Of Dominoes, Slippery Slopes, Thin Edges of Wedges, and Camels' Noses in Tents: Pitfalls in Christian Ethical Consistency
Department of Materials Science & Engineering
Stanford University Stanford, CA 94305
From: PSCF 42 (September 1990) 162-172
It has become almost commonplace for many Christian advocates to adopt general ethical positions that rule out consideration of degrees of significance or exceptions to a universal rule. Any departure from such a universal rule is immediately decried as setting the dominoes to falling so that if the first exception or special consideration is made, nothing can prevent the ultimate collapse of all ethical considerations; carelessly sliding down the slippery slope" from initial inconsistency to ethical chaos; or opening the door to ethical excesses by letting the thin edge of the wedge" or the camel's nose" make its first entrance. While upholding in every way the basic biblical concern for the value of human beings and human life, this paper challenges these images and suggests that greater faithfulness to our calling as God's stewards and servants follows from a view that is less dominated by a legalistic, one-sided view of the dangers, and more informed by the reality of expressing the compassion of Christ in this fallen world. Many Christian discussions of bioethical topics adopt a view in which warnings are made against the "domino" effect of deviating from rigid regulations, or against the "slippery slope" down which we are doomed to slide if we so deviate, or against the "thin edge of the wedge" or the "camel's nose in the tent" that will threaten our society once it is allowed to enter. There is a proper area within which to express such concerns, but it does not cover every aspect of the subjects to be considered. They are often dominated by a one-sided view of all the dangers involved in a real situation. It is the purpose of this paper to warn against the simplicity of these approaches, to argue against their universal appropriateness, and to suggest that the responsible course of Christian action in these issues is, as usual, far more complex than they allow. Informed Christians do indeed express awareness of the pitfalls of this kind of approach. Sider, for example, is aware of the problems:
To be sure, slippery-slope arguments are treacherous. We dare not reject something good merely because it might theoretically encourage or lead to some danger or abuse.1
The use of such arguments is usually triggered by certain basic assumptions about why departures from a rigid approach may in special circumstances be advocated. It is commonly assumed that any deviation is based upon a non-Christian attitude, denying the value of the individual involved. Such an attitude, for example, is expressed by Grant in connection with the specific subject of euthanasia:
The current meaning of the word (euthanasia) is "deliberate intervention to bring about the death of another human being," usually because the life of that person is judged valueless.2
Such semantic choices make a discussion of bioethical issues as difficult as the definition of "evolution" as "atheistic chance" does for a discussion of creation and evolution, or as the definition of "abortion" as "the murder of babies" does for a discussion of abortion issues. What is troubling about such semantic choices is that they are often made by distinguished Christian thinkers whose overall assessment of ethical issues is extremely helpful and influential.
The source of the conflict is the tension between compassionate action on the one hand, action motivated by and carried out through a dedication to Jesus Christ, and the non-Christian and even immoral excesses that such actions can lead to if left in the hands of the secular and fallen world.3 Christian writers appear to be often reacting only to the latter of these two positions. Insofar as the danger of such excesses is often very real, their warnings are well taken and deserve to be constantly heard. But it is the argument of this paper that the desire to counteract this excessive danger must not be allowed to dominate our viewpoint so completely that we are no longer able to see the actual situation and the diversity of compassionate and realistic solutions that we are called upon to advocate as responsible Christians.
It is the intention of this paper to emphasize the following points:
In order to be responsible stewards of the world and the situations in which God places us, we must be aware of these distinctions and the alternatives implicit in them. To make no distinctions between potential, actual, and former persons; to ignore differences between biological and personal life; to pay no attention to the limits imposed on responsible action by the reality of the situations; or to exclude actions of compassion within a context that still preserves justice, are not examples of combatting dominoes, slippery slopes, thin edges of wedges, or camels' noses in tents. Rather they are examples of failure to be responsible stewards for God in the real world He has created but which today suffers from the effects of sin.
We must remain aware, on the other hand, that if we advocate exceptions for extreme circumstances, we must be no less diligent in guarding against misinterpretation of the motives for what is being advanced, and against the abuse of such suggestions that would almost certainly follow in many cases if the exception became the rule.
