The “Culture of Death”

Perspective and Politics in Medical Ethics

Kevin T. KeithColumbia University Seminar on Death

12 November, 2008

Contemporary Bioethics and “The Culture of Death”

The origin of the concept of “death” as a coordinating theme in current controversies over bioethical topics can be seen as an evolutionary process with distinct phases.

2

Culture of Death

1. Prologue

2. Coalescence: “Ends-of-Life” . . . “Death”

3. Meme – Making: “The Culture of Death”

4. “Death” in the Current Debate

Prologue

3

Culture of Death

Bioethics and “The Culture War”

• Medical-ethical issues dominating left/right conflict

• Abortion issue often credited with creating “religious right”

• Other biotech issues encroaching as technology/culture evolve:

• Termination of treatment (“euthanasia”)

• Contraception / Sex-ed / AIDS

• Assisted reproduction

• “Embryo issues”: IVF embryos / stem-cell research / gamete/embryo transfer

• Medical futility / futility laws

• “Ends-of-life” issues given priority by many conservatives, especially religious

Beginning with abortion, the most-intractable social-policy controversies in the US have increasingly centred on healthcare and biotechnology.

4

Culture of Death

The Evolving Battleground

• Cultural trends contributed to new/controversial biotech-related practices (refusal of life extension; living wills; ART; embryo storage/research; etc.):

• Patient autonomy movement piggybacked on consumer-rights, civil-rights movements

• Increasing familiarity of biotech in general (transplants, life-support, etc.)

• More-permissive sexual morality

• Increasing reproductive options for women

• Acceptance of “non-traditional” families

• Liberal values / policies seemed ascendant, 60s – 80s (90s?)

• Biotech raced forward – overlapping controversies (IVF/surrogacy/cloning/etc.)

• Biotech issues arose piecemeal – unrelated technologies, no “conspiracy”

Biotech controversies multiplied as social mores changed and technological advances piled up at a rapid rate.

5

Culture of Death

Liberal Defenses of Biotech Advances

• Liberals defended reproductive freedom and new biotech on personal liberty/autonomy basis (“classical liberalism”) and as civil rights issues (“new liberalism”):

• Reproductive autonomy (“family planning”, contraception, abortion, ART)

• Patient autonomy (Quinlan (1976), Principles of Biomedical Ethics (1979), Cruzan (1983)), termination of treatment, “right to die”

• Self-actualization movement (cosmetic surgery, gender reassignment [Walter/Wendy Carlos, 1972; Renee Richards 1975/77], body modification)

• Technology advances defended as contributions both to basic science and to personal liberty

• Conservative opposition pitched as anti-science and anti-liberty

• Decline of overtly religious social mores shifted presumption in personal/bio-medical liberty issues to favor autonomy / experimentation

• Rise of “bioethics” as a field/profession moved debates to academic/philosophical turf, away from tradition or religion

The rhetoric and perspectives of the broad movement toward greater personal liberty and reduced social/legal pressure for conformity created a climate favoring liberty in use of biotech – and the legal framework to make it stick.

6

Culture of Death

Conservative Criticism of New Technologies / Liberties

• At first, focused on specific issues for specific reasons:

• Contraception violated religious mores, elevated sex

• “Human beings” killed by abortion (later IVF, stem cell research)

• Euthanasia / termination of treatment / living wills smacked of suicide, violated God’s will, rejected “gift of life”

• Etc.

• This divided conservative community into separate issue groups, sometimes at odds

• Protestants generally unmoved by contraception issue; some Catholics favored IVF

• Broader coalitions generally organized around religious affiliations or party politics

• Conservative funders/groups created think-tanks, lobby shops, publishing houses to promote conservative viewpoint outside mainstream/academia

Conservatives responded to each new issue/technology as it arose – putting them on the defensive during the “liberal ascendancy” period.

7

Culture of Death

Coalescence

8

Culture of Death

Conservative Political Organization Includes Bioethics• Pre-Reagan political conservatives largely focused on electoral politics

• Goldwater / Schlafly / Reagan (pre-Pres)

• Conservative intellectuals outside political activist world• Buckley / Podhoretz / Hayek / Friedman / etc.

