Publicly Accessible Intuitions: “Neutral Reasons” and Christian Bioethics

Author Posting. (c) Taylor & Francis, 2007.

This is the author's version of the work. It is posted here by permission of Taylor & Francis for personal use, not for redistribution.

The definitive version was published in Christian Bioethics, Volume 13 Issue 2, May 2007.

doi:10.1080/13803600701473695 (http://dx.doi.org/10.1080/13803600701473695)

Publicly Accessible Intuitions: “Neutral Reasons” and Bioethics

Angela McKay

The Catholic University of America

The question of how Christians and members of other religions should argue for their views in the “public forum” has received a great deal of scholarly attention. Some scholars maintain that Christians should offer “neutral” reasons for their beliefs – reasons that are “accessible” even to those that do not share their religious commitments.[1] Other scholars maintain that Christians should not shrink from offering “robustly Christian” defenses of their beliefs.[2] The debate is complex, and it is further complicated by the fact that it is not at all clear what a “neutral reason” is, or what would make a given argument “accessible” to the broader public.[3] It is not even clear, for that matter, how the broader public should be characterized.

Although debates about the appropriate manner of Christian participation are typically conducted at a highly theoretical level, it seems to me that we might gain some clarity about the issues at stake and the feasibility of offering “neutral reasons” if we examine the sorts of arguments for Christian bioethical positions that are found in a typical undergraduate anthology of bioethics, and which are typically used in undergraduate philosophy courses in bioethics, for two reasons. First, however we are to characterize the “public forum,” it seems to me that an argument has a far better chance of succeeding when offered to an undergraduate audience than it does in the public forum, and consequently if a given type of argument cannot succeed in an undergraduate classroom it will have little chance of succeeding with the broader public. Second, the type of argument that appears in an undergraduate bioethics course is likely to be somewhat similar to the type of argument that those who insist on the need for “neutral” or “publicly accessible” arguments have in mind.

In this paper, after offering a general characterization of a typical undergraduate audience and of the arguments typically offered to such audience, I examine a specific example of one such argument, namely Leon Kass’s contention that a choice for physician assisted suicide is “undignified”. Although Kass is Jewish rather than Christian, he argues for positions that most Christians share, and he argues for these positions without presupposing the truth of specific religious claims. I argue that although Kass has some important intuitions, he too readily assumes that these intuitions will be shared by his audience, and that this assumption diminishes the force of his argument. An examination of the limitations of Kass’s argument is helpful insofar as it illustrates the real challenge faced by religious believers who wish to defend their beliefs in the “public forum”. For it illustrates that what needs to be made “accessible” is the Judaeo-Christian understanding of man and his place in the world. While I do not wish to claim that this task is impossible, I do think that it is far more difficult than most realize.

Neutral Reasons

I proposed above that we assume the “public” in question to be the student population of a typical undergraduate philosophy course for non-majors. Such a public, I propose, is in the typical case intelligent, but at the same time possesses very little knowledge of specific philosophical positions, and may or may not have specific religious commitments. Even when – as is the case for those of us who teach at religiously affiliated schools – our students are predominately members of a specific religion, it is often the case that their moral beliefs are not determined by their religious upbringing. To the contrary, even those who have been raised to believe that, say, abortion is wrong, are still making up their minds on the matter, and while they often want to believe that the morals they have been raised with are correct, they also – quite rightly – want reasons why they should believe this. Most students, moreover, want reasons that do not presuppose the truth of a certain religion or even the existence of God.

What sort of reasons, then, can be offered to such an audience? Whatever the reasons that can be offered to such an audience, a certain type of reasons are offered to such an audience, namely the arguments that are found in the anthologies of bioethics typically used in such classes. These arguments can be characterized in the following way: (a) they contain no religious claims: while they may refer to the Bible or to other religious texts, they do not treat these texts as authoritative; (b) they do not presuppose any sophisticated philosophical knowledge or that the reader ascribes to any particular theory of the good; and finally, at least when such arguments are convincing, (c) they rely heavily on appeals to the reader’s intuitions and common sense to argue for the veracity of their claims.

