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Silencing the singer: antibioethics in Germany.

Until recently, philosophers in the German-speaking countries have for the most part neither worked on nor published about normative questions in modern medicine and biotechnology. Only some twenty years after the United States and other European countries did an interdisciplinary and pluralist bioethics debate begin to emerge slowly in Germany as well. However, for the last two years this fledgling bioethics discussion seems to have taken an idiosyncratic turn. Triggered by lecture invitations to Australian philosopher Peter Singer, a militant protest movement has formed. Singer's permissive positions toward abortion and euthanasia have not only been heavily attacked, attempts have been made to stifle public discussion about them altogether. [1] 'Bioethics' has become a term of opprobrium in certain circles, and those who provide a forum for such topics find themselves accused of murderous inhumanity, economic opportunism, or at best of criminal naivete.

What follows is an exploration of this peculiar state of affairs. Despite similar tendencies in Austria and Switzerland, we shall restrict ourselves to the German case, where we feel most competent. More precisely, we shall restrict ourselves to the former Federal Republic of Germany, for we are as yet too ill-informed about the sparse bioethics activities in Eastern Germany. In the role of chroniclers assessing developments in German bioethics we feel ourselves in a doubly unpleasant situation. On the one hand it is embarrassingly easy for a German critic to publish abroad rather than at home. On the other hand the freedom of speech of Peter Singer and other bioethicists has been valiantly defended in public by some German scholars, in particular by Christoph Anstotz, Dieter Birnbacher, Rainer Hegselmann, Norbert Hoerster, Hartmut Kliemt, Anton Leist, Georg Meggle, Reinhard Merkel, Beate Rossler, Hans-Martin Sass, and Ursula Wolf. We stand on their shoulders.

Antibioethics in Germany

As in all countries with an expanding program in biomedical research, Germany had its public discussions in the early eighties about appropriate protection of animals and about the permissibility, hopes, and risks of genetic engineering, research on human embryos, and in vitro fertilization. A public demand for applied ethics attracted several philosophers to bioethical problems. Books were written, publication series were founded, translations of some influential works appeared--including a 1984 translation of Peter Singer's Practical Ethics. [2] Increasingly, meetings and lectures addressed bioethical topics. The term 'bioethics' had, however, long been avoided as overspecialized; the emphasis was on the field's interdisciplinary nature and its rejection of the cult of expertise. 'Ethics of the sciences' or 'ethics in medicine' were the reigning expressions before the growing recognition and discussion of Anglo-American 'bioethics' became familiar in Germany.

Between 1986 and 1989 activities in bioethics generally increased. Graduate students worked in this field; university jobs in applied ethics were about to be established; many medical schools offered some teaching in medical ethics; major funding institutions awarded grants in the field. Both universities and the physicians' associations of the various German states established IRBs (so-called Ethikkommissionen) to review human experimentation. The first institutions for medical ethics sprang up: in 1986 the Akademie fur Ethik in der Medizin was established with an interdisciplinary membership, describing itself as a forum for research, discussion, and teaching in medical ethics, and publishing a journal, Ethik in der Medizin. In the same year the Zentrum fur medizinische Ethik opened in Bochum, and later on the Zentrum fur Ethik in den Wissenschaften in Tubingen, as well as the Forschungsinstitut fur Philosophie in Hannover, sponsored by the Catholic church.

In the summer of 1989 a series of events now termed the "Singer Affair" brought a crucial change. Peter Singer had been invited to give a lecture at a meeting, "Bioengineering, Ethics, and Mental Retardation," in Marburg. As most readers will know, Singer argues on the basis of preference utilitarianism in favor of active euthanasia for severely disabled newborn infants if the parents request it. Shortly before his scheduled lecture at Marburg, where he intended to discuss this issue, news spread that protest demonstrations had been planned both by organizations of disabled people and by opponents of biotechnology. These groups accused Singer of denying handicapped people the right to life and, by questioning an absolute right to life, of having begun the slide along the same slippery slope that ended in the extermination atrocities under Hitler. The organizers withdrew Singer's invitation and ultimately the whole event was canceled. Further scheduled lectures by Singer were either prevented or disrupted by hooting and shouting.

In this already emotionally charged atmosphere, the liberal newspaper Die Zeit published the first article to defend Singer and further explain his position on euthanasia and the killing of severely disabled newborns. Die Zeit then itself became the target of sharp criticism. In reaction the paper published a quick succession of discussions, interviews, and articles pro and contra Singer's Practical Ethics. Other major daily and weekly newspapers joined in the "new discussion about euthanasia." But there was no genuine controversy. Instead, a vast consensus unified left-leaning and conservative papers, all of which strongly opposed ever again questioning anybody's right to life.