Pitfalls of Legalism
In almost every challenging ethical decision, traditionalists are likely to find some form of legalism extremely attractive. This is because legalism appears to be "safer" than leaving choices less rigorously limited. Legalism assumes that life is intrinsically simple and that the Christian walk can be simply defined by excluding choices that are assumed in every way and at every time to be impermissible.
In developing a legalistic approach to life's problems, those in authority do their best to codify the guidelines of the Bible into an essentially timeless set of direct "do's" and "don'ts," which then become the direct tests of faithfulness to Christ. An individual Christian is called upon not to evaluate a specific situation in the light of his relationship with Christ, the inputs and insights of fellow Christians in the Body of Christ, and its own special requirements, but simply to be obedient to the required list of positive and negative prescriptions. Legalistic fidelity is the most important test of faithfulness to Christ. If we take this course, then any departure looks like a falling domino, a slide down the slippery slope, a wedge inserting its thin edge, or a camel pushing his nose into the tent.
A mature Christian does
not act without awareness of the law,
but acts in such a way that the fullness of the intent of the law may be fulfilled.
The alternative to legalism is Spirit-guided "maturity" (Galatians 3:23-25). Christians are called upon to follow Christ in all of their lives, seeking to allow Him to live out His purpose and will through them. Christians are strengthened in the teachings and life of Christ and informed with the outlook and perspectives of the Bible. Then they are sent forth to walk a life of faith in fellowship with Christ, seeking to understand what it means in a variety of cases, many not specifically covered by the biblical text, to put those teachings and perspective into practice. To speak of a "mature" Christian is to speak of one who has the knowledge, the faith, and the relationship with Christ that makes this kind of action possible.
A mature Christian does not act without awareness of the law, but acts in such a way that the fullness of the intent of the law may be fulfilled (Matthew 5:17). Jesus provides a number of examples of such maturity in the Sermon on the Mount (Matthew 5-7) and throughout His life (e.g, Matthew 12:10-13, 23:23; Mark 2:23-27, 7:9-13; John 9:16).
The Importance of Definitions
Any appropriate standard of mature human conduct must be expressed in words and concepts that are defined in terms that conform to created reality. The limitations of a simplistic (usually legalistic) view are aggravated severely when Christians approach difficult ethical issues with faulty definitions.
A cherished biblical concept is expressed by "the sanctity of human life." Christians derive their attitude toward the sanctity of human life from the biblical teaching on the creation of man and woman in God's image, the love of God for human beings, and His concern that human practices reflect this love and esteem. We can derive powerful general guidelines from this teaching, but if we ask for specific biblical teaching on many of the ethical issues facing us, we find that instances of such teaching are few and relatively ambiguous.
What does "the sanctity of human life" mean? Does "the sanctity of human life" mean that we should try to produce as much "human life" as possible? Clearly not, otherwise Christians would have as many children as possible. Any attempt to limit procreation, even if only by abstinence, is a limitation on the expression of "human life." Mature responsibility, in a genuine appreciation for "the sanctity of human life," requires us to limit the amount of human life in existence.
"The sanctity of human life" concerns primarily our attitudes toward already living individuals with the capability of expressing human qualities. We must carefully distinguish between "human life" as the biological properties of living humans, and "human life" as the expression of humanity that flows from the development of such biological properties in the "normal" course of time.
If we ask for specific
biblical teaching on many of the ethical issues facing us,
we find that instances of such teaching are few and relatively ambiguous.
We value "biological life" because it is so closely related to human potentialities, and we treat it with respect. It is because of human potentialities that we are concerned for "the sanctity of human life," and not for the mere existence of "biological human life."
When the Bible speaks of "psuche," it speaks of the "self," that central aspect of the human to which we normally give the term "personhood." Personhood is the expression of all of the human qualities beyond those of the purely biological. It is the existence of personhood with which the "sanctity of human life" is primarily concerned.
Personhood is not expressed without the biological basis for human life, but neither does it exist automatically simply because biological human life is present. It is a central property of a mature human individual. It comes into being gradually with the passage of time during the biological development of the individual, and it ceases to exist when the biological functioning is no longer appropriate to sustain it. For its expression, it depends upon a degree of biological development that is consistent with it.
Personhood is not
expressed without the biological basis for human life,
but neither does it exist automatically simply because biological human life is present.
