An argument in pictures and symbols

Drawings: Adobe stock; Photos: elephant and human

The essentiality of dignity

Start with this:

1. Dignity is an essential property of anything that has it.

2. Necessarily, something has dignity if and only if it is a person.

3. Therefore, personhood is an essential property of anything that has it.

Now, suppose the standard philosophical pro-choice view that

4. Personhood consists in developed sophisticated cognitive faculties of the sort that fetuses and newborns lack but typical toddlers have.

Consider a newborn, Alice. By (4) Alice is not a person, but if she grows up into a typical toddler, that toddler will be a person. By (3), however, we cannot say that Alice will have become that person, since personhood is an essential property, and one cannot gain essential properties—either you necessarily have them or you necessarily lack them.

Call the toddler person “Alicia”. Then Alice is a different individual from Alicia.

So, what happens to Alice once we get to Alicia? Either Alice perishes or where Alicia is, there is Alice co-located with her.

Let’s suppose first the co-location option. We then have two conscious beings, Alice and Alicia, feeling the same things with the same brain, one (Alice) older than the other. We have standard and well-known problems with this absurd position (e.g., how does Alicia know that she is a person rather than just being an ex-fetus?).

But the option that Alice perishes when Alicia comes on the scene is also very strange. For even though Alice is not a person, it is obviously appropriate that Alice’s parents love for and care for her deeply. But if they love for and care for her deeply, they will have significant moral reason to prevent her from perishing. Therefore, they will have significant moral reason to give Alice drugs to arrest her intellectual development at a pre-personhood stage, to ensure that Alice does not perish. But this is a truly abhorrent conclusion!

Thus, we get absurdities from (3) and (4). This means that the pro-choice thinker who accepts (4) will have to reject (3). And they generally do so. This in turn requires them to reject (1) or (2). If they reject (2) but keep (1), then Alice the newborn must have dignity, since otherwise we have to say that Alice is a different entity from the later dignified Alicia, and both the theory that Alice perishes and the theory that Alice doesn’t perish is unacceptable. But if Alice the newborn has dignity, then the pro-choice argument from the lack of developed sophisticated cognitive abilities fails, because Alice the newborn lacks these abilities and so dignity comes apart from these abilities. But if dignity comes apart from these abilities, then the pro-choice argument based on personhood and these cognitive abilities is irrelevant. For it dignity is sufficient to ground a right to life, even absent personhood.

So, I think the pro-choice thinker who focuses on cognitive abilities will in the end need to deny that dignity is an essential property. I suspect most do deny that dignity is an essential property.

But I think the essentiality of dignity is pretty plausible. Dignity doesn’t seem to be something that can come and go. It seems no more alienable than the inalienable rights it grounds. It’s not an achievement, but is at the foundation of what we are.

From fetal pain to the impermissibility of abortion

At some point in pregnancy it is widely acknowledged that fetuses start to feel pain. Estimates of this point vary from around seven to thirty weeks of gestation.

We cannot directly conclude from the fact that some fetus can feel pain that killing that fetus is impermissible. For it seems permissible, given good reason, to humanely kill a conscious non-human animal. But perhaps there is an indirect argument. I want to try out one.

It has been argued that if the fetus is the same individual as the adult person that the fetus would grow into, then it is wrong to kill the fetus for the same reason that it is wrong to kill the adult: the victim is the same, and no more deserving of death, while the harm of death is greater (the fetus is deprived of a greater chunk of life).

But if a fetus can feel pain, then this offers significant support for the hypothesis that the fetus is the same individual as the resultant adult. Imagine the fetus has a constant minor chronic pain, is carried to term, and grows into an adult, without ever any relief to the pain. The adult will then feel the pain. If the fetus is not the same individual as the adult, there are two possibilities at the time of adulthood:

1. There are two beings feeling pain: the adult and the grown-up fetus.

2. At some point the grown-up fetus had perished and was replaced by a new individual feeling pain.

Option (1) seems crazy: if I have a headache while sitting alone on the sofa, there is only one entity in pain on the sofa, namely me, rather than me and some grown-up fetus. Option (2) is also rather implausible. On our hypothesis we have the continuous presence of a brain state correlated with pain, and yet allegedly at some point the individual with the pain perishes and a new individual inherits the brain with the pain. That doesn’t seem right.

If we reject both (1) and (2), we have to conclude that the fetus in pain is the same individual as the adult that it grows up into. And thus we conclude that at least once fetuses are capable of pain, abortion is wrong.

This argument doesn’t say anything about what happens prior to the possibility of fetal pain. I think that is still the same individual, but that requires another argument.

Against the incredulous stare objection to our coming into existence at conception

There are two main kinds of arguments against abortion: Those based on the idea that we begin existing at conception and those based on the idea that personhood begins at conception.

One of the main objections to thinking that our existence begins at conception is the incredulous stare: How can that single cell be me?!

Here my recent geometrical observations about how I will be very small in almost every reference frames become relevant. Exactly the same argument establishes that in almost every reference frame, I start out really small. In almost every reference frame, I start out less than a nanometer in size (any non-zero size can be substituted here), and hence much smaller than a single cell.

Thus, it seems we are simply stuck with a counterintuitive result about what we are like at our beginning. Even if we don’t begin at conception, in almost all reference frames we begin as something much smaller than a single cell.

Can the geometrical observations show that personhood begins really small, too, and thereby undercut the incredulous stare at the idea that a single cell is a person?

