Humanity and humans

From childhood, I remember the Polish Christmas carol “Amidst the Silence of Night” from around the beginning of the 19th century, and I remember being particularly impressed by the lines:

Ahh, welcome, Savior, longed for of old,
four thousand years awaited.
For you, kings, prophets waited,
and you this night to us appeared.

I have lately found troubling the question: Why did God wait over a hundred thousand years from the beginning of the human race to send us his Son and give us the Gospel?

The standard answer is that God needed to prepare humankind. The carol’s version of this answer suggests that this preparation intensified our longings for salvation through millenia of waiting. A variant is that we need a lot of time to fully realize our moral depravity in the absence of God. Or one might emphasize that moral teaching is a slow and gradual process, and millenia are needed to make us ready to receive the Gospel.

I think there is something to all the answers, but they do not fully satisfy as they stand. After all, a human child from 100,000 years ago is presumably roughly as capable of moral development as a modern child. If we had time travel, it seems plausible that missionaries would be just as effective 100,000 years ago as they were 1000 years ago. The intensification of longings and the realization of social moral depravity are, indeed, important considerations, but human memory, even aided by writing, only goes back a few thousand years. Thus, two thousand years of waiting and learning about moral depravity would likely have had basically the same result for the individuals in the time of the Incarnation as a hundred thousand years did.

I am starting to think that this problem cannot be fully resolved simply by considering individual goods. It is important, I think, to consider humankind as a whole, with goods attached to the human community as a whole. The good of moral development can be considered on an individual level, and that good needs a few decade rather than millenia. But the good of moral development can also be considered on the level of humankind as well, and there millenia are fitting for the development not to ride roughshod over nature. Similarly, the good of longing for and anticipation of a great good only needs at most a few decades in an individual, but there is a value in humankind as a whole longing for and anticipating on a species timescale rather an individual timescale.

In other words, reflection on the waiting for Christ pushes us away from an overly individualistic view. As do, of course, other aspects of Christian theology, such as reflection on the Fall, the Church, the atonement, etc.

Am I fully satisfied? Not quite. Is the value of humankind’s more organic development worth sacrificing the goods of thousands of generations of ordinary humans who did not hear the Gospel? God seems to think so, and I am willing to trust him. There is doubtless a lot more to be said. But it helps me to think that this is yet another one of those many things where one needs to view a community (broadly understood) as having a moral significance going beyond the provision of more individualistic goods.

Two more remarks. First, a graduate student pointed out to me (if I understood them right) that perhaps we should measure individual moral achievement relative to the state of social development. If so, then perhaps there was not so great a loss to individuals, since what might matter for their moral wellbeing is this relative moral achievement.

Second, the specifically Christian theological problem that this post addresses has an analogue to a subspecies of the problem of evil that somehow has particularly bothered me for a long time: the evils caused by lack of knowledge, and especially lack of medical knowledge. Think of the millenia of people suffering and dying of in ways that could have been averted had people only known more, say, about boiling water, washing hands or making vaccines. I think there is a value in humankind’s organic epistemic development. But to employ that as an answer one has to be willing to say that such global goods of humankind as a whole can trump individual goods.

(Note that all that I say is meant to be compatible with a metaphysics of value on which the loci of value are always individuals. For an individual’s well-being can include external facts about humankind. Thus the good of humankind as a whole might be metaphysically housed in the members. The important thing, however, is that these goods are goods the human has qua part of humanity.)

More on doing and allowing

Let’s suppose disease X if medically unchecked will kill 4.00% of the population, and there is one and only one intervention available: a costless vaccine that is 100% effective at preventing X but that kills 3.99% of those who take it. (This is, of course, a very different situation than the one we are in regarding COVID-19, where we have extremely safe vaccines.) Moreover, there is no correlation between those who would be killed by X and those who would be killed by the vaccine.

Assuming there are no other relevant consequences (e.g., people’s loss of faith in vaccines leading to lower vaccine uptake in other cases), a utilitarian calculation says that the vaccine should be used: instead of 316.0 million people dying, 315.2 million people would die, so 800,000 fewer people would die. That’s an enormous benefit.

But it’s not completely clear that this costless vaccine should be promoted. For the 315.2 million who would die from the vaccine would be killed by us (i.e., us humans). There is at least a case to be made that allowing 316.0 million deaths is preferable to causing 315.2 million. The Principle of Double Effect may justify the vaccination because the deaths are not intentional—they are neither ends nor means—but still one might think that there is a doing/allowing distinction that favors allowing the deaths.

I am not confident what to say in the above case. But suppose the numbers are even closer. Suppose that we have extremely precise predictions and they show that the hypothetical costless vaccine would kill exactly one less person than would be killed by X. In that case, I do feel a strong pull to thinking this vaccine should not be marketed. On the other hand, if the numbers are further apart, it becomes clearer to me that the vaccine is worth it. If the vaccine kills 2% of the population while X kills 4%, the vaccine seems worthwhile (assuming no other relevant consequences). In that case, wanting to keep our hands clean by refusing to vaccinate would result in 158 million more people dying. (That said, I doubt our medical establishment would allow a vaccine that kills 2% of the population even if the vaccine would result in 158 million fewer people dying. I think our medical establishment is excessively risk averse and disvalues medically-caused deaths above deaths from disease to a degree that is morally unjustified.)

From a first-person view, though, I lose my intuition that if the vaccine only kills one fewer person than the disease, then the vaccine should not be administered. Suppose I am biking and my bike is coasting down a smooth hill. I can let the bike continue to coast to the bottom of the hill, or I can turn off into a side path that has just appeared. Suddenly I acquire the following information: by the main path there will be a tiger that has a 4% chance of eating any cyclist passing by, while by the side path there will be a different tiger that has “only” a 3.99999999% chance of eating a cyclist. Clearly, I should turn to the side path, notwithstanding the fact that if the tiger on the side path eats me, it will have eaten me because of my free choice to turn, while if the tiger on the main path eats me, that’s just due to my bike’s inertia. Similarly, then, if the vaccine is truly costless (i.e., no inconvenience, no pain, etc.), and it decreases my chance of death from 4% to 3.99999999% (that’s roughly what a one-person difference worldwide translates to), I should go for it.

So, in the case where the vaccine kills only one fewer person than the disease would have killed, from a first-person view, I get the intuition that I should get the vaccine. From a third-person view, I get the intuition that the vaccine shouldn’t be promoted. Perhaps the two intuitions can be made to fit together: perhaps the costless vaccine that kills only one fewer person should not be promoted, but the facts should be made public and the vaccine should be made freely available (since it is costless) to anyone who asks for it.

This suggests an interesting distinction between first-person and third-person decision-making. The doing/allowing distinction, which favors evils not of our causing over evils of our causing even when the latter are non-intentional, seems more compelling in third-person cases. And one can transform third-person cases to be more like first-person through unencouraged informed consent perhaps.

(Of course, in practice, nothing is costless. And in a case where there is such a slight difference in danger as 4% vs. 3.99999999%, the costs are going to be the decisive factor. Even in my tiger case, if we construe it realistically, the effort and risk of making a turn on a hill will override the probabilistic benefits of facing the slightly less hungry tiger.)

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).