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Appeals to Nature in Biomedical Ethics

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APPEALS TO NATURE
IN BIOMEDICAL ETHICS

By

Gwenolyn Gail Kott

A THESIS
Submitted to
Michigan State University
in partial ﬁilﬁllment of the requirements
for the degree of

MASTER OF ARTS

Department of Philosophy

1995

ABSTRACT

APPEALS TO NATURE
IN BIOMEDICAL ETHICS

By

Gwenolyn Gail Kott

This paper explores two critiques of biomedicine, that share common grounds for their
objections. In each case, ‘nature’ and ‘naturalness’ serve as models of moral rightness.
First, I examine Paul Ramsey’s ethical challenge to in vitro fertilization. He morally con-
demns the unnaturalness of artiﬁcial conception. Secondly, I examine J. Gay-Williams’
ethical challenge to euthanasia. He morally condemns the unnaturalness of actively pro-
moting death. In contrast, I argue ‘nature’ and ‘naturalness’ are only descriptive terms,
referring to things that exist or happen without human design. ‘Naturalness,’ alone, can-
not deﬁne the morality of any biomedical procedure. Meaningful moral objections to in

vitro fertilization or euthanasia need some grounds unrelated to ‘naturalness.’

Copyright by
Gwenolyn Gail Kott

1995

ACKNOWLEDGMENTS

I wish to thank my thesis director, Dr. Martin Benjamin and my thesis readers, Dr. Richard
Hall and Dr. Stephen Esquith. Their thoughtful comments and criticisms helped to ﬁne

tune my paper on “Appeals to Nature in Biomedical Ethics.”

iv

TABLE OF CONTENTS

INTRODUCTION .......................................................................................................... 1
UNNATURAL FERTILIZATION ................................................................................. 2
Natural Courses of Action ............................................................................................. 2
Rationality ..................................................................................................................... 4
Medical Ethics .............................................................................................................. 5
Social Disaster .............................................................................................................. 6
UNNATURAL DEATH ............................................................................................... 8
Natural Courses of Action ............................................................................................ 8
Rationality ..................................................................................................................... 9
Proper Medical Treatment .......................................................................................... 10
Social Disaster ............................................................................................................ 11
NATURE AND NATURAL ........................................................................................ 13
Nature 1 ...................................................................................................................... 13
Nature 2 ...................................................................................................................... 14
Nature 3 ...................................................................................................................... 14
Naturalistic Fallacy ..................................................................................................... 15
Natural Prescriptions .................................................................................................. 16
Natural Functions ....................................................................................................... 16

Complex Functioning ................................................................................................... 17

Agency ....................................................................................................................... 17
Rationality .................................................................................................................. 18
Condemning Civilization ............................................................................................. 19
Condemning Medicine ............................................................ I .................................... 19
Empty Moral Distinctions ........................................................................................... 20
Immoral Intentions ...................................................................................................... 21
Unnatural Violence ...................................................................................................... 23
Social Disaster ............................................................................................................. 24
Rhetorical Persuasion ................................................................................................. 25
Rational Restraint ....................................................................................................... 26
CONCLUSION ........................................................................................................... 27
NOTES ....................................................................................................................... 29
BIBLIOGRAPHY ....................................................................................................... 31

vi

INTRODUCTION

The concepts of nature and naturalness frequently enter discussions of biomedical ethics.
Often, appeals to nature underlie objections to particular biomedical procedures. For in-
stance, one may say that a certain biomedical procedure interferes with natural functions
and natural goals. This way of thinking presumes that nature has a positive moral value.
It assumes that something’s being “natural,” makes it right. This assumption invites us to
ask whether naturalness has any moral signiﬁcance. If so, can someone ground an objec-
tion to a speciﬁc biomedical procedure by appealing to nature?

Two current issues in biomedical ethics that receive criticisms based on appeals to
nature are in vitro fertilization (IVF) and euthanasia. Since the relationship between na-
ture and right conduct often plays a key role in arguments that challenge particular bio-
medical procedures, this relationship invites careﬁil examination. In this paper, I will
identify and critically examine the hidden meaning of appeals to nature. I focus on the

arguments against unnaturalness set forth by Paul Ramsey and J. Gay-Williams.

UNNATURAL FERTILIZATION

The ﬁrst example, of biomedical critiques that appeal to nature, is Paul Ramsey’s chal-
lenge to IVF. He bases his objections on this procedure’s unnaturalness. Understanding
his position requires an explanation of the medical procedure that he terms unethical. The
surgical procedure referred to as IVF is a process of collecting some of a woman’s eggs
and then fertilizing them ‘in vitro’ with her partner’s sperm. ‘In vitro’ is a Latin term that
literally means ‘in glass.’ Some fertilized eggs develop in a petri dish until the eight-cell
stage when a cell biopsy can determine the genetic normality of the eggs. The next step is
the surgical transfer of genetically normal embryos from a petri dish to a woman’s uterus.
Around 25% of the time, one of the embryos will become implanted in the uterus and
continue normal development until maturity. ’

In contrast, so-called “natural” fertilization is a process that occurs during a sexual
union in which a male releases sperm inside the vagina of a female. In this process, the
actual fertilization occurs in the fallopian tubes. This happens when a sperm cell unites

with an ovum before descending into the uterus for ﬁrll development.

Natural Courses of Action:
Ramsey gives fertilization through sexual intercourse, often called natural fertilization, a
much higher moral weight than IVF. He strongly criticizes biomedical interference with
the course of events leading to ordinary fertilization, holding that:
Procreation, parenthood is certainly one of those ‘courses of action’ natural
to man, which cannot without violation be disassembled and put together

again any more than we have the right to impiously destroy the environ-
ment ofwhich we are a part 2

3

As presented by Ramsey, IVF is problematic because it intrudes on the purpose-
ﬁrlly innate processes of nature. Like An'stotle, Ramsey holds that “... all things in nature
have certain works and courses of action.” 3 This means nature designed all things for
sustaining life and maintaining good order. According to this theory, everything in the
universe has a purpose. As an example, one may say that nature designed eyes for seeing
and eyelashes for protecting the eyes.

