[1] Let me begin by thanking the Journal of Lutheran Ethics for making possible such extensive consideration of my Procreative Ethics: Philosophical and Christian Approaches to Questions at the Beginning of Life. I owe particular debts of gratitude to my friend Paul Hinlicky for his generous and detailed engagement with the book and to Jennifer Hockenbery and James C. Peterson for their contributions to the conversation.
[2] Professor Hockenbery focuses on two of my twelve chapters, suggesting first that my attempt at a natural law defense of artificial contraception in chapter one lacks a “female perspective on sex.” She cites Heloise, Veronica Franco, and Hildegard of Bingen as women who “saw sexuality as part of the full human experience.” I certainly agree with this assessment, a fact I should perhaps have made more explicit, especially as it serves the case I’m trying to make. What Hockenbery calls my “history of the philosophy of sex,” however, is actually a more specifically pointed reflection on the way demographic changes, particularly of the last one hundred and twenty years, might affect the way one reasons about artificial contraception from a natural law perspective. The key point is that decisions about procreation and contraception must now be made within the contexts of much longer life expectancies, much surer child survival, and greatly increased percentages of elderly in our populations. While, as Hockenbery notes, a utilitarian might point to a variety of desirable outcomes in defending artificial contraception, my purpose is much more specific: it is to suggest a possible argument for artificial contraception that would be consistent with Thomas Aquinas’s understanding of natural law as it has been articulated by Martin Rhonheimer, particularly in his Natural Law and Practical Reason. At the heart of the argument is Rhonheimer’s understanding of Humanae Vitae, whose central statement he considers to be the teaching on “the inseparable connection, willed by God and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning.”1 For him, the “key to the argument” lies in the “concept of responsible parenthood,” which is present only where the limitation of the number of children has its “origin in an act of the virtue of chastity” (114). My contention is that the “unitive” and “procreative” meanings of sexuality are loosened by the greatly extended life expectancies during which married sexuality occurs. Moreover, as children’s survival into adulthood becomes more certain, the decision to procreate must be understood as a decision to procreate and rear. Thicker accounts of marriage and parenthood might also cause us to situate the intentions involved in marital sexuality under a broader group of virtues than chastity/temperance. Decisions about sexuality and contraception might well be formed as matters of justice, charity, and marital friendship.
[3] Hockenbery’s second concern is that I do not “assert strongly enough” the “relational nature of the fetus and the relational nature of born members in society.” She goes on then to advance a broadly pro-life argument suggesting how a more relational view of the self might lead to social and economic changes that would lower rates of abortion. I find myself in agreement with nearly all of the argument but would point out that my purpose is the more limited one of showing how the best pro-abortion arguments can be challenged successfully. No doubt this purpose derives from my having spent the last forty-five years in secular research universities, where the pro/choice, pro/abortion assumption is a virtual given. To show that the kinds of arguments made by Dworkin, Thomson, Boonin, Singer and others need not be the last word on abortion seemed to me a worthwhile way to contribute to nudging discussion in a pro-life direction.
