Meeting Transcript
February 2, 2006

COUNCIL MEMBERS PRESENT

Edmund Pellegrino, M.D., Chairman
Georgetown University

Benjamin S. Carson, Sr., M.D.
Johns Hopkins Medical Institutions

Rebecca S. Dresser, J.D.
Washington University School of Law

Daniel W. Foster, M.D.
University of Texas, Southwestern Medical School

Michael S. Gazzaniga, Ph.D.
University of California, Santa Barbara

Robert P. George, D.Phil., J.D.
Princeton University

Alfonso Gómez-Lobo, Dr. phil.
Georgetown University

William B. Hurlbut, M.D.
Stanford University

Leon R. Kass, M.D., Ph.D.,
American Enterprise Institute

Peter A. Lawler, Ph.D.
Berry College

Paul McHugh, M.D.
Johns Hopkins University School of Medicine

Gilbert C. Meilaender, Ph.D.
Valparaiso University

Janet D. Rowley, M.D., D.Sc.
The University of Chicago

Diana J. Schaub, Ph.D.
Loyola College

INDEX

• Session 1: The Concept of Human Dignity
  
• Session 2: The Concept of Human Dignity (cont'd)
  
• Session 3: Moral Obligations to Children
  
• Session 4: The Fundamental Needs of Children
  

   

CHAIRMAN PELLEGRINO:  Good morning.  Welcome.  Let the record show that Dr. Daniel Davis, the Executive Director of the President's Council on Bioethics, is present as the Official Government Representative.

I also want to welcome Dan who was appointed recently to the directorship and he is my boss now, officially.

(Laughter.)

As tractable as I ought to be, he'll have trouble, no doubt, ordering me around, but Dan, we're happy to have you.  Dan, you have his curriculum vitae.  He's come to us from Georgetown with extensive administrative experience, not only in academia, but in government and otherwise.  He has his doctorate degree in philosophy, and his concentration is in philosophy of medicine. 

Dan, thank you for joining us.

DR. DAVIS:  Thank you.

SESSION 1: THE CONCEPT OF HUMAN DIGNITY

CHAIRMAN PELLEGRINO:  The first session this morning is a continuation of our discussion on the question of dignity.  As you know, we've been looking at it.  The Council has used the term in a number of its publications, explicitly and implicitly, and we thought it well to examine the spectrum of meanings from wide points of view.

This morning we have two points of view presented.  We'll start first with the representation our first speaker will give us, from the point of view of philosophy and philosophy of neurobiology, looking at the question of human dignity.

You have the curricula of all the speakers and I'm not going to vex them or put them through the déja-vu phenomenon, hearing themselves described again and asking who is it that they're talking about.  So if you make reference to the text, I think you'll have it straight and in no way filtered through my aging cerebrum.

So we'll start, immediately, Dr. Churchland.  The floor is yours.  We'll follow the usual procedure.  Following Dr. Churchland's presentation, we'll have an open discussion by the Council Members and we'll begin immediately to try to keep ourselves on schedule.

Dr. Churchland.

DR. CHURCHLAND: Thank you so much and thank you so much for inviting me to be here.  It's a great privilege to be here and I come with good wishes from my colleagues in California.

I looked over the working paper prepared by Adam Schulman and this was after I had accepted your invitation and I was really quite daunted, because it's such a wonderful document that I felt I really might not have much to add.

So I spent a certain amount of time thinking how I could be most useful to the Committee.  And my view was that it might be better, rather than to — let's see now, all right, how do we do this?  There you are.

Rather than to focus on a discussion of the concept of dignity, to just sort of remind ourselves, I think what we all know is that categories including categories about ethics and politics, as well as categories about the natural world, are learned from examples.  They have a radial structure by which I mean there are sort of central exemplars and then further out from the central exemplars are cases where some people think they fall in the categories.  Some people think that they don't.  And there may not be agreement.

The other thing about categories that we all know is that they change over time.  When I looked in the OED as to what Chaucer thought dignity meant, it's really a little bit different, I think, from what Shakespeare meant later on and probably also what we mean now.

Schulman noticed this, of course, in his discussion of dignity and so he asked the question what is essential to human dignity.  And I thought perhaps it might be most useful to the Committee if I approached this in a slightly indirect way.  And the perspective that I'm going to take will be the perspective of biology or more specifically neurobiology.

And the first point that I want to make has also been made by many other people, including Mike Gazzaniga, who is here, which is that moral dispositions are part of our human nature.  Second, I'm going to make several historical points on medical technologies.  And finally, I'm going to draw a connection between Aquinas and modern neuroembryology.

Moral dispositions are part of who we are.  It appears from everything we know from both neurobiology, but certainly evolutionary biology and ethology that we social groups have been selected for, that individuals who had social traits such that they could cooperate, share food, share in defense and so forth, did very well.  And consequently, the disposition, via the genes, is in many social animals to behave well towards one another, care for one another, and whatever is necessary in order for traits to propagate through or spread through a population.

And certainly one is that people have to — or animals have to be able to identify one another.  They have to be able to cooperate and to compromise.  They also have to be able to detect cheating and to be willing to punish the cheaters.

We know, of course, that there is an interaction between genes and culture and between culture and learning, that the genes do not wire up the brain for specific standards of behavior, but that standards of behavior are typically learned by the young in the social group.

We also know now that learning involves changes in gene expression, and that certain properties have to be in place in the neonate in order for social dispositions to flourish, for example, it's now known, although this is not surprising, that levels of oxytocin vary as a function of infant fondling and that levels of oxytocin and consequently levels of — or population density of oxytocin receptors are extremely important for social cognition, generally, and for social behavior, in particular.

So that's just the very general kind of background that I want to give you about the neurobiology or more generally, the biology of social behavior.  It's the particular standards that vary from culture to culture and indeed vary within a culture over time that I now want to turn to.

There have been profound changes in moral beliefs about certain kinds of practices.  At various points in our own culture, public executions were common as was child labor, slave labor, genital mutilation and lack of female suffrage.  This, of course, has changed, and I just use this to remind us that, in fact, child labor was very common.

And I want now to specifically address, not just changes in attitudes toward certain institutions, but also I want to look a little bit more closely at changes in attitudes toward specific medical technologies.  Now what I'm going to say hereafter really does require quite a lot of commentary and I was a little bit reluctant to send out the slides in their naked form because I can't provide the commentary unless I'm actually here.

So I want to provide some commentary, but I also want to invite commentary on this and Ed Pellegrino has already been very helpful in making some observations to me.

All right, a very general background point, and it looks like the following, that when humans are ignorant of the causes and the mechanisms of a particular phenomenon they can't control it, whether it's the weather or certain kinds of diseases or what have you.  And when we are ignorant and we cannot control it, we tend to acquiesce and we see the gods or God as the thing that is in control of it.

As we acquire knowledge, we often acquire control and it's not uncommon and it's quite understandable that through this transition, we tend to see technology as usurping the proper role of God.  And this was, for example, true with regard to anesthesia.  Many people felt that the experience of pain, especially in childbirth, was entirely appropriate and that it would be usurping God's proper role to intervene in amelioration of pain in childbirth.

But when the benefits of a particular technology become well understood, when those benefits are seen to be dramatic and to overwhelm the particular objections of tradition, then we tend to see a moral reversal.  Not just a wholesale reversal, but what typically happens, and of course, we've seen this in our own time with genetic engineering, limits are negotiated.  We say that the technology has a particular sphere within which it can operate and then we put limits and regulations on the development of that technology.  And that's, of course, very true of anesthesia.  You can't just haul off and anesthetize people or yourself willy-nilly.  It has to be very highly regulated and highly controlled.

So I want to remind you that there has been opposition and reservation on the part of various religious groups throughout history with regard to medical technologies.  At the same time, and this I couldn't actually put in the slides, it's very important to understand that there have been just the same, many religious groups who have been wholly supportive.  And so often, the controversy has really been within religions as opposed to a controversy between religion and the secular world.

In the 18th century, once smallpox vaccination was discovered, it was bitterly opposed by various sects, although so far as I could tell, not officially, for about 30 years.  Actually, it extended much beyond that, well into the late 19th century in Montreal in Canada.  French theologians in the Sorbonne objected, English theologians objected and I just mentioned two papers that were really quite influential.  And there really was very little religious basis for the objection to smallpox, but roughly speaking, people referred to those who did oppose, referred to the text where it is said "He hath torn and he will heal" which of course, is very open-ended and ambiguous after all.

But the relief from smallpox via vaccinations was, of course, extraordinary.  At one point there were roughly 1 in 13 children who died every year of smallpox.  Within a period of about 20 years, that completely changed, and as we know within our own time, it's extraordinarily rare to meet anyone who has ever known anyone with smallpox or even very few of us who have had a smallpox vaccination, although I bet you have and I certainly did too.

And now we still see reservations about other kinds of vaccines.  For example, the Focus On The Family organization is concerned about the vaccine for cervical cancer which we have reason to believe is about 100 percent effective.  The opposition seems to derive mainly from concern about premarital sex and especially about sex amongst unmarried adolescents.

I'm not putting this here to say that this is an inappropriate concern, but only that we do still have, based on religious concerns, opposition to certain kinds of vaccines.

Now the issue of dissection is slightly more controversial than the slides would suggest.  There was certainly opposition to the notion of dissection of cadavers.  I think Ed Pellegrino can probably give you a more detailed account of this reservation than I can, but certainly there were people in the Renaissance, for example, Leonardo, who was — who had dissected bodies and who was scorned or condemned for having dissected bodies, dead bodies.

