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March 27, 2005
Did Descartes Doom Terri Schiavo?
By JOHN LELAND
 
In the parade of faces talking about Terri Schiavo last week, two notable authorities were missing: Aristotle and Descartes. Yet their legacy was there.

Beneath the political maneuvering and legal wrangling, the case re-enacted a clash of ideals that has run through the history of Western thought. And in a way, it's the essential question that has been asked by philosophers since the dawn of human civilization. Is every human life precious, no matter how disabled? Or do human beings have the right to self-determination and to decide when life has value?

"The clash is about how we understand the human person," said Samuel Gregg, director of research at the Acton Institute for the Study of Religion and Liberty, a conservative policy group.

The plea last week to prolong Ms. Schiavo's feeding, against the wishes of her husband or what courts determined to be her own expressed inclinations, echoed the teachings of Aristotle, who considered existence itself to be inviolable.

On the other side, the argument that Ms. Schiavo's life could be judged as not worth living echoed Descartes, the Enlightenment philosopher who defined human life not as biological existence - which might be an inviolable gift from God - but as consciousness, about which people can make judgments.

For most of history, the conflict between these schools of thought has allowed room for compromise, said Robert Veatch, a professor of medical ethics at Georgetown University who supports the right of patients to suspend treatment. He cited a Roman Catholic judgment from the Middle Ages that if a patient needed to travel 300 miles by donkey cart to a shrine to be healed, that was too much. "The idea that all life is valuable or sacred has in almost all settings been qualified in some way," Professor Veatch said.

Yet this idea that all life is sacred has exerted a powerful force in America, said Mark A. Noll, a professor of history at Wheaton College, a prestigious evangelical school in Illinois, and the author of "The Old Religion in a New World: The History of North American Christianity. " It fueled the abolitionist movement of the 18th and 19th centuries, which insisted on the humanity of slaves, against the prevailing views of social science. In the early 20th century, the same ideal stood up against eugenics, which advocated forced sterilization to prevent the weakest members of society from reproducing.

In both battles, Professor Noll said, people who held the sanctity of all human life as a religious conviction triumphed over an Enlightenment contention "that said 'No, we can qualify this value' " - meaning the value of a human life could be determined by scientific thought.

As late as 1927, the United States Supreme Court ruled that the government could sterilize mentally retarded people against their will. "Three generations of imbeciles are enough," Justice Oliver Wendell Holmes wrote in the court's decision involving a woman mistakenly deemed retarded.

In this context, Professor Noll said, "the preference for life has been a protection against the exploitation of little people by big people." The conflict as it exists now began to take shape with the emergence of modern medicine in the late-19th and early-20th centuries, said Gary M. Laderman, an associate professor of religion at Emory University and author of "The Sacred Remains: American Attitudes Toward Death, 1799-1883."

Medical breakthroughs that prolonged human life by technological means changed the way Americans could see death and by extension, the ways they defined life.

The setting for death shifted from the home to the hospital, where doctors, rather than religious leaders, claimed authority. Medicine lionized the figure of the heroic doctor, and treated death as a kind of failure, Professor Laderman said. Doctors were free not to tell patients that they were terminally ill, claiming for themselves the right to determine what was appropriate. Death became a "medicalized" state, to be determined by human expertise. Like life, it could be treated as a medical option.

By the 1960's and 1970's, medical patients began to claim this right for themselves, said Bruce Jennings, a senior research scholar at the Hastings Center, a bioethics research group that has supported patient rights. In this, they conspicuously followed the model of the political and consumer movements of the era, which shifted authority away from experts and institutions to individuals.

To adopt Professor Noll's language, they redefined the little people.

"This offered a slightly different way to frame the issue: not so much as a conflict between valuing life and the freedom of choice, but a different attitude toward technology itself," Mr. Jennings said. "On the one hand, there's a widespread feeling in the United States that everything can be cured and we don't have to die. But there's another fear of imprisonment by technology in a way that undermines our integrity and dignity. It's claiming freedom from these institutions or technology."

The philosophical line in this history, then, is not straightforward, but includes a peculiar American twist: The evangelical revival of the 18th and 19th centuries produced the abolition movement, which gave rise to the women's suffrage movement, which inspired the civil rights movement, which led to the patient's rights movement. But now the patient's rights movement faces off with many 21st-century evangelical Christians in the Schiavo case.

At the same time, the scientific legacy of the Enlightenment, which argued that human life resided not in the body but the mind, is now being undermined, as modern neuroscience demystifies elements of thought and personality as heartless biochemical or genetic processes. The mind is simply prisoner to the body's DNA.

The ideas at play over this history do not conclude with Ms. Schiavo's case, but feed into arguments over abortion, stem-cell research, assisted suicide, the death penalty and even animal rights.

In their competing claims, these ideas are part of what defines America, said Courtney S. Campbell, a professor of medical ethics at Oregon State University who has argued for the rights of patients to pull the plug.

"It goes back to the foundations of the Republic - the right to life and the right to liberty in the Declaration of Independence," he said. "It's a deep-rooted conflict that goes to the core of who we are as a people and as a political society, so it's not surprising that it can be polarizing."
 
 

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