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Choice devours itself--Julian Savulescu's deceptive dance

I echo Wesley J. Smith's opinion of Julian Savulescu, though he puts it more nicely than I would. Smith says,

Julian Savulescu represents all that I find so objectionable about the mainstream bioethics movement.

Savulescu, just to give my readers a point of reference, is an Oxford professor and bioethics journal editor. A couple of years ago Savulescu happily published the now-infamous "after-birth abortion" article favoring infanticide ("Why Should the Baby Live") and smirkingly defended it on the grounds that a) philosophers have been down with infanticide for a couple of decades, too bad hoi polloi didn't notice and b) now that hoi polloi have noticed (darn!) and are horrified, they should shut up and butt out because they are not experts.

Now Savulescu has decided to advocate mandatory organ donation.

[T]here is a basic moral obligation to donate organs. Why? Because this is not just an easy rescue, it is a zero cost rescue. Organs are of no use to us when we are dead, but they are literally lifesaving to others. Nonetheless, most people choose to bury or burn these lifesaving resources, and are allowed to. Yet the state extracts death duties and inheritance taxes, but not the most important of their previous assets—their organs.

This proposal is chilling enough, but Savulescu is pretty obviously counting on the fact that most people, including most philosophers, still believe that vital organs are taken from cold corpses, which is emphatically not the case. Hey, what's to lose? You don't need 'em after you're dead, right? Of course, this sweeps under the rug all manner of legitimate concerns about whether one's treatment before one is dead will be influenced by the desire to procure organs, whether protocols for declaring death are sufficiently rigorous, whether there is a reliably detectable state of "whole brain death" that really is true biological death, whether hospitals even follow the basic protocols that are already in place, and much else, but bioethicists get to live in a tidy world where none of that concerns us.

Savulescu's proposal is alarmingly totalitarian on its face, but there is more to be said even than that. I want to point out an interesting coincidence between this most recent article by Savulescu and an earlier one. In "Death, Us, and Our Bodies" (2003) Savulescu explicitly advocated throwing out the dead donor rule:

If we believe that what matters is our mental state, then we should review the rule that we can only take organs from those who satisfy brain or cardiorespiratory criteria for death (see the papers by Zamperetti et al and by Bell p 176 and 182). This is called the “dead donor rule”. Since I believe we die when our meaningful mental life ceases, organs should be available from that point, which may significantly predate brain death.

At the risk of boasting, I have to mention that, when I read about Savulescu's advocacy of forced organ donation on Wesley J. Smith's blog "Human Exceptionalism," I predicted the existence of an article in which Savulescu advocated the abandonment of the dead donor rule. I had never actually seen such an article, but I predicted it, and it took me less than five minutes' googling to find it.

This might seem counterintuitive. In Savulescu's hot-off-the-e-press article in which he now advocates mandatory organ donation, he expressly bases this recommendation on the claim that organ donation is "zero cost" because organs are of no use after we are dead. Why, then, would I make that prediction? And shouldn't I in charity assume that Savulescu has changed his mind and no longer advocates the abandonment of the dead donor rule, even though I did predict and find that article from back in 2003?

Not a bit of it. The whole thing is actually consistent in a macabre way, but you have to know the lingo. Indeed, Giubilini and Minerva's infanticide article points the way to a proper understanding of Bioethicist-ese: G & B speak there repeatedly of a newborn child, breathing and living outside of his mother's womb, as merely a "possible child." In fact, they assert quite clearly that a person does not exist even after birth and that killing a newborn baby is preventing a person from coming into existence. In the same vein, in the 2003 article Savulescu says that "[l]ife in the significant sense has ceased" and that "[o]ur biography...has closed." See how it works? The concept of the cessation of life, the very concept of death, is being used in different senses in Savulescu's two articles. In the 2003 article Savulescu says outright that that the dead donor rule should be abandoned and that organs should be available at an earlier point when our "meaningful mental life ceases." There, he is using the word "dead" in the ordinary sense in order to argue that donors who are not dead in that biological sense should nonetheless be able to donate organs. In the 2015 article, where he advocates the policy of the state's requiring organ donation, he says that our organs are of no use to us when we are dead, there using the word "dead" in the new-and-improved sense of "no longer having meaningful life" while, of course, relying on hoi polloi to assume that he means "dead" in its ordinary sense so that they won't be too shocked by the proposal.

I believe that the proposal, taken from both articles put together, is forcibly to take organs from, inter alia, people who are not biologically dead by any criterion whatsoever but whose "meaningful life" has allegedly ceased. When Savulescu says that this is "zero cost" to them, then, he doesn't really mean because they are biologically dead but because they are no longer "meaningfully" alive in his view.

