A Thirty-Year Perspective on Personhood: How Has the Debate Changed?

From Ethics and Medicine, 17:3 (2001): 177-186.

 

Introduction

The concept of personhood remains the central and enduring focus of any intelligent discussion of bioethical norms. Whether the perspective is secular or religious, couched in theological discourse or philosophical verbiage, any theory that wishes to show how man should behave must begin with what man is. Indeed, personhood “pops up” in the most unexpected places. Physicist John Polkinghorne claims that a grand, unified “Theory of Everything” must include and reconcile quantum mechanics, general relativity theory, and amazingly, the personhood of human beings:

Let us come straight to the point. A central question is the significance to be assigned to personhood in forming a credible and adequate account of reality. By a person I mean at least this: a self-conscious being, able to use the future tense in anticipation, hope and dread; able to perceive meaning and to assign value; able to respond to beauty and to the call of moral duty; able to love other persons, even to the point of self-sacrifice (Polkinghorne, 2000, p. 11) .

Thus, personhood is the “ground zero” of bioethical reflection. I have chosen the past thirty years as the basis of the following discussion, since during this period many changes have occurred in how personhood is viewed by society. To be more precise, the debate has been driven so much by the Supreme Court’s landmark Roe v. Wade decision in 1973, that we could readily talk about personhood “pre-Roe” and “post-Roe.”

This change in understanding has also been brought about by changes in the discipline itself. Bioethics began as an impulse of theological discourse, in an attempt to curb and control potential societal abuses of modern technology. In the mid-1960s, most bioethicists were religious thinkers and theologians. Currently, however, many members of hospital ethics committees are physicians and lawyers, and secular philosophers teach university bioethics courses.

This subtle shift has profound implications. The foundations were originally deontological in nature, the “should” of bioethics, whereas now the basis of most decisions is utilitarian, with an emphasis on outcomes. According to (Meilaender, 1995) , the entire discipline has lost its “soul.” Nowhere is this shift more evident than in the ongoing controversy over personhood.

This paper will review the concept of personhood and its relevance to bioethics. I begin with a historical overview of the traditional understanding of personhood in secular and religious thought. I will then examine some modern challenges to personhood, and the recent shift towards utilitarian thinking. Finally, I will argue that personhood must remain the central focus of bioethical discourse, especially in view of technological advances that may make conservative utilitarian arguments moot.

 

Personhood In Historical Context

Theological beliefs attach great value to human life. Certainly the Judeo-Christian outlook has dominated Western culture, and has influenced secular trends as well. Brannigan and Boss give this concise summary:

        Roman Catholics, Muslims, and Orthodox Jews believe that human life is sacred because it is a special creation of God. Only humans are ensouled; therefore all and only human life has moral value. There is no distinction between biological humanhood and personhood. We, as humans, have moral value simply because we have a human genotype, no matter what our age or stage of development (Brannigan & Boss, 2001, p. 189) .

Theologically, in the words of Wennberg, “personhood can be equated with the imago dei . . .” He adds, “the terms human person and image of God are virtually synonymous” (Wennberg, 1985, p. 36) .

The normative Christian view has been that personhood begins at conception. For example, Tertullian held that God created the soul at the moment of conception, arguing against the infusion of a soul at a later time (Gorman, 1982) . Jerome and Augustine spoke harshly of any “acts destroying the fetus after conception” (Noonan, 1970, p. 15) . This was in striking contrast to the alternative views of pagan society: “Christians discarded all pagan definitions of the fetus as merely part of the mother’s body. To Christians, the fetus was an independent living being” (Gorman, 1982, p. 77) .

The Judeo-Christian tradition of the value of life had great influence over Western culture for centuries, only coming into serious conflict with other societal values at the time of the Enlightenment. Clearly, the most egregious example of a rejection of the conservative view occurred with the eugenics movement of the early twentieth century, culminating in the horrible excesses of the Holocaust. However, another crisis that led to the need to define humanity more precisely was the rise of modern medical techniques for abortion. A conflict of values between the traditional view of persons and the permissive liberalism of abortion led directly to the legal battleground of Roe. Richard Neuhaus has demonstrated the centrality of the abortion issue:

        Even if some of the great questions that occupy bioethics might theoretically be isolated from the question of abortion, they seldom can be in cultural and political fact. Whether by inherent logic or by historical accident, the abortion debate has become the magnet to which all the other life-and-death debates are attached. We can try to pull them back from that debate, but they are inexorably drawn back to it . . . In ways even more relentless and entangled than at present, arguments about what we insist are “other” questions will be emerging from and returning to the question of abortion (Neuhaus, 1992, p. 222) .

