When the University of Notre Dame’s O. Carter Snead published What It Means to Be Human in late 2020, Roe v. Wade remained an entrenched precedent in US law enshrining abortion as a legal right. Now, however, in light of the Supreme Court’s overturning Roe in Dobbs v. Jackson Women’s Health Organization, Snead’s book has gone from engaging to urgent—so much so that the New York Times listed it as one of the ten books to read to understand the abortion debate in the United States.
Snead calls for the United States, and the West more generally, to develop a legal approach to bioethical issues that recognizes human embodiment and vulnerability, rather than solely championing radical individualism. He focuses on three bioethical controversies that particularly showcase the dark side of individualism: abortion, other artificial methods of reproduction (such as in-vitro fertilization and surrogacy), and end-of-life measures like assisted suicide/euthanasia. He gives a detailed ‘genealogy’ of public bioethics in America, identifying the legal cases which have birthed our present-day conflicts and showing how our contemporary bioethics is supported by the insufficient understanding of the human person which constrains medical judgment in the West.
Snead is the director of the DeNicola Center for Ethics and Culture at Notre Dame. He defines “public bioethics” as the “governance of science, medicine, and biotechnology in the name of ethical goods. ” It is a fraught domain, straddling partisan, creedal, and deeply personal tensions.
The aftermath of the Dobbs decision illustrates this multi-layered conflict well, with many of those who identify as anti-abortion nevertheless vocalizing their dismay at the rolling back of federal protections for abortion services. These voices maintain that abortion laws ought not be reversed until there are stronger social supports in place for the vulnerable women who are driven to choose abortion in the first place. Snead , however, contends that this is a fundamental mistake.
To make such an argument is to overlook the formative role of the law. Snead argues, “we must remember that the law exists to protect and promote the flourishing of persons by regulating conduct, but also to teach and shape the public’s understanding of the demands of justice, freedom, and equality.” Laws pertaining to bioethical issues, at least in the United States, have emerged largely in response to various abuses and controversies, such as the Tuskegee Syphilis Experiment, in which the government conducted a study on a group of nearly 400 African American men without their knowledge or consent. Over half of the men were designated as a control group and left untreated for decades after a treatment became available. This horrific abuse led to the National Research Act in 1974, which mandated certain ethical standards for medical research.
Snead argues that law has a purpose beyond the mere prevention of such violations of human dignity. He suggests that “the richest understanding of the law is an anthropological one.” Snead’s contribution here to the field of public bioethics is a meaty consideration of how existing laws are shaping public ethical understanding, and whether this public understanding, which is largely based on legal principles, can be reconciled with the lived reality of human persons—a reality that goes far beyond legal principles and touches on social, emotional, and theological truths.
This project—the examination of bioethical disputes through the lens of legal precedent— is possible because the field of bioethics is increasingly delineated and dominated by lawyers and legal experts, as theological voices have faded from the conversation. Daniel Callahan has referred to this as the “secularization of bioethics.” Regardless of one’s position on the validity of religion, Callahan argues, it is clear that “[religious perspectives] have provided a way of looking at the world and understanding one’s own life that has a fecundity and uniqueness not matched by philosophy, law, or political theory.” Abandonment of the Christian tradition has cut the West off from that tradition’s strong sense of the dignity of the body and the value of human interdependence, and has reduced our understanding of the human person to the one-dimensional limits of existing law.
Individualism vs. interdependence
Although the idea of interdependence is hardly a new one, it has made a resurgence among those dealing with topics of community, care, and human dignity. It offers a compelling antidote to the dominant anthropology of today. Throughout the past century, many Western thinkers focused on defending the rights and dignity of the individual against the encroaching threats of collectivism. However, this defense too often ignored the reality that individuals are rooted in communities, upon which they are dependent at various points throughout their lives. We come into the world dependent on our parents for every element of our care, and we continue to depend on others as we are educated and grow in virtue. When we are sick; when we are injured; when we reach the end of our lives; again and again, we need the help of our families, friends, and neighbors. Today, though, it is all too common to prize self-sufficiency as a virtue—a virtue by nature inaccessible to the sick and to the disabled, to pregnant women and to the elderly, and to children of any age.