[4] I do think Hockenbery too easily equates the language of “uniqueness” and “irreplaceability” with that of “self-reliance.” For me, human beings are unique and irreplaceable while at the same time so obviously dependent not only on other human beings but also on the non-human environment and on God that most appeals to “self-reliance” seem unjustifiable. I also would point out that while a “fetus and the mother” may be in a “relationship so complete and complex that no mathematician can definitely state whether they are one or two,” abortion kills only one of them. Two points about Hockenbery’s characterization of the way I refer to the “person like me argument” also deserve clarification. First, one of the positions defending a right to life from conception is Don Marquis’s “Future Like Ours” argument, which turns on the fetus’s “having a future-like-ours that contains experiences of the sort that one now values or will later come to value (if one is not killed).”2 I defend this argument against criticisms by David Boonin, suggesting that what Boonin’s argument is really designed to do is to induce forgetting in you and me that we were once fetuses. Second, it does seem to me that arguments whose goal is to distinguish stages of fetal development are implicitly “person like me” arguments. The fetus can be killed at certain stages because it is not a person like us. If it were a person like us, we would protect it. Yet none of us has ever been more like anyone else than we are like the fetus who has become us. Hockenbery’s position seems problematic on these points, even as they apply to her understanding of our profoundly relational character. She suggests the similarity between the rest of us and fetuses by calling attention to the relational quality of our lives: even a “5 year old child cannot survive without significant human relationship.” Yet we don’t use this relational quality of the five year old to justify the permissibility of its being killed. Thus there must be some way in which the fetus is not like the five year old, not “like us.” Moreover, when Hockenbery seems to be seeking a way in which to mark off the point at which a fetus ought not to be killed (11), her emphasis is not on the fetus’s relationship but on its separateness: “there seems to be a time when nature seems to say the relationship looks more like one person and a time when nature suggests the relationship looks more like two people.” This kind of unmediated reading of what nature says seems dubious. To those of us who refuse to forget that we were once fetuses, and who consider genetic inheritance to be an important component of what makes each of us unique—while still in constant relationship to others, nature, and God—“what nature seems to say” is that the relationship looks more like two people from conception onward. And this seems to me, in fact, a way of taking Hockenbery’s central emphasis on relationality as seriously as possible, for it is a way of insisting that the relationality that characterizes our existence from conception till death ought never to be used against any being to justify its killing. There is never a time when the fetus is not like us: unique, irreplaceable, relational, dependent, desiring—in a way appropriate to its stage of development—to live.
[5] Rightly noting that formats such as this tend to encourage a highlighting of differences rather than a focus on areas of agreement or overlap, Professor Peterson presents his responses as a series of “objections,” primarily to my chapter seven, “Why Designing the Subjects of Justice is Likely to be Unjust”—itself a kind of lengthy response to From Chance to Choice: Genetics and Justice by Allen Buchanan and others. One thing I certainly agree with Peterson about is that “Christian ethics is as much about moving us to act rightly with God and one another, as it is about what we should not do.” Indeed it’s my concern that we be able to act rightly toward God and one another that causes my wariness of the new eugenics and the breaking down of the distinction between therapy and enhancement—however difficult it is, of course, to distinguish these with precision.
[6] One problem with Peterson’s list is that it’s frequently unclear whether these are his objections to my positions or objections I raise to frequently cited arguments in the literature. The effect is to obscure my positions, which, in several cases, are virtually identical with Peterson’s objections. Just a couple cases in point. What I say about moral repugnance, for instance, is that “we may not want to discount its” wisdom “altogether,” but that “unexplained and unjustifiable repugnance can look a great deal like simple prejudice” (Oehlschlaeger, 320). Obviously it is not my position that moral repugnance should “end consideration” of matters, as Peterson’s “objection” would suggest. One could infer from “Objection 1” that I somehow oppose “blood transfusions, autopsies, and organ transplantation,” which, of course, I do not. These interventions are perfectly consistent with the best therapeutic traditions and practice of medicine.
[7] Objection 2 presents a similar problem. Its point is that cloning is “doomed by the impossibility of achieving it” because “people with identical genes are still different persons developing by their unique experiences and choices.” That “there is truth to this claim”—i.e. “that increased genetic control, even cloning, poses no threat to human uniqueness as every person is largely the product of his or her own experience”—is something I freely grant (see Oehlschlaeger, 189, quoted here ). I do note, however, that this defense of cloning “seems just a little disingenuous,” as cloning is, “after all, an attempt to replicate” (Oehlschlaeger, 189). Peterson’s objection is one of the standard genethical defenses of cloning. I grant the partial descriptive rightness of that defense but challenge cloning on other grounds, too complex to develop here but mostly having to do with generational justice. A final note about “Objection 2” in passing. Peterson observes without commenting that “many mammal species have been successfully cloned.” I’m not sure whether he considers that fact unproblematic. I certainly consider it very problematic, as do many of us who think that our commoditizing the non-human animals is a sign and symptom of our fatal estrangement from what sustains us.
