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The Failure of Liberal Bioethics


By: Ross Douthat
New York Times
August 17, 2011

Link to Original Article

 

Here’s a telling passage from this Sunday’s Times Magazine story on “selective reduction” — the increasingly commonplace practice whereby twin pregnancies are “reduced” to single babies via abortion:

Dr. Mark Evans, an obstetrician and geneticist, was among the first to reduce a pregnancy. He quickly became one of the procedure’s most visible and busiest practitioners, as well as one of the most prolific authors on the topic. Early on, Evans decided the industry needed guidelines, and in 1988, he and an ethicist with the National Institutes of Health issued them. One of their central tenets was that most reductions below twins violated ethical principles.

Two years later, as demand for twin reductions climbed, Evans published another journal article, arguing that reduction to singletons “crosses the line between doing a procedure for a medical indication versus one for a social indication.” He urged his colleagues to resist becoming “technicians to our patients’ desires.”

But of course, 20 years later …

In 2004, however, Evans publicly reversed his stance, announcing in a major obstetrics journal that he now endorsed twin reductions. For one thing, as more women in their 40s and 50s became pregnant (often thanks to donor eggs), they pushed for two-to-one reductions for social reasons. Evans understood why these women didn’t want to be in their 60s worrying about two tempestuous teenagers or two college-tuition bills. He noted that many of the women were in second marriages, and while they wanted to create a child with their new spouse, they did not want two, especially if they had children from a previous marriage. Others had deferred child rearing for careers or education, or were single women tired of waiting for the right partner. Whatever the particulars, these patients concluded that they lacked the resources to deal with the chaos, stereophonic screaming and exhaustion of raising twins.

In other words, Dr. Evans moved from warning doctors against becoming “technicians to our patients’ desires” to becoming pretty much exactly that himself. His progress calls to mind a piece that the liberal columnist Ellen Goodman wrote in 1980, when the first test tube babies were created. The full column isn’t available online, but the conservative bioethicist Wesley Smith has some excerpts:

A fear of many protesting the opening of this [the first IVF] clinic is that doctors there will fertilize myriad eggs and discard the “extras” and the abnormal, as if they were no more meaningful than a dish of caviar. But this fear seems largely unwarranted.

… Should we, they ask, respond like a consumer society to the demands of the buyer? If we don’t stop here, where do we stop? The questions are cosmic. But the issue in front of us at this moment is quote specific: one clinic.

… I think we should neither fund such a clinic at this time, nor prohibit it. We should, rather, monitor it, debate it, control it. We have put researchers on notice that we no longer accept every breakthrough and every advance as an unqualified good. Now we have to watch the development of this technology—willing to see it grow in the right direction and ready to say no.

Needless to say, the fears that Goodman dismissed as “largely unwarranted” proved to be completely justified. (Hundreds of thousands of embryos aresitting on ice in the United States, and presumably hundreds of thousands more have been “discarded” in the years since that “one clinic” opened its doors.) But like Dr. Mark Evans with selective reduction, Goodman gradually adapted herself to exactly the kind of developments that she once suggested should be resisted. By the mid-2000s, she was enthusiastically championing embryo-destroying stem cell research, pooh-poohing the idea that “a leftover frozen embryo” had any moral status worth respecting when cures might be at stake. (At one point, Smith e-mailed her about the seeming tension between this enthusiasm and her earlier anxieties. “My lines have changed,” she wrote back.)

There are three broad camps in contemporary debates over bioethics. In the name of human rights and human dignity, “bio-conservatives” tend to support restricting, regulating and stigmatizing the technologies that allow us to create, manipulate and destroy embryonic life. In the name of scientific progress and human freedom, “bio-libertarians” tend to oppose any restrictions on what individuals, doctors and researchers are allowed to do. Then somewhere in between are the anguished liberals, who are uncomfortable with what they see as the absolutism of both sides, and who tend to argue that society needs to decide where to draw its bioethical lines not based on some general ideal (like “life” or “choice”), but rather case by case by case — accepting this kind of abortion but not that kind; this use of embryos but not that use; existing developments in genetic engineering but not, perhaps, the developments that await us in the future.

The liberal camp includes many thinkers I admire, and it has produced some of the more eloquent reflections on biotechnology’s implications for human affairs. But at least in the United States, the liberal effort to (as the Goodman of 1980 put it) “monitor” and “debate” and “control” the development of reproductive technologies has been extraordinarily ineffectual. From embryo experimentation to selective reduction to the eugenic uses of abortion, liberals always promise to draw lines and then never actually manage to draw them. Like Dr. Evans, they find reasons to embrace each new technological leap while promising to resist the next one — and then time passes, science marches on, and they find reasons why the next moral compromise, too, must be accepted for the greater good, or at least tolerated in the name of privacy and choice. You can always count on them to worry, often perceptively, about hypothetical evils, potential slips down the bioethical slope. But they’re either ineffectual or accommodating once an evil actually arrives. Tomorrow, they always say — tomorrow, we’ll draw the line. But tomorrow never comes.

 




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