Before June 1989 using Singer's book in university philosophy classes would have been unproblematic. But by the following winter an effective taboo was in place. At the University of Duisburg and later on in other universities, classes discussing Practical Ethics had to be withdrawn. [3] Those opposed not only to Singer's philosophy but to any discussion of it as well were a motley group. Organizations of disabled people who believed such discussions threatened their own right to life were joined by critics from the political left, from the feminist movement, and from opponents of genetic engineering and reproductive technology. In this last group, unified by enduring fears of the new technological developments, Marxists and anarchists play an important role (though their numbers are small) in the expression of opinion. With their rigid theoretical stance and practical militance, these opponents to new genetic and reproductive technology deserve a closer look. As in the debate on nuclear energy, these critics not only reject certain possible and blatantly risky consequences of the new technologies; they question the future of industrialized society as a whole. Initially, nuclear energy seemed to promise a solution to one of industrialization's main problems: limited resources. These hopes have gradually evaporated, giving way to ambivalent judgments even among proponents. Germany's movement against genetic engineering, successor to the movement against nuclear energy, was to be understood as likewise anticapitalistic. With genetic engineering, these critics argued, science did indeed create new possibilities for overcoming certain obstacles impeding capitalism's progress. They raised fears that humans might be selected and bred according to the functional needs and economic interests of capitalism, and called for a vigorous campaign of civil disobedience to block this threat. The same call to civil disobedience characterizes the new discussion about euthanasia, which, so the argument goes, would justify the extermination of nonfunctioning human beings (the elderly, the sick, and the handicapped), thus complementing, as it were, the capitalist goals of genetic engineering.

A bioethics that promotes the "scientific" discussion of euthanasia, and that even justifies it under certain circumstances, allegedly serves only the interests of capitalism. Here ethics is seen to be perverted into a "public relations department of the new biotechnologies." [4] This unflattering view appears to be immune to objections, which are either discredited as pure positivism, or countered by pointing to cooperation between bioethical centers and the pharmaceutical industry.

The whole discussion is made still more difficult by the fact that many critics of bioethics renounce rationality, which they view as a mere instrument of technological thinking. To identify inconsistencies or to correct argumentation is futile if these critics refuse to accept standards of coherent argumentation and reject an allegedly "instrumental" rationality in favor of some higher moral rationality.

Pace Singer's own interpretation of these German events, a discussion with these opponents is barely possible and moreover not sought by them. Oliver Tolmein, one of the most active of the German antibioethicists, describes Singer's ethics as simply "deny[ing] the right to life of the disabled" and contends that any debate about it would be as "senseless as to debate a theory arguing for the superiority of the Aryan race. In both cases it is the cognitive will [Erkenntniswille] at the theory's foundation that must be attacked." [5] However, the antibioethics movement is much broader and stronger than this group alone. Representatives of the Catholic and Protestant churches and of church-affiliated charitable organizations early joined the defense of a right to existence of "all human life, be it handicapped, disabled or unborn." [6] The major organizations of disabled people, their parents, teacher associations, some unions, and a remarkable number of academics joined the protest.

Concerned about the prospects for an open discussion of bioethical questions and also for the principle of academic freedom, members of the General Society for Philosophy emphasized the anomaly of academicians suppressing debate in their "Mainz Declaration": "We are especially concerned that attempts to stifle the discussion have also been undertaken by academics and that the invitation to Singer has already become an object of governmental inquiries in one case." The society tried to publish this declaration in several major newspapers, but even Die Zeit did not report it. Despite the large number (180) and lustrous scientific reputation of the signers, this declaration of September 1989 was first published in September 1991 in a reader on the new debate on euthanasia. [7] Another declaration by philosophers from Berlin was more successful in attracting public attention, and appeared in two major newspapers (TAZ and Frankfurther Rundschau) in the beginning of 1990. Its signers expressed dismay at the "scandalous events" that prevented debate over Singer's arguments. It provoked a counterdeclaration from various associations, groups, and private persons against "deadly philosophical liberalism." Criticism against Singer slowly broadened to encompass, first, ethicists defending related positions, then the whole of bioethics, and finally analytical philosophy, which is viewed as the intellectual foundation of bioethics.

Critics even found cause to be grateful that Singer had been invited to lecture in Germany, on the grounds that the storm unleashed by this invitation served to expose German bioethicists and their links to the bioethical "Internationale." [8] Activities of the antibioethicists have recently included objections against advertising a university chair in applied ethics (which was eventually given to someone working in another field), and against meetings addressing bioethical issues. Indeed, the journal E coli-bri has inaugurated a special column, "Conferences disrupted or (unfortunately) held." Hence a major success in the eyes of antibioethicists is the recent cancellation of the fifteenth Wittgenstein Conference, whose topic this year was to have been applied ethics and its foundations. [9] At present several other meetings seem to be endangered. Such events also cast a shadow over the academic future of those who work on bioethical issues. Several years ago it looked as if there were a need for young scholars in this area, yet now an interest in Anglo-American bioethics might jeopardize an academic career. Antibioethics is not limited to boycotts, demonstrations, or the disruption of classes. Government ministries (recall that all German universities are state-funded) and funding organizations receive inquiries and complaints concerning their support of "unconstitutional" bioethical projects. Philosophy departments are asked to proclaim their noninvolvement in the new bioethics, and two new petitions condemning bioethics are presently being circulated. In a "Kinsauer Manifesto" explicitly condoning the forcible disruptions of Singer's public appearances, the well-known philosopher Robert Spaemann is collecting the signatures of prominent figures in favor of the protection of the unborn and against active euthanasia. And a "Memorandum against the New Lebensunwert Discussion" refers to Germany's recent Nazi history in the demand to abandon the new bioethicists, who "leave the tradition of human rights." [10]

How is this specifically German development to be explained, and why was the development of bioethics in Germany so delayed in the first place?