Now I want to turn to the issue of anesthesia.  Various kinds of anesthetics have been used for a long time, including especially I think alcohol.  But of course, it was in the 18th and 19th centuries that the really important discoveries were made regarding ether and chloroform and then, of course, later in the 20th century.

The main issue about the use of anesthesia concerned childbirth.  The argument was, and again this is from only some religious orders and opposed by others, the argument was that in Genesis 3:16 it is said to the woman — this, of course, is after the expulsion from the Garden of Eden — to the woman God said, "I will greatly multiply your pain in childbearing, in pain shall you bring forth children."

And the painting that you see here is actually a medieval painting of a woman undergoing a Caesarian section without any sort of anesthesia, typically, of course, they died. 

In America, William Thomas Green Morton pioneered the surgical use of ether in 1846 and in Scotland, it was James Young Simpson who discovered the use of chloroform.

There's quite a lot of documentation regarding opposition in England and in Scotland to the use of anesthesia and there was a lot of debate about it.  And interestingly, still some of Simpson's letters are extant and we can see something of the nature of the debate from his letters.  So I give to you just one very small quote from a clergyman in Scotland who wrote to Simpson arguing "that chloroform is a decoy of Satan.  It appears to be a blessing, but it will harden society and rob God of the deepest cries for help."

Simpson tried to respond to these arguments, but of course, eventually the use of chloroform and ether in childbirth was deemed to be such a blessing and such a boon that these sorts of arguments really just kind of faded away.  And I think it's hard for many people to realize how deep in spirit the opposition to anesthesia was during this period.

Pope Pius XII, 1956, condemns transplants from living donors and Ed Pellegrino informs me that this was only if the life of the person was put in danger.  In other words, it was a very reasonable opposition to the idea that one might sell one's own body in order to provide organs for someone else.  Nevertheless, this was interpreted by many, both within and outside of the Catholic Church as a condemnation of the use of organ transplants at all and especially the use of organ transplants from living donors. 

And what's so interesting about all of these cases is how our attitudes really shifted.  And it almost shifted imperceptibly so that now it is considered a tremendous benefit if a twin provides a kidney to another twin.

And so now we turn to the issue of blastocysts and the use of embryos in stem cell research with the possibility, a possibility of great benefits to humans.  And I'm going to back up a little bit here and address what I think many of the scientists indicated they did not want to address and that is, is the conceptus or the blastocyst a person?        Now in his book, The Ethical Brain, Mike Gazzaniga makes a number of very useful points, but one of the very useful points is on this particular issue.  He points out that continuities are typical in biology and that very often we can, nonetheless, distinguish endpoints of a continuum, especially in those instances where we need some kinds of rules or standards.

Plato actually made the same point.  He said that there is something called the fallacy of the beard.  And the fallacy goes like this.  One might argue that there is no sharp distinction between the clean shaven man and the man with the full bushy beard because at every point there is the tiniest increment of length of hair.  And if one were to argue then that there's no difference between the clean shaven and the bearded man, argued Plato, that would be wrong.  It would make no sense and consequently, we should be able, even if we can't make precise distinctions, we should be able to make rough distinctions that make sense.

And in his book, Gazzaniga essentially argues the same thing.  The blastocyst may have the potential to be a person, but is not yet, in fact, a person and we should be able to distinguish between a conceptus and a fully formed human that is born at term.

We may not be able to draw precise distinction as to exactly where it becomes a human, but we can draw a rough and useful distinction and I'm going to come back to that point in a moment.

And just to add my own point here, I think we need to be terribly careful about the idea that if something is a potential X, then we need to treat it as an X.  I am a potential cadaver.  I am potential fertilizer, but I would not want you to treat me as a cadaver or as fertilizer.

And the point I really want to make now draws on Aquinas.  Aquinas, arguably the greatest Catholic theologian of all time, had a very interesting view about human nature and he addressed very specifically because he was tremendously interested in the biology of all of this, about when the rational soul, meaning the soul that is capable of true mental thought, when the rational soul enters the fetus.  And this was in his famous tract, Summa Contra Gentiles. 

Now what he thought was that there are essentially a variety of stages and that at the very earliest stage what he would call the conceptus, which he really just thought of as the sperm now in a nice environment because he didn't really know that the egg contributed anything, partly because they didn't know there were eggs.  That early on the conceptus has a vegetative or nutritive soul meaning that it can grow and that it can develop.  Later, it has a sensory soul, meaning that it can respond to sensory information.  And significantly later, it has the capacity for thought.  And he thought each of these stages had to be tied to the appropriate bodily organs that were in place at that time.

And part of the reasoning behind this was he wanted to, as Aristotle did, to be able to explain why it is that rocks and streams and trees do not have rational souls.  And the argument is really very interesting and very modern.  The argument is they do not have the appropriate organs.  And they both realized that for rational soul the appropriate organ was the brain.

And so I'm just going to put in this quote which I added on the plane yesterday just to indicate to you how really advanced in his thinking Aquinas was: "The vegetative soul which is present first when the embryo lives the life of a plant is corrupted so that it has its time and then a more perfect soul follows which is at once both nutritive and sensory and then the embryo lives the life of an animal."  (It's not yet a person.)  "With its corruption, the rational soul follows infused from without. "

Now we may not think the rational soul is infused from without or we may, it doesn't really matter to the argument.  In any case, it was his view that males at 40 days had a rational soul and that females at 90 days had a rational soul.  I'm not sure why the difference, but in a certain sense, that's an empirical question and what he would have said is that's a purely empirical question and on which he would be happy to be wrong.

And as I said with regard to the current controversy about stem cells, I actually feel very optimistic, optimistic because of the history of medical technologies and the changes in attitudes that we have seen historically toward medical technologies.  And in concluding then I want to just say a little bit about how maybe we can move from the controversies themselves to negotiating various kinds of regulations, agreements about how to do it so that although we might all need to compromise a little bit, we can move forward.

Colin Blakemore is the head of the Medical Research Council in the United Kingdom and he is the head of United Kingdom regulation of stem cell research.  In 2001, the House of Commons prepared legislation that allowed human fertilization and embryology for research purposes to go on, but they introduced regulations.  And amongst other things, the regulations prohibit reproductive cloning, but it allows for new knowledge and applications.

The House of Lords, the second house, provided bills for a stem cell bank which set down very strict codes of conduct under the regulation of a steering committee.  So very roughly this is how this looks.  So there's a stem cell steering committee and these groups are all independent of one another.  And this is extremely important, I think, in order for the researchers and the donors, for example, to be kept separate.

So in the United Kingdom, the stem cell bank roughly works as follows.  There are separate facilities for research grade and clinical grade stem cell lines.  The banks and the supplies are ethically sourced.  They are quality controlled adult, fetal and embryonic stem cell lines.  They will be accessible to people in the Academy and in industry and overseas, but only with proper license and accreditation and all of this is dependent on the approval of a completely independent steering committee in order for you to have access.

Now I am not sure that this is exactly the pattern that we might want to follow.  I think it will be important for us to see where the strengths are in the U.K. regulatory system, where the weaknesses are, to develop our own regulations that suit us and our particular needs and our particular constituencies.  But I do have — and this is why I'm optimistic — I do have the feeling that, as an understanding of the benefits increases, and as an understanding of what the conceptus really is and what a five-day-old embryo really is, that attitudes will change.  We will see that there are  enormous benefits to be had here and, like any other technology, as long as we regulate it and regulate it well, starting cautiously and moving forward, I think we can do it and I think we can do it well.

So to sort of wrap up and I do apologize for sort of going over all of this very fast, I think there is a way to go forward.  I think we can learn from the past.  I think we can see ways in which small steps can be made.  We need to respect one another's points of view, but we need to listen and we need to be able to compromise with each other.  But let's not simply prohibit all of it.  Let's just find a way to do it right.  Thank you.

CHAIRMAN PELLEGRINO:  Thank you very much, Professor Churchland.  Professor Churchland's remarks are now open for discussion.  If you'll just signify your willingness to comment by turning on the light and we'll try to keep everyone in our minds.  If we miss you, get our attention.

Dr. Meilaender.       

PROF. MEILAENDER:  I have some other more specific questions I may get a chance to get to later, but there's just a general question I wanted to ask first because I'm puzzled.  I didn't think that we'd asked you to give us a suggestion about a way forward.  I thought we had asked you to clarify the concept of dignity.  And I guess I'd like you to say a little bit about what your remarks have to do with the concept of dignity because I'm sort of baffled by that.

DR. CHURCHLAND: I think that's a fair question.  And let me try to address it in the following way.  I began with the notion of the concept of dignity and what I really wanted to stress is that it's not that there is a kind of language-independent or community-independent notion of dignity that lives in Plato's realm, that, as I tried to sort of indicate and I do apologize for doing it in a rush, is that the notion of dignity changes over time.  But I suspect and I don't know whether Mike would agree with me on this, but I suspect that the fundamental dispositions to respect one another, cooperate with one another are very biologically deep and if perhaps that's where dignity resides, then fine.

My guess is that that's where at least the notion that I understand by respect and I think that's pretty close to dignity, I think that's where that resides.  And I think that's probably why although we see enormous differences cross-culturally in specific standards, how justice should be done and whether you should have trial by jury or trial by ordeal.  We see all those kinds of differences.  But fundamentally across all cultures you see this capacity and this willingness for respect for one another, for understanding, cooperation, sharing and also for willingness to punish the miscreants. 