Ramsey adds that nature designed natural procreation for survival of our species.
He claims the “spiritual autonomy“ of nature creates a moral scope for viewing the self-
initiated processes that perpetuate all living things without any medical help. Ramsey in-
sists “there are aspects of existence that ought not to be violated.” " He holds that medi-
cal professionals have a duty to prevent “natural gestation” from becoming a mechanical
process of “decantation.” 5 This comparison of IVF with wine-making illustrates Ram-
sey’s view that reproductive technology lowers our respect for humanity.

The moral contrast between natural and unnatural medicine unfolds as Ramsey
cites Leon Kass, an Executive Committee Secretary at the National Academy of Sciences.
Kass makes the following claims regarding the role of humans in the natural order:

Human procreation is human partly because it is not simply an activity of
our rational wills. Men and women are embodied as well as desiring and
calculating creatures. Human procreation joins the pleasure of sex, love

and the desire for children in the activity by which we continue the chain of
human existence. 6

This quotation relies on Aristotle’s claim that “man is a rational animal,” 7 to show the
tightness of natural procreation. Kass contends the physical embodiment of humans

places us in the animal kingdom where nature directs the perpetuation of our species.

4

In other words, humans are “embodied” by the innate physical responses of sex-linked
hormones. Kass argues that these chemical changes show the natural rightness of

[sexually] “begetting” children.

Rationality:
Conversely, he contends that ignoring our embodiment denies our human rationality. This
rationality gives humans understanding of the superiority of natural procreation. Kass
holds that biological parenthood promotes adequate caring for children. 8 In his view, we
only develop much needed psychological attitudes of love and responsibility toward chil-
dren through sexual begetting of children. Kass stresses that the intrusive procedure of
IVF will make sexual intercourse unnecessary and parenting inadequate. He concludes
that there is no acceptable substitute for natural procreation.
In the following quote, Kass predicts that IVF will replace the “healing profession”

with “embryologists-geneticist-physicians.” 9

The mysterious and intimate processes of generation are to be moved from

the darkness of the womb to the bright lights of the laboratory (where)

the divorce of new life from human sexuality began with artiﬁcial in-

semination and will ﬁnish with ectogenesis, the full laboratory growth of a
baby from sperm to term. ‘0

Expanding on the warning from Kass, Ramsey states that IVF threatens to “replace
human procreation with laboratory manufacture.” “ “Manufacturing” is mechanically
making, fabricating, ﬁctitiously inventing or reproducing the work of nature. Ramsey
often uses the term, ‘manufacturing,’ to criticize IVF as unnatural means of procreation.
He argues that “the mimicry of natural fertilization cannot be guaranteed to be perfect.”

’2 In his view, IVF weakly imitates the true thing, and creates a false state of affairs.

Medical Ethics:
Ramsey claims that placing “artiﬁcial fertilization and gestation on a parity with natural
processes” is medically unethical. ‘3 He concludes that IVF creates unnatural, unnecessary
and, immoral risks of genetic defects.

According to Ramsey, this needless risk of man-made birth defects grew out of
“liberal abortion attitudes.” ’4 He ﬁnds that “... teams of scientists are now hard at work

as 15

assaulting the entire process of human gestation. This leads to Ramsey’s claim that

reproductive technology ignores medical ethics to operate on the “principles governing
biological manufacture ...” ‘6

The problem as outlined by Ramsey carries over into other areas of reproductive
technology. He ﬁnds “inherent immorality” in various medical practices that destroy the

integrity of natural functioning. ’7

Ramsey insists that IVF, artiﬁcial insemination, abor-
tion, and vasectomy and genetic engineering unwisely manipulate the natural process of
procreation. He recommends that the medical profession condemn the entire trend.
In contrast with immoral alteration of natural events, Ramsey outlines the proper
role of biomedicine regarding infertility as follows:
If, infertility is a clinical defect which should be remedied, this would call

for reconstructive surgery on the oviducts By contrast, without curing a
medical condition, IVF concentrates on a product. ’8

Here, Ramsey morally distinguishes reconstructive surgery on the oviducts from surgical
fertilization and implantation. He views the former as a respected medical procedure
while holding that “IVF is not a medical procedure.” ‘9 Ramsey ﬁrrther states that IVF is

an evasive response to the desire for children that ignores the cause of infertility.

6

The proper medical response to infertility, given by Ramsey, is either curing clini-
cal defects or comforting those who must accept them. Ramsey interprets this as assist-
ing nature. He holds “The proper objective of medicine is to serve and care for man in

all his natural courses of action.” 2°

Social Disaster:

Ramsey ﬁrrther develops the idea that tampering with nature is dangerous by citing two
important literary ﬁgures. In 193 2, Aldous Huxley published Brave New World. describ-
ing fertilizing and decanting rooms in the East London Hatchery. Later, in 1947, C. S.

Lewis published The Abolition of Man, illustrating “man’s project of gaining ever increas-

 

n 21

ing power over nature. Ramsey recites the following warning from C. S. Lewis:

What we call Man’s power over Nature turns out to be a power exercised
by some men over other men with Nature as its instrument The long-

term exercises of power in breeding will mean the power to make its de-
scendants into what it pleases. 22

Ramsey claims that both Lewis and Huxley “singled out genetics, pharmacology and ex-
perimental embryology as sources of coming great evils” that are “the greatest threats to
the humanity of man.” 23 Ramsey contends this is correct, since IVF is “a long step to-
ward genetic Hatcheries and unlimited genetic changes.” 24
From Ramsey, we receive the warning that IVF opens the door to wide-scale tech-
nological abuse of procreation. He sees “the prospect of controlled breeding programs
aimed at producing superior members of the human race.” 25 Biomedicine becoming a
distorted science is a reality for Ramsey. He contends that IVF treats humans like ma-

chines whose “natural courses of action” can be “disassembled and put together again.” 26

7
In other words, IVF turns “medical care into a technological function.” 27 Comparing
IVF with manufacturing allows Ramsey to convey a sense of harshness that he contrasts
with the ﬂuid events of “natural genesis.” 28
He uses this contrast to justify a moral distinction between ordinary fertilization
and IVF. He predicts that a false sense of ethics will make our species into a “controlled
product wholly plastic to ingenious scientiﬁc interventions and alterations” like the

“breeding” and “cloning” of superior humans. 29

Ramsey adds that IVF represents a
snow-balling displacement of medical ethics that will bring “social disaster.” 3° He con-

cludes that condemning the practice of IVF reﬂects medical wisdom.

