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LOSING OUR DIGNITY: HOW SECULARIZED MEDICINE IS UNDERMINING FUNDAMENTAL HUMAN EQUALITY

Charles C. Camosy

(Hyde Park, NY: New City Press, 2021, paperback, 224 pp., $22.95)

Reviewed by Wesley J. Smith

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Utilitarian bioethics poses one of the great contemporary challenges to universal human equality in the West. But most people are not aware of the peril that this way comes. Indeed, most of us pay little attention to bioethics (the term is a contraction for biomedical ethics). As a consequence, many believe that medicine and the ethics of healthcare are still governed by the “do no harm” values of the Hippocratic Oath, when the truth is exactly the opposite.

Here’s the problem in a nutshell: Most influential bioethicists generally reject the equal dignity of all human life, and instead embrace variations of what is known in bioethical parlance as the “quality of life” ethic. As suggested by the name, this ethic grants different moral value to people—and even animals— based on their individual “relevant” capacities. Humans who don’t pass muster—the unborn, infants, people with cognitive incapacities or dementia—may even be categorized as “non-persons” and then exploited as natural resources— or even killed. To mention perhaps the most notorious example: Terri Schiavo was first diagnosed as persistently unconscious and then dehydrated to death over two weeks by having her feeding tube withdrawn. If you did that to a dog, you would rightly be imprisoned for animal abuse. But do that to a “nonperson” human being and it is considered medical ethics.

Of course, not all bioethicists take such a crass view. One of these outliers is Fordham University professor Charles C. Camosy, who has vigorously entered the public square in word and electronic media appearances to defend the equal dignity and moral worth of every human being. Toward that end, he has authored Losing Our Dignity: How Secularized Medicine Is Undermining Fundamental Human Equality, a highly approachable volume that presents a stalwart critique of contemporary bioethics without getting too deep into the philosophical weeds for a lay readership.

Camosy correctly accuses the reigning school of bioethicists of corroding Western Civilization’s adherence to universal human rights by undermining the intrinsic equal dignity of the most vulnerable among us. It is an important thesis, and Camosy handles it well without diving too deeply into technical minutiae. At only 194 pages with good-size font (plus endnotes), his book takes just the right approach to engage a general audience with limited philosophical or medical background.

Camosy opens by explaining why human equality is seriously threatened in modern bioethics discourse. He attributes the problem primarily to our culture’s growing secularism and the indisputable fact that most members of the intelligentsia reject the theological and philosophical premise that we all “share a dignified nature in common . . . that bears the image and likeness of God.”

Much as modern secularists try to do so, there is no denying the historical importance of religion—particularly, Christianity—in creating a culture of compassion for the ill, disabled, and elderly. Camosy provides a good nutshell version of that history and the part that faith played in the growth of our robust public health system, focusing particularly on the contributions of women religious. Indeed, in reading this portion of the book, I wondered where we would be today but for the selfless service of countless nuns to the ill and infirm.

Moreover, he correctly worries that the increased secularization of society and the values that underlie modern healthcare promote the reductionist idea that human beings are merely “so many organic machines.” This exposes the most vulnerable among us to being considered discardable for their lack of utility—or worse, used instrumentally.

Wisely, Camosy illustrates his thesis with actual bioethics controversies that have made international headlines in recent years; this also serves to personalize his pointed critiques. He begins with the tragic case of Jahi McMath, the Oakland, California, teenager declared “brain dead” by doctors after a terrible post-throat-surgery bleed. Readers may recall that doctors wanted to force Jahi off life-support—asserting that she was dead—but were thwarted by her mother, Nailah, who filed a lawsuit denying the death declaration and complained loudly to the media. Camosy reports that Nailah’s temerity so infuriated the hospital’s chief medical officer that—pounding the desk—he callously exclaimed: “What is it you don’t understand? She’s dead, dead, dead!” Good grief.

Eventually, Nailah was allowed to take Jahi—still on life-supporting machinery—to New Jersey, a state that allows a religious exemption to a brain death declaration. Nailah’s gambit created the incongruity of Jahi’s being alive in New Jersey but dead in California.

But was she really and truly “dead?” Beyond Camosy’s disbelief in brain death as a legitimate phenomenon—a distinctly heterodox opinion in bioethics, medicine, and even religious communities—he also marshals more specific evidence for his conclusion that Jahi was not dead. For example, Jahi’s body did not decompose in the months and then years in which her mother cared for her in New Jersey—and such decay almost always results when people are truly brain-dead. In addition, Jahi started menstruating. Nailah also took videos of Jahi seeming to respond to simple requests, such as to move her hands or foot. Eventually, the videos were viewed by noted neurologist Dr. Alan Shewmon—also a disbeliever in brain death—who wrote a sworn declaration that whatever indications of brain death Jahi exhibited in Oakland, she no longer qualified as a brain-dead patient.

Jahi died of liver failure in 2018—four years after California declared her deceased. An autopsy showed improvement in her brain function after the original MRI tests—which should be of tremendous interest to brain scientists, but seems to have left them instead whistling and looking at the floor because of the potential consequences to organ transplant medicine that would flow from a successful challenge of brain death as “dead.”

Whatever one might think of brain death, the other examples Camosy presents add great weight to his critique of current secular bioethics. For example, he grapples with the travesty that was the Terri Schiavo case. Camosy describes some of the media bias that permeated reporting about the case—and correctly notes that, regardless of whether she was unconscious (a matter of dispute), Terri did not need medical machinery to sustain her life; she merely required sustenance delivered through a tube and being kept warm and clean.

