2 November 2010

What makes life valuable?

Professor John Harris's speech from the Battle of Ideas.

I want to try to answer a fundamental question here, but if I fail to answer it no matter, because you will have already worked out an answer. If you have not, you could not conceivably have a view about the ethics of abortion. If my answer does not agree with yours, that is fine with me. I have no interest in whether or not you agree with me; what I am interested in is an answer to the question of what it is that makes life valuable.

To have a view about the ethics of abortion, indeed to have a view about most issues in healthcare, is to have an answer to this question. By ‘valuable’ I don’t mean anything very special, simply what it is that makes it right to save a life if we can, wrong to end a life if we can, what makes a life worth saving, worth preserving, worth prolonging. That is the fundamental question.

The value of life

To get a handle on this question, consider a very large teaching hospital. It’s on fire. And because it’s a very slow-burning fire and we are the management of the hospital, we have to work out how to prioritise the contents of the hospital for rescue. How are we going to do that? First we have to know what we’re dealing with. The hospital contains patients of all ages, including pregnant women; but there are other life forms as well. There are doctors, for example, and nurses, and midwives, and cleaners, and cooks, and a whole range of other human staff.

This hospital has a very large assisted reproduction facility, so there are also embryos, sperm and eggs aplenty, thousands of them frozen in fridge drawers. It’s a teaching hospital with a lot of science going on, so there is also an animal house with many laboratory animals, there are pot plants on the shelves, and there are of course bacteria and viruses and many other living things.

So we are going to do some prioritising. I’m assuming that you would think that we ought to rescue the patients before the viruses, and you may make all sorts of other distinctions. Now to do this, even to think about it, is to take a view about the value of life: about which lives are more important, morally speaking. This is unavoidable. It doesn’t just arise in relation to abortion, though many people seem to think that it does – it is a perennial problem about how we respond to all of the other living things in the world.

Let us here concentrate on prioritising between various life forms that might be thought of in one way or another as human, and ask whether it is reasonable to make distinctions between them from the perspective of the importance of their lives and hence the importance of rescue. So for example, to go back to our burning hospital and the pregnant women in the maternity wards: do they count for two? If they are pregnant with sextuplets, do they count for seven? Do we rescue them first or give them equal priority? Do the young get equal priority with the old, does it matter how much life expectancy they have left?

If it’s a matter of life expectancy you might expect that newborns count the most, because other things being equal they have the longest life expectancy, and the terminal patients in the cancer ward have much less. So perhaps the old age pensioners also count for less because they have less un-elapsed time. There are all sorts of familiar but acute problems.

Being alive

If we think just about humans, and the sort of humans that are called in to question in abortion, many people think that the problem just is to answer the question, ‘When does life begin?’ Once we know the answer to that question it is assumed that we know to whom we have moral responsibilities, who we should save. But that question is unhelpful. The sperm and egg are alive before conception, and they are human if they are anything; and conception can result in many things. It can, for example, result in a hydatidiform mole, a cancerous multiplication of cells that will not form anything.

But worse than that – the human zygote, the human embryo, the newly-alive human individual, is less complex and interesting in every way save one or two than a hamster or a parrot, a cat or a canary, or the Sunday roast. The human embryo is a very simple creature. So what does it have going for it that the Sunday roast does not or did not before it became a roast?

Species membership

There are two possibilities. The first is simply its species membership: simply the fact that it is human, it is one of us. But the fact that something is ‘one of us’ does not in itself accord us the reason to prioritise it. History is notoriously full of generally vicious appeals to the idea of ‘one of us’. We should not prioritise individuals because they are ‘one of us’, whether ‘us’ is defined as white like me, male like me, female like some of you, or British or black or whatever.

That is not a good reason: unless you can supplement it with some account of why being white or British or female gives you an edge, makes you more important than those who are not like ‘us’. It is disreputable to prioritise our species simply because they are our species.

We are all descended from a female ape in Africa about 5-7 million years ago, and at sometime in that evolutionary process we changed species: if human individuals survive it is inevitable that we will change again, that we will further evolve, and that eventually human beings will no longer exist. That itself is not an important fact so long as creatures that matter morally in the ways that we do, that are valuable in the ways that we are valuable, continue to exist.

So I have a perfectly easy mind about the human race dying out so long as creatures that are comparable in moral importance and value continue to exist. But that again raises the question of what it is that makes creatures of any sort morally important.

Potentiality

Species membership isn’t enough, and being alive isn’t enough. There is one other thing that the human embryo and the human fetus has going for it that cats and canaries and the Sunday roast do not, and that is its potential: its potential to become a glorious, thinking, feeling individual like all of us. Unfortunately, potentiality is not a very good argument for moral value either, for two very different but mutually reinforcing sets of reasons.

