Rethinking Life and Death by Peter Singer is a brilliant book. It’s accessible and easy to read. Peter Singer interweaves a fascinating fabric of gripping narratives, dramatic individual fates, lawsuits, bits of history and medical ethics into a forceful imperative to rethink our ethical convictions about life and death.

Time to Think Harder

No matter what you have thought about abortion, infanticide, vegetarianism or euthanasia, Peter Singer makes a compelling case why we need to think harder about questions of beginning and end of life (and everything in between). The main target of his critique is the concept of “sanctity of life”. He argues against a definite point at which life begins, against life as valuable in itself and against a distinction between treatment-withdrawal and euthanasia. His central line of thought suggests that a lot of our ethics arise from a primarily religious (Judeo-Christian) background that cannot live up to today’s technological progress. Instead he pledges for what one could call a mostly utilitarian framework replacing more traditional Kantian principles.

New Commandments

The book culminates with the suggestion of five new commandments:

There is a lot that could be discussed about the composition of these five commandments, where the old commandments come from, and how much the new commandments are direct replacements or actually rather supplements of the old ones. Peter Singer suggests these commandments as a starting point for a larger discourse within our society – or in his own words a revolution of bioethics.

One has to keep in mind that this book was written more than twenty years ago and some of the examples, statistics and speculations would need serious refinement on the basis of today’s body of knowledge, but for this review I want to to focus on two main areas: the question of rational or evidence-based ethics and the question of an apparently utilitarian ethics framework.

An Empiricist Approach to Ethics: Science-based Ethics?

In his book, Peter Singer correctly traces the origins of many ethical convictions back to the Judeo-Christian religion. He contrasts them with a “more rational” or “more realistic” approach recognising varying values of a human life and making judgements based on the perceived value of the competing lives. In his arguments he draws on a wide range of medical, biological and anthropological findings, which suggests the proposed ethical revolution was about science versus religion, and hence his new commandments were evidence-based, while the old ones were based on religious institutions. But is this supposed contrast between faith-based versus evidence-based ethics valid? Is there even such a think as evidence-based ethics?

Today’s scientific discourses would probably doubt there is, but rather argue that all our evidence is shaped by our conscious and subconscious convictions, and that there is not such a thing as a neutral ideology. As Russell, et al.[1] write: the ontological assumption that “ethical and moral issues faced by policy-makers can be reduced to questions of ‘best evidence’” (Russell, et al. 2008) seems no longer reasonable. Put succinctly: every statement is influenced by some underlying assumptions that can rightly be called a “set of beliefs”.[2] Making these beliefs transparent can help to unmask potential biases and misrepresentations and help to think more clearly about the actual ideas. So, what are these assumptions or beliefs that shape Singer's book?

A Utilitarian Approach to Bioethics: Worthy or Useful?

The main target of criticism in Peter Singer’s book is the concept of “sanctity of life”. To present an alternative concept, the author spends large parts of the book describing and analysing the functioning and the added value of a human life, that is its utility (how useful is a person / a life / a body). His new commandments centre around the ideas of consequentialism and it is therefore only correct to demand an end to all speciesism. But his worldview also seems to imply that there is not much more than matter, that human life is first and foremost a complex interaction of biochemical processes and that there is a way to find a consensus on how to measure the worth of a life. Most of these ideas can be easily traced back to enlightenment and post-enlightenment thinkers like Jeremy Bentham, John Stuart Mill and Auguste Comte. And most of these ideas have been heavily debated in history.[3] This is not to say that including utility in ethical debates is not useful, but to warn against utility as absolute measure of value. Singer’s book seems to advocate a positivist, utilitarian approach to ethics suggesting that it is more scientifically robust and that it ultimately brings a better world. Whenever a paradigm is presented as absolute or without an alternative, it brings the danger of abuse and of oppression. To prevent that, a more thorough reflection of Peter Singer’s underlying assumptions would be needed. Why is it still worth reading?

Questions of Ultimate Worth

If it is true for Peter Singer that he needs to reflect on his underlying assumptions, it’s also true for us. Singer’s strong emotional and at times polemic style challenges the reader to not just accept positions because these seem to be traditional Judeo-Christian values: Can we give concise and reasonable answers where the worth of a life comes from? What to do when it seems like you must decide between two lives? What makes human life special? What does responsible medicine look like, especially with all its recent developments? But the book poses an even bigger challenge: Behind these specific questions and their answers lies a bigger narrative, and Peter Singer’s gist is something like this:

For the past two millennia our lives in the Western world have been shaped by a Judeo-Christian framework that was oftentimes naïve and oppressive, but for a long time we didn’t have a better one. But thanks to our scientific and educational progress we now can do better. The right mix of scientific evidence and responsible reasoning can overcome the limitations of the old system. What we need is a moral revolution to create a better world and to reduce overall suffering.

As Christians in the 21st century, and especially as medics, it is on us to answer this challenge. What is the Judeo-Christian framework really about? Is there an overall benefit for the greater society, especially for those who do not believe in the Christian God? And if so, why?

Hard Thinking, Honest Questioning

Searching for ways to effectively counter the narrative above will demand hard thinking, honest questions, and a true willingness to listen, because otherwise we won’t discover our blind spots. Peter Singer’s book “Rethinking Life and Death” helps to do exactly that. If we manage to accept that challenge, this book will not be the death of traditional ethics but actually a key to their resurrection.

Footnotes

[1] Russel, Greenhalgh et al 2008: Recognising rhetoric in health care policy analysis

[2] For literature see e.g. Gray 2018: Seven types of atheism; Shweder et al 1993: The big three of morality;

Beauchamp&Childress 2012: Principles of medical bioethics; Haidt 2013: Moral psychology for the twenty-first century; Goldenberg 2005: Evidence-based ethics? On evidence-based practice and the "empirical turn" from normative bioethics';

[3] See e.g. Gray 2018; Russell et al 2008;

Review by a member of the MTL Medics Cross-Current Group, 2019