Logan Brewster

Biomedical Ethics
Professor Brown
Writing Assignment 4
#1
1.

Descartes argued that animals lack res cogitans, which means “thinking stuff,” and

therefore lack a soul. In lacking a soul, animals (according to Descartes) also lack a mind –

which means they cannot feel pain. They may exhibit “pain behavior,” but without a mind, they

are not conscious and exist without the feeling of pain. Descartes was so adamant about his view

to the point that he believed no animal could feel pain and that (as Pence puts it) “only human

beings have minds…a soul and a capacity to experience pain,” (Pence p. 199-200). Pence

describes the views of C. S. Lewis as an attempt to find a middle ground between what Descartes

believed and believing animals to have full consciousness and awareness of pain. Lewis believed

that animals do in fact feel pain, but not to the same extent as humans feel pain. He believes that

a certain consciousness is required to understand that one has just felt pain. In other words, one

needs a soul (consciousness) to recognize that whatever senses just reacted to the pain was

actually “my pain,” (Pence p. 200). Lewis is fundamentally stating that animals have reactions to

pain, but do not register it as their own pain and deserve no greater medical testing privileges

than humans.

Peter Singer rejected the idea that all animals are without the capacity to feel pain

because he believes there is a gradient to how one perceives pain. Some people have higher pain

tolerances than others, but does that make them any less capable of feeling pain? Singer would

say that this question is ridiculously rhetorical and would answer with a resounding no. To that

end, animals also feel pain along said tolerance gradient, and are therefore able to feel pain.

Singer specifically rejected Descartes’s views because they encompassed the horrific acts of

dissection without anesthesia and because they aligned with every principle of speciesism. Most
 Brewster #2

prominently, Descartes’s views follow the principle that animals are inferior to humans because

they lack a mind, consciousness, and a soul. Singer rejected both Descartes and Lewis’s defense

of animal testing because they believed in the Christian doctrine “that humans have souls created

by God, whereas animals do not,” (Pence p. 199). 

According to Singer, speciesism is the systemic prejudice of animals concerning their

rights as sentient things. Put simply, it is when humans devalue animals and treat them as though

they are nothing more than (as Pence likes to put it) “tasty flesh.” Singer condemns all

speciesism because he sees it as being on par with racism and sexism. In his argument, he states

that “If our moral concern for children, women, and minorities stems from their sensitivity to

pain, family ties, and ability to reason, why wouldn’t these factors extend our moral concern for

animals?” (Pence p. 201). However, Singer does believe some animal testing to be permissible,

primarily testing that has utilitarian benefits. Utilitarian beliefs emphasize the theory of

maximization, which states that ethically permissible actions “produce the greatest good for the

greatest number,” (Pence p. 202). Singer believed that as long as the suffering of the animals is

minimal and yields the most benefit to the many, animal testing is morally permissible. 

Pence summarizes the “Official View” as “…using animals in research is indispensable

and also reduces harm to humans from medical research,” (Pence p. 205). Essentially, animals

have value but no more value than humans, thus their experimentation is necessary for the

advancement of the human race. Pence goes over three different critiques of the “Official View,”

with each criticism compounding on each other. Pence evaluates the “Official View” utilizing

three distinct, yet comparable, observations. The first criticism Pence touches on is the simple

assumption that “the infliction of pain on animals is inherently wrong,” (Pence p. 205). This

gives way to the theory of “equivalence,” which states that the permissibility of animal suffering
 Brewster #3

is equal to that of human suffering. The next critique Pence describes is the simple fact that an

alarming amount of the science involved in animal testing has little to no real benefits to humans.

Pence mentions a study conducted by Philosopher of science Niall Shanks and anesthesiologist

Ray Greek that found that between the years of 1976 and 1985, 209 new-animal tested-drugs 102

previously approved drugs were recalled for having severe side effects to humans. To further

devalue the use of animal testing, it must be accounted that the complexity of the human genome

has made the results of testing on animals almost pointless because of how different the activated

genes are between varying species. The final critique of the “Official View” that Pence discusses

is that the benefits of animal testing do not outweigh the moral cost of the suffering of so many

animals. Pence implores questioning the justification of “…torturing a million pigs,” when one

considers our ability to use human embryos and/or human volunteers. Obviously, there are

certain ramifications to both embryonic testing and the use of human volunteers, but those

consequences are certainly morally justified by the benefits outweighing the moral costs. 

I believe that there are certainly many unfortunate ramifications to animal testing, but

those are permissible given certain criteria. I would not say I align myself entirely with the views

of Peter Singer, but I do draw on a couple of his reasonings. I think it is unjust to rigorously test

chimpanzees and any other endangered species if there is a chance of harming that species.

