16 SEPTEMBER 1995, Page 20


Peter Singer, author of the entry on Ethics in

Encyclopaedia Britannica, applies his own brand of morality to abortion

IN HIS recent encyclical, Evangelium Vitae, Pope John Paul II proclaims that the widespread acceptance of abortion is a mortal threat to the traditional moral order. Although the views on abortion that I put forward in Rethinking Life and Death' are diametrically opposed to those of the Pope, I sometimes think that he and I at least share the virtue of seeing clearly what is at stake in the debate.

• If I accept that it is justifiable for a woman to kill her foettis in the womb because she considers her family com- plete, or would rather have a child at a time that would better suit her career plans, or because a prenatal test has shown that her child will have Down's syn drome, I know that I cannot continue to hold conventional views about the sanctity of human life at other times and in other states. Many others who accept abortion seem to do so without seeing any of the wider issues. That can only be the result of confused thinking, or perhaps the pressures of the political process. Why tackle a more formidable foe than the one that stands in the way of gaining your objective?

The confusion begins with language. Those who defend laws allowing women unrestricted access to abortion usually describe themselves as 'pro-choice'. Thus they sidestep the awkward question of whether the foetus has a right to life. But to present the issue of abortion as a ques- tion of individual choice (like sexual behaviour between consenting adults) is already to presuppose that the foetus does not really count. No one who thinks that a human foetus has the same right to life as any other human being could see the abor- tion issue as a matter of choice, any more than we could see child abuse as a matter of choice for the parents of the child.

Those against abortion also trade on a misnomer. Only the handful among them who refuse to kill animals in order to please their palates are truly 'pro-life'. Opponents of abortion might more honest- ly describe themselves as being 'pro- human-life', but even then they ought to oppose capital punishment, and perhaps killing in war too. Even 'pro-innocent- human-life' is not quite right, because you could save more innocent human lives by raising money for Oxfam than you can by "I'm not sure how I feel about these mega-churches." campaigning against abortion. What oppo- nents of abortion are really against is the intentional taking of an innocent human life. That sounds like a good thing to be against, but to take an absolute stance against it raises some unexpected prob- lems.

Thus both sides avoid the crucial ques- tion underlying the abortion debate: given that the foetus is a living being, and indis- putably a human being in the sense that it is a member of the species Homo sapiens, is it always wrong intentionally to take the life of an innocent member of our species? This question can be answered in a way that is both defensible and consistent with support for abortion, but not without reconsidering our conventional views about the wrongness of taking human life.

I was forced to think about the defini- tion of death some years ago, when I was invited to be a member of a panel at a con- ference held at Melbourne's leading chil- dren's hospital. The panel had been asked to consider the ethics of medical decision- making for two special categories of infant patients. The first category was anen- cephalics — that is, babies born essentially without a brain. Sometimes the top of the skull is missing, replaced by a mere flap of skin. In other cases, the skull is intact, but filled with fluid, so that if a torch is held to one side of the skull, its light can be seen through the other side. These babies have some brainstem function, and, if cared for, can live for months or, in rare cases, even years; but they can never become con- scious, and usually they are allowed to die within a few days of birth. The second cat- egory was 'cortically dead infants'. These babies have usually suffered a massive bleeding in the brain. Again, the brainstem survives, and the baby may be able to breathe unaided, but there is no prospect of consciousness. With good medical care, such babies could live for many years, per- haps even a normal life-span. Since they have working brainstems, nei- ther anencephalics nor 'cortically dead infants' are legally brain-dead. Should they be kept alive as long as possible? No one at the conference wanted that. Even 'pro- life' advocates urged that these babies should be 'allowed to die'. In doing so, they drew a tenuous distinction between withdrawing life-sustaining treatments, knowing that the babies would then die (which they said was ethical), and directly intending the babies' deaths (which they said was murder).

Dr Frank Shann, a specialist at the hos- pital, told a hushed audience of a time when in one bed he had a cortically dead baby from which treatment was going to be withdrawn, and in the next bed a baby with a defective heart. Had the cortically dead baby been legally brain-dead, he would have been able to transplant its heart to the baby with the heart defect, and at least one baby would have survived. Under our present definition of death, however, that would have been murder. Since no other infant heart was available, both babies died.

Where was the sense in this? Within the past 30 years we have moved from a defi- nition of death in terms of the cessation of heartbeat to one in terms of the death of the whole brain. But we can now keep people 'alive' for months after their brains have wholly ceased to function. What can be said in defence of the definition of death in terms of the death of the brain, other than the fact that it makes it easier to obtain organs for transplantation, and frees up hospital beds that would other- wise be occupied by people who will never recover consciousness? If the crucial fact is the certainty that the loss of conscious- ness is irreversible, then why should we not go a step further and define death in terms of the death of the cortex? It is the cortex, not the brainstem, that is associat- ed with consciousness, and with everything that makes a human being a person, rather than a mere vegetative existence.

The conference panel was asked to con- sider if it would be ethical to take organs from anencephalic and cortically dead infants, and whether we should change the definition of death to make this possible. We were deeply divided. Some, moved by the waste of life revealed in Dr Shann's presentation, supported a shift to a defini- tion of death in terms of the extinction of the cerebral cortex. Others thought that to take organs from these infants would be to use living humans as a means to an end. They also pointed out that to change the definition of death would be to declare `dead' human beings still capable of breath- ing unaided.