We cannot speak meaningfully of a creature "thinking" before a working brain has been formed, of having emotions before a central nervous system has come into being, or of making responsible choices before the neocortex (that part of the cerebral cortex peculiar to mammals and human beings that is responsible for the higher mental functions) is active. Nor can we speak meaningfully of the existence and sanctity of personhood in an individual for whom all brain activity has irreversibly ceased, regardless of the continuation of other biological life processes.
Now the usual warnings against dominoes, slippery slopes, thin edges of
wedges, and camel's noses frequently ignore all of these distinctions. They
commonly speak as though all human life were personal human life, as though the
nature of the human life of an individual did not have significant differences
with time as the related biological structures develop, and as though efforts to
delineate distinctions between non-personal and personal were totally misguided.
Biological Development and Decay as Process
For a more appropriate assessment of ethical issues involving human beings it is essential to realize that pregnancy-to-birth-and-beyond is a process and that dying-death is a process. Legalistic thinking tends to assume independent and discrete events; mature responsibility requires that we recognize the role of process in the created world.
Understanding the nature of the process that leads from a fertilized ovum to a responsible human person is essential for an evaluation of ethical issues. At every stage of biological growth and development, new properties come into being for the developing fetus. There are significant beginnings at every stage of development through the entire gestation period and extending beyond birth. No dramatic transformation of brain activity (of capability for expression of personhood) occurs even at birth. It is not until the tenth day after birth that the neocortex shows sign of change, and the neocortex does not begin to come into action until five weeks to seven months after birth.
Much confusion in many debates in which the terms "living," "human," and "person" are frequently used unthinkingly, could be avoided if we assessed their meaning with a little care and perception. Following are a few crucial suggestions.
(1) The sperm and the ovum that meet to form the fertilized ovum are themselves already alive. The moment of fertilization of the ovum marks the beginning of a new living entity. No confusion or uncertainty is involved. Debate about when life starts is unjustifiable. Similarly, there need be no confusion or uncertainty about when life ends. Life ends when the last biological process (e.g., growth of nails or hair) in a corpse ceases.
For a more appropriate
assessment of ethical issues involving human
beings it is essential to realize that pregnancy-to-birth-and-beyond
is a process and that dying-death is a process.
(2) Someone might suppose that at some time in the development that follows conception there might be a period when the fetus is not human, and then a later period when it is. The confusion here results from our ambiguity about the meaning of the term "human." Fundamentally "human" is a biological distinction: a creature is "human" if it has the genetic structures characteristic of "Homo sapiens" and it is not human if it does not. If we ask, "When does human life begin?" the answer is again perfectly clear and undebatable. Human life begins at conception. One second after conception the fertilized ovum is as "human" as any "one-second-old fertilized ovum" will ever be. Similarly the answer to the question of when human life ends can be clearly given: human life ends when life (as in (1) above) in a human being ceases.
(3) One of the difficulties is that when the questions, "When does human life begin?" or "When does human life end?" are asked, the asker may really have quite a different question in mind, namely, "When does human personhood begin (or end)?" These are two quite different questions: the discussion of human life is not the same as the discussion of human personhood. No recourse to the argument that the definition of "personhood" is too ambiguous to be useful can be used as a legalistic guide for ethical actions through the simplistic identification of "human life" with "living human person."
(4) The continuity of the biological process affords no simple transformation in basic properties at birth or death. Therefore, continuity of biological process affords no meaningful argument, to maintain the sanctity of life of a fetus immediately after birth, while denying the sanctity of life of a fetus immediately before birth.
When the questions, "When
does human life begin?" or
"When does human life end?" are asked, the asker may really
have quite a different question in mind, namely,
"When does human personhood begin (or end)?"
(5) At the same time, however, we must be careful to avoid the "fallacy of the continuum." This argues that since the infant clearly has a "right to life," and since there is a continuous process leading from the fertilized ovum to the infant, the newly fertilized ovum has the same" "right to life" as an infant. This approach neglects the complex process of development that takes place in time, which radically changes the properties of the unborn in the period between fertilization and birth. Although the fetus at birth is still only potentially" a "human person," it is orders of magnitude closer to that state than is a newly fertilized ovum.
The comparable argument at the end of life is that since the living human person has a "right to life," and there is a continuous process leading from the living human person to the human creature with biological life only, the human with biological life after the cessation of personal life has "the same" "right to life" as a living human person. After the cessation of personal life, the still living human is a "former" "human person." At both ends of human life, biological life exists without personal life.
