Moral Status

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MORAL STATUS

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Moral status is a concept that deals with who or what is so valuable that it should be treated with special regard. Many cases are simple. A pebble on the beach is thrown into the water without a second thought. It is one of trillions of such rocks that for billions of years have rushed in and out with the tide. Beach pebbles possess no moral standing in themselves, although certain pebbles and sand may be treated with special regard for other reasons.

But the people bathing on that same beach are totally different. To wantonly toss one of them into that same water would constitute an immoral, reprehensible act. That is because normal adults possess interests and rights that morally obligate people to highly regard their well-being. But what about the toddler experiencing her first beach day, a dog joyfully retrieving a ball, the coral reef just offshore, the seaweed within sight? Does each entity have moral status? By what criteria does society decide? And once that is settled, is moral status absolute, or do circumstances and conflicting interests make a difference?

Moral status is not a new concept, but it does constitute a new entry in the third edition of this encyclopedia. Its inclusion likely relates to the fierce battle in Western, particularly American, society over the moral status of the human embryo. This issue is perhaps the most contentious bioethical debate in the early years of this new century. It follows and is related to the abortion debate, decades old but still controversial. The moral status of fetal and now embryonic human life commands attention because it juxtaposes questions of sex, identity, faith, humanity, and healing.

In this entry, theories dealing with single standards or issues—personhood, sentience, and environment—will be delineated and then compared with a multistandard approach for resolving questions of moral status. Then, leading moral theories are applied to the societal dilemma of care for patients with Alzheimer disease.

The Moral Status of a Human Embryo

President George W. Bush, believing that protectable human life begins at conception, asked Congress in his 2003 state of the union address to "pass a law against all human cloning." This president reflects the views of many Americans. The Roman Catholic Church and a host of conservative Protestants almost uniformly hold pre-embryonic human life as sacred—and hence of the highest moral status.

William E. May, a Jesuit moralist, acknowledges a significant difference between the capacities of a human embryo and a normal adult. Human individuals of intelligence and self-consciousness are "moral beings" because they have the capacity to comprehend, love, and choose. Although they are moral beings, because they are "minded" entities, their moral status is no greater than any other human being's, because all humans, including embryos, are "beings of moral worth." All share "something rooted in their being human beings," beginning at conception. This "something" is the soul, "the principle immanent in human beings, a constituent and defining element of their entitative makeup, that makes them to be what they and who they are: beings of moral worth capable of becoming minded entities or moral beings; it is a principle of immateriality or of transcendence from the limitations of materially individuated existence" (p. 425).

Protestant Scott Klusendorf, reflecting a similar view, contrasts a human "nature" or essence with the capacity for certain "functions" or abilities. A fetus may lack functional ability, but it "is nonetheless a person because he or she has a human nature from the moment of existence."

The origin of the idea that human nature is a manifestation of an eternal essence is ancient. Its roots go back at least to Plato, and extend up through the early church fathers to Aquinas and on to the philosophers Descartes and Kant.

Religious conservatives are not the only ones who are against a medical technology that violates the human embryo. For example, secular moralist Hans Jonas is particularly concerned about a genetics technology that could produce autonomous organisms. "If it is a categorical imperative for mankind to exist, then any suicidal gambling with that existence is categorically forbidden." Out of profound respect for the human product of a long trial of evolution, Jonas protests against humans playing as "creators at the roots of our being, at the primal seat of its mystery."

Despite the fervent pleas for recognition of the preembryo's full moral status, the majority of embryologists and bioethicists favor therapeutic use. The primary bioethical rationale is twofold: the supposed minimal moral status of preembryos, and possible use of them for treating up to an estimated 128 million Americans (American Association for the Advancement of Science) with a wide variety of ills.