[8] Similar points could be made about a number of the other “objections” but I’ll move on to two more important matters. One has to do with Peterson’s claim that I have “not made an adequate case for clearly distinguishing between cure and enhancement, nor for banning the latter.” I would freely grant that I’ve not clearly distinguished between therapy and enhancement. What I have tried to do is much more modest and much more closely related to my reading of the dominant trends in the genethical literature. Most of that literature, as I read it, at least, seeks to undermine the distinction, opening the way for the normalization of very extensive genetic enhancements as they become technically possible. What I offer is merely a rearguard defense of a diminishing distinction, a suggestion that we ought not to give up entirely on the difference between therapy and enhancement. And I make no arguments, at any point in the book, for “banning” anything. My interests lie in trying to understand what is going on and in offering reasoned positions. What is and is not banned in this society will be determined, I’m certain, by the managerial class, and I want no part of that.
[9] No doubt my treatment of enhancement would have been clarified if I had added that I tend to identify enhancement with the achievement of positional advantage. Perhaps again this reflects my experience in the highly competitive environment of the secular research university and my sense of the extraordinarily competitive quality of our current economic condition. I assume that as genetic enhancements become available they will be adopted by elites seeking to give their children every advantage in life, and there is no more likelihood that they will be broadly distributed than that we will decide to send all high school graduates to Ivy League institutions. If I then have a more specific sense of enhancement than Peterson (a point about which I’m uncertain), I suspect I also have a broader and more inclusive sense of what counts as therapy.
[10] “Objection 4” offers a case in point. He suggests that one of my points is that “Genetic enhancement treats children as artifacts of our own making”—an argument I do suggest. What follows then is a rhetorical question: “Would this include doing invasive surgery on a child born with a cleft palate so that they can eat and speak more easily?” The answer here seems clearly “no”: doing corrective surgery on a cleft palate is not a matter of enhancement at all but rather a clearly therapeutic procedure whose purpose is to ensure normal function. Or, in “Objection 10,” where Peterson takes issue with my admittedly somewhat imprecise reference to “ordinary functioning.” Peterson asks rhetorically: “Eight dental cavities per adult? 20/30 vision? Life expectancy of 32 in many countries?” Again, what we do in these areas seems to me to be much better understood as matters of therapy rather than enhancement. We fix people’s teeth in order to restore them to something like a norm of functioning; the same is true of “corrections” in vision. The fact that a life expectancy of 32 in some countries appalls us is not because people in those countries are not as good a human beings as they might be. It rightly appalls us because 32 falls so far short of the normal life expectancy characteristic of countries in the developed world. Seeking to raise those life expectancies seems to me clearly consonant with an idea of therapy: the intention is to move them closer to something like the natural limit of life expectancy, itself approached more closely in the developed world. It’s worth noting that the widespread improvements in life expectancy that have occurred since the demographic transition have not been the products of genetic enhancement or design.
[11] Related to Peterson’s objections to my insistence on the distinction between therapy and enhancement is his desire to defend eugenics. Peterson’s limiting of the meaning of eugenics to “seeking a good physical start for a child at birth” detaches the word much too greatly, in my view, from its history of use. This is no place to review that sorry history, but I will remind readers that the Virginia act of 1924 under which Carrie Buck was sterilized was called the Eugenical Sterilization Act. The example Peterson gives, in Objection 6, of Ashkenazi Jews using genetic counseling in their communities to prevent the conception of children who will suffer from Tay-Sachs disease seems to me, again, much better understood as an exercise of therapeutic rather than eugenic intention. The purpose is to prevent suffering for an identifiable, even if hypothetical, individual, suffering judged to be so intense as to outweigh the value of life itself. There is no question involved of producing an improved version of the human being as in eugenics.
[12] Peterson argues that “what is entailed in eugenics is the idea that some genetic inheritances are better than others.” For me that’s precisely the reason to be wary of any attempts to rehabilitate eugenics. To illustrate his claim, Peterson cites what must seem to him a relatively unproblematic example: “It is better to be born able to see than not to be able to see.” Several points need to be made here. First, as a sighted person, I must say that this is something I do not know. Second, if I asked the unsighted persons of my acquaintance whether they would prefer to be sighted, I suspect they would say yes. But I’m fairly certain they would reject any suggestion that theirs is an inferior genetic inheritance—in part, out of solidarity with other unsighted people. Third, to put the matter as Peterson does is to isolate one feature of a genetic inheritance, detaching it from all other aspects of the individual’s genetics. Fourth, to correct blindness—by any means—seems to me much better understood as a matter of therapy rather than eugenics. The difference between the hereditarily unsighted and the sighted does not involve inferior and superior genetic inheritances. There is no question here of producing a better version of the human being, only of intervening—if such is possible and chosen—to create or restore typical functioning.