At both ends of human life, biological life exists without personal life.
(6) Too much significance cannot be attributed to the fact that the fetus has various behavioral patterns that "look like" those of an infant, such as thumb sucking or eagerly swallowing amniotic fluid injected with sugar. An anencephalic (a fetus without a developing brain) which has "no chance" of developing into a person, will do the same. Similarly too much significance cannot be attributed to the fact that the human after the irreversible cessation of personal life still exhibits biological reactions to stimuli, or growth of nails or hair.
(7) The acceptance of organ transplants forces us to make a distinction between "biological life" and "personal life." In fact, the taking of an organ for transplant requires us to have determined that the "personal life" of the donor is ended, and that the "biological life" has not.
What then do we make of all these complex inputs in our effort to live out a responsible Christian life? We strive to respond maturely to the reality of the situation, while also keeping significant distinctions in mind. We recognize that many ethical dilemmas need a case-by-case evaluation, as has been argued and illustrated by Gardner,4 and cannot be settled once and for all by laying down rules without possibilities of nuance.
Since the "beginning" or "ending" of personal life is a continuous process that cannot be associated with a single discrete event or development, we start by ascribing a sense of profound value to every kind of human life, whether pre-personal, personal, or post-personal. Although "personal life" is the focus of biblical teaching on the value of human life, we ascribe unique value to human life before the full development of personal life, and to human life after the cessation of personal life, out of a sense of reverence for all human life, through what Wennberg has called the "overflow principle."5 Our sense of the sanctity of personal human life "overflows" to include non-personal (such as the anencephalic), pre-personal or post-personal forms of human life. We do not condone the ending of the pre-personal life of the fetus for reasons simply of human choice or convenience, nor do we condone the disrespectful treatment of post-personal human life or even of corpses themselves.
But at the same time we do not totally forget the real distinctions between
non-personal, pre-personal and post-personal when conflicts arise between
different stages of human life. All human life demands to be treated in a way
consistent with its value, but all human life does not demand to be treated in
the same way. It is in these difficult interactions that the working out of
Christian principles and ethics is put to the test.
Denigration of Life vs. Compassion for Life Another common pitfall in discussions of dominoes, slippery slopes, thin edges of wedges, and camels' noses in tents is the assumption of unworthy motives for those who advocate deviations from an inflexible ethical code. It is important to realize that such advocates-even if their recommendations should be judged ultimately unacceptable-often do not act at all from the unworthy motives ascribed to them.
The Example of Abortion
What are some of the unworthy motives ascribed to those who are willing to consider the possibility of abortion in suitable cases of exceptional need? They are said to consider the unborn to have no intrinsic value, but to be only a physical appendage of the mother's body, totally at her whim to nurture or destroy. They are said to be concerned only about getting rid of an unwanted problem, a potential burden, or an inconvenience that could have been responsibly avoided in the first place by abstinence or contraception. They are said to be concerned only with their own selfish convenience or pleasure, and to be unwilling to be bothered with the trouble associated with the completion of pregnancy. In the event that abortion is requested because of severe disease, malformation, or dysfunction of the unborn, they are charged with destroying human life because their own life might be troubled or inconvenienced by the care and love that would be required. In brief, they are said to be involved in the denigration of human life in order to preserve their own selfish desires.
In a not insignificant number of cases where abortion is considered, however, it is not a denigration of human life that is the motivating factor, but mature compassion for human life. The importance of the motive of compassion must be realized if we are to evaluate responsible Christian attitudes toward abortion and related issues. The following set of guidelines is proposed.
(1) The attempt to use a single term "abortion" for any act of terminating the life of a zygote, embryo, or fetus is consistently misleading. To suppose that ending the life of a 2-day-old fertilized ovum can meaningfully be called by the same name (with the same meaning) as ending the life of an 8-month-old fetus is to obscure the total issue. Mature Christian responsibility must recognize the significance of "process" in the development of the unborn.
(2) Because the unborn is both living and human, abortion is always a serious matter and a moral decision. The future of the unborn is not to be decided by the whim of any human being, even the mother.
In a not
insignificant number of cases where abortion is considered,
however, it is not a denigration of human life that is the motivating factor,
but mature compassion for human life.
