Ill-Gotten Gains
by Tom Regan
The Story
Late in 1981 a reporter for a large metropolitan
newspaper (we'll call her Karen to protect her interest in remaining
anonymous) gained access to some previously classified government files.
Using the Freedom of Information Act, Karen was investigating the federal
government's funding of research into the short- and long-term effects of
exposure to radioactive waste. it was with understandable surprise that,
included in these files, she discovered the records of a series of
experiments involving the induction and treatment of coronary thrombosis
(heart attack). Conducted over a period of fifteen years by a renowned
heart specialist (we'll call him Dr. Ventricle) and financed with federal
funds, the experiments in all likelihood would have remained unknown to
anyone outside Dr. Ventricle's sphere of power and influence had not Karen
chanced upon them.
Karen's surprise soon gave way to shock and disbelief. In case after
case she read of how Ventricle and his associates took otherwise healthy
individuals, with no previous record of heart disease, and intentionally
caused their heart to fail. The methods used to occasion the "attack" were
a veritable shopping list of experimental techniques, from massive doses
of stimulants (adrenaline was a favorite) to electrical damage of the
coronary artery, which, in its weakened state, yielded the desired
thrombosis. Members of Ventricle's team then set to work testing the
efficacy of various drugs developed in the hope that they would help the
heart withstand a second "attack." Dosages varied, and there were the
usual control groups. In some cases, certain drugs administered to
"patients" proved more efficacious than cases in which others received no
medication or smaller amounts of the same drugs. The research came to an
abrupt end in the fall of 1981, but not because the project was judged
unpromising or because someone raised a hue and cry about the ethics
involved. Like so much else in the world at that time, Ventricle's project
was a casualty of austere economic times. There simply wasn't enough
federal money available to renew the grant application.
One would have to forsake all the instincts of a reporter to let the
story end there. Karen persevered and, under false pretenses, secured an
interview with Ventricle. When she revealed that she had gained access to
the file, knew in detail the largely fruitless research conducted over
fifteen years, Ventricle was dumbfounded. But not because Karen had
unearthed the file. And not even because it was filed where it was (a
"clerical error," he assured her). What surprised Ventricle was that
anyone would think there was a serious ethical question to be raised about
what he had done. Karen's notes of their conversation include the
following:
- Ventricle:
- But I don't understand what you're getting at. Surely you know that
heart disease is the leading cause of death. How can there be any
ethical question about developing drugs which literally promise
to be life-saving?
- Karen:
- Some people might agree that the goal--to save life--is a good, a
noble end, and still question the means used to achieve it. Your
"patients," after all, had no previous history of heart disease.
They were healthy before you got your hands on them.
- Ventricle:
- But medical progress simply isn't possible if we wait for people to
get sick and then see what works. There are too many variables, too much
beyond our control and comprehension, if we try to do our medical
research in a clinical setting. The history of medicine shows how
hopeless that approach is.
- Karen:
- And I read, too, that upon completion of the experiment, assuming
that the "patient" didn't die in the process--it says that those who
survived were "sacrificed." You mean killed?
- Ventricle:
- Yes, that's right. But always painlessly, always painlessly. And the
body went immediately to the lab, where further tests were done. Nothing
was wasted.
- Karen:
- And it didn't bother you--I mean, you didn't ever ask yourself
whether what you were doing was wrong? I mean...
- Ventricle (interrupting):
- My dear young lady, you make it seem as if I'm some kind of moral
monster. I work for the benefit of humanity, and I have achieved some
small success, I hope you will agree. Those who raise cries of
wrong-doing about what I've done are well intentioned but misguided.
After all, I use animals in my research--chimpanzees, to be precise--not
human beings.
The Point
The story about Karen and Dr. Ventricle is just that--a
story, a small piece of fiction. There is no real Dr. Ventricle, no real
Karen, and so on. But there is widespread use of animals in
scientific research, including research like our imaginary Dr.
