J CMnEpldemiol Vol. 45, Printed in Great Britain

No. 7, pp. 799-801,

0895-4356/92$5.00+ 0.00 Pergamon Press Ltd

1992

Second Thoughts Editors’ Note-We were intrigued by this essay, which originally appeared in the Australian journal, Bioethics 1991; 5: 67-71. We thank the author and also the Editors and publishers of Bioethics for their permission to reprint the essay here.

WHEN

PHILOSOPHERS

SHOOT FROM THE HIP

JAMES RACHELS Department of Philosophy, University of Alabama, Birmingham, AL 35294, U.S.A. (Received for publication February 1992)

events being reported are morally troubling, or worse. And frequently philosophers are willing to provide just such comments. The story then appears, with a pronounced moral slant: “Suchand-such has happened, and the ethicists say it’s bad.” More often than not, this combination of reporters’ interests and philosophers’ snap judgments had a conservative effect. The new developments are viewed as troubling against the background, not of careful analysis, but of accepted wisdom. In March 1990 a story appeared in American newspapers about a Los Angeles couple who had decided to have another child in the hope that the baby’s bone marrow cells could be used to save the life of their teenaged daughter. Abe and Mary Ayala, who are in their forties, had not intended to have an additional child; in fact, Abe Ayala had had a vasectomy. But their 17-year-old daughter, Anissa, was dying of leukemia, and a bone marrow transplant was her only hope. After 2 years of searching in vain for a suitable donor, they decided to have another child because there was a one-in-four chance that the new family member would be a suitable donor. So Abe Ayala had his vasectomy reversed and Mary Ayala became pregnant. The baby, a girl named Marissa, was born on 6 April and she is indeed a compatible donor. The transplant procedure, which will be accomplished sometime in the fall, will involve little risk for the baby, and Anissa’s chances of surviving will rise from zero to between 70 and 80%.

These days moral philosophers often find themselves in the heady position of being called upon by newspapers to comment on the latest public controversies. Being treated as quotable experts by the media may be old stuff for economists, and a few other academic types, but it is a new experience for philosophers, a visible result of the applied ethics movement that began 20 years ago. Sometimes the newspapers want columns of commentary. The op-ed page, pioneered by the New York Times, has now become a regular feature of most large metropolitan dailies. Oped columns aren’t much like articles in Bioethics, but for the general public they are a good substitute. They allow enough space, and writing them allows one enough time, for serious reflection. Sometimes, however, the newspapers want something different. The telephone rings, and a reporter rattles off a few “facts” about something somebody is supposed to have done. Ethical issues are involved-something alarming is said to have taken place-and so the “ethicist” is asked for a comment to be included in the next day’s story, which may be the first report the public will have seen about the events in question. Usually when this happens the reporters aren’t interested in detailed analysis or lengthy qualifications. A short, pithy quote is what’s wanted. Nor are the reporters eager to hear reassurances that the alarming events really aren’t alarming. That doesn’t make good copy. What makes good copy is the idea that the 799

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The Ayalas were understandably elated to learn that An&a’s life might be saved. However, the newspaper stories prominently featured quotations from medical ethicists who labeled their decision “troublesome” and even “outrageous”: “The ideal reason for having a child,” said a well-known figure in the field, “is associated with that child’s own welfare-to bring a child into being and to nurture it. One of the fundamental precepts of ethics is that each person is an end in himself or herself, and is never to be used solely as a means to another person’s end without the agreement of the person being used.” The Ayalas’ baby “is not seen as an end in itself, but as a means to another end. The fact that the other end is laudable doesn’t change that.” Another expert was quoted as saying that the Ayalas’ decision means “we’re willing to treat people like objects”-and, he added, “I don’t think we ought to do that.” [l]. The Ayalas are real people, not characters in a made-up classroom example, and they didn’t care much for the ethicists’ comments. Mrs Ayala said that the ethicists ought to be worrying more about the shortage of marrow donors, and less about their decision. Anissa herself was asked what she thought about all this, and she said that she was “sort of troubled” by the criticism, but added that “We’re going to love our baby.” If Anissa were trained in philosophy, she might find the criticisms less troubling. She might observe that people have always had babies for reasons other than the “ideal” one. Real life rarely measures up to philosophers’ expectations. People have children so that the children can share in the family’s work, to please the grandparents, or just because it’s expected of them. They sometimes have second children because they don’t want the first to be an “only child”. None of this is strange or unusual; it’s just the way life is. What is important is, as Anissa insists, that once born the children are loved and nurtured within good families. Anissa might also point out that her mother, in fact, had wanted another baby anyway-it was only her father’s wish to have no more children. And finally, she might express some appropriate scepticism about the idea that an individual “is never to be used solely as a means to another person’s end without the agreement of the person being used.” Does this mean that, if Anissa already had a baby sister, the baby could not be used as a donor because