Drawing on philosophers such as Robert Bellah, Michael Sandel, Charles Taylor, and Alasdair MacIntyre, Snead describes the anthropology which shapes contemporary bioethics as both “expressivist” and “individualist.” This anthropology of individualism prompts us to hold up the isolated individual as the fundamental unit of society. In addition to overlooking the fact that each of us is “embedded in a web of social relations,” the individualist narrative reduces each person to nothing more than his will. Thus, he is defined by what he chooses. This obscures the embodied nature of the human person, and it has dire implications for the personhood of people, like embryos or Alzheimer’s patients, who are limited in the autonomous exercise of the will.
Simultaneously, the anthropology of expressivism prompts us to place undue significance on expressing our “inner depths.” Snead summarizes this notion as the belief that “individuals thrive insofar as they are able to freely create and pursue the unique projects and future-directed plans that reflect their deeply-held values and self-understanding.” Over-emphasizing self-expression only exacerbates fear of death and undercuts the sanctity of the lives of people with grave illnesses or injuries . When our individual life projects are the center of the universe, then the world passes away along with us—or with our ability to act out those projects.
The replacement of morality in the public discourse with ‘rights talk‘ is further evidence of expressive individualism’s dominance. This, too, comes at the expense of the most vulnerable in our midst. Snead writes that the “primary mechanism” of expressive individualism in the sphere of American public bioethics is “the assertion of ‘negative’ rights. Negative rights (e.g. freedom of speech, freedom of religion) are those rights which assert that an individual ought not to be prevented from the pursuit of a particular good. They have long held sway in American political life, and international organizations such as the United Nations and the European Union invoke them more and more frequently.
Is there a problem with the hegemony of negative rights? After all, the assertion of rights-language has protected the dignity of billions across the globe, especially since the Second World War. But in Snead’s view, negative rights don’t do enough for those to whom “more than justice is owed.” Stanley Hauerwas, an ethicist at Duke University and friend of the DeNicola Center for Ethics and Culture, argues to this effect in an essay on “How to Think Theologically About Rights.” Hauerwas suggests that, while rights talk might be helpful in adjudicating disputes between strangers, it is “inappropriate for determining the relationship between parents and their children.” This reflects Snead’s treatment of the abortion issue, in which he admonishes those who would remove from the context of the parent-child relationship.
Snead argues that the key to countering expressive individualism and the amorality of rights-dominated discourse is to “remember the body.” In holding fast to our embodied nature, we push back against the lie that the human person can be reduced only to a will or to a life project. Remembering the body must begin with the acknowledgement that we all came into the world dependent on the “unconditional care and concern” of others for our survival. As we age, we continue to be dependent on others “to teach us how to behave, the habits of forbearance and delayed gratification, the discipline to restrain our selfish animal impulses to put ourselves first, and the moral vision to see others as objects of respect and concern, with goods that we share in common.” Later, in periods of illness and old age, we will need the same unconditional care we required in our infancy. Having ourselves received such care from others, we have the obligation to pattern our lives so as to care for the vulnerable in our own lives, whether children, friends, or aging parents.
These networks of care are made possible by the cultivation of what Alasdair MacIntyre (in his book Dependent Rational Animals) calls “the virtues of acknowledged dependence.” These virtues fall into two categories: those that shape us for “uncalculated giving” and those that encourage “graceful receiving.” The former includes hospitality, just generosity, and misericordia, which Snead describes as “the virtue of taking on the suffering of another as your own.” Among the virtues of graceful receiving, we find gratitude and humility. Snead writes that the person who has been formed by these virtues will have a “disposition of welcoming and hospitality to others in all their uniqueness and particularity, a toleration of imperfection and difference.” Such a disposition would certainly be a refreshing presence in our conflict-ridden times.
According to Snead, these virtues can only exist in society when we intentionally develop the moral imagination. Each person learns to look beyond the narrow strictures of what is “rightfully” owed and begins “to see himself in the dependent child, the disabled, and the elderly to remember his origins and his future.”