UNNATURAL DEATH

The second example, of biomedical critiques that appeal to nature, is Gay-Williams’ chal-
lenge to euthanasia. Like Ramsey, he bases his objections on this procedure’s unnatural-
ness. To understand his position, we need an explanation of the practice of euthanasia
that he considers unethical. Euthanasia is a term taken from the Greek language, which
literally means the good death of another. Although people deﬁne euthanasia in many
ways, Marvin Kohl holds that acceptance for the following deﬁnition is growing:

The act or method of inducing as painless a death as possible where the or-

ganism is acutely suffering or in an undesirable state, where the relief of the

condition is the only or primary motive and where there is convincing evi-

dence that the resulting death is a greater good than the failure to ac-
tively intervene. 3’

In contrast, Gay-Williams rejects any deﬁnition that ignores the intentional aspect
of euthanasia. He deﬁnes “euthanasia” as intentionally taking the life of a person suffering
from an illness or injury and recovery cannot reasonably be expected. 32 He holds that

euthanasia only refers to the unnaturalness of deliberate and intentional killing.

Natural Courses of Action:
The main thrust of Gay-Williams challenge to euthanasia is like Ramsey’s challenge to
IVF. Gay-Williams appeals to the inherent wrongness of unnatural courses of medical
action, contending:
Our reﬂexes and responses ﬁt us to ﬁght attackers, ﬂee wild animals, and
exercise caution and care necessary to protect ourselves. Our bodies are
also structured for survival When we are cut, our capillaries seal shut,

our blood clots and antibodies are produced to ﬁght against alien organ-
- 33
isms

9

According to Gay-Williams, our body chemistry and all of our organic structures right
down to the cellular level work to protect our bodies. He claims the processes of nature,

that are purposefully designed for survival, are literally assaulted by euthanasia

Rationality:
Gay-Williams argues that euthanasia is wrong because our rational understanding makes
us unlike animals. We are aware that our physiological systems and our innate behavioral
responses aim at survival. He contends that:

The organization of the human body and the behavioral responses make the

continuation of life a natural goal. By reason alone, we can recognize that
euthanasia sets us against our own nature. 34

In this view, “reason” asks us to recognize the survival goals built into our natural proc-
esses and patterns of behavior. He adds that euthanasia ignores our natural fear of death
and life-threatening events. Gay-Williams insists that our basic human instincts and re-
spect for the natural goals of the human body demand non-interference with death.

For Gay-Williams, showing respect for the self-sufﬁciency of our natural body
systems gives credence to the notion of human dignity. He claims that “dignity comes

from seeking our [natural] ends.” 35

Here, the term ‘dignity’ implies the Kantian notion

of respect for persons as ends in themselves. This perspective on human dignity grounds

a natural duty to sustain life and oppose medical acts bringing unnatural death.
Gay-Williams further builds his argument for the inherent wrongness of euthanasia

by appealing to our general disapproval of ‘killing. He claims euthanasia is different from

letting nature take its course because euthanasia is a “deliberate and intentional” killing. 36

10

Gay-Williams states that:
Euthanasia involves acting as if the inclination towards survival and aware-
ness of this as an end did not exist. Thus, euthanasia denies our basic hu-

man character and requires that we regard ourselves or others as something
less than ﬁrll human. 37

According to Gay-Williams, deliberately taking a human life is wrong regardless of any
incurable suffering. In other words, suffering from a disease or injury without reasonable
hope of recovery does not justify killing a human being.

Furthermore, Gay-Williams claims we cannot know with certainty that any illness
or physical impairment is incurable. Since modern medicine “does not possess perfect
and complete knowledge, a mistaken diagnosis is possible and spontaneous remission
does occur in many cases.” 38 He concludes that allowing unnatural introduction of

death, works against our natural self-interest.

Proper Medical Treatment:
Like Ramsey, Gay-Williams restricts the proper role of medicine to either curing physical
ailments or comforting those who must accept them. Both of these individuals contend
that proper medical treatment means working to make a patient well or allowing nature to
take its course. Gay-Williams cites three cases of medical actions resulting in a patient’s
death without intending that death. These cases show his views on how intentions relate
to proper medical treatment.

The ﬁrst case is when a seriously ill or injured patient dies from an injection of the

wrong drug. Gay-Williams claims this only shows a wrongful death.

11

He insists that euthanasia does not take place when the physician does not intend to cause
death, 39 Gay-Williams claims that death never results from an accident in euthanasia.

The second case is when a patient receives an injection of a drug intended to treat
his disease or improve his condition. Yet, the patient dies as a result of a bad reaction to
the proper medicine. Gay-Williams argues that “this is neither wrongful killing nor eutha-
nasia,” where medical actions intend to cause death. 4°

The third case is nontreatment or withdrawal of treatment when there is no rea-
sonable hope that treatment will save a life. Gay-Williams claims many people mistakenly
term this situation, “passive euthanasia,” but it is not euthanasia, at all, because the in-
tended outcome is not death. ’1 The goal is often sparing unjustiﬁed pain, indignation and
ﬁnancial expense. According to his theory, death following nontreatment or withdrawal
of treatment occurs as a natural result of injuries or disease and not from the failure to re-
ceive treatment. Gay-Williams argues that a killing does not take place in nontreatment

Death naturally resulting from injury or disease, according to Gay-Williams, re-
ﬂects our duty to respect the body’s innate defense mechanisms. He adds that it is right
to reduce suffering only if this does not defeat these mechanisms. Gay-Williams holds
that “we may legitimately seek easeful death,” but never “wrongful [intentional] death.”
He adds that “euthanasia is not just dying. It is killing.” 42 Since killing offends our sense

of morality, Gay-Williams reasons that euthanasia offends medical ethics.

Social Disaster:
For Gay-Williams, like Ramsey, the seeds of social disaster exist in the misplaced com-

passion of physicians who treat patients’ desires, instead of treating illnesses.