So I have the feeling that the notion of dignity is very deep.  I think that it is part of our social, our biological social disposition.

PROF. MEILAENDER:  Well, there is an awful lot of human history that might suggest the opposite about that willingness to respect each other, but if I understand your answer, then what you're saying is there really isn't some concept such as human dignity.  It's just that we're more or less wired to listen to and respect each other.  That's what the concept means, neither more nor less than that as far as you're concerned?

DR. CHURCHLAND: Well, not exactly because I think built on this fundamental platform, of course, different cultures at different times add their own pieces and their own dimensions.  One of the things that I did in struggling with how best to address the issue of dignity was just to talk to a whole lot of people outside of the Academy because they tend to — anyway.

And so I talked to all kinds of people and asked them really what they had in mind.  And the thing that I found very striking about this little piece of sociology which is not a controlled experiment, is that people did exactly what the OED does.  It starts — they start by giving you examples.  One person, a corporate lawyer, began by talking about dignity under conditions of terrible humiliation.  And so he talked about Martin Luther King.  Other people talked about dignity in the context of having the freedom to pursue one's talents and choices.  And then they would tell a story.

And so what I got was essentially a series of exemplars.  This is what I think dignity is.  And then if I would press them, but what do you really mean by that, they'd say well, I don't know, which is, of course, the right answer.  So that when you look at the OED, what do you see?  Well, they start with Chaucer and then they just move on through a series of authors where they take sentences out of a particular text where the issue of dignity arises.  And you can see development.  These aren't exactly the same in every instance.  But the core of it all, I think, is the ethical brain.  It is what makes us want to cooperate, to want to be part of the human community.  Where that breaks down, I think, traditionally, has been in-group versus out-group.  So we are prepared to be cooperative and to compromise and share within the group, but not so to the out-group.

And as the human community has come to know each other better, those sorts of barriers have broken down and now people are quite ready to be kind and cooperative and helpful to people in the — as it were, the out group.

So I'm sorry if I disappointed you.  But my aim was to try to go at the notion of dignity, as I think it really lives and breathes and then to suggest that because that notion changes, because attitudes towards medical technology change, so I think that we can move forward.

CHAIRMAN PELLEGRINO:  Gil has one more.

PROF. MEILAENDER:  Just a very quick — I have to say I still don't see that as helping too much clarify on the concept of dignity, but I may come back to some other questions later, if I have a chance.  But I just think that's an astonishing account of the world in which we live.  It bears almost no relation to empirical reality as far as I can see it.

CHAIRMAN PELLEGRINO:  Dr. Carson.

DR. CARSON: Thank you.  That was really quite interesting.  I have one observation and then one question.  In the example you gave of the cadaver and the fertilizer, that you were a potential cadaver or potential fertilizer and I could see where you were going with that in terms of the embryo being a potential human being.  However, it seems to me that the direction is incorrect.  If, in fact, the fertilizer or the cadaver were potentially going to become a human being, I think we might treat it differently and we certainly wouldn't be willing to disperse it or cut it apart if we knew it was going to become a human being.  So I think probably you have to reverse the order of the sequence.

Now the question is in terms of the soul that you discuss briefly and to greater detail in the writing that you provided, you indicated pretty much that there really is no such thing.  And my question is, obviously, if there is such a thing it would be relatively intangible and very hard to define.

What evidence would be acceptable to you that there was such a thing?

DR. CHURCHLAND: Ah, well, I think that's a great question.  If there were a research program that could show me that, for example, you needed to use the notion of a soul in order to explain say decision-making or you needed the notion of a soul in order to explain perception, then of course, I would be persuaded.  I mean I think it's an empirical question and so it just seems to me — but, of course, it's also a very private matter.  But it does seem to me that the idea of a nonphysical soul that separates from the physical body is something that's very hard for us to countenance because we know that, for example, when the brain is in the body and certain parts of it are damaged, you lose visual perception or you lose memory or as Mike's work shows that if the brain is split and you have two halves, to some degree they can act independently.

And I mean I think the split brain work in particular, partly because it was early in cognitive neuroscience, really made us realize that there's something very fundamental about what the brain is doing in all of these mental functions and that probably the idea of a nonphysical soul which, of course, Aquinas knew was a problematic idea and basically in a certain sense argued against. 

This is not to say that there isn't something that lives beyond.  I mean I think what does live beyond are our colleagues and our children and our culture and our ideas.  And I think it's also quite possible to have a very, so to speak, spiritual existence in contact with the natural world and with culture and other humans, without thinking that there is a nonphysical soul.

DR. CARSON: But basically it sounds like what you're saying is there really would be no criteria from which — that could be acceptable in the scientific realm that there was such a thing.

DR. CHURCHLAND: Oh, not at all.  I would be happy to see evidence, of course.

DR. CARSON: But what I'm asking is what evidence would be convincing?  It's sort of like the question you ask a child when they don't want to bed and you say well, what would be a good reason for you to go to bed?

(Laughter.)

DR. CHURCHLAND: Let me put the question this way.  I'm going to answer your question with a question.  Suppose I thought that as many people did until about 1950 that life involved élan vital, a spiritual force, that livingness itself was an immaterial force.

Now suppose I ask you, you know, you don't think that that's the case, so what would count for you as evidence that that was the case?  And you'd be hard put to it to answer because you'd say well, look, we know now about life because we know about ATP and mitochondria and RNA and DNA and cell membranes and trans-membrane proteins and how cells make a group.  And if I had to give you what would be evidence for vital force?  Well, I don't know. 

I think we're at a point in science where we say much the same thing about a soul which is that we're not closed-minded about it.  If there were a research program whose conclusion was that, I'd look at it very closely.  So it isn't a closed issue, it's just that's where I see the probabilities lie.

CHAIRMAN PELLEGRINO:  Dr. Schaub.

DR. SCHAUB:  I wanted to ask you a quick question about one of the instances in your presentation and then if you're willing to take questions on the article that was distributed, I'd like to ask you a question about that as well.

DR. CHURCHLAND: Sure.

DR. SCHAUB:  The instance I wanted to ask you about is childbirth and pain and the use of anesthesia.  Hasn't there been a backlash against the use of anesthesia in childbirth arising not from religious figures but from women themselves?  So it seems that many women desire to bring forth their children in pain and that they believe there is a connection between this great pain and the great joy of childbirth and as a result, there's been a return to natural childbirth.  So I wonder if you could comment on that and maybe tie that to some kind of sense of the dignity of women.

DR. CHURCHLAND: That's a great question.

DR. SCHAUB:  Do you want me to ask the other question now or do you want to respond to that?

DR. CHURCHLAND: Let me answer this one in case I get muddled.  Of course, it's a choice.  And if someone prefers not to avail themselves of it, then that's — that is, indeed, their choice.

The problem was that in the 19th century people wanted it not to be a choice.  They wanted nobody.  And this included people who had to have Caesarian sections. 

Now I know of nobody who argues that in the event of a Caesarian, what you want to do is avoid anesthesia.  But the other point I think is that anesthesia in childbirth in say the 1960s and 1970s was often misused.  And it was often convenient for obstetricians and I'm sure Dr. Pellegrino can correct me on this, but it was often convenient for obstetricians to anesthetize the woman and do it quickly.  And so quite rightly some women felt that maybe they'd rather do it the old fashioned way.

On the other hand, if the pain is going on for days and days and days as it can, and it is excruciating, as it can be, then lots of women do still wish to avail themselves of that possibility. 

Now the third and final point is that anesthesia, especially using spinal anesthesia, is such now that you can have pretty much the joy, you can have the joy of the pushing and you can have the joy of immediately feeding the infant and having it placed on your tummy.  You're not confused, you're not muddled, you're not asleep.  You can have all that joy, but you don't have to have well, I've done it.  It's actually pretty darn miserable.  And I was pretty darn happy actually to have a little sniff of the old NO there, NO2.  I didn't mind that at all.  And I was pretty into childbirth and the babies and I still am, but I did not mind at all.  And I did not feel that my pain helped anybody or that you know, I was closer to nature, my God, as a result of feeling all of that.  So I'm sorry, I took too long.

CHAIRMAN PELLEGRINO:  I have in the following order:  Gomez-Lobo, Hurlbut, Lawler and Kass, hopefully as you appeared.

DR. GÓMEZ-LOBO:  I have some more general comments and perhaps a question dispersed here and there.  And the reason is I want to have a better sense of the direction of your presentation.  At times, it seemed to me that it was all geared towards the question of embryonic stem cells, which is the great debate today in the U.S.  And that's fine.

But then what arises in my mind is the following question, well, why invoke Aquinas in this context?  I know that lots and lots of people mention Aquinas here and the big problem with Aquinas, of course, was that he thought that the rational soul had no organ at all.  It came totally from outside the biological process.  In fact, in the Quaestiones Disputatae de Anima, he says it explicitly, that it comes through — it comes out of the door, etcetera.

And then my question is well, why should we even think along those lines.  But the feminine ovum was discovered by von Baer in 1827.  The 50-50 contribution of the gametes was known by the middle of the 19th century.  And so that is something, I think, we should take very seriously.  Incidentally, the fact that Aquinas thinks that the rational soul comes in at 40 days does not mean it's morally permissible to destroy an embryo before 40 days.  He thinks it's a grave sin.  It's just not homicide.  So in a way, one can say he had the ethics right, but the embryology wrong or something along those lines.