(3) The unborn is involved in a process of becoming personal as its capability for personhood develops with its biological framework, a process that is not completed until well after birth. It is therefore appropriate to view early abortion as the ending of human life, but not as the ending of personal life. Compassion for existing personal human life in extreme cases (incest and rape, and the reduced responsibility of minors, the retarded, and the emotionally and psychologically disturbed) may lead us to allow the ending of the human life of the unborn at an early stage of development. Likewise, compassion for the unborn may lead us to end the development of the pre-personal unborn under circumstances in which continued development would almost certainly lead to severe suffering of a personal human life.
(4) In many cases (psychological problems of the parents, abnormality of the fetus, etc.) abortion can be viewed either as (a) a way to escape from the burdens of caring for a human life that God has given to a couple in order to test, strengthen, and then bless them; i.e., a way to escape selfless sacrifice, care for the defenseless, and redemptive suffering, instead of accepting these burdens in faith; or (b) a way to exercise human stewardship before God in such a way that the normal commitments to the reduction of human disease and suffering (both that of the developing unborn and that of the family in which the pregnancy has occurred) are extended to the area of terminating the life of the pre-personal unborn, before it develops to the state where personal suffering, limitation, and deprivation have meaning.
Mature compassion for all
personal human life leads to the recognition
that the simple forbidding of all abortions by no means guarantees a
major increase in social awareness and honoring of the value
of personal human life.
Few, if any, informed Christians would consider it morally objectionable to abort a fetus that has no prospect" for personal existence; nor should a person who has such an abortion be charged with prejudice against the handicapped. Most persons would take means to prevent conception of severely handicapped children if they could, and would not thereby be charged with prejudice against the handicapped. Also, rejecting the prospect" of having a handicapped child should not be identified with rejecting the handicapped child that one now" has. Clearly these are very complex issues that must be decided by each couple before God and their community of faith. Those who make the choice of (a) should receive every support and sustenance that their community can provide; those who make the choice of (b) also need that same support and sustenance. (5) Mature compassion for all personal human life leads to the recognition that the simple forbidding of all abortions by no means guarantees a major increase in social awareness and honoring of the value of personal human life. If abortions are forbidden, then babies are born. If the cancellation of the evils of uncontrolled abortion leads to similar or even greater evils of uncontrolled child neglect, abuse, abandonment, corruption, and suffering, then no major ethical advance has been made. It is clear that the route toward the highly desirable control and limitation of abortion must be coupled strongly both with intense efforts toward the voluntary use of contraceptive methods, and with intense efforts toward providing a framework for the care of poor, underprivileged, neglected, and unwanted children. In the event that either of these last two avenues is severely limited or unpracticed because of social mores, extremely careful and judicious thought must be taken before forbidding at least early abortions.
The summary of the case presented here is simply that opposition to the
forbidding of all abortion can arise just as persuasively from mature compassion
for personal human life flowing from a responsible Christian approach to life as
from a callous disregard of the value of the fetus. It does not help Christian
discussions of the issue to attribute only base motives to those who are willing
to contemplate an abortion exception without capitulating to fears of dominoes,
slippery slopes, thin edges of wedges, or camels' noses in tents.
The Example of Euthanasia
What are some of the unworthy motives ascribed to those who would consider taking a more or less active role in euthanasia, allowing or helping a human person to "die well"? They are charged with utilitarian motives that declare the ill or incapacitated person to be useless to society, and capable of serving only as a burden to society-hence to be done away with quickly and quietly to save the trouble of continued care and expense. Again, they are charged with the denigration of human life in order to preserve their own selfish desires.
Any informed discussion of the issues of euthanasia, of "dying well," must again recognize that attitudes toward euthanasia may be as often motivated by mature Christian compassion as by these kinds of unfeeling denigration of human value.
(1) The medical profession tends to find itself by practice and often by law pressed into a consideration of "only" biological factors. Given the technological possiblity of sustaining biological life, medical staff find few alternatives except to apply this technology to its fullest (as long as competition among several patients for its application is not a vital factor in the decision). As medical technology advances, the problem becomes more critical; we may approach the day when we are able, if we choose, to maintain biological life in a majority of cases well beyond the termination of personal life, or in situations where personal life will never be experienced. It becomes increasingly important for genuine regard and mature compasson for personal human life and the welfare of the whole person to safeguard against these trends.