12

Both individuals hold that unthinking sympathy and benevolence may lead to wrongful
medical acts. As to euthanasia, Gay-Williams claims a patient may believe he and his fam-
ily would beneﬁt from his medically induced death. Yet, “suffering is a natural part of
life” with value for individuals and families. 43

Conversely, Gay-Williams holds that opposing natural suffering by endorsing
“euthanasia as a social policy is a slippery slope.” 4‘ In his view, euthanasia might “have a
corrupting inﬂuence so that in any case that is severe, doctors and nurses might not try
hard enough to save the patient.” 4’ Gay-Williams claims that offering unnatural death as
a solution to suffering may bring an overall decline in the quality of health care. and adds:

It is only a short step ﬁom voluntary euthanasia to involuntary euthanasia,

to directed euthanasia administered to a patient who has given no authori-
zation, to involuntary euthanasia conducted as part of a social policy. 46

He argues that “the category of hopelessly ill” may provide opportunities for abuse.
“Embedded in a social policy, it would give society the authority to eliminate all those
who might be considered to ill to ﬁrnction normally any longer.” ‘7 Gay-Williams con-
cludes that abruptly disrupting nature, with acts intending death, promises dire conse-

quences for society at large.

NATURE AND NATURAL

Both Ramsey and Gay-Williams ground their objections to speciﬁc biomedical procedures
on their unnaturalness. This strategy requires the primary assumption that nature, itself,
and natural courses of action reveal moral rightness. Some parallel arguments given by
Ramsey and Gay-Williams reveal the following variations of this assumption: First, they
assume a rational awareness of our natural embodiment and behavioral responses can and
should guide moral action. Second, they assume a rational respect for nature deﬁnes hu-
man dignity. Third, they assume only assisting nature or allowing nature to take its
course is the proper role of medicine. Fourth, they assume unnatural remedies for health
problems pose moral threats to the ideals of humanity. Fifth, they assume IVF and eutha-
nasia can only bring social disaster. All of these assumptions imply that nature and natu-
ralness have a positive moral value.

Understanding this implication requires us to explore the meaning of ‘nature’ and
‘natural.’ Confusion often surrounds these terms because we use them in different ways.
as 48

Three different meanings become more clear in John Stuart Mill’s essay, titled “Nature.

I will explain these meanings and call them: ‘nature 1,’ ‘nature 2’ and ‘nature 3.’

Nature 1:
According to Mill, ‘nature 1’ is, “... a collective name for all facts or a name for the
mode in which all things take place.” ‘9 Mill claims the ﬁrst meaning of nature is “the

”50

sum of all phenomena, together with the causes that produce them. Quite simply,

‘nature 1’ refers to all living and non-living things and the changes they undergo.

13

l4

’

This all-inclusive meaning carries over to the adjective, ‘natural 1. It describes all physi-
cal attributes of everything ﬁom marine life to modern architecture and all physical events

from cell grth to atom splitting. Everything that exists or happens is ‘natural 1,’

Nature 2:

Nevertheless, a second meaning of nature often narrows the broad meaning of ‘nature 1.’
According to Mill, ‘nature 2’ is “... not everything that happens, but only what takes place
without the voluntary and intentional agency of man.” 51 Therefore, ‘natural 2’ refers to
the powers and properties that humans have not rearranged for their own purposes.

Things without human shaping includes things such as wind patterns and ocean currents.

Nature 3:
In contrast, there is a third sense of nature, which I call ‘nature 3,’ Mill contends that
many people have used this concept to convey the ideas of “commendation, approval, and

” ’2 He holds, “Nature does not stand for what is, but for what

even moral obligation.
ought to be; or for the rule or standard of what ought to be.” 53 According to Mill, the
unfounded prescriptive view of ‘nature’ has existed in all ages but, “the authority of Na-
ture’s imaginary code” peaked when:
Christian theology erected Nature into the criterion of morals [while]
man is by nature wicked. This very doctrine has made moralists almost

unanimous in proclaiming the divinity of nature and setting up its fancied
dictates as an authoritative rule of action. 5“

Mill points out the irony of Christian theologians praising our purposeﬁrl ‘natural
2’ inclinations while condemning our human natures. He argues that contradictions al-

ways arise from the prescriptive use of ‘nature 3.’

15
These contradictions reveal the falsehood of ‘natural 3’ prescriptions. Since ‘nature 3’ has
no criteria of its own, Mill insists that people create ‘nature 3’ by combining descriptions
of ‘nature 1’ or ‘nature 2’ with unfounded moral views to fashion their own moral rules.
In the following passage, Mill describes how ‘nature 3’ shapes moral arguments:
That any mode of thinking, feeling, or acting is according to nature is
usually accepted as a strong argument for its goodness [and] the impu-

tation of being contrary to nature, is thought to bar the door against any-
thing so designated. 55

Mill claims the third use of ‘nature’ poses serious problems for moral theory. He holds

many people think wrongly that, “Nature” gives us physical criterion for moral behavior. ’6

Naturalistic Fallacy:

David Hume explains the problem with appeals to ‘nature 3. ’ According to Hume, it is
one thing to describe something and something quite different to place a value on that
thing. 57 In other words, people assign values to things. The value of anything is a judg-
ment, that is outside of pure description. Nature, itself, has no inherent value to sanction
it as a model for morality.

G. E. Moore’s interpretation of this argument is called the "naturalistic fallacy.” ’8
He claims no value statement that something is good or bad, right or wrong, follows logi-
cally from a purely descriptive statement about what something is. According to Moore,
it is logically unsound to move from descriptive facts about nature to prescriptive conclu-
sions. ‘Nature 3’ prescriptions for human conduct result from improperly taking “what is”

the case with unaltered things of ‘nature 2’ and deducing “what ought to be” for humanity.

Any appeal to the morality of ‘nature 3’ slips from “is” premises to “ought” conclusions.