• In Reagan years, conservative network sprang up• Funding: Mellon, Scaife, DeVos, etc.

• Think Tanks / Lobbying / Development: Cato Inst., Christian Coalition, Heritage Found.,Olin Inst., Acton Inst., Ctr. Pub. Policy Res., Family Res. Counc., etc., etc.(earlier: Hoover, Amer. Enterprise Inst.)

• Media: Regnery, mainstream conservative imprints, talk radio, Drudge, World Net Daily

• Religious/other conservatives concerned about “life issues” drawn into network

• In G.W. Bush years, conservative bioethics was well-organized:• President’s Council on Bioethics

• Ctr. for Bioethics & Human Dignity, Nat’l Catholic Bioethics Ctr., Ctr. Bioethics & Culture, Amer. Bioethics Advisory Council, Amer. Life League

The “conservative revolution” included the conscious development of cooperating and interconnected organizations forwarding conservative thought in a variety of arenas, including bioethics.

9

Culture of Death

Overlapping Themes Found in “Ends-of-Life” Issues

• “Ends-of-life” – birth and death – found to be similar, not different

• Transition point: Life/Death

• Point at which “personhood” comes into question

• “Vulnerability”: point of inability to speak for own interests/personhood

• Many bioethics issues were ends-of-life issues:

• Abortion, euthanasia, termination of treatment, living wills, futility, stem cells/IVF embryos – obviously

• Contraception, sex-ed, organ harvesting, egg harvesting, cloning – less obviously

• Conservative groups/activists/bioethicists began to focus on ends-of-life as a concept in itself – coordinating activity and resources, bridging gaps between groups with different issue focus

• “Pro-life” became synonymous with more than just abortion

Conservatives created common ground among themselves by grouping ends-of-life issues under an overarching rubric, expanding “pro-life” ideology to encompass many issues.

10

Culture of Death

“Death” Emerges as Theme/Talking Point

• Common thread in ends-of-life issues is death:

•Most ends-of-life issues defined by death to which conservatives object (abortion, stem cell research, termination of treatment, etc.)

• Conservative aim in most ends-of-life issues is to prevent death

• Liberal or non-conservative positions seen as promoting death

•Vagueness as to whether this is a claim of consequence or intention

• This perspective had several strategic implications for conservative bioethics:

•It coordinated activism around different issues into cooperative efforts to prevent undue deaths

•It created a “common enemy”, or common ill consequence, obviating focus on procedure (abortion, cloning, etc.) and reframing around outcome (death)

•Allowed conservatives to make disfavored procedures synonymous with death (abortion is murder, stem cell research is murder, Plan B is abortion/murder, etc.)

Conservative opposition to biotech and other healthcare controversies began to emphasize the death of human organisms as the source of objection – removing sex, liberty, autonomy, reproductive rights, etc. from the debate.

11

Culture of Death

Meme-Making

12

Culture of Death

“Culture of Life”

• “Culture of life” coined as synonymous with Catholic teachings on sexual ethics:

“The culture of life means respect for nature and protection of God's workof creation. In a special way, it means respect for human life from the firstmoment of conception until its natural end." – Pope John Paul II (1993)

“In our present social context, marked by a dramatic struggle between theculture of life and the culture of death, there is need to develop a deepcritical sense capable of discerning true values and authentic needs.”– Evangelium Vitae, Pope John Paul II (1995)

• Adopted into conservative politics:

“Promoting a Culture of Life[W]e say the unborn child has a fundamental individual right to life which cannot be infringed. We support a human life amendment to the Constitution . . . . We praise [George Bush] for signing the Born Alive Infants Protection Act [which] ensures that every infant born alive . . . is considered a person under federal law. . . . And [for] outlawing partial birth abortion . . . . We oppose the non-consensual withholding of care or treatment . . . just as we oppose euthanasia and assisted suicide.” – Republican Party Platform, 2004

The term “culture of life” was coined in a 1993 speech, specifically focusing on abortion and contraception, by Pope John Paul II, and almost immediately invoked the corresponding term “culture of death”.

