Lost in the moral maze?

When does human life really begin? And how should it end? From stem-cell research to advances in medicine, the merciless march of technology creates a succession of moral dilemmas that earlier generations didn't have to face. How should we respond? Mary Warnock, Britain's leading philosopher, shows you the way
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The Independent Online

A guide to ethics might be thought to be a kind of handbook on how to behave properly, like a guide to etiquette, or the Highway Code. Useful though such a guide might be, it is not possible to write it. Ethics is a complicated matter. It is partly a matter of general principles, even rules, like those of manners; but largely a matter of judgement, of reasoning, of having the right feeling at the right time, and every time is different. Above all it is a matter of trying to be a particular sort of person. And though ethics (or moral philosophy, as I prefer to call it) has been secularised, it is almost impossible to think about the origins and development of morality itself without thinking about its interconnections with religion.

We must distinguish, though not absolutely, public from private morality. I have come to believe that the relation between private morality and a public policy that is democratically acceptable is a subtle and complicated interrelation. But we must try to get it right, otherwise we shall be dominated for ever by the ethics of the pub bore, who will say, "I think it's disgusting. There ought to be a law against it." The pub bore speaks intuitively. Even if he has good reasons for his judgement, he may not be able to articulate them (just as one may recognise someone from a distance, without necessarily being able to say what it was about him that made him so recognisable).

His conclusion, that the thing is wrong, may be sound. But he makes the false assumption that his judgement should, or could, be translated into a law which should govern everyone. When people become legislators or politicians, they assume new responsibilities. They have specifically to exercise reason and caution in attempting to foresee the consequences for everyone of the measures they are proposing. This is not to say that they can be wholly Machiavellian, putting on one side the sensibilities of morality for the sake of successful rule. But it is to suggest that there are a number of kinds of moral judgements that they are not entitled to make, judgements that a private person might make out of friendship, love, or a desire for self-sacrifice, or indeed out of shame or outrage. Moreover, they owe a duty to be able to explain why they have come to the conclusion they have.

They must be seen to have thought rationally; and in public circumstances this means to have thought about the long-term consequences of what it is they propose. They must be seen to be consistent in the stance they take, not only because they will probably advance their own careers if so perceived, but because steady, principled government is what is needed by society. So the interplay between the public and the private comes at the place where principles are to be articulated, and the consequences for society as a whole openly taken into account.

In the sphere of public morality it is not enough simply to say: "I feel I must" do this or that, except in the case where the public and private conflict. A public figure who resigns over a conscience issue is entitled to say, "I can do no other." But public morality as such must be explained, and explained with reference to a common good.

My own background is a small illustration of this. My mother, though not pious, had had a very pious background, in that her grandmother, a German, had married into another German family that had converted to Christianity from Judaism.

Religion was serious. My mother took church-going for granted, and having been a public schoolmaster's wife (my father died before I was born), she also took for granted not just Sunday attendance, but bells summoning one to chapel every day. The liturgy was something I grew up with, and cathedral services were a source of endless pleasure. I went to a very religious school, where it was assumed that the true purpose of school was to make us good. Its motto was Caritas Humilitas Sinceritas ("Charity, humility, sincerity"), and the adolescence of myself and my friends was engaged largely with the contemplation of the last of these virtues. We endlessly examined ourselves to find out whether we had really meant what we said or were only showing off; whether we really liked the things we professed to like, despised those things we claimed to, or whether these sentiments, too, were insincere. We may often have behaved badly, but we wanted to be good.

When does human life begin?

Questions about the ethics of infertility treatments entered my life abruptly, when, in 1982, I was asked to chair a Government Committee of Enquiry into Human Fertilisation and Embryology. The committee was set up as a result of increasing public awareness of (and unease about) the new techniques involved in assisted reproduction, following the birth in 1978 of the first "test-tube baby".

The techniques of in vitro fertilisation are now widely accepted as more or less routine (though the success rate is not enormously high, even today). However, at the beginning there were those who objected to the use of the techniques themselves as "unnatural"; but this argument is no more secure than any other argument based on the concept of the natural. So at least it seemed to the committee, and so it seems to me.