What many of us do not realize, however, is the degree to which the moral imagination is shaped by the law.
Parenthood as paradigm
Snead does his best work where he considers how the virtues of acknowledged dependence apply to particular bioethical issues, particularly abortion and assisted dying laws. Over the past century, the majority of the world’s countries have legalized abortion—and these laws have, for the most part, become looser and looser. This has led not only to billions of deaths but also to irreparable harm for the women abortion purports to help. For Snead, the paradigmatic example of the virtues of acknowledged dependence is the relationship between parent and child:
[Michael Sandel] describes parenthood as a “school of humility,” in which we ideally accept children as gifts rather than products of rational control and place their needs and futures above our own. The lived reality of dependence, relationality, and intersubjectivity comes into sharpest relief between parents and children. Becoming a parent makes it (sometimes painfully) clear that one’s good is not entirely self-contained to the truth and goals found solely by interrogating one’s inner depths.
For MacIntyre, parenthood to a disabled child is the true exemplar of the virtues of giving and receiving. In such cases, mothers and fathers must show unconditional care throughout the entirety of a child’s life—not merely until he can walk or talk or feed himself.
Laws legalizing abortion obscure the relationship of care between parent and child. Instead, they assert the rights of the woman against the child growing in her womb. Snead points out that during the initial legal arguments over abortion in the United States in the 1970s concerns about physical and psychological harms pregnancy might pose for a mother quickly “expanded to the harms to women … caused by unwanted parenthood following the child’s birth.” According to this reasoning, “there is no natural relationship, no claim arising from the maternal-fetal connection or any plea of kinship that can impose an obligation on the woman to carry her in utero offspring to term.” This is a clear manifestation of the anthropology of expressive individualism, which reduces each party in the situation to an isolated, disembodied will.
Snead points out that this is a far cry from the way pregnancy really works. When a mother is expecting a child, there exist “a woman and her biological offspring literally joined in body, one inside the other, utterly dependent on the other, with lives integrated and intertwined to a degree like no other human relationship.” The intimacy of this relationship is the perfect ground on which to cultivate the virtues of acknowledged dependence. The tendency of abortion laws to characterize the relationship with the same impersonal tone as a dispute between business partners is a failure to remember the way in which our bodies shape, limit, and give life to our reality.
Taking seriously the embodied reality of the relationship between the expectant mother and her child calls forth a response from the surrounding community. The concept of the “unchosen obligation” is central to Snead’s treatment of abortion, and it applies to obligations owed both to the unborn child and to the mother herself. We have obligations to vulnerable others, based on their position of their need, that we might not have chosen for ourselves. In her dissent to the Supreme Court’s 2007 judgment against partial-birth abortion, Justice Ruth Bader Ginsburg maintained that abortion was necessary to protect a woman’s “dignity and autonomy, her personhood and destiny … her place in society.” The fact that anyone could argue for the destruction of unborn life in order to safeguard a woman’s dignity should give us pause. Just as parents and children are not isolated wills in opposition to each other, neither do they exist in isolation from a wider network of family, friends, neighbors, and fellow citizens who are called to extend the virtues of acknowledged dependence toward them.
The dependence of the pregnant woman, particularly of the woman facing an unplanned pregnancy, “constitutes a summons for aid that must be answered by all those able to render it.” Snead claims that “this is an unchosen obligation that binds everyone who can to respond to her vulnerability and need.” Furthermore, these obligations do not end with the birth of the child; the community must continue to serve the postpartum mother and her newborn child.
Laws legalizing abortion impoverish the moral imagination of society, leading us to view abortion as a solution to the vulnerability and neediness of an expectant mother and her unborn child. Instead, we should strive for laws that recognize both the inviolable dignity of the unborn and the necessity of social support for mothers in need.
Dependence and dying
The influence of expressive individualism and necessity of community support is just as discernible at the end of life as it is at the beginning. Assisted suicide (in which the patient self-administers a lethal drug) is legal in several U.S. states, and voluntary euthanasia (in which a third party kills a willing—or presumed willing—patient ) is legal in Belgium, the Netherlands, Luxembourg, Germany, and Spain, with debates currently taking place in France.
