The traditional Western ethic has always placed great emphasis on the
intrinsic worth and equal value of every human life regardless of its stage or
condition. This ethic has had the blessing of the Judeo-Christian heritage and
has been the basis for most of our laws and much of our social policy. The
reverence for each and every human life has also been a keystone of Western
medicine and is the ethic which has caused physicians to try to preserve,
protect, repair, prolong, and enhance every human life which comes under their
surveillance. This traditional ethic is still clearly dominant, but there is
much to suggest that it is being eroded at its core and may eventually even be
abandoned. This of course will produce profound changes in Western medicine and
in Western society.
There are certain new facts and social realities which are becoming
recognized, are widely discussed in Western society and seem certain to
undermine and transform this traditional ethic. They have come into being and
into focus as the social by-products of unprecedented technologic progress and
achievement. Of particular importance are, first, the demographic data of human
population expansion which tends to proceed uncontrolled and at a geometric rate
of progression; second, an ever-growing ecological disparity between the numbers
of people and the resources available to support these numbers in the manner to
which they are or would like to become accustomed; and third, and perhaps most
important, a quite new social emphasis on something which is beginning to be
called the quality of life, a something which becomes possible for the first
time in human history because of scientific and technological development. These
are now being seen by a growing segment of the public as realities which are
within the power of humans to control and there is quite evidently an increasing
determination to do this.
What is not yet so clearly perceived is that in order to bring this about
hard choices will have to be made with respect to what is to be preserved and
strengthened and what is not, and that this will of necessity violate and
ultimately destroy the traditional Western ethic with all that this portends. It
will become necessary and acceptable to place relative rather than absolute
values on such things as human lives, the use of scarce resources and the
various elements which are to make up the quality of life or of living which is
to be sought. This is quite distinctly at variance with the Judeo-Christian
ethic and carries serious philosophical, social, economic, and political
implications for Western society and perhaps for world society.
The process of eroding the old ethic and substituting the new has already
begun. It may be seen most clearly in changing attitudes toward human abortion.
In defiance of the long held Western ethic of intrinsic and equal value for
every human life regardless of its stage, condition, or status, abortion is
becoming accepted by society as moral, right, and even necessary. It is worth
noting that this shift in public attitude has affected the churches, the laws,
and public policy rather than the reverse. Since the old ethic has not yet been
fully displaced it has been necessary to separate the idea of abortion from the
idea of killing, which continues to be socially abhorrent. The result has been a
curious avoidance of the scientific fact, which everyone really knows, that
human life begins at conception and is continuous whether intra- or
extra-uterine until death. The very considerable semantic gymnastics which are
required to rationalize abortion as anything but taking a human life would be
ludicrous if they were not often put forth under socially impeccable auspices.
It is suggested that this schizophrenic sort of subterfuge is necessary because
while a new ethic is being accepted the old one has not yet been rejected.
It seems safe to predict that the new demographic, ecological, and social
realities and aspirations are so powerful that the new ethic of relative rather
than of absolute and equal values will ultimately prevail as man exercises ever
more certain and effective control over his numbers, and uses his always
comparatively scarce resources to provide the nutrition, housing, economic
support, education, and health care in such ways as to achieve his desired
quality of life and living. The criteria upon which these relative values are to
be based will depend considerably upon whatever concept of the quality of life
or living is developed. This may be expected to reflect the extent that quality
of life is considered to be a function of personal fulfillment; of individual
responsibility for the common welfare, the preservation of the environment, the
betterment of the species; and of whether or not, or to what extent, these
responsibilities are to be exercised on a compulsory or voluntary basis.
The part which medicine will play as all this develops is not yet entirely
clear. That it will be deeply involved is certain. Medicine's role with respect
to changing attitudes toward abortion may well be a prototype of what is to
occur. Another precedent may be found in the part physicians have played in
evaluating who is and who is not to be given costly long-term renal dialysis.
Certainly this has required placing relative values on human lives and the
impact of the physician on this decision process has been considerable. One may
anticipate further development of these roles as the problems of birth control
and birth selection are extended inevitably to death selection and death control
whether by the individual or by society, and further public and professional
determinations of when and when not to use scarce resources.
Since the problems which the new demographic, ecologic and social realities
pose are fundamentally biological and ecological in nature and pertain to the
survival and well-being of human beings, the participation of physicians and of
the medical profession will be essential in planning and decision-making at many
levels. No other discipline has the knowledge of human nature, human behavior,
health and disease, and of what is involved in physical and mental well-being
which will be needed. It is not too early for our profession to examine this new
ethic, recognize it for what it is, and will mean for human society, and prepare
to apply it in a rational development for the fulfillment and betterment of
mankind in what is almost certain to be a biologically oriented world society.
