Does religion deserve a place in secular medicine?

By Brian D. Earp

The latest issue of the Journal of Medical Ethics is out, and in it, Professor Nigel Biggar—an Oxford theologian—argues that “religion” should have a place in secular medicine (click here for a link to the article).

Some people will feel a shiver go down their spines—and not only the non-religious. After all, different religions require different things, and sometimes they come to opposite conclusions. So whose religion, exactly, does Professor Biggar have in mind, and what kind of “place” is he trying to make a case for?

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Is unwanted pregnancy a medical disorder?

by Rebecca Roache

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Abortion is often in the news. Yesterday, The Atlantic Wire reported a poll of Americans’ moral views, which found just under half of Americans believe abortion is morally wrong. Today, The Sun is running an article on the devastating effects on women of having abortions. And, a couple of weeks ago, the law in Ireland was changed to allow abortion under certain circumstances.

Whether (and under what circumstances) abortion is ethical, and whether (and under what circumstances) it should be permitted by law, are two of the most well known and fiercely debated issues of our age. I do not wish to engage with them here. Instead, I will argue as follows:

  1. Abortions cause suffering, and neither permitting them nor banning them is likely to reduce this suffering to an acceptable level.
  2. The best way of reducing the suffering caused by abortion is to reduce unwanted pregnancies.
  3. Current attempts to reduce unwanted pregnancies in the UK do not work well enough.
  4. Viewing unwanted pregnancy as more like a medical disorder and less like a social problem is likely to enable more effective measures to address it.

I then propose such a measure, and defend it against some possible objections.

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Too long in gestating: an overdue inquiry into the Abortion Act

Whatever your view of abortion, there are too many abortions, and too many of them are too late. Even abortion’s fiercest advocates don’t pretend that it’s a Good Thing – just the lesser of two evils.

In 2010 there were 189,574 abortions in England and Wales – an 8% increase in a decade. The tightly policed regime envisaged in 1967, when the Act became law, hasn’t existed for ages, if indeed it ever did. There is abortion on demand, whatever the statute book says.

1967 was a long time ago. There have been many medical advances and societal changes since then. It’s time to take stock of the Act.

That’s what a recently announced cross-party commission, to be chaired by Fiona Bruce MP, will do.

It will focus, rightly, on two issues: medical advances and attitudes to discrimination. Continue reading

Abortion and the cognitively impaired mother

It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.

As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’

There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?

It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made. Continue reading

“Legitimate rape,” moral consistency, and degrees of sexual harm

By Brian D. Earp

See Brian’s most recent previous post by clicking here.

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“Legitimate rape,” moral consistency, and degrees of sexual harm

Should abortions be allowed in the case of rape? Republican Todd Akin—running for the U.S. Senate from the state of Missouri—thinks not. His reasoning is as follows:

From what I understand from doctors, [pregnancy resulting from rape is] really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down. But let’s assume that maybe that didn’t work or something. I think there should be some punishment. But the punishment ought to be of the rapist, and not attacking the child.

There appears to be no scientific basis for the claim that the trauma of forced intercourse can interrupt ovulation or in any other way prevent a pregnancy; indeed pregnancy is just as likely after rape as after consensual sex, according to the evidence I have seen. This news article sums up the relevant data – though please note that one of my readers [see comments] takes issue with the standard interpretation of the most frequently-cited studies.

Let’s start, for now, then, with a bit of data that is not in question: thousands of pregnancies per year, in the U.S. alone, ensue from cases of reported rape or incest–either through the caveat of Akin’s theory that “maybe [the body’s defenses] didn’t work or something” or through the medically orthodox explanation that the body has no such defense. Assuming that falsely reporting rape is relatively rare, as seems to be the case; and acknowledging that many rapes are never reported in the first place, we should be able to agree that pregnancies resulting from rape are a life-changing reality for thousands of women on an annual basis. By “rape” I mean any penetrative act done without clear consent; and here I’m calling attention to the sub-set of such acts that result in conception. I won’t say much about the term “legitimate” — which I find troubling in a hundred ways — simply because other writers have gone to town on it, and I want to say something new.