13

Culture of Death

One Meme Fits Every

• The concept of a “culture of death” was expanded to cover an extraordinary variety of issues:

“[T]he neo-Darwinian outlook provides a handy foundation for the Culture of Death's rejection of human dignity . . . .”– “Darwin, Hitler, and the Culture of Death”, by Michael Baggot, LifeSite News, 5/6/2008

Schopenhauer, Nietzsche, Ayn Rand, Darwin, Galton, Haeckel, Marx, Comte, J.J. Thomson, Sartre, de Beauvoir, Elisabeth Badinter, Freud, Reich, Helen Gurley Brown, Mead, Kinsey, Sanger, Clarence Gamble, Guttmacher, Derek Humphry, Kevorkian, Peter Singer [chapter subjects]– Architects of the Culture of Death, by Donald DeMarco, Ignatius Press, 2004

“What walked into Columbine High School Tuesday was the culture of death.”- “The Culture of Death”, by Peggy Noonan, The Wall Street Journal, 4/22/1999

“Have the [Islamic] religious leaders who preach a culture of death lost their status as noncombatants?”– “Worshippers of Death”, by Alan Dershowitz, The Wall Street Journal, 3/3/2008

“[N]ature, preferring the traditional family, is not fooled by man’s ‘redefinitions.’ The wage for violating the law of nature is not a life of liberation but a culture of death.”– “Constitutionalism”, by Dennis Teti, in On Principle, v4 n3, June 1996

The concept of the “culture of death” has been seized on as a criticism not only of specific positions on ends-of-life issues, but of liberalism and modern society in general.

14

Culture of Death

One Meme Fits All

• And sometimes all at once:

“Homosexuality, Islam, and abortion have something in common. . . . Abortion has proved that we are willing to kill for sex, and homosexuality (AIDS) has proved that we are willing to die for it. A culture of death prevails in our nation today because we, the Church of Jesus Christ, have allowed the seed of the serpent to have its murderous way. . . . Islam is another murderous cover-up for the devil.”– Flip Benham, Director, Operation Rescue & Operation Save America

“This culture of death is all so rational; indeed reason run amuck. We are mad with reason. Death is seen as the solution to the problem. Take the pill, fall asleep, abort the fetus and get on with an unencumbered life.”– Peter Sellick, “Our Culture of Death”, ON LINE Opinion, 10/31/2008

“Like a successful corporation, the culture of death is gaining market share. As late as 20 years ago, it was confined mainly to abortion clinics and hospitals. It now has expanded to research labs: ten states permit embryonic stem cell research, while eight states permit human cloning, known as "therapeutic cloning." . . . Both Democratic presidential candidates [and] Sen. John McCain, support taxpayer-financed embryonic stem cell research.”– Mark Stricherz, “Exposing Culture of Death, Inc.” (review of Embryo: A Defense of Human Life, by Robert P. George and Christopher Tollefsen, in Catholicity, 3/29/2008)

“Culture of Death: abortion, euthanasia, contraception, homosexuality, so-called gay ‘marriage’, embryonic stem cell research, in-vitro fertilization, etc. . . .” – “bob”, (some clown who comments on my blog)

The expansive conception of “the culture of death” allows commentators to bring many issues under the same critical attack simultaneously.

15

Culture of Death

“Culture of Death”

• The phrase “culture of death” became prominent within conservative commentary, especially in regard to bioethics issues:

“We cannot but recall today that shadows of death threaten people’s lives at every stage of life, are especially menacing at its earliest beginning and its natural end. The temptation is becoming ever stronger to take possession of death by anticipating its arrival, as though we were masters of our own lives or the lives of others. We are faced by alarming signs of the "culture of death", which pose a serious threat for the future.”