Now, if we are essentially persons, given that by the previous argument we begin smaller than a cell, then indeed something smaller than a cell is a person.

So the remaining case to consider is views on which we are only accidentally persons, and we pre-exist our personhood. A typical view in this family will say that we are animals that come into existence at conception or implantation, and that about 1.5-2 years after our beginning, we come to have the property of personhood.

In the previous argument, I looked at the set K of all the spacetime locations of my body, and it followed that for almost every reference frame F, there was a time t in F and near my beginning such that the t-slice of me was really tiny. The obvious analog is to look at the set K^* of all spacetime locations of my personal body—i.e., of my body at times at which I am a person—and repeat the argument. The problem with this move is that whether a spacetime location is within my body is intuitively independent of reference frame, but whether a spacetime location is within my personal body could more plausibly depend on the reference frame, if my 4D personal body is not all of my 4D body.

So at this point, I don’t have a version of my smallness argument against the view that to be a person I have to be big, when that view is coupled with the idea that I can exist without being a person.

Where are we?

Unless something like the Bohmian interpretation or a spatial collapse theory is right, quantum mechanics gives us good reason to think that the position wavefunction of all our particles is spread across pretty much all of the observable universe. Of course, except in the close vicinity of what we pre-theoretically call “our body”, the wavefunction is incredibly tiny.

What are we to make of that for the “Where am I?” question? One move is to say that we all overlap spatially, occupying most of the observable universe. On a view like this, we better not have position do serious metaphysical or ethical work, such as individuating substances or making moral distinctions based on whether one individual (say, a fetus) is within the space occupied by another.

The other move is to say I am where the wavefunction of my particles is not small. On a view like this, my location is something that comes in degrees depending on what our cut-off for “small” is. We get to save the intuition that we don’t overlap spatially. But the cost of this is that our location is far from a fundamental thing. It is a vague concept, dependent on a cut-off. A more precise thing would be to say things like: “Here I am up to 0.99, and here I am up to 0.50.”

Gaining and losing personhood?

1. Love (of the relevant sort) is appropriately only a relation towards a person.

2. Someone appropriately has an unconditional love for another human.

3. One can only appropriately have an unconditional R for an individual if the individual cannot cease to have the features that make R appropriate towards them.

4. Therefore, at least one human is such that they cannot cease to be a person. (1–3)

5. If at least one human is such that they cannot cease to be a person, then all humans are such that they cannot cease to be a person.

6. If all humans are such that they cannot cease to be a person, then it is impossible for a non-person to become a human person.

7. All humans are such that they cannot cease to be a person. (4,5)

8. It is impossible for a non-person to become a human person. (6,7)

9. Any normal human fetus can become a human person.

10. Therefore, any normal human fetus is a person. (8,9)

(I think this holds of non-normal human fetuses as well, but that’ll take a bit more argument.)

It’s important here to distinguish the relevant sort of love—the intrinsically interpersonal kind—from other things that are analogously called love, but might perhaps better be called, say, liking or affection, which one can have towards a non-person.

I think the most controversial premises are 2 and 9. Against 2, I could imagine someone who denies 7 insisting that the most that is appropriate is to love someone on the condition of their remaining a person. But I still think this is problematic. Those who deny 7 presumably do so in part because they think that some real-world conditions like advanced Alzheimer’s rob us of our personhood. But now consider the repugnance of wedding vows that promise to love until death or damage to mental function do part.

Standing against 9 would be “constitution views” on which, normally, human fetuses become human animals, and these animals constitute but are not identical with human persons. These are ontologies on which two distinct things sit in my chair, I and the mammal that constitutes me, ontologies on which we are not mammals. Again, this is not very plausible, but it is a not uncommon view among philosophers.

Normal parental effort and abortion

We owe our children at least a normal degree of effor for their welfare. For instance, we owe it to them to provide food, water, education and affection in normal circumstances by the normal means of doing so. It is plausible that what we owe our children goes significantly beyond the provision of a normal degree of effort for their welfare. Maybe working 6-10 hours a day at a job to provide for one’s family is a normal degree of effort, but if the only way to keep one’s children from starving is to work 11 hours a day, that’s surely one’s duty. But when the effort would go far enough beyond what is normal, duty is replaced by supererogatory heroism.

Now, it is far from clear what degree of effort does or does not exceed what is normal. However, the following seems clear:

1. An effort that was practically necessary for the survival of virtually every single child in human history, and was typically expended by a parent, does not exceed normal parental effort.

For instance, physically putting food in the mouth of an infant was practically necessary for the survival of virtually every single child in human history, and probably every single such child, unless some myth like that of Romulus and Remus turns out to reflect a real case, and was typically expended by a parent. Thus, the effort of putting food in infants’ mouths is normal, and hence owed.

But:

2. Pregnancy was practically necessary for the survival of every single child in human history, and was typically engaged in by a parent.

Hence, wherever the required effort line lies, it does not lie below the level of pregnancy as such. In particular, it follows that Judith Jarvis Thomson’s violinist argument cannot apply to every pregnancy. In fact, I think it is plausible that a typical pregnancy constitutes a normal degree of parental effort, and hence her argument does not apply to a typical pregnancy either.

Complicity, Fetal Tissue and Vaccines

I just got permission from the National Catholic Bioethics Quarterly to post my 2006 paper on fetal tissue and vaccines. It is here.

