Andrew Gunn
Dr Andrew Gunn is a Brisbane general practitioner currently completing an MAPhil at the University of Queensland.

Introduction

Australian ethicist Peter Singer must have a thick skin. His recent departure from Melbourne was marked in The Age by an article titled “Good riddance to a warped philosopher”1. His appointment as professor of philosophy at Princeton University in the United States led to demonstrations and death threats.

Singer (a.k.a. Professor Death2) attracts a variety of opinions. Commentary ranges from “the most dangerous man in the world”3 to “the greatest living philosopher”4 - although these two opinions are not necessarily contradictory. He is widely condemned as a “Nazi”, a distressing (but not unique) fate for a man of German/Austrian Jewish stock who lost several close relatives in the Holocaust5.

This article discusses a few myths surrounding Singer’s philosophy. The philosophical differences creating divergent opinions on Singer also have important repercussions on health care. Ethics, not science, underlies many health care controversies.

Peter Singer

Singer has published profusely over several decades – a couple of dozen books, hundreds of articles and thousands of interviews and lectures. Nonetheless, public criticism of Singer’s work – and there is plenty of it - often focuses on the same two or three sentences plucked from the millions available. Indeed, outside philosophical forums it appears quite normal to damn Singer’s work having only read about it, rather than having read it. “I can’t recall or find the book in which he [Singer] wrote these views” wrote one medical critic recently, before using a misquote to discuss Singer6.

Singer says that his book “Practical Ethics” provides the commonest material that gets flung in his face7. For instance, there is the quote that “…killing a disabled8 infant is not morally equivalent to killing a person. Very often it is not wrong at all.”9 Feed this into a few internet search engines and you will find it reproduced on a hundred web sites. Various inaccurate versions are also propagated, for instance, one which substitutes the word “child” for “infant”.

Singer believes that to be a “person” one requires “characteristics like rationality, autonomy, and self-consciousness”10. He thinks neonates, whether disabled or not, do not yet hold these characteristics and that personhood takes over a month to develop. One could speculate, of course, that Singer was rather busy when his children were newborn. Perhaps, had he not been, his views now would be different. But if one accepts that a neonate is not a person, then it is not irrational to believe that killing a neonate would not be morally equivalent to killing a person. Singer believes that the views of parents, not doctors or governments, should be central in decisions made regarding their newborn children.

Many of Singer’s critics assume that Singer does not regard disabled children (as distinct from neonates) as persons1,2,6. This is incorrect. Singer is specific on this point:

“it is one thing to say, before a life has properly begun, that such a life should not be lived; it is quite different to say that, once a life is being lived, we need not do our best to improve it. We are sometimes prepared to say the former: we are never prepared to say the latter.” 11

Before becoming infamous for his views on euthanasia, Singer had already made his mark on the world as the author of “Animal Liberation”12. Many believe this was a catalyst for the modern “animal rights” movement. Singer argues that many non-human animals experience pleasure and pain, and humans make them suffer without adequate justification. For instance, he believes most research involving animals is ultimately meaningless and that eating animals is generally unnecessary, environmentally harmful and cruel.

Singer thinks that if hard choices need to be made they should not be on the basis of species but on the presence or absence of a capacity to suffer. Taking an assumption like this and examining what it infers is something that academic philosophers like Singer do for a crust. For instance, Singer’s suggestion that experimentation on insentient humans might be ethically preferable to experimentation on sentient apes. This raised a furore but was intended as an argument against using apes rather than an argument for using comatose humans7.

Treatment of animals has noticeably improved in Western societies in the last quarter century. In some part this is due to Singer. This may be an unusual case of a philosopher leading the crowd rather than being ignored by it.

Nonetheless, Singer himself admits his work is not strikingly original13. His thoughts are firmly based on several centuries of utilitarian tradition. Singer’s contribution has been to carefully develop the logic and force of arguments arising from certain positions within that ethic and, of course, think the unthinkable.

Utilitarianism

Singer’s ethics can be understood within the context of Western philosophy’s distinction between consequentialist and non-consequentialist ethics. Apologies for the jargon, but Singer is a consequentialist of the act-utilitarian variety. In essence, this ethic decrees an action morally right if, at the end of the day, it works out the best overall for all those affected. Non-consequentialists typically believe certain rules should be followed without regard to their consequences.

Singer’s most vehement critics are almost all non-consequentialists. They often claim to be believers in a rule that all human life is of equal worth. Singer arouses their passion by unblinkingly discussing possible circumstances – in particular, the presence of incurable and extreme suffering - when a human’s life may be worth less, or worthless, or even best foregone. Further angst arises from the, in my opinion unnecessary, desire of Singer to avoid considering the lost futures of dead or potential fetuses and newborns in his analysis lest that imply a moral duty to constant reproduction.

Interestingly, at times his detractors strongly support his positions, for instance, that there may be no moral difference between a late termination and infanticide2. Singer would, of course, allow that there is a difference if people get more upset about one than the other.

People responsible for developing and enforcing moral rules have a lot to lose from utilitarianism. The man tipped to be the next Pope is said to have stated that the Anti-Christ today would be a “vegetarian philanthropist”.14 Any guesses who he had in mind?