Ventricle's. So the story, while its details are imaginary--while it is,
let it be clear, a literary device, not a factual account--is a story with
a point. Most people reading it would be morally outraged if there
actually were a Dr. Ventricle who did coronary research of the sort
described on otherwise healthy human beings. Considerably fewer would
raise a morally quizzical eyebrow when informed of such research done on
animals, chimpanzees, or whatever. The story has a point, or so I hope,
because catching us off guard, it brings this difference home to us, gives
it life in our experience, and, in doing so, reveals something about
ourselves, something about our own constellation of values. If we think
what Ventricle did would be wrong if done to human beings but all right if
done to chimpanzees, then we must believe that there are different moral
standards that apply to how we may treat the two--human beings and
chimpanzees. But to acknowledge this difference, if acknowledge it we do,
is only the beginning, not the end, of our moral thinking. We can meet the
challenge to think well from the moral point of view only if we are able
to cite a morally relevant difference between humans and
chimpanzees, one that illuminates in a clear, coherent, and rationally
defensible way why it would be wrong to use humans, but not chimpanzees,
in research like Dr. Ventricle's....
The Law
Among the difference between chimps and humans, one
concerns their legal standing. It is against the law to do to human beings
what Ventricle did to his chimpanzees. It is not against the law to do
this to chimps. So, here we have a difference. But a morally relevant one?
The difference in the legal status of chimps and humans would be
morally relevant if we had good reason to believe that what is legal and
what is moral go hand in glove: where we have the former, there we have
the latter (and maybe vice versa too). But a moment's reflection shows how
bad the fit between legality and morality sometimes is. A century and a
half ago, the legal status of black people in the United States was
similar to the legal status of a house, corn, a barn: they were property,
other people's property, and could legally be bought and sold without
regard to their personal interests. But the legality of the slave trade
did not make it moral, any more than the law against drinking, during the
era of that "great experiment" of Prohibition, made it immoral to drink.
Sometimes, it is true, what the law declares illegal (for example, murder
and rape) is immoral, and vice versa. But there is no necessary
connection, no pre-established harmony between morality and the law. So,
yes, the legal status of chimps and humans differs; but that does not show
a morally relevant difference and will not morally justify using these
animals, but not humans, in Ventricle's research.
The Value of the Individual
[An] alternative vision [to
utilitarian value] consists in viewing certain individuals as themselves
having a distinctive kind of value, what we will call "inherent value."
This kind of value is not the same as, is not reducible to, and is not
commensurate either with such values as preference satisfaction or
frustration (that is, mental states) or with such values as artistic or
intellectual talents (that is, mental and other kinds of excellences or
virtues). We cannot, that is, equate or reduce the inherent value of an
individual to his or her mental states or virtues, and neither can we
intelligibly compare the two. In this respect, the three kinds of value
(mental states, virtues, and the inherent value of the individual) are
like proverbial apples and oranges.
They are also like water and oil: they don't mix. It is not only that
[a man's] inherent value is not the same as, not reducible to, and not
commensurate with his satisfaction, pleasures, intellectual and
artistic skills, etc. In addition, his inherent value is not the
same as, is not reducible to, and is not commensurate with the valuable
mental states or talents of other individuals, whether taken singly
or collectively. Moreover, and as a corollary of the preceding, the
individual's inherent value is in all ways independent both of his or her
usefulness relative to the interest of others and of how others feel about
the individual (for example, whether one is liked or admired, despised or
merely tolerated). A prince and a pauper, a streetwalker and a nun, those
who are loved and those who are forsaken, the genius and the retarded
child, the artist and the philistine, the most generous philanthropist and
the most unscrupulous used car salesman--all have inherent value,
according to the view recommended here, and all have it equally....
What Difference Does It Make?