Both opponents and advocates of therapeutic use agree that after conception nature doesn't delimit a threshold for moral status. Opponents argue for conception, but conception itself is more process than event. In the life sciences what earlier seemed an event is now known otherwise because of advanced instrumentation that can record microscopic change over milliseconds. In light of modern embryology, Ronald Green, in his The Human Embryo Research Debate, argues that bioethics should recognize that certain moral presuppositions underlie the choice of an ethically significant point on the "curve of biological change." In opposing transcendental and evolutionary determinists, he contends that the very idea that personal values lead one to choose morally particular points in an ongoing biological process, "converts us from passive identifiers of biologically fixed truths to active choosers of markers on life's spectrum" (p. 26).

Common belief holds that the zygote comes into existence when the sperm and ovum unite. But just when that union occurs is now unclear. The ovum chemically signals uterine sperm, not yet in the fallopian tubes. If that invitation doesn't initiate the union, there are other options:(1) when the successful sperm penetrates the ovum wall (zona pellucida) into the egg's cytoplasm, immediately emitting electrochemical charges that seal the zona; (2) when after the eight-cell stage the paternal chromosomes become active; or (3) when syngamy (literally, "spouses joining together") occurs, the pairing of twenty-three male and female chromosomes, eighteen to twenty-four hours after zona penetration. Thus, Green states, the "moment" of fertilization is a series of processes that take twenty-four to forty-eight hours. Moreover, for the next ten days the embryo may divide, resulting in twins, triplets, or larger multiple sets of offspring (pp. 27–29).

The moral status assigned to a preembryo depends on one's presuppositions. However, most conservatives and liberals alike tend to be asymmetrical in how they view a human's moral status at life's beginning and ending. That is because human life attains moral status due to its nature, but loses moral status due to function deficit.

On the one hand, at life's beginning, human genetic nature is prized, although function is minimal. For example, a universal ban exists on use of embryos for research after their fourteenth day, when the embryonic disk is pinhead size, and has only a fifty-fifty chance of live birth eight and one half months hence. No organs exist, and neurological cell differentiation is forty days off. Viability is five months ahead and dawning self-consciousness a year away.

Yet, on the other hand, at life's end, function—or its loss—is paramount, although human nature continues to be quite evident. When an adult is pronounced dead by neurological criteria, the heart hardly ceases to beat as it is transplanted from one body into another. Death has been pronounced, though millions of neurons may still be firing, just not coordinating any vital bodily functions. Spinal cord reflexes may be sufficiently coordinated to cause spontaneous limb movement, even as vital organs are procured for transplantation.

The above opposing, contemporary notions of the moral status of human tissue—be it pre-brain or postbrain—are a concrete illustration of how diverse ethical assumptions yield different moral conclusions. Society's assigning of moral status may be quizzical to some ideal observer, for it is a complicated process which not only involves logic, but also varying cultures, traditions, and religious beliefs—in a word, civilization, in all its variety.

Leading Single-Standard Moral Theories

Contemporary bioethicists divide into two camps on moral status: those who advocate a single standard and those who are eclectic. Three leading single-standard theories concern personhood, sentience, and environment.

PERSONHOOD. The personhood standard sounds simple, but it can have such diverse and conflicting meanings that some philosophers, particularly Ruth Macklin, question the value of its use. Nevertheless, moral agents are so conscious and appreciative of their own personhood that this criterion inevitably emerges as a primary consideration. Three primary views of personhood exist: genetic, mental, and developmental.

Genetic personhood, sometimes called minimalist or low personhood, includes all human beings, regardless of age or developmental stage. Although this position is more commonly called sanctity of life, it is included here because it has an important, biologically inclusive view of personhood. The Roman Catholic Church's statement on doctrine, "Respect for Human Life in Its Origins and on the Dignity of Procreation," (Vatican) speaks of the human embryo as "the unborn child" who "must be cared for, to the extent possible, in the same way as any other human being."

John T. Noonan argues that from conception until whole brain death, human beings possess necessary and sufficient qualities for full moral status. The criterion for personhood is simple and straightforward: If your parents are human, "you are human." Although the theory is clear, the implementation of its logical implications is limited. For example, if preembryos are of highest moral status, a national assault on the natural tragedy of early spontaneous embryonic abortions (over 60% of fertilized eggs) would be appropriate—or at least a vocal bemoaning of this wanton waste of human life.