Schiavo was dehydrated to death by court order and died in 2005. Camosy believes that the popular support for this court order is cause for great alarm. And he correctly blames the bitter cultural divide over abortion. He writes:

Acknowledging that human beings like Terri have fundamental equality with all other human beings simply because of their common humanity would have clear implications for acknowledging the fundamental humanity of prenatal human children—and on the same basis. And to be fair, that is why a good number of anti-abortion pro-lifers also care so deeply about the debates over severely brain-injured populations. The toxicity of abortion politics infects all issues we look at in this book.

It’s true. Abortion is akin to the slavery problem of the 19th century. Even when debating issues that would seem to be either ancillary or unconnected, all advocacy roads lead ultimately to abortion—just as they once did to slavery.

And yes, Camosy does devote a chapter to that contentious question. He provides a brief history of Roe v. Wade—much of which will be familiar to those of his readers who are already pro-life—but he also makes a cogent point that I had never considered. The case wasn’t really about protecting the freedom of women, but the rights of doctors. He writes, “Significantly, Blackmun’s opinion mentions the word ‘physician’ forty-eight times, but the word ‘woman’ only forty-four times.” Indeed, he adds, “It couldn’t be more clear than when, in the opening lines of the decision,” Blackmun insists that in the first trimester, “the abortion and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician” in order to give the physician “the room he needs to make the best medical judgment.” Wow.

Camosy also delves into the notorious Charlie Gard and Alfie Evans cases in the United Kingdom, in which doctors and courts refused to continue life support for two catastrophically ill babies and prevented their parents from taking their babies elsewhere for proffered care. These are infuriating examples of medical authoritarianism from which the USA is not exempt. For more information, Google search “futile care” and “Tinslee Adams.”

Losing Our Dignity’s greatest contribution comes toward the end of the book when Camosy prophetically warns that the next degradation of human equality will target people with dementia. As millions of families know, caring for loved ones afflicted with Alzheimer’s disease or other forms of dementia can be daunting. And too often the medical system fails all concerned, both in financing and delivering care. Indeed, Camosy correctly observes that it can get so bad that “the care that is offered is not just inadequate, but abusive.”

The question is, why? Again, the Catholic bioethicist returns to a consistent theme, writing:

Medicine and medical ethics are much further down the path toward secularization and even irreligion. The same central issue running through this book—whether human equality is fundamental or whether equality comes from having certain traits that not every human being has [i.e., self-awareness, ability to enjoy life, etc.]—presents itself here quite clearly. Many human beings with late-stage dementia cannot be said to have rationality or self-awareness; the same was said, as we saw in previous chapters, of Terri Schiavo, Jahi McMath, and Alfie Evans. They are clearly human beings, but as [Princeton bioethicist Peter] Singer so strongly insists, they no longer have traits that make someone a person.

In other words, these vulnerable people are due to be the next category of humans thrown out of the lifeboat by hastening their deaths—whether through refusing care or lethally injecting them. Bioethics is already normalizing this through advocacy and practice in countries like the Netherlands, Belgium, and Canada.

Camosy closes with a helpful section on what to do about our spreading ethical mess. Basically, he concludes that morality can be restored in healthcare only if each of us engages the issue and pushes back. He urges us to “live out a culture of responsibility, encounter and hospitality,” by which he means engaging in a variety of actions from “sounding the alarm” to “regularly visiting and volunteering in nursing homes,” to working “to ensure government and other resources provide better care in nursing homes, including better pay and reimbursement rates.”

He also urges us to build bridges of dialogue that focus on the “objective value of human beings” (his emphasis). And not just when valuing people is convenient. Inclusion often requires self-sacrifice. He writes, “Justice demands that we treat the vulnerable as the equals of the powerful at all times, even when this is deeply inconvenient (like when doing so strains our resources), and perhaps especially when it is deeply inconvenient.” Indeed. That is the very way that Christianity overcame the pagan gods of Rome.

We have now reached the part of a positive book review in which the reviewer generally cites a few quibbles and shortcomings in the text. I have only two: one small and one more substantive.

First the quibble. The book needs an index! Camosy’s work is important—not only as an apology for human equality, but as a resource for those who engage the devolution of our bioethics and healthcare culture. It is hard for readers to find particular points absent an index that pinpoints where to look.

More substantively, Camosy offers scant help for those who wish to make a more secular argument for human equality. It’s not as if he doesn’t understand the need. He writes, “Aristotle and his followers (both then and now) demonstrate that it is not necessary to accept the theological claims at the heart of this book in order to dialogue about the common nature of human beings and the source of their fundamental equality.”

In our secularizing times, this would seem essential to protecting intrinsic human dignity, but the author mostly punts. That’s a shame. We do have a common nature beyond theological understandings that can serve as a philosophical basis for defending the logic of universal human equality. Even a five-page focus on those arguments—and perhaps, references for further research—would have helped the activists he hopes to inspire engage the issue with those who either reject God or don’t think that religious values are a proper basis for crafting public policy.

But don’t let my mild pique at that dissuade you from digging into the richness of Losing Our Dignity. Camosy has written an important and timely reminder about the perilous times in which we find ourselves and the stakes of current bioethical discourse. Please read the book and join the cause of protecting the medically vulnerable. The life you save may belong to the one you most love.

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Original Bio:

Award-winning author Wesley J. Smith is chairman of the Discovery Institute’s Center on Human Exceptionalism and author of Culture of Death: The Age of ‘Do Harm’ Medicine.