Although not endangered, I do not promote the use of gross amounts of mice for lab testing if it

can be avoided. I understand it is difficult to find results and conduct proper testing when limited

to certain animals, but if the use of a few more mice will spare an endangered species from being

tested on, by all means, use the mice. Most varying species of mice are very prolific and

coincidentally share much of the human genome, so they are often the first test subjects. I believe

this gives pharmaceutical companies plenty of opportunities to expand their use of alternative
 Brewster #4

testing methods and steers the industry away from poor testing practices. A subpage of the

National Institute of Environmental Health Sciences provides a couple of examples of alternative

testing in the form of “biochemical or cell-based (in vitro) systems [and]…computer programs

with advanced systems,” (NIH). Primarily, I disagree with the use of endangered species for

medical testing, but I do appreciate the need for animal testing, so the use of mice and/or new

alternative testing methods seems like fair compromises from my perspective.

2. 

a.

The God Committee was a group of seven Washington (state) residents that were tasked

with determining which patients would be allowed dialysis treatment. Essentially, this

hodgepodge of community members began drafting a criterion for deciding the kidney disease

patients to receive this functionally “artificial kidney.” Pence describes the official Admissions

and Policy Committee at Scribner Hospital as a “…committee of seven members [that] represent

the community: a minister, a lawyer, a housewife, a labor leader, a state government official, a

banker, and a surgeon,” also mentioning “The committee worked anonymously and never met

candidates,” (Pence p. 267). The God Committee accounted for many factors in their decisions

including place of residence, age, financial ability, and other miscellaneous elements. The

members of the committee agreed that the candidates for dialysis should be Washington (State)

residents, presumably because of their relative proximity to the hospital performing the dialysis.

These candidates were to be no more than forty-five years of age because the committee

appeared to value new life more than older lives. I would assume that this standard was set

because the minimum age is roughly middle-aged, so those persons have already experienced
 Brewster #5

much of what life has to offer. After meeting the requirements for age and residence, the ability

to pay for dialysis was considered. If patients were unable to afford the treatment, or if insurance

did not cover it, they were ineligible for dialysis. Provided all prior criteria have been met; a

patient then must be examined in much closer detail to evaluate their worth in society. Pence

thoroughly summarizes, “Famously, the committee then considered personal characteristics

about possible recipients: employment, children, education, motivation, achievements, and

promise of helping others…a candidate’s abilities to tolerate anxiety and to manage medical care

independently…whether a candidate had previously used symptoms to get attention from

relatives and physicians…the personality and personal merit of the candidate and the family’s

support for a patient on chronic dialysis,” (Pence p. 267). 

One could assume that the members of this committee rationalized their choices as being

in the best interest of the community. In other words, these meticulous calculations of social

value were justification enough for denying dialysis treatment. If you had little chance or

motivation to provide input into the community, then you had little reason to deserve this

treatment when many others could/would contribute more to society. Pence then briefly

mentions that the elderly that do not have any (living) siblings and/or children were often utterly

disregarded for testing by these criteria. I would promote the committee decisions as being harsh

but realistic because although all life should be valued, after a certain point some life is worth

more than others. If you compare this dilemma to the ongoing debate on how to program self-

driving cars, it is easy to find many similarities in the majority’s logic. 

The question in programming autonomous cars is if/when a scenario arises when a car’s

computer must decide whether to kill an elderly to save a child or vice versa. Some people

believe the value of the elderly to be less than that of the value of the child. I would reason this
 Brewster #6

decision by noting that the elderly person may have contributed much to the community, but has

little potential  for continued contribution, whereas the child is the exact opposite. This is not to

devalue the moral worth of the elderly, but rather their societal and logical worth. That said, I do

see other people's arguments arising from taking into consideration the wisdom and knowledge

that the elderly can pass down to younger generations and how that may play into their societal

value. Regardless, there are those that when asked the autonomous car question, answered in

favor of allowing the child to live because the potential for benefit simply outweighs the value of

previous contributions. Funnily enough, a former Brookings (website) Expert, Strategist, and

Senior Fellow named Peter W. Singer was quoted in an article stating, “We are still at the

‘horseless carriage’ stage of this technology, describing these technologies as what they are not,

rather than wrestling with what they truly are,” (Lin p. 81). 

Some comparisons could be made to Singer’s statement and the truth behind the dialysis

experience, in particular, there are certain side effects of dialysis that are rather severe. Pence

quotes a nephrologist “…about daily life on dialysis: ‘Insomnia is extraordinarily common and

many [patients] experience severe muscle cramping and pains of different sorts…along with

nausea, vomiting, and poor spirits…among the roughly 300,000 patients undergoing dialysis in

any given year, about 65,000 (or 23%) will die,’” (Pence p. 284). Sepsis, not of the other

aforementioned side effects, is more concerning than the others for the simple fact that it is the

poisoning of the blood, and those on dialysis are already immunocompromised. The risk of

fatality could be far too high when noting that the dialysis machine is supposed to be helping

your immune system, not harming it. 

