Bring Back the Body

What It Means to Be Human:
The Case for the Body in Public Bioethics
by o. carter snead
harvard, 336 pages, $39.95

In 2014, France’s High Audiovisual Council, the government body that regulates broadcast advertising in that country, banned one of the most moving TV commercials ever made. Titled “Dear ­Future Mom,” the ad addressed women pregnant with children diagnosed with Down syndrome. “Dear future mom,” said one child with Down syndrome. “Don’t be afraid,” said another. “Your child will be able to do many things.” “He’ll be able to hug you.” “He’ll be able to run towards you.” “He’ll be able to speak and tell you he loves you.”

In France, 96 percent of Down syndrome pregnancies are terminated; some Nordic states claim to have virtually eliminated the condition through selective abortion. Produced by several European Down syndrome associations (and aired in the United States), “Dear Future Mom” was a modest attempt to arrest the eradication of an entire category of human beings. And it proved a global hit, breaking records for social-media shares and winning the support of Matteo Renzi, the Italian Prime Minister, among many other public figures.

So why did the French government bar it? When I interviewed a spokeswoman for the audiovisual council in 2017, she wouldn’t speak on the record. But the agency insisted that it was reacting to audience complaints. There were, in fact, just two such complaints, as the ad’s French sponsor learned in the course of years-long litigation.

One complainant took issue with the sponsor’s pro-life stance generally, not with anything specific to the ad. The second complaint came from a woman who had aborted a Down syndrome pregnancy and found the ad “violent.” In the end, France’s highest administrative court, the Council of State, upheld the ban, on the grounds that “Dear Future Mom” could “disturb the consciences” of women who had aborted Down syndrome pregnancies. (An appeal is still pending before the European Court of Human Rights.)

“Disturbing the conscience” is an interesting justification for state censorship. To protect the right to eugenic abortion from criticism of any sort, it seems, the French state must silence the moral claims of children with disabilities. To permit children with Down syndrome to address expectant mothers is impermissible, because it brings into view the nagging obligations of embodied love: between mother and child, between the strong and the weak, between the human family and some of its most vulnerable members.

For O. Carter Snead, such acts of silencing are not surprising. In What It Means to Be Human: The Case for the Body in Public Bioethics, Snead offers a thoroughgoing critique of modern bioethics. The field, he argues, fails to account for central dimensions of our shared humanity. We are born into bodies—bodies that are subject to “vulnerability, dependence, frailty, and finitude”—and this fact imposes moral obligations upon us, toward ourselves and others.

Instead of supplying an ethical program befitting an embodied being, modern bioethics “defines the human being fundamentally as an atomized and solitary will”—a subjective, mental thing that happens to be attached to a fleshly apparatus. For this disembodied entity to be happy, it must maximize its capacity to choose, to make and realize plans, and above all to express itself, including by ignoring or overriding the natural ends and limits imposed by the human body.

Put another way: Modern bioethics rests on an incorrect philosophical anthropology, and there is no setting bioethics right without first getting the anthropology right.

Snead, a legal scholar at the University of Notre Dame and a bioethics adviser to Pope Francis, is particularly concerned with American law, though the developments he analyzes span the developed world. He begins by tracing the history of public bioethics in the United States. Well into the twentieth century, Snead notes, the U.S. had no codified safeguards against the experimental abuse of human subjects, a fact that proved not a little embarrassing to American prosecutors at the Nuremberg Doctor’s Trial.

It was only in the 1960s and 1970s that Congress and the courts were impelled to set down some bioethical principles, and then only in response to a cascade of shocking revelations that horrified the public. The ­Tuskegee Study, in which U.S. government researchers “studied” the effects on and progression of syphilis among poor, black sharecroppers in Macon County, Alabama, provided bogus nontreatments under false pretenses and even proactively prevented the men from seeking proper care. The experiment lasted four decades. Then there were the findings of Harvard anesthesiologist Henry Knowles Beecher, who blew the whistle on more than twenty ­medical experiments conducted without informed consent and with no therapeutic benefit to the human subjects. Finally, monstrous experiments were conducted on just-­aborted babies while they were still alive ex utero.

Americans can thank a coalition of mainly African-American activists and Roman Catholic lawmakers, not least the late Sen. Edward Kennedy, for putting a stop to the worst of these abuses. Yet as Snead shows, the adoption of the National Research Act and the creation of various bioethical oversight bodies and protocols didn’t alter the fundamental pattern of American bioethical debates, which persists to this day.

That pattern, as Snead describes it, goes something like this: A new development outrages the public and captures its imagination. Scientists clamor for autonomy. Theologians warn against “playing God.” Congress or the courts haphazardly split the difference. Yet the debate as a whole, including opposition to new experiments and biotechnological developments, is framed around “the goods of autonomy and self determination,” deployed to “secure the informed exercise of free will by rational, able-minded persons.”

That last category, of course, excludes all human beings at the earliest stages of life and many at later stages. Some people are excluded permanently, since their handicaps deprive them of the “qualifying” cognitive capacities for the duration of their lives.

How did we end up here? Snead blames a bad anthropological account arising from ­eighteenth-century social-contract theories and the expressive individualism that Robert Bellah identified as the basic American worldview, one in which “human flourishing consists in the expression of one’s innermost identity through freely choosing and configuring life in accordance with his or her own distinctive core intuitions, feelings, and preferences.” Though it abounds in the rhetoric of liberation, the expressivist impulse, fully worked out, leads paradoxically to new forms of tyranny. State censorship of any message that might remind mothers of the love of children with Down syndrome is but one example.

Snead devotes the bulk of his book to demonstrating how American bioethics, time and again, reflects this disembodied vision of what it means to be human: from Justice Harry Blackmun’s infamous assertion in Roe that the law can’t protect “one theory of life” to Justice Anthony Kennedy’s still more infamous discernment of a constitutional right to “define one’s own concept of . . . the mystery of human life”; and from the discovery of a “right” to family formation for same-sex and other couples by way of commercial surrogacy to the “right” of each person to die at a time of his or her choosing.

Religious Americans won’t succeed in reversing these trends if they don’t learn to anchor their arguments in something other than the rights talk that has become common even among conservatives. Snead proposes an “anthropology of embodiment” that draws heavily on the work of Alasdair MacIntyre. He exhorts us to remember that we are embodied beings who begin and end life in states of total vulnerability and spend most of it embedded in networks that we don’t choose and that don’t choose us.

When we acknowledge our own vulnerability and dependence, we are compelled to extend care and concern to those who are more ­obviously vulnerable and dependent than we are. The law, Snead says, must ­intervene when and where networks of care have failed—for example, where hospice care is substandard or nonexistent for the elderly, tempting them and their caretakers to choose assisted suicide or euthanasia. And, one hopes, the same solicitude for the vulnerable and dependent will awaken our society to the need to pass laws that prohibit abortion and euthanasia.

Careful readers of this book will find it an ambitious reorientation program for the entire pro-life movement. It is a most welcome development.

Sohrab Ahmari is the op-ed editor of the New York Post.