Life, Liberty, and the Defense of Dignity

3/1/2003

By Leon Kass

Encounter Books 2002 Paperback Buy here

Book Review
Reviewed by James Stacey Taylor

In 2001, Leon Kass was appointed by President Bush to chair the President’s Council on Bioethics. Kass’s views on bioethical issues thus carry considerable weight, especially among politicians of a certain political persuasion. Moreover, as Kass notes in his Introduction to Life, Liberty and the Defense of Dignity, bioethical issues are likely to be “a dominant concern of the new century—indeed, of the new millennium” (1). In this, Kass is surely right. The recent advances in medical technology that have brought us the possibility stem cell research, cloning, the Human Genome Project, and the increasing number of ways that can now be used to prolong human life for increasingly lengthy periods of time have brought with them a myriad of bioethical questions. And not the least of these questions, as Kass notes, is the question of whether such new technology should be used at all. Given the importance of these issues, and the importance of Leon Kass in deciding the approach America will take towards them, it is exceptionally important that Kass’s conclusions concerning these issues are well and clearly justified.

As the title of Life, Liberty, and the Defense of Dignity indicates, Kass addresses some of the most pressing issues in contemporary bioethics from the point of view of one who wishes to protect human life, human liberty, and human dignity. For Kass, these terms have particular meanings—ones that he takes to be central to the classical liberal use of these concepts, where “classical liberal” refers to “regimes, societies, mores, principles and worldviews that celebrate human freedom” (3). Here, a “truly human bioethics” (18) will be one that “does full justice to the meaning of our peculiarly human union of soul and body in which low neediness and divine aspiration are concretely joined” (20). Such an approach to bioethics will take liberty seriously, where “liberty” is understood as “self-rule, not self-indulgence” (50), and “the freedom of private life,” understood in terms of private family life “rooted in the bonds of lineage and relation” and freedom to worship (51). And last, but by no means least, Kass’s approach to bioethics takes the ideal of human dignity seriously, which he understands “to reflect and embrace the worthiness of embodied human life” (17-18).

This approach to bioethics is an admirable one, as is Kass’s choice of the issues that he covers. Kass divides Life, Liberty, and the Defense of Dignity into three sections. In the first section of the book, “Nature and Purposes of Technology and Ethics,” Kass argues in Chapter 1 “that technology as a way of life is doomed” (49), and, in Chapter 2, that the current practices of professional ethicists are both inadequate and inappropriate as means of addressing the bioethical issues that we currently face. In the second section of this volume, “Ethical Challenges from Biotechnology,” Kass addresses particular areas of bioethical concern. In Chapter 3, he addresses the question of whether or not we “Should allow or encourage the initiation and growth of human life in the laboratory?” (81). Here, Kass argues that “in vitro fertilization and embryo transfer to treat infertility” “is perfectly compatible with a respect and reverence for human life” (91). However, experimentation on embryos and blastocysts (that is, early-stage embryos that contain between one hundred and two hundred cells), Kass argues, is not compatible with such respect. Moreover, Kass argues, respect for human life is also incompatible with growing embryos into full-term babies, should the technology become available. In Chapter 4, Kass considers some of the implications of the human genome project, including those that arise out of the possibilities of genetic engineering and screening that this project promises. Kass argues here that, contrary to usual beliefs, genetic self-knowledge might not be good for us, as individuals, for it poses not only a threat to our ability “to live easily and wisely” but also a threat to “human freedom and spontaneity” (125). Moreover, argues Kass, concerns that contemporary geneticists are “playing God” are well-founded, for the use of genetic technology is not only dehumanizing and subtly coercive, but its “quasi-messianic goal of a painless, suffering-free…existence” for humans is illusory (132).

Kass continues to criticize the contemporary pursuit of technological progress in Chapter 5, where he argues against the cloning of humans. Referring to organ transplantation as “simply a noble form of cannibalism” (185), Kass turns in Chapter 6 to argue that there are a series of powerful presumptions that tell against the propriety of organ donation. Since this is so, Kass argues, the existing prohibitions on the sale of human organs for transplantation should be maintained, for to allow such exchanges would be “to forget altogether the impropriety overcome in allowing donation and transplantation in the first place” (195). In Chapters 7 and 8, Kass turns his attention from ethical issues arising as a result of persons wishing either to create or prolong human life, to those associated with the desire of some persons to bring their own lives to an end. Here, Kass argues against there being any “right to die,” and also against the view that euthanasia and physician-assisted suicide can gain moral support from the appeal to the idea of “death with dignity” (244). Kass ends the second section of Life, Liberty, and the Defense of Dignity with arguments “against our insatiable lust for unending life” (24).