Mental personhood is the category most commonly associated with personalist theory. Mental personalists hold that an autonomous individual's brain function warrants the highest moral status. The origin of this view was the Enlightenment philosopher Immanuel Kant (1724–1804). He believed that only a moral agent possesses the autonomy and freedom to attain full moral status, so he excluded women, children, and animals because they were considered to be deficient in mental capacity.

Several modern bioethicists have argued extensively for the significance of cerebral functioning. This capacity is variously perceived to include individuals who are: self-conscious and capable of self-direction (Engelhardt), able to enter meaningful relationships (McCormick), capable of minimal independent existence (Shelp), or in possession of a minimal IQ of 20 to 40 (Fletcher). Michael Tooley, author of Abortion and Infanticide, argues that his notion of personhood is common sense and that most people would agree

that anything that has, and has exercised, all of the following capacities is a person, and that anything that has never had any of them is not a person: the capacity for self-consciousness; the capacity to think; the capacity for rational thought; the capacity to arrive at decisions by deliberation; the capacity to envisage a future for oneself; the capacity to remember a past involving oneself; the capacity for being a subject of nonmomentary interests; the capacity to use language. (1983, p. 349)

Tooley not only views prenatal human life as of limited moral status, he is a self-described "radical" in advocating limited infanticide. Peter Singer, in his 1979 book, Practical Ethics, basically agrees with Tooley.

H. Tristram Engelhardt Jr., author of the 1996 book, The Foundation of Bioethics, joins with other mentalists in viewing cerebral function as of highest importance morally. But he disagrees with Tooley and Singer on infanticide. According to Engelhardt, although newborns do not possess an intrinsic right to life, high moral status is "imputed" to them because of their vital social and cultural role. Critics, such as David H. Smith (2001), argue that this concession is inconsistent.

Singer's notion of significant moral status does not include human newborns, but it does include several mammals: chimps, monkeys, and probably cetaceans. A similar conclusion on mammals is held by Mary Anne Warren and Tom Regan, who each offer different rationales.

Developmental personhood, a variation of the mentalist type, contends that the closer an entity approaches undisputed personhood, such as a normal human adult possesses, the higher the moral status. This intuitive, commonsense approach is held by thinkers as diverse as biologist Clifford Grobstein, Catholic theologian Lisa Sowle Cahill, Protestant ethicist James W. Walters, (1997), and philosophers Warren and Judith Jarvis Thomson, the latter suggesting that a "newly fertilized ovum, a newly implanted clump of cells, is no more a person than an acorn is an oak tree"(p. 199).

In his 1997 book, What Is a Person?, Walters advocates the notion of "proximate personhood" as a developmental scheme positing three markers to aid in more concretely identifying the aspects of moral value that indicate escalating moral status. First, potentiality for undisputed personhood is important because the embryo is unlike any other tissue. After implantation in a young woman, if development is normal, an embryo will likely grow to adulthood. Given the advances in cloning technology, the notion of potentiality may not be as significant as it was, but because the gestating fetus, featured in large full-color coffee-table books, is such a powerful symbol of life, a developing fetus connotes more about life than it may intrinsically possess.

The second marker is development toward undisputed personhood. Strictly speaking, a nine-month fetus, or even a newborn, is no more a moral agent than is an early fetus or embryo. Most people, however, intuitively view the moral status of a preembryo as different from that of an advanced fetus. The more closely a fetus/newborn approximates a normal, mature individual, the greater its moral status. It is not that the newborn possesses great intrinsic moral status, but that its moral status is bestowed because of parents' and society's need to value something so personally symbolic.

A third marker is emotional bonding of the parents to the fetus or newborn. The greater the bond, the more moral worth is ascribed to the fetus/newborn. In his 1992 book, Freedom and Fulfillment, Joel Feinberg views infanticide as immoral for utilitarian reasons, arguing that the common good and social utility are the moral basis for the loving treatment of newborns. This third marker of proximate personhood, "bonding of," is a social criterion, whereas "potentiality for" is intellectual and "development toward" is physical.

