What It Means to Be Human: The Case for the Body in Public Bioethics, by O. Carter Snead. Cambridge, MA: Harvard University, 2020, 321 pages, $39.95.

The laudable efforts O. Carter Snead makes as the director of the de Nicola Center for Ethics and Culture at the University of Notre Dame to protect the lives of unborn children, their mothers, and all neighbors in need make it unpleasant to point out difficulties with What It Means to Be Human. I have been involved with pro-life causes for nearly forty years, and the central concern of Snead’s book is showing that the law should protect every human life, “regardless of age, disability, cognitive capacity, dependence, and, most of all, regardless of the opinions of others” (270). All humans, he argues, from conception until biological death, are persons, and the law should acknowledge that and protect them. The fact that current law does not protect the very young and others with health challenges the way that it protects the healthy and cognitively able is evidence, Snead says, that the anthropological roots of the law are defective.

When Snead extends his discussion beyond abortion, however, his zeal to protect the unborn leads him to paint pictures that may hinder effective pastoral care. These sections are not essential to Snead’s primary message about protecting the vulnerable. His treatment of abortion law and of our culture’s assumptions about what it means to be human make the book’s central argument worthy of careful attention, especially by Christian readers.

Snead’s book is a single argument for an ambitious thesis: The anthropology of American public bioethics is Expressive Individualism. This anthropology is inadequate to lived human reality because it “forgets the body” by failing to take human finitude and dependence into account. American public bioethics ought to be grounded in an anthropology that treats all human organisms regardless of age, ability, or cognitive capacity as full members. As embodied beings we are all limited, dependent, and on a “scale of disability.” The law should encourage the formation of the social networks, virtues, and moral imagination that will fulfill our obligations to give sacrificial care to all humans in need.

By “American public bioethics” Snead means the laws and ethical discussions governing and informing American medical practice. His focus is more on laws and Supreme Court decisions than on the actual practice of medicine. This does not make a difference when he is addressing abortion or physician-assisted suicide; it makes a significant difference, though, when he turns his attention to assisted reproduction and end-of-life decision-making in the hospital. The term “Expressive Individualism” comes from Charles Taylor’s Sources of the Self,[1] and it refers to the assumption that “the individual, atomized self [is] the fundamental unit of human reality” (86). On this view, the self has no unchosen obligations; its project is to define itself through the autonomous exercise of the will.

The heart of Snead’s argument is his claim that Expressive Individualism is inadequate to lived human reality. Drawing on the work of Alasdair MacIntyre and Michael Sandel, Snead advocates an anthropology that takes our embodied existence seriously.[2] Snead’s anthropology makes our mutual dependence and social connectedness fundamental. Relationships and obligations exist whether we choose them or not. Networks of unconditional sacrificial giving and grateful receiving begin with family relatives and extend outward to all in need. The virtues of gratitude, just generosity, hospitality, and taking on others’ suffering as our own are pursued in response to our finitude and need for each other. Those responsible for shaping our moral imaginations should encourage growth in this “ethic of giftedness” (100). Snead contends that the law should contribute to shaping our moral imaginations, so if the law is teaching only Expressive Individualism, it needs to be changed.

Chapter 3—the longest in the book by far—traces the history of abortion law in the United States, giving a detailed account of the Roe v. Wade decision and the decisions after it that have dealt with efforts to limit the right to abortion. With many Supreme Court rulings to consider, Snead finds multiple grounds for concluding that Expressive Individualism is the underlying anthropology. Having already argued that this understanding of human existence is inadequate, Snead proposes (in broad terms) ways that the law should be changed to take human embodiment (and in particular the vulnerable lives involved) firmly into account. Crucial to Snead’s argument is his claim that the law must treat all human organisms as persons with the same dignity as healthy, mature adults. The dependence and vulnerability of both the unborn child and the mother generate an obligation for the law to protect and care for both of them.

The discussion of abortion is followed by a shorter analysis of assisted reproduction in Chapter 4. Unlike abortion law, the laws regulating assisted reproduction provide no more than consumer protection for people seeking fertility services. The near silence of the law on protecting the children created by in vitro fertilization (IVF) is evidence, according to Snead, that Expressive Individualism is the grounding anthropology. The abuses he describes involving screening embryos to select a baby’s sex or to avoid a Downs Syndrome child are genuinely alarming. Snead would have the law fight these abuses, as well as study the negative health consequences for babies conceived via IVF.

The shortest chapter in the book looks at what the law and bioethical consensus encourage and allow in end-of-life medical decision-making. Snead divides his treatment into two parts. The first considers life-sustaining medical treatment and in particular the difficulties that arise when a person nearing death is unable to make decisions about their own care. Snead argues that the use of living wills to allow incompetent patients to exercise their autonomy insists on binding the patient to choices made long before knowing what their condition will be. He contends that in this the law refuses to take into account the patient’s diminished physical and mental condition. Snead proposes that an adequate anthropology of embodiment would empower proxy decision-makers to make choices with the current limitations in mind, enfolding the sick person in their social network rather than confining them to their individual past choices.

The second part of Snead’s chapter on death and dying concerns physician-assisted suicide. Focusing on the Oregon law that first legalized physicians prescribing lethal doses of drugs to allow “death with dignity,” Snead quickly details the many ways that Oregon’s law puts the individual’s power of choice over everything else, including the sound practice of medicine. Even though this section of the book is brief, it provides the strongest reason to think that Snead’s thesis—that Expressive Individualism is driving the law—is correct.