Given the technological
possiblity of sustaining biological life,
medical staff find few alternatives except to apply this technology to its fullest.
(2) It is often mature Christian compassion and not denigration of the value of the individual that leads to efforts to help an individual to "die well" rather than to subject him to fruitless and usually depersonalizing efforts to maintain his life. So many of the techniques for prolonging life in the case of terminal illness have the effect of sustaining biological life, but of destroying personal life. Instead of being sustained in a friendly atmosphere surrounded by those whom the patient loves and cares for, the patient is isolated in a sterile hospital room separated from any personal contact except that of busy impersonal technicians, and is subjected to drugs and medical apparatus with its tubes, needles, catheters, etc. which reduce the patient to a biological mass incapable of dignity, self-expression or personal relationships. A misguided reverence for biological life that leads us to go to all lengths to preserve it actually involves us in an assault on a person. It is mature compassion and a keen awareness of the genuine value of the individual that leads us away from this course of action. A beautiful case story is told of the death of Francis Schaeffer by his wife Edith.6
(3) The process of helping a patient to die well by respecting his wishes and not necessarily invoking extraordinary measures to sustain biological life is often called "passive euthanasia." It is called "euthanasia" because specific measures are not used to prolong life; it is called "passive" because specific measures are not used to shorten life. Such a distinction overlooks the fact that when measures are not used to prolong life, this omission in itself is a measure to shorten life. Attempts therefore to always make a sharp demarcation between "passive" and "active" euthanasia may be inappropriate. The choice of a patient not to enter into treatment but into a pattern designed to help him die well, does not appear to have any major ethical difference with the choice of a patient to terminate treatment already begun. Certainly either choice made on behalf of a patient unable to make the choice for himself can reflect mature compassion and concern for the value of the dying person and not simply a desire to get rid of an unpleasant situation and a valueless individual.
It is the goal of Christians to contribute to the authentic "dying well" of those who are terminally ill and beyond the meaningful help of medical treatments. This goal involves attention to the stated desires of the person himself, and/or his loved ones in the event that the person has not expressed himself or is not able to express himself. It also involves expressing genuine care for the whole person, and not just for the maintenance of biological life. Christian involvement in the hospice movement is one example of a response to the situation characterized by mature compassion.
So many of the techniques
for prolonging life in the case of terminal illness
have the effect of sustaining biological life, but of destroying personal life.
Any participation in euthanasia by a Christian should be directed solely by compassion and concern for human persons, primarily for the person who is terminally ill and those affected by his life and death. Of course euthanasia in a Christian framework cannot be practiced against the wishes of the terminally ill person in order to make life easier or less expensive for the survivors. If it is to be practiced at all, then it is practiced on behalf of the person who is terminally ill. We help him to "die well" because we love him.
Suppose even that one were willing to admit that there might conceivably be
some exceptional and unusual cases where what might be construed as "active"
euthanasia might be lovingly and maturely carried out. It would still be true
that Christians should oppose the general legalization of active euthanasia, in
the expectation that the number of cases in which it would be misused and abused
would far exceed those few exceptional cases where it might be properly used.
But it leaves open the possibility that there might be a way to legally
constrain the exercise of the exceptional action that the needs of that
exceptional case and the needs of the usual case might both be met. It isn't
necessary to close one's eyes to the dangers of falling dominoes, slippery
slopes, thin edges of wedges, and camels' noses in tents to be willing to
foresee and provide for genuine exceptions authentically motivated by love and
Problems Generated by Increasing Scientific Ability
Some of the problems of the type discussed in this paper arise with increasing urgency today because of the striking advances made in our scientific ability to preserve at least biological life in circumstances where only a few years ago leaving the matter "in the hands of God" would have inevitably led to rapid and unquestioned death.7 It is at the cutting edge of these possibilities that the tension between a legalistic approach and an approach fulfilling mature Christian responsibility is most clearly realized.
If "the sanctity of human
life" is mistakenly taken to mean the sanctity of all
human biological life, there is no end to the ethical dilemmas that
we will shortly face.