16

Natural Prescriptions:

Mill insists those who say we ought to act according to ‘nature 1’ cannot mean we ought
to follow the laws of nature, since every act and its consequences follow these laws. He
adds that, “Telling people to conform to the laws of nature, when they have no power but

what the laws of nature give them, is an absurdity.” ’9

When we import ‘nature 1’ into a
prescription, we are actually saying that everything we do is right This use can inadver-
tently imply that anything from slavery to nuclear destruction is right.

Persons who use ‘nature’ as a prescription, might mean that we should follow the
ways of ‘nature 2. ’ Yet, ‘nature 2’ also creates problems for moral theory. According to
Mill, if letting ‘nature 2’ take its course is morally right, then, to do anything with

”60

forethought and purpose would be a violation of the natural order. Quite simply, all

human acts interfere with ‘nature 2. ’ Mill states that to plant, to build, and to wear

9, 61

clothes, are “clear violations of the directive to follow nature. ‘Nature 2’ is a sequence

of mere happenings without human shaping, that cannot provide moral principles.

Natural Functions:

In contrast, Ramsey’s objections to ‘unnatural 2’ medicines assume that ‘natural 2’ de-

scriptions of human instincts and body processes can supply moral guidelines. Ramsey

assigns moral propriety to “natural procreation” and “biological parenting.” 62 Gay-

Williams assigns moral rightness to “natural instincts for survival” and to “natural body
as 63

processes. They both describe these functions as involuntary and spontaneous. This

implies that unaltered human functions happen independently of human willing to conform

17

with ‘nature 2.’ They conclude that doctors should respect the self sufficiency of these

‘natural 2’ events.

Complex Functioning:

However, this view ignores the complexity of human functioning that prevents us from
conforming with ‘nature 2. ’ Our body processes and instincts do not ﬁt into categories of
‘natural 2’ and ‘unnatural 2,’ because they always interact with our intentional behavior.
Our conscious thoughts, emotions and actions inﬂuence naturally occurring events such as
respiration, pulse and heart rate. Our voluntary and involuntary functions interact in a
way that makes conformity with unaltered events, impossible.

Those who prescribe 'natural 2' behavior both endorse and condemn what is hu-
man. For instance, the ‘natural 2’ inclinations endorsed by Ramsey and Gay-Williams may
ﬁt into two mutually exclusive classes, ‘natural 2’ and ‘not natural 2.’ Ramsey refers to
‘natural 2’ inclinations toward sexual “begetting” or “siring” of children. 6“ Gay-Williams
refers to the ‘natural 2’ inclinations to “ﬁght attackers” and “ﬂee wild animals.” 6’ These
examples try to show the purposefulness of ‘natural 2’ events. We ﬁnd ‘naturalness 2’ in
the attitudes of fear and sexual arousal that accompany spontaneous chemical changes in
the human body. Both fear and sexual arousal stimulate the adrenal glands to produce
chemicals that travel through the bloodstream to speed up the heart rate and blood pres-

sure.

Agency:

18

Yet, while our chemical responses to fear and sexual arousal meet the requirements for
‘naturalness 2,’ our immediate physical reactions reveal human agency. We can choose to
participate or not participate in sexual activity, to ﬁght or not ﬁght attackers, and to ﬂee
or not ﬂee wild animals. This shows that human design inﬂuences our natural inclina-
tions. They are both ‘natural 2’ and ‘not natural 2,’

Very little of human ﬁmctioning is entirely ‘natural 2,’ Human functioning almost
always reﬂects the ‘agency’ that opposes ‘natural 3’ prescriptions for conformity with ’na-
ture 2’ The concept of human agency usually refers to responsibility for voluntary, inten-
tional action. Human agency describes actions outside the realm of “nature 2.” Exclud-
ing human agency excludes moral responsibility. When we enter the realm of moral
evaluation, we have left the realm of ‘natu‘e 2. ’ Therefore, moral appeals to nature are

empty.

Rationality:
Yet, we ﬁnd parallel appeals to nature made by Ramsey and Gay-Williams that. try to link
rationality with letting nature take its course. In their appraisals of ‘natural 2’ fertilization
and ‘natural 2’ suffering, Ramsey and Gay-Williams equate ‘naturalness 2’ with moral
tightness. They argue that a reasoned understanding of our ‘natural 2’ body processes
grounds a commitment to non-interruption by the medical community.

However, appeals to our rational understanding of ‘nature 2’ often hide conceptual
contradictions. The act of moral prescription implies that we have rational choices. Yet,
appeals to “nature” call for irrational conformity with the mere happenings of ‘nature 2.’

Mill states that:

19

Nature, understood as the spontaneous course of things when left to them-
selves is absurd and contradictory. The aim and object of action are to
alter and improve Nature. If the natural course of things were perfectly
right to act at all would be meddling, which must make things worse. If
action could be justiﬁed, it would only be in direct obedience to instincts
but to do anything with forethought and purpose would be a violation of
the perfect order. 6"

Endorsing conformity with nature is nonsense, according to Mill. He claims that our

rationality gives us the power to oppose and alter the purely natural occurrences.

Condemning Civilization:
Rational interference with “nature 2” largely deﬁnes civilized activities. For example, toi-
let training interferes with the ‘natural 2’ act of eliminating waste products, anywhere at
all. Should we eliminate toilet training because it interferes with a ‘natural 2’ happening?
Or, perhaps we should eliminate artiﬁcial lights and heat since they alter ‘natural 2’ states
of affairs. The mere fact that we disrupt ‘natural 2’ events makes no moral statement.
Since all civilized behavior violates ‘nature 2,’ it cannot guide ‘nature 3’ prescrip-
tions. No mere description of ‘nature,’ with or without human intervention, can deﬁne
moral action. Simply because an act is ‘natural 2’ does not mean that we should do it.
Acts of human agency aim at changing the course of ‘nature 2.’ Our civilized interference
with ‘nature 2’ includes housing, communication systems, education and transportation.
Condemning ‘unnaturalness 2’ inadvertently condemns all civilization. Despite the
claims of Ramsey and Gay-Williams, our human rationality makes us alter, not protect
‘natural 2’ events. In Mill’s words, rational thinking asks us to conquer, not obey the

67

ways of ‘nature 2. ’ All human progress is ‘unnatural 2’ in the sense of changing

‘natural 2’ states of affairs. Unavoidable interference with nature is a part of our exis-

20
tence. Humans have been altering ‘nature 2’ ever since they ﬁrst stood on two feet. Al-

’

tering our innate behavior is not a moral violation of ‘nature 2. We would oppose all

human progress by condemning interference with ‘nature 2. ’

Condemning Medicine:

Ramsey’s and Gay-Williams’ objections to unnatural forms of medicine imply that it is
morally wrong to disrupt natural events.