Now, given everything I’ve just said, what could be going on with Todd Akin’s moral reasoning for him to casually downplay the relevance of rape and incest to the abortion debate while maintaining, as he does, that there should be no exceptions to anti-abortionism even in those cases? Psychologist Brittany Liu uses the notion of “moral coherence” to provide an explanation:

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Peter Singer and Christian Ethics: Beyond Polarization

For those of us doing Catholic moral theology, we most often hear and read the name “Peter Singer” invoked by our colleagues in a dismissive way.  Indeed, if one can somehow show that another’s argument is heading in a Singer-like direction, then for many of us one essentially has reduced it to the absurd.  Furthermore, and very unfortunately, Singer remains consistently dismissed as a ‘popularizer’ who can’t be taken seriously as an academic given how widely his work is read.

But when I actually look carefully and systematically at his work I see not only how consistent and even rigorous it often is, but also how much it common it has with Christian Ethics.  Consider, for instance, the topic of abortion.  Though Peter Singer is pro-choice for abortion and infanticide, and the Catholic position condemns the intentional killing the fetus and early embryo as intrinsically evil, the actual disagreement between the two on this very complex topic turns out to be very narrow. Both believe that public policy cannot retreat into a privacy-centered moral neutrality with regard to (1) the moral status of the fetus and (2) whether one can kill or refuse to sustain a fetus.  Both also agree, assuming for the sake of argument that a fetus is a person, that no unintended negative effects of making abortion illegal would justify allowing for the legal killing of fetuses. Both reject the American Supreme Court abortion decision Roe v. Wade.  Both agree (again, assuming a fetus is a person) that not only would it be morally wrong to kill a fetus, but that one has a moral duty to support a fetus for nine months with one’s body.  Both reject the idea that viability is a morally significant dividing line.  Both also see a strong logical connection between one’s view of abortion and one’s view of infanticide.  In fact, it is my contention that the wide divergence in their ultimate conclusions comes from a very complex argument involving the distinction that Aristotle and Thomas made between “active” and “passive” potential.  On every issue but that one, Peter Singer looks a lot like John Paul II on abortion.

Singer also criticizes Christianity for being speciesist, but he (along with, to be fair, many Christians) is largely unaware of how complex the tradition is on this topic. For instance, the traditional definition of a person is “an individual substance of a rational nature”—with no mention of biological species as morally significant. Indeed, the Christian tradition makes explicit room for non-human persons (angels and aliens are good examples) and even (in the past) for the concept of human non-persons (human beings who are “slaves by nature”, for instance). Furthermore, the Catechism of the Catholic Church insists that it is seriously morally wrong to needlessly cause non-human animals pain and suffering, and even PETA has used the words of Pope Benedict (now known as “the Green Pope” for his heroic ecological work) criticizing factory farming in their advertisements. This should not be a surprise to anyone who reads Genesis and learns that not only are non-human animals created “good” without any reference to human beings, but that God intended other animals to be our companions, not our food.

The most overwhelming case of all for overlap involves how each understands our duties to the poor. Singer broke on the academic scene with his 1972 article on Famine, Affluence and Morality, and continues to hammer away at the problem of poverty through his continued work (especially his recent book: The Life You Can Save) and personal giving. Modern-day Roman Catholic movements to aid the impoverished (led by the American Bishops via their poverty arm called Catholic Relief Services) are not only absolutely massive in scale and trend-setting among their peer organizations, but their roots go back to the very beginnings of Christianity. Indeed, though Jesus himself rarely speaks of Hell, when he does so it is almost always connected to a failure of one’s duties to the poor, and the early Christian Church largely served as the social welfare system of the ancient world.  Singer himself built on precisely this point when, in the second edition of Practical Ethics, he suggested we give 10% of our resources to those in absolute poverty in part because this was the tithing percentage required by the social welfare mechanism of the age: the Catholic Church. In a shocking indictment of most of us, I suspect, both approaches insist that a selfish failure meet one’s duty to aid the global poor is seriously immoral behavior—akin to something like indirect homicide.