Vaccines and cell-lines descended from tissue derived from abortion

A number of Catholic authorities have made a moral distinction between the Pfizer and Moderna vaccines, on the one hand, and the AstraZeneca and Johnson & Johnson vaccines, on the other, with respect to the involvement of cells that descend (after many generations) from an aborted fetus (e.g., see here and here). The difference appears to be that in the Pfizer and Moderna cases, the cells were only used in a confirmatory test of efficacy, while in the other two vaccines, they were used throughout the development and production. Consequently, the Catholic authorities said that the AstraZeneca (AZ) and Johnson & Johnson (JJ) vaccines may be used if no alternatives are available, but the Pfizer and Moderna are preferable if available.

A colleague at another institution asked me if I thought that the moral distinction here is sustainable. I do think it is, and my judgment concurs very closely with the recent statements from Catholic authorities: all four vaccines may (indeed, should) be used, but the Pfizer and Moderna ones are to be chosen when available.

In a 2004 paper, I argued that (a) while it is not categorically forbidden to engage in research using cell-lines that ultimately descend from tissue from an aborted fetus, (b) this may only be done for “sufficiently beneficial purposes”. Such research—and likewise the use of the fruits of the research—is thus a situation that involves the weighing of different factors rather than categorical prohibitions. It seems clearly right that in the case of the vaccines (AZ and JJ) where the illicitly derived cell-lines are used more heavily, we have more of the morally problematic feature, and hence we need greater benefits to outweigh them. Those benefits are available in the case of the current pandemic when alternatives that involve less of the problematic features are not available: thus the AZ and JJ vaccines may be used when the alternatives are not available. But when the alternatives—which also appear to be significantly more effective as vaccines!—then they should be used.

In a 2006 paper, I argued that the Principle of Double Effect allows one to use, and even manufacture, vaccines that make use of the morally tainted cell-lines. The use of the cell-lines in itself is not innately morally evil (after all, it need not be wrong to transplant an organ from a murder victim). What is problematic is what I call “downstream cooperation” with the plans of those involved in the evil of abortion: they likely acted in part (probably in very small part) in order to procure tissue for public health benefits, and now by using the vaccine, we are furthering their plans. But one need not intend to be furthering these plans. Thus, that “downstream cooperation” is something one should weigh using the complex proportionality calculus of Double Effect. In the paper I concluded that the use of the vaccines is permissible, and in the present emergency the point is even clearer. However, it seems to me that the more heavily the cell-lines are used, the more there is of the unintended but still problematic cooperation with the plans of those involved in the evil of abortion, and so one should opt for those vaccines where the cooperation is lesser when possible.

I note that even apart from the moral considerations involving cell-lines descended from aborted fetuses, in a time of significant and unfortunate public vaccine scepticism, it was rather irresponsible from the public health standpoint for the vaccine manufacturers to have made use of such cell-lines if there was any way of avoiding this (and I do not know if there was given the time available).

Abortion, contraception and Christian tradition

It is traditional Christian teaching, as far back as we can trace it, that:

1. Abortion is always wrong.

Nonetheless, historically many Christian theologians, such as Thomas Aquinas, accepted the best science and philosophy of the day (Aristotle!) which held that:

2. Human existence starts about a month and a half after conception.

Our science no longer teaches (2), of course: it is scientifically clear that we have the same organism at conception—or at very latest at implantation—as at birth.

However, for those of us who think that Christian tradition carries significant epistemic weight, it is interesting to ask why it was that historically Christian teaching stalwartly affirmed (1) despite many Christian thinkers accepting (2). I see two hypotheses each of which may explain this puzzle. Both hypotheses may be true (and indeed I think they are).

The first hypothesis is that (1) is simply a datum of the apostolic teaching of the early Church (it is after all found in the first-century Didache). The Church’s stalwart acceptance of the prohibition of abortion notwithstanding the tension between this prohibition and the best science of the day is a sign that the prohibition of abortion was grounded in divine revelation rather than philosophical speculation.

The second hypothesis is that the reasons for the traditional prohibition of abortion are logically independent of the moral status of the embryo or early fetus. We also know that the early Church forbade contraception. If the embryo or early fetus is not a human being, the an early abortion may not be morally very different from contraception. But the Church was opposed to contraception. Via this second hypothesis, the apparent tension between the blanket prohibition on abortion and the philosophical and scientific views on the beginning of human life is further evidence for an apostolic prohibition of contraception.

Basing public decisions on controversial comprehensive doctrines

According to Rawlsians, it is wrong to make decisions in the public arena based on controversial comprehensive doctrines.

Here is a counterexample. We meet up with aliens who are incredibly truthful: not only have we never found one to lie, but we have never found one to even accidentally say the false. The aliens inform us that they have figured out whether controversial comprehensive doctrine D is true. We have very good reason to believe the aliens. The aliens inform us of a fanatical plan: Each state has two weeks to submit a statement to the aliens as to whether D is true. Those states that either fail to submit such a statement or who get the answer wrong will be completely destroyed. And then the aliens will leave.

It is obvious that the right thing for the state to do is to do its best to figure out whether D is true, and then on the basis of its best determination make the statement to the aliens. It is clearly wrong to refuse to answer, and it is also clearly wrong to simply guess without basing oneself on one’s best determination of the truth value of the comprehensive doctrine. It is clearly the right thing in this case to make a public decision on the basis of a controversial comprehensive doctrine.