Explaining the Singer Affair

We think it impossible to find simple explanations for the frightening events we have described, especially such explanations as might be offered from an external perspective. Any correct analysis must first acknowledge that the controversy does not turn on the narrow self-interest of any of the battling parties. In the first instance, the various positions are motivated by neither financial support from the organizations of disabled people, nor an increase in the numbers of tithe-payers for the churches, nor improved career possibilities for bioethicists. Rather, this dispute is above all one about Weltanschauung, and both sides have much to lose. One side objects to the unnecessary and irresponsible prolongation of suffering of some human beings, and worries about the possible end of academic freedom or even an open society. The world view of the other side leads to protest against the legitimation of murder and a refusal to sacrifice public morality to crude mercantilism. Both sides envision a society in which they do not want to live. Whawt are the causes of their bitter conflict?

A common credo of the German anti-Singer front might be reconstructed as embracing three theses:

* Singer's positions are murderous.

* The right to free speech does not extend to the public propagation of murderous positions, hence civil disobedience is justified.

* For disciplines that study values, the academic is the public. Hence free speech in the academy will not be extended to include discussion of murderous positions.

Each of these points depends for its relevance on the validity of the preceding ones. Let us examine the arguments for and against each of these theses.

1. Singer's positions are murderous. Supporting the moral permissibility of abortion, of killing severely disabled newborns, or of voluntary euthanasia is viewed as murderous for three reasons.

First, such support directly justifies "murderous" actions. For many opponents of the "deadly ethics," as Singer's position has been called, [11] there cannot be any doubt about the truth of this claim. The number of these opponents exceeds that of prolifers in the abortion debate, since the neonatal euthanasia Singer argues for under certain circumstances is of course even more at odds with public morality than is abortion on demand. But the whole discussion revolves around the justification of the judgment that this killing is murderous. It is by no means evident to everyone that abortion or voluntary euthanasia are to be considered as objectionable (murderous) killing. Hence it is necessary to discuss the question. There is no way around such debates unless one appeals to privileges knowledge (as do some theological dogmatics) or closes one's eyes to the existing pluralism of values.

Second, Singer's positions theoretically imply the justification of murderous actions (a logical slippery slope). And third, their general acceptance would produce murderous actions (an empirical slippery slope). Both slippery slope arguments play a dominant role in antibioethics and are moreover frequently conflated. They are also unjustifiably played down as merely derivative by many bioethicists. However, the important questions about whether such central conceptions and criteria as "life worth living," "autonomous preference," and "internal perspective" really are precise enough are controversial and must be considered still open. [12] Hence the alleged danger of a logical slippery slope has yet to be demonstrated. Yet Singer's critics frequently presuppose its existence by the way they describe their opponents' position.

With their acute and horrified awareness of the Nazi crimes, German critics underswtandably feel they have a special duty to warn of empirical slippery slopes. Moreover, their warnings are taken very seriously by a German audience. Not that these critics impute racist fanaticism and a Nazilike willingness to murder to those who support euthanasia from compassion. But the fact that almost the entire population passively tolerated the Nazi mass crimes is taken as a sufficient warning against any relativization whatsoever of the sanctity of human life. However, the likelihood of a psychosocial slippery slope is and remains an empirical question that cannot be answered by simplified historical comparisons, in particular since there are human values at stake on the other side as well. The declining Weimar Republic and the National Socialist regime differed in many relevant regards from Germany's current democracy. Recent experiences of other countries that have liberalized voluntary euthanasia, such as Holland, would have to be taken into account, and studied in detail. This has not yet been done in Germany: at most, the generalizability of such experiences is denied from the outset. The attractive possibility of conducting small-scale studies to test psychosocial consequences has not even been broached.

2. The right to free speech does not extend to the public propagation of murderous positions. The view that a ban on free speech is justified in the case of an "armchair murderer" [13] gains support among a wider intellectual public in Germany than in many other democratic countries. People are all too ready to brand someone as a "theoretical murderer" even on the basis of objectively insufficient evidence. On the contrary, it might be legitimate and appropriate for a country whose past includes the grim phenomenon of the Third Reich to subject arguments against the danger of a slippery slope, whether logical or empirical, to a particularly high standard of evidence.

Moreover, many people are quite prepared to violate civil rights if they consider the cause to be urgent. These antiliberal attitudes are a symptom of deep opposition to ethical pluralism, although such opposition contradicts Germany's official political self-image. Liberalism's central conviction--that self-determination also governs those moral values according to which human beings lead their lives--is sacrificed by many to the conviction that there exist universally binding moral values. This conviction, we think, feeds a widespread resistance to change in German social arrangements. It underlies the reluctance to accept restructuring of family life, new understandings of sexual morality, or feminist redefinitions of gender roles. Appeals to universal morality have also supported the existing policy of barring political extremists from civil service jobs. For example, members of fringe political parties are not permitted to hold positions in the postal service.