The last of the three requirements is, it seems to me, necessitated by the first two. For such a public needs some kind of motivation to believe the things they are told, and in this case the motivation can only come from an appeal to their experience, their common sense, or their intuitions. It is not enough, for instance, to simply tell such an audience that it is wrong to take innocent human life and expect them to concede the point. Such an audience will rightly demand an explanation of why it is wrong to take innocent human life, and will rightly raise some very difficult examples of situations where it seems that it would be right to take an innocent human life. The only convincing response must take the form of an intuitively appealing argument that demonstrates that it is in fact not right to take life in those situations.

As I shall argue, it is the necessity of an appeal to intuition and common sense that presents the biggest stumbling block to religious believers who wish to offer “neutral” arguments for their bioethical positions. For the Judaeo-Christian worldview is radically different from the secular worldview, and it follows that the intuitions that seem natural given a Judaeo-Christian understanding of the world and man’s place in it will not seem at all natural under a more secular worldview. Those who wish to offer neutral arguments for these positions, then, face a Herculean task: they must make Judaeo-Christian intuitions accessible to non-believers. Kass’s argument against physician assisted suicide, I will argue, demonstrates just how difficult such a task must be.

Kass and Neutral Reasons

Leon Kass has written a great deal about bioethical issues, and the manner in which he addresses these issues makes the arguments he offers ideal candidates for inclusion in anthologies of bioethics. For Kass approaches bioethical issues in a way that appears to meet all three of the criteria outlined above. First, although he makes frequent references to biblical ideas about man and man’s place in the world, he does not treat these claims as authoritative, but rather uses them as examples that help make his point. Secondly, although Kass himself is clearly influenced by Aristotelian ideas, he does not presuppose that his readers possess sophisticated philosophical knowledge. Finally – and this may explain why Kass’s arguments appear so frequently in anthologies of bioethics – Kass’s arguments appeal to the intuition and the common sense of his readers.

In what follows, I address a small portion of a broader argument against euthanasia and physician-assisted suicide put forward by Kass in his Life, Liberty and the Defense of Dignity, namely Kass’s argument that a choice for physician assisted suicide is “undignified”. Although I share Kass’s intuitions, his argument has several important weaknesses, and these weaknesses, I will argue, are illustrative of the gap between Kass’s intuitions and those of his readers.

“Dignity”

Before delving into the details of Kass’s argument, it is important to clarify the term “dignity”. This term arises frequently in discussions about euthanasia and physician-assisted suicide, and is appealed to by both those who oppose such practices and by those who favor them. These appeals are complicated by the fact that the same term can be and is used in many different ways, leading some to argue that “dignity” is a useless term that should be removed from ethical discourse about bioethics.[4] While the term “dignity” is far from useless, it is certainly important to specify how the term will be used and what it will mean. Since I will be concerned with Kass’s arguments about a specific sense of dignity, and since Kass uses “dignity” in two different senses in the article we are concerned with, it is important to distinguish these at the outset.[5]

One sense of “dignity,” which Kass refers to as universal dignity, refers to the dignity or status that a thing possesses simply in virtue of being the kind of thing it is. This sort of dignity is the dignity that a thing is said to possess simply in virtue of its membership in a given species, and those who possess this sort of dignity are said to command respect from others, not in virtue of any qualities they themselves possess, but in virtue of the kind of thing they are. This is, I take it, what opponents of the death penalty have in mind when they say that the death penalty is “contrary to human dignity”. The claim is not that the criminal himself has character traits that command our respect, but rather that the criminal is a human being and that all human beings deserve at least some minimum of respect from us.

A second sense of “dignity,” which Kass refers to as full dignity, refers to the dignity that is exhibited in the individual actions or character traits of a given individual. This is the sort of dignity we have in mind, I take it, when we assert that certain actions are “undignified” or say that something is “beneath” our dignity. While the former sort of dignity is something that is ostensibly possessed by every member of a kind, the latter is something that only some members of a kind possess, and which may or may not be exhibited in action.[6] When we describe actions as dignified, then, we are claiming that they exhibit “full dignity,” and when we describe actions as undignified, we are claiming that they are incompatible with “full dignity”. In what follows, I will be concerned to examine Kass’s argument that a choice for physician-assisted suicide is contrary to “full dignity”.

Kass’s Account of Full Dignity

In the course of a broader argument against all forms of euthanasia, Leon Kass offers an argument designed to show that one acts in an undignified way when one opts for physician-assisted suicide. There are, it seems to me, two distinct features of this argument. First, Kass offers a general account of what full dignity is. Secondly, Kass argues that given such an account, a choice for physician-assisted suicide is undignified.