The mental and developmental personhood views are powerful in underscoring the salience of the human brain, without which moral discussion would be impossible. Yet people intuitively sense that there is more to moral status than abstract mental capacity. For example, brilliant sociopaths ostensibly have the highest (personal) moral status, and are treated accordingly, whereas wolves are sometimes killed by hunters. Yet wolves, sentient and highly intelligent animals, mate for life, love their offspring and that of others, work cooperatively with other wolves, never kill for sport, and often share food. The eighteenth-century Scottish philosopher David Hume claims in his Treatise of Human Nature that he does not know of a convincing argument for the view that thinking is superior to nest building, because each is a "wonderful and unintelligible instinct in our souls" (p. 179). Thus, as important as development toward and achievement of personhood is, common sense suggests there is more to moral status.

SENTIENCE. Contrary to personhood's focus on the intellect, a number of thinkers contend that thinking is overrated. The English philosopher Jeremy Bentham (1748–1832), in his book titled An Introduction to the Principles of Morals and Legislation, claims that the pains and pleasures of animals matter: "The question is not, Can they reason; nor, Can they talk? but, Can they suffer?" (p. 283). Henry Sidgwick agrees, observing in The Methods of Ethics (1874) that given the utilitarian goal of maximizing pleasure, it would be "arbitrary and unreasonable" to exclude "any pleasure of any sentient being" (p. 414).

Moral consideration of nonhuman animals was revolutionary 200 years ago, and it still is. Concerned about challenges to human status, physician-ethicist Willard Gaylin asserts in his 1990 book Adam and Eve and Pinocchio:

The order of change between the chimpanzee and the human being is of such a magnitude as to represent a break, a discontinuity. We are not the next step, or even a giant leap forward. We are a parallel and independent entity; a thing unto ourselves; in a class of our own; sui generis.… The distance between man and ape is greater than the distance between ape and ameba. (p. 12)

The moral status of animals has varied throughout human history. In the Ten Commandments, God commanded a Sabbath rest for people and cattle alike. Yet the father of modern Western philosophy, René Descartes (1596–1650), starkly contrasts immortally ensouled humans—even madmen—with even the brightest animals, which are merely divinely created "machines" driven by organ-derived passions. The anguished crying and screams of animals are but the grinding of a machine's gears and levers.

Nevertheless, if sentience, the capacity to sense pleasure and pain, is the sole criterion for judging moral status, where in the evolutionary scale is the line between sentience and nonsentience? Rats and mice are intelligent, sentient creatures, but humans hardly respect them. Yet the nineteenth-century English naturalist Charles Darwin, who studied earthworms, considered them sentient, even capable of some form of reason. Earthworms, after a drenching rain, slither onto hard surfaces, suggesting a basic sentience. Worms have identifiable sense organs and nervous systems, unlike unicellular animals such as amoebas. Nevertheless, there is dispute among knowledgeable microbiologists even about whether single-celled organisms can be sentient, with the American zoologist Herbert Spencer Jennings (1868–1947) claiming that if amoebas were large animals and a part of everyday human experience, their behavior would suggest feelings of pain and pleasure, hunger and desire.

If a moral line cannot be drawn between humans and all other animals, and if even amoebas may possibly be primitively sentient, are we to consider all 750,000 species of animal life sentient? In Practical Ethics, Singer draws a line between shrimp and oysters, the latter possessing a very simple nervous system. He further argues that different species have different interests. For example, only persons are sentient, self-aware beings who can conceptualize their own futures. The great apes, and possibly cetaceans, pigs, dogs, and cats, are persons; but mice, birds, and other small-brained animals are probably not. Thus for Singer, possession of sentience is necessary for full moral status, but it is not sufficient. Highest moral status is reserved for normal adult humans.

