The dominant intellectual culture of the Western world is undergoing profound change. The enormity of what is taking place and the accompanying fundamental shift in underlying moral commitments is difficult fully to express. The implications, however, have been particularly prominent in medicine and bioethics. Practices that prior generations would have recognized as medically and morally impermissible, such as eugenics, abortion, physician-assisted suicide, and active euthanasia are growing elements of health care. Bioethicists routinely endorse a reproductive ethos framed within a moral account of “responsible parenting”, encouraging individuals and couples carefully to choose when to become parents and to be selective about those children conceived and born. Ultrasound scanning, maternal serum screening, and other forms of genetic testing, such as chorionic villus sampling, fetal biopsy, or amniocentesis to check for genetic conditions, to encourage abortion of less than perfect offspring are standard aspects of prenatal care in much of the Western world.
Where once abortion was recognized as the killing of a child in the womb, where even pro-choice activists were committed to keeping abortion safe, legal, and rare; the goal has become abortion without restriction and without apology until the child is born. Some scholars even argue for the acceptability of infanticide as a sort of “after birth” abortion, where killing the newborn should be permissible anytime abortion would have been (Giubilini and Minerva 2013). The legal availability of abortion and medically assisted death are appreciated as keystones for securing the autonomy of persons. The spring and summer of 2022 quickly became an age of rage, as protests accompanied the announcement of the Dobbs v. Jackson Women’s Health Organization (No. 19-1392, 597 U.S.__(2022)) decision, the United States Supreme Court opinion overturning Roe v. Wade (1973), which had created a Constitutionally protected right to abortion. That many legal scholars considered Roe v. Wade a poorly reasoned judgment, that majorities of men and women in the U.S. think there should be (perhaps significant) limits on abortion, or that many of the individual states will surely provide very easy access to abortion as such decisions are returned to the voters, did little to temper pro-abortion outrage.
Physician assisted suicide and active euthanasia are similarly being systematically assimilated into healthcare. While laws regarding medically assisted death vary, Belgium, Luxembourg, Switzerland, and the Netherlands have embraced forms of medically assisted dying for some time (see, for example, Gordijn and Jansses 2001; Cohen-Almagor 2016). In North America forms of physician-assisted suicide are legal in Washington, DC and at least the states of Oregon, California, Colorado, Washington, New Mexico, Maine, Montana, New Jersey, Hawaii, and Vermont. Canada has enthusiastically embraced physician-assisted suicide and active voluntary euthanasia, with such practices compassing more than 3.3% of all deaths in 2021. In some countries and jurisdictions, it is not even necessary to have a terminal illness or to be in significant physical pain to be eligible for active euthanasia or assisted suicide. Rhetorically referred to and justified under the thinly veiled euphemism “Medical Assistance in Dying”, such practices have brought the active killing of patients openly into medical care.
Consider also that many no longer appreciate differentiation between the sexes, male and female, to be a basic fact of biological reality. Bioethicists, hospitals, and medical centers assert that children are “assigned” a sex at birth, that women can have a penis, and that men can have a vagina, get pregnant, and breastfeed. It is not just that disorders of sex development exist, such as rare cases of an individual being “intersex”. Instead, the biological reality of being male or female has been brought into question as no more than historically and culturally conditioned social constructions. The Boston Medical Center’s website, for example, chastises critics for thinking that the “assigned sex at birth and/or gender are a fixed, concrete concept and/or binary” with male or female being the only options. Major medical schools and healthcare providers, such as the Vanderbilt University Medical Center, provide specialty clinics focused on hormonal, surgical and other forms of therapy for individuals, including adolescents, who self-identify as transgender. California has sought to make itself a sanctuary state for transgender youth, passing a law giving itself emergency jurisdiction over any child in the state if the child has been “unable to obtain gender-affirming health care or gender-affirming mental health care”, reportedly even if the underage child’s parents object, whether or not they live in California. Indeed, the United States Senate confirmed a Harvard University Law School trained jurist to the U.S. Supreme Court, who testified publicly under oath during her confirmation hearings that she did not know how to define “woman.”
The zeitgeist driving such fundamental intellectual changes is new. Shifting understandings of what constitutes a biological fact of the matter and the desire to enshrine a strong legal right to abortion and euthanasia on demand mark a profound change from what had been the background Christian foundations of the West. Few anymore affirm God’s existence in the public square. Fewer still take God’s commands seriously when thinking through how best to shape personal behavior, medical treatment, or public policy. Reference to God for personal guidance opens one up to public shaming, political ridicule, and professional ostracization. As this volume explores, the recent history of bioethics discloses a significant shift in moral commitments within the dominant intellectual culture of the Western world. The implications are wide-ranging and profound.
Healthcare professionals find themselves working within a new cultural context. Actions that the Christian West had always treated as matters of serious moral significance, such as abortion, sexual intercourse, reproduction outside of the marriage of man and woman, surrogate motherhood, third-party assisted reproduction, castration, physician-assisted suicide, and euthanasia among others have been deflated and demoralized into preferred lifestyles and deathstyles. Each simply represents a different way in which one might choose to live one’s own life. Some, such as abortion and same-sex marriage, have been enshrined into law or become the subject of legal decisions, with dissenters dismissed as anti-women, anti-science, or bigots. Others, such as active euthanasia, gender reassignment procedures, and addiction, remain the subject of scientific and moral controversy regarding concepts of health, disease, and appropriate medical care. As I explore throughout the volume, in the process of rejecting its Christian roots the Western world has upended traditional understandings of truth, including epistemological and ontological concerns central to scientific and moral judgment, thereby reshaping medicine and society.
(excerpted from chapter 1)