Since Kass’s definition of full dignity derives from his account of universal dignity, it is necessary to begin with a brief account of Kass’s understanding of universal dignity. Kass believes that there is something about human life as such that commands a “proto-religious” respect from us. It is this intuitive recognition that there is something “special” about human life, he believes, that ultimately grounds taboos against murder, cannibalism and incest: we sense that certain actions violate the respect that must be shown to human beings.[7] What we recognize, moreover, is that humans are special because they, alone among other things, are capable of “god-like” actions: “man has a special standing because he shares in reason, freedom, judgment and moral concern, and as a result, he lives a life freighted with moral self-consciousness.”[8] Many features of Kass’s account of universal dignity, of course, merit further examination, but such an analysis is outside the scope of this paper. The details mentioned here are important for our purposes only insofar as they provide the background for Kass’s account of full dignity.

Membership in a species capable of noble or godlike actions is what grounds man’s universal dignity, but it is the realization of these capacities that confers full dignity on human beings. Man achieves full dignity, that is to say, when he acts in a manner that reflects the nobility, god-likeness, and uniqueness of his species: “this universal attribution of dignity to human beings pays tribute more to human potentiality, to the possibilities for human excellence. Full dignity or dignity properly so-called, would depend on the realization of these possibilities.”[9] Given Kass’s previous account of what it is that is “god-like” about human beings, it would follow that a man achieves full dignity when he actualizes his capacity to live a life “freighted with moral consciousness”; ie. when he lives a good life: “dignity would seem to depend mainly on having a good moral life, that is, on choosing well. Is there not more dignity in the courageous than in the cowardly, in the moderate than in the self-indulgent, in the righteous than in the wicked?”[10] An act is dignified when it reflects man’s highest qualities, and conversely an act is undignified when it is unbefitting man’s special status.

It is worth pointing out that the definition of full dignity offered above leaves room for a class of human action that is neither dignified nor undignified. Drinking a glass of water (at least under normal circumstances) neither reflects the nobility, god-likeness and uniqueness of the human species nor undermines it. In fact, the adjective dignified seems reserved for especially good actions (or, when used to describe a character trait, for especially good people), and similarly, it seems that we would not say that an action was undignified in the full sense unless it exhibited an absence of what should be present. Most human actions, it seems, would fall somewhere in between.

Kass’s definition of full dignity is, or at least ought to be, relatively uncontroversial. Indeed, it is either echoed by or compatible with the accounts of dignity offered by other philosophers, even those who disagree with Kass about the acceptability of euthanasia and physician assisted suicide. For example, Jyl Gentzler, who argues that a choice for death is – at least in some instances – acceptable, gives a definition of dignified action that is remarkably similar to Kass’s. Gentzler argues that “dignified” choices or actions are those that exhibit human excellences or virtues. After examining several insufficient descriptions of human dignity and noting that these descriptions, while inadequate, still seem to capture something of what those who propose them mean by dignity, Gentzler argues that when we describe an action or a person as dignified we likely mean something similar to what Aristotle meant with his notion of the fine or noble.[11] What we mean by a dignified life, Gentzler argues, is likely a life that exhibits virtue. It follows that what we mean by a dignified death is likely a death that exhibits virtue. A choice for death, she concludes, will be dignified if that choice exhibits human virtue.[12]

Kass’s definition also seems to capture what many proponents of physician-assisted suicide mean when they argue for a right to “die with dignity”. John Hardwig, for instance, argues that in some circumstances individuals have a “duty” to die, and then claims that a choice for death in those circumstances is dignified.[13] Similarly, in her excellent study of Roman suicide, Miriam Griffin shows that Stoic philosophers were preoccupied with the question of whether suicide exhibited virtue, and that they condoned or condemned suicide on precisely these grounds.[14] All of these uses appear to link a dignified death with a noble or virtuous death.

Although it is true that some thinkers simply equate dignified action with autonomous action rather than with some specific kind of autonomous action, even this understanding is compatible Kass’s claim that dignified actions are those actions which express what is highest about human beings. It would merely be the case that – as such a definition seems to imply anyhow – the “best” actions that human beings are capable of are free actions, and that no one free action is to be preferred over any other.[15] To fully express one’s humanity, on such a reading, is to direct the course that one’s life will take, not to realize some specific goal.