Is this, in one sense, an uncharitable reading of Savulescu? In one sense, yes. I also believe it is absolutely true.

Let me point, again, to a parallel move in Giubilini and Minerva, whom Savulescu obviously admires and whose article he greatly overrated.

If a potential person, like a fetus and a newborn, does not become an actual person, like you and us, then there is neither an actual nor a future person who can be harmed, which means that there is no harm at all. (emphasis added)

No harm. Zero harm. Zero cost. The parallel could not be clearer. In the looking-glass world of bioethics, if "you," in the meaningful sense, do not exist anymore when your meaningful mental life ceases, then there is "zero cost" to you from taking your organs, even if you are living and breathing in the biological sense, just as there is "no harm" to the living newborn baby in killing him, since he does not exist as a person.

It's also worth pointing out that Savulescu and Giubilini and Minerva went into major spin mode after the infanticide article came out, to the point of lying outright by stating that it did not propose policy when it explicitly did. So deceiving the ignorant masses is nothing new to these folks.

There is one other small bit of icing on the cake to all of this which fits grimly well with my concept of "choice devours itself." In the 2003 article, Savulescu sweetened his proposal of abandoning the dead donor rule by arguing that it could be a form of honoring the wishes of the person.

Where a person has consented to organs and tissues being used for the benefit of others, that wish must be respected regardless of family preferences for the fate of the body. To fail to respect such wishes is wrong for two reasons:

it fails our obligation to respect the autonomy of people

it fails the most basic duty of rescue, to benefit others.

He also suggests there that people be able to complete advance directives allowing their organs to be taken when they have become "permanently unconscious."

(Even in the earlier article, Savulescu sketches his own "beneficence centered view" and implies that it is his view and that it would justify taking organs without consent. This shows that my interpretation of his later view is actually correct and that he has not changed his views but is only quietly leaving unstated, in his most recent article, his radical proposal to abandon the dead donor rule from his earlier article. Conjoined with his so-called "beneficence-centered view," which he has now made even clearer and more dogmatic, that organs should be taken coercively, this has quite obviously radical consequences that might scare the horses.)

Savulescu uses the autonomy language for about a nanosecond in the recent article, stating rather stridently that

if people wish to donate their organs or gametes for posthumous conception, it fails to respect their past autonomy to over-ride their wish to donate organs or gametes.22 It is positively wrong to let families over-ride the expressed wish of organ donors to donate, even though this is standard medical practice and there is no legal basis for it.

But he instantly abandons all interest in the autonomy of the individual when it comes to refusing the use of organs.

Likewise there is no ethical obligation to obtain consent to use data or discard tissue that is not central to a person's life plans and conceptions of their own good. To use someone's discarded hair to stuff a pillow without their consent is not wrong. It might be bizarre, but it is not immoral.

Even more importantly, it is legitimate to restrict freedom and not obtain consent when it is in the public interest.

Which, of course, takes us directly to the above quote advocating mandatory organ donation.

This is choice devours itself with a vengeance. Indeed, it is an almost pure example thereof: "Because we care so much about your autonomy, your mean old relatives mustn't be allowed to block your intent to donate your organs. But autonomy, shmautonomy if you don't want your organs donated. What a chintzy, grasping, nasty person you are then. We have a duty to ignore your wishes and take your organs in the interests of the public good when we determine that you have no more legitimate use for them."

The modern leftist starts by advocating x because it is an expression of S's autonomy and important for that reason. But then he advocates that x be forced upon S, because it is what S should want even if he actually doesn't want it.

Julian Savulescu is particularly adroit at covering his raw power play in a thick sauce of academic verbiage and misdirection. I suggest that he not be allowed to get away with it.

P.S. In reading back through the old threads on the infanticide article, I have found some blistering things I said there in the comments thread about infanticidal ethicists. I think that I shall bring them back to the light of day again in the form of a free-standing post soon.

Comments (3)

Way to go, Lydia. This is darn good work in tracking and sniffing out the real direction of the thinking of people like Savulescu. And I don't know how you could hold your nose enough to dig this carefully - I would have given up in the early stages. The stench of this kind of thinking is appalling.

"Choice" devours itself because the kind of choice that is meant is the kind born of the serpent's offer laid before Eve, it is born of Satan. It is meant to devour men's souls.

How can the justification of theft be the mere fact that the thief is better off? For that is precisely why the thief steals.

Thanks much, Tony.

TA, I guess it's supposed to be some "disinterested party" who takes on behalf of the organ recipient. Then it's not really stealing; it's "pursuing the common good." Or something like that.

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