Of course, this is a very special case: a case where what rides on the decision is so important that it trumps most other considerations. But we can lower the amount that rides on the decision and still keep the intuition. Suppose that instead the aliens promise to kill one per thousand people at random if we get the answer wrong. That should, I think, be enough to overcome any qualms we may have about using controversial comprehensive doctrines in public policy. But now there are real-world issues riding on controversial comprehensive doctrines where what is at stake is of a similar or greater magnitude. Abortion is a paradigm case.

Medical conscience exemptions

After listening to a talk by Christopher Kaczor, and the ensuing discussion, I want to offer a defense of a moderate position on the state not compelling healthcare professionals to violate their conscience, even when their conscience is unreasonably mistaken. I think a stronger position than the moderate position may be true, but I won’t be defending that.

This is the central insight:

1. It is a significant harm to an individual to violate their conscience, even when the conscience is irrationally mistaken.

One reason that (1) is true is the Socratic insight is that it is much better to suffer wrong than to do wrong, together with the Conscience Principle that to act against conscience is always wrong.

My argument will need something a bit more precise than (1). For convenience, I will stipulate that I use “grave” for normative considerations, goods, bads and harms whose importance is at least of the order of magnitude of the value of a human life. The coincidence that “grave” not only means very serious but also place of burial in English—even though the etymologies are quite different—should remind us of this. When you read the following, whenever you read “grave” and cognates, don’t just read “serious”, but also imagine a grave.

Then what I need is this:

2. It is a grave harm to a conscientious individual to gravely violate their conscience, even when that conscience is unreasonably mistaken.

(I suspect this is true even if one drops the “conscientious” and “gravely”, but I am only defending a moderate position.) The reasons for (2) are moral and psychological. The moral reasons are based on the aforementioned Socratic insight about the importance of avoiding wrongdoing. But there are also psychological reasons. A conscientious person identifies with their conscience in such a way that gravely violating this conscience is shattering to the individual’s identity. It is a kind of death. It is no coincidence that the Catholic tradition talks of some sins as “mortal”.

Next, here is another reasonable principle:

3. Normally, the state should not require a healthcare professional to provide care when the care is likely to come at a grave cost to the professional.

For instance, the state should not require a healthcare professional to donate her own kidney to save a patient. For a less extreme case that I will consider some variations of, neither should the state require a professional who has a severe bee allergy to pass through a cloud of bees to help a patient when allergy reaction drugs are unavailable and when other professionals lacking such an allergy are available.

In order for (3) to be useful in pracice, we need some way of getting rid of the “Normally” in it.

Notice that (3) is true even when the grave cost to the professional results from the professional’s irrationality. For instance, normally a healthcare professional who has a grave phobia of bees should not be required to pass through the cloud of bees, even if it is known that the professional would not be seriously physically harmed. In other words, that the cost results from irrationality does count as an abnormality in (3).

Under what abnormal conditions, then, may the state require the professional to offer care that comes at grave cost to the professional? This is clearly a necessary condition:

4. The need is grave.

But even if the need is grave, if someone else can offer the care for whom offering the care does not come at a grave cost, they should offer it instead. If the way to save a patient’s life is for one doctor to pass through a cloud of bees, and there is a doctor available who is not allergic to bee stings, then a doctor who is allergic should not be made to do it. Thus, we have this condition:

5. There is no way of meeting the need without someone being required to take on a likely grave cost.

We can combine these two conditions into a neater condition (which may also be a bit weaker than the conjunction of (4) and (5)):

6. If the care is not provided by this professional, a grave harm will likely result to someone.

This suggests some principle like this:

7. Unless failure of this professional to provide this instance of care will likely result in a grave harm, the state should not require a healthcare professional to provide care when the care is likely to come at a grave cost to the professional.

Now we go back to (2), the claim about the grave cost of violating conscience. Let us charitably assume that most medical professionals are conscientious, so that any given medical professional is likely to be conscientious. Then we get something like this:

8. Unless failure of this professional to provide this instance of care will likely result in a grave harm, the state should not require a healthcare professional to provide care that gravely violates their conscience, even when that conscience is unreasonably mistaken.

But this cannot be the whole story. For there are also conditions that render one incapable of doing central parts of one’s job. For instance, someone with a grave phobia of fires should not be allowed to be a fire fighter. And while a fire fighter with that grave phobia should not be made to fight a fire when someone else is available, if they had the phobia at the time of hiring, they should not have been hired in the first place. And if they hid this phobia at the time of hiring, they should be fired.

We have, however, a well-developed societal model for dealing with such conditions: the reasonable accommodations model of disability legislation like the Americans with Disabilities Act. It is reasonable to require an office building to put in a ramp for an employee in a wheelchair who is unable to walk; it would be unreasonable for a bank to have to hire a guard specially to watch a kleptomaniac teller. What is and is not a reasonable accommodation depends on the centrality of an aspect of a job, the costs to the employer, and so on.

So my moderate proposal says that we handle the worry that a particular conscientious objection renders a professional incapable of doing their job by analogy to the reasonable and unreasonable accommodations model, and qualify (8) by allowing in hiring or licensure the requirement that the accommodations for a conscientious restriction on practice would have be reasonable in ways analogous to reasonable disability accommodations. A healthcare professional who has only one hand could, I assume, be reasonably accommodated in a number of specialities, but likely not as a surgeon.

The disability case also should push us towards a less judgmental attitude towards a healthcare professional whose conscientious objections are unreasonably mistaken. That an employee became a paraplegic from unreasonable daredevil recreational activity does not render the employee uneligible for otherwise reasonable accommodations.