Now in the case of our modern understanding of embryonic development, it is true that there are continuities, but there is this big break between the gametes and the zygote.  The genetic structure of the zygote is dramatically different from that of the gamete.  So there's an interruption of continuity there.

Now the other thing that seems to be pretty clear is that there is something we can vaguely call a genetic program in the zygote, the heredity goes through that stage and that therefore in terms of genotype at least, it's undeniable that we go back to the zygote stage.  And in that regard, I side with Ben on this one, to say I'm a potential cadaver, but I'm not a cadaver.  I find that tremendously puzzling because the idea of potentiality is the idea of an active power to become something.  One can say that the newborn child has the potential to see and start seeing after perhaps a couple of days or a couple of weeks, but death and becoming a cadaver is the loss of all potentiality.  There's a drastic dis-analogy there that should be taken into account.

Now finally, not to extend myself too long, the question of the use of the term "person," I think to a great extent, the debate in the U.S. today hinges on the fact that the term person is used in two different ways.  It is used by some people as a phased sortal as they say in philosophy, as a term that tells us what sort of thing something is during a phase of its existence.  A little bit like a teenager, a teenager is a phased sortal.  A phased sortal is a concept such that if one ceases to fall under it, one does not cease to exist.  But a proper sortal is different.  A proper sortal is such that if one ceases to fall under it, one ceases to exist. 

Now taking into account — if one takes that into account, of course, people would think that a human being has dignity and therefore is owed respect throughout her life, of course we'd be using the term "person" as a proper sortal.  In other words, it would be tied to the notion of human biological individual.  And there, I think, the genetic evidence is rather clear.  Particular DNA starts at fertilization. 

So I would draw a rather different conclusion and the — but the final point that I want to make is this.  Someone can say yes, you think that, but let some time pass and we'll come around and it's going to be like anesthesia.  But I rather doubt it.  I think that here we're at a very crucial and deep point which is you know, hardly, hardly such that we could abandon it rationally.

Thank you.

DR. CHURCHLAND: Thank you.  Wonderful questions, all.

The point about Aquinas was really introduced to remind us that there has not been a univocal position amongst people with religious beliefs on this question.

And the point about the rational soul for Aquinas and it's easy to find the textual data, is that he says the proper — it does come from the outside, but the proper organs have to be in place, otherwise, the rational soul can't have a home and God wouldn't do that.

So really I wanted to make two points and one is then that even amongst highly respected theologians, there are differences of opinion and that arguably Aquinas' point does mesh with a current conception.  All right, let's put that aside.

Second point, there's a radical discontinuity between the gamete and the conceptus.  There's a radical discontinuity when cell differentiation begins, as radical from my point of view.  Why not?  There's a radical difference once neurons and neural networks begin to develop.

It all depends in the way, in what you really mean by radical discontinuity and whether you wish to press the idea of there being a discontinuity such that you don't have a person and suddenly you do in the proper sort of sense, or whether you want to see that there are many, many changes here.  And what I don't think you want to do is to bring to the debate a prejudgment about which of those discontinuities for say religious reasons we're going to take as serious and which we aren't.

What I'm prepared to do is to say let's look at the empirical data, let's assume that there are differences of opinion.  Aquinas and I have an opinion about the importance of the brain and the fetus for the rational soul.  Your opinion is different.  I grant you that.  Let's come together on it.

I think that's the main point.

DR. GÓMEZ-LOBO:  A brief rejoinder.  First of all, I feel very uneasy about characterizing the discussion as a discussion of religious opinion.  Aquinas borrowed all of this from Aristotle.  As far as I know he never did any empirical work on embryology.  It's not a matter of theology.  It's not a matter of belief.  It's not a matter of religion or of biblical background.  So I'm totally with you.

Let's look at the empirical data, but there, I think that it is perfectly possible to give an argument to the effect that say the development of the neural system is certainly caused by the genetic program in the individual, whereas in one gamete, of course, there's nothing of that nature.  The two events, the two changes are radically different.  Empirically, I don't see how they can be put on a par.

CHAIRMAN PELLEGRINO:  Dr. Hurlbut.

DR. HURLBUT:  I want to talk about the question of potential and progress and I want to try to get back into the heart of what I think you brought to us, specifically in the paper which really does address some very fundamental questions about the foundations of human dignity.

First, however, I'd like to make a point or ask a question, it's sort of preliminary.  It seems to me that there's a sense in which the term "I'm a potential cadaver" does not have the same meaning as, as Alfonso said, an organism with a program to unfold in a certain way can become something.  And correct me if I'm wrong on this, but it seems to me, none of us are potential cadavers.  We have a capacity to die and then cease to be.  In that sense, we're never a cadaver.  That would like saying we are molecules.  We have a capacity to die, but we are never cadavers.  Do you see my distinction there?

DR. CHURCHLAND: Up to a point.  Look, much of this depends on how you choose to use the word "potential."  And I don't think — like I think many concepts that are useful in the workaday world, it doesn't have necessary and sufficient conditions.  And the point was made earlier that if something has potentiality, it must be an active process; like who says?  I mean I think if you look in the dictionary, you're not going to find that.  That may be a particular conclusion that you wish to have in the context of talking about the potentiality of the conceptus, but it isn't a word that affects the notion, it isn't a sense that determines our use of the word "potential" in general.

People talk about so-and-so's potential for madness, or his potential as an artist.  We talk about the potential for energy in a particular development.  We talk about the potential for sea rising, given global warming.  We use that word in many, many ways and it's not confined to the discussion of the development of the conceptus.

So the only point I wanted to make and it's essentially a point that Mike makes much better in The Ethical Brain and that is, even granting that there are continuities with some differences such as the beginning of cell differentiation and so forth, we don't want to say that the thing at this end is exactly the same as the thing at this end or should be treated as such because it has the potential to be such.  I don't see the rationale for it.

DR. HURLBUT:  Okay, I will go on from there, but I think you make an important point.  There are different ways to view potential, but that the reason the concept of potential in the embryo is important is because it's used in a specific limited sense and that is an active potency, an unfolding of being.  Just as we wouldn't say that a four-year-old girl was infertile.  We'd say her fertility is in her, but not yet expressed.  We would likewise say that reasonably that there is an active potency toward a particular nature of being expressed that an embryo is incipient, is an incipient form of an unfolding being.

DR. CHURCHLAND: Well, I hate to get sort of all Aquinas on you here, but if we're going to go into philosophical territory, I just might do that.

Look, Aquinas made several distinctions about the very notion of potentiality.  There was the first order of potentiality and the second order of potentiality and we don't really want to have to go into that here because I think that would bore everybody to tears.  But suffice it to say these are very, very different kinds of notions and the first one he says is where the conceptus has the potential to be a person.  And the second one is where the infant has the potential to be an adult and he views those in very, very different ways.  And it's essentially based on the biology, albeit a fairly old and ancient biology.  But there isn't a sort of single right way to use the notion of potential.

DR. HURLBUT:  Okay, what I really wanted to ask you was this.  In your paper, you speak of moral progress and you also at the same time speak of our evolved moral capacities as basically serving a utility function, of social cohesion and so forth.  As you obviously know, there's a huge debate about what the origins of that concept are.

Why in this sense is it meaningful to speak of progress at all?  Is it because it increases general social utility, individual benefits?  Or is it because it ascends towards some larger reality?

What I'm getting at here is the question that in spite of the fact that you repeatedly in your paper seemed to imply that the brain is a causal machine, that there is some kind of a computational power going on, you also make reference to the use of reason and so forth and I think these are very crucial questions when it comes to human dignity, because there's the question of human freedom, human ability to transcend those things which seem to be on an evolved basis.  It's almost as though you're pulled, like most of us are in this debate, between the sense that there's a cold calculation of evolutionary benefit and some transcendent goodness that represents moral progress. 

Do you see what I'm getting at?  Is there something of a contradiction here?

DR. CHURCHLAND: I really do look at things biologically, I have to confess.  I thought very hard about that sort of question because it's a very deep question and for anybody who does approach ethics from a biological point of view, you have to think about it.

And my feeling is that we count things as moral progress to the degree that they really enhance human flourishing and that by and large the flourishing of the group entails the flourishing of individuals, that when the group does well, it does well because individuals do better.

And consequently, I think that, for example, having a judicial system where you're tried by a jury of peers, is much more conducive to — let's put it this way, less turmoil, less revolution and so forth, than a system where people are — use trial by ordeal.

And that many of these changes that we count as moral progress are such because they reduce social turmoil.  They make it possible for people to achieve things.  There's this great scene, the best scene in Romeo and Juliet happens at the beginning.  What happens at the beginning is, of course, the idiot Montagues and the idiot Capulets are having this tremendous row for no good reason.  It's just two warring factions, in-group/out-group.  And the prince comes in, settles it, sends them on their way. 

And I think it's a great scene because I think in part what Shakespeare is telling us is that you want to have a system of authority.  It doesn't really much matter necessarily how it comes into being, but you must have a system of authority so that people don't take the law into their own hands.  And that's why a police force is a good thing.  And that's why legislation is a good thing and so forth.  We do not want the Hatfields and McCoys.  It causes tremendous problems.

If we don't have a judicial system, then when a child predator does something really terrible to a child, I can bet you and I would do it too, I'd go after that guy with my bare hands, if we didn't have a judicial system in which I largely believed.

So I think it isn't a transcendent sense, but it's a sense of progress that's very historical, but takes very seriously, as Aristotle did, the idea of human flourishing and of institutions and conditions that make it possible for humans to flourish.