Kass’s definition of full dignity, finally, seems to fit our own ordinary descriptions of dignified action. We tend to say, for instances, that certain things are “beneath one’s dignity,” or that certain actions are “undignified.” What we seem to mean in those circumstances is that such actions fall short of the way the individual in question ought to behave. If we claim that menial tasks are “beneath the dignity” of a queen or head of state, what do we mean, other than that the person in question is supposed to act in a certain way, and that the acts in question fall short of the standard? Or if we say that it is “undignified” for a lawyer to wear sweatpants to court, what do we mean but that lawyers are supposed to present themselves in a certain way and that this lawyer has not done so? It would only make sense that when we say that a certain choice for death is “undignified,” it follows that such a choice is inconsistent with the way that human beings ought to behave.

There seems to be room for general agreement, then, that “full dignity” has to do with those actions that are in keeping with or at least not contrary to the special status that we have as human beings. Obviously, one’s account of what is or is not dignified will vary, depending on precisely what it is one thinks is special about human beings, but the fact remains that – at least at a sufficiently general level – there is some relative agreement about what is under debate when we consider the question of whether a choice for physician-assisted suicide is dignified.[16]

Full Dignity and Physician Assisted Suicide

To this point, Kass has succeeded in offering an account of full dignity that (a) makes no religious claims, (b) is accessible, and (c) is highly intuitive. It is at precisely this point, however, that the real work begins. For Kass must now show that a choice for physician-assisted suicide is an undignified choice. At this stage, the task becomes more difficult, for while many – perhaps most – would agree that an action is dignified if it exhibits what is highest and best about mankind, views about which actions do or do not exhibit mankind’s nobility differ widely. Kass, then, must find some way of arguing that a choice for physician-assisted suicide is undignified, and given the parameters laid out in the first section, he must make this argument largely on the basis of an appeal to intuition and common sense.

Kass acknowledges that assisted suicide can appear to be a dignified choice. Yet he proposes two arguments designed to show that such a choice is in fact undignified. The first argument he proposes has to do with the choice for death in such a circumstance, while the second has to do with the decision, in such a circumstance, to ask for assistance in dying. Both choices, he argues, fail to exhibit the “nobility of soul” that is a necessary component of a dignified death.

Although those who maintain that individuals should be allowed to choose death typically argue that such a choice “affirms the dignity of free will against dumb necessity,” Kass claims that (a) this is not the real motive behind most such choices and that (b) when this is the motive, it is a motive that is paradoxical at best.[17] The real motive behind such choices, Kass believes, is in the typical case not a desire to affirm free will in the face of dumb necessity, but a desire to end pain and trouble. While we might empathize with and understand such a motive, however, such a motive cannot be considered dignified. Truly dignified action consists in summoning the courage to face one’s troubles, not in running from them. To kill oneself to avoid pain and trouble, then, is undignified because it is a cowardly thing to do. Courageous individuals do not run from hardship; they stand and face it.

Not all people, of course, opt for death merely out of a desire to avoid pain and trouble. However, Kass claims that the alternative motive – the affirmation of free will in the face of dumb necessity – is paradoxical at best. One cannot, he argues, honor oneself by eliminating oneself. To the contrary, it is an embarrassment if “autonomy reaches its zenith precisely as it disappears.”[18] For both of these reasons, Kass believes that a choice for death cannot be a dignified choice; it is not a choice that reflects the special nobility that human beings are capable of.

It is still less dignified, Kass maintains, if one’s choice for death is such that it involves asking other people for assistance. To ask someone else for assistance because you cannot end your own life is to inflict a terrible duty on someone else: it is to demand that someone else become your killer. This is not a duty that someone “in full possession of their dignity” should inflict on anyone they truly love, nor is it a duty that one should impose on the very physician from whom one demands humaneness and respect.[19]

As before, Kass’s arguments are guided by important intuitions. The guiding intuition behind the claim that a choice for death is undignified is, I take it, the intuition that those who wage a valiant war with their illness, who endure it with grace and courage, who amidst all the pain nonetheless manage to show a cheerful face to the world, exhibit more nobility than those who seek death as a way of avoiding the difficulties their end will involve. Similarly, I take it that Kass is arguing that the individual who is truly noble or truly dignified would love others, be they his family or his physician, too much to foist such a terrible choice on them. What I wish to examine, however, is whether Kass has made a case against assisted-suicide that will convince those who do not already share his intuitions.