Following the lead of Bentham and Sidgwick, Singer advances a thoroughgoing utilitarian argument for determining moral status. Singer's utility is nuanced, however, taking into account a penetrating criticism of classical utilitarianism, namely that people value ends beyond enjoying pleasure and avoiding pain. Singer's preference utilitarianism holds that an individual's good is determined by that person's preferences or values. Further, in calculating the universal good, the preferred interests of all sentient beings are weighed equally: "The principle of equal consideration of interests acts like a pair of scales, weighing interests impartially. True scales favor the side where the interest is stronger or where several interests combine to outweigh a smaller number of similar interests; but they take no account of whose interests they are weighing" (1979, p. 19).

The idea of preferences or interests presupposes at least rudimentary mental life. And if organisms care if their interests are met, they may register this in behaviors suggesting pain or pleasure. Nonsentient organisms, by Singer's definition, cannot have interests and hence have no sense of pain or pleasure. Nevertheless, the boundary between sentience and nonsentience is indistinct, at best.

The notion of interests is controversial. In his 1980 book, Interests and Rights, Raymond Gillespie Frey argues that only humans can have interests, because interests presuppose beliefs, and beliefs require complex language use, a singularly human capacity. Steven Sapontzis decries such moral elevation of abstract rationality in his 1987 book, Morals, Reason, and Animals. He shows that most people are only sometimes rational, and they live by emotion, hope, rhetoric, eccentricity, and intuition as well. Reason has no unique moral quarter, because there is no generally recognized method of rationality that commands categorical obligation.

Sapontzis argues for animal-human equality, but he especially uses reasons to advance his claim that reason is overrated. Thus with Sapontzis, as with most other sentiencefocused thinkers, humans, at least implicitly, receive preeminent moral status. It is no mere coincidence that human beings usually end up possessing the highest moral status via the rules of moral sentience they have devised.

ENVIRONMENT. "Environmental ethics stretches classical ethics to the breaking point," declares Holmes Rolston III, a leading environmental philosopher (p. 33). The radical significance of environmental ethics is that it alone raises the issue of whether there are nonsentient entities that can be objects of duty.

This issue was poignantly raised in 1973 by Richard Sylvan's thought experiment: Imagine you are the last human on Earth and you are about to die, and the idea occurs to you of gleefully destroying the last remaining redwood tree. The ethics of this "last person" dilemma raises important issues: for example, the nature and breadth of ethics and the moral status of organisms as individuals, as progeny of ecosystems, and even as possible moral equals.

Classical ethical theory, with its focus on the individual, is typified by Kant's autonomous person as the only morally considerable end in itself. But the post-Kantian John Rawls, author of A Theory of Justice (1971), desires to include children and other nonrational humans in his moral universe, so he defines persons as those who have the "capacity" for rationality, even if it is undeveloped.

Like sentience-focused ethicists, other thinkers are moving beyond what Robert Elliot calls "unjustifiable human chauvinism." Of course, humans are only a small part of nature, and now the moral status of other aspects of nature—trees, rivers, mountains, rare plant species—is on the ethics horizon. Environmental ethics challenges society to risk exploring uncharted terrain, to go beyond anthropocentric culture. Advocates contend that it is more serious than rights for rocks, citing how revolutionary the early steps leading to rights for women, children, and ethnic minorities were. With the increasing rate of environmental deterioration, these new thinkers suggest that environmental ethics is as important as medical or business ethics. Rolston contends that the planet's deterioration is as great a threat as nuclear war—and more probable.

Max Oelschlaeger, editor of Postmodern Environmental Ethics (1995), perceives a "linguistic turn" in contemporary ethical reflection. No longer is language seen as mirroring the real world; language is inseparable from humans' personal spaciotemporal culture. Language is not representative of an independent reality but rather plays an "ontogenetic" role in defining the human, "meaningful world." Humans are more "biologically underdetermined" and more culturally driven than previously thought. The ecocrisis originates in and is sustained by the older conception of language. Calling for a postmodern consciousness of language, Oelschlaeger suggests that "modern ethical theory is linguistically naïve" (pp. 2–9). He decries the separation of theory and practice, advocating a new cultural language of, above all else, environmental sustainability.