Yet, a commitment by the medical community to not interfere with 'nature 2’ would leave
us helpless to oppose ‘naturally 2’ occurring viruses, infections and diseases. All medicine
is “unnatural” in the sense of trying to alter ‘natural 2’ events and ‘natural 2’ body proc-
esses. For instance, vitamins, antibiotics, therapy, surgery and immunizations work to-
ward interrupting, slowing and often reversing the ‘natural 2’ events of injury, infection,
disease, aging and death. Therefore, when a doctor brings about health, he creates an
artiﬁcial change.

When Ramsey and Gay-Williams condemn IVF and euthanasia for being
“unnatural” remedies, they are condemning all medicine. Yet, human nature rejects doing
nothing about pain or suffering when we can do something. The abilities and talents that
we are born with clash with passive observance of human suffering. Biomedicine may
one day develop the ability to genetically correct birth defects or extinguish the cause of a
deadly virus or crippling disease. Interrupting ‘nature 2’ cannot be immoral simply be-
cause we impose our free wills on ‘natural 2’ events. We cannot deﬁne right and wrong

medical practices by evaluating their relationships to ‘nature 2.’

21

Empty Moral Distinctions:
However, Ramsey and Gay-Williams do not deﬁne right and wrong medical interference
with ‘nature 2.' Their objections to the unnaturalness of IVF and euthanasia imply a broad

3

moral directive for non-interference with ‘nature 2. Yet, while all medicine attempts to
modify undesirable ‘natural 2’ events, neither Ramsey nor Gay-Williams explicitly con-
demns all medicine. Neither of these individuals places all medical practices under the
heading of wronng interference with ‘nature 2. ’

They are unlike persons, such as Jehovah’s Witnesses, who object to all medical altering
of ‘natural 2’ events.

Instead, Ramsey and Gay-Williams only oppose certain medical procedures that
they set in opposition to a prescriptive meaning of nature. This appears more sympathetic
to human needs and suffering than blanket condemnations, but it is not more rational. It
is absurd to distinguish between various medical practices without explaining the differ-
ence between moral and immoral interference with ‘nature 2. ’ Yet, Ramsey and Gay-
Williams do not specify or defend any meaningful criteria for deciding which medical acts

’

violate and which acts assist ‘nature 2. They simply carve out exceptions to condemning
all medicine.

For example, Ramsey explicitly endorses surgery to correct blocked fallopian
tubes, as moral assistance to ‘nature 2.’ 68 He claims this surgery assists the ‘natural 2’

scheme of things and IVF wrongfully interferes with ‘nature 2. ’ Ramsey judges one pro-

cedure as moral and the other as immoral. Even though both of these procedures alter

22

‘nature 2’ for the goal of fertility, Ramsey assigns them different moral weights. There-

fore, his appeals to ‘naturalness 2’ cannot defend his moral judgments.

Immoral Intentions:

We also ﬁnd unjustiﬁed moral distinctions when Gay-Williams differentiates the practices
of “active euthanasia” and “passive euthanasia” on the basis of ‘naturalness 2.’ He con-
demns the intentional termination of ‘natural 2’ body processes. This is often called
‘active euthanasia.’ Yet, he endorses the withdrawing or withholding of medical treat-
ment for hopelessly suffering patients. This is often called ‘passive euthanasia.’

He holds that termination of the body processes is not the intended result in passive treat-
ment. For Gay-Williams, intentionally bringing about death is an immoral act against
‘nature 2.’

The moral evaluations of Gay-Williams turn on individual intentions toward our
‘natural 2’ functions. This implies that we can determine the morality of a biomedical
procedure by analyzing the intended consequences. Yet, we cannot, with certainty, know
the intentions of others. Since people often have primary, secondary or multiple inten-
tions, we may even wonder about our own intentions. Moral judgments based on inten-
tions are ambiguous. This platform absurdly ignores the fact that humans often feel con-
fused about, or simply misunderstand, their own intentions or those of others.

Yet, Gay-Williams assigns different moral weights to “active” and “passive” eutha-
nasia. He bases his judgment on whether or not the doctor intends to terminate the

‘natural 2,’ functions. He does not recognize that all forms of euthanasia, in some sense,

23

intend to bring death. Medical decision-making and care of patients shape the ‘natural 2’
courses of events, even when this is passive in a mechanically causal sense. 69

The doctor and patient relationship in ‘passive treatment’ is a special relationship
where the moral distinction between omission and commission disintegrates. This special
relationship resembles a parent and child relationship. For example, a parent who with-
draws or withholds the feeding of a child, causes the child’s death. Likewise, a doctor
who accepts responsibility for the care of a patient and then withdraws or withholds life-
sustaining treatment, causes the patient’s death, though he physically does nothing.
Therefore, withholding or withdrawing life-sustaining treatment is like giving a lethal in-
jection.
In each of these treatments, informed, deliberate, uncoerced medical decision-making
demonstrates moral agency and responsibility for promoting death. 7° We cannot ﬁnd a

moral difference between these practices based on their relationships to ‘nature 2. ’

Unnatural Violence:
Yet, Gay-Williams condemns [active] euthanasia for violently ending the ‘natural 2’ func-
tions that support life. He insists it is rational to perceive the self-sufﬁciency of ‘nature 2’
and let nature take its course. According to Gay-Williams, when we violently end a life,
we ignore our rational respect for our ‘natural 2’ defense mechanisms. 7‘

However, Gay-Williams ignores the fact that euthanasia is not necessarily violent.
The Dutch legal system does not prosecute doctors who conform to their formally speci-
ﬁed conditions for euthanasia. Many Dutch physicians claim that death by lethal injection

can be a swift, painless and humane end to incurable pain and suffering. 72 Yet, if we try

24

to express moral rightness in terms of “naturalness 2,” some doctors and patients will con-
trast abrupt death with unbearable living. “Naturalness 2,” provides no moral grounds for
a choice.