[13] Apologists for the new eugenics exercise considerable rhetorical sleight-of-hand through the word “enhancement.” In his conclusion, Peterson refers, for example, to his having no wish to return to a period “before the physical enhancements of fluoride and vaccination enhanced” his “body’s abilities beyond their natural state.” Once again these medical interventions simply proceed from the therapeutic intention exercised by way of prevention. They raise none of the questions involved in eugenics, either as it has been practiced in the past or as it is envisioned in the future. The rhetorical goal of the new eugenicists is to use the word “enhancement” in such a way as to make readers think that designing children is no more problematic than fluoridation. I think there are very substantial reasons to continue to understand these as quite different kinds of practices. One raises a whole host of questions—explored at length in the book—that the other simply does not. In order to be able to continue to think clearly about such matters, the therapy-enhancement distinction—however imperfect—seems to me still of value.
[14] Professor Hinlicky rightly notes my deep indebtedness to the work of Stanley Hauerwas, and the book might be seen overall as an attempt to assist Christians in regaining something like semantic authority over themselves and their practices—much as Hauerwas has done in his work. The way Hinlicky’s review is presented and structured brings this out, for many of his sections suggest the way I describe practices as they are presented in the bioethical literature and then offer re-descriptions both of how to understand what is going on there and also of how Christian practices might differ. He notes in section 2, for example, how I suggest that one consequence of the way abortion is sometimes defended is an undermining of social trust. In section 7, he emphasizes the point that Thomson’s famous violinist argument for abortion choice assumes we have no choice to be just, to let ourselves die in a way that a fetus cannot. Further examples involve my placing of calls for genetic enhancement of children within a much larger ideology of limitless, debt-fueled growth (section 9); my identification of a “sacrificial system” in Ronald Dworkin’s defense of abortion (sections 10, 12); my attempt to picture a “narrative self stemming from the Biblical tradition” as an alternative to the “sovereign self of late modernity” and the biotechnological project (section 16); and my argument for an understanding of suffering that is quite different from that assumed by much of the bioethical literature (section 19). I do argue from the “hope of reorienting persons,” as Hinlicky says, and, I hope, too, with a full recognition of our “post-modern, post-Christendom situation of critical pluralism.”
[15] But as my purpose is to appeal to all readers, not only to Christians, I address many questions philosophically and attempt also to present Christian convictions and practices in such a way that they will seem understandable and coherent to non-Christians. Here I am guided by the MacIntyrean conviction that the task of the postmodern ethicist is to describe practices and the assumptions that underlie them in such a way that they become open to rational scrutiny. This way of doing ethics often yields a more occasional rather than systematic presentation, and I think that the difference between my more occasional and Hinlicky’s more systematic approach accounts for some of his questions about the “coherence” of my proposal.
