Most people understand the word “death” to mean the end of biological life or, as Merriam-Webster defines it, “a permanent cessation of all vital functions.” But now an influential cadre of utilitarian bioethicists wants to redefine it to include a subjective and sociologically based meaning. Their purpose isn’t greater scientific accuracy. Rather, by making “death” malleable, they hope to open the door further to treating indisputably living human beings as if they were cadavers.
Legally, human death is declared when medical testing discerns the irreversible cessation of one of two biological functions that must work for a human being to be considered an integrated functioning organism. The first is the cardio/pulmonary function, the irreversible cessation of which is sometimes called “heart death.” The other is the brain; irreversible total brain failure, or the permanent cessation of the brain and each of its constituent parts acting as a brain, is popularly known as “brain death.” (Brain death is controversial in some quarters, but I won’t go into that here.)
The redefiners contend that these approaches are too constraining. What also matters, they claim, is the exhibition of characteristics that they claim earn an individual the status of “person.” Let’s call this “personhood theory”—the belief that moral value, and even death, can be determined by the presence or permanent absence of mental capacities such as self-awareness. In this view, those who, through injury or illness, have lost the ability to express personhood should be considered dead or, at least, as good as dead.
Princeton’s Peter Singer is the most renowned promoter of personhood theory, which he notoriously claims justifies infanticide, a lethal act he sees as no more portentous morally than killing a mackerel. “Since neither a newborn infant nor a fish is a person,” Singer wrote in Rethinking Life and Death, “the wrongness of killing such beings is not as great as the wrongness of killing a person.” Singer expanded on this theme in his utilitarian philosophical treatise, Practical Ethics, asserting:
When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if killing the hemophiliac infant has no adverse effect on others, it would according to the total view, be right to kill him.
If Singer were alone in the “personhood” camp, we could dismiss him as a radical saying the kinds of radical things that bring success in academia and applause from the liberal media. (Singer is regularly featured in New York Times stories and columns as an ethics expert.) But he is nowhere close to the bioethics fringe. Indeed, some of the most prominent thinkers in the field endorse personhood theory and believe in redefining death, either in law or effectively based on policies they propose, such as the live organ harvesting of persistently unconscious patients.
Recently, the argument for subjective death was made in QJM, a medical journal published by the prestigious Oxford University Press. From “The Death of Human Beings,” by N. Emmerich (my emphasis):
When we say that someone has died, we do not merely mean that some biological entity no longer functions. We mean that they, some unique mind or person, understood as a cognitive phenomena or psychological entity, has ceased to exist. Despite being a non-biological term, personhood admits of the application of the terms life and death and, furthermore, reflects the ordinary meaning of the terms.
Emmerich’s article was honored as an “editor’s choice.”
Changing the definition of death from the irreversible cessation of biological processes to a subjective determination that personhood has ceased would be morally catastrophic. In real-world terms, it could lead to the ending of all human non-persons’ biological existence—that is, the mass homicide of tens of thousands of persistently unconscious patients. Even more insidious, it would allow for treating such living people as if they were dead; their bodies could be live-harvested for organs or experimented on. One article in the prominent Journal of Medical Ethics argued that “living cadavers”—patients in a persistent vegetative state—should be allowed to be stripped of their own kidneys, which would be transplanted and replaced with pig organs to test whether porcine viruses would cross the species barrier.
That’s not all: Such uses could also be applied to living fetuses, perhaps even infants, who under this theory might not yet be considered “living” human beings because they haven’t developed the mental capacities deemed necessary for personhood. You think I exaggerate? Emmerich goes there (my emphasis):
A severely anencephalic neonate is a human organism that may be alive (or dead) in the sense of zoe [Greek for “life”]. However, they will never have a life in the sense of bios [having a life]. On the account offered by Schofield et al. life begins at conception. We should, therefore, distinguish between the commencement of biological or organismic life and the point at which the fetus becomes a subject, and not just an object, of life.
Redefining death would unleash profound evil. And there is no reason to think that the oppression such a policy would enable would be limited to the cognitively incapacitated and the preborn gestating. Once we agree that human value should be judged on a sliding scale, it won’t take long for us to discriminate against “persons” based on the perceived quality of their personhood. As history has repeatedly shown, when we abandon the view that all of us matter equally, who matters and who doesn’t depends on who has the power to decide.
Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant for the Patients Rights Council. His new book, Culture of Death: The Age of “Do Harm” Medicine, will be published by Encounter Books on May 17, 2016.
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