In the third and final section of Kass’s book, “Nature and Purposes of Biology,” consisting solely of Chapter 10, Kass turns his attention to the scientific quest that has led to the development of the biotechnologies that have given rise to the ethical questions that he addressed in the preceding section. Here, Kass argues that the contemporary practice of science is dehumanizing, homogenizing, and leads to an overly materialistic view of human life. He concludes Life, Liberty, and the Defense of Dignity by claiming that “life and soul are irreducibly mysterious” (296), and that “Biology may do some of its finest work when it is brought to acknowledge and affirm the mysteries of the soul and the mysterious source of life, truth and goodness” (297).

Kass recognizes that nothing he could say would “prevent many readers of this book from regarding it as a Luddite tract” (25). Insofar as the term “Luddite” is used in current parlance to denote a person who is unthinkingly opposed to technological progress, charging Kass with being a Luddite would be unfair. Life, Liberty and the Defense of Dignity is manifestly not the work of an unthinking person, but the work of someone grappling intelligently with some of the most difficult ethical questions of our age. But since this is so, it is odd that Kass explicitly rejects (apparently wholesale) all of the resources analytic philosophy has to offer the intelligent person to address these problems. Kass’s rejection of rational, analytic, philosophical ethics is especially surprising since he accepts both that he is addressing a series of difficult ethical problems, and also that the “rationality at work” in philosophical ethics is “above all a problem solver” (61; italics in original). The conclusion of this syllogism should not have been hard to draw.

Perhaps, though, this criticism of Kass’s rejection of analytic ethical reasoning is based on an overly-simple interpretation of his views. And, indeed, Kass offers two distinct lines of criticism against analytic ethics—although he himself does not appear to recognize that these criticisms are distinct from each other. First, Kass criticizes analytic ethics for providing “sophistic” (59), “abstract” arguments that are completely divorced from “real moral deliberation” (57). To illustrate his point Kass provides the example of a moderately demented elderly woman in a nursing home who, after repeatedly asking her son to help her die, suffers a stroke and then develops double pneumonia. The question now arises as to whether or not her pneumonia should be treated. Some of her family members, mindful of her earlier requests for aid in dying, say no. Her physician says yes, as he believes it would be immoral for him not to treat her. What to do? In Kass’s example, the problem is solved simply: The woman’s son “manages to get her to see what needs to be decided and that she has a choice” (58), and she lucidly elects to be treated. By contrast, Kass claims, were this problem to be addressed by professional ethicists the decision would be reached through discussions that are “generalized, remote, highly influenced by the current fashions of bioethics” (58). Instead of focusing on the real issue at hand—this woman’s decision—the discussions of the professionals would focus on the tyranny of medical paternalism, consequentialism versus deontology, the possible distinction between killing and allowing to die, and so on. The woman’s “concrete human situation” would be “drowned out by a flood of theory” (59).

Clearly, drowning out a person’s “concrete human situation” with a “flood of theory” would be a bad thing. But, equally clear, this is by no means an inevitable consequence of the decision-making process of analytic ethics. Indeed, given the current emphasis in analytic ethics on the Principle of Respect for Autonomy Kass’s preferred solution to this problem—finding out what the woman really wants, and acting on this—is precisely that which would be endorsed by professional ethicists. This will come as no surprise to persons familiar with how professional ethicists actually work. No competent professional ethicist would ignore the views of the person whose situation is under discussion, as Kass implies here. Furthermore, no competent professional ethicist would talk in purely theoretical terms, with no interest in the concrete situation. To do so would be to make a mockery of the claim that he was applying ethics. And no ethics committee would dictate what is to be done, as Kass also implies. Its members (which would comprise not only ethicists, but also lawyers, clergy, physicians, and laypersons) would merely advise the persons most intimately connected with the situation, and help to clarify their options. Finally, in having the woman choose life Kass’s example seems rather hand-picked. Given his opposition to euthanasia and physician-assisted suicide, what would Kass suggest be done if the woman had, in response to her son’s questions, again requested that she be killed? Presumably, he would have denied her request—and he would have done so on the theoretical grounds that he elaborates in Chapters 7 and 8. This poor woman’s “concrete human situation” then really would be drowned out by a “flood of theory.”

