Bioethics is much larger than the sum of its parts. The discipline isn't "only" about how patients are treated in hospitals or the arcane detatis of public health policy. Rather, because many leading bioethicists reject intrinsic human dignity and seek to remake medical ethics and public policy to reflect that nihilistic worldview, the bioethics movement (as I call it) threatens to subvert human freedom. Indeed, if we reject human exceptionatism in bioethics - and the danger here is acute - the principle of universal human rights could buckle.
Bioethicists don't see themselves as undermining freedom, of course. Many betieve they champion tiberty by focusing intently on patient autonomy as the fundamental undefinning of bioethical analysis. Moreover, they note, bioethical advocacy helped bring an end to the bad old days of medical paternalism under which dying patients were often "hooked up to machines against their wiU," when they wanted to die naturally, at home, surrounded by family.
The Belief in Human Dignity Led to Better End-of-Life Care
Bioethics - along with the hospice movement - did indeed spark a revolution in the humane care of dying people. But the decades that have since passed have obscured why that great humanitarian reform was achieved: The most prominent leaders of these efforts were inspired by a robust Christian faith and a strong adherence to the sanctity/equality of human life.
The late English physician Dame Cedly Saunders, whose dedication to dying patients drove her over several decades to create the modern hospice movement, is a perfect example. In a 1998 interview for a book I was writing, she described how her work as a hospital social worker led to an epiphany: "I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term 'total pain,' from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since."1
This insight - and her great calling to reform end-of-Uf e care - arose directly from her deep Anglican faith, as I recounted in my book Culture of Death (citations omitted):
Saunders' epiphany was not "rational," but spiritual, coming from a deep empathy inspired by her religious faith. Her work was a "personal calling, underpinned by a powerful religious commitment," wrote David Clark, an English medical school professor of palliative care and Saunders' biographer, to whom she has entrusted the organization of her archives. So strong was Saunders' faith in what she perceived as her divine call: "I have thought for a number of years that God was calling me to try to found a home for patients dying of cancer," she wrote to a correspondent. Saunders' initial idea was for St. Christopher's hospice to be a "sequestered religious community solely concerned with caring for the dying." But the idea soon expanded from a strictly religious vision into a broader secular application, in Clark's words, "a fullblown medical project acting in the world."2
Similarly, the bioethics pioneer, the Christian theologian Paul Ramsey, was the first leader in the then-nascent movement to focus on methods by which dying patients could be treated more humanely within the medical system. He called it treating "the patient as a person," and indeed wrote a book by that title, arguing that patients should be aUowed to refuse unwanted life-extending treatment even if it resulted in their deaths.
Ramsey was not motivated by a belief that a dying or profoundly disabled patient is somehow less valuable than those who are healthy and able-bodied - a prominent view in contemporary bioethics. (As we shaU see, the problem today is that many in bioethics want to treat some patients as "non persons.") To the contrary, in The Patient as a Person, he clearly foresaw the nexus between upholding the sanctity of human life on one hand, and preserving human freedom on the other (my emphasis):
Just as man is a sacredness in the social and political order, so he is a sacredness in the natural and biological order. …