Individual organisms and complex ecosystems. On both deontological (duty-oriented) and utilitarian grounds, extending moral status to sentient beings makes sense. But on what basis is life itself the threshold of moral status? If speciesism (the moral elevation of a species simply because of its nature) exists, by a similar logic the charge of "sentientism" applies to animal rightists who would arbitrarily prohibit extension of moral consideration to all of life.

Animals can and should experience a good life, but biocentrists believe the standard for moral status is too high. They point to how interests can be served and harms avoided by letting all organisms fulfill their unique ends—loosely specifiable biological goals whose fulfillment results in a type of flourishing. Plants have no subjective life, only an objective one. "Nothing matters to a tree, but much is vital to it," says Rolston, who is an advocate for a "vital ethic" (p. 34). Deep, or thoroughgoing, ecologists explain that to act contrary to the purposes of a plant means that one impedes the plant's biologically given goals.

Whereas anthropomorphism holds that all moral status somehow relates to human well-being, biocentrism sees all life as possessing moral status. Paul Taylor and Gary E. Varner argue for biological individualism—that each organism of life possesses intrinsic value. That each organism possesses independent value follows from the premise that each organism's flourishing makes the world a better place.

Further, Taylor is a species egalitarian in that he sees all criteria that devalues any life-form as an equally arbitrary, immoral imposition. Varner agrees that all living things have intrinsic moral value, but contends that not all live entities are morally equal. He believes that it is softheaded to think that pulling a carrot is as wrong as killing a horse. A plant has only biological needs, whereas a horse also has sentient interests in life, and a human can possess complex interests that are not found in lower forms of life.

Unlike Taylor and Varner, most environmental philosophers tend to be holistic rather than individualistic. That is, they express more moral concern for ecosystems and species than for individual living things. Rolston rejects the confines of classical ethics, in part because of its fixation on individual entities: "In an evolutionary ecosystem, it is not mere individuality that counts; the species is also significant because it is a dynamic life-form maintained over time. The individual represents (re-presents) a species in each new generation. It is a token of a type, and the type is more important than the token" (p. 35).

Can moral status be assigned to ecosystems? If so, then logically the moral standing of a species would likely trump almost, if not all, claims of individual animals or plants when there is a serious conflict. Most environmentalists are primarily concerned with preserving evolutionary processes, and this involves predation that could sometimes be stopped by human intervention. Natural ecosystems appear to exist beyond the moral categories that have served anthropocentric interests in the past. Only environmental ethics challenges society to sort out maxims between conventional anthropomorphic morality and urgent planetary needs.

Multi-Standard Theory

In the postmodern era, confidence in single theories of right and wrong has diminished. Because academics keenly sense the historical conditionedness of every human construct, it is no happenstance that leading moral philosophers are eclectic in moral theory.

As indicated above, however, there are very thoughtful single-standard thinkers. In his 1989 book, In Defense of the Land Ethic, J. Baird Callicott, for instance, consciously rejects ethical eclecticism because in hard cases it inevitably leads to "moral incommensurability." This occurs because competing moral claims employ differing terms that thwart decisive comparison and resolution.

Nevertheless, a powerful case is made for a more modest, multi-standard theory. In Rawls's influential A Theory of Justice, the basis for choosing ethical theory is "reflective equilibrium." Rawls develops this concept in the context of arguing for an "original position" of personal anonymity hypothesized behind a "veil of ignorance," from which one chooses ideal norms of justice. The conditions of that initial situation are generally shared and "preferably weak." Those conditions are Socratically conceived, working "from both ends," going back and forth, altering conditions of the original position, making and withdrawing judgments.

One postulates reasonable conditions and assumes principles that finally match one's "considered judgments duly pruned and adjusted." This conceptual give and take is Rawls' reflective equilibrium: "It is an equilibrium because at last our principles and judgments coincide; and it is reflective since we know to what principles our judgments conform and the premises of their derivation." Rawls's notion of justice does not come from self-evident premises or principles; "instead, its justification is a matter of the mutual support of many considerations, of everything fitting together into one coherent view" (pp. 20–21).