What about the worry about the rare cases where a healthcare professional has morally repugnant conscientious views that would require discriminatory care, such as refusing to care for patients of a particular race? Could one argue that if patients of that race are rare in a given area, then allowing a restriction of practice on the basis of race could be a reasonable accommodation? We might imagine an employee who has panic attacks triggered by a particular rare configuration of a client’s personal appearance, and that does seem like a case for reasonable accommodations, after all.

Here I think there is a different thing to be said. We want our healthcare professionals to have certain relevant moral virtues to a reasonable degree. Moral virtues go beyond obedience to conscience. Someone with a mistaken conscience may not be to blame, for the wrongs they do, but they may nonetheless lack certain virtues. The case of the conscientious racist is one of those. So it is not so much because the conscientious racist would refuse to care for patients of a particular race that they should not be a healthcare professional but it is because they fail to have the right kind of respect for the dignity of all human beings.

One may think that this consideration makes the account not very useful. After all, a pro-life individual is apt to be accused of not caring enough for women. Here I just think we need to be honest and reasonably charitable. Caring about the embryo and fetus has human dignity does not render it less likely that one cares about women. Compare this case: A vegan physician believes that all higher animal life is sacred, and hence refuses to prescribe medication whose production essentially involves serious suffering of higher animals. Even if such a physician’s actions might cause harm to patients who need such (hypothetical?) medication, the belief that all higher animal life is sacred is not evidence that the physician does not care about such patients–indeed, it seems to render it more likely that the physician thinks the patients’ lives to be sacred as well, and hence to be cared for. There may be specialties where accommodation is unreasonable, but the mere fact of the belief is not evidence of lack of relevant virtues.

Pro-life outreach to fellow Christians

At a recent pro-life event that I participated in, the question was asked the panel how to convince a pastor that one’s church should support the pro-life cause, notwithstanding pro-choice congregation members. An answer was offered by a panelist that talked well of standard texts of Scripture that have bearing on the humanity of the fetus.

A day after the event, one of the audience members told me that there was too much focus on the status of the fetus, because even if students are convinced that human life starts at conception, they still think that because of conflict between the rights of the fetus and the rights of the mother, abortion is permissible.

In light of this, it seems to me that a crucial part of pro-life outreach to fellow Christians—including but not just pastors—is to focus on more general texts about our duties towards the vulnerable and needy. While a major part of the debate over abortion is indeed focused on the moral status of the fetus, both motivationally and intellectually it seems really important to focus on a deep underlying assumption that we do not have much in the way of onerous duties towards others, unless we have voluntarily undertaken those duties. Yet the Gospel teaches that we do have such duties, duties binding under pain of eternal damnation. Thus in addition to a reliance on texts about the status of the unborn, one needs motivationally powerful texts like:

Then he will say to those at his left hand, ‘Depart from me, you cursed, into the eternal fire prepared for the devil and his angels; for I was hungry and you gave me no food, I was thirsty and you gave me no drink, I was a stranger and you did not welcome me, naked and you did not clothe me, sick and in prison and you did not visit me.’ Then they also will answer, ‘Lord, when did we see thee hungry or thirsty or a stranger or naked or sick or in prison, and did not minister to thee?’ Then he will answer them, ‘Truly, I say to you, as you did it not to one of the least of these, you did it not to me.’ And they will go away into eternal punishment, but the righteous into eternal life. (Matthew 25:41-46).

These texts make it clear that we have highly onerous duties towards others, duties we may have done nothing to acquire. It is very difficult to defend disconnection from the violinist while thinking about such texts.

But of course if we use such texts then we had better be sure that we live so that they do not condemn us, too. For they are indeed terrifying texts on many fronts. May God have mercy on all our souls!

Being a bad person and doing wrong

Until recently, I assumed everyone agreed to something like this principle:

1. If performing an action constitutes you as a bad person, the action is morally wrong.

Virtue ethicists, of course, make this a biconditional that defines wrongness, but I would have assumed that just about everybody would agree that the conditional (1) is true.

But I am now thinking that (1) is not accepted as widely as I thought it is. What makes me think this is the way that Thomson’s violinist case resonates with so strongly with so many people, and presumably continues to do so even if one adds the necessary proviso that the violinist is one’s own minor child (otherwise it wouldn’t be applicable to typical cases of abortion). Yet it seems utterly obvious to me to that:

2. If the violinist is your own minor child, disconnecting from the violinist makes you a bad parent and a bad person.

But one cannot consistently accept (1) and (2) and think it is morally permissible to disconnect from the violinist when the violinist is one’s own child.

I would love to see empirical data on whether people who find the violinist case compelling deny (1) or deny (2). Thomson herself probably denies (2).

Symmetry and Thomson's violinist

I’ve been thinking about Thomson’s Violinist case. I should say about that case that it seems utterly obvious to me that in the case where the violinist is your child and you are in no long term danger from the connection, it’s a vicious failure of parental duties to disconnect.

But my current interest is not so much in figuring out the case itself, as trying to figure out why so many people find it compelling. To that end, I’ve been thinking about two symmetric cases.

