Robert George

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation (CDPS) is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice.

The following is the text of an address delivered by Professor George at the twentieth anniversary conference of the Society of Catholic Social Scientists in New York, October 2012. George identifies the intellectual roots of recent threats to conscience rights—especially for people of faith—in the American College of Obstetrics and Gynecology’s 2008 report that, he argues, makes ideological claims rather than using scientific evidence to support the denial of conscience rights to medical professionals in the areas of birth control and abortion.

Abstract. We argue that all human beings have a special type of dignity which is the basis for (1) the obligation all of us have not to kill them, (2) the obligation to take their well-being into account when we act, and (3) even the obligation to treat them as we would have them treat us, and indeed, that all human beings are equal in fundamental dignity. We give reasons to oppose the position that only some human beings, because of their possession of certain characteristics in addition to their humanity (for example, an immediately exercisable capacity for self-consciousness, or for rational deliberation), have full moral worth. What distinguishes human beings from other animals, what makes human beings persons rather than things, is their rational nature, and human beings are rational creatures by virtue of possessing natural capacities for conceptual thought, deliberation, and free choice, that is, the natural capacity to shape their own lives.

The author, a member of the U.S.President's Council on Bioethics, discussesethical issues raised by human cloning, whetherfor purposes of bringing babies to birth or forresearch purposes. He first argues that everycloned human embryo is a new, distinct, andenduring organism, belonging to the speciesHomo sapiens, and directing its owndevelopment toward maturity. He then distinguishesbetween two types of capacities belonging toindividual organisms belonging to this species,an immediately exerciseable capacity and abasic natural capacity that develops over time. He argues that it is the second type ofcapacity that is the ground for full moralrespect, and that this capacity (and itsconcomitant degree of respect) belongs tocloned human embryos no less than to adulthuman beings. He then considers and rejectscounter-arguments to his position, includingthe suggestion that the capacity of embryos isequivalent to the capacity of somatic cells,that full human rights are afforded only tohuman organisms with functioning brains, thatthe possibility of twinning diminishes themoral status of embryos, that the fact thatpeople do not typically mourn the loss of earlyembryos implies that they have a diminishedmoral status, that the fact that earlyspontaneous abortions occur frequentlydiminishes the moral status of embryos, andthat his arguments depend upon a concept ofensoulment. He concludes that if the moralstatus of cloned human embryos is equivalent tothat of adults, then public policy should bebased upon this assumption.

Profoundly important ethical and political controversies turn on the question of whether biological life is an essential aspect of a human person, or only an extrinsic instrument. Lee and George argue that human beings are physical, animal organisms - albeit essentially rational and free - and examine the implications of this understanding of human beings for some of the most controversial issues in contemporary ethics and politics. The authors argue that human beings are animal organisms and that their personal identity across time consists in the persistence of the animal organisms they are; they also argue that human beings are essentially rational and free and that there is a radical difference between human beings and other animals; criticize hedonism and hedonistic drug-taking; present detailed defenses of the prolife positions on abortion and euthanasia; and defend the traditional moral position on marriage and sexual acts.

This book defends the conjugal view of marriage. Patrick Lee and Robert P. George argue that marriage is a distinctive type of community: the union of a man and a woman who have committed to sharing their lives on every level of their beings (bodily, emotionally, and spiritually) in the kind of union that would be fulfilled by conceiving and rearing children together. The comprehensive nature of this union, and its intrinsic orientation to procreation as its natural fulfillment, distinguishes marriage from other types of community and provides the basis for the norms of marital exclusivity and permanence. Lee and George detail how the basic moral norms regarding sexual acts follow from the ethical requirement to respect the good of marriage and explain how the law should treat marriage, given its conjugal nature, examining both the same-sex-marriage issue and civil divorce.