The first is a logical problem. Acorns are not oak trees. The fact that something has the potential to become something else does not give us a reason to treat it now, before it has acquired that potential, as if it has acquired that potential. Most of us share one very important piece of potential: we are potentially dead meat. But that does not afford any of you to treat any others of you as if you were already dead meat. The fact that something has potential does not give a good reason to treat it, before it has achieved that potential, as if it had achieved that potential.

The non-logical argument is simply that it is not only the human zygote that has the potential to become a wonderful creature like you and me. Lots of other things do. The first is the unfertilised egg and the sperm before they get together. It is alleged that the zygote is morally important, valuable, because of its potential to become something else. The something else that it has the potential to become is a glorious adult creature. So the potentiality argument says: ‘This is important if and only if it has the potential to become that.’

But consider – something has the potential to become a zygote. Whatever does, shares the importance that the potentiality argument conveys; because whatever has the potential to become a zygote has the potential that the zygote has. And the unfertilised egg and the sperm have the potential to become a zygote.

The potentiality argument says that we ought to protect certain things because of their potential in order that they may achieve their potential. And if we’re going to protect the zygote, the embryo, then we have to protect not only the egg and the sperm, wherever they are to be found, but all the other things that can form a zygote: and that is the nucleus of every cell in your body and mine, thanks to the neat little bit of trickery that Professor Ian Wilmut first used in animals a few years ago. And indeed, now we can manufacture eggs and sperm out of stem cells as well. So potentiality won’t do the trick.

The problem that we are left with is the problem: how do we account for the moral importance - if it has one - of the embryo or the fetus? It’s not the fact that it’s human, it’s not the fact that it has potential, so what if anything is it?

And that is the same question as why we should prioritise the normal adult patients and children in the hospital over the hospital cat and the bacteria and the viruses and the pot plants and all the other living things in the hospital that we think are of lesser importance. What is it that gives the embryo importance - if you think it has moral importance such that it ought to be protected? And if you, like me, don’t think that the embryo and the fetus has that moral importance that requires that it be protected, what gives it to you and me?

The meaning of life

Consider now a different question: not, ‘What is the value of life?’, but ‘What is the meaning of life?’ One very eloquent answer to the question of what is the meaning of life was delivered by a contemporary philosopher: the late, genuinely great, Douglas Adams, in his five-part trilogy The Hitchhiker’s Guide to the Galaxy.

In that marvellous book of philosophy – and I do think Adams is a substantial, powerful and important philosopher – a race of hyperintelligent, pan-dimensional beings set out to answer the question of the meaning of life, the universe and everything. And to that end they build a super-computer called Deep Thought which they programme to solve the problem.

Having done so they go up to Deep Thought and they say, ‘Can you answer the question?’ And he (or she) says, ‘Tricky’. They say, ‘But can you do it?’ She says, ‘Yes, but it will take me seven million years to run the programme.’ So seven million years later they go back and repose the question and get the immortal, the famous answer to the meaning of life, the universe and everything: ‘42’.

Clearly, ‘42’ is an unsatisfactory answer to such a profound question. But the problem is that we lack the perspective from which to criticise that answer, because we don’t know what a good answer to any such question would look like. Because we don’t know what a good answer to the question would be, we lack a perspective from which to criticise what we instinctively feel is a bad one. That is why I think that this is a genuinely profound piece of philosophy.

What is a person?

Now let us return to our question, the value of life, by doing a little thought experiment. Consider this question: are there persons on other planets? We don’t know the answer to this question definitely, but - unlike the hyper-intelligent pan-dimensional beings in Douglas Adams’ book - we know what we are looking for. We are not looking for animals on other planets, or plants, or bacteria, or just any old life form. We are looking for a particular type of life form – a particularly morally important, valuable type of life form.

Unless we lack imagination totally, we don’t expect it to be human necessarily, but we know roughly what it would have to be like to qualify as a person. Science fiction – and more than science fiction, religion – is teeming with non-human persons: gods, demi-gods, and so on. They are all examples of non-human persons.

Now suppose that, instead of us finding them, they turn out to have the superior technology and they find us. After a long exhausting journey they arrive tired and hungry – what would we say to them about ourselves? Remember that they have the superior technology. What could we say about ourselves that could (or should) convince them that they had found persons on other planets, rather than animals or plants or bacteria; and that given that their food supplies are running very short, it would be more appropriate to have us for lunch in the social sense rather than in the culinary sense?

I hope that we would have something to say, because our lives might depend on it. And of course that is precisely the issue. Just as in the issue of abortion, or the case of the hospital fire, creatures’ lives depend upon the answer to this question, so this is a very important question and we have to find the answer.