Even if Kass’s characterization of the decision-making procedures of professional ethicists is mistaken, showing this does not meet his two charges that analytic ethics is too “universal” or “abstract” to be of practical use, for “no guidelines can cover all real cases” (63), and that the “far-out, cleverly contrived dilemmas” (65) of analytic ethics bear no relationship to the actual problems that people face. Yet, these charges are readily rebutted. The first of these charges applies not only to analytic ethics, but to any principle-based approach to morality. Once this is recognized, the charge that “universal,” “abstract” guidelines have no practical import can immediately be seen to be false. The Ten Commandments, the Golden Rule, Kant’s categorical imperative, the utilitarian command to maximize the greatest happiness for the greatest number, the Hippocratic oath—all are “universal” and “abstract” guidelines for living a moral life of the sort that Kass objects to, and all can be put into practice.

What, then, of Kass’s charge that analytic ethics focuses on “far-out, cleverly contrived dilemmas” that bear no relationship to the real world? Unfortunately, just as Kass’s charge that professional ethicists rely on theory at the expense of engaging with a person’s concrete human situation is a mischaracterization of what ethicists do in a clinical context, so too is this a mischaracterization of the methods of analytic ethics. To be sure, analytic ethicists do sometimes draw from “far-out, cleverly contrived” situations—as did their intellectual forebears, the ethicists in the Judeo-Christian tradition. But neither the great medieval ethicists in the Judeo-Christian tradition nor the modern inheritors of their intellectual methodology develop such situations just for fun. They do so to abstract from the messy and complicated situations of real life in order to focus on one particular aspect of them to clarify what the ethical response to this isolated aspect of a messy, real-life situation should be. Then, once this has been decided, another element of the real situation is abstracted through the development of another “far-out, cleverly contrived” situation—and so on, until all aspects of the real life situation have been carefully discussed and an informed, reflective ethical decision regarding it can be made.

To see this methodology at work and to see how powerful it is, consider the example of this methodology that Kass refers to: J.J. Thomson’s example of “a woman who wakes up to find a world-famous violinist grafted onto her body” (65) and who needs to live there for nine months in order to survive. (Kass omits this latter part, perhaps because without it the situation seems to have no connection to the issue of abortion. Moreover, for some reason he fails to cite Thomson’s article, or even mention her by name.) Is this example far-out? Certainly. Is it irrelevant, as Kass claims? No. Thomson’s point here is a simple one. If you consider it morally permissible for the woman to unplug the violinist from her body in this situation, then you should also consider it morally permissible to a woman to “unplug” a fetus from her body, if it arrived there through no voluntary action of her own (for example, though rape). Kass is right that the situation is far-out—far-out situations generate clear moral responses. He is also right that the situation is cleverly contrived—it has to be, for it to be a direct analogy to the real-life ethical issue at hand. But he is utterly wrong to think that such far-out, cleverly-contrived situations can tell us nothing about ethics, or how we should live.

Kass’s criticisms of the use of theory if ethics are thus based on mischaracterizing both the activities of professional ethicists, and the role that theory plays in their deliberations. However, his second criticism—that for all the proliferation of ethics talk neither healthcare professionals nor the public appear to be any more ethical than they used to be—is based on an accurate perception of the problem at hand. Kass claims that ethicists have failed to educate the public because they have failed to address the “moral sensibilities and affections or habits and customs of moral agents” (63). Kass seems correct here. Even if analytic ethics succeeds in discovering what should be done in any given situation, this discovery will be impotent unless the people involved in the situation are persuaded that they should follow the ethicists’ advice. But this is a criticism not of analytic ethics itself, but of the public-relations skills of professional ethicists. Moreover, this criticism does not only apply to the analytic ethicists whom Kass objects to. It applies to all who work in bioethics—including those (such as Hans Jonas and Dan Callahan) Kass admires. This criticism also applies—perhaps even with more force—to religious practitioners and devotees. After all, Judaism, Christianity, and Islam have had millennia to educate persons into a deeper moral sensibility. And if these wonderous and beautiful religions have failed (and they have, apparently, in Kass’s view) to achieve this educational aim it seems unfair to criticize contemporary analytic ethicists for not succeeding in just two or three decades.