Those who are familiar with ethical theory are probably the most skeptical of conversation between Peter Singer and Christian Ethics—especially because Singer is utilitarian and the Church is a big fan of exceptionless moral norms. But even here the possibilities for overlap are striking and important. The Catholic Church has a teleological ethic which, yes, is ultimately directed toward union with God, but is proximately directed at the flourishing of the “universal common good.”  Even exceptionless moral norms are teleological in nature given that they are at the service of this kind of flourishing. Furthermore, Singer is exploring a new kind of objectivity in his moral theory—even to the point where it is no longer clear that he will remain a preference utilitarian. Indeed, in his latest edition of Practical Ethics he admits that preference utilitarianism is at variance with his moral intuitions about replacement theory (especially of persons), the good of distant future persons, and whether the existence of persons at all is a morally good thing. Especially as Singer moves to include more objectivity into his theory and go beyond preference utilitarianism, he becomes an even better conversation partner for Christian Ethics.

Much more needs to be said to back up these ideas and arguments, of course, and I try to do just that in my new book Peter Singer and Christian Ethics: Beyond Polarization—just released this weekend in the United States by Cambridge University Press. (Available in both paperback and Kindle versions.)  I’m certainly interested in any feedback about the book, so feel free to send me a note (either here or via e-mail: camosy@fordham.edu), or join the discussion on the book’s Facebook page.  The book will also serve as the basis of an exchange/debate between Julian Savulescu and myself next Autumn, so if you are in or around Oxford October 17th-19th, come by and see us.

Charlie Camosy

Fordham University (webpage is here)


The Kansas Anti-Abortion Bill: An Affront to Autonomy

On Monday, the state of Kansas in the USA passed an anti-abortion bill which includes several morally controversial measures (http://www.huffingtonpost.com/2012/05/04/kansas-abortion-bill_n_1478706.html). One measure receiving a great deal of media attention is the provision to prohibit tax deductions for abortion insurance coverage, thus making a women’s ability to have an abortion far more dependent on her socio-economic status. This is of course an important issue, but I shall address an aspect of the bill which I find even more disagreeable. Continue reading

Rick Santorum, birth control, and “playing God”

By Brian Earp

See Brian’s most recent previous post by clicking here.

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Rick Santorum, birth control, and “playing God”

Rick Santorum thinks that birth control is immoral. Santorum, a former Senator from Pennsylvania, is one of two human beings – if the polls have it right – likeliest to become the Republication nominee for President of the United States this election cycle.

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Practical Ethics Given Moral Uncertainty

Practical ethics aims to offer advice to decision-makers embedded in the real world.  In order to make the advice practical, it typically takes empirical uncertainty into account.  For example, we don’t currently know exactly to what extent the earth’s temperature will rise, if we are to continue to emit CO2 at the rate we have been emitting so far.  The temperature rise might be small, in which case the consequences would not be dire.  Or the temperature rise might be very great, in which case the consequences could be catastrophic.  To what extent we ought to mitigate our CO2 emissions depends crucially on this factual question.  But it’s of course not true that we are unable to offer any practical advice in absence of knowledge concerning this factual question. It’s just that our advice will concern what one ought to do in light of uncertainty about the facts.


But if practical ethics should take empirical uncertainty into account, surely it should take moral uncertainty into account as well.  In many situations, we don’t know all the moral facts.  I think it is fair to say, for example, that we don’t currently know exactly how to weigh the interests of future generations against the interests of current generations.  But this issue is just as relevant to the question of how one ought to act in response to climate change as is the issue of expected temperature rise.  If the ethics of climate change offers advice about how best to act given empirical uncertainty concerning global temperature rise, it should also offer advice about how best to act, given uncertainty concerning the value of future generations.


Cases such as the above aren’t rare.  Given the existence of widespread disagreement within ethics, and given the difficulty of the subject-matter, we would be overconfident if we were to claim to be 100% certain in our favoured moral view, especially when it comes to the difficult issues that ethicists often discuss.