I mean bear in mind, child labor was bitterly — the legislation against it was bitterly opposed.  If you go back and look at the arguments against women's suffrage, all hell was going to break loose if woman had the vote.  Well, some people still think that.

But in any case, it counts, I think, as moral progress when — and it isn't always moral progress.  Sometimes, we take a step we think is progress and we realize maybe that wasn't such a good idea and we have to revise it and change it.  Not all movement is movement forward.

And sometimes you can't tell until, as Dewey, a great American philosopher, said, you view it as a social experiment and hence you be as cautious as possible, but you view it as an experiment to see whether social flourishing will be enhanced, whether the possibility for individuals will be enhanced.  And guess what?  Public education introduced in the 19th century did despite great misgivings, enhance human flourishing.

So that's kind of — that's a long answer and yet it's also a short answer, so I'm sorry.  That's the best I could in quick time.

CHAIRMAN PELLEGRINO:  Dr. Lawler?

DR. LAWLER:  Thanks a lot for a great presentation.  And let me restore Professor Meilaender's question, sort of.  Your view of the world is altogether too happy.

(Laughter.)

DR. CHURCHLAND: Nobody has ever accused me of that before.

(Laughter.)

DR. LAWLER:  Right, right.  It's probably a continuum of happiness or something.  But it seems to be something like this.  With appropriate qualifications which you just introduced, the world is constituted by progress and technology.  The more we control, the more we understand.  Superstition recedes and our natural capacity for respect, dignity and cooperation and all that comes to the fore.  And so the world is basically constituted by moral progress.  And I think there's some truth to this.

On the other hand, there's another way of thinking which is something like this.  Technology and biotechnology without appropriate controls threaten our very humanity, our very dignity.  And in our world, where everything is constituted by choice, we have the world of technology which is real and the world of preferences which is the world that weighs nothing. 

How can we control technology with mere preferences or mere weightless choices?  And this view is connected with say Nietzsche, Heidegger, Leon Kass.

(Laughter.)

And these people at different levels for different reasons, not all the same, these people worry that the unlimited progress of technology, especially as it morphs into biotechnology, threatens the very conditions under which human dignity is possible.  I don't completely agree with that view, but I don't completely disagree with that view either.  Isn't there something to it?

DR. CHURCHLAND: Of course, there is something to it.  And I don't entirely disagree.  And that's why I was careful to say at the end that we need to talk about regulations.  We need to talk about limitations.  We need to talk about how to do this in such a way that we don't have a biotechnology that goes out of control.

But if I may get historical again and please indulge me for just a moment, catastrophizing technology is a long and distinguished tradition.  And we know, for example, in our — in the very recent past, that many stories about the potential catastrophe of genetic engineering came to the fore.    

Now these were not unreasonable worries.  What we need to do in the face of reasonable worries is to have regulations, negotiate how best to do it and that's why at the end I wanted to draw attention to how it's been done in the U.K., not that I think that there's no room for improvement.  Obviously, there is.  But I think that you can't — look, we all know you can't just say stop technology.  I mean it isn't possible.  My father, way out there on the farm said we will have no television in this house.  Well, we didn't, but you know what?  All our neighbors did and so far as I can tell, television was a big hit.

You can't just say there will be no more progress in this area.  So whether you're talking about the use of fire or gunpowder or nuclear weapons or whatever, there's always a terrible danger and I'm very mindful of that danger.  And in the case of nuclear weapons, I've been especially mindful because I've had the great privilege to know Herb York who negotiated the Test-ban Treaty.

And so there are grave and terrible dangers.  I would love to put that genie of nuclear weapons back in the bottle, but believe me, none of us can do it.

But I think we can, in the case of biotechnology, make good decisions.  That's not because I'm, you know, a Pollyanna.  I think we will also sometimes make bad decisions and have to take them back.  But as long as we're flexible so that we can cautiously move forward, revise our decisions if they were unwise and try to do it well, but you know, with the best will in the world, you are not going to stop that stem cell research.  It's going to happen.  It's happening in the U.K.  It will happen elsewhere in Europe.  The benefits will be seen.  So let's do it.  Let's regulate it.  Let's be very careful about it.  But I'm not that happy.

(Laughter.)

CHAIRMAN PELLEGRINO:  Dr. Kass.

DR. KASS:  I also want to stay on the dignity question.  If you even offer a small hint that the embryo question is on the table, lots of my colleagues will see to it that it gets defended.  It was no part of your paper that was submitted.  If it was, it was a tiny part and I was, myself, much more concerned with the larger notion of human dignity as is implied by your attachment to the neurosciences and your account of the human being as brain with body and things of that sort.

Now I was hoping, given your paper, which wasn't really about human dignity, that you would come and say look, human dignity is a passé notion.  We don't really need it and we can't defend it, because it rests on an account of the human person that neuroscience is now showing us is untenable.

If you looked at the OED, there are examples, but each of those examples is pegged to a prior definition that's offered, all of them sharing some sense of elevation, of worth, of excellence.  And the excellence of the human person, of human beings, I mean there are excellences of other animals as well, but the excellence of the human being has something to do with the performance of specific human activities in a particularly fine or noble or high form.  Not all of them other-directed, by the way.  Aristotle's Ethics is not primarily about the virtues of usefulness to the community.  In fact, not once in the account of any of those virtues up to justice does he talk about the utility of them.  He talks about their being for the sake of the beautiful or the noble and the whole context of the Ethics is individual flourishing and happiness.

So I would have thought that you would have said, the soul being an unnecessary notion and that all there are are brains, that it would be very hard to see how this particular neurochemical, neuroelectro-chemical functioning carried anything like dignity, or what would make something dignified as opposed to undignified?

And I don't think that you can sustain a notion of human dignity on a purely material account of the human being.  That would be point  number one.

Point number two, I can't resist on the subject of the soul.  I found it somewhat odd that Aristotle — that Aquinas' teaching of the soul was sort of imported here for its utility, but against a background where one thought that the notion of the soul was utterly passé.  And it's true that none of us believe in the vital élan, although I don't think the account that we now have of the materials of life add up to an account of what aliveness is, but that's another subject.  But that's partly because the problem as posed in the middle of the last century was to see what would be left over after you conceded a full mechanistic account of the body, and then these poor fools tried to invent some kind of ghost in the machine that somehow explained the things that mechanism couldn't explain.

But for real proper discussion of the soul, you need to ask what in the world does it mean, what do you mean when you're talking about it?  And Aristotle's account of the soul is not an account of some kind of — I've forgotten how you chose to embarrass treatment of the soul.  It's, in the first instance, the form of the naturally organic body possessed by certain kinds of powers.  And it is not material.  That is to say, and here I think there's a demonstration, this is a philosophical point, not an empirical point. 

The philosophical point is and I don't think it's been refuted, the eye, the eye has extension.  De Anima 2.12.  The eye has extension.  You can hold it in your hand.  It has length and breadth.  You can measure it.  But sight, the power of seeing, you cannot hold in your hand.  Never mind the activity of seeing which is not a thing.

You can't see without the material thing, but to see, the act of seeing — the brain doesn't see.  You see as a result of the brain being in a certain way.  And that means that there's much more that has to be done here before we yield to the neuroscience's wonderful mechanistic account of mechanism, the full account of the human person, because if we cede to them, then I think you have to say human dignity goes with it.  I don't see any way of saying — I don't see any way of justifying your very nice person amorality about cooperation and being nice and so on. 

I mean there is the ape and the tiger that Thomas Huxley in Evolution and Ethics reminded us too that has been somehow part of our history.  I don't think you can develop a notion of what moral progress really is as opposed to simply saying there's change, and you've got an account of what human dignity is, and I don't think you can sustain a notion of human dignity on the basis of neuroscience and materialistic neuroscience alone.

That's a bit much —

DR. CHURCHLAND: Oh, I think I can handle it.

DR. KASS:  Okay.

DR. CHURCHLAND: All right, there is a lot to respond to.  Look, I stand upbraided.  I did not say very much about dignity because I tried to approach it in a different direction.

I did that for several reasons.  One, as I said, I thought Adam Schulman's discussion was extremely useful and I thought that it also showed that there were rather different conceptions, historically, and currently. 

I also thought that Ruth Macklin had dealt with many of the issues about whether dignity is really the critical element to be discussed.  So I didn't want to do that again, otherwise I'm sure I would have been upbraided for repetition.

So as I said, I asked myself how can I be most useful?  And I think if I had just given the same talk on the nature of dignity as viewed by Nietzsche or Aristotle and then Kant and so forth, you would have been even more disappointed.  So I decided to — I should perhaps have not come.  I should have said hey, I've got nothing to say.  But I was not about to squander an opportunity to talk to this group —

(Laughter.)

— and also to meet some of you.   So I asked — I mean maybe this is just a pragmatist sort of question I shouldn't have asked, but I said what could I do that might be useful?  And so I tried to do what I thought might be useful, knowing that I couldn't expect agreement on everything, but hey, agreement on everything is pretty boring.  If you and I agreed on everything, you'd probably wander off and talk to somebody else.

So I did my best.  I stand scolded.  Can we move on?

Now you wanted to say something?

DR. KASS:  Forgive me if I was — if that was received as a sort of aggression. 

DR. CHURCHLAND: No, no, no.  I just thought that you were disappointed and I am very sorry to have disappointed you.

DR. KASS:  No, I would like to ask this question.  Let me put it in the form of a question.  You're steeped in neuroscience and its implications for philosophy.  And you've worked in that area and are interested in neuroethics.