Lifeboat: You, who are a really bad pianist, and a really bad violinist find yourselves drifting in a lifeboat in space, kidnapped and put there by the Music Lovers’ Society, to keep you both from performing publicly. The lifeboat is designed for one person, and the hyperspace engines don’t work with the mass of two people. Fortunately, your calculations show that in nine months the lifeboat drift will get you back to earth, and there is air, food and water enough for two for nine months. But it’s really uncomfortable. You both have to sit squished together on an uncomfortable chair, you’re away from your friends (though you can talk to them on hyperspace Skype whenever you like), from your job, etc. Waste disposal is handled hygienically but it’s a rather disgusting process under the circumstances. However, when the violinist is asleep, you could just push him out of the airlock, and then use the hyperspace engines to get back home in a day. Of course, the violinist could do the same to you.

Frankenkidney: Both you, who are an excellent pianist, and an excellent violinist are suffering from kidney failure. The Music Lovers’ Society kidnapped both of you and out of two malfunctioning kidneys made a single functioning frankenkidney. When you awake, you are taped to the violinist, with your abdomens touching. You know that where the abdomens are touching you each have a hole, and in that hole is that frankenkidney. You could wait nine months because that’s how long it takes for the lab to culture brand new kidneys for you and the violinist. Or you could pull the frankenkidney from the violinist’s body, put it in yours, and then have some straightforward surgery to close up the hole. Of course, the violinist could do the same to you.

I am thinking—perhaps too optimistically—that in these cases people would say: “You’re in the same boat as the violinist and just need to make the best of it.”

Notice that in terms of the consequences of your decision, as well as desert and contract, these cases are very much like the original violinist story. Your personal space is encroached on by a violinist who is innocent of the encroachment. You can end the encroachment at the expense of the violinist’s life.

But the cases are different from the original. In the original, the situation benefits the violinist and harms you. In the symmetric cases, either you are both harmed (Lifeboat) or both benefited (Frankenkidney). Moreover, in the original case, the violinist continues to derive a benefit from you without giving anything back. (I think that’s something disanalogous to the abortion case, by the way, since the life of one’s child is a benefit to one, even if one does not see it this way.)

However, I do not know that these differences about the flow of benefits and harms matter, given that neither you nor the violinist have any responsibility for being in the situation in any of the three cases. Suppose we take the Lifeboat case and add this to the story:

Lifeboat Supplement: After a few hours in the lifeboat, the violinist’s body’s thermoregulation has shut down and the lifeboat’s heating system is working poorly. Your body heat is enough to maintain a liveable temperature for the two of you in the lifeboat, and medicine can fix his problem once you get back to civilization, but if the violinist threw you out the airlock, he’d soon die of hypothermia. You'd do fine physically without him, though.

In the supplemented lifeboat story, there is a net flow of life-giving benefits from you to the violinist, just as in the original violinist case. But it would be absurd that as soon as the violinist’s body’s thermoregulation shuts down you can throw him out the airlock. Yet the resulting story is now very much like the original violinist story, I think.

My conjecture is that a central reason the violinist case seems compelling to so many has to do with the asymmetry between the two parties, and when one primes the thinking by starting with a more symmetric situation, as in the Lifeboat case, the intuitions change, and perhaps stay changed even if one adds an asymmetric supplement.

By the way, for another symmetric analogy, see Himma.

The unknown mechanism of action of the IUD

A fellow philosopher just sent me this very interesting quote from an article in a reputable medical journal:

[I]f it was conclusively shown that the sole or principal mode of action [of the IUD] was to prevent the embryo from implanting, then this method, as in the case with emergency contraception, would be considered by the Roman Catholic church as causing an early abortion. As a result many agencies involved in the research, development or delivery of contraception prefer to leave the mechanism of action issue unresolved, which may explain why research into the contraceptive mechanisms of IUDs has been sparse in the last 20 years.

The quote’s invocation of politics fits with vague suspicions I had.

But in any case, I wonder whether leaving the “the mechanism of action issue unresolved” helps all that much morally. Suppose that prevention of implantation is morally on par with paradigmatic cases of killing an adult human. Now consider this story. You are a doctor on board a spaceship marooned on an alien planet. All your drugs have been destroyed but one of your patients is suffering severe pain. The aliens have a callous attitude to human life, but in exchange for a piece of fine art they offer you a drug. The aliens always tell the truth and they guarantee that the drug “terminates the pain.” But when you ask them about the mechanism by which it does so, they say: “Trade secret. It terminates the pain.” You try asking more general questions like: “Does it suppress pain signals in the brain?” They just say: “That would terminate the pain. It terminates the pain. Why ask more?” Then someone else in your crew asks: “Does it terminate the patient?” And the aliens say: “That would terminate the pain. It terminates the pain. Why ask more?”

The end result is that you have no idea whether the drug terminates the pain by suppressing the pain as such or by killing the patient. It is clear that in that case we should not use the drug, except as a last-ditch hope for a patient who is already dying. (I am not saying it is acceptable to kill someone who is already dying. But if someone is already dying, then one can tolerate a greater risk of unintended death.)

I am not saying, of course, that we need to find evidence against every crazy hypothesis. There is, after all, the hypothesis that ibuprofen works by annihilating the patient and calling in aliens that replace the patient with a pain-free simulacrum. The tiny but non-zero probability of that hypothesis should not keep us from using ibuprofen. But when we do not know how some drug or procedure works, and one of the serious hypotheses is that it works by killing someone, then that’s a problem.