However, Snead begins his treatment of ethics at the end of life by considering those cases in which a third party decides to cease life-sustaining treatment. In almost all such cases, he explains, this decision is made privately. We tend only to hear about termination of treatment “in the rare instance where family members or caregivers disagree so strongly that they seek a resolution through the courts and the court of public opinion,” such as the dispute over Scott Quiner’s treatment for Covid-19 earlier this year. When such cases reach the news, the response tends to be a renewed push for the creation of ‘advanced directives,’ in which able-bodied, fully conscious individuals specify ahead of time the treatment that they wish to receive in future medical situations. While Snead affirms the prudential wisdom of advanced directives, he also situates them within the narrative presented by expressive individualism. The overwhelming tendency to see death as “the final act of life’s drama,” as Oregon’s Death with Dignity Act puts it, is a failure “to account for the diminished agency that comes with suffering, the more complex array of preferences and desires of patients in this context, and the web of other people affected by such decisions.”
The desire to fit death neatly into one’s life project is particularly characteristic of the push for assisted suicide in the United States, where ‘death with dignity’ advocates project, in Snead’s words, “an image of freedom, choice, and dignity that resonates deeply with rugged American individualism and Romantic expressivism.” In Europe, euthanasia laws require “intolerable suffering” as a prerequisite for those seeking to end their lives In the United States, however, a 2018 survey of patients seeking assisted suicide revealed that only 26 percent cited uncontrolled pain as a reason for wanting to end their lives. Meanwhile, 92 percent of respondents expressed fear of diminishing autonomy, 91 percent of “being ‘less able to engage in activities making life enjoyable,” and 54 percent of burdening their family and friends. Since initial legalization, European euthanasia laws have snowballed from openness to voluntary euthanasia to involuntary euthanasia—even allowing euthanasia of children and those suffering from mental illness.
Whether a patient seeks assistance in dying because of extreme pain or because he fears being a burden, the legalization euthanasia and assisted suicide only ends up compounding harm to the most vulnerable. For example, 68 percent of surveyed patients who pursued assisted suicide in Oregon were on government health insurance, which covered assisted dying but capped potentially life-saving interventions. The availability of assisted dying decreases the availability of end-of-life care, and increases the price of the care that is available.
Prior to the legalization of assisted suicide in Oregon, the state had made advances in developing hospice programs. Since legalization, however, the use of hospice care in Oregon has fallen below the national average rate. In 1994, the New York Task Force on Life and Law predicted the way assisted dying laws would effect the most vulnerable: “They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group.” Ultimately, euthanasia and assisted suicide purport to eliminate the pain, suffering, and psychological distress of dying, but end up eliminating the patient instead.
As he does with abortion, Snead calls for the law to strengthen networks of giving and receiving—and to cultivate the moral imagination—in order to counteract the grave harms of current assisted dying laws. During the 2020 lockdowns, several US states directed the Medicaid funds allocated for in-home caregivers towards the spouses, children, and other unpaid caregivers of housebound patients. But what about those vulnerable persons who lack strong familial or social connections? This is where the state might step in to encourage citizens to see themselves in those who are suffering. Despite its lenient laws regarding euthanasia, the Netherlands provides a beautiful example of how this might look. The Humanitas Retirement Village provides rent-free living accommodations for young people in an elder-care facility, with the stipulation that these young residents interact with their elderly neighbors and provide assistance with social media tasks. This creativity in overcoming the isolation and age segregation of an individualist culture is just one way in which society might care for the aging.
In What it Means to Be Human, Snead presents a view of the human person that values broken, fragile, ailing bodies just as much as it values those which are young, strong, and beautiful. He does not offer a definitive solution to the anthropological concerns which he raises—but he proposes that we can do better. As a society, we in the West should turn away from laws that view the mother and the child as conflicting parties; from the temptation to create children in petri dishes; and from the narrative that depicts dying as a burden. Instead, we should strive to support parents (especially those living in poverty), to provide friendship to those struggling with infertility, and to encourage family caregivers of the sick and elderly. In doing so, we all will become a little kinder, a little more understanding, and a little more human.