This is one of the reasons that differentiation between non-personal biological life and personal life is so critical. If "the sanctity of human life" is mistakenly taken to mean the sanctity of all human biological life, there is no end to the ethical dilemmas that we will shortly face. We will be driven to expend vast amounts of effort and financial aid in increasingly more difficult cases of preserving and extending non-personal biological human life, an effort that will have the practical effect of depersonalizing our society and contributing to the loss of the authentic sanctity of personal human life. This is not the first time that unassailable human motives have contributed to socially destructive and painful consequences simply because of our finite knowledge, foresight and ability. The frighteningly large proportion of starving people in the world today, especially among children, is a direct, though obviously totally undesired, consequence of major medical successes in reducing deaths during pregnancy, childbirth, and early childhood. Similarly the growing problem of a larger proportion of physically and personally suffering elderly in our population is a direct consequence of major medical successes in extending the average lifespan by control and conquest of diseases and physical conditions that earlier took many of these lives and were accepted as "the will of God."
How do we continue to
provide the treatments of medical technology
when the funds to pay for them are not available from any source?
The assumption that the extension of every human life in every conceivable circumstance is always a positive goal for a society concerned with the lives of many human persons is a highly questionable one-at least unless we undertake major efforts to meet the new challenges to the sanctity of human life that often result.
Two major problem areas can be defined. First there is the question of whether we "should" do something simply because now we "can" do it. Simplistic yes or no answers fail rather badly unless we look fairly carefully at the actual situations being considered. We may well find that in some areas the pursuit of the possible may undermine the very values that we seek to uphold. An authentic desire to uphold the sanctity of personal human life, coupled with a real sense of compassion and responsibility for such personal human life, may lead us not to do some of the things that we may become able to do.
Second, we will certainly come up against the very practical question of the
expenses involved; as techniques become more sophisticated, their cost
increases-they cannot be extended to greater and greater numbers of patients
without limit. We may simply have to face the question head on: "How do we
continue to provide the treatments of medical technology when the funds to pay
for them are not available from any source?" At what point does the
concentration of resources on one highly visible and scientifically interesting
case justify the necessary withdrawal of support from a hundred other less
visible and less scientifically interesting cases?
Should We Do What We Can Do? As far as our technical ability is concerned, we could remove the processes involved in conception, fertilization and implantation further and further from the loving context of the family and into the safer and more efficient environment of the laboratory. Should we further such efforts?
By the application of new technology, we probably will have the ability to keep alive every fetus from the third month on-or perhaps even earlier-no matter how malformed, handicapped, dysfunctional, or lacking in ability to develop into a human person, and even though many will live for only a few years of severe suffering for themselves and their families. Should we further such efforts?
Sophisticated modern technology has the ability to maintain human biological
life even beyond the termination of personal life. Should this be the normal
course for everyone? It even appears possible to maintain biologically alive the
corpses of previous persons for years after personal death has occurred-and all
this for the benefit of humanity since such corpses could be used in a
cost-effective way for training medical students, testing drugs and surgical
procedures, medical experiments, as organ and blood banks, and as manufacturing
units for antibodies. Should this be a social priority? Gaylin expresses a
cogent reaction to such elevation of technology-even for the benefit of human
persons, "Sustaining life is an urgent argument for any measure, but not if that
measure destroys those very qualities that make life worth sustaining."8
How Much Can We Responsibly Afford?
When every human life has infinite worth, the extension of that human life is worth an infinite cost. Unfortunately, we cannot escape the ultimate conclusion that we cannot afford to pay an infinite cost, because we are only finite creatures. We are driven against our wills to consider the mundane matter of the cost of such technologies and the choice of a pattern of response that is both responsible and affordable.
Roberta Friedman describes one aspect of this problem. " 'We can keep a human life going for as long as we have to,' says Stanford intensive care nursery (ICN) coordinator Rose Ann Petersen, `But who is willing to pick up the price tag?'..."9 This article goes on to point out that the first week of ICN care often costs more than $12,000 a day. One family whose twins spent nine weeks in the hospital's ICN were billed $225,000. Often with minimum coverage by insurance, families face the need to sell off all of their assets or to enter into a lifetime of debt. But this is not the end. The cost of care after the baby is sent home continues at an astronomical rate. Petersen estimates that raising a baby with cerebral palsy to age 21 may cost $40,000 a year in hospital costs alone. Efforts to preserve life lead to the meeting of the initial astronomical expenses-but few are prepared for the costs needed to maintain that life in a meaningful way.