Let us begin with Kass’s first claim, namely that a choice for death is never dignified. As Kass describes the situation, a choice for death is either (a) an attempt to escape from troubles and pains or (b) an eminently futile way of raging, so to speak, against the dying of the light: one asserts one’s autonomy by eliminating oneself. To choose death for reasons of type (a) is undignified because “there is more dignity in courage than in its absence,” and to choose death for reasons of type (b) is impossible because it is paradoxical.

Although Kass’s first claim has a certain appeal, the appeal weakens when we begin to ask ourselves exactly why such a choice would exhibit cowardice. It is certainly true that in many instances, an attempt to escape from trouble and pain is cowardly. But surely not every attempt to escape trouble and pain exhibits such cowardice. If it did, then there would be something cowardly about taking aspirin for a headache.[20] We do not think it is cowardly, moreover, to run from a burning building or from a bomb that is about to explode -- or at least, not in every circumstance. When do such choices become cowardly? They become cowardly, it seems, when one chooses to escape trouble and pain rather than engage in some noble, important, but painful and difficult task. It is not cowardly to run from a burning building if the building is empty, but if there are small children who need to be saved, and if one has the means of saving them but chooses not to out of fear, then the choice to escape trouble and pain exhibits cowardice. Similarly, an individual who knows how to disable a bomb that threatens the lives of many people but who instead flees the scene is cowardly, because such an individual places the avoidance of pain and trouble before something noble, important, and choice-worthy.

All of this allows us to offer a precision to argument (a). It is cowardly to run from pains and troubles if one chooses to avoid pain and trouble over some higher, more noble, but also painful and troublesome alternative. To state this precision, however, is to see what is incomplete about Kass’s argument. For Kass’s argument to go through, there would have to be something noble about living one’s life through to the very end, about seeing it out rather than ending it. There would have to be something heroic about not ending one’s life in the same way there is something heroic about risking one’s life in our other examples. Absent such an account, we have no reason to agree that it is “cowardly” to seek an end to pains by ending one’s life.

But is there something noble about seeing one’s life through to the end, something so noble that one exhibits cowardice by ducking out early? If so, exactly what is noble about enduring a painful and debilitating disease through to the end? Exactly what is noble about continuing to live, even when it means becoming incontinent, demented, and dependent? If we are to abide by the requirements outlined at the beginning of our discourse, we need to offer an argument that is intuitively appealing, one that demonstrates, on the basis of common sense alone, that there is something noble and important about such a life. The problem here is that the intuitions are all too often on the other side. Roman and Greek philosophers, who, as Miriam Griffin points out, tended to exhibit a less favorable attitude towards suicide than their peers, typically included debilitating pain and illness among the things that rendered suicide acceptable, especially if one’s illness made virtuous actions more difficult.[21] Even Plato in his Laws appears to include illness among those things that render suicide acceptable.[22] Possible exceptions are found in Aristotle, who asserts that it is cowardly to kill oneself to avoid pain, and in Socrates’ argument in the Phaedo that even if we long for death, the god has placed us on earth to perform a certain task, and it is wrong to desert our posts ahead of schedule.[23] Even here, however, Aristotle does not offer an explanation for his claim, and insofar as Socrates bases his argument against suicide on an appeal to the need to perform the tasks that the god has given, it is not at all clear that such an argument could be included in a contemporary anthology of bioethics. Kass, then, needs to offer some intuitively appealing account of why it is important to remain alive, even when continued life promises pain, suffering, and humiliation. If we are allowed recourse to religious claims or even to posit God’s existence, of course, we can make such arguments. But how are such claims to be made appealing without them?

The case becomes all the more difficult when we consider those cases where the choice for death is not motivated solely by a desire to avoid future pain and degradation. Kass asserts that when one’s choice for death is not motivated by a desire to “escape from pains and troubles,” the choice for death exhibits a paradoxical attempt to assert one’s autonomy. In the event that such a choice really is an attempt to assert autonomy, then there is a certain amount of sense to Kass’s claim that it is paradoxical. A choice for death certainly is an exercise of autonomy, but it is an exercise of autonomy that, so to speak, also eliminates one’s autonomy once and for all.

The problem that arises here, however, is that it is not at all clear that Kass has sufficiently outlined the motives. It may be true that many kill themselves because they wish to escape from pain and trouble, and it may also be true that many kill themselves in an attempt to assert autonomy in the face of circumstances beyond their control, but surely these two motives do not exhaust the options?