Opposition to pluralism leads to a striking and much criticized discouragement of controversy in German culture, as well as to a moralizing zeal that encourages right and left, clerical and secular groups alike not to attend seriously to the exact content and wording of those bioethical positions with which they disagree. Quotations are wrenched out of context, or words ascribed to Singer that in fact have been written about him.

By this point it should be clear that behind the debate on bioethical questions lurks a controversy about fundamental issues of political philosophy. What is undeniably at stake here are the limits of political liberalism, as instantiated in bioethics. If this much could be acknowledged by both sides, much could be gained in the way of sharpened focus and lowered emotional temperature in these debates. That liberalism has to face the problem of protecting minority rights, and that it has some difficulties with this issue, is clear from ongoing debates in political philosophy. [14] And it is exactly this problem that is raised by at least those opponents of Singer who sincerely condemn his position as murderous, seeing the unborn and newborn as victims in need of protection.

A certain lack of confidence in democratic mechanisms (which indeed have not yet had to undergo a crucial test in Germany) no doubt also encourages self-appointed watchdogs who guard minority rights, fundamental values, and society's moral development. These watchdogs belong not only to the older generation of Germans, who personally experienced the Nazi regime and its consequences, but also to the younger generation, who have become particularly sensitive to arguments from psychosocial slippery slopes after being confronted with many recently published descriptions of the Nazis' euthanasia and eugenics policies and their public denial. [15] It certainly is not a matter of pure chance to find authors of these descriptions among the ranks of the most vehement antibioethicists. Moreover, numerous publishers, reporters, and physicians feel their professional ethos obliges them to assume this role of watchdog to reveal scandals or protect patients.

A deeply rooted fear of a loss of societal values--a very German argument--leads to hasty and premature legal of actions that are morally explosive. An impressive example is a recently passed Law for the Protection of Human Embryos. It not only totally prohibits egg donation, surrogate motherhood, or any nontherapeutic experimentation on the human embryo, thus abbreviating moral discussion on these issues in the society at large, but also includes sanctions that at present lack any practical relevance, such as the prohibitions against constructing chimeras, against cloning, or against genetic engineering in germ cell lines. Legislators might have intended to assuage public fears with regard to future technologies, but they thereby exceed their competence.

3. Academic freedom will not be extended to discussion of murderous positions. With some good will a reconstruction of reasons and motives that undergird these 1 and 2 can at least be attempted. The same cannot be attempted for thesis 3, which denies academic freedom to disciplines that study values, thereby prohibiting absoltely all discussion of certain normative topics. Of course no one would deny that ethical theory can and should have practical implications, nor that one has a responsibility for the way in which one presents complex problems to the audience of a public lecture. However, the disruption of philosophy classes, the prevention of lectures by hooting and other physical means, and the proscription of scientists and their publications cannot be justified. Here a fundamentalist illiberalism surfaces, one with no confidence in the distinction between what is tentatively thought and disputed, and what is carried out in social practice. The difficulties with this position of distrust are all too clear. In the first place, to distrust in this way is to violate a fundamental value of democratic societies, thus courting potentially horrifying psychosocial and political damage. Furthermore, when problems are rendered taboo, they awre pushed dangerous beyond scrutiny and forethought.

Because these flaws are so plain, the ban on academic discussion is not advocated openly. Rather, "Singer and Co.," also known as the "biocrats" and "death-ethicists," are emphatically denied the status of scholars. Hence the word philosophy is generally put in sneer quotes; bioethicists are mocked as "philosophizing university teachers"; their moral integrity is denied; they are dismissed as political propagandists. By speaking of the "new killing ethics" as shallow and unphilosophical, of Peter Singer as "a Nazi," of Practical Ethics as a piece of political propaganda, or of those German scholars who wish to discuss this book as "neofascists," opponents of bioethics pretend that the target of their attacks is by no means academic freedom, but rather that they are engaged only in a political fight, with no holds barred.

To a considerable degree the current German discussion in and about bioethics is characterized by appeal to authority and declaration rather than by reasoned argument, by defamation rather than by attempts at justification. Thus we have to emphasize once more that our reconstruction of the theoretical credo of the antibioethicists will almost certainly give an exaggerated impression of the level of rationality in the German discussions. Realizing that the battle is fought on several planes might, however, dilute the venom of both the national debate and of the international perceptions of that debate.

It should be noted that there are considerable exceptions to the gloomy picture of muzzled discussion painted above. Some journals have dedicated special issues to the ethical discussion of euthanasia and human genetics. [16] Among the numerous recent publications on bioethical issues some prove to be philosophically quite sound. [17] We hope these presage still further contributions to a reasoned debate.

Bioethics before Singer

One reason for the tempest around Singer was the lack of a scholarly or popular bioethics discourse in which the discussion of different ethical theories, justificatory strategies, value judgments, and analogies could have been conducted. Hence at first many people viewed Singer as an isolated enemy, realizing only later that there could be international schools of similar thought and kindred thinkers.