There is a long tradition of looking for such an answer in philosophy. The most eloquent answer was given by the great John Locke around 1690 in his essay concerning human understanding. He deliberately chose to use the term ‘person’ rather than ‘human’: he called it a forensic term, and wanted to say that he was not just trying to describe individuals like him. This is how Locke put the point:

We must consider what person stands for; which I think is a thinking intelligent being, that has reason and reflection, and can consider itself the same thinking thing, in different times and places; which it does only by that consciousness which is inseparable from thinking and seems to me essential to it; it being impossible for anyone to perceive without perceiving that he does perceive.

So what Locke suggests is a combination of consciousness and self-consciousness: self-awareness. Not just perception, which is simple awareness, but self-perception: self-awareness.

Self-awareness

There is one other way or arriving at an answer to the question of the value of life, and this involves another thought experiment. What makes life valuable to you? What makes life worth living? What makes it important to you to go on living? Write down the 20 things that make life worth living in rank order of importance!

The answers that you would give would interest me greatly and I hope might even appeal to my prurient interest, but they are not of theoretical interest – what is of theoretical interest is that you are the types of being for whom that is a meaningful question. You are the types of being who do have valuable lives, and who could compile such a list - if you got over the sense of embarrassment about the exercise.

So if you ask the question ‘what sorts of beings are valuable?’ my answer is: those sorts of beings that are capable of having valuable lives. That is to say, those sorts of beings that are capable of having lives that they themselves value, that they themselves want to continue. If you ask what sorts of creatures they are, you get John Locke’s answer: because in order to have a valuable life you have to know that you’ve got a life.

So to get a life, you have to know that you’ve got one, you have to be an independent centre of consciousness, existing over time, with enough intelligence to know that you’re such a being, and enough self-awareness to be able to take up an attitude, to form a view, about whether you want life to continue or not. So to be capable of valuing life is to have a view one way or the other as to whether you want it to continue. And to have such a view you have to know that you do have a life and that it might be possible for it to continue.

This is what it takes to be a valuable being. And on this account, the wrong done when you end the life of such a being, or fail to sustain it when you have the opportunity to do so, is the wrong of depriving that being of something that they don’t want to be deprived of – their life. This answer yields an account, not only of the value of life, but of the wrongness of ending life. It follows from this that it is not a wrong to the individual whose life is ended if it is ended when they are not capable of wanting it not to end, when they are not a person.

This provides an account of what persons are, which can be applied to persons on other planets, to human creatures, to dolphins and chimpanzees – and that can be applied to the developing human individual. This account enables you to draw distinctions between that individual and its mother, and between that individual and creatures like you and me. This same account enables us to make sense of conundrums at the other end of life, dealing for example with individuals in permanent vegetative state. Such cases would be impossible to decide without taking a view about the moral importance of the sort of lives concerned.

The ethics of the UK abortion law

One further point. Consider the present law, which allows for termination of pregnancy right up to term for serious fetal handicap. We know that disability of whatever sort does not affect the value of human life, and does not affect the value of the individual who is disabled. We also know that disability is not the sort of thing that could diminish, by one scruple, the value of a life.

So if it is legitimate to end the life of a disabled fetus or embryo, this has nothing to do with the fact that they have a disability. It has to do with the fact that they are not an individual of a moral status that allows their life to be protected whether they have a disability or not.

That is also why gestational age has nothing to do with the ethics of abortion. Fetal viability, the ability to survive independently of the mother, is not a moral consideration but a practical consideration. As it happens it is a consideration to which the law attaches importance, but it cannot conceivably explain why some individuals have protected lives and others do not. Many adult humans are not independent in the relevant sense, but are dependent on machines to keep them going. Independence, whether from a mother or from a piece of technology, does not plausibly carry with it moral status.

I see no indication that we have got the wrong policies on abortion in the United Kingdom, as they are broadly conceived. We permit abortions over the whole range of gestational age and I think that this accords with the moral considerations, which are that it is not possible to think that the developing human embryo or fetus has anything about it which relevantly distinguishes it, morally speaking, from other life forms that we don’t protect: except those characteristics which we have discredited already, its species membership and its potential. But for what it is, the fetus is not the sort of being that has a valuable life: at least on any argument that I have considered.

Now if you do not like my conclusion, fine. I am not an evangelist, and I don’t want to manoeuvre the law in any particular direction. I am democrat, and these things are not ultimately up to me or to you, but to society. But society must have reasons for what it does and I see no reason to tighten the abortion law that we currently have. It’s important to err on the safe side when there are cloudy issues, whether it’s about fetal pain or about fetal rights to life or the value of fetal life, but I am pretty confident that the safe side is development over the first three trimesters of human development.

If you disagree, answer this – what would justify, what would show the moral importance of the fetus, how would it relevantly differ from cats, canaries, chickens, and other life forms?

John Harris is Lord Alliance Professor of Bioethics at the University of Manchester; joint editor-in-chief of The Journal of Medical Ethics; and a member of the Human Genetics Commission. Professor Harris was speaking in the session ‘What makes life sacred?’, organised by BPAS at the Battle of Ideas, 30 October 2010.