Naturally Singer is vegetarian. Singer, unlike some utilitarians, also proposes a radical egalitarianism and is said to give a fifth of his income to international relief agencies15. This is another byproduct of his consequentialist ethic that can view a person’s death by passive inaction, such as not donating to famine relief, as badly as actively causing that death.

This sets an impossible standard for moral perfection, so it is no surprise Singer stands accused of hypocrisy. Lately Singer has spent big money on care for his demented mother rather than bumping her off and donating the savings to the starving. Some critics crow that this disproves his philosophy2,6, although the implausibility of this argument has not passed unnoticed - “as if he [Singer] would be worth listening to only if he took a pillow and suffocated his mother”13. Singer himself comments that “My mother is not suffering… So it’s not like the cases of euthanasia that I’ve written about.”7. Besides, expecting ethicists to follow their philosophy is like expecting doctors to practise what they preach on health promotion.

Utilitarianism has had a major impact on Western societies in the last couple of centuries. Decriminalisation of “victimless crimes” was once unthinkable. Although many of Singer’s suggestions remain on the fringes, utilitarian ethics do underlie many health policies of recent decades. Some examples are availability of pregnancy termination (to avoid the problems of backyard abortions), methadone maintenance (because overall outcomes are better), and at times allowing a degree of coercion when community benefit is thought to outweigh individual “human rights” infringements - for instance, immunisation programs, random breath testing and compulsory seatbelts. Moves toward legalising voluntary euthanasia often reflect a belief that overall the consequences might be better if, in specific circumstances, people are assisted to end their lives in defiance of a “thou shalt not kill” rule. Utilitarianism may even underlie “non-judgmental” counselling - this is believed to result in better outcomes than constantly pointing out to people, verbally or non-verbally, that they are breaking the “rules”. Harm minimisation is also based on utilitarian principles, replacing the (over-simplified) catch-cry of “the greatest good for the greatest number” with “the least harm of the least number”16.

The unsung ascendancy of utilitarianism means we now see non-consequentialists - for instance, many strongly religious people - being forced to enlist utilitarian arguments against various reforms. That is, claiming that a reform causes harm rather than making the, for them, more heartfelt but, for others, less persuasive claim that a reform is wrong because it is wrong. In the drug arena, we see statements that needle exchanges should be closed due to the hazards of improperly discarded needles, that safe injecting rooms should be prohibited because they encourage drug use and that methadone creates more harm than good because it is addictive and dangerous. In each case the argument is that the utilitarian sums have been done incorrectly and the harm of these reforms outweighs their benefits - which always requires evaluation as evidence-based ethics is an inexact science.

Conclusion

Study of ethics is often viewed as an ivory tower pursuit irresponsibly divorced from the messy real world. On occasions, this appraisal is accurate. Nonetheless, ethics is important because it is pure politics – that is, the small “p” politics of social power. Ethics can dictate who should be allowed to do what to whom, and there is little that is more political than that.

The case of Peter Singer demonstrates that, like all political clashes, clashes of ethics often generate more heat than light. Ethics, not science, does underlie many health care controversies. Whether understanding the ethics creates any solutions is another question, but realising where both oneself and one’s opponents are coming from has to be a start.

References and notes

1. Oderberg, David S. “Good riddance to a warped philosopher” The Age 28 April 1999

2. Morse, Anne “Princeton Professor Singer: For Mom he changes his tune” NeoPolitique.org Nov 1999

3. Carol Cleigh of the Illinois group Not Dead Yet - quoted by Jason Zinoman in “The ethics of baby-killing” Salon.com July 2 1999

4. in a recent interview in the New Yorker

5. Smith, Wesley J. “Animal rights extremism at Princeton: Peter Singer gets a chair” frontpagemag.com 22 Oct 1998

6. Retractor. “Sitting in judgment from a big-time bioethical chair”. Australian Doctor 21 April 2000

7. Boyce, Nell “Only human” New Scientist 8 Jan 2000

8. The original 1979 edition used the word “defective” rather than “disabled”. Singer says he is criticized for this but in the 1970’s “defective” was commonly used in medical literature (“Ethics, Health Care and Disability” seminar at Princeton University Oct 12, 1999)

9. Singer, Peter. Practical Ethics 2nd ed. Cambridge Uni Press 1993 p191

10. Singer, Peter. Practical Ethics 2nd ed. Cambridge Uni Press 1993 p182

11. Kuhse, Helga and Peter Singer. Should the baby live? The problem of handicapped infants. 1985 Oxford Uni Press. The quote is from the preface.

12. Singer, Peter. Animal Liberation New York:Avon 1975

13. Sharlot, Jeff. “Why are we afraid of Peter Singer?: The world’s most reviled philosopher just wants more happiness for everyone” Chronicle of Higher Education – chronicle.com March 10, 2000

14. as reported on ABC Radio National during May 2000

15. Bandler, James. “Furor follows Princeton philosopher” The Boston Globe Online – Boston.com 27 July 1999

16. Mugford, Steven. “Harm reduction: does it lead where its proponents imagine?” reprinted in Psychoactive drugs and harm reduction: From faith to science edited by N. Heather, A. Wodak, E. Nadelmann and P. O’Hare. London:Whurr

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