The message in this case is that premature birth should be avoided by major efforts at improved and increased prenatal care: "The cost that one pre-term infant generates could provide routine prenatal care for 25-30 women." These figures are startling in themselves. We do not need to be prophets, however, to realize that increasingly refined technology to do increasingly difficult jobs will have increasingly high price tags.
"We can keep a human life
going for as long as we have to,
but who is willing to pick up the price tag?"
Dr. Ernie W. D. Young also describes the problems we face with the increasing cost of higher technology health care:
The cost of rescuing very-low-birth-weight premature infants is approximately $50,000 per survivor, with total expenditures of $500,000 being common. Seldom are the parents asked to meet such staggering bills-these amounts are commonly paid by the state. In addition, there is no way of calculating the emotional cost to parents and siblings of providing lifetime care to a child who survives with major disabilities-yet these costs are real...At the other end of life, it is a well-established fact that the bulk of medical expenditures occur during the last year of life. The price of adult intensive care is substantial: the bed alone can cost $2,000 per day! To this amount must be added operating-room charges, physicians' fees, the cost of medications and incidentals.10
Young again emphasizes the present serious failure and the major need for the prevention of prematurity in the first place.
Concerning care for the elderly he points out the growing proportion of national spending on their care, so that in 1985, after a rapid expansion, 28% of all federal spending went to the 12% of the population that were over 65. Intensive care for the elderly may be something that our society simply cannot afford by early in the next century. By the very desire to lead responsible lives and make choices consistent with faithful stewardship of resources, we may be driven to the conclusion that we should do the best we can to alleviate the sufferings of the elderly within the context of upholding their choice, human dignity, and value, but that heroic attempts to solve a problem that has no genuine solution may well fall into the category of unethical.11,12
Ardent advocates against any departures from standards that attribute essentially infinite worth to every human life, see such departures as the beginning of falling dominoes, sliding down slippery slopes, letting in the thin edge of the wedge or the camel's nose into the tent, leading to inevitable degradation of society, denigration of human value, and loss of those aspects of human life that make it truly sacred. Insofar as they are right in these fears-and there is no question but that severe dangers exist-we would not hesitate to agree with them.
But their choice sees only one set of dangers and ignores the equally tragic results of being unwilling to meet more compassionately and realistically the authentic ethical issues being raised. They fail to see that the call for Christians to act in exceptional cases may be motivated by mature compassion and concern for the sanctity of life and the dignity of the human person, not by a sense of the valuelessness of life or a desire to abandon needy persons. Dominoes fall, slippery slopes slide, thin edges of wedges and noses of camels push in-in both directions. Once we make legalistic safety the ultimate test of all social actions, we make expressions of the mature compassion of Christ socially impossible.
Christians are called upon to exercise the creativity of love in this area as well as in others: to provide for the exceptions needed as expressions of mature Christian compassion and stewardship within the context of responsible living.
1Ronald J. Sider, Completely Pro-Life.
Downers Grove, IL: InterVarsity Press, 1987, pp. 39, 40.
2George Grant. Technology & Justice. Notre Dame, IN: University of Notre Dame Press, 1986, p. 104.
3This tension is analogous to the tension caused by the biblical teaching that we should overcome evil with good while we love our enemies, and at the same time that Christians should be defenders of the poor and helpless.
4R. F. R. Gardner. Abortion, the Personal Dilemma. Grand Rapids, MI: William B. Eerdmans, 1972.
5R. N. Wennberg. Life in the Balance: Exploring the Abortion Controversy. Grand Rapids, MI: William B. Eerdmans, 1985.
6E. Schaeffer, "Till Death Do Us Part," Christianity Today, 4:31, 1987, p. 20.
7R. H. Bube. "Crises of Conscience for Christians in Science." Perspectives on Science and Christian Faith 41, 1989, p. 11.
8W. Gaylin. "Harvesting the Dead," in Bioethics, T. A. Shannon, ed. Mahwah, NJ: Paulist Press, 1987, p. 553.
9R. Friedman. "Miracle Babies," The Stanford Magazine. Winter 1988, p. 47.
10E. W. D. Young. "Where is Health Care Heading? The Answers Can Be a Bit Unsettling," Physician's Notebook," Peninsula Times Tribune, December 27, 1988.
11D. Callahan. Setting Limits. New York, NY: Simon and Schuster, 1987.
12N. Daniels. Am I My Parents' Keeper?" New York, NY: Oxford University Press, 1988.