The abiding moral objection to the use of in vitro fertilisation, though, is its reliance on continued research using live human embryos. For if in vitro fertilisation is to be offered to infertile patients, its success rate has to be improved. This inevitably entails that human embryos must be used experimentally and then destroyed.

There is an enormous difficulty in discussing the ethical issues involved. There is a strong tendency for people on both sides of the debate to raise the question, "When does human life begin?" But it would be much clearer if people asked at what stage an embryo becomes morally significant; or at what stage we ought to treat an embryo as we treat other human beings. It would then be clear that no further scientific knowledge would settle the question. It is a matter of ethical decision. Of course the science of embryonic development had a bearing on the moral decision that had to be taken; no one can make a sound moral judgement without knowledge of the facts about which they are to judge. And a close scrutiny of the facts may seem almost necessarily to dictate a moral judgement.

Thus, in my own case, the very fact of the development of the primitive streak, the true emergence of one single individual, on however tiny a scale, seemed to dictate the judgement that one could treat the collection of cells before this stage differently from its treatment thereafter, and that, given the benefits that will come from research using these very early embryos, or pre-embryos, it was right that they should be used.

There were other ethical issues that had to be addressed by the committee of enquiry, such as the proper regulation of artificial insemination by donor, and the moral status of surrogacy, especially surrogacy organised as a business. But none, in my opinion, raised such fundamental moral questions as the issue of research using human embryos. For this was a matter of life and death; of the sanctity or expendability of human life.

There were, of course, those who were opposed to the use of human embryos for research, whatever the benefits. These people relied on an absolute doctrine, that no one must deliberately take a human life, at whatever stage of its development.

The central question, "What status should be accorded to the early embryo?" had to be settled by different means. And the only means available was the degree to which people felt that the early embryo was a child. A majority felt that the early embryo, before it had formed itself into a single individual and before it was capable of even rudimentary sensation or perception, was not sufficiently like a child to be accorded the status of one. Therefore research was permitted. Utilitarian considerations came in, insofar as the benefits to the infertile and to society at large were cited in justification of research. The consequences to the embryos were discounted.

What I learned from these arguments was that there is a difference between what is a generally agreed moral view (eg that children should not be used as subjects of research) and a morality which, though not agreed, is nevertheless broadly acceptable.

When I first came across the use of the word "acceptable" in this context, I thought of it as a typical civil service cop-out. They, the civil servants, did not want to use definite words that would commit them, like "right" and "wrong". But I came to see that I was confusing private with public morality. In public issues where there is a radical difference of moral opinion (as between those who think the early embryo should have the same moral status as a child and those who do not), and where no compromise is possible, the concept of the acceptable is a useful and indeed indispensable one.

The right to have rights

A right is something you claim, and which you can prevent others from infringing. It is an area of freedom for an individual that someone else must allow him to exercise, as a matter of justice.

It is sometimes held that rights may be engendered not by any law, but by a person's absolute need, the satisfaction of which constitutes not merely something he desires, but something to which he is entitled. It is certainly true that there is a connection between a perceived need and a right.

But in fact the concept of a need is slippery. For example, even at the very beginning of the Welfare State, with the Beveridge Report, William Beveridge recognised that the welfare ideal, for the state to meet the basic needs of everyone equally, would change over time, and would eventually escalate so that it could hardly be afforded (though I doubt whether he foresaw that it would come so soon). What counts as an absolute need is relative to what is seen to be an intolerable way to live if the need is not met. And to make a judgement as to what is intolerable is, in my view, a moral one. So even if needs do generate rights, the idea of the morally good and the morally bad precede these rights.

Death

Euthanasia is a topic that poses specifically moral dilemmas, dilemmas which, these days, it is a recognised part of moral philosophy to discuss. This story illustrates the interrelation between public and private ethics.

There is a woman whose life cannot last for more than three months. She is in great distress, because her illness progressively affects her ability to breathe.