Analytic ethics can thus fend off Kass’s criticisms with ease. What, then, of Kass’s own view of how to approach ethics? For Kass, “the true route begins with practice, with deeds and doers, and moves only secondarily to reflection on practice” (68-69). For Kass, “We need to think less about doctrine and principles and the rules to govern behavior, more about education and institutions—and what sort of people we want to produce” (73). Leaving the rather ominous and totalitarian sounding phrase “what sort of people we want to produce” to one side, this “practice-first” approach to the moral life seems very strange indeed. Surely any civilized society would wish for members to have some moral compass before they interacted with their fellow citizens, rather than leaving them to develop it (with luck!) through the practice of such interaction? Surely Little Johnny should be taught why teasing his classmates is wrong before he does so, rather than getting to use the tears of Little Jilly as an object lesson after the fact? Moreover, if we are thinking even less about “the rules to govern behaviour” than we do now, what should we teach in the educational institutions that Kass sets such store by? Mere lists of facts? But this cannot be right—especially since, as Kass recognizes, facts alone cannot motivate. Indeed, given Kass’s own endorsement of the importance of a liberal education “for thoughtfulness and understanding” (52) it is surprising that he does not wholeheartedly endorse the analytic ethicists’ focus on just this—namely, the thoughtful development of ethical principles through the careful examination of case studies to arise at the correct moral principles to guide practice.

This defense of analytic ethics and criticism of Kass’s own approach is, of course, fairly abstract—and Kass opposes abstraction. How, then, do Kass’s arguments fare over more concrete ethical issues? Alas, not well. For a start, at times Kass’s distrust of universal ethical principles leads him into inconsistency. For example, in Chapter 3 Kass criticizes embryo adoption and surrogate pregnancy on the grounds that clarity about one’s origins is “crucial for self-identity, itself important for self-respect” (100). However, in Chapter 4 he argues against people being allowed to secure genetic self-knowledge on the grounds that ignorance of their origins would foster “human freedom and spontaneity” (125). Similarly, in discussing the Human Genome Project, Kass laments the possibility that if genetic diseases and abnormalities can be screened for, children born with them might be regarded “as inferior human beings who should not have been born” (130). Kass is right that such an attitude towards a person is morally repugnant. However, children who just happen to have been raised from embryos into viable babies in a laboratory do not qualify as human for Kass, since they lack the “bonds of lineage, kinship and descent” that people with more usual origins possess; and, for Kass, “To be human means not only to have human form and powers; it means also to have a human context and to be humanly connected” (95). Kass thus advocates that unimplanted, in vitro embryos be allowed to die, for if they lived they would produce inferior human beings—or, at least, would do so according to his undefended account of what constitutes a human life. But this looks very much like the sort of reasoning that he holds so abhorrent when applied to the genetically malformed. Moreover, since the only real difference Kass notes here between laboratory-raised embryos and people with more usual origins is that the former do not know their parents while the latter do, one wonders what Kass’s views are concerning the moral status of children who are put up for adoption at birth.

In addition to these argumentative inconsistencies and worrying conclusions—and there are many others in the text—Kass’s distrust of any principled approach to ethics leads him to argue from the importance of being and living in a manner that is somehow properly human and consistent with human dignity. But these are (despite Kass’s distrust of abstraction) highly abstract concepts, and Kass never tells us exactly what they mean, or how they are supposed to inform decisions about bioethical issues. We do know that, for Kass, a life with human dignity is one that is “lived always with and against necessity, struggling to meet it, not to eliminate it” (18). It thus appears that Kass’s objection to gene therapy lies in its possibility to secure for “a painless, suffering-free” existence for people. Similarly, his objection to voluntary, active euthanasia is that it is more dignified to face one’s “troubles and pains” (251) than to be euthanized. Kass’s idea that a life lived with dignity requires struggle is widespread. Both Kant and Mill found something morally distasteful in the life of the pure-lotus eater, and this philosophical disquiet finds popular expression in the U.S. Army’s slogan “Be all that you can be.” However, Kass overlooks the fact that even if a person’s needs and desires can be readily met without struggle, this situation itself might challenge those within it. If one is so readily provided for, it would be difficult to motivate oneself to “be all that one could be.” In fact, it might be even more difficult to emerge triumphant in the struggle to overcome the temptation to lotus-eat in such a Brave New World than it would be to triumph in the struggle to survive out of it. As such, the ease and leisure medical advances bring might even serve to enhance rather than undermine the possibility for human dignity, understood on Kass’s own terms.

