‘The Unique Worth of an Individual Human Life’

The Center for Bioethics and Culture Network selected Leon R. Kass, M.D. to receive its Paul Ramsey Award for 2010 — an award honoring those “who have demonstrated exemplary achievement in the field of bioethics.” Dr. Kass, the Addie Clark Harding Professor in the Committee on Social Thought and the College of the University of Chicago and Hertog Fellow at the American Enterprise Institute, accepted the award with these remarks, which were presented, slightly abbreviated, at the Center’s annual dinner, in San Francisco on March 19, 2010.

Thank you very much for the honor you have given me. I am very sorry that I cannot be with you this evening to express my gratitude and to let you know, face to face, how greatly I esteem the work of the Center for Bioethics and Culture Network. The Ramsey Award has a very special meaning for me, for Paul Ramsey was my mentor and friend, and my first teacher in bioethics. More than anyone else, he was responsible for major changes in my moral outlook and my life’s work. Tonight I wish to acknowledge my debt to Ramsey and to continue my conversation with him — and with you — on a subject where we once differed in print.

I first met Paul Ramsey in his writings, an early-1960s essay on the “Moral and Religious Implications of Genetic Control.” That article changed my mind, not only by leading me to discover, against my enlightenment complacency, that abortion and even contraception were moral questions, but also by showing me for the first time the power and profundity of a religious perspective on these matters. It was curious. The men of science who then wrote on bioethics were largely mush-headed, soft-hearted utopians, trusting in an invisible hand of progress more providential than God Almighty. And here was Ramsey, a professed man of faith, who could reason better than them all, and, moreover, was not afraid of being found unpopular.

In 1968, while I was working at the National Institutes of Health (NIH), a letter I wrote to Ramsey secured me an invitation to a series of seminars that he would conduct with members of the Georgetown medical faculty on bioethical topics. These seminars led to his first two books in bioethics, The Patient as Person and Fabricated Man, both published exactly forty years ago, the first monographs in the nascent field of bioethics. Re-reading them today, I rejoice in their lasting power, even as I bemoan the fact that few writings since hold a candle to Ramsey’s pioneering efforts. In the Georgetown seminars, a doctor would report on some morally charged medical area: experimentation in human subjects, definition of death, organ transplantation, etc. Ramsey would then begin to ask questions, always designed to understand how the physician himself understood the moral questions implicit in his domain. For Ramsey, practicing ethics was not top-down application of abstract theories, but grounded and guided reflection on concrete actual practices.

One day Ramsey asked me to read a draft manuscript on genetic manipulation; I believe it was on “Parenthood and the Future of Man by Artificial Donor Insemination.” I was flattered. I read with care, scribbling comments, questions, and stylistic emendations in the margins. Nervously, I arrived at his apartment, wondering how the Professor would take to my comments, including my not infrequent complaints about his prose. My fears were absolutely unfounded. We spent three or four hours in what was for me exhilarating conversation. It was the first of many such occasions, for I was privileged to read in draft nearly all of the chapters of The Patient as Person and Fabricated Man. Each chapter was the subject of a lengthy evening session. No point I might raise did he regard as too small, no argument too absurd. In Paul Ramsey I had met a man devoted both to high moral principle and to learning and inquiry. I admired his generous ways and warmed to his earthy manner.

My reading and conversing with Ramsey in Washington proved more exciting than the research I was doing at NIH. It now seemed to me possible that one could reason vigorously and powerfully about the moral questions raised by scientific advance, questions that had already begun to bother me. That year Dan Callahan began to recruit people to start the Hastings Center, and it was Ramsey who got me invited to the founding meetings of the Center. Forty years ago this April Fool’s Day, I left the laboratory for work in ethics and philosophy, work for which I had no formal training, but for which I felt myself somehow ready, thanks largely to the encouragement and example of Paul Ramsey, and, I must add, also Hans Jonas. Later that year, in one of my first publications, I reviewed Fabricated Man for Theology Today, concluding as follows:

In this age when scientism is in the pulpit, and when so many theologians are eagerly scrambling past each other to be the first to embrace the Double Helix, this non-Christian, scientist-reviewer is especially grateful to Professor Ramsey for his stubborn refusal to part with the unique wisdoms that are his as a Christian theologian and as a profound student of the moral life. Would that more of his fellow theologians and moral philosophers would follow his example and hearken to their calling. We desperately need their special understanding as we face the awesome powers, now gathering, for controlling the bodies and minds of men.

At Hastings, Ramsey and I were close colleagues through the 1970s, especially in the research group on death and dying and on the board of directors, where we were frequently allies in lost causes. Again and again, I was impressed by Paul’s blend of tenacity and fairness in public meetings. He took other people’s remarks often more seriously than they did in making them; accordingly, his questions often produced embarrassment and even irritation. But I never saw a grain of anger or nastiness, even when it might have been justified. Whatever one might say, theoretically, about the possibility of the union of Christianity and gentlemanship, there was no doubt that all of us were in the presence of a Christian gentleman. And an avuncular one at that: my grown daughters still recall visits from their “Uncle Paul,” during which he would read to them and sing them little ditties they remember to this day. It was Ramsey who gave our eldest, then a wide-eyed age five, her first lesson in metaphysics: promising to show her something that she had never seen before and would never see again, he took from his pocket a simple unshelled peanut, revealed to her its hidden contents, and made it disappear forever in the usual way.