Leaving aside for the moment the question of the choices for death that occur in the context of assisted suicide, it is clearly untrue that suicides in general need be motivated by one of these two goals. It is easy to find examples of suicides which appear to have been motivated by neither a desire to avoid pain nor a last, paradoxical attempt to assert freedom in the face of necessity, but by the noblest of motives. What are we to say, for instance, of a secret agent who swallows a cyanide capsule to avoid betraying his country’s secrets? Or of someone who kills himself in an attempt to preserve his family’s honor? Suppose, alternatively, that there is not enough food for my family, that I am old and infirm and cannot help to find food, and that I kill myself so that my grandchildren will have more food to eat. In all of these situations, it looks like the suicide stems from a noble motive.

If suicide can sometimes be motivated by a noble desire, then it seems as if we should at least entertain the possibility that a choice for assisted suicide could also be motivated by a noble desire. Could not such a choice be motivated by a desire to spare one’s family pain or to relieve them of a burden? While it is probably true that many of those who claim to have such motives do not, we still must acknowledge the possibility of such motives. It seems that we should concede, then, that at least some choices for assisted suicide stem from noble motives.

Although this makes Kass’s task harder, it does not make it impossible, for noble motives do not guarantee good or noble actions. What needs to be shown, however, is that a choice for death, even one motivated by the best of intentions, is still an ignoble or undignified choice. But this, again, is not something that is intuitively obvious, particularly if one’s intuitions are not Judaeo-Christian intuitions.

Kass’s final claim, namely that it is not dignified to ask someone else to be one’s executioner, succeeds or fails depending on whether or not a choice for death can be noble or at least avoid being ignoble. For while it is indeed undignified to ask someone else to do something base or ignoble, there is no dishonor in asking someone for assistance in other endeavors.

Publicly Accessible Intuitions

In the above, I argued that Kass’s case against physician-assisted suicide falls apart at the crucial moment, and that it falls apart for the following reason: although Kass’s argument is motivated by important intuitions, it is not at all clear that a secular audience will share those intuitions. Kass faces a peculiar sort of problem: he must find a way to make his intuitions accessible to his audience. Kass’s arguments stop, that is to say, at precisely the point they need to begin. The question, however, is whether these intuitions are even the sort of thing that can be made accessible to a secular audience. At this point it might be helpful to say a bit more about Kass’s particular intuitions.

I noted above that Kass’s arguments appear to be motivated by two equally important intuitions. The first of these is that there is something valuable and important about living one’s life through to the end, something so important that one exhibits cowardice by ducking out early. This means, among other things, that even if one knows with a high degree of certainty that one will soon become demented, that one will soon be unable to control one’s bowels, and that one will soon be the source of pain, trouble, and even discord among one’s family, there is still something valuable and important about one’s continued life. The second intuition is that the task of living one’s life to the end is so important there is no motive, however lofty, that could give one good cause to end one’s life. Even if one could spare one’s family a great deal of difficulty, financial hardship and emotional pain by taking one’s life, one would still exhibit more dignity in living.

I believe that Kass’s intuitions are both important and correct. They are also, however, intuitions that stem from a Judaeo-Christian understanding of man and his place in the world, and it is not immediately obvious that one who does not share such an understanding would or even could share these intuitions. It is probably not even true, in fact, that all practicing Christians share such intuitions. Christians believe that these things are true, to be sure, but they quite often believe these things in spite of conflicting intuitions. In fact, to develop one’s ability to see that all human beings – not merely some – are worthy of love, and that all human life has value is arguably part of what it is to grow in faith. It seems to have been obvious to Mother Teresa that the lives of the demented, poor, incontinent and infirm had value, but it is not at all clear that this is always intuitively obvious to everyone, even to those who fervently believe that such lives do have value.

Those who wish to argue for Christian positions in the public forum, then, have a unique and difficult task. For they do not merely need to appeal to the intuitions of their audience; they need to find a way to make their intuitions accessible to their audience, for their intuitions are not the sort of thing that a secular audience readily shares. It is necessary, then, to find some way of helping one’s audience to appreciate the depth of these intuitions.