The rather tardy theoretical interest of German institutionalized philosophy in medical ethics, and more generally in applied ethics, can be explained only speculatively, for lack of a more thorough investigation. After the atrocities of National Socialist Germany, the imposition of a far-reaching taboo upon the two complex issues of euthanasia and eugenics (to which central questions of modern medical ethics are related) seemed a matter of course to many Germans. Probably a reactive "restoration of value orientations" [18] after the period of Nazi crimes, as well as the preoccupation of post-Kantian ethics with abstract problems of justification rooted in the history of German philosophy, contributed to the several years' delay in the "normative turn" to Anglo-American ethics in Germany. The delay was reinforced by a widespread prejudice against and blanket disapproval of utilitarian ethics among German philosophers--both because of its "crassly" mercantile principle of calculation and because of its mainly subjectivist theory of values, invoking the dread specter of "positivism." The prejudice against this subjectivist value theory is of course also extended to the new contractarian theories of Anglo-American provenance, and explains why this prominent source of applied ethics excited little interest in Germany until quite recently. [19]

The tardiness with which supporters of other ethical theories (natural law theory, neo-Aristotelianism, Kantianism, or discourse ethics) developed an interest in the ethical problems of modern biomedicine probably stems from the relative indifference of physicians, scientists, and politicians to the need for professional proponents of a secular, normative ethics to address complex practical problems. Most importantly, the smoothly functioning representative role of the churches and their theologians was widely accepted. To disturb this with a possible pluralism in normative theories was neither attempted nor desired, although a lone philosopher--most often supporting Aristotelian or theistic ethics--might occasionally be asked to join commissions of consultation and inquiry.

Another important factor lies in understandings of the structure and jurisdiction of the German health care system that vary greatly from that of the United States. Of relevance are a deeply rooted paternalism (traditional physicians' ethos; no patients' rights movement; no professionally felt need to provide courses in systematic, philosophically oriented medical ethics for medical students) on the one hand; and a national health care system based on principles of solidarity and subsidies (which spared Germany a debate about justice in resource allocation a la the United States or Great Britain) on the other. Finally, the courts were only marginally involved in questions of ethical and medical standards of treatment (no case law system; no contingency fees for lawyers). Given that philosophers were seldom celebrated for their persuasive analysis of complex moral problems, their elaboration of possible solutions, or catalyzing discussion, it comes as no surprise that many (protectionist?) physicians distrust ethical theories and rather tend to stick with their own casuistic thinking and judging.

Abortion and Eugenics

Until the 1970s the termination of a pregnancy was illegal both for the pregnant woman and for those who helped her. The prochoice movement that swept the Western World reached the Federal German Republic in 1971, where after a heated debate, abortion on demand was legalized during the first trimester of pregnancy. Because of the Constitutional Supreme Court's decision designating the human embryo from implantation on as a potential human being under the protection of the state, German abortion law was changed in 1975 into a "broadened indication" law, still in place today. With abortion now in principle prohibited, a pregnancy can nevertheless be terminated in case of rape, medical danger to the mother's life, severe fetal handicap, or social hardship. It is the last of these "indications" that now serves as a formal back door for what is in effect quite liberal abortion praxis. About nine-tenths of abortions are officially justified by the social hardship exception. [20]

Public discussions over the abortion law that took place in the seventies engaged theologians and lawyers, but very few philosophers. Prolife and prochoice positions were dependent on more general attitudes--be they toward women's liberation or toward the secularization of society--rather than one a well-thought-out position on the moral status of the embryo. This has not changed very much; witness the revived political discussion of abortion policies attendant on the accession of the German Democratic Republic (which had a more liberal abortion policy)--a discussion now aggravated by problems of research on human embryos and by prenatal diagnosis.

Despite their divergent positions on the law and morality of abortions, most politicians and interest groups officially refuse to call into question a fundamental obligation to protect the life of human embryos, as has recently been confirmed by Germany's Law for the Protection of Human Embryos. But the high number of semilegal abortions in Germany is evidence of a de facto denial of the embryo's right to life. The churches theoretically take a prolife positions, but by providing services that fulfill the legal requirement of preabortion counseling, they help women seeking abortions--even if their counseling tends to be mainly prolife. Few German authors engage in philosophical discussions about the status of the embryo. The "classical" Anglo-American publications on this question have been translated only recently. [21] Anyone who argues in Germany that an embryo's right to life to depends upon its sensory capability, brain maturation, or birth now risks attack from the antibioethicists. [22]

Unfolding somewhat tangentially to the right-to-life debate is the controversy over the moral permissibility of selective abortion. According to law the existence of a "fetal indication" for abortion depends "upon the question of whether carrying a handicapped fetus to term and raising this child could reasonably be demanded" of the parents. The concept of "reasonable demand" is, of course, relative and vague. Yet the intention is clear: to avoid any direct judgement about the worth of a life--be it that of a disabled embryo or of a disabled child--but simultaneously to preserve maneuvering room for parental decisions. Both goals have been confirmed in numerous professional and political declarations, together with an emphatic rejection of "any eugenic tendency in modern human genetics." However, the moral position supported here is simply incompatible with a full-blown right to life for the human embryo. The days of these little-discussed inconsistencies of "public morality" are probably numbered, as the growing possibilities for prenatal diagnosis raise urgent questions about their moral limits.

