Transplantation through a Glass Darkly

Abstract

Bioethical problems take many different forms, and fascinate many different kinds of people. Physicians and philosophers, lawyers and theologians, policy analysts and talk show hosts are all drawn by the blend of practical urgency and moral complexity that characterize these issues. But there seem to be only two kinds of bioethical problems that typically pull into their orbits not only theorists and practitioners, but pickets and protesters as well. When it comes to the treatment of fetuses and animals, people take to the streets. On the same day that demonstrators on both sides of the abortion issue lamented the Supreme Court's decision in Casey, representatives of PETA (People for the Ethical Treatment of Animals) gathered at the University of Pittsburgh to protest the implantation of a baboon's liver in a thirty-five-year-old man--the father of two children--whose own liver had been destroyed by hepatitis B virus. There is, of course, a big difference in the way the disputes are perceived: abortion's bona fides as a central ethical issue are well established, but despite an upsurge of interest among ethicists over the past decade and a half, concern about animals still seems a bit quirky, too exclusively the domain of zealots who maintain the moral equality of all species, and thereby mark themselves as fundamentally out of sympathy with our basic ethical traditions. Here I try to pull moral consideration of nonhumans closer to the ethical center, arguing that thinking about the fate of nonhumans at our hands shares with abortion--indeed, with many of our culture's most difficult moral issues--a fundamental problem: we don't really know what we are talking about. More concretely, we're at a loss to say what it is about baboons that makes their livers fair game, when we wouldn't dare take vital organs from those of our own species whose abilities to live rich, full lives are no greater than those of the nonhumans we seem so willing to prey upon. Unless we're able to isolate and defend the relevant moral distinction, we should reject the seductive image of solving the problem of organ shortage by maintaining colonies of animals at the ready for transplantation on demand. Moral Outliers Public protest about abortion is not galvanized by concern about the quality of informed consent, or its impact on the doctor-patient relationship. What does lie at the center of the dispute is an absolutely crucial kind of ignorance. As a society, we don't know what fetuses are, and, in an important sense, we don't know what pregnant women are either. Are fetuses babies or tissue? Are pregnant women mothers bound by special duties to their unborn children, or independent adults exercising their right to make important self-regarding decisions under the protection of a mantle of privacy? Because we don't know these things, and they matter so much, we have a hard time imagining what responsible compromise might really be like. And what gets people out into the streets in response to a daring attempt to rescue from certain death a young father of two? What, for that matter, causes medical research advocacy organizations to spend large amounts of money, not on research, but on fullpage ads in the New York Times defending what scientists do? Is it concerns about justice in the allocation of medical resources? Doubts about the courage to fail ethos? Misgivings centered around the independence of IRB review? Surely not. The ground of protest and counter-protest is a similar kind of ignorance about the fundamental terms of the relevant moral discourse: we don't know what animals are, either. We treat them as if they were morally protean; we mold them into anything from much-loved companions and symbols of virtue to mere machines for making food and instruments for scientific research. Our ignorance as a society about these dark corners of our moral commitments, our lack of consensus about where outliers really fit, is extremely divisive when coupled with individual assurance that there is in fact available knowledge about these matters, that the answers are of surpassing importance, and that there is something suspicious, if not downright evil, about the people who don't get it. …