I wasn't expecting you to, say, repeat the history of philosophy on the subject of human dignity.  The question is what — on the subject of human dignity, on whatever notion of human dignity, do we have anything to learn from neuroscience if the brain is all there is?

DR. CHURCHLAND: I know that's your question and that's why I was about to move on.  So you said, and this really, really surprised me, I think, that you hoped that I would say that if the mind is what the brain does, then there's no such thing as dignity.  And perhaps you hoped that because then I'd be a really easy target, right?  You could shoot that lady down.

But I wouldn't say that because here's how I think about the brain.  I think that it's an extraordinarily complex device, which amongst other things guides movement and behavior, makes decisions, remembers and remembers both in this declarative way that we know and also in procedural ways and that when the brain is split, we see disconnection phenomena that Mike has discussed and experimented on so well.  We know that in Alzheimer's it's not that there is a nonphysical self that remains with all those memories and has that reason and knows how to find the way home, we know that in a seriously demented person those capacities are compromised and they're compromised because the brain is compromised.

We know that when somebody feels pain we can ameliorate the pain by changing various states of the brain.  Now the problem — and you know, no one knew this better than Descartes — the problem with the idea that there is a nonphysical soul that somehow does the feeling and the thinking and the remembering and it's all intact, the problem has always been, as Father Malebranche said, and I'm sure you must know this: So how does this nonphysical thing connect to the brain?  Where is the interaction?

And nobody has ever been able satisfactorily to give an account of that.  And not only not give an account of it, nobody — and here's the interesting sort of real response to your question, nobody even has a research program to show how that might be done. There isn't even the merest beginning of a research program to show how the nonphysical soul could interact with the brain.  The only neuroscientist or the only scientist that I know of that ever did really was John Eccles and to his great credit he gave it a real go.  And he had the idea that the soul interacts with the brain at the synapse, but neuroscientists find that deeply implausible for all the physiological reasons that we know about.

So doesn't dignity vanish?  No.  Perception doesn't vanish.  Pain doesn't vanish, if we are a material thing.  Pain is as real as it would be if we were a nonphysical soul.  It's real.  Memory is real and it's sure real when they're losing it and don't have it any more.

And reason is real.  We don't know in terms of the nervous system what it is for neurons to get together and reason.  And respect that we hold for one another is like love that we hold for one another.  It's real.  It's what the neurons, under certain conditions, do.

So we can't, I think, at this stage of neuroscience, give a detailed account of that, but we know that various hormones have a big effect on that.  We now know, for example, that if you put a woman into a tent and let her sniff either estrogen or testosterone, certain parts of her brain are more apt to testosterone and men are the other way around, unless they're gay, in which case they're more apt to — the part of the hypothalamus is more apt to testosterone.

So we're beginning to sort this all out, but it doesn't mean that you know, we're just like a lawn mower.  We are an extraordinary device, all nervous systems are.  I mean it's like saying how can it be if temperature is really just motions of molecules, how can it be that just motions of molecules can make water boil?  That makes no sense.  There must be caloric fluid or something.

Sometimes science surprises us by telling us that our intuitions about certain concepts need a bit of a change and I think perhaps we're learning.  I mean this is sort of the great revolution in philosophy right now.  We're learning what it means for us to understand ourselves and we're not the only culture who does.  I mean primitive cultures have done this too, who have understood ourselves primarily as material beings with these wonderfully complex capacities.

I'm sorry I took too long.

CHAIRMAN PELLEGRINO:  We have the following who would like to speak:  Dresser, McHugh, Rowley, George and Gazzaniga.  The time is short.  May I suggest the following?  I would like to give everybody I've listed a chance to ask your question.  Would you be willing to take a couple of questions together, instead of taking them one by one?

DR. CHURCHLAND: And I will be very brief in my response.

CHAIRMAN PELLEGRINO:  If we can do it that way, we might be able to get it all worked in.  So I'm going to ask Dr. Dresser to kick off and then Dr. McHugh.

PROF. DRESSER:  All right, I'll try to be really fast.  I guess — I think you've had a difficult job and part of the frustration you may be hearing is because we are facing a frustrating task of what do we do with this dignity stuff? 

And obviously, it's relevant to a lot of bioethics concepts, beginning of life and we've put out three, four reports on some issues surrounding that. 

I wonder if you have any thoughts about topics such as use of drugs and other medical interventions for "lifestyle purposes," things like selling organs; of course, death with dignity, and part of the problem is people on different sides of arguments use the dignity word. 

As you say, Ruth Macklin has written about this, but I don't think the debate or the analysis has been exhausted, so I wonder if you have any thoughts about those theories?

CHAIRMAN PELLEGRINO:  Thank you very, very much.  I think there may be some overlap and we'll give the doctor a chance.

Dr. McHugh, you're next and then after that, Dr. Rowley.

DR. MCHUGH:  Well, it was terrific, Pat, and you're still your old sassy self.

(Laughter.)

Welcome and all.  What I wanted to say to back up some of these other issues, maybe we're talking about two domains of knowledge and you are committing yourself to the domain of science or that science philosophy.  Yet, when you come to explain yourself, you turn to the poets.  You turn to Shakespeare to tell us the value of the legal process, after all, but that's not new with Shakespeare.  The Oresteian tragedies lead up to exactly the same point.  And yet, in your discussions, you spend an awful lot of time walloping the religious folks, except coming down for what you consider the better cite, Catholic philosopher Aquinas, and not me.

(Laughter.)

I'm an Augustinian, but that's besides the point.

(Laughter.)

And you point out various things about what one Pope did and another Pope did.  After all, there was another Pope Clement who very much spoke about autopsies, the important things, that he played a bit role in the black death issues.  The reason I feel about that is that I was at the Brigham in 1956 when they were doing — I was a young intern at the Brigham, when they were starting to do the twin transplants and we heard this and then we went to look, it was just as you said, he wasn't stopping that.  He was worried about the possibility of selling and buying things. 

And by the way, Jack Kevorkian, one of the things Jack Kevorkian spoke about is that we should chop away at the people we're going to be executing because after all, we could use their organs and then kill them.  So he was prescient.

I wonder, in the process of talking about human dignity, two things.  Why you aren't talking about how the scientists get it wrong so often.  After all, from Semmelweis showing people they ought to wash their hands and he couldn't persuade the doctors to do it and was ostracized in Vienna for that, through eugenics and frontal lobotomy and now we have this sex change operation, all of which come from scientists. What is it about the scientists that they don't speak the way the poets do in relationship to this?  So that's the first question.  And maybe you should be talking more about what the poets tell us because they provided domains of knowledge that maybe biologists, you and me, can't get to biologically.

And the second little question is look, in the dignity question, can you do as well as Jefferson did and bring us up to some sense of where we are, created equal, endowed with certain inalienable rights?  After all, that was the position that permitted a tremendous amount of progress to occur in our culture.  And the Lincoln-Douglas debates are all on that.  I'm not telling you something you don't know.

So why don't you wallop the scientists for a bit to find out in what way they get us into trouble and then talk about whether some cultures are better than other cultures because of the poets they listen to?

CHAIRMAN PELLEGRINO:  Thank you, Paul.

DR. CHURCHLAND: Okay.

CHAIRMAN PELLEGRINO:  Dr. Rowley.

DR. ROWLEY:  I appreciated your comments very much and I want to ask you to follow on with the sense, as you have described human dignity or in a sense where man flourishes best, what kind of implications that has for our society and for the kinds of concerns that society should have?  And I'm thinking particularly in terms of children and the poor in both health care, education and things of that sort.

CHAIRMAN PELLEGRINO:  Thank you very much.  Dr. Gazzaniga?

DR. GAZZANIGA:  Well, Pat, thank you again for a wonderful talk.  It certainly has provoked great interest.

I would like to offer a way of thinking about human dignity that is similar to the difficulties of thinking about a concept such as, say, personal responsibility and what I heard you saying today can be illustrated in the following way to get us to think about this.  Let's imagine that everybody in the room here is the only person on earth.  You are the only person on earth.  Then there's no concept of personal responsibility.  There's no concept of human dignity.  You're not going to strut over to a tree and say hey, show me some dignity.

All of these things are obviously social constructs that come from a group interacting and the rules that we set down and confer on these concepts are as a result of hypotheses and attitudes that we engender towards each other because we live in a group.  So in my analysis, the neuroscience really does not speak so much to concepts of human dignity and of personal responsibility as does the hypothesis that we generate as a result of living together in a social group.  And so we're looking, we're chasing the wrong dog here.

What we should be trying to understand is the social ideas that come out of groups living together and that's where these concepts are held.

CHAIRMAN PELLEGRINO:  And now Dr. George and that will be the end of the questions and then the terrible task I've imposed on our speaker to respond to all of you in a very brief time.

Dr. George?

PROF. GEORGE:  Thank you.  Dr. Churchland, I do want to raise the issue of personal responsibility.  I'd like to know what the implications are for personal responsibility of the rejection of the contracausal view of rational choice.  I thought that one way that we might be able to get at it is just to ask you whether the following proposition is true or false or meaningless.  I just want to take a situation of moral monstrosity.  Hitler chose to do wrong in killing, murdering millions of Jews and others.  He didn't have to do it, but he did it.  And because he did it, he deserved to be punished. 

So can I accept the Humean view that you accept and still say that that proposition is true or is it false or is it meaningless?

DR. CHURCHLAND: Sure, it is true.  But I'll come back, see if I can do this quickly. 

CHAIRMAN PELLEGRINO:  Thank you.