From the outset, modern human genetics has been severely criticized in Germany, in particular by antiestablishment, feminist, and Green groups. The praxis, ethos, and standards of prenatal genetic counseling in Germany differ little from those of other countries--except perhaps for a heightened ethical reflection and sensibility. [23] But from its very beginning its practitioners had to defend themselves against the charge of perpetuating the ideology or even the practice of National Socialist eugenics. [24] Critics claim either that prenatal diagnosis is a political tool, or that it leads to a psychosocial slippery slope creating a climate for the elimination of the unfit, or at least an increased discrimination against the sick, the feeble, and the disabled. The churches have also persistently spoken out concerning this last danger. However as they acknowledge that prenatal diagnosis protects fetal life, calms parents, and is a precondition for future therapy, in contrast to the Greens or movements of disabled people, the churches stop short of demanding complete abolition of prenatal diagnosis. Instead they recommend following the dictates of conscience in individual cases. It is difficult to say which position is more inconsistent: the Christian sanctity-of-life morality in combination with openness to selective abortion; or the prochoice maxim that the Greens and several left-leaning groups combine with a complete ban on selective abortion, even in case in which the most severe suffering is to be expected. Rarely in political, religious, or professional declaration is there talk of "compassion" for a child who would go through life severely disabled. The historically rooted taboo against evaluating the worth of human life obviously doesn't allow for even this.

The German philosophical discussion of this topic so far has been over-shadowed by the abortion debate. A thorough explanation, for example, of the relationship between parental self-determination and broader morality, or an account of responsibilities in, for, and by society has yet to be carried out. By now the issue has, however, become a pressing one, and related research seems correspondingly urgent. Because of the outrage over Singer's support of euthanasia in cases of severely disabled newborns, those organizations of disabled people who view Singer as compromising the right to life of all handicapped have won new forces in the fight against what they call "cripple abortions. [25]

The main accusations take the form of "a guiltless killing of the suffering, the sick, and the handicapped"; of inhumane "quality control" of fetuses and newborns; of forcing disabled people to justify their own existence. And undeniably (although it has not yet been argued with such consistency) the following conclusion must be drawn: if it is justifiable to kill handicapped embryos despite their ordinarily full-blown right to life, then indeed a logical slippery slope permits a slide toward killing born people suffering from the same handicaps. The second postulate of those who feel threatened is that a permissive policy of selective abortions in the absence of a strong prolife stance would lead to the killing of handicapped adults, as well as to discrimination against the parents of disabled off-spring. This psychosocial slippery slope, however, appears to us neither probable nor irreversible.

Active Euthanasia and

Termination of Treatment

Until the Singer Affair, active euthanasia of newborns was not an issue discussed in Germany. It plainly ssood under a taboo. Much the same is true for other forms of nonvoluntary euthanasia. However, there is a difference between these cases and mercy killing at the request of fatally ill patients. Various groups tried to prove that the existing moral and legal prohibitions against voluntary enthanasia were irrational and inhumane. It was argued that with appropriate measures against possible abuse, this form of euthanasia would not differ morally from assisted suicide, which is not illegal in Germany. One of the aims of the "German Society of Humane Dying" (DGHS), founded in 1980 and now numbering about 32,000 members, is to win a broader consensus for this insight. Resistance from different sides (churches, politicians, physicians) was immense and mostly apdictic--not least because representatives of the DGHS used a sometimes unfortunate and one-sided form of argumentation. Behind this resistance stood the official prohibition of suicide by the churches; physicians' insistence on a traditional Western deontology that includes the Hippocratic prohibition against killing; fear of a slippery slope; and a distrust of the idea itself, with its associations of horror and taboo. It was only through the extremely dramatic self-accusations of the physician Julius Hackethal in 1984 that this debat e on active voluntary euthanasia gained a broader public. Hackethal had invited suits for active euthanasia in several cases, but was acquitted because all that could be proved was that he assisted in the suicide of terminal patients. At that time many people were afraid that public acceptance of voluntary euthanasia might have suffered a severe setback by Hackethal's eagerness for publicity. But at least in part this fear turned out to be unjustified. Since 1985 opinion polls have shown that about two-thirds of Germans favor the legalization of active voluntary euthanasia. [26] In 1986 a number of highly reputable lawyers and physicians published a well-rasoned "Alternative Draft of a Law for Aid in Dying" that recommended against punishing physicians who fulfill their patients' final wishes for active euthanasia. [27] The fifty-sixth Conference of Geman Lawyers and the German Physicians' Association rejected the draft by majority vote, however.

Those few philosophers writing on euthansia [28] certainly did not play a leading role in the discussion, but they increasingly took notice of the ongoing international debate. Slowly this whole controversy became emotionally defused, interdisciplinary, and pluralist--until the vehement opponents of euthanasia were given a new lease on life by the Singer Affair.

The public taboo in Germany extends equally to discussing termination of treatment. On the one hand, the "Guidelines for Aid in Dying" of the German Physicians' Association permit patients to forgo life-prolonging treatment if they are irreversibly dying; [29] on the other hand these guidelines' restrictiveness, the lingering conceptual vagueness, and some completely neglected problems--such as treatment for patients in PVS or the problem of fluid and nutrition--are barely discussed. The classical American controversy over the "active/passive" distinction has been taken up only recently, although the New England Journal of Medicine, which published the 1975 paper by James Rachels that initiated the discussion, is read by many German physicians. One has the impression that physicians and theologians recognize both the inevitability of and the problems with forgoing life-sustaining treatment, but want nonetheless to have it handled unsystematically, nonpublicly, and casuistically. Empirical studies of the issues surrounding termination of treatment have not yet been published, and use of advance directives is mostly regarded with pronounced skepticism. The Baby Doe debate of 1984 did not exite much attention still less the published recommendations for abating treatment such as The hastings Center's Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Bying. In the philosophical debate this topic has been lying fallow.