the baby was not old enough to give permission? Should Anissa herself be left to die, for the sake of respecting this principle? Perhaps the ethicist quoted in the New York Times thinks so; he was quoted as saying “It’s outrageous that people would go to this length” [l]. Curiously, there is an argument, proceeding from principles endorsed by the most conservative pro-life advocates, that supports the Ayalas’ decision. This argument invokes the idea that we are conferring a benefit on someone by bringing them into existence. The new baby, not Anissa, seems the really big winner here: after all, if her parents had not decided to have her, the baby would have not got to exist. Those who oppose abortion sometimes ask: Aren’t you glad your mother didn’t have an abortion? The answer, of course, is that most of us are happy that our mothers didn’t do that; otherwise we wouldn’t be here now. The people who ask this question think that something follows about the mortality of abortion, although it isn’t clear what; but they usually fail to notice that we could just as well ask: Aren’t you glad that your parents didn’t practice birth control? (Orthodox Catholics, at least, are consistent on this point). We should be equally happy that contraceptives were not used by our parents, and for the same reason: otherwise, we wouldn’t be here now. Similarly, Anissa’s little sister might someday be asked: Aren’t you glad that your parents decided to have you? Aren’t you fortunate that Anissa needed those stem cells? Perhaps this means that conservatives who take a pro-life view ought to be happy with the Ayalas’ decision, rather than being critical of it. It might be doubted, however, that this is a sound argument. The idea that we are conferring a benefit on someone by bringing them into existence is easily disputed. I would rather rest my defense of the Ayalas’ decision on a different sort of reasoning. First we may consider two separate questions: (1) Suppose a couple, before having any children at all, is trying to decide whether to have one child or two. They slightly prefer having only one. But then they are told that if they have only one child it will die when it is a teenager. However, if they have two, both will probably live full lives. Would it be wrong for the couple to decide, for this reason, to have two children? (2) Suppose a couple already has two children, one a teenager dying of leukemia, and the other an infant who is the only available

Second Thoughts

bone-marrow donor. The infant cannot give its permission, of course, but then again it would not be harmed at all by the procedure. Would it be wrong, under these circumstances to use some of the infant’s stem-cells to save the teenager’s life? It seems to me it would be easy enough to argue that the answer to both these questions is no. Then the inference to the permissibility of the Ayalas’ decision would be obvious. But this is a peripheral point. My subject here is in the performance of the philosophers“ethicists”-as commentators on public events. Sometimes they do what we might think philosophers ought to do: challenge the prevailing orthodoxy, calling into question the assumptions that people unthinkingly make. But just as often they function as orthodoxy’s most sophisticated defenders, assuming that the existing social consensus must be right, and articulating its theoretical “justification”. And when all else fails, there is another familiar argument that can be relied upon: the slippery slope. Any departure from business-as-usual can be pronounced “troubling” because of what it might lead to. The Ayalas’ decision was also criticized on this ground. It was said that it might lead to “fetus farming,” or to abortions so that the aborted fetus can be used for life-saving purposes. Of course we don’t know exactly what will happen to the Ayala family, or to social values, in consequence of decisions such as theirs. But two comments seem relevant. First, there is nothing new about their sort of decision. In the publicity surrounding the Ayala case, it was revealed that other families have been making similar decisions for quite some time. Dr Robertson Parkman, head of the Division of Research Immunology and Marrow Transplantation at Los Angeles Children’s Hospital, told a reporter that he personally knows of cases going back to 1974 in which families have had additional children to obtain marrow transplants. But until now there has been little publicity about it. The new publicity also revealed that, in previous cases, medical ethicists have been able to do much more than complain about such decisions after the fact. In 1986 a Californian woman, Phyliss Baker, who had had a tubal ligation, asked a physician to reconnect her Fallopian tubes so that she could have another child. The physician, knowing that Mrs

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Baker was trying to save the life of her 3-yearold son, who needed a marrow transplant, consulted a bioethicist and then refused to do the operation. The physician’s and the bioethicist’s moral scruples were preserved, and Travis, the 3-year-old, died [2]. Second, the recent history of medical ethics is dotted with episodes in which ethicists have reacted with alarm to new developments, predicting dire consequences that never occurred. Greg Pence’s new book, Classic Cases in Medical Ethics, recounts several such episodes [3]. A review of these cases suggests caution, lest our quick-and-easy comments today look silly tomorrow. In 1978, for example, Louise Brown was the first baby to be born as a result of in vitro fertilization. This important event prompted alarmed and highly critical responses from physicians, theologians, and philosophers that are embarrassing to look back upon today. Pence reminds us of a whole series of exaggerated statements and predictions: terrible consequences were sure to follow for the parents, the child, and society. But today Louise is a happy, rambunctious child, and so are many others like her. What will happen to the Ayalas? One plausible scenario is that Anissa will be saved, the new baby will grow up happy-or at least with the same mixture of happiness and unhappiness as the rest of us-and the Ayalas, like the Browns, will forever after think that ethicists are jerks. If terrible consequences transpire, then of course if might turn out that they were wrong. But in their particular circumstances, I do not see how they could have been wrong to weigh their daughter’s life more heavily than the philosophers’ vague fears [4].

REFERENCES The New York Times 17 February 1990; 1. The Birmingham News 16 April 1990; 4D. Pence GE. Classic Cases in Medical Ethics. New York: McGraw-Hill; 1990. [This book is a valuable corrective in another way as well: Pence demonstrates how the facts about these cases are often very different than philosophers assume them to be.] This article is based on one section of a paper presented at a conference on Moral Philosophy in the Public Domain, University of British Columbia, June 1990. [The complete paper will appear in a volume of essays growing out of the conference, to be edited by Earl Winkler.]

When philosophers shoot from the hip.

A visible result of the 20-year old applied ethics movement is the use of moral philosophers as quotable newspaper sources. In situations like the op-...
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