It was, in fact, over a similar question of metaphysics and the compatibility of Christianity and nobility — or, if you prefer, of Jerusalem and Athens — that Paul and I had a serious theoretical disagreement. The immediate subject was what Ramsey called “The Indignity of ‛Death with Dignity,’” but the larger question concerned the nature and ground of human dignity, a subject still vital to all bioethical discussions. Presciently and wisely, Ramsey wrote to oppose the shallow views of human life that informed the emerging “death with dignity” movement, which spoke as if dignity would reign if only officious doctors kept their machinery at bay and let nature take its course with the mortally ill. But Ramsey’s argument ultimately rested on his belief that death itself was an inherent indignity, because it “contradict[ed] … the unique worth of an individual human life.” This view rested, in turn, on his Christian faith: that we human beings, originally created for immortality, fell through sin into our mortal condition, where we enjoy only an alien dignity bestowed upon us by God, Who out of His infinite love became man and was crucified, and Who thus redeems us and offers us salvation from sin and the conquest of death.

Against this view, half a lifetime ago, your honoree took up the pen against his teacher. In an essay entitled “Averting One’s Eyes or Facing the Music? — On Dignity in Death,” I argued that death was not in itself an affront to human dignity; that human dignity was intrinsic and rooted in our nature, not alien and bestowed; and that it was manifested — or not — in how we lived our lives and faced our deaths — some of us with dignity, some without it. Moreover, against Ramsey, I insisted that what was most dignified and worthy about us was not what made each of us a unique and irreplaceable human being, but rather what we had humanly in common — our species-specific capacities for understanding, community, and moral excellence. Then in the grip of natural philosophy, forged from equal doses of Aristotle and Darwin, I even argued from the natural necessity of mortality to the goodness of mortality, seeing in it the condition of making the most of our allotted time, and suggesting that it is through procreation and transmission of tradition that we embodied human beings best participate in the enduring and transcendent.

Time and further study have taught me my lessons, even though I have not yet converted fully to Ramsey’s point of view. Though I still celebrate what we human beings have in common, I no longer devalue our individuality and no longer regard as mere sentimentality the celebration of our “uniqueness.” The human soul comes to us never in its generality, always in its particular embodiments, each with our own special manifestations of the glories and miseries of being human, each with our particular — yes, unique — trajectory from living zygote in the womb to lifeless body in the grave. The only human life we can live and celebrate is not universal but parochial, and not a single moment of it will ever come again. True love loves uniquely the one whom it has been given to me to love: my beloved — like my father or mother of blessed memory, or my family and friends — is not replaceable. Alas, Paul Ramsey’s like I shall not see again, and I wish it were possible for me to tell him that I now really see what he was getting at with his peanut and his celebration of our unique individuality. I am still willing to give one or two cheers for my own mortality, but I now find it impossible to assent naturalistically to the extinction of those near and dear. Thus, if I now universalize this insight about my own life and love, I see clearly why the equal and immeasurable preciousness of every human life — each one equally in God’s image, each one equally unique — must remain the first principle of any decent bioethics. This was the crucial starting point of Paul Ramsey’s work, and the guiding nerve of his magisterial The Patient as Person.

Yet, that said, our human dignity is not exhausted by what makes us irreplaceable actors upon the human stage. It still matters greatly how we act and how well we use our God-given powers in the drama in which we are privileged to play a part. Because there is more to human dignity than our vitality and uniqueness, we must be careful lest single-minded attachment to the bedrock principle of life undermine the edifice that we seek to erect upon it. For if we think that death is an irreducible evil and always an affront to human dignity, we will be hard-pressed to avoid embracing the project for the conquest of aging and mortality and the indefinite prolongation of life. We will be hard-pressed to remember why we should not mortgage the future of our children to purchase better health care for ourselves. And we will be hard-pressed to recognize the dehumanizing possibilities embedded in the project for the mastery of nature for the relief of man’s estate and the biotechnical pursuit of superior performance, ageless bodies, and pharmaceutically happy souls.

Paul Ramsey understood the dangers of dehumanization and gave them prominent place in his bioethical writings. If The Patient as Person emphasized what Ramsey’s prize student Gil Meilaender, in his new book, calls personal dignity, Fabricated Man emphasized what Meilaender calls human dignity — the dignity of the human species as human, with its aspirations and possibilities for excellence and virtue, love and friendship, righteousness and holiness. Those of us who care about dignity must care equally for both sorts. It will not do, for the party of dignity, to be so monomaniacal in its defense of life in its beginnings that it accepts babies born in bottles so long as no embryo dies in the process, or rejects a ban on placing human embryos into animal wombs because that might be the only way to rescue embryos now frozen in freezers. It will not do for the party of dignity, addressing painful decisions at the end of life, always to insist on stretching those we love and dread to lose on the rack of medicalized prolongation. Important though it is, the dignity of “Life at the Edges” — the theme of another one of Ramsey’s books — is no more crucial than the dignity of “Life in Its Flourishing.” Following the lead of Paul Ramsey, we must stand up for this dignity as well, if we wish to avoid the soul-flattened degradations of a Brave New World. Only in this way can we preserve for future generations a world still hospitable to the many wonderful and worthy activities of which the upright and God-seeking animal alone is capable.