Given the callousness of the aliens, the hypothesis that they are offering a euthanasia drug is a serious hypothesis. Likewise, the hypothesis that the IUD works primarily by preventing implantation is a serious hypothesis (see the suggestive evidence in the above-quoted paper). In both cases, then, unless we can find significant evidence against this serious hypothesis, the use of the drug or method is wrong (except perhaps in exceptional cases).

We rightly have a guilty-until-proved-innocent approach to medical interventions. Apart perhaps from exceptional cases (e.g., terminal ones), a medical intervention must be tested for its effects on the directly affected parties. The manufacturer's failure to gather data on the effects of the IUD on some of the directly affected parties, namely the embryos, means that the IUD has not been tested up to the morally required standards of testing medical interventions, and hence cannot be licitly used (apart perhaps from some exceptional cases), even absent the data that we have that is suggestive of fatal effects on those parties.

Abortifacient effects of contraception and the Principle of Double Effect

Suppose that a contraceptive has the following properties:

• Fewer than 1% of users have a pregnancy annually.

• At least 5% of users annually experience a cycle where the contraceptive fails to prevent fertilization but does prevent implantation.

I think there is good empirical reason to think there are such contraceptives on the market. But that’s a matter for another post. Here I want to look at just the ethics question. So let’s suppose that the above stipulated properties obtain, and in fact that they are known to obtain.

The cases where the contraceptive prevents implantation are cases where the contraceptive kills an early embryo: in short, they are cases where the contraceptive is being abortifacient. The question I want to address in this post is this: Could someone who thinks early embryos have whatever property (personhood, membership in the human race, the imago dei, the possession of the soul, etc.) that makes it paradigmatically wrong to kill adult human beings nonetheless defend the contraceptive on the grounds that the deaths due to implantation-prevention are just an unintended and unfortunate side-effect?

Basically, the defense being envisioned would invoke some version of the Principle of Double Effect, which allows for some actions that have a bad side-effect that isn’t intended as a means or as an end. Of course, Double Effect requires that there not be other reasons why the action is wrong. But let’s bracket the question—which I address at length in my One Body book—whether there are other reasons the contraceptive could be wrong to use, and just focus on the abortifacient effect.

We can ask the question from two points of view:

1. Can the manufacturer justify the production of the contraceptive on the grounds that failures of implantation are just an unfortunate side-effect?

2. Can the user justify the use on those grounds?

Regarding 1, here’s a thought. For the contraceptive to be competitive, it has to be highly effective. If one does not count the 5% of annual cases where fertilization occurs but implantation is prevented as part of the contraceptive’s effectiveness, then one can at most claim 95% effectiveness for the contraceptive. And that effectiveness would put the contraceptive significantly behind the most effective formulations of the pill. In fact, it will put it somewhat behind the results that can be achieved by Natural Family Planning by a well-prepared and well-motivated couple. So for commercial purposes, the manufacturer will have to be advertising 99% effectiveness. But one cannot with moral consistency claim 99% effectiveness while holding that 5% of that is an unfortunate side-effect. By claiming 99% effectiveness, one is putting oneself behind the mechanisms that one knows are being used to achieve that effectiveness.

Suppose that a manufacturer advertises an analgesic that is guaranteed to be 99% effective at pain relief. But suppose that 5% of the time, the analgesic kills the patient and 94% of the time it relieves pain non-fatally. Then indeed the analgesic relieves pain 99% of the time, since killing the patient stops the pain. But by holding out 99% effectiveness, the manufacturer is showing that that it is really intending this to be a pain-relief-cum-euthanasia drug rather than a mere pain-relief drug.

What about 2? As we saw from the case of the manufacturer, the user cannot intend 99% effectiveness while saying that the deaths of early embryos are unfortunate side-effects. But the user, unlike the manufacturer, can say: “From my point of view, this is about 94% effective, with a 5% likelihood of a fatal side-effect, which side-effect I don’t intend.”

There are two points I want to make here. First, Double Effect requires there to be no reasonable alternatives to the course of action. But there are methods of fertility control that do not cause implantation-failure, for instance Natural Family Planning, and some of these methods are not less effective when compared against the 94% figure. And one cannot with moral consistency compare these method against the 99% effectivness figure while holding out that 5% of that is an unfortunate side-effect one would like to avoid.

Finally, imagine a hypothetical male contraceptive pill that works by releasing genetically engineered sperm-eating viruses that has the following annual properties:

• Fewer than 1% of female partners get pregnant.

• But 5% of female partners get a fatal viral infection from it.

• No men die.

Clearly, nobody would tolerate such a product. Both the manufacturer and the men using it would be accused of murder. Technically, it might not be murder if the deaths of the women were not intended, but the act would be closely akin to vehicular homicide through criminal negligence. Any Double Effect justification would have no hope of succeeding, because Double Effect requires that the unintended bads not be disproportionate to the intended goods. But a 5% annual chance of death is just not worth the contraceptive effect, especially when there are alternatives present. Indeed, even if the only alternative to using this nasty contraceptive were abstinence, which isn’t the case, surely total abstinence would typically be preferable to inducing a 5% annual chance of death (unless perhaps the woman were already suffering from a terminal disease).

Of course, my arguments are predicated on the assumption that killing an early embryo is morally on par with killing an adult. That's another argument.

A disconnect between lay and philosophical pro-choicers

Without having done any scientific survey, I get the impression that philosophical pro-choicers tend to agree with philosophical pro-lifers on positive answers to the questions:

1. Does a fetus have basically the same intrinsic moral standing as a normal newborn baby?
2. Does the life of members of the human biological species begins at or around conception?