To view the value of individuals in
this way is not an empty abstraction. To the question, "What difference
does it make whether we view individuals as having equal inherent value,
or as utilitarians do, as lacking such value but to varying degree?"--our
response to this question must be, "It makes all the moral difference in
the world!" Morally, we are always required to treat those who have
inherent value in ways that display proper respect for their distinctive
kind of value, and though we cannot on this occasion either articulate or
defend the full range of obligations tied to this fundamental duty, we can
note that we fail to show proper respect for those who have such value
whenever we treat them as if they were mere receptacles of value or as if
their value was dependent on, or reducible to, their possible utility
relative to the interests of others. In particular, therefore, Ventricle
would fail to act as duty requires--would, in other words, do what is
morally wrong--if he conducted his coronary research on competent human
beings, without their informed consent, on the grounds that this research
just might lead to the development of drugs or surgical techniques that
would benefit others. That would be to treat these human beings as mere
receptacles or as mere medical resources for others, and though Ventricle
might be able to do this and get away with it, and though others might
benefit as a result, that would not alter the nature of the grievous wrong
he would have done. And it would be wrong, not because (or only if) there
were utilitarian considerations, or contractarian considerations, or
perfectionist considerations against his doing his research on these human
beings, but because it would mark a failure on his part to treat them with
appropriate respect. To ascribe inherent value to competent human beings,
then, provides us with the theoretical wherewithal to ground our moral
case against using competent human beings, against their will, in research
like Ventricle's.
Who Has Inherent Value?
If inherent value could nonarbitrarily be
limited to competent humans, then we would have to look elsewhere to
resolve the ethical issues involved in using other individuals (for
example, chimpanzees) in medical research. But inherent value can only be
limited to competent human beings by having the recourse to one arbitrary
maneuver or another. Once we recognize that we have direct duties to
competent and incompetent humans as well as to animals such as
chimpanzees; once we recognize the challenge to give a sound theoretical
basis for these duties in the case of these humans and animals; once we
recognize the failure of indirect duty, contractarian, and utilitarian
theories of obligation; once we recognize that the inherent value of
competent humans precludes using them as mere resources in such research;
once we recognize that perfectionist vision of morality, one that assigns
degrees of inherent value on the basis of possession of favored virtues,
is unacceptable because of its inegalitarian implications, and once we
recognize that morality simply will not tolerate double standards, then we
cannot, except arbitrarily, withhold ascribing inherent value, to an equal
degree, to incompetent humans and animals such as chimpanzees. All have
this value, in short, and all have it equally. All considered, this is an
essential part of the most adequate total vision of morality. Morally,
none of those having inherent value may be used in Ventricle-like research
(research that puts them at risk of significant harm in the name of
securing benefits for others, whether those benefits are realized or not).
And none may be used in such research because to do so is to treat them as
if their value is somehow reducible to their possible utility relative to
the interests of others, or as if their value is somehow reducible to
their value as "receptacles." What contractarianism, utilitarianism, and
the other "isms" discussed earlier will allow is not morally tolerable.
Hurting and Harming
The prohibition against research like
Ventricle's, when conducted on animals such as chimps, cannot be avoided
by the use of anesthetics or other palliatives used to eliminate or reduce
suffering. Other things being equal, to cause an animal to suffer is to
harm that animal--is, that is, to diminish that individual animal's
welfare. But these two notions--harming on the one hand and suffering on
the other--differ in important ways. An individual's welfare can be
diminished independently of causing her to suffer, as when, for example, a
young woman is reduced to a "vegetable" by painlessly administering a
debilitating drug to her while she sleeps. We mince words if we deny that
harm has been done to her, though she suffers not. More generally, harms,
understood as reductions in an individual's welfare, can take the form
either of inflictions (gross physical suffering is the clearest
example of a harm of this type) or deprivations (prolonged loss of
physical freedom is a clear example of harm of this kind). Not all harms
hurt, in other words, just as not all hurts harm.
Viewed against the background of these ideas, an untimely death is seen
to be the ultimate harm for both humans and animals, such as chimpanzees,
and it is the ultimate harm for both because it is their ultimate
deprivation or loss--their loss of life itself. Let the means used to kill
chimpanzees be as "humane" (a cruel word, this) as you like. That will not
erase the harm that an untimely death is for these animals. True, the use
of anesthetics and other "humane" steps lessens the wrong done to these
animals, when they are "sacrificed" in Ventricle-type research. But a
lesser wrong is not a right. To do research that culminates in the
"sacrifice" of chimpanzees or that puts these and similar animals at risk
of losing their life, in the hope that we might learn something that will
benefit others, is morally to be condemned, however "humane" that research
may be in other respects.