– Urbi et Orbi, Pope John Paul II (Christmas, 2000)

“[Contraception is] not about choice. It's not about health care. It's about making everyone collaborators with the culture of death.“

– Dr. Susan Orr, 2000 (Bush appointee as HHS Acting Deputy Asst. Sec. Population Affairs)

“Before this column appears, Terri Schiavo may well be dead. If so, another milestone will have been passed in the long retreat of Western Civilization from a Christian-rooted culture of life to the pagan culture of death of pre-Christian Rome.”

– “The Culture of Death Advances”, by Pat Buchanan, World Net Daily, 3/30/2005

“[Peter Singer’s] philosophy is one-sided and distorted. It plays into the Culture of Death because it distrusts the province of the heart, fails to and discern the true dignity of the human person, and elevates the killing of innocent human beings . . . .”– “Peter Singer: Architect of the Culture of Death”, by Donald DeMarco, Social Justice Review 94no. 9-10 (September/October 2003):154-157

“Culture of Death” soon caught on among conservative social critics, as both a criticism of policies they opposed and a rallying-cry for their supporters.

16

Culture of Death

“Culture of Death” in Bioethics Debates

• Several prominent conservative bioethicists adopted the meme:

• Wesley J. Smith (Culture of Death: The Assault on Medical Ethics in America)

• Ramesh Ponnuru (The Party of Death: The Democrats, the Media, The Courts, and the Disregard for Human Life)

• Donald DeMarco (Architects of the Culture of Death)

• Similar themes from Leon Kass, Robert George, W.E. May, etc.

• The “culture” encompasses not only a conglomeration of issues, but also social trends and the individual philosophers or bioethicists seen at fault for creating the “culture”

• Thus, one can be part of “the culture”, subject to it, living within it, or working for/against it

“Culture of Death” soon caught on among conservative social critics, as both a criticism of policies they opposed and a rallying-cry for their supporters.

17

Culture of Death

How Does “Death” Function in “Culture of Death”?

• Note that we are getting far from the original concept of “ends-of-life”

• “Death” may appear indirectly

• Secondary effect of certain policies (liberalized drug laws, etc.)

• Generalized social disinhibition or desensitization to death (acceptance of assisted suicide)

• Death may be semi-metaphorical

• Exclusion of disabled from society; indifference to disabled persons’ health needs

• Regard of some human beings as non-persons (fetuses, brain-dead)

• Death may come to pervade society

• Violent media; graphical killings

• Inter-generational conflicts, refusal to care for elderly, etc.

“Death” becomes not merely a danger but a symptom of societal decline: we become more accepting of death, which makes us less concerned about deaths.

18

Culture of Death

Current Debate

19

Culture of Death

“Culture of Death” Proves a Potent Political Weapon

“Since 1973's Roe vs. Wade ruling, the death toll every day duplicates the number of innocents killed on 9/11. Yes, 3,000 daily abortions. Who can be excused? Who will vote for intrinsically evil crimes on the altar of human sacrifice? Why worry about financial or national security when voting for death and destructive actions? Sens. Obama and Biden command the culture of death, not change. Obama lacks leadership and moral values. Such a candidate does not belong in the White House.– Michael J. Kabacinski, letter to the editor, The Morning Call, 10/30/2008

• Note this requires/assumes a receptive audience that understands and responds to the concept of the “culture of death”

• To the extent these appeals work – even on partisan “base” – they demonstrate the increased political salience of the “culture of death” meme in contemporary politics

The concept of the “culture of death” has reached the point that it can be used effectively as a political appeal – to a receptive audience.

20

Culture of Death

“Culture of Death” Becomes a Target, Not Just a Criticism

• The “culture” can be taken literally

• “Changing the culture” is a focus of some conservative activism

• Different from opposing individual policies or attacking general “culture of death” mindset

• Some conservatives are/were(?) playing a long game:

• Incrementally make abortion less accessible/”crisis pregnancy” care more accessible

• Improve end-of-life care to obviate assisted suicide

• Dissenting opinions on contraception

• Overall goal is to change public attitudes toward controversial procedures

Some conservatives have launched a “culture change” project to rehabilitate the “culture of death” as a means of eliminating objectionable acts or policies – implicitly accepting that the “culture of death” is now the dominant culture.

21

Culture of Death