[16] In the interests of time, I will concentrate on one of these questions here, that regarding my invoking “Christian liberty” by way of response to Ronald Dworkin’s influential “public argument” about abortion in Life’s Dominion. In what he bills as a serious attempt to find grounds for agreement on abortion, Dworkin proposes that there are two ways of characterizing objections to abortion, the “derivative” and the “detached.” The “derivative” position holds that “abortion is wrong in principle . . . because [it] violates someone’s right not to be killed, just as killing an adult is normally wrong because it violates the adult’s right not to be killed.” This position derives from “rights and interests that it assumes all human beings, including fetuses, have.” On the “detached” view, abortion is “wrong in principle because it disregards and insults the intrinsic value, the sacred character, of any stage or form of human life.” But this objection does not derive from, or “presuppose any particular rights or interests.” Government has a “detached responsibility” for “protecting the intrinsic value of life” but no “derivative responsibility” to prohibit abortion. Many pro-life people believe they hold the “derivative objection,” Dworkin argues, while actually holding the “detached” position, one they share with pro-choice people who nevertheless find abortion objectionable. Here Dworkin believes he has found the basis for a kind of consensus between the pro-life and pro-choice positions.3
[17] My chapter brings out significant problems in Dworkin’s conceptions of the sacred and of intrinsic value, but I will not go into those matters here. My invoking “Christian liberty” is to suggest an alternative to Dworkin’s argument that no one can hold the derivative objection without simultaneously holding that abortion should be illegal in all cases, including those of rape and incest. But I suggest one can do this quite simply by holding that fetuses have a right not to be killed but that much of society is not yet prepared to grant this degree of recognition to the truly intrinsic value of fetal life. A pro-life witness rooted in Christian liberty would encourage a moral imagination formed by the Gospel: one that might, in the victim of rape or incest, cause her to return good for evil by carrying her baby to term. But it would simultaneously have to recognize the woman’s right to self-defense based on something like the Bad Samaritan argument (a version of which, in my secular self, I have to endorse). To expect the rape or incest victim to carry to term is to insist on a degree of supererogation we do not expect from others. To do such on the basis of the Gospel is likely to make it impossible for the rape or incest victim—or others—ever to hear the Gospel.
[18] To put this in the terms Hinlicky introduces, one might say that we have to grant freedom of self-defense to women operating in a Hobbesian world. I do not endorse the Hobbesian conception of social life nor would I want to identify Christian freedom with the freedom to be a Bad Samaritan. If something like a Hobbesian picture emerges from my chapters, it does so in connection with my descriptive accounts of current practices and justifications, not from anything prescriptive. (See, for instance, my development in Chapter 4 of assumptions implicit in Thomson’s famous violinist argument for abortion or Donald Regan’s claim that abortion could be outlawed for the sake of a great national purpose like population growth). My own assumption is, as I put it in the book’s introduction, much closer to Tristram Engelhardt’s principle of permission, which holds that “respect of the right of participants to consent is the necessary condition for the possibility of a moral community.”4 Of course an appeal to Christian liberty is “subversive” of the “kind of sovereignty” I hope to have “decoded” in our “brave new world” on its way from abortion to eugenics. I think pro-life witness should be regarded precisely as a form of civil disobedience, whose only power of “coercion,” if it can be called that, lies in its appeal to the conscience and imagination of those living currently under the abortion regime. The kinds of subtle coercion abortion critics must resist can be seen even in such apparently innocuous places as Dworkin’s explanation of why pro-lifers cannot simultaneously hold the derivative objection and the rape or incest exception. To do so is inconsistent with an understanding of the “most basic responsibility of government,” which is “to protect the interests of everyone in the community, particularly the interests of those who cannot protect themselves” (Dworkin, 14). If one subscribes to this description, and it’s hard to see how one would not, then one must either renounce the derivative objection or the rape/incest exception—or find oneself no longer a member of the community. Note how Dworkin’s logic violates Engelhardt’s “principle of permission,” for it forces pro-lifers either to renounce important elements of their comprehensive views of life or be excluded from the community. My approach recognizes that critics of abortion do hold something like the derivative objection while, in many cases, also supporting the rape/incest exception, or an even broader right to abortion. They can do this while simultaneously affirming Dworkin’s principle that government’s responsibility is to protect everyone in the community, particularly the most vulnerable. They will have to add, however, that at present in the United States of America, government does not do this, for it has not yet arrived at a capacious enough sense of who belongs to the community.
NOTES
1. Natural Law and Practical Reason: A Thomist View of Moral Autonomy. Trans. Gerald Malsbary (New York: Fordham), 113. Future citations will be given parenthetically.
2. David Boonin, A Defense of Abortion (Cambridge: Cambridge University Press, 2003), 57, 61.
3. Life’s Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom (New York, Knopf), 10-11.
4. The Foundations of Bioethics, 2nd ed. (New York: Oxford University Press, 1996), 123.