PS: But you really have to question human superiority What
justifies the things we do to animals? What justifies keeping a person in
a vegetative coma alive? There are two basic views that support cruelty
to animals: either you accept the Aristotelian view that the universe has
a purpose and the less rational are here to serve the more rational, or
you believe the Judeo-Christian view that God has given us dominion over
the world. But once you get away from those two worldviews, there just
isn't a basis for drawing a sharp moral boundary between us and
them.
PT: But you are still drawing a boundary Why draw one at all?
Aren't you still guilty of human arrogance in saying apes deserve human
rights, when other animals don't? Who are we to decide?
PS: That's absolutely true, and what we really have is an infinite
range of gradations of awareness. But if you are trying to shape policy,
you need to draw lines somewhere.
PT: Let's take a specific case. Research on chimpanzees led to the
hepatitis B vaccine, which has saved many human lives. Let's pretend it's
the moment before that research is to begin. Would you stop it?
PS: I'm not comfortable with any invasive research on chimps. I
would ask, Is there no other way? And I think there are other ways. I
would say, What about getting the consent of relatives of people in
vegetative states?
PT: That would cause a riot!
PS: Well, if you could really confidently determine that this
person will never recover consciousness, it's a lot better to use them
than a chimp. I agree, it doesn't go over well, and people throw up their
hands in shock and horror. But I'd like them to explain why it's better
to lock a fully-conscious, self-aware chimp in a seven-foot cage in
solitary confinement than to experiment with someone lying unconscious in
a hospital ward.
PT: How do your views differ from those of Aristotle, aside from
your use of the word "sentient" in place of the word "rational?" It still
seems you're placing humans right at the top of the so-called Great Chain
of Being, as the most sentient and self-aware creatures.
PS: But there's a huge difference. Aristotle attributed purpose to
the universe, and I don't. He was wrong to think that the universe is
constructed on some teleological principle.
PT: You deal in great depth with the issue of medical ethics and
people in vegetative comas in your book Rethinking Life and Death. You
point out that when we call people brain dead, we're arbitrarily marking
the moment of death because they're not literally dead.
PS: My point is that we shouldn't pretend breathing human beings
are dead when they're not.
PT: We should say they're alive but nonetheless their life is not
viable.
PS: Right. They're alive but that life is not worth living.
PT: Do you think we're avoiding a difficult moral dilemma by
calling them brain, dead, so that we can, for instance, feel it's
acceptable to harvest their organs for transplant?
PS: Yes. We have pushed them out of the category of the living,
because the living need to be protected and we can never kill an innocent
human being. But if we say they're really dead, we can feel comfortable
removing their hearts.
I think that fiction is starting to break down. The more accurate
description is that these are people whose cortexes have been destroyed
so they will never again have any consciousness. We can now detect signs
of brain activity in many of these people that we couldn't detect before.
So it's getting harder and harder to pretend they're simply dead.
PT: In your discussion of medical ethics, you suggest that doctors,
patients and their relatives should be free to make the decision to end a
life when it's no longer wanted, in particular by the patients
themselves, or if there is awful suffering. It seems to me that this
isn't actually that radical a view, that there's already a whole tacit
structure in place to allow people to do just that. It's actually
happening all the time.
A surgeon recently told me about the first time he saw this happen,
when he was a resident. A man was dying of liver cancer, and he could
have lingered in great pain for several more weeks. On ward rounds, the
consulting physician turned to the resident and told him to listen for
pneumonia. There wasn't any sign of pneumonia, and he said so, but the
physician told him to listen again closely. Then he understood what was
being asked of him, and he said yes, there might be pneumonia.
The doctors were then free to tell the man's wife, who was on the
board of the hospital and understood exactly what was really being said
to her, "Pneumonia can be very painful, and we would like to administer
high doses of morphine, but there is a high risk that he will die
quickly."
She had the opportunity to intervene if she wished, but was never
explicitly asked to decide that her husband should be killed--an almost
impossible burden.
PS: You're absolutely right, a lot of this goes on all the time and
it's kind of ironic that all this flak I get is really just for saying,
Hey, wait a minute, let's look at what we're doing and see if we can find
a coherent:: ethic for it.
PT: Why is it so hard for us to admit it? We. get into big trouble
when we're forced to take an overt ethical stand.
PS: One reason is we don't like to know that we're taking
responsibility for life-and-death decisions.
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