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Murder and medical ethics

Daniel Sportiello | Wednesday, August 24, 2011

I spent last fall as a teaching assistant in Medical Ethics. I was responsible for leading two discussion sections every Friday. My students taught me a great deal — though not what I expected.

After our discussions, I worried that, in teaching my students certain moral debates — in presenting without evaluation, for example, the very best pro-life and pro-choice arguments — I had corrupted my students, had injected enough uncertainty into their principles such that, at a critical moment, they would do precisely the wrong thing; whereas, if I had just left them to their naïveté, the wrong thing would have struck them as unthinkable. That the decisions we debated — abortion, euthanasia, and so on — are often made in confusing and deeply traumatic circumstances only compounded my worry.

Imagine for a moment that the debates in Medical Ethics really have the importance that we tell our students they do. Imagine, for example, that abortion really is murder — and thus, that it is evil to seek it. And consider one of my students — young, passionate, and impressionable: her parents, simple but principled, taught her that abortion is an abomination, the murder of a child, before sending her off to college to learn the ways of the world. She is a biology major and will one day go to medical school — and so she registers for Medical Ethics, where she hears any number of pro-choice arguments that her parents had never taught her. These arguments shake her confidence: she remembers the principles that she learned as a child, but she no longer knows just what to believe — not, anyway, in her heart of hearts.

And now imagine that, in medical school, she becomes pregnant herself. She is, predictably, very alone and very afraid — and is, therefore, sorely tempted to abort her child. It is now that the arguments that she learned in Medical Ethics are at their most dangerous, for they can serve only to weaken her resolve: if the best philosophers cannot agree that it is wrong, she thinks, who can blame her for choosing abortion? After all, she heard some pretty convincing arguments that it is her right! And so she murders her child — something she would not have done had I not taught her so well.

Imagine, on the contrary, that abortion is a human right — that it is evil to withhold it. And consider another of my students — young, passionate, and impressionable: her parents, simple yet principled, taught her that abortion is a godsend, that it is the right of every woman, before sending her off to college to learn the ways of the world. She is a biology major and will one day go to medical school — and so she registers for Medical Ethics, where she hears any number of pro-life arguments that her parents had never taught her. These arguments shake her confidence: she remembers the principles that she learned as a child, but she no longer knows just what to believe — not, anyway, in her heart of hearts.

And now imagine that, as a doctor, she is asked by her patient to authorize an abortion. She is, predictably, full of apprehension — and is, therefore, sorely tempted to deny her patient. It is now that the arguments that she learned in Medical Ethics are at their most dangerous, for they can serve only to weaken her resolve: if the best philosophers cannot agree that it is permissible, she thinks, who can blame her for withholding abortion? After all, she heard some pretty convincing arguments that it is murder! And so she violates the human rights of her patient — something she would not have done had I not taught her so well.

Perhaps neither of these situations is particularly plausible. But more plausible, I think, is a third: imagine again that abortion is murder and that my first student avoids pregnancy in medical school. She becomes an obstetrician and spends a career delivering healthy babies to happy parents. Only intermittently do those parents ask her, instead, to abort their children. When they ask this of her, she first remembers the principles that she learned as a child — but she then remembers the many arguments that I taught her. She remembers that she is a doctor, a woman of the world, and that whatever seems to be black and white is always, in the end, many shades of gray. Surely, she thinks, abortion cannot be as bad as they say: it is distasteful, certainly, but hardly evil. It is a thing to be done and forgotten.

And so she kills. Not often, and not gladly. But she kills nonetheless. And the blood that spills is, at least partly, on my hands.

This, then, is my fear. When I voiced it to a fellow graduate student, he reassured me that our students do not listen to us anyway. Which may well be true. But it is better not to take the chance if the stakes are as high as we take them to be — if, for example, abortion really is murder. Consider a parallel case: we teach our children, before we send them off to college, that murder is wrong. We would never allow them to take, much less demand that they take, a course that would seriously question this — that would, so to speak, look at both sides of the murder debate. What would be the point? Even if said course did not manipulate them into the pro-death camp, presenting that camp as though it were a legitimate option — as though intelligent and responsible students sometimes concluded that murder is permissible, or even a human right — could only serve to weaken their resolve: if the best philosophers cannot agree that murder is wrong, they might think in a moment of rage, who can blame them for murdering? After all, they heard some pretty convincing arguments that it is fine!

An education in virtue requires the assumption that certain options are unthinkable — the assumption, in other words, that they aren’t options at all. To present them to our students as though they are is to fail as teachers.

It was this, my failure, that my students taught me. I hope that this column will serve to thank them.

Daniel John Sportiello is in his fourth year in the philosophy Ph.D. program. Listen to his radio show on WVFI. He can be reached at dsportie@nd.edu.