Nevertheless, even if euthanasia is violent in the sense of abruptly stopping life

3

functions, violence cannot distinguish what is ‘natural 2’ from what is ‘unnatural 2. F re-
quently, what we call ‘nature 2’ delivers violence in the forms of heart attacks, strokes and
devastating illnesses like cancer. As noted by Mill, death, itself, is a form of violence that
nature delivers to every living thing. 73

However, Gay-Williams uses the term, “killing” to show that a doctor who initi-
ates death, commits an immoral act. 74
He ignores the fact that killing is usually condoned in certain situations. For instance, we
generally view killing in war or self-defense as morally justiﬁed. Also, many people con-
done the intentional killing of incurably suffering animals. Therefore, the bare fact that

euthanasia intentionally disrupts ‘natural 2’ processes, cannot ground a moral objection.

Instead, the term, killing, suggests rhetorical persuasion.

Social Disaster:
Instead of giving us moral reasons, Ramsey and Gay-Williams appeal to our worst fears

about ‘human nature 2’ and new medical technology. They both prescribe controlling the

“evils” 7’ that adhere in ‘human nature 2.’ They both offer “slippery-slope” 7’ arguments

about giving too much power to the medical community. Their arguments say altering
‘natural 2’ events can start out innocently and gradually lead up to morally unacceptable

practices. Ramsey warns us “the principles governing biological manufacture” of chil-

25

dren will lead to dangerous experiments aimed at breeding and cloning superior humans. 77
Gay-Williams delivers the warning that it is “a short step from voluntary euthanasia to in-
voluntary euthanasia conducted as part of a social policy.” 78
These predictions that biomedicine will produce social disaster presuppose a nega-
tive picture of ‘human nature 2’ leaning toward greed and abusive power. Ramsey and
Gay-Williams foresee evil domination by lawmakers, medical technicians and health care
professionals. In this context, Ramsey and Gay-Williams see our ‘natural 2’ inclinations
as immoral and want us to interfere with something ‘natural 2.’
However, their impoverished views of “nature” at work in our human personalities
contradict their arguments for the rightness of what exists by ‘nature 2.
It also undermines their objections to the “unnaturalness” of IVF and euthanasia. Since
most human behavior alters ‘nature 2,’ arguing that we should let ‘nature 2’ take its course

generates contradictions. We cannot maintain this as a philosophical position and live in

civilized society.

Rhetorical Persuasion:

People who assign a moral value to ‘nature’ are combining description with prescription.
This kind of conceptual chaos exists in the appeals to ‘nature 3’ made by Ramsey and Gay-
Williams. These individuals conﬁrse, blur and even mesh together various descriptions of
‘nature 1’ and ‘nature 2’ with unsupported moral views. In essence, Ramsey and Gay-
Williarns substitute emotional persuasion for moral reasoning when they assign moral

rightness to descriptive accounts of our ‘natural 2’ inclinations and body processes.

26

Their harmonious descriptions of ‘nature 2’ at work within ourselves, attempt to
persuade us that ‘naturalness 2’ has a certain tightness that we should not violate. These
descriptions play on our respect for “nature” as a powerful and pervasive source of causa-
tion. This is a rhetorical technique that masks the emptiness of objecting to the unnatu-
ralness of IVF or euthanasia. Both Ramsey and Gay-Williams exploit the ambiguity that
often surrounds the different meanings of the term, ‘nature.’

Even though Ramsey and Gay-Williams show a general moral concern for misused
medical technology and administration, their prophecies are merely rhetorical persuasion.
They make dramatic predictions about the terrible effects of altering natural events. Ram-
sey predicts biomedicine will create superhumans that enslave the rest of society.
Gay-Williams’ predicts society will initiate a contagion of killing persons deemed unﬁt.

This reveals unnecessary pessimistic generalizations about ‘human nature 2.’

Rational Restraint:

,

In contrast, Kohl offers a positive view of ‘human nature 2. He holds self-imposed moral
constraints prevent us from crushing an insect, believing this is permissible, and moving on
to the belief “it is permissible to kill all living things.” 79 In Kohl’s View, ‘human nature 2’
gives us the rationality to distinguish between permissible and impermissible killing.

Yet, whether we view human nature negatively or positively, the morality of a par-
ticular medical procedure or medical act does not come ﬁom its ‘naturalness 2.’ We can
morally evaluate difﬁcult medical decisions about human suffering, only if we recognize

that ‘nature 2’ lacks the normative dimension needed to justify moral action. IVF and

euthanasia do not lead to moral decay simply by altering ‘nature 2.’

CONCLUSION
Ramsey and Gay-Williams use descriptions of ‘nature 2’ in normative ways to gain support
for their objections to IVF and euthanasia. These appeals to “nature” cannot by them-
selves determine the rightness of any medical procedure. We cannot condemn IVF and
euthanasia simply for being “unnatural” solutions to health problems.

However, when Ramsey and Gay-Williams voice their objections to IVF and
euthanasia, they play on our emotions. The common name for this technique is rhetorical
persuasion. Ramsey dramatically presents IVF as the equivalent of manufacturing human
beings and Gay-Williams dramatically presents euthanasia as the equivalent of premedi-
tated murder. Yet, our general respect for ‘nature 2’ and fear of uncontrolled medical
technology act as an unsupported platform for their moral views.

They overlook the fact that ‘nature 2’ is indifferent to morality. Instead of giving
moral reasons, they discuss medical interference with ‘nature 2_’ Yet, Ramsey and Gay-
Williams do not condemn all medicine. They base their choices of what medical practices
to call ‘natural 2’ and ‘unnatural 2’ on prior moral judgments about IVF and euthanasia.
Yet, since all forms of medicine attempt to counteract ‘natural 2’ occurrences, none are
immoral merely because they alter or disrupt a ‘natural 2’ sequence of events

Rather, it is the use or abuse of medical technology that justiﬁes moral judgment.
Although biomedicine holds the potential to enhance human dignity by addressing pain and
suffering, it also holds the potential to degrade human dignity by actual misuse. The
geneses of new biomedical procedures have the potential to alter the beginning, the con-
tinuation and the end of human life. These possibilities can bring varying degrees of bio-

medical achievement or destruction to the human race.