DR. CHURCHLAND: Now the first question, drugs and lifestyle and selling organs and so forth, I think these are things that we, of course, need to regulate.  But these are really, really complex questions, but the selling of organs, of course, is very tightly regulated and certainly in our country, but so far as I know, pretty generally.  And you really don't want to have to do that.

Death with dignity, yeah, I think we probably all have different views on that.  But I guess it's a really big question and I know that many of you have struggled with that.  So I guess I won't say too much about that.  But maybe you and I can chat a little bit outside. 

Okay, so the Augustine scholar, science gets it wrong.  Absolutely, science does get it wrong.  And there are lots of instances of that.  So that was why I kind of wanted to say it isn't always progress and sometimes what looks like progress turns out not to be such a good idea and you realize the need for regulation.

So you do want to have regulations.  I mean I'm really one of those people who doesn't think that everyone should just have a free hand, that we should down-regulate everything and let folks go.  I think we do need to negotiate together.

We need to compromise and come to reasonable conclusions about what can and can't be done.  And I think we've done that on organ transplants, for example. I think that's actually worked extremely well.  I mean one of the things you require there is that the doctor doing a transplant has nothing to do with the patient who is giving it up.

Okay, so dignity and flourishing, of course, does involve, as you're quite right, it does involve many, many aspects of life and I kind of picked up from your question and I might be wrong about this, that you made me think that there are other sort of deeper and more pervasive problems than the problem of deciding whether the conceptus has the rights and privileges of a person, that maybe we can come to agreement on that, move forward and then maybe address some of the deeper problems of poverty and unwanted children and so forth.

Okay, and then there was Mike Gazzaniga's question and I think he just puts it a lot better than I do, but I think I basically agree in the sense that the disposition for cooperation and respect, that's part of what we have and we're selected for as social animals.  And then the particular configuration that we give to that via our institutions of a variety of kinds depends on accidents of history, on how people think about things, about what their empirical hypotheses are and their general attitudes.

So that's why I think we can expect to see differences and why we shouldn't think the differences between us on say the dignity of the conceptus is telling us anything deep.  It's just that people disagree.  And finally, can we hold people responsible on the assumption that the brain is a causal machine?

What I wanted to argue for in the paper was absolutely that — and let me just go back to evolutionary biology.  I mean one of the things we do know is that if you want social traits of cooperation, sharing and so forth, compromise, to spread throughout a population, you have to punish the miscreants, because if you don't, they'll take over. 

And so if there ever was a justification for punishment in terms of social utility, that's it.  And I don't foresee that going away, at least not in the immediate future, so I think that is the justification for punishment.

Now the particular forms that punishment takes is going to vary.  I mean some people swat their children, some frown, some pinch them and so forth.  And with regard to capital offenses, some people still like public executions.  Others don't want executions at all and then there's everything in between.  So the particular form that punishment takes is going to be negotiated and reasoned about and empirical information about say the nature of madness and the nature of genes like MAO-A mutants will come and will be relevant and then we'll just have to do the best we can.

PROF. GEORGE:  I am sorry, Dr. Churchland, I think I made myself misunderstood then.  I wasn't asking whether you believed in whether there was a justification for punishment.  I was asking whether you believed that there could be personal responsibility if you accept the Humean view, so my exact question was, is the following true or false or meaningless:  Hitler chose to kill millions of Jews and others.  He didn't have to do it.  Because he did it, because he did it, not for some future utility, but because he did it, it's a retributive question, a question about retributive justice, he deserved to be punished.

DR. CHURCHLAND: Well, my view on retribution is very different from Richard Dawkins's.  I think it serves a very important social function.  I think people need not only to have a system of justice, but they need to see someone who did something truly terrible, they need to see them punished.  And if they don't see that, then they take justice into their own hands.

So I think there's a powerful need for retribution.  You see it in baboons, chimpanzees, dolphins, wolves, and you see it in us.  And I think if you set up a system of criminal justice where you just send the really terrible ones off to a nice farm, all hell would break loose. 

PROF. GEORGE:  But would there be a reason to punish Hitler if there would be no social utility in doing so?  I'm trying to get —

DR. CHURCHLAND: I think it's within the broader utility, of course, it has to be.

PROF. GEORGE:  So it's not because he did it, because he's personally responsible and he deserves it.

DR. CHURCHLAND: Our understanding of "personally responsible" is embedded within this broader context.  That's my take on it.  And I mean look, there isn't a Platonic heaven wherein the notion of pure justice, in and of itself, resides.  It just ain't so.

PROF. GEORGE:  Well, I didn't

know that I was implying that it is, but I did want to know whether Hitler chose to do it or didn't choose to do it and whether he is responsible because he chose to do it and whether he should be punished because he's responsible.

DR. CHURCHLAND: What do you think?

PROF. GEORGE:  I think the answer is yes, that he did it.  Didn't have to do it.  Because he did it, he's responsible and he should be punished, irrespective of any social utility in punishing him.

DR. CHURCHLAND: It's not the social utility of his particular punishment I'm talking about.  I'm talking about the institution of punishment itself.  And for the institution of punishment to work, individuals have to be punished, ergo, I would punish him and for the reasons you say.

CHAIRMAN PELLEGRINO:  Thank you, very, very much for a valiant effort.  I'm going to take the Chairman's prerogative of saying we have a little extension of time, let's come back at the hour, 11 o'clock, and we have a little flexibility toward the end and thank you all for your comments and I'm sorry, I couldn't get any of mine in.  Thank you.

(Laughter and applause.)

(Off the record.)

SESSION 2: THE CONCEPT OF HUMAN DIGNITY (CONT'D)

CHAIRMAN PELLEGRINO:  We are about to move to our second speaker for the morning, Dr. Daniel Sulmasy, and again as with our other speaker, you have a complete or fairly complete, quasi-complete curriculum vitae in front of you for the details.  Dr. Sulmasy is a physician who is still seeing patients, the Director of the Center for Bioethics at St. Vincent's Hospital in New York and at New York Medical College as well.  He also is a Franciscan Friar.  We've asked Dan to reflect on the concept of dignity as seen from the classical point of view and religious point of view as well.

Dan, lest I take more of your time, I think you can take it away.  We have one or two Council Members who I'm sure will be here and will not miss anything too vital unless they stay out more than 30 seconds.

(Laughter.)

DR. SULMASY:  Well, I'm honored to be here, actually, among so many former teachers and esteemed colleagues, both in medicine and medical ethics.  And I'm going to try to do three things this morning that I hope will be useful to the Council, but given the brief time I'm allotted, I'm going to present them in a fairly compressed, abbreviated form and may wind up speaking too quickly here to do that.

The first thing I want to do is provide my own outline of a history of the philosophical uses of the word dignity, particularly as it relates to religious uses.  Second, sketch at least an argument about the meaning of dignity on the basis of consistency and its use.  And third, to sketch an argument about the meaning of dignity based on theory of value.

So dignity appears to be an important concept in ethics.  All of you are aware of this.  It occurs in documents like the Universal Declaration of Human Rights at the U.N., the European Convention on Human Rights and Biomedicine, and even somebody like Dworkin  has noted that the very idea of human rights seems to depend upon what he calls the "vague, but powerful idea of human dignity."

So the history part first.  The word dignity has an interested history in Western thought and I apologize for the very whirlwind tour I'll give and I could expound on these things, if you want at length later.

While it's often argued that the idea of dignity is essentially religious, and I know this argument has recently been made before you, the first place that I want to start is with scripture where it's very hard to make that argument at all.  The Hebrew translated as dignity, gedula, occurs rarely in the Hebrew scriptures and it means they are something more like nobility of character or personal standing in the community.

The Greek word, semnotes, occurs only three times in the whole Christian scriptures and it's best translated, most people would say, by the word seriousness. 

Aquinas uses dignita s and its cognate, 185 times in the Summa Theologiae, and I read them all, and it tends to mean the value that something has proper to its place in the great chain of being.  So plants have more dignity than rocks and angels have more dignity than human beings, sort of the way he uses it.

In a nutshell, while Christians may always have had some concept of human dignity, until very recently, it "had not been developed into either a clearly defined literary form or an internally consistent set of ideas."

Now Aristotle uses semnotes only three times and not at all in the Nichomachean Ethics.  In the Eudemian Ethics, he defines dignity as a virtue, the mean between servility and unaccommodatingness.  That's sort of hardly the way we tend to use the word today.

Roman stoics, particularly Cicero and Senecca made copious use of the word.  Recent translators would note that for the Romans, the Latin word literally meant worthiness.  And in its common political sense it meant a person's reputation or standing.

It's the Renaissance writer, Pico della Mirandola, who's credited with making the first connection between human freedom and dignity.  By contrast, Hobbes tied dignity to power.  He wrote that "the value or worth of a man is, as of all other things, his price; that is to say so much as he would be given for the use of his power."

In turn, Hobbes offered this definition of dignity:  "the public worth of a man which is the value set on him by the commonwealth is that which men commonly call dignity."

Now although he never cites him, Kant's notion of dignity seems to be a response to Hobbes.  Kant writes, "the respect I bear others or which another can claim from me, is the acknowledgement of the dignity of another man, that is, a worth which has no price, no equivalent for which the object of evaluation could be exchanged.  He insists elsewhere, "humanity itself is a dignity."

