Peter Singer on Ashley's Treatment

    Peter Singer, prominent Princeton ethicist, weighs in today on the case of the parents who allowed medical interventions to limit the physical growth of their disabled daughter.  Her name is Ashley and I blogged about the case earlier, here.   It turns out, as I suspected, that Singer, in his support for Ashely's treatment, is closer to a Confucian than a Taoist position on the matter.

    Singer maintains his usual utilitarian stance, arguing that what matters most is to avoid suffering and, though he leaves this unspoken in this short piece, increase pleasure or happiness.  If Ashley's treatment adds to her and her parents' pleasure, then it is good, and that goodness overrides other ethical concerns.  But in making his pleasure/pain calculations, he accepts that preferences are social, not individual.  Consider this sentence:

Beyond that, she is precious not so much for what she is, but because her parents and siblings love her and care about her.

     That has a strong Confucian ring to it - and it might meet with objections from utilitarians who would focus on individual, as opposed to group, preferences.  Of course, he is missing one important aspect of the social dimension of Ashley's identity: it is not only that her parents and siblings love her, but also that she loves them and gives meaning and significance to their lives as well.

     I will admit that at first, when I read this piece, I thought that Singer was contradicting himself.  He is famous for the argument that parents should have the right to kill disabled infants if that would allow them to avoid discomfort and maximize happiness.  But, with a bit more consideration, I realize that he is being consistent, and this demonstrates a possible flaw in both utilitarian and Confucian thinking.  What they share is their dependence on the parents' calculations.  If parents understand themselves to be in a position of pain and suffering, then they might elect to give up on a disabled child.  If, on the other hand, they are inspired by their child, whatever his or her condition, they will work to find the greatest happiness in the circumstances. 

    The key question then is: how can parents know if they will derive more happiness or more pain from caring for a disabled child before they have actually done it?  Our modern cultural context sends many, many powerful signals that disability is tragedy and sadness.  A utilitarian position offers no hints as to how to define happiness or how to proceed in such difficult circumstances and, without such counsel, utilitarianism will likely lead to more abandonments - and if Singer's ethics prevailed, killings - of disabled children. 

    Confucianism is, I believe, superior in this regard because it would suggest that caring for a disabled child allows a parent to cultivate and express his or her humanity.  Although there will be obvious moments of suffering and pain, there will be a larger and more significant goodness that is created and extended out into the world.  Thus, while a Confucian perspective would not be absolutist on this point - it would allow, for example, for abortion of disabled fetuses if the circumstances of the existing family warranted it - it would encourage parents of disabled children to invest themselves in the performance of daily care as a means for deepening their own humanity. 

    In short, Singer and Confucians would agree that, in this case, Ashley's treatment is a good thing.  Confucians would, however, be more willing to encourage others to follow this example.

    Singer draws a much clearer line between himself and Taoist understandings:

The objections to Ashley’s treatment take three forms familiar to anyone working in bioethics. First, some say Ashley’s treatment is “unnatural” — a complaint that usually means little more than “Yuck!” One could equally well object that all medical treatment is unnatural, for it enables us to live longer, and in better health, than we naturally would. During most of human existence, children like Ashley were abandoned to become prey to wolves and jackals. Abandonment may be a “natural” fate for a severely disabled baby, but it is no better for that reason.

      What we might now call the "yuck test" is a crude distortion of Taoist thinking; but the question of what is "natural" or not is quite close to a Taoist sensibility.  Singer is saying that "natural" is not necessarily "better."  A Taoist might say that "natural" encompasses both "better" and "worse" but will, in the end, win out.  We may try to intervene in Way in immediate and specific ways but Way will continue to unfold naturally and, at some more distant moment, overwhelm our human efforts of control.   While that might be cold comfort for Ashley's parents, the more general lesson might be defined as an ethics of acceptance as opposed to an ethics of intervention.   While I think Ashley's parents have done the right thing, we all need to be open to the dynamism of life and how changing circumstances might make today's right decision look rather different.

Comments

[Dee Hansen]

Had the Taoist or Confucianists had the medical breakthroughs that we have today, I assure you, they would be in support of Ashley's parents. Even with the surgery ... there is still pain from not knowing what will happen to your son or daughter when you die... a child or adult who depends on your every need both physically and emotionally.

With typical developing children, they have choice. They can fly through the window of independence by their own design. Our children who have global delays do not have that option. They live at the mercy of others EVERY SINGLE DAY OF THEIR LIFE ..

[Elisabeth's Mom]

After reading your article I took you up on your offer to travel to China.

Some of the details about China at this point in history are fuzzy because it has been a very long time since I last traveled there. In fact, it's been 20 something years.

I see Lao Tzu is writing out his "five thousand characters" and I hear the comforting words from Confucius saying we must love without discrimination even though there are warring factions brewing and warlords will be ascending upon this place of tranquility.

So I leave and travel to another part of the world where I find a person hovering over another person who appears to be dead. It appears this person is carving a sharp object into the dead human body. In the bushes, there is person hiding who gasps at what is happening and runs away. The person continues with the work at hand but is interrupted later by a group of people who are shouting. It looks like this person with the sharp object is trying to explain something but nobody is listening.

I can't help thinking of what the horrible consequences were for the first person who carved into a dead body to discover what was inside and how similar the situation is today for a young biologist looking through a microscope and seeing something for the very first time.

All the primitive forces of nature known to humans continue to flow in one direction while forces driving the inquisitive nature of humans flow in a different direction.