She is too weak to be able to move, and she is dependent on her husband and nurses. The consultant whom she used to see at an earlier stage of her illness has indicated that there is no more treatment he can give, but calls on them frequently and has become a friend. She is terrified of dying of suffocation. One day they are talking about it, the three of them together, and the doctor says to her, "You shall not die by suffocating. I promise." She is relieved, and sleeps well that night, suffering no nightmares. The next day the doctor privately tells her husband that he is gradually increasing the dosage of morphia. Both the doctor and the husband know what is implied. Within weeks, the woman has died.

This story poses an ethical problem. Ought the doctor to have intervened as he did? Or ought he to have "allowed nature to take its course"? The woman is "naturally" ill; she has not suffered an accident, she has not been linked up to any life-support machines. Everything possible has been done for her. Her disease was slowed down by drugs. This means that there has already been intervention of a kind that would not have been possible even 25 years ago. If nature had really been allowed to take its course, she would have been dead long ago. The difference is that this was intervention with the aim of prolonging her life, and so is taken for granted.

It is worth noticing how evanescent our concept of the "natural" is. Those who, for example, object to the idea of curing genetic diseases by gene manipulation on the grounds that it is "unnatural", should perhaps, on the same grounds, object to curing appendicitis by means of surgery. We tend to regard as "natural" those medical interventions to which we are accustomed, and which are often successful. Nothing could be less "natural" than a plastic hip joint, yet hip-replacement surgery is seldom objected to on the grounds that it is contrary to nature.

The next crucial factor is that the woman and her husband love each other, and can therefore discern where each other's interests lie. The wifeis distressed by the constrictions placed on her husband's freedom through her dependence on him. He is moved by his love for her. Yet there is an asymmetry between them. She, quite without hesitation, can say that she wants to die. He feels instant guilt at harbouring the thought that he wants her to die, even though he believes it would be in her own interest. Each day for her is more horrible than the last. Yet he believes that, if it becomes his wish, it must be selfish. If he wants her to die this must be because it is in his own interest that she should. And we are taught, from childhood, that we should never wish someone else dead.

There is another element to which husband and wife may give different weight. The wife, let us say, always placed a high value on independence. She now finds that, though she wants to die, she cannot see how to. Suicide would seem a proper choice; but she cannot do it. Nor can she ask her husband to help her, because this would be to make him commit a crime. Imminent death produces a kind of paralysis. And death is so final, and so infinitely significant for the dying person, that to choose it for oneself may seem somehow to trivialise it.

The doctor understands all of this. He understands the husband's guilt and his agony at witnessing his wife's distress. He understands, equally, the wife's horror at her inability to breathe.

He regards it as his duty as her doctor to make her death as easy as he can, hence his promise. However, he also knows that even voluntary euthanasia, where the patient has expressed a wish to die, is against the law, and that intentionally killing someone is murder and punishable by mandatory life imprisonment (no one who has been convicted of a mercy killing over the last decade has served less than six years of his sentence). And here the doctor, in weighing up all the considerations, is moving from the consideration of private to public morality.

I must first make clear what I mean by "private morality". I do not mean a morality consciously made up by someone for his own use, principles adopted by someone who says, "This is how I ought to live; it is my own plan, and it applies to no one else." Such a set of principles might, I suppose, be adopted (rather as a nun takes her vows) but it must be rare. And if the principles were really supposed to have no relevance to anyone else, then it is doubtful whether it would be properly thought of as a morality.

When I speak of private morality, I mean a morality grounded in a mixture of principle and sentiment, from whatever source these come, which together give rise to an imperative for the person who experiences the mixture. It may be quite narrow. It may be felt, for example, in determining how one must treat one's children and may not in any sense suggest a scheme of how one should live one's entire life. It is the outcome of what in the 18th century was called "moral sense", and it is frequently felt as sympathy, compassion or pity. The characteristic of "private morality" is that it rests on a feeling that I must do, or refrain from doing, something, never mind the consequences, or what prudence might dictate.

Besides his sympathy with his patient, and his interpretation of his moral duty as a doctor, the doctor was also bound to consider the status of euthanasia under the law. And this is to change the question from one of private to one of public ethics.

