Ending (and creating) a life: It’s not all about you

RP: You say that a lot of our thinking about issues such as end-of-life care and embryo research is based on the template of the choosing individual who is engaged in a project of self-creation and self-actualization. You say that this image wrongly ignores important features of the human condition: our relationships with others, and the fact that we are bodies, not just wills. That sounds a little abstract. How do those blind spots play out in American life?

Snead: I looked at the vital conflicts of public bioethics — the law and policy over abortion, assisted reproduction and end-of-life decision-making — analyzing them inductively and asking what vision is at the root of current policies. It's a conception of a person as an atomized individual will that finds its authentic and original truths and then configures a life accordingly. This philosophy tracks what Robert Bellah and Charles Taylor have called "expressive individualism."

But we are not mere wills, we are not mere minds. The human person is a dynamic integrated unity of mind and body. When you reduce persons to minds, you miss the key parts of human life that flow inexorably from our embodiment: namely our vulnerability, our mutual dependence and our subjection to natural limits as embodied beings in time. As beings who live and die. As corruptible bodies. 

If you look at end-of-life decision-making, and you take as your point of departure the individual will whose highest calling is the free construction of one's meaning and destiny, you miss entirely the human context that characterizes these decisions. People who have lost their capacities to illness are not seeking to realize their unencumbered will, and it is not appropriate to project onto them the views of their past selves. The person's vulnerability, dependence and limits are invisible in this view, as are our obligations to that individual.

RP: One of the points you make about end-of-life care is that people are generally quite bad at predicting their future desires, especially when confronted by complex and hard-to-predict medical situations. I suppose the folly of basing the law on such flawed predictions is connected to the limitations of expressive individualism in general.

Snead: We push people to try to control their future decisions about life-sustaining treatments by memorializing their current preferences. But this misunderstands the reality and needs of that context.

When people go to the doctor, they are not seeking to define themselves and assert their unencumbered wills. They are instead going to ask someone to take care of them. It's a profound relationship of vulnerability. My goal in this book is not to settle the policy questions such relationships raise but to dislodge the philosophy that we now use to settle them.

RP: Your chapter on assisted reproduction, similarly, does not have a policy agenda. It instead targets the assumption behind our mostly laissez-faire policies on it: that we don't need to worry about any harms done to the lives it creates, because they wouldn't have existed in the first place without it. That just intuitively feels wrong.

Snead: The late John Robertson, one of the most influential thinkers behind the creation of the law of assisted reproduction, held that we can't concern ourselves with the harms that might befall some of the people created through, for example, cloning. It wouldn't matter, either, if there were increases in birth defects or autism or prematurity due to multiple gestations after a woman has received a particular kind of fertility treatment. Robertson argues that these harms are not cognizable injuries that should lead us to limit the freedom of parents to choose those techniques. The technique is a benefit, not an injury, to the child who would not otherwise exist.

But the law isn't merely a wooden philosophical exercise, it's a human enterprise to serve human beings. The most important purpose of the law of assisted reproduction should be to protect the children who are born using it, which may require regulating or even prohibiting some interventions.

RP: You make a strong case that these disparate areas of the law show a basic consistency in philosophical assumptions. I wonder if you see expressive individualism as having affected our response to Covid-19.

Snead: If you want to create wise, just and humane policies and laws for a community and a nation of embodied beings, you have to recognize that the most essential thing is what Alasdair MacIntyre has called networks of uncalculated giving and graceful receiving, composed of persons who are willing to make the goods of others their own goods without any expectation of getting anything in return. The purest form of this ethic is the parent-child relationship. The child can expect to be taken care of not because she has done something to earn the right to be cared for but just because she is the child of these parents.

We have to participate in and shore up these networks not just because they provide for our survival and our flourishing. They also teach us what we are supposed to become: the kind of people who can make others' goods our own. By virtue of our embodiment we are made for love and friendship.

Bottom of Form

That's the lens through which I look at Covid. What I end up with is something like a preferential option for the weak and vulnerable. We are most fully human when we are taking care of each other. You wear a mask because you want to take care of other people; you don't bristle at the intrusion on your autonomy. In terms of allocating the vaccine, it means giving it to the weakest and most vulnerable and those who take care of them.

RP: While, as you say, you do not go into policy prescriptions in any detail, the upshot of your argument does not seem like one that either Republicans or Democrats would be fully comfortable with.

Snead: I would say both of our major political parties, and the principal ideologies that undergird those parties, embrace a kind of individualism, whether it is lifestyle individualism or commercial individualism. On the left, people will react adversely to the idea that the relationship of a mother and a child in the womb is not a relationship of strangers fighting over scarce resources. On the right, people will bridle at the idea that this relationship should focus us on our obligations to mothers and children more generally.

You can certainly make an argument for private ordering as the principal method of nurturing these networks. People on the right might find that attractive. You can also make the case that there are people — migrants, the poor and others — to whom we have obligations that require collective action. Progressives might have that impulse. People are going to raise objections based on their own commitments and affinities, but there also may be room for compromise and common ground as well.

Disclaimer: This article first appeared on Bloomberg, and is published by special syndication arrangement.