The Morality of Self-Injury

The Journal of Medical Ethics, a leading British bioethical journal, has done it again. Back in 2011, they offered us the barbaric thesis of Alberto Giubilini and Francesca Minerva defending infanticide: the two authors argued for “after-birth abortion,” claiming that the killing of a child post-birth would be justifiable if done under “circumstances … that would have justified abortion.” Well, the Journal is back with its latest contribution to barbarism: a defense of letting people who engage in self-injury (e.g., cutting or burning themselves) to do so, at least in some circumstances. Thanks to Wesley Smith for flagging this piece.

Let me say up front that I am aware that critics will reject my arguments because I have already branded the ideas “barbaric.” I agree with Princeton’s Robert George who, writing about the Giubilini-Minerva thesis, has properly insisted that the response to “madness” is not dispassionate engagement but calling a spade a spade. Killing newborns is madness, not an undiscovered form of abortion. It is the consummate example of Zbigniew Stawrowski’s “sleek barbarians,” dressed not in animal skins and fur capes but lab coats and Gucci suits, yet still advocating inhumane ideas. Does a scholar owe dispassionate consideration to and engagement with ideas that are, frankly, barbaric? Does that mean I am required to take seriously the notion that Josef Mengele and Sigmund Rascher are “scientists”?

The latest bioethical barbarism is an article by Patrick Sullivan of the University of Manchester’s School of Law. Sullivan argues that people who commit self-injury should, at least in some instances, be allowed to do so lest their “autonomy” be impaired. He claims that those who cut, scratch, burn, puncture, pierce, punch, carve, or hit themselves could be exercising “an autonomous decision” and, even if they weren’t, it would not indicate “a lack of capacity to participate in this type of therapeutic programme.” What is this therapy? Allowing the person to go on cutting, scratching, burning, puncturing, piercing, punching, carving, or hitting himself, provided they get “access to clean razors” and consultation with “staff … to help [them] … understand how to injure [themselves] … more safely.”

I did not make this up.

Most people would instinctively recognize that people who engage in self-mutilation are mentally ill. That people doing these things need to be stopped. That cutting, scratching, burning, puncturing, piercing, carving, and/or hitting yourself is objectively not good, regardless of how “normal” or even “relieved” you might feel. That aiding or abetting such self-destructive behavior does its victim no favor.

But most people have not studied theoretical bioethics. There (in contrast to Catholic medical ethics) objective standards of good and evil have long been banished, replaced by the golden idol of “autonomy.” In secular bioethics, the lodestones of ethical decision-making are either unfettered “autonomy” or bald consequentialism—what produces the “greatest good,” however the person framing the question wants to key up the desired answer. Secular bioethics generally has almost nothing to do with βιος, “life,” either feigning epistemological ignorance about that question, applying the Caiaphas Principle to calculate “greatest good” of who lives and dies, or pushing an autonomous “choice” to which life is subordinated.

Douglas Farrow rightly recognizes that modern “autonomy” has become the new name for an old evil, one stretching back to the apple tree in Eden: the idolatry of a self-sufficient pride that denies accountability to a Creator (and the real order of values he created) in the name of the “values” one mints himself, values which when scratched on the surface reveal some old staples of human failure. He’s worth quoting at length:

When Moses returns to the holy mountain with his people, they are warned first and foremost to make no idolatrous image. That commandment, together with the commandment against killing, is broken when we embrace suicide or euthanasia. Why? Because we claim that our lives are ours independently of God, that we possess them in such a way as to have the right to their disposal. We do likewise at the other end of life when we embrace contraception and abortion. We do in the middle, as it were, when we determine the right to determine our own “gender identity” or “marry” a same-sex partner. … The old gods, sex, mammon, and death, are reviving and reasserting themselves as the gods of autonomy (pp. 41, 42-43, emphasis original).

Adam and Eve claimed “autonomy.” So, ultimately, did Satan. The problem is that, despite their claims of “free to be you and me,” their freedom was and is circumscribed by a real world of real values, of good and evil whose rightness or wrongness did not and do not depend on the eye of the beholder.

That means that there are real, objective standards in the world, including the medical world. But the ascendance of an “autonomy” untethered from those standards means that medicine has become wish fulfillment. Surgical excision of objective values has turned at least some branches of medicine (such as gynecology) into consumer wish fulfillment. Thus, fertility is not a natural and normal aspect of a person but a “biological rhythm” whose value depends on its utility at a given moment. Pregnancy is not a natural and normal aspect of the average woman in her childbearing years; it’s good if she wants the baby, bad if she does not. Palliating pain versus positively killing is increasingly being treated as distinctions without differences. And now, cutting, slashing, or burning yourself might sometimes even be okay, provided you do it sterilely.

When I studied moral theology in the 1970s and 1980s, standard textbooks usually included some discussion of “mutilation.” It typically occurred in the context of sterilization because, unlike contraception, sterilization achieved infertility by cutting perfectly normal and healthy organs on request. Some textbooks added a discussion of “sex change surgery,” recognizing that there were some confused people who thought that by lopping off genitalia or doing some plastic reconstruction on the chest and crotch, one could turn a man into a woman or vice versa, the testimony of every cell in that person’s body notwithstanding. In Catholic moral theology, the discussion generally ended with the obvious conclusion that this was irrational activity, contrary to the reality and finalities of the sexual person and, to the degree that such actions were more comprehensive or pervasive, the more perverse.

There are those, of course, who would proclaim that society and even ethics has “moved on” and “evolved,” that the “objective good” of a person is what the person believes he autonomously wants. And so now, instead of offering the self-injuring restraint, we offer them clean razors and hydrogen peroxide while we pride ourselves on respecting their “autonomy” as we watch them slash themselves, all the while jettisoning the first principle of medical ethics, primum non nocere, “first, do no harm.” Because how can it be harmful? In a world with no objective medico-moral standards, we just defined harm away.

Jesus Christ was, therefore, a poor bioethicist. Mark 5:1-17 speaks of a man prone to cutting himself: the Gerasene demoniac. The Bible emphasizes his isolation. He wanders the tombs, places of death and decay that were unclean for Jews. The region itself is outside of Israel proper. He gashes himself with stones. He cries out in incoherent voices. Apparently, some of the locals had unsuccessfully attempted to “bind him … with a chain” to keep him from self-injury.

Jesus, believing the man was possessed, failed to recognize that the demoniac might still have “capacity to engage in therapy” if he relieved his stress using cleaner stones. Instead of guiding him on the path toward more antiseptic gashing, Jesus exorcised him. (And, to add insult to injury, he violated animal rights by driving the devil into pigs. Did they “autonomously” commit suicide by plunging off the hill? Reminds me of—I think it was David Hume—whose comment on this pericope was not to rejoice in the liberation of this Son of Abraham unto freedom, but to lament in the property damage to the swineherds.)

Of course, in our “evolved” society, if genital mutilation is justified in the name of “gender identity” (even for minors), how far a bridge is it to releasing stress via self-injury? And then why, as one commentator asked, if someone thinks he is really a paraplegic in an ambulatory body, shouldn’t we “celebrate” someone who packs his legs in dry ice to the extent that they have to be amputated?

In the Old Testament, self-mutilation was often associated with worship of Baals, the false Canaanite gods (see I Kings 18:28). The Baals were also associated with child sacrifice. They’re back, in the name of autonomy, of “choice,” killing our children and justifying self-injury. Unlike Elijah’s day, however, these false prophets are now peer-reviewed.