An important exception is the "Einbecker Recommendations" of the German Scoiety for Medical law, which are a first attempt to define the limits of treatment obligation toward severely handicapped newborn infants. [30] For about three years these recommendations were little discussed, either in public or among physicians--which also means they were not attacked.

With the Singer Affair this changed completely. Not only was active euthanasia said to "touch the foundatious of humanity of our nature," [31] but further, any treatment of defective newborns that is justified by explicit criteria (rather than performed clandestinely according to the physician's conscience) was now open to attack by the anti-Singer front. Soon after the first battles, critical inquiries from the Greens were directed toward government ministries concerning the "Einbecker Recommendations," as well as the issue of nontreatment.

Again, this is a paradoxical situation that can only be understood in the context of the Naxi trauma and is aftermath often the same authors who vehemently criticize modern medicine's inhumane vitalism also attack as presumptuous and dangerous any attempt to regulate these problems in a generalized way.

There is perhaps some hope to be gleaned from this otherwise depressing situation. There seems to be no way back to a medicalization, or fearful concealment, of ethical issues in medicine. These issues can no longer be veiled or made taboo. and that, at least, is progress.


[1] Many readers will already be familiar with Peter Singer, "Bioethics and Academic Freedom," Bioethics 4 (1990): 33-44; Singer, "On Being silenced in Germany," New York Review of Books, 15 August 1991, pp. 36-42.

[2] important among the early publications were O. Hoffe, Sittliche-politische Diskurse: Philosophische Grundlagen - politische Ethik - biomedizinische Ethik (Moral and political discourses: philosophical foundationspolitical ethics - biomedical ethics) (Frankfurt/M: suhrkamp, 1981); P. Koslowski, P. kreuzer, R. Low, eds., Die Verfuhrung durch das Machbare: Ethische Konflikte in der modernen Medizin und Biologie (The seduction of the feasible: ethical conflict in modern medicine and biology) (Stuttgart: Hirzel, 1983); and H. Schafer, Medizinische Ethik (Medical ethics) (Heidelberg: Verlag fur Medizin-Dr. Ewald Fischer, 1983). Series of particular influence were Ethik der Wissenschaflen (Ethics of Science) (Wilhelm Fink Verlag/Ferdinand Gehoningh); Gentechnologie: Chancen und Risiken (Gene technology: hopes and risks) (Frankfurt/M: J. Schweitzer Verlag), and Medizinethische Materialien (Medical ethics materials) (Bochum: Zentrum fur Medizinsche Ethik).

[3] Valuable documentations of these events are: R. Hegselmann, H. Kliemt, eds., Peter Singer in Duisburg: Eine kommentierte Dokumentation (A documentary with commentary) (privately published and available via Heinrich-Heine-Buchhandlung, 43 Essen, Viehofer Platz), and R. Hegselmann, R. Merkel, eds., Zur Debatte uber Euthanasie: Beitrage und Stellungnahmen (The euthanasia debate: contributions and points of view) (Frankfurt/M: Suhrkamp, 1991).

[4] E. Klee, "Durch Zyankali erlost": Sterbehilfe und Euthanasie heute (Salvation through Zyankali: aid in dying and euthanasia today) (Frankfurt/M: Fischer, 1990), p. 81.

[5] Oliver Tolmein, "Terror del Normalitat" (The terr or of normality), Konkret 7 (1989): 27. In this article, however, he violates his own principles by attempting to criticize Singer on the grounds of the "Kritische Theorie." See Tolmein's Geschatzes Leben: Die neue "Euthanasie"-Debatte (Esteemed life: the new "euthanasia" debate) (Hamburg: Konkret Literatur Verlag, 1990).

[6] Introduction to the special bioethics issues of Caritas: Zeitschrift fur Caritasarbeit und Caritaswissenschaft (Periodical for caritas work and caritas learning) 90 (1989): 388.

[7] Hegselmann and Merkel, Zur Debatte uber Euthanasie.

[8] J. Paul, "Das 'bioethische' Netzwerk" (The "bioethical" network), Knokret 1 (1991): 69.

[9] James Lindemann Nelson, "What Has History to Do with Me?" Hastings Center Report 21, no. 3 (1991): 2.

[10] This "Memorandum" was published in the reputable Frankfurter Rundschau, 2 August 1991, and other newspapers.

[11] T. Bruns, U. Pensellin, and U. Sierck, eds., Todliche Ethik (Deadly ethics) (Hamburg: Verlag Libertare Assoziation, 1990).

[12] See J. C. Wolf, "Euthanasie auf abschussiger Bahn" (Euthanasia on the slippery slope), Zeitschrift fur Padagogik 37 (1991): 267-83. The author is the German translator of Practical Ethics.

