Robert George

In various places we have defended the position that a new human organism, that is, an individual member of the human species, comes to be at fertilization, the union of the spermatozoon and the oocyte. This individual organism, during the ordinary course of embryological development, remains the same individual and does not undergo any further substantial change, unless monozygotic twinning, or some form of chimerism occurs. Recently, in this Journal Jason Morris has challenged our position, claiming that recent findings in reproductive and stem cell biology have falsified our view. He objects to our claim that a discernible substantial change occurs at conception, giving rise to the existence of a new individual of the human species. In addition, he objects to our claim that the embryo is an individual, a unified whole that persists through various changes, and thus something other than a mere aggregate of cells. Morris raises a number of objections to these claims. However, we will show that his arguments overlook key data and confuse biological, metaphysical, and ethical questions. As a result, his attempts to rebut our arguments fail

As Charles Camosy observes, he and I agree more than we disagree. He believes with no less conviction than I do that deliberately killing infant children is profoundly morally wrong and a grave violation of human rights.1 So where do we disagree?I think that killing infant children, or promoting the moral permissibility of doing so, is moral madness, and that we should say so, rather than treating infanticide as just one more legitimate, albeit in the end morally mistaken view. We owe this to potential victims of the potential mainstreaming of support for infanticide.Professor Camosy suggests that my view, or its public expression, is uncharitable towards advocates of infanticide and ‘at variance with a Christian …

I am, of course, aware that infanticide was accepted and practiced in ancient Greece and Rome, and is still practiced in places like India and China today; just as I am aware that slavery was accepted and practiced in ancient Greece and Rome , and is still practiced in some places today. But if philosophers, no matter how sophisticated, were to step forward today to argue that slavery is morally acceptable , I would call that madness.Of course, the ‘madness’ I am referring to in condemning the advocacy of infanticide and slavery or their moral permissibility is moral madness. I am not making a clinical diagnosis of a psychiatric condition. I take it that this was obvious, but that Charles Camosy is nevertheless troubled that I would say such a thing. But I do say it. And at the risk of giving offense, I will say it again: advocating the moral permissibility of killing healthy newborn infants is moral madness; and it is scandalous, especially in a journal expressly directed not merely to philosophers but to physicians, nurses and other healthcare professionals—people whose attitudes shape decisions they make about the lives of real people, including real infants.Whatever errors of fact and judgment are made possible by the complexities of human development or a prenatal …

Battin et al examined data on deaths from physician-assisted suicide in Oregon and on PAS and voluntary euthanasia in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it—namely, that there is for the most part ‘no evidence of heightened risk’ to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

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 paper by Magill and Neaves in this issue of the Journal attempts to rebut the "natural potency" position, based on recent advances in direct reprogramming of somatic cells to yield "induced pluripotent stem" (iPS) cells. As stated by the authors, the natural potency position holds that because "a human embryo directs its own integral organismic function from its beginning . . . there is a whole, albeit immature, and distinct human organism that is intrinsically valuable with the status of inviolability and deserving full moral respect" (p. 26). The authors boldly assert that "The recent production of iPS . . . highlights a prima facie absurdity for the natural potentiality argument" (p. 29). Yet the argument against natural potency is both logically flawed and based on a characterization of the scientific evidence that is factually inaccurate.

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 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.

While we should acknowledge the blessings that genetic knowledge, and the biotechnologies it makes possible, have delivered or will deliver soon, there are urgent worries to consider. The first worry is that we may compromise, or further compromise, in both science and politics, the principle that every human being, irrespective of age, size, mental or physical condition, stage of development, or condition of dependency, possesses inherent worth and dignity and a right to life. The second worry, closely related, is that many people are coming to view procreation as akin to manufacture. They also regard children not as gifts to be cherished and loved even when "imperfect," but rather as products that may legitimately be subjected to standards of quality control and discarded or killed in the embryonic, fetal, and even infant stages if they do not measure up. The glory of our political tradition is its affirmation of the profound, inherent, and equal dignity of all human beings. The history of our politics and social practice, our law and economics, and even our medicine is in significant measure the struggle to live up to the demands of this affirmation. What we need is fidelity to the principles of human equality and dignity that have always served us well when we have had the wisdom and fortitude to honor them