27

28

We will not judge the morality of the outcomes using alignment or discord with ‘nature 2.’
The passing of time will reveal whether biomedical procedures bring morally negative or morally
positive results. The general and speciﬁc outcomes of biomedical procedures like IVF and
euthanasia will mirror the moral character of our society and its individuals.

A moral society requires the exercise of practical judgment at all levels of society. Our
law-makers must exercise strict control over the many new types of biomedicine. We need wisely
articulated social policies that reﬂect the best interests of the particular individuals directly af-
fected and the best interests of society at large. Equally important, those who practice biomedi-
cine must appeal to widely accepted moral principles as they evaluate particular cases.

Yet, appeals to what is ‘natural 2’ and ‘unnatural 2’ in a descriptive sense can never ground
the rightness or wrongness of a biomedical procedure. We must not allow emotional appeals to

‘nature 2’ or ‘naturalness 2’ to distract us from genuine moral evaluation.

10.
ll.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.

33.
35.
36.
37.
38.
39.

#99999!"

NOTES

. Ronald Munson, “Reproductive Control,” Intervention and Reﬂection.

(St. Louis: Wadsworth, 1992) 156.
Paul Ramsey, “Shall We Reproduce,” J.A.M.A. 220 (June 12, 1972): 1484.
Ibid., 1484.
Ibid., 1484.
Ibid., 1483.
Leon Kass, “Making Babies,” Public Interest 26 (1972): 30.
Richard. Mckeon, editor, “Nichomachean Ethics,” The Basic Worlth of Aristotle
1097b.
Kass, “Making Babies,” 34.
Ibid., 35.
Ibid., 35.
Ramsey, “Shall We Reproduce,” 1482.
Ibid., 1480.
Ibid., 1480.
Ibid., 1483.
Ibid., 1483.
Ibid., 1482.
Ibid., 1481.
Ibid., 1481.
Ibid., 1481.
Ibid., 1485.
C. S. Lewis, The Abolition of Map (New York: Macmillan, 1947) 238.
Ibid., 238.
Ramsey, “Shall We Reproduce,” 1483.
Ibid., 1481.
Ibid., 1484.
Ibid., 1484.
Ibid., 1484.
Ibid., 1482.
Ibid., 1484.
Ibid., 1485.
Marvin Kohl, “Euthanasia,” Encyclopedia of Ethics (1992 ed.) 336.
J. Gay-Williams, “The Wrongfulness of Euthanasia,” Intervention and Reﬂection.
(St. Louis: Wadsworth, 1992) 156.
Ibid., 157.
Ibid., 157.
Ibid., 157.
Ibid., 156.
Ibid., 157.
Ibid., 157-158.

29

4o.
41.
42.
43.
44.
45.
46.
47.
48.

1874)
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.

70.
71.
72.

72.
73.
74.
75.
76.
77.
78.
79.

30

Ibid., 156.

Ibid., 157.

Ibid., 157.

Ibid., 158.

Ibid., 158.

Ibid., 158.

Ibid., 158.

Ibid., 158.

John S. Mill, Nature. the Utility of Religion and Theism. (London: Longman,
5-13.

Ibid., 6.

Ibid., 5.

Ibid., 8.

Ibid., 9.

Ibid., 12.

Ibid., 10.

Ibid., 11.

Ibid., 13.

David Hume, Tr_eatise of Human Nature. (London: Longman, 1739) 469.
G. E. Moore, Principia Ethica, (New York:: Cambridge UP, 1948) 143.

Mill, _N_ature. the Utility. 16.

Ibid., 20.

Ibid., 5-13.

Ramsey, “Shall We Reproduce,” 1482.

Gay-Williams, “The Wrongfulness of Euthanasia,” 157.

Ramsey, “Shall We Reproduce,” 1484.

Gay-Williams, “The Wrongfulness of Euthanasia,” 158.

Mill, Mture. the Utility. 19-20.

Ibid., 20.

Ramsey, “Shall We Reproduce,” 1482.

Martin Benjamin, “Moral Agency and Negative Acts in Medicine.”
Medical Responsibility,(Princeton, Humana P., 1979) 170-180.
Ibid., 171.

Gay-Williams, “The Wrongfulness of Euthanasia,” 157.

Ronald Munson, “The Dutch Experience,” Intervention and Reﬂection.
(St. Louis: Wadsworth, 1992) 153.

Ramsey, “Shall We Reproduce,” 1482.

Mill, Mture. the Utility. 19-20.

Gay-Williams, “The Wrongfulness of Euthanasia,” 158.

Ramsey, “Shall We Reproduce,” 1483.

Gay-Williams, “The Wrongfulness of Euthanasia,” 158.

Ramsey, “Shall We Reproduce,” 1482.

Gay-Williams, “The Wrongfulness of Euthanasia,” 158.

Kohl, “Euthanasia,” 337.

 

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Benjamin, Martin. “Moral Agency and Negative Acts in Medicine.” Medical
Responsibilig, (Princeton, Humana P., 1979) 170-180.

Gay-Williams, J. “The Wrongfulness of Euthanasia,” Intervention aad Reﬂection.
(St. Louis: Wadsworth, 1992).

Hume, David. matise of Human Nature. (London: Longman, 1739).
Kass, Leon. “Making Babies,” Public Interest 26 (1972).

Kohl, Marvin. “Euthanasia,” Encyclopedmf Ethics (1992 ed.)
Lewis, C. S. The Abolition of Man (New York: Macmillan, 1947).

McKeon, Richard. editor. “Nichomachean Ethics,” The Baﬂc Works of Aristotle.
(New York: Random House, 1941).

Mill, John S. Nature. the Utility of Religion and Theis_n_1, (London: Longman, 1874).

Munson, Ronald. “The Dutch Experience,” Intervention and Reﬂection.
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Munson, Ronald. “Reproductive Control,” Intervention and Reﬂection.
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