[13] See T. Bastian, ed., Denken-Schreiben-Toten: Zur neuen "Euthanasie"-Diskussion (Thinking, writing, killing: the new "euthanasia" discussion) (Stuttgart: Hirzel, 1990).

[14] For a recent discussion of this point, see W. Kymlicka, Liberalism, Community and Culture (Oxford, Clarendon Press, 1989), chs. 9-13.

[15] See R.J. Lifton, The Nazi Doctors (New York, 1986); E. Klee, ed., Dokumente zur "Euthanasie" (Documents regarding "euthanasia") (Frankfurt/M: Fischer, 1985); H. W. Schmuhl, Rassenhygiene, Nationalsozialismus, Euthanasie (Racial hygiene, National Socialism, euthanasia) (Gottingen: Vandenhoeck & Ruprecht, 1987); P. Weingart et al., Rasse, Blut und Gene: Geschichte der Eugenik und Rassenhygiene in Deutschland (Race, blood, and genes: the history of eugenics and racial hygiene in Germany) (Frankfurt/M: Suhrkamp, 1988).

[16] For example Analyse & Kritik 2 (1990); Ethik und Sozialwissenchaften, in press; Studia Philosophica, in press.

[17] N. Hoerster, Atreibung im sakularen Staat: Argumente gegen [section] 218 (Abortion in the secular state: arguments against [section] 218) (Frankfurt/M: Suhrkamp, 1991); A. Leist, Eine Frage des Lebens: Ethik der Abtreibung und der kunstlichen Befruchtung (A question of life: the ethics of abortion and assisted reproduction) (Frankfurt/M., New York: Campus, 1990); essays in Hegselmann and Merkel, Zur Debatte uber Euthanasie, K. Bayertz, ed., Praktische Philosophie: Grundorientierungen angewandter Ethik (Practical philosophy: foundations of applied ethics) (Reinbeck: Rowold, 1991).

[18] J. Nida-Rumelin, "Analytische Philosophie in der Bundesrepublik," Prima Philosophia, Special Supplement 1: Ethik (1990), pp. 7-11.

[19] The neglect extends to such authors as Beauchamp, Daniels, Engelhardt, Gauthier, Glover, Harris, Rachels, or Tooley (to give only a few examples), hence Germany has experienced a true impoverishment in its bioethics discussion.

[20] Statistisches Jahrbuch (Statistical year-book) (Bundesamt fur Statistik, 1990). The degree of liberalism toward abortion varies greatly in different regions of Germany.

[21] A. Leist, ed., Um Leben und Tod: Moralische Probleme bei Abtreibung, kunstlicher Befruchtung, Euthanasie und Selbstmord (Of life and death: moral problems of abortion, assisted reproduction, euthanasia, and suicide) (Frankfurt/M: Suhrkamp, 1990).

[22] German proponents of these positions (in the given order) are: A. Leist, Eine Frage des Lebens; H.-M. Sass, "Hirntod und Hirnleben" (Brain death and brain life), Medizinethische Materialien 20 (Bochum, 1989); N. Hoerster, Abtreibung im Sakularen Staat.

[23] See D.C. Wertz and J.C. Fletcher, eds., Ethics and Human Genetics: A Cross-Cultural Perspective (New York, Berlin: Springer, 1989).

p24] U. Sierck and N. Radtke, eds., Die WohlTATER-Mafia: Vom Erbgesundheitsgericht zur humangenetischen Beratung (The dogooder Mafia: from race hygiene and sterilization courts to genetic counseling), 5th ed. (Hamburg: Marbuse, 1989).

[25] F. Christoph, Todlicher Zeitgeist: Notwehr gegen Euthanasie (Deadly spirit of the times: self-defense against euthanasia) (Cologne: Kiepenheuer & Witsch, 1990).

[26] EMNID polls, published yearly by the DGHS.

[27] J. Baumann et al., Alternativentwurf eines Gesetzes uber Sterbehilfe (Model legislation regarding aid in dying) (Stuttgart, New York: Thieme, 1986).

[28] Early and sharp philosophical analyses in favor of legalized euthanasia were provided by N. Hoerster, "Rechtsethische Uberlegungen zur Freigabe der Sterbehilfe" (Legal-ethical reflections concerning the legalization of euthanasia), Neue juristische Wochenschrift (1986), pp. 1786-92.

[29] Deutsche Bundesarztekammer, "Richtlinien fur die Sterbehilfe," (Guidelines for aid in dying) Deutsches Bundesarzteblatt 76 (1979): 957-60.

[30] Deutsche Gesselschaft fur Medizinrecht, "Grenzen der arztlichen Behandlungspflicht bei schwerstgeschadigten Neugeborenen" (The limits of the physician's professional duties toward badly damaged neonates) Medizinrecth 1 (1986): 281-82.

[31] Robert Spaemann, "Kinsauer Manifesto."

Bettina Schone-Seifert is an associate professor at the University of Gottingen; Klaus-Peter Rippe is an associate professor at the University of Saarbrucken.
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Title Annotation:opposition to the philosopher Peter Singer
Author:Schone-Seifert, Bettina; Rippe, Klaus-Peter
Publication:The Hastings Center Report
Date:Nov 1, 1991
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