Following Rawls' lead, Tom L. Beauchamp and James F. Childress, in Principles of Biomedical Ethics (2001), develop their own coherence theory. They too begin with "considered judgments," basic societal warrants, such as religious tolerance, that are accepted at first without "argumentative support." An ethical issue, considered in light of one's paradigmatic considered judgments, prompts a careful, nuanced assessment and then a more general account of the issue's moral warrants. All elements considered, one weighs and trims, cuts and adds, attempting maximal coherence. The resulting action guides are never absolute, however, and if their inadequacy is too great the process of finding appropriate norms begins anew. Regardless, ethical coherence is dynamic, as continually "we revise, generalize, specify, and balance moral beliefs" (pp. 397–400).

Warren, in her carefully reasoned 1997 book, Moral Status: Obligations to Persons and Other Living Things, advocates a "Multi-Criterial" theory, a commonsense, pragmatic approach to determining moral status, appealing to her readers' moral intuitions. It is such common/good sense intuitions, she notes, that give rise to ethical reflection and judgment in the first place. Warren argues that the burden of demonstrating the inadequacy of a society's given morality—its faulty reasoning or inadequate empirical data—rests on those who would challenge it.

Commonsense morality gains empirical support from the faltering of many single-standard advocates when confronting hard cases. Single-standard theorists are indispensable in focusing attention on society's specific moral inadequacies. These theorists often blink, however, when their theories are pushed to the limits; they often fail to take their rationales to their logical conclusions. For example, Roman Catholic thinkers do not call for a huge medical initiative against early naturally aborted human embryos. Engelhardt modifies his high-standard personhood by "imputing" moral status to human newborns. And Taylor argues for the equality of all life-forms, but if mosquitoes were spreading malaria, would he morally disallow eradication efforts?

The case that Warren makes for a "sliding scale" of moral status appeals to the basic moral intuitions of many people. The evolutionary scale extends from amoebas to normal human adults, with the more neurologically complex beings accorded greater moral status.

Despite its appeal, the multi-standard approach also has its downside. It can easily provide an ethical justification for the moral status quo. For example, despite Warren's argument for heightened sensitivity to the relative moral status of all organisms, she provides justification for several practices that many humane persons find morally objectionable: meat eating (and thus implicitly, factory farming), sport hunting, and sometimes caging animals. Acceptance of each of these practices is carefully nuanced, but their practice, according to Warren, can be a moral option.

Another related problem with a multi-standard, common morality is that by its very nature it fails to foster morally prophetic voices. Perhaps society's view of moral status is best served by a chorus of voices articulating various conceptions of moral status, thus stimulating careful thought about an array of viewpoints. In this way, democratic societies foster humane progress in ethical sensitivity. The relevance of competing bioethical theories is tested by many real-life dilemmas, not least of which is the modern scourge of Alzheimer disease.

Individuals with Alzheimer Disease

Concomitant with the advantages of longer lifespans is today's challenge of Alzheimer disease. Of course, the moral status of the newly diagnosed Alzheimer patient is very high, but what of the individual with severe Alzheimer disease? The case of Alzheimer disease is a fitting condition for comparison of the four leading theories' indications of moral status.

PERSONHOOD. The genetic variety of this theory would appear to be simple: As long as there is organic life, there is high moral status. However, the Vatican, holding the genetic view on perinatal life, favors a natural death in senescent cases. Mental (and developmental) personhood theory puts a premium on the moral standing of the fully competent person, suggesting that the registered wishes of an autonomous person for his or her care as an Alzheimer patient should morally hold.

An important unresolved issue, however, is whether the will of the fully competent person should trump the desires of the partially demented patient when a discrepancy exists regarding future care. In her response to Ronald Dworkin's autonomy argument for the fully competent person, Rebecca Dresser argues that the partially competent patient's current desires should be heeded, because the patient's present condition was not clearly foreseen, and, given that the patient will never return to full competence, these wishes should override earlier directives.