In the early years of the modern bioethics movement (1965-1980), the lines were sharply drawn on both sides of the abortion question, with the debate centered on the personhood of the fetus versus the rights of pregnant women. Respected writers such as John T. Noonan, Harold O.J. Brown, Francis Schaeffer, and C. Everett Koop went beyond the traditional theological understanding, and added biological and philosophical reasons that the unborn child is a human person from conception. Yet there is no doubt that the conservative view had begun to erode in this era. Many have blamed the decline of the Judeo-Christian worldview and the rise of secular humanism as key factors in the modern denial of personhood (Schaeffer & Koop, 1979, pp. 20-21) .

However, even the U.S. Supreme Court acknowledged the centrality of personhood. In the 1973 decision, Judge Blackmun stated: “If this suggestion of personhood is established, the appellant’s case, of course, collapses, for the fetus’ right to life is then guaranteed specifically by the [Fourteenth] Amendment.” However, the Court declined to rule on that basis: “We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer” (Roe, 1973) . The Court went on to make autonomy, defined as a woman’s right to privacy, the central issue. This was held as a higher (or at least more clearly visible) principle, over the human life of the fetus.

One reason that Roe denied personhood to the fetus was its lack of independent viability; i.e., if the fetus was still dependent on the mother for life, it was not yet a person worthy of protection. Nonetheless, in the years since Roe v. Wade (and as reaffirmed in the 1992 Casey decision), even this view of personhood has not been determinative. From a legal perspective, there has always been an exception clause that operates after the point of viability, for “pregnancies endangering a woman's life or health” (Casey, 1992) . Because of broad definitions of such exceptions, abortion has essentially been legal up to any moment before physical birth.

Indeed, many pro-choice scholars have regarded personhood as irrelevant. Some have gone so far as to assert that the Roe decision needlessly alienated the religious and politically conservative community, in denying personhood to the fetus. Lawrence Tribe, a liberal constitutional scholar, has written: “The Court could instead have said: Even if the fetus is a person, our Constitution forbids compelling a woman to carry it for nine months and become a mother” (Tribe, 1990, p. 135) .

Judith Thompson presented a compelling argument along these lines in 1971. Though her “unconscious violinist” illustration preceded Roe v. Wade, there is no evidence that it influenced the Court, since the Court refused to concede personhood to the fetus. Thompson’s argument, briefly stated, goes like this: Imagine that you awake one morning to find that you have been kidnapped and had your circulatory system attached to a famous violinist. The Society of Music Lovers, in an attempt to save the violinist from a fatal kidney ailment, is using your healthy body to cleanse his bloodstream. After nine months, he will have recovered, and can be safely disconnected from you. To say that you are legally and morally obligated to accede to this situation is clearly outrageous (Thompson, 1971) . Thompson extends this analogy to pregnancy, and thus argues persuasively that even personhood does not trump a woman’s right to autonomy.

Francis Beckwith presents a cogent refutation of the violinist argument by showing that the two circumstances (violinist and pregnancy) are in no way morally equivalent. For example, he points out that pregnancy is not always a voluntary moral obligation, as in the case where couples conceive in spite of contraceptive efforts. Such a couple is still morally responsible to protect such unplanned children. Beckwith then contrasts the unnatural and artificial situation of the violinist with the natural state of the unborn:

It is evident that Thompson’s violinist illustration undermines that deep natural bond between mother and child by making it seem no different from two strangers artificially hooked-up to each other so that one can ‘steal’ the service of the other’s kidneys. Rarely has something so human, so natural, so beautiful, and so wonderfully demanding of our human creativity and love been reduced to such a brutal caricature (Beckwith, 1995, p. 193) .

Beckwith goes on to state that abortion is not merely the withholding of treatment, as with the violinist, but is an active form of killing. Indeed, Thompson’s case seems particularly weak at this point, since few have disputed that abortion is the active destruction of life. Legal scholar J. Budziszewski has said it well: “Whether a particular act of killing counts as murder is, of course, an ethical question, but whether it kills is a biological question. To kill is to take life, and the unborn child is alive” (Budziszewski, 1997, p. 230) .

Is the living entity that is killed in abortion a person? Peter Kreeft perhaps best illustrates the centrality of this question in his allegorical dialog, The Unaborted Socrates. In a conversation between the philosopher and an abortionist named Dr. Herrod, the question of personhood is the key:

Socrates: Now, rationally, what does killing mean?
Herrod: I suppose it means forcibly putting a live organism to death.
Socrates: And is abortion’s object a live organism?
Herrod: Of course.
Socrates: And is the [termination] of the process its death?
Herrod: Yes.
Socrates: Is the death forcible?