So, as Singer observed, perhaps we should focus less on the moral dilemma of a flawed

machine and focus more on scrutinizing the operation of the machine itself. Perfecting the
 Brewster #7

treatment before determining who should be allowed its use would be more ideal, but as we have

seen with patients utilizing the Right to Try Act, those desperate enough will use whatever

treatment available to them so long as it improves their condition. Although Singer may

emphasize questioning the ethicality of a flawed machine, it was still necessary to proceed with

the creation of the God Committee. 

           b.

Alcohol-Related End-Stage Liver Disease, further referred to as ARESLD, is the most

common cause of liver destruction. The body registers alcohol as a toxin (because that is exactly

what alcohol is) and processes it through the liver. When one regularly partakes in excessive

amounts of alcohol, the liver rapidly deteriorates. More specifically, the breaking down of

alcoholic compounds requires the destruction of liver cells. If one is constantly drinking, liver

cells never get a chance to regenerate, and cirrhosis occurs. The liver quickly burns itself out and

becomes a non-functioning black mass that puts much more strain on the rest of the body. The

ethical question at hand is whether or not alcoholics who develop ARESLD deserve to be put on

the waiting list for liver transplants. This cannot be answered without first addressing a few other

issues that physicians query, “Is a nondrinker more deserving of a donor liver? Can someone

with ARESLD be blamed for the loss of his [or their] liver? Would a drinker keep on drinking,

thereby destroying the new liver, or would drinkers be transformed by receiving the gift of life?”

Another question that must be considered is “…whether alcoholism is a disease or a chosen

behavior,” (Pence p. 272). The first question to be answered is whether or not a nondrinker is

more deserving of a liver transplant than an alcoholic, and this closely ties with whether or not

alcoholism is a disease. If we look at alcoholism as a disease, as was the standard in medicine up

 Brewster #8

until fairly recently (the early 1990s), it is clear that those in need of a liver transplant should all

be considered equally. Put plainly, no one patient should be valued over the other with regards to

ARESLD. Pence brings up the arguments of two University of Michigan medical ethicists Carl

Cohen and Martin Benjamin, “At the very least, the medical system sends out contradictory

messages: first eat healthy, exercise, and take responsibility for your health; second, we will

rescue you in illness and do everything possible to keep you alive, regardless of cost or time

expended by medical staff,” (Pence p. 273). It becomes difficult to rationalize this contradiction

when human lives are at stake and one could assume a poor lifestyle and still feel secure in

knowing that medical staff will still attend to their every need. Conversely, alcoholism could not

only be a chosen behavior, but alcoholics could be much more likely to revert to drinking again.

Pence mentions the argument from a couple of physicians in Chicago, “Alvin Moss and

Mark Siegler argued that as ARESLD principally causes liver failure…and as recidivism is

likely among alcoholics, patients who develop liver failure ‘through no fault of their own’ should

have a higher priority for donor's livers than patients with ARESLD, whose condition ‘results

from failure to obtain treatment for alcoholism,’” (Pence p. 272). These physicians bring up the

interesting note that regardless of their condition, addicts must agree to seek rehabilitation. Moss

and Siegler argue that because alcoholics often have the opportunity and the resources required

to seek help and stay sober, there is no excuse and there are no exceptions to treatment for

ARESLD. With regards to relapsing alcoholics, an NIAAA (National Institute on Alcohol Abuse

and Alcoholism) publication states that “There is evidence that approximately 90 percent of

alcoholics are likely to experience at least one relapse over the 4-year period following

treatment,” (NIAAA). This statistic would suggest that alcoholics are far too susceptible to

regression to warrant a liver transplant. However, in moral respect of all human life, I do think
 Brewster #9

ARESLD patients should be included on transplant lists. As I have stated in previous works,

there is always a chance for recovery in any affliction, whether by the grace of God or some

other miracle. 

In the spirit of fairness to other diseased individuals, I believe these alcoholic patients

should be lower on the list to receive the transplant because a child who has barely experienced

life should be given the opportunity to survive before one who has lived part of life and hindered

themselves through their addiction. I can understand how one might view alcoholism as a disease

and unattributed to the patient’s own choices because it is very possible to have an alcoholic that

became addicted by no fault of their own. Peer pressure, nature and/or nurture, and undiagnosed

depression are just a few instigators of addiction that come to mind. At the very least, I feel it is

only fair to consider a patient’s alcoholism and the high chance of relapse when determining

their spot on the transplant list. 

 Brewster #10

Works Cited

 Lin, Patrick. Why Ethics Matters for Autonomous Cars. 2015,

https://www.link.springer.com/content/pdf/10.1007%2F978-3-662-45854-9_4.pdf.

 NHS Choices, NHS, www.nhs.uk/conditions/dialysis/side-effects/.

 “Relapse and Craving-Alcohol Alert No. 06-1989.” National Institute on Alcohol Abuse

and Alcoholism, U.S. Department of Health and Human Services,

https://www.pubs.niaaa.nih.gov/publications/aa06.htm.

 “Alternatives to Animal Testing.” National Institute of Environmental Health Sciences,

U.S. Department of Health and Human Services,

www.niehs.nih.gov/health/topics/science/sya-iccvam/index.cfm.