SENTIENCE. Sentience theory aims to maximize pleasure and minimize pain in all sentient creatures. As an Alzheimer patient's senses wane, moral status similarly decreases. To avoid speciesism, this view is egalitarian in that whatever treatment is good for nonhuman animals is appropriate for Alzheimer patients of similar sentience. Singer argues for equal consideration of interests, but not all interests are equal. Self-conscious beings receive "prior consideration," as they have a heightened capacity for suffering—or for happiness. In a different vein, Singer, who argues strongly for voluntary active euthanasia, says that it should be banned if the consequences of nonvoluntary euthanasia in demented patients would lead to "insecurity and fear" among possible future dementia patients (1979, p. 139). In practice, mainline personhood theory would assign a lower moral status to a moderately advanced Alzheimer patient than would sentience theory. This is because in Alzheimer disease, incompetence in reasoning precedes incapacity for sensual experience.

ENVIRONMENT. Given environmental theory's priority on the biosphere and ecosystems, the moral status of individual Alzheimer patients, it would seem, is hardly on the ecological radar screen. Nevertheless, environmental theory has considerable, albeit indirect, relevance: This iconoclastic theory dethrones the rational man (and it was man in the Enlightenment) as the exclusive measure of moral status.

Rawls continues the anthropomorphic scheme in A Theory of Justice, making an aside to demented individuals: "Those more or less permanently deprived of moral personality may present a difficulty. I cannot examine this problem here, but I assume that the account of equality would not be materially affected" (p. 510). Rawls's and previous philosophers' social contract models have fostered equality and other human goods, but this model's purview is narrow. According to Mary Midgley, in her 1995 article titled "Duties Concerning Islands," the social contract is a valid aspect of common morality, but it now dominates ethics, whereas ordinary people see moral claims more broadly. Midgley proclaims that humans have real moral duties to an array of entities beyond "sane, adult humans": for instance, the dead, the insane, embryos of all animals, artifacts, rivers, countries, landscapes, and the biosphere. By casting the moral net far beyond adult humans, Midgley shatters the wall dividing rational persons from the rest of life, thus supporting at least the relative moral status of all Alzheimer patients.

MULTI-STANDARD. Stephen Post exemplifies an ethical eclecticism in his extensive writing on Alzheimer disease. Like environmental ethical theorists, Post decisively rejects the identification of moral status with rationality. In his The Moral Challenge of Alzheimer Disease, he criticizes modern society's "hypercognitive" values of rationality and memory. Post appears to be against mainline personhood ethics, calling Alzheimer patients "persons" and citing them as Earth's neediest people who deserve "preferential moral significance." Post may be more personalist than he knows, however, because in the Dworkin–Dresser debate he sides with Dworkin's contention that the fully competent person's wishes trump the later, counterexpressions of a demented mind. And, further, Post equates being a valuable human being with one's capacity to "will, feel, and relate." Overall, however, Post is closest to the sentience camp because after the Alzheimer patient advances beyond a sentient state, he sees invasive, life-prolonging treatment as an "assault" on a patient oblivious to its purpose. As long as the Alzheimer patient can sense any pleasure in life, loved ones should embrace this live, sentient individual in light of what was once so much more. No vitalist, Post concludes the second edition of his book as follows: "Death is not the enemy; the only real enemy is the burden of technologically protracted morbidity under conditions of severe dysfunction" (p. 142).

Why a particular entity is treated with special regard, thus receiving a certain moral status, is dependent on what ethical standard one holds—personhood, sentience, environment, or ethical eclecticism. And why a person embraces one standard rather than another is finally a metaethical issue (literally, an issue beyond ethics; an issue involving one's religious or philosophical worldview). In liberal societies the existence of various foundational religious and philosophical positions ensures continued lively discussion of moral status, made possible by a consensus that other persons have significant moral status, thus allowing for such social debate.

james w. walters

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