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Preserving Life: Public Policy and the Life Not Worth Living.

Preserving Life: Public Policy and the Life Not Worth Living

Bioethical issues have a vivid quality. They draw our attention to events of such emotional intensity--infanticide, euthanasia, suicide, abortion--that we often neglect the social and intellectual contexts in which the events occur. One of the welcome features of Richard Sherlock's book is the author's attempt to locate bioethics within the larger framework provided by modern liberal thought.

Sherlock insists that the complex and paradoxical nature of current bioethical cases demands an identification of those public resolutions that will meet our communal aims. He searches for this resolution through a long and not entirely successful discussion of political philosophy from its classical origins through modern liberal theory. Sherlock's goal is to establish the importance of regimes--that common set of beliefs shaping the rules and practices of a political society--in political life. Regimes "assume a certain vision of the fundamental moral choices regarding justice that define their existence as independent human communicates, set forth the rights and duties of the rulers and the ruled and establish the various means of enacting, administering, and adjudicating the laws."

A regime-oriented view of politics excludes those empty liberal theories that view all values as problematic, all questions as open. Hume demonstrated that inductive reasoning rests on arbitrary premises (something must be accepted without proof as a condition of reasoning). It is today widely accepted that systems of belief require an anchor, a starting point itself outside the rules that retain and falsify beliefs. Sherlock all but ignores Hume's epistemology. But he adopts and then adapts Hume's perspective in seeking the prior values that must be in place for political life to occur, with a special concentration on the nonarbitrary premises of liberal communities.

The key premise of liberalism, on Sherlock's view, is an endorsement of human equality informed by two vital features. First, human beings are the most important creatures on earth (what other commentators have less charitably labeled "speciesism"). Second, all members of the human species have equal worth. The vocabulary of rights is the principal expression of this sense of equality.

Sherlock's central contention is that this sense of equality is inconsistent with all "quality of life tests" (those that provide answers to the questions of when a life is not worth living), and, in any case, it is impossible to specify a precise quality of life threshold that will meet the generalizing requirements of policy and law. Recent efforts to introduce such criteria in debates over abortion, euthanasia, and suicide pose "no less severe a test to our collective principles than did the slavery crisis that was confronted a century ago." The stakes are high, and Sherlock's sentiments are clearly on the side of life as such, regardless of its quality.

The standard liberal response to these difficulties--let the individual decide--does not work for Sherlock since it depends on the equally troubled notion of competence, and the devices used to infer preferences from incompetent patients "typically are sheer fictions." Liberal regimes thus break down across a number of domains in bioethics.

The trouble is that Sherlock may underestimate the difficulties of maintaining liberal values in bioethical practices. At times he passes over extremely complex and sensitive problems with the confidence of a preacher inspired by divine guidance. He has no difficulty, for example, in seeing the fetus as "patently human" by at least the gestational period when most abortions are performed, even though the status of the fetus is an open and complicated issue in many liberal societies. Nor is he overly troubled by suicide, since "the overwhelming evidence is that suicidal persons are impaired, disturbed human beings...." He dismisses wholesale most attempts, such as surrogacy and substituted judgment, to reconstruct the preferences of those without capacity. He continues to affirm the liberal principle of equal worth even while recognizing the puzzling imperfections of this principle in bioethics. These confident judgments suggest an author with a clear agenda and unshakable beliefs.

If the agenda is inspected closely, however, it will be seen as one more entry in the divisive setting of liberal politics today, not a resolution but a partisan defense of pro-life values against secular assaults. There are interesting sideshows. Sherlock argues persuasively that humane and compassionate medical care is best ensured by therapy decisions that try to "save a patient's life over a long time." Also, he maintains that sentience--specifically the capacity to experience the results of exercising a right--is threshold for having the right itself. The latter is an intriguing claim, suggesting quality of life arguments in a different vocabulary. But, alas, Sherlock does not develop the argument. We are left with the more general support of life's intrinsic value.

A darker possibility comes too easily to mind in reading Sherlock's book. Liberal regimes may be collapsing as their core values fail to resolve bioethical issues. Sherlock's book is a heroic attempt to restore integrity to liberalism that may be most interesting in its failure to convince.

Medical Genetics

The description of findings about medical geneticists' attitudes toward prenatal diagnosis for sex selection in the Report ("Latest Word," April/May 1988) was correct. But it was inaccurate that these findings were part "of an NIH study." Our study, done among medical geneticists in nineteen nations, was funded entirely by the Pew Charitable Trusts, the Norwegian Marshall Fund, and the Miller Foundation. Please correct this error. We desired that this study be funded privately, even though one of us was employed by the NIH at the time, to reduce suspicion abroad in receiving a questionnaire about genetics and ethics from a U.S. government agency. Also, we doubted if our questionnaire would have survived a legally required review by the Office of Management and Budget of all surveys supported by federal funds which will be given to ten or more persons.

Fred M. Frohock is professor and chair of the department of political science at Syracuse University, Syracuse, NY.
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Author:Frohock, Fred M.
Publication:The Hastings Center Report
Article Type:Book Review
Date:Dec 1, 1988
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