Update
AMA Council's Ethics Overwhelmed by Public Sentiment
Jim Walters, PhD Professor of Christian Ethics
Loma Linda University
The AMA's Ethics and Judicial Council boldly charged ahead, setting the moral agenda on use of anencephalic infants as organ sources, got hit with an avalanche of criticism, and whimperingly went back to its corner, explaining that more scientific study needs to be given to the "consciousness" of these newborns.
The AMA's Council didn't realize that its call for the legality of immediate procurement of organs from anencephalic infants would incite widespread, visceral seething. How was it to anticipate brickbats from within and without the AMA, and that hardly anyone in the hearings would come to its defense? It was just making a reasoned, pragmatic judgment--in the best American tradition. The problem of hundreds of infants dying for want of organs was to be resolved in part by declaring that anencephalics--who are permanently unconscious beings throughout their brief vegetative lives--are appropriate organ sources. Of course, state law on death would have to be altered before physicians could implement the Council's opinion. But the point is that the usually staid AMA took a bold lead in formulating an ethically reasoned policy on a very controversial issue.
On hindsight, the Council must wish it had stuck by the "dead donor" rule--that transplant organs may only be procured from the dead. Instead the Council stated that because of the unique condition of anencephalics, these newborns should be considered an "exception" to standard laws that call for a determination by either whole brain or circulatory death. Accordingly George Annas, a Boston University professor of health law, was quoted by the Los Angeles Times: "You can't kill babies to take their organs, no matter how many lives could be saved." And The New York Times cited USC bioethicist Alexander Capron's criticism that the policy would harm the whole organ donation program because the public would be confused by the allowance of organ procurement from breathing, bottle-sucking newborns.
However, the tactical error of not calling for the parental option of having their anencephalic newborns declared legally dead (as some bioethicists, including Robert Veatch and I think would be appropriate) is secondary. The rock-bottom issue confronted by the AMA Council is the visceral sense in the great majority of citizens--professionals and laypersons alike--that if it looks like a person and acts like a person, it must be a person. This sense of so many people is understandable and cannot be ignored. Any legislative policies that grossly violate the public's sense of right and wrong--even if largely unexamined by the public--could seriously undermine the public's confidence in current law and morality.
But ah! There are unpleasant facts about bodily "actions" at the margins of human life that the public is largely unaware of and isn't clamoring to know. For instance, brain-dead bodies on the operating table ready for organ procurement sometimes undergo considerable twitching. Further, cadavers are documented to have, on occasion, actually sat up in bed. Yet such facts do not make us reconsider brain death--and go back to awaiting putrefaction to ensure death. We reassure ourselves that bodily movements of the dead are merely spontaneous actions originating in the spinal cord and are not significant. The issue of "significance" is precisely the point here: Is the life of a newborn who has absolutely no higher brain tissue morally significant in itself, or is its life more analogous to that of a spontaneously active cadaver?
Undergirding this debate are two polar views of the human person: physicialist and personalist. Physicalism maintains that the essence of a person is found in his or her biological makeup. All humans are persons, ipso facto. The thorough-going physicalist tries to save every human life possible. There is something special about being human, about human being--the very fact that you are a human being.
William E. May, a Roman Catholic theologian, is a physicialist who argues that all humans are "beings of moral worth" because all share "something rooted in their being human beings to begin with." This
something is the principle immanent in human beings, a constituent and defining element...that makes them to be what they and who they are.... it is a principle of immateriality or of transcendence from the limitations of materially individuated existence.1
Personalism contends that the essence of a person is found in one's mental capacities and ability to use these in satisfying ways. Whether one is human is finally unimportant. If a computer were self-conscious, it would possess moral worth--as do angels and extraterrestrials.
Philosopher Michael Tooley is a personalist who declares that "person" as characterized by
the capacity for self-consciousness; the capacity to think; the capacity for rational thought; the capacity to arrive at decisions by deliberation; the capacity to envisage a future for oneself; the capacity to remember a past involving oneself; the capacity for being a subject of non-momentary interests; the capacity to use language.2
The Ethics and Judicial Council's opinion on anencephalics got caught between the millstones of personalism and physicalism. One is the favorite of a number of philosophers; the other the assumption of society at large. Most citizens are somewhere between the extremes. In the future we will increasingly face stark questions of human essence as the life-sustaining capability of medicine expands and the healthcare dollar shrinks.
REFERENCES
1. William E. May, "What Makes a Human Being to be a Being of Moral Worth?" The Thomist 40 (July 1976): 416-38.
2. Michael Tooley, Abortion and Infanticide (Oxford: Clarendon Press, 1983), 439.
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