For the law has to govern the behaviour of everyone, and distinguish what is permissible from what is criminal. The law cannot take account of feelings, or motive (though sentencing should be able to do so). The law is concerned only with intention.

Was there guilty intent? The woman and her husband also had to consider these public issues. The woman did not want to implicate either her husband or her doctor in criminal activity. But I shall concentrate on the doctor. For it is part of his professionalism that he understand the law in the matter of euthanasia, that he act within it, or, if he believed it right to do so, campaign for it to be changed.

The way such doctors let themselves off the hook when challenged is through the argument from "double effect", an argument that has now been recognised as a way of distinguishing legitimate from illegitimate termination of life, both by the Vatican's Declaration on Euthanasia, and by the British Medical Association's ethical guidelines on the same subject. The argument turns on a distinction between foreseeing an outcome and intending it. So a doctor may claim that, in increasing a dose of morphia, he intended to ease the suffering of his patient, although he also foresaw that this would shorten her life. Her death would then be an "unintended consequence" of the dosage. And this is different, so the argument runs, from the doctor's quite deliberately administering a fatal injection, or even increasing the normal dosage gradually, with the express intention of causing the death of the patient.

I am thankful that it has become generally recognised, even by such hardliners as the Vatican Council, that the argument from double effect will be accepted, and that doctors who deploy it will feel safe from prosecution. That does not prevent my regarding it as a very dubious argument, and one that turns the attention away from the real point. Moreover it has a fake exactitude. It pretends that we can and do know exactly where one intention ends and another begins.

However there are those, both among the general public and doctors, who do not regard the outcome in our story as benign. They may hold on religious grounds that it is not for the doctor or anyone else to shorten someone's life. Or, without appeal to any specific religious dogma, they may appeal to the principle that deliberately to kill someone, or to take action that will result in their death, is always wrong; and that this is the moral point of the criminal law in respect of murder.

Whatever the quality of her life, and whether she has a short or a long time to live, it is simply wrong, in our story, that the woman should take her own life, or have it taken for her, or have anyone permit that it be taken.

The benefits of an 'ethical' education

Because such values as as love, commitment, honesty, pleasure, friendship and loyalty are permanent, children can begin to understand that there are things that areworth doing, and other things of which one must be ashamed. School is a place where a child can practise doing what is good, and can come to prefer it to doing what is bad. And moral values are not the only values where, as a child learns to distinguish good from bad, he acquires a source of permanent significance in his life; he begins to be able to set himself new goals, and discover a point in doing things well rather than badly. Thus to teach a child the difference between a shoddy and a creditable performance, as an actor, a singer or an instrumentalist, is to introduce him to values that are, like ethical values, superficially changing but fundamentally timeless.

When educationalists talk of the need for "moral and spiritual education", I hope that this is what they mean. There is sometimes an outcry that "spiritual" must mean religious, and children, unless their parents specifically choose this, should not be taught the dogmas of religion. I would argue that religion is one expression of the "spiritual" that people may find of great significance, and perhaps indispensable. For the stories taught in religion contain ideas that may seem to lose their point if stripped from their religious context.

In truth, any teaching is "spiritual" that opens a child's eyes to the position he as a human being occupies in the universe. A lesson in palaeontology, biology or chemistry may be spiritual, insofar as the pupil may learn where he stands in the world, and what his responsibilities are.

A good school, then, will produce ambitious pupils who want to go on with what they have started. Whatever they do, they will want to do it well. As they more clearly see the implications of being human, they will want to be good specimens of humanity. Without this private want, they cannot be relied on to try for the ethically best in the public sphere.

The morality that lies behind all efforts to improve things in the world, to defend human rights, to pass generally acceptable laws, to seek peace and justice, is essentially that of private standard-setting, and of private ideals to be pursued. And this is why children from the earliest age, and in the most trivial and unheroic contexts, must learn that, being human, they are subject to temptation, and being human, they can, if they want to, triumph.

This is an edited extract from An Intelligent Person's Guide to Modern Ethics by Mary Warnock (Duckworth, £8.99). To order your copy call Independent Books Direct on 08700 798 897

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