The denotations of the concepts of a proper human life and human dignity that Kass’s arguments rest on, then, are not only unclear, but, when clarified, are difficult to apply univocally in practical bioethical debates. These flaws severely weaken Kass’s arguments—so much so that his conclusions often end up looking like mere assertions. Kass’s arguments are further weakened to the extent that rest on false dichotomies. For example, in his discussion of cloning Kass claims that “to say ‘yes’ to asexual reproduction and baby manufacture is to say ‘no’ to all natural human relations, is to say ‘no’ also to the deepest meaning of coupling, namely, human erotic longing” (157). But this just isn’t true. If human cloning becomes legal and readily available, a couple might, for example, decide to have a cloned child, and a “natural” child to express their erotic longing. Or a couple might decide to clone because one carries a genetic disorder, and yet they still retain their deep erotic longing for each other.

The difficulties noted above are all systematic ones, present throughout Life, Liberty, and the Defense of Dignity. But Kass also makes many individual mistakes and omissions. For example, he claims that Kant’s moral teaching is “perfectly comfortable” with “the sale of organs” (17), when, in fact, Kant roundly condemns the commodification of the human body—a fact that Kass himself notes when discussing organ sales (185). Similarly, he claims that Thomas Hobbes was “the first teacher of rights” (204) when he clearly wasn’t. Kass also claims that the concept of autonomy as this is used in bioethics “has come to mean ‘choosing for yourself, whatever you choose’” (16, 216). Again, this is simply false. Both theorists of autonomy and the bioethicists who draw from their work invariably distinguish agents that are autonomous, such as adult humans, and those that are not, such as children, animals, and the incompetent. Since all these agents have desires, it cannot be the case that the exercise of autonomy consists merely of desire satisfaction. Instead, theorists of autonomy note that autonomous desires, those worthy of respect, are those that persons endorse, in the sense of wanting to have and wanting to be moved by them, ones that they have after reflection, and so on. At times, Kass even makes claims that are self-contradictory. It cannot be true that “…truth and error themselves, no less than freedom and dignity, become empty notions when the soul is reduced to chemicals” (137). If one does live in a world that can be completely described scientifically (if “the soul is reduced to chemicals”) the claims about that world will themselves be either true or false. Worse yet, Kass fails to address many of the powerful arguments that are offered against his position. For example, he does not address (or even mention) any of the powerful utilitarian arguments offered in favor of physician-assisted suicide or active voluntary euthanasia, that are the mainstays of most discussions of these issues in both academic and policy circles. It simply isn’t true, as Kass asserts, that if rights-based arguments for these practices fail then “the only possible philosophical ground for a right to die” is “arbitrary will, backed by moral relativism” (218). And, as Hamlet recognized in his famous soliloquy, it is not clear that it takes more courage to suffer “the slings and arrows of outrageous fortune” than it does to make quietus, as Kass claims in discussing euthanasia (251). Similarly, Kass outlines a list of morally-suspect reasons that persons might give in favor of having a cloned child, such as using it as an organ bank, or as a replacement for a dead sibling (149), even though his accurate account of the science behind cloning that he outlined just a page earlier clearly shows that were cloning properly understood these reasons would evaporate (147-148). For Kass not to note this is disingenuous at best. Other errors and omissions of strong opposing arguments abound.

This has been a long review, and one might leave it with a feeling that there is nothing of value in Kass’s Life, Liberty, and the Defense of Dignity. But this impression would be mistaken. Kass writes that his aim in this volume “is to encourage greater thoughtfulness” (26), and he will certainly achieve this. However, the truly thoughtful reader should not be content with Kass’s account of the issues—a comment that I am sure that Kass would endorse. Instead, on reading Kass’s book and on being persuaded by his eloquence and erudition that the issues he addresses are important and complex, the thoughtful reader should then turn to the professional ethicists, persons who consider all sides of these questions fairly and thoroughly, and concisely, clearly, and cogently argument for their conclusions. In brief, after becoming interested in bioethics through Kass’s work, persons should turn to theoretically informed, analytic bioethics to really think through these issues.