If what I have argued above is correct, then the question we are faced with is whether it is possible to make Christian (or in Kass’s case, Judaeo-Christian) intuitions accessible without resorting to overtly religious claims. While I am skeptical about the extent to which it is possible to do this, I do think that one can go some ways towards making such an intuition accessible. In what follows, I want to point to one instance where I think such an intuition was – at least in part – made “publicly accessible”.

The movie “Million Dollar Baby” met with much critical acclaim and violent opposition from right to life groups, who argued that the movie was propaganda for the euthanasia movement. Rightly understood, however, the movie actually goes a long way towards making the sorts of intuitions that Kass has accessible to those who do not share them. “Million Dollar Baby” tells the story of a young woman, Maggie Fitzgerald, who wishes to become a boxer, and who convinces an embittered old trainer, Frankie Dunn, to teach her. During the course of the training, Maggie and Frankie develop a beautiful relationship, and it is clear that each finds in the other the love for which they desperately long. For Frankie, Maggie is a replacement for his estranged daughter, for Maggie, Frankie is the father she lost. However, when Maggie’s spinal cord is crushed and she is paralyzed, Maggie decides that she wants to end her life. As she sees it, she has done everything she needed to do. She has fulfilled her dreams, she is peaceful, and she sees nothing of value in the idea of continuing to live as a quadriplegic. Although Frankie does not want Maggie to die, he blames himself for her accident and feels that he is selfish for wanting her to continue to live. So, when Maggie attempts to kill herself by biting off her tongue, Frankie finishes the job.

If Maggie and Frankie are taken to be the moral mouthpiece of the movie, then the movie might indeed be little more than propaganda for the euthanasia movement. But it is obvious throughout the movie that neither Maggie nor Frankie have a clear conception of what is most meaningful about their lives or even about their relationship. This is because the movie is narrated by an individual – Eddie Dupris – who, if he is not the moral mouthpiece, is at least closer to one than either Maggie or Frankie. Eddie is an ex-boxer, and Frankie’s only friend. Eddie has also suffered a career ending injury, and Frankie blames himself for Eddie’s injury, just as he blames himself for Maggie’s. Eddie, however, has realized what neither Frankie nor Maggie can. It is evident from Eddie’s narration that both Maggie and Frankie misunderstand Maggie’s situation in an important way. What Maggie does not see is that Frankie needs her; that she gives purpose and meaning to his life. She would be a burden, yes, but she is a burden that Frankie desperately wants and needs. Frankie, similarly, cannot see past the fact that Maggie has suffered a debilitating injury that he perceives to be his fault.[24] He cannot see that he has given Maggie something far more important than boxing instruction. The tragedy of the movie, in fact, is that Frankie never tells Maggie that he needs her, and never even tells her that she is “his darling” until he is in the very act of killing her. This is tragic, of course, because the knowledge of Frankie’s need for her is perhaps the only thing that would have enabled Maggie to see some value in her continued life.

Understood in this way, the movie “Million Dollar Baby” provides a “publicly accessible” defense of Kass’s intuition. For the noble thing for Maggie to do would be to endure a painful and debilitating condition for the sake of the man who loves her and who desperately needs her in his life, and it is obvious that she – albeit unwittingly – does a very terrible thing when she asks such a man to be the agent of her death.

Even a defense such as this one, however, can only go so far. The movie illustrates an important truth, and a truth that one can comprehend even without overtly religious claims. The movie illustrates the truth that human beings need love more deeply than they need anything else in life, and that one does those one loves a terrible harm by deserting them, let alone by asking them to take one’s life. To state this truth, however, is to see the limitations of it. For we who share Judaeo-Christian intuitions about man and his place in the world also think that even those who are alone and unloved, whose families are clearly waiting for them to die and are annoyed that they have not; we think that even these lives are important and valuable. And while I am hopeful that there is a way to make this intuition “publicly accessible” without making “robustly Christian” claims, I must also confess that I am not sure how one would do so.

I often hear it said that the truth of certain Christian ethical positions is “obvious,” so obvious that one could not deny these positions without possessing, to use Anscombe’s famous phrase, “a corrupt mind.”[25] I think it is important for religious believers, however, to acknowledge that these truths are not always as obvious as they seem, particularly when one does not presuppose the truths of faith or even the existence of God. There may well be a way to make these truths intuitively obvious, and the attempt to do so is both necessary and important, for believers and non-believers alike. Like all important tasks, however, it is also a difficult one, and unless we wrestle with the difficulties it raises, our arguments will strike many as unconvincing.