(In some cases, (1) will need to be qualified to: "fetus with brain states", and then the following discussion will need to be restricted to somewhat later abortions.) Of course, the pro-choice and pro-life philosophers disagree on the implications of these positive answers. Thus, pro-choice philosophers who give a positive answer to (1) will either say that killing a normal newborn is permissible or that it is wrong for reasons other than its intrinsic moral standing (e.g., the hurt to adults in our society). And pro-choice philosophers working on abortion tend to distinguish between us and members of our biological species, holding that we are constituted by and not identical with members of our biological species.

I also suspect, again without any scientific survey, that lay pro-choicers by and large answer (1) and (2) with "no". Moreover, I suspect that many of them think that (1) and (2) are crucial disputed questions in the discussion of abortion. In fact, it may be that quite a number of them think that abortion is permissible because the answers to (1) and (2) are negative and even accept the conditional:

3. If the answers to (1) and (2) are positive, then abortion is at least typically impermissible.

If so, then the position of lay pro-choicers is apt to be unstable. It is predicated at least in part on negative answers to (1) and (2), whereas the relevant experts—philosophers working on abortion, whether pro-choice or pro-life—tend to agree that the answers are positive.

Like I said, these are just anecdotal impressions. It would be valuable to have research on both lay and philosophical pro-choicers to see if these impressions are correct or not. Suppose it turns out that my anecdotal impressions turn out to be correct. Then the disconnect between lay and philosophical pro-choicers suggests that even if the philosophical debate is at a stalemate, there are ways for the social debate to move.

The draft

Suppose Belgium is being attacked by a vicious enemy who is particularly targetting civilians—especially children—in a terroristic campaign. Currently, Belgium has an all-volunteer army. However, experts with excellent predictive track records estimate that conscripting 200,000 men for about a year will save almost as many lives, mainly those of children. These 200,000 draftees would be subject to the rigors and hardships of a tough year-long military campaign. Surprisingly, however, due to recent improvements in personal armor, the campaign is expected to result in fewer than 100 deaths of draftees.

There is nothing morally objectionable about the government having such a draft and those called up for it would have a moral duty to serve. Note that the projected death-rate expected from the campaign is about 50 times lower than the US military death-rate in WWII. Such a low death-rate makes this draft close to obviously right.

Now compare this to Judith Jarvis Thomson's arguments—like the famous violinist one—for abortion. In the Belgian draft case, in pregnancy and in Thomson's cases, people lose significant aspects of their ordinary freedoms and capabilities, and do so for the sake of saving the lives of others. I think the draft case underlines that Thomson's cases underestimate the degree to which we can be legitimately morally required to make significant sacrifices to save the lives of others.

Notice, too, three differences between the draft and violinist cases. While the particular people saved by the draft in my story are primarily children, and hence not the draftees themselves, the practice of instituting a draft in such dire wartime circumstances is one that all can potentially benefit from. If I am to be drafted and save the life of some child and I am considering running off, I should reflect that it's just a matter of my luck that the invasion happened now rather than when I was a child and when others would have been drafted to protect me. I need to do my bit or else I will be a freerider. It is not so in the violinist case. I am not a famous violinist. People are not at all likely kidnap anybody to provide life support for me! The pregnancy case here is like the draft case, but even more so. For we all not merely potential beneficiaries of the practice, but actual beneficiaries, since we all came into existence through pregnancy.

Second, in the draft case there is a not insignificant chance that the child whose life one's being drafted will save will be one's own child, while the violinist is a stranger. But in the case of pregnancy the child is almost always one's own (the exception is in cases of surrogate pregnancy). Again, the pregnancy case is more like the draft case, and even more in that direction.

The third difference may seem to play in a different direction, however. Both the pregnancy and the violinist cases involve direct use of one's internal organs. But in the draft, one's womb and one's kidneys are not being drafted—it is the use of external organs, like hands and legs, that is required of one. While there may be a small difference along these lines, I think the difference is not particularly significant. The soldier fights not just with hands and legs, but also with the brain, and is required to do so. To have one's kidneys get used, as in the violinist case, is no more invasive of one's person than to have to obey orders, to have to focus with one's brain and mind on the tasks that one's commander requires one to focus on. The loss of autonomy on a military campaign is, if anything, greater than in the pregnancy and violinist cases.

Note, too, that the draft argument gives support for two claims. First, it supports a moral claim: It is one's duty, on pain of freeriding, to do one's bit for saving lives. Second, it supports a policy claim: It can be both permissible and reasonable for the state to require this of one.

An argument against Christian materialism on a pro-life view

1. No one is saved who does not have a love for God in this life.
2. If materialism is true, early human embryos do not have a love for God.
3. At least some, perhaps all, people who die as early embryos are saved.
4. So, materialism is false.

One might think that in premise (2), the antecedent isn't doing any work: that it is simply true that early embryos do not have a love for God. Not so. For if love for God is a matter of a certain orientation of the soul towards God, then people who do not have a brain might nonetheless have a love for God.

One might even try to run the argument with young infants instead of embryos. But there, I think, the argument could run into difficulty. For it may be that a young infant's brain hardware is sufficiently developed to love God, but simply does not have the software for it. And God could miraculously give the infant the software. I suppose the Christian materialist could think that God could miraculously join the embryo with a brain, perhaps a brain in another dimension. But it is not clear that that both such an embryo would then be one of us humans and that brain would be its brain.