So we need to have an account of how one ought to act under moral uncertainty.  The standard account of making decisions under uncertainty is that you ought to maximise expected value: look at all hypotheses in which you have some degree of belief, work out the likelihood of each hypothesis, work out how much value would be at stake if that hypothesis were true, and then trade off the probability of a hypothesis’ being true against how much would be at stake, if it were true.  One implication of maximizing expected value is that sometimes one should refrain from a course of action, not on the basis that it will probably be a bad thing to do, but rather because there is a reasonable chance that it will be a bad thing to do, and that, if it’s bad thing to do, then it’s really bad.  So, for example, you ought not to speed round blind corners: the reason why isn’t because it’s likely that you will run someone over if you do so.  Rather, the reason is that there’s some chance that you will – and it would be seriously bad if you did.


With this on board, let’s think about the practical implications of maximising expected value under moral uncertainty.   It seems that the implications are pretty clear in a number of cases. Here are a few.



One might think it more likely than not that it’s not wrong to kill animals for food.  But one shouldn’t be certain that it’s not wrong.  And, if it is wrong, then it’s seriously wrong – in the same ballpark as murder.  So, in killing an animal, one risks performing a major moral wrong, without any correspondingly great potential moral upside.  This would be morally reckless.  So one ought not to kill animals for food.



One might think it more likely than not that it’s not wrong to have an abortion, for reasons of convenience.  But one shouldn’t be certain that it’s not wrong.  And, if it is wrong, then it’s seriously wrong – in the same ballpark as murder.  So, in having an abortion for convenience, one risks performing a major moral wrong, without any correspondingly great potential moral upside.  This would be morally reckless.  So one ought not to have an abortion for reasons of convenience.



One might think it more likely than not that it’s not wrong to spend money on luxuries, rather than giving it to fight extreme poverty.  But one shouldn’t be certain that it’s not wrong.  And, if it is wrong, then it’s seriously wrong – in the same ballpark as walking past a child drowning in a shallow pond.  So, in spending money on luxuries, one risks performing a major moral wrong, without any correspondingly great potential moral upside.  This would be morally reckless.  So one ought not to spend money on luxuries rather than giving that money to fight poverty.


Abortion and Equality

During the year I’ve just spent in the US, several of the ethical issues commonly discussed in the media – gay marriage, assisted suicide, whether there should be universal health care, along with several others – have seemed to me largely unproblematic in themselves. The main issue in each case is how to deal politically with the fact that many people have deeply mistaken views.

Abortion, however, is not one of these issues. Though I certainly believe abortion should be available free and on demand, deep ethical problems arise out of the apparent conflict between two serious interests: those of the fetus and those of the woman bearing it.

The weight of philosophical argument over the last five decades has been in favour of abortion. Here is one argument against. Note that it is an argument against, which may well be (and I believe is) outweighed by arguments for. The argument can be constructed on the basis of a principle of equality, or a principle requiring one to give priority to the worse off. The example I shall use is highly circumscribed, and the application of the argument to the actual world may therefore be quite limited especially in the case of equality, since how to measure equality is considerably more disputed than how to give priority to the worse off. And there are also philosophical assumptions which could be questioned – for example the notion that moral status attaches not only to actual persons or those with a currently exercised capacity for well-being, but to individuals with the potential for well-being or a capacity for well-being dependent on developing physical attributes. It’s perhaps also worth pointing out that standard versions of consequentialism or utilitarianism count against abortion in the case I describe.

Consider a world containing just two individuals: a woman, and the fetus she is carrying. The woman wishes to abort her fetus, and is able to do so. If she does so, she will live a life with a  high level of well-being; and her fetus will live a (very short) life at the zero level. If she does not, then she will live a life with a moderate level of well-being, and her fetus will live a life at a level slightly below that of the woman’s life.

Assume that these two outcomes are the only ones possible in this world. Then both equality and ‘prioritarianism’ appear to count against abortion. For if the woman aborts her fetus, she will bring about great inequality between herself and her fetus, and fail to give priority to the worse off.