[1] See for instance Scott Rae and Paul Cox, Bioethics: A Christian Approach in a Pluralistic Age (Michigan: William B. Eerdmans Publishing Company, 1999) 282-293; Jack Mahoney, “Christian doctrines, ethical issues, and human genetics,” Theological Studies, December 2003, 719-749; and Robert Audi. Religious Commitment and Secular Reason, (Cambridge: Cambridge University Press, 2000).

[2] Among those who argue that Christians need not and indeed should not attempt to find such reasons are Gilbert Meilander and Tristam Engelhardt. See for example Gilbert Meilander, “Against Consensus,” Studies in Christian Ethics, v.18 n.1 2005, 75-88 and Tristam Engelhardt The Foundations of Christian Bioethics (Lisse: Swets & Zeitlinger 2000).

[3] For an excellent discussion of this question, see Jeremy Waldron, “Religious Contributions in Public Deliberation,” San Diego Law Review v.30 1993, 817-48.

[4] See for instance Ruch Macklin, “Dignity is a Useless Concept,” BMJ v.327 n.20, Dec. 2003 1419-1420. Macklin argues that the term dignity is invariably reduces to either (a) autonomy or (b) respect for persons, and that when it does not reduce to either of these two terms it is used as a meaningless rhetorical slogan.

[5] Scholars have proposed a variety of different names for the senses of dignity that I will distinguish in the following paragraph. The sense of dignity that I call ontological is sometimes referred to as “intrinsic” or “connatural” dignity, while the sense of dignity that I call moral is sometimes referred to as “manifested” or “existential” dignity. See for instance Patrick Lee, “Personhood, Dignity, Suicide and Euthanasia,” The National Catholic Bioethics Quarterly, v.1 n.3, Autumn 2001 and Luke Gormally, “Pope John Paul II’s Teaching on Human Dignity and its Implications for Bioethics,” C. Tollefsen ed., John Paul II’s Contribution to Catholic Bioethics, (Netherlands: Kluwer 2004) 7-33.

[6] note that some people detail other senses of dignity as well

[7] Kass, Life, Liberty and the Defense of Dignity (San Franciso: Encounter Books, 2002), 238.

[11] Jyl Gentzler, “What is a Death with Dignity?” Journal of Medicine and Philosophy v.28 n.4 2003, 477.

[13] John Hardwig, “Is There a Duty to Die?” in John Hardwig ed., Is There a Duty to Die? (Routledge 2005) 119-36.

[14] Miriam Griffin, “Philosophy, Cato, and Roman Suicide: I,” Greece and Rome, 2^nd Ser., v.33 n.1 Apr. 1986, 75.

[15] Jyl Gentzler does a nice job of pointing out that those who propose such a definition often involve themselves in contradictions, because they simultaneously assert that everyone should be able to direct their lives in any way they desire and claim that certain actions, such as smoking, are reprehensible. See Gentzler, 475.

[16] In email correspondence, Christopher Tollefsen offered a neat formulation of this view, noting that: ““dignity” is a kind of summarizing term that supervenes on whatever we have to say about a) the specialness of human persons and b) whatever moral consequences that has. it's not a foundational term -- it is available to any ethicist who has an account of why we are valuable, and what the consequences in some domain are of that.”

[20] Thanks to Michael Gorman for offering this example.

[22] Plato, The Collected Dialogues of Plato, Edith Hamilton ed. (Princeton: Princeton University Press, 1961) 1432.

[23] Aristotle, Nichomachean Ethics, Terrence Irwin ed., (Indianapolis: Hackett Publishing Company 1985), 1116a15.

[24] Many critics argue that because Eddie Dupris tells Frankie that if Maggie were to die, she would die thinking “I done alright,” Eddie Dupris ultimately tells Frankie to kill Maggie. To say this, however, is to take the quote out of context. Eddie tells Frankie this in response to Frankie’s claim that he “killed her” by allowing her to fight. Eddie, like Frankie’s priest, is merely attempting to convince Frankie that Maggie’s condition is not his fault. It is important to remember, moreover, that although Eddie has an inkling of what Frankie might do, Frankie does not discuss the prospect of killing Maggie with Eddie.

[25] Elizabeth Anscombe, “Modern Moral Philosophy,” in Stephen Cahn ed., 20^thCentury Ethical Theory (New Jersey: Prentice Hall 1995) 351-364.