Now the Kantian notion probably has a more familiar ring in the 21st century, but it's another long story and if you want, I can go into more detail on that in the questions.  I can trace how the Kantian idea of dignity was married to the notion of human beings having been created in the image and the likeness of God by a Kantian theologian in the 19th century named Antonio Rosmini, and it subsequently made its word into Catholic theology and was first explicitly used in the encyclical Rerum Novarum in which Leo XIII defended the dignity of workers in the 19th century.

Before that, you have almost no Catholic Christian use of dignity the way it's used today.  And thus, it's actually by a retrospective baptism of a Kantian idea that dignity became the important word it is in, particularly Catholic, but other forms of Christian thought today.  Very late.

Now given the history I've just very sketchily outlined, it's clear and from Adam's paper as well, that many people have historically used the word dignity to mean different things.  And I want to suggest for you, and this may be helpful to the Council's work, a convenient way to classify those uses.  And the way I'll do it and it's a development from the paper I gave you, is to distinguish between attributed, intrinsic and derivative conceptions of dignity.

By attributed dignity, I mean the worth or value that human beings confer on others by acts of attribution.  The act of conferring this worth or value may be accomplished individually or communally, but it always involves some choice.  Attributed dignity is, in a sense, created.  It constitutes a conventional form of value and thus we attribute worth or value to those we consider "dignitaries," to those who carry themselves in a particular way or have certain talents, skills or powers.  We even attribute worth or value to ourselves, sometimes, using the word this way.  The Hobbesian notion, I will suggest to you, is an attributed notion of dignity. 

By intrinsic dignity, I mean the worth or value that people have simply because they are human.  Not by virtue of any social standing, ability to evoke admiration or any particular sets of talents, skills or powers.  Intrinsic value is the value something has by virtue of being the kind of thing that it is.  Intrinsic dignity is the value that humans have by virtue of the fact that they are human beings.  This value is thus not conferred or created by human choices, individual or collective, but prior to attribution.  So Kant's notion of dignity would be an intrinsic notion.

By derivative dignity, I mean the way some people use the word to describe how a process or state of affairs is congruent with the intrinsic dignity of a human being.  Thus, dignity is sometimes used to refer to a virtue, a state of affairs in which a human being habitually acts in a way that expresses the intrinsic value of the human.  This use of the word is not purely attributed, since it depends upon some conception of the human that's prior to it.  Nonetheless, the value itself to which this word refers is not intrinsic, since it's dependent upon this intrinsic value of the human.

Aristotle's use of the word is derivative and I think so are a lot of stoic uses of the word derivative.

Now these conceptions of dignity are by no means mutually exclusive.  Attributed, intrinsic and derivative conceptions of dignity are often at play in the same situation and yet each has been taken as the central focus for particular claims in bioethics.

So next I want to sketch out an argument that to be consistent in our use of moral words, to do the kind of moral work that somebody like Dworkin wants the word dignity to do, to make good use of the word in bioethics, that the notion of intrinsic dignity is the foundational notion.

And so the first argument is simple in its form.  It's to say that consistency is at least a necessary condition of an argument, even if we wouldn't — we would quickly add that it's not sufficient.  And in discussions about its fundamental moral meaning, then the word dignity can either be defined as the value or a worth or worth that a human being has either in terms of some property or in terms of simply being human.

I want to show that defining the fundamental moral meaning of dignity is the value that human beings have by virtue of their possession of some particular candidate property, leads us quickly to inconsistencies in our universally shared and settled moral positions.

Therefore, I think we'll be led to the alternative, that dignity is in its fundamental moral sense defined simply in terms of being human.  Now, of course, this kind of argument depends on the exhaustiveness of the list of candidate properties, but at least it puts the burden of proof on those who oppose assigning priority to the intrinsic sense to come up with the alternative property.  And if it's not one on my list, you may say well, age or size or IQ, whatever other property you want to give, to define the fundamental worth or value of a human being.

So what sorts of candidate properties have been proposed?  Well, some have argued that human dignity in its most fundamental moral sense depends upon the amount of pleasure or pain we have in our life.  And certainly, however, though I think again very quickly here, most of us can tell stories of extraordinary lessons in dignity that we've learned from persons whose lives have been racked by pain and most of us also know very undignified human beings who have spent their whole lives in pursuit of pleasure. 

Merely basing our moral stand squarely on a balance between pleasure and pain is seen, at least since the time of Aristotle, as a fairly anemic account of morality and human dignity and one that most persons would reject.

Second, some people might think that Hobbes was right, that human dignity depends upon one's social worth.  But there are problems with such a conception of dignity:  the unemployed, the severely handicapped, the mentally ill and all others who can't contribute to the economic well-being of society and are cared for by physicians would then have no dignity.  Yet, our society, I think, has gone to great lengths to recognize the dignity of such persons.             If we didn't believe that human dignity remains even if people are handicapped and have lost their economic value to society, we wouldn't be making handicapped access ramps for them.

Third, some people might think that dignity depends upon freedom, but again, I think this is a hard view to take consistently.  You'd have to hold that those who have lost control of certain human functions or have lost or who have never had the freedom to make choices have lost or never had dignity.  And this would mean that, for instance, infants, the retarded, the severely mentally ill, prisons, the comatose, perhaps even the sleeping, would have no dignity and I think that would be wrong.

Now some might suggest that what counts is the capacity for control and freedom, not the exercise, the active exercise of it.  One might suggest that some individuals without full control and freedom, nevertheless deserve to be treated with dignity, either because they have a potential for such a capacity so that, for instance, children come to be regarded as placeholders for actual bearers of dignity or they have a history of having exercised such a capacity, so that the demented come to be regarded as remnants of those who bear dignity.

But I think those arguments are quite tenuous too.  You might recognize where they come from.  But who would feel dignified and secure being named a placeholder or a remnant?

Further, these arguments still can't answer why those who never could or never will make free, rational choices, such as the severely mentally retarded, are worthy of our respect?  The fundamental meaning of human dignity, I think is not found simply in our freedom and control.

And the famous photograph of the Reverend Dr. Martin Luther King, sitting in the Alabama prison cell, I think is a portrait of what it means to have human dignity radiantly depicted, despite lost freedom and lost control.  Prison bars and the attitudes of others didn't erase his dignity.

Fourth, some people might suggest that human dignity is something that individuals are free to choose to define as they wish, according to their own inner lights, but of course, that's the ultimate conversation stopper.  You know, you can't impose your view of human dignity on me.  But this also leads to inconsistencies. 

First, I think the concept of a moral term implies that it has universal meaning.  That's a position acknowledged by both Kant and utilitarians like Hare.  Second, it means making it an objective argument that morality is subjective which is internally self-contradictory.  And third, to say that human dignity is subjective is to claim that one person can never reliably recognize the dignity of another person because I can never know exactly what any of you think human dignity means until you've told me what it means.  But I think we all recognize dignity or value in each other before any of us opens our mouths.  And so I think human dignity can't be a purely subjective notion.

Thus, all the argument from consistency would claim is that a fundamental human dignity must therefore be something that we have simply because we're human.  It's a notion that drove the civil rights movement in this country. It's the notion that Martin Luther King said he learned from his grandmother who told him this is what dignity means, Martin, don't let anybody ever tell you you're not a somebody, that being somebody, not the properties one has, not the color of one's skin or being free to do what you'd like, is what gives you dignity, because you are a somebody, a human being. 

And that's the foundation — and if that's the foundation of the notion of dignity in the civil rights movement, the argument from consistency says that's what it ought to mean in bioethics.

Now very briefly again, I'm conscious of the time here, I just want to outline another way that was more developed in the paper that we can arrive at a similar conclusion, an argument that depends on the theory of value or axiology.

Classically, people distinguish between intrinsic and instrumental values, but I think instrumental values are really a subclass of attributed values.  So the primary distinction I want to draw is between intrinsic values and attributed. Intrinsic value is the value something has of itself, the value it has by virtue of being the kind of thing that it is.   It's valuable, independent of any values, purposes, beliefs, interests or expectations.  Truly intrinsic values, according to the environmental ethicist, Holmes Rolston, are objectively there, discovered and not created by the valuer.

By contrast, attributed values are conveyed by a valuer.  Attributable values depend completely upon the purposes, beliefs, desires, interests or expectations of a valuer or group of valuers.  An instrumental value, for example, is one that is attributed to some entity because it serves a purpose for the valuer.  The instrumental value of the entity consists in its serving as a means by which the valuer achieves some purpose.  But there can also be noninstrumental attributed values as well, like the value of humor, which doesn't necessarily serve any clear instrumental purpose.

So the next step in my argument would be to say that if there are intrinsic values in the world, then the recognition of the intrinsic value depends upon one's ability to discern what kind of a thing it is.  And this brings me to the notion of natural kinds.  This is a relatively new concept in analytic philosophy, but I'll just say this, there's more of it in the paper.  But the fundamental idea behind natural kinds is that to pick something out from the rest of the universe, you have to pick it out as a something.  And this leads to what proponents have called a modest essentialism, that the essence of something is that by which one picks it out from the rest of reality as anything at all, as a member of a kind.

And the alternative seems inconceivable, that reality is really just completely undifferentiated, that human beings carve up the amorphous stuff of the universe for their own purposes.  It seems to me bizarre to suggest that there really are no actual kinds of things in the world independent of human classification, that there really aren't such things as stars or slugs or human beings.

And thus, the intrinsic value of a natural entity, the value it has by virtue of being the kind of thing that it is, depends upon one's ability to pick that individual out as a member of a natural kind.

And so I define intrinsic dignity with a capital D, as the intrinsic value of entities that are members of a natural kind that is as a kind capable of language, rationality, love, free will, moral