(This article is presented as a resource for those interested in the
history of the pro-abortion movement in the United States. Taken from
CALIFORNIA MEDICINE September 1970, it illustrates that even as
abortion was being legalized and abortionists were denying that they
were killing children, in reality they were well aware of what they
were doing and justified it with the claim that "this schizophrenic
sort of subterfuge is necessary because while a new ethic is being
accepted the old one has not yet been rejected.")
A New Ethic for Medicine And Society
The TRADITIONAL WESTERN ethic has always placed great emphasis on the
intrinsic worth and equal value of every human life regardless of its
stage or condition. This ethic has had the blessing of the Judeo-
Christian heritage and has been the basis for most of our laws and
much of our social policy. The reverence for each and every human
life has also been a keystone of Western medicine and is the ethic
which has "caused physicians to try to preserve, protect, repair,
prolong and enhance every human life which comes under their
surveillance. This traditional ethic is still clearly dominant, but
there is much to suggest that it is being eroded at its core and may
eventually even be abandoned. This of course will produce profound
changes in Western medicine and in Western society.
There are certain new facts and social realities which are becoming
recognized, are widely discussed in Western society and seem certain
to undermine and transform this traditional ethic. They have come
into being and into focus as the social by-products of unprecedented
technologic progress and achievement. Of particular importance are;
first, the demographic data of human population expansion which tends
to proceed uncontrolled and at a geometric rate of progression;
second, an ever growing ecological disparity between the numbers of
people and the resources available to support these numbers in the
manner to which they are or would like to become accustomed; and
third, and perhaps most important, a quite new social emphasis on
something which is beginning to be called the quality of life, a
something which becomes possible for the first time in human history
because of scientific and technologic development. These are now
being seen by a growing segment of the public as realities which are
within the power of humans to control and there is quite evidently an
increasing determination to do this.
What is not yet so clearly perceived is that in order to bring this
about hard choices will have to be made with respect to what is to be
preserved and strengthened and what is not, and that this will of
necessity violate and ultimately destroy the traditional Western
ethic with all that this portends. It will become necessary and
acceptable to place relative rather than absolute values on such
things as human lives, the use of scarce resources and the various
elements which are to make up the quality of life or of living which
is to be sought. This is quite distinctly at variance with the Judeo-
Christian ethic and carries serious philosophical, social, economic
and political implications for Western society and perhaps for world
society.
The process of eroding the old ethic and substituting the new has
already begun. It may be seen most clearly in changing attitudes
toward human abortion. In defiance of the long held Western ethic of
intrinsic and equal value for every human life regardless of its
stage, condition or status, abortion is becoming accepted by society
as moral, right and even necessary. It is worth noting that this
shift in public attitude has affected the churches, the laws and
public policy rather than the reverse. Since the old ethic has not
yet been fully displaced it has been necessary to separate the idea.
of abortion from the idea of killing, which continues to be socially
abhorrent. The result has been a curious avoidance of the scientific
fact, which everyone really knows, that human life begins at
conception and is continuous whether intra- or extra-uterine until
death. The very considerable semantic gymnastics which are required
to rationalize abortion as anything but taking a human life would be
ludicrous if they were not often put forth under socially impeccable
auspices. It is suggested that this schizophrenic sort of subterfuge
is necessary because while a new ethic is being accepted the old one
has not yet been rejected.
It seems safe to predict that the new demographic, ecological and
social realities and aspirations are so powerful that the new ethic
of relative rather than of absolute and equal values will ultimately
prevail as man exercises ever more certain and effective control over
his numbers, and uses his always comparatively scarce resources to
provide the nutrition, housing, economic support, education and
health care in such I ways as to achieve his desired quality of life
and living. The criteria upon which these relative values are to be
based will depend considerably upon whatever concept of the quality
of life or living is developed. This may be expected to reflect the
extent that quality of life is considered to be a function of
personal fulfillment; of individual responsibility for the common
welfare, the preservation of the environment, the betterment of the
species; and of whether or not, or to what extent, these
responsibilities are to be exercised on a compulsory or voluntary
basis.
The part which medicine will play as all this develops is not yet
entirely clear. That it will be deeply involved is certain.
Medicine's role with respect to changing attitudes toward abortion
may well be a prototype of what is to occur. Another precedent may be
found in the part physicians have played in evaluating who is and who
is not to be given costly long-term renal dialysis. Certainly this
has required placing relative values on human lives and the impact of
the physician to this decision process has been considerable. One may
anticipate further development of these roles as the problems of
birth control and birth selection are extended inevitably to death
selection and death control whether by the individual or by society,
and further public and professional determinations of when and when
not to use scarce resources.
Since the problems which the new demographic, ecologic and social
realities pose are fundamentally biological and ecological in nature
and pertain to the survival and well-being of human beings, the
participation of physicians and of the medical profession will be
essential in planning and decision-making at many levels. No other
discipline has the knowledge of human nature, human behavior, health
and disease, and of what is involved in physical and mental well-
being which will be needed. It is not too early for our profession to
examine this new ethic, recognize it for what it is and will mean to
human society, and prepare to apply it in a rational development for
the fulfillment and betterment of mankind in what is almost certain
to be a biologically oriented world society.
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