I sympathised with those members of the panel who thought it wrong that both of Dr Shann's patients should have had to die; but I shared the scepticism of the other members of the panel about changing our concept of death so as to turn a warm, breathing baby into a corpse. So I offered a third proposal: let us accept that cortically dead and anencephalic babies are living human beings, but acknowledge that because they can never be conscious their lives are of no benefit to them. We could then permit the removal of their organs (provided their parents consent) in order to preserve the lives of others who can ben- efit from continued life.

My proposal was supported by one or two other members of the panel, but most balked at the idea of judging that the con- tinued life of a human being was of no ben- efit to that human being, and therefore could be taken. Though I did not carry the day on that occasion, not long after Britain's law lords unanimously took an important step towards the position for which (unknown to them, of course) I had argued. In deciding the tragic case of Tony Bland, a teenager who had been in a per- sistent vegetative state since the Hillsbor- ough football stadium tragedy in 1989, their lordships held that because Bland would never recover consciousness his continued life was of no benefit to him, and his doctors could lawfully undertake a course of conduct intended to end it. Their lordships did not feel themselves able to authorise an explicit act that would end Bland's life, and therefore no doubt they would have rejected the idea that his vital organs might be removed while he was still alive; but Lord Browne-Wilkinson and Lord Mustill, at least, said that they saw no clear moral basis for the legal distinction between withdrawing life-sustaining treat- ment and actively ending life.

What does all this have to do with the issue of abortion? If we can now acknowl- edge that anencephalics, cortically dead infants and the irreversibly comatose are living human beings whose lives may inten- tionally be terminated, then we should be able to do the same with the human foe- tus. This means that we will at last proper- ly engage with the arguments of those opposed to abortion.

Yes, we can say, the foetus is a living human being, but that alone is not suffi- cient to show that it is wrong to end its life. After all, why — in the absence of reli- gious beliefs about being made in the image of God, or having an immortal soul — should mere membership of the species Homo sapiens be crucial to whether the life of a being may or may not be taken? Sure- ly what is important is the capacities or characteristics that a being has. It is doubt- ful if a foetus becomes conscious until quite late in pregnancy, well after the time at which abortions are usually performed; and even the presence of consciousness would only put a foetus at a level compara- ble to a rather simple non-human animal — not that of a dog, let alone a chim- panzee. If on the other hand it is self- awareness, rather than mere consciousness, that grounds a right to life, that does not arise in a human being until some time after birth.

Many, perhaps most, human societies have treated infanticide very differently from the killing of an older child or an adult. In accepting abortion, we are departing from the particular moral order that has dominated Christendom, but we are not departing from moral order as such. We are following all those societies, from ancient Greece to traditional Japan, and from the nomadic Kung of the Kala- hari to Pacific islanders, which selected who will be allowed to become a member of the community and who will not. Cur- rently, we make that decision before birth when we permit abortion, and we make it after birth when we withdraw or withhold life-sustaining treatment from severely dis- abled infants.

What response can those who oppose abortion make? While admitting that the actual capacities of a foetus are inferior to those of a dog, they can say that the foetus has the potential to far surpass a dog. This is true, but in a world that is already over- populated, and in which the regulation of fertility is universally accepted, the argu- ment that we should bring all potential people into existence is not persuasive.

More difficult to answer is the demand that those who believe a living human foe- tus can be killed should say at what point, and why, in the development from foetus to child killing becomes wrong. Why, for example, should the life of a premature baby born at 23 weeks' gestation be more The wreck of HMS Pretentious. worthy of protection than the life of a foetus at 24 weeks? One possible answer is that in the absence of any sudden change in the foetus or newborn infant itself birth is as good a place as any to draw a line that the law can uphold. But it would also be possi- ble, if less neat, to accept that just as the human being develops gradually in a physi- cal sense, so too does its moral significance gradually increase. We do not, as our treat- ment of disabled newborn infants shows, consider the newborn as full members of the community immediately on birth.

Perhaps, like the ancient Greeks, we should have a ceremony a month after birth, at which the infant is admitted to the community. Before that time, infants would not be recognised as having the same right to life as older people. Such a date would still be early enough to ensure that the rights of all those who are self-aware are fully protected, but it would be late enough to detect most cases of severe and irrepara- ble disability. There would be no pretence that any dramatic change had occurred in the nature of the infant at that time, but rather a recognition that this was a child who was loved and wanted by its parents or by others who would care for it. In doing this, we would be shedding the disguises that our lip-service to the sanctity-of-life ethic has led us to place around life and death decisions for human beings. Among these disguises are the idea that the brain- dead are 'really' dead, as if this were a mat- ter of science, rather than of ethics, and the fiction that in withdrawing treatment from disabled infants we are not intentionally bringing about death because we merely let nature take its course'.

I began this article by saying that Pope John Paul II was right to see the accep- tance of abortion as a threat to the moral order for which he stands. But as I argue more fully in Rethinking Life and Death, the moral order that the Pope defends is an empty shell, founded on a set of beliefs that most people have laid aside.

In the past 30 years, the idea that it is always wrong intentionally to take innocent human life has been overturned on several different fronts: abortion, experimentation on embryos, the definition of death, the withdrawal of food and fluids from irre- versibly comatose patients, the treatment of severely disabled newborn infants, and even, in some countries, assisted suicide and voluntary euthanasia.

It is time for a more open recognition of the fundamental change on which we have embarked. Without that, people on both sides of the debate will continue to argue past each other, and the ethical problems raised by our developing medical capabili- ties will prove irresolvable.

* Rethinking Life and Death is published next week by Oxford University Press (£7.99). Professor Peter Singer is also the author of Animal Liberation, often described as 'the Bible of the Animal Liberation movement'.