The Criterion of Inherent Value
It remains to be asked, before
concluding, what underlies the possession of inherent value. Some are
tempted by the idea that life itself is inherently valuable. This view
would authorize attributing inherent value to chimpanzees, for example,
and so might find favor with some people who oppose using these animals in
research. But this view would also authorize attributing inherent value to
anything and everything that is alive, including, for example, crabgrass,
lice, bacteria, and cancer cells. It is exceedingly unclear, to put the
point as mildly as possible, either that we have a duty to treat these
things with respect or that any clear sense can be given to the idea that
we do.
More plausible by far is the view that those individuals have inherent
value who are the subjects of a life--who are, that is, the
experiencing subjects of a life that fares well or ill for them over time,
those who have an individual experiential welfare, logically
independent of their utility relative to the interests of others.
Competent humans are the subjects of a life in this sense. But so, too,
are those incompetent humans who have concerned us. And so, too, and not
unimportantly, are chimpanzees. Indeed, so too are the members of many
species of animals: cats and dogs, monkeys and sheep, cetaceans and
wolves, horses and cattle. Where one draws the line between those animals
who are, and those who are not, subjects of a life is certain to be
controversial. Still there is abundant reason to believe that the members
of mammalian species of animals do have a psycho-identity over time, do
have an experiential life, do have an individual welfare. Common sense is
on the side of viewing these animals in this way, and ordinary language is
not strained in talking of them as individuals who have an experiential
welfare. The behavior of these animals, moreover, is consistent with
regarding them as subjects of a life, and the implications of evolutionary
theory are that there are many species of animals whose members are, like
the members of the species Homo sapiens, experiencing subjects of a
life of their own, with an individual welfare. On these grounds, then, we
have very strong reason to believe, even if we lack conclusive proof, that
these animals meet the subject-of-a-life criterion.
If, then, those who meet this criterion have inherent value, and have
it equally relative to all who meet it, chimpanzees and other animals who
are subjects of a life, not just human beings, have this value and
have neither more nor less of it than we do. (To hold that they have less
than we do is to land oneself in the inegalitarian swamp of
perfectionism). Moreover, if, as has been argued, having inherent value
morally bars others from treating those who have it as mere receptacles or
as mere resources for others, then any and all medical research like
Ventricle's, done on these animals in the name of possibly benefiting
others, stands morally condemned. And it is not only cases in which the
benefits for others do not materialize that are condemnable; also to be
condemned are cases, such as the research done on chimps regarding
hepatitis, for example, in which the benefits for others are genuine. In
these cases, as in others like them in the relevant respects, the ends do
not justify the means. The many millions of mammalian animals used
each year for scientific purposes, including medical research, bear mute,
tragic testimony to the narrowness of our moral vision.
Conclusions
This condemnation of such research probably is at odds
with the judgement that most people would make about this issue. If we had
good reason to assume that the truth always lies with what most people
think, then we could look approvingly on Ventricle-like research done on
animals like chimps in the name of benefits for others. But we have no
good reason to believe that the truth is to be measured plausibly by
majority opinion, and what we know of the history of prejudice and bigotry
speaks powerfully, if painfully, against this view. Only the cumulative
force of informed, fair, rigorous argument can decide where the truth
lies, or most likely lies, when we examine a controversial moral question.
Although openly acknowledging and, indeed, insisting on the limitations of
the arguments..., these arguments make the case, in broad outline, against
using animals such as chimps in medical research such as Ventricle's....
Those who oppose the use of animals such as chimps in research like
Ventricle's and who accept the major themes advanced here, oppose it,
then, not because they think that all such research is a waste of time and
money, or because they think that it never leads to any benefits for
others, or because they view those who do such research as, to use
Ventricle's words, "moral monsters," or even because they love animals.
Those of us who condemn such research do so because this research is not
possible except at the grave moral price of failing to show proper respect
for the value of the animals who are used. Since, whatever our gains, they
are ill-gotten, we must bring to an end research like Ventricle's,
whatever our losses. A fair measure of our moral integrity will be the
extent of our resolve to work against allowing our scientific, economic,
health, and other interests to serve as a reason for the wrongful
exploitation of members of species of animals other than our own.
Borrowed from Tom Regan's Ill-Gotten Gains, in Donald Van DeVeer
and Tom Regan, eds., Health Care Ethics: An Introduction (Temple
University Press, 1987). |
