a human being. But the same is also true of the unfertilised egg and the sperm. If certain things happen to the egg (like meeting a sperm) and certain things happen to the sperm (like meeting an egg) and thereafter certain other things do not (like meeting a contraceptive), then they will eventually become a new human being.

It is sometimes objected that it is only the fertilised egg that has all the necessary potential present in one place, so to speak, and it is this that is crucial. It is only when the egg has been fertilised, so the argument goes, that a new unique entity exists that itself has all the potential necessary to become a new human being. This seems plausible enough until we remember that something had the potential to become that fertilised egg; and whatever had that potential, had also the potential to become whatever it is that the fertilised egg has the potential to become!

If then we ignore the first difficulty with the potentiality argument, and concede that we are somehow morally required to actualise all human potential, we are all in for a highly exhausting time. And it is clear that if we put the maximal effort into procreation that this imperative demands, our endeavours will ultimately be selfdefeating.

All that can safely be said of the fertilised egg is that it is live human tissue. Life itself does not begin at fertilisation, for the egg and the sperm are alive also. Life continues, and so what we need is not an account of when life begins but of when life begins to matter morally. Clifford Grobstein’s answer to this question has been influential, and it is worth looking at what he proposes.

When does self begin?

Grobstein argues that what matters is not the beginning of life, nor yet of human life, but of self. Self for Grobstein is personhood, that which makes us ‘characteristically human’, that which has an ‘inner’ life. A self will have a sense of self, and this means in effect self-awareness. ‘Self is not just sensation, it is sensation within a bounded object that is the physical equivalent of the discreteness of the feeling of self.'⁵ This is a fairly minimal conception of self, as we shall see, and Grobstein offers three criteria of recognition of the presence of self. First, a self will exhibit ‘behaviour diagnostic of a rudimentary self-state’,⁶ and this behaviour would be some minimal response to external change. The example offered of such a response is the stimulation of an embryo by stroking its skin with hairs, and the response ‘was a slow and weak turning of the head away from the stimulus’.⁷

The second criterion is the possession of ‘non-behavioural functional processes’.⁸ An example of such a process is the nervous system, and the criterion is that ‘the self be capable of being recognised as a self by others’.⁹ The first two criteria are very rudimentary and do not in fact distinguish persons from animals, or even the human foetus from that of most animals. For these reasons, Grobstein is forced to place all the burden of recognition of self in this third criterion:

The question is to determine when in development the embryo or fetus is generally recognizable as human and evokes empathy as another self. Prior to that point, assumption of the presence of an inner self requires some objective evidence of its existence. Subsequent to that point the burden of proof shifts. A self is to be assumed unless there is strong evidence to the contrary. The question thus becomes the stage at which the embryo or fetus can first be generally recognized as human, generating empathy as a person or a person to be.¹⁰

By showing us diagrams of more and more humanoid foetuses Grobstein is able to persuade us that the stage in question is at the end of the first tr...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgments
• Introduction
• 1 Beings, human beings and persons
• 2 Above all do no harm
• 3 Must doctors help their patients?
• 4 Killing: a caring thing to do?
• 5 The value of life
• 6 The beginnings of life
• 7 Whose body is it anyway?
• 8 A woman's right to choose?
• 9 Sexual morality and the natural
• 10 Respect for persons I
• 11 Respect for persons II
• 12 Death is abolished
• Notes
• Suggested further reading
• Index