Over a quarter century ago, Richard John Neuhaus coined the phrase “the naked public square” to describe efforts to drive religiously influenced values and their adherents out of public life and policy making. Neuhaus foresaw the intolerance of the “tolerant” hanging out a “practicing Christians/Jews please check your values here” sign. He also rightly pointed out that a naked public square was inherently undemocratic, disenfranchising the vast majority of Americans who did not voluntarily submit to a values tracheotomy, while leaving an ever-shrinking “society” of a minority to pretend that its little echo chamber was the “public consensus.”
Neuhaus looked at the big picture. I think we also need to examine what is occurring in sub-societies. I’m concerned about the “naked public ward” at the local hospital.
In the Journal of Medical Ethics blog of February 26, Brian Earp asks “Does religion deserve a place in secular medicine?” There are lots of people whose answer would be: “no!”
With all due respect, I’d rather ask what gives one school of “medical ethics” the right to decide?
Bioethics is, after all, a relatively recent phenomenon. It came to be more and more prominent starting in the 1970s.
Which is not to say that there were no bioethical dilemmas earlier. Catholic moral theology had a long history of a subfield called “medical ethics,” in which lots of ink had been spilled by the time bioethics began to come into its own. Nor should anyone be surprised: hospitals after all were—like universities—Catholic inventions.
But Catholic medical ethics was not especially supportive of the brave new world into which some researchers and their bioethicist friends were prepared to lead us. The bioethics issues of the 1960s—can you have sex without babies?—turned into the conundrum of the 1970s, represented by Dolly the Sheep and Elizabeth Brown—can you have babies without sex? In the middle of this arrived Roe et al. v. Wade with its highly unscientific nostrums feigning agnosticism about when life begins. Once death ceased being the physician’s enemy and a consumer’s choice, euthanasia also began garnering attention.
For those unwilling to be restrained by a medical ethics rooted in objective moral goods deserving of respect independently of the agent’s will, a new “bioethics” clearly was needed. Adopting either a version of (i) consequentialism or utilitarianism; (ii) a voluntaristic notion of “autonomy”; or (iii) some Kantian principles that could constrain only those not creative enough to circumvent them, a thriving industry was thus born which has since felled at least a minor rain forest.
The point is: bioethics in no small measure sought to displace religiously rooted medical ethics and, given the philosophical schools it preferred, in practice introduced the ethos of a “naked public square” into medicine (all the while acting like a secular priesthood vested in lab coats, repeating its own dogmas, chief of which is a wholly voluntaristic “autonomy”).
At first, on a theoretical level, these shifts may have had limited meta-impact. They had impact on particular patients, e.g., those hatched or dispatched by practitioners of the new art, but they had still not yet colored the overall atmosphere of the medical profession.
That is increasingly not true.
Back in 1988, I wrote an essay in America, “A Dilemma for Institutions with Consciences.” It was a reaction to a New Jersey Supreme Court death case (that Court was on the “leading edge” of “death with dignity” jurisprudence) in which a facility that objected to a particular course of non-treatment—one which would result in the patient’s death—was nevertheless forced to lend itself to the death process. I already asked back then whether an institution could have a conscience on which it could act. The writing was on the wall.
Obamacare is blamed in some quarters for the erosion of institutional conscience rights and it shares no small blame for that process. But, truth be told, the process really commenced in the 1980s when, amongst the misbegotten progeny of that metastasized judicial cancer called Roe v. Wade, numerous courts already decided that hospitals had to open their doors to abortions. One of the reasons why abortion clinics proliferated—and why their advocates so strenuously defend them against rational medical regulation—is that much of the medical profession did not want to be associated with the abortionist.
But, in much of life, the least commonly tolerated practice often aspires to become the normative lodestone. The refusal of so many physicians to sully their hands with the “right” that usually won’t speak its name resulted in various professional groups trying to force mandatory abortion training on medical schools (institutional conscience again) and students (individual conscience). There are already examples internationally of doctors refusing to perform abortions losing their positions. In the brave new world, you cannot not get involved: if you don’t perform an abortion because you honestly (and correctly) see this as killing, you will be professionally forced to send your patients—mother and child—to someone who will kill. Now, in the wake of the February 6 Supreme Court of Canada decision establishing a right to “physician-assisted death,” the professional group of Ontario physicians seems poised to compel doctors to perform—or refer—the killing of the aged, ill, or incapacitated.
All in the name of a voluntaristic “autonomy” that collapses all medical standards (especially in OB-GYN) into “what the patient-consumer wants is what the ‘responsible’ physician should provide.” And don’t try to go AWOL….
In the name of ethical pluralism while chafing at the limits of Catholic medical ethics, secular “bioethics” introduced its own axiological standards. Now, feeling more its oats, some of its practitioners appear quite ready to introduce an ethical monopoly: theirs. And they then ask whether “religion deserve[s] a place” in medicine.
Witold Stawrowski, the contemporary Polish philosopher, rightly calls the bluff on this axiological sleight-of-hand. Secularism, like religion, claims its absolutes, its worldview, and its control. Secularism, in other words, is just as much a religion as the confessions it seeks to exorcise. So why does it “deserve” a place—indeed, a privileged, controlling place—in medicine?
Editor’s note: The image above is a scene from the iconic 1931 horror film “Frankenstein” starring Boris Karloff as Frankenstein’s monster.