The final chapter gives a clear, concise summary of Snead’s overall argument. He makes clear his hope that as the law takes embodied human flourishing more seriously, the law will step in and provide all the protection, care, and moral formation that others fail to provide. Snead’s expansive notion of the state’s authority over many areas of life is evident throughout the book. In his conclusion, he insists on it.

The issues that Snead surveys to make the case that the law needs to change are politically contentious and touch the lives of most people. Much is praiseworthy about the book. His persistent and forceful appeal for the law to protect vulnerable humans, especially unborn children and people nearing the end of life, will be bracing for readers already committed to a biblical view of humans as God’s image-bearers. Although Snead does not mention religious reasons for cherishing all human lives, what he says the law should do to protect human life is consistent with a biblical anthropology. The larger ethic he advocates, with its concern for the vulnerable, the sick, and the challenged, is also consistent with a biblical understanding of how humans should treat each other. How Snead gets from the facts of vulnerability to the existence of moral obligations to give care (and without reference to God’s law) is not explained carefully in the book. Readers familiar with God’s law will see merit, though, in the virtues Snead commends and the importance of cultivating moral imaginations that see every human as a person worthy of protection and care.

Snead is at his best when he is explaining Supreme Court decisions. His account of the history of the high court’s rulings on abortion is clear, precise, illuminating, and sobering. He details the ways that Justice Blackmun’s reasoning in Roe v. Wade depends on legal inventions and novel philosophical arguments never considered in the cases that put the issue before the Supreme Court. Moreover, Snead traces the shifting basis for the right to an abortion from privacy, to liberty, and finally to equality. Without laying any stress on it, Snead makes clear that Supreme Court appointments make a significant difference in the extent to which U.S. law allows the meaning of the life of an unborn child to be determined entirely by the child’s mother.

Snead’s claim that Expressive Individualism is the anthropology underlying abortion is tempting, but not convincing. This is most evident in the high court’s willingness to shift the grounds for its conclusions. Abortion law is consistent with aspects of Expressive Individualism, but any individualism explains the law if an unborn child is not a person. Yet Snead’s careful explanation of Expressive Individualism shows that it is a threat to all people who are not capable of exercising their capacity for autonomous choice in a robust way. The use he makes of MacIntyre, Taylor, and Sandel to explain the defects in this kind of self-centered approach to human existence is valuable in itself. Carl Trueman’s recent The Rise and Triumph of the Modern Self traces the fruit of Expressive Individualism in the Sexual Revolution of the last sixty years, and Snead’s compact account of this “modern self” is a useful way into the current discourse on the self’s quest for identity.[3]

Snead’s dissatisfaction with Expressive Individualism turns out also to work against his stated goal of fostering a political consensus for reforming the law on a more adequate anthropology (10). If his analysis is correct, enough Americans now embrace Expressive Individualism for the courts to take it for granted. Any political debate about establishing a different foundation will depend on reaching out to people who will find Snead’s alternative bizarre. Readers who already understand the futility of making autonomous self-assertion our chief end will find Snead’s misgivings about Expressive Individualism heartening. Self-centeredness in fact leads to loneliness and undermines real community. As Snead notes, though, Expressive Individualism is at least in part a reaction to stifling moral demands from people in authority. Readers in the grip of Expressive Individualism—the people Snead needs to join the political conversation—are likely to see his alternative vision for the law as paternalistic, authoritarian, and even oppressive.

This rhetorical weakness, though, is relatively minor compared to the curious deficiencies in his treatment of assisted reproduction and life-sustaining medical treatment. His description of assisted reproduction correctly identifies many of the ways the techniques involved can be abused. Snead incorrectly suggests, though, that everyone who makes use of these techniques has killed some of their children in order to have a living child. Most major cities have fertility specialists who will commit to using procedures that honor the life of every embryo conceived and endeavor to bring them to term. In a Bioethics class of twenty students at Covenant College last year, I had two students announce (without prompting) that they were conceived by IVF. Their parents were and are PCA members in good standing, and no embryos were destroyed in the process. Snead is right that the law does far too little to protect unborn children in the assisted reproduction process. Telling only part of the story about how IVF works runs the risk of leading people to believe that all parents of IVF babies were reckless with human life.

The most disappointing section of Snead’s book is his brief discussion of decisions surrounding life-sustaining medical treatment. Most of what he says about the laws and hospital practices regarding end-of-life decision-making is fifteen years out of date. I have been serving as a volunteer ethics consultant for hospitals since 1995. The legal and medical environment that Snead describes would have been accurate back then. Patients who could not make decisions about their own care were called “incompetent,” and the “living wills” in use were blunt instruments that asked the medical team to obey choices made years before that rarely fit the situation the patient was facing. Things have changed a lot in end-of-life law and practice since 2005. No patient is called “incompetent” without the declaration of a court. Patients who cannot make decisions are called “decisionally incapable,” and maybe only for a short time. The rise of Palliative Care as a medical specialty has shifted the focus from what the doctors think is best for the patient to what the patient would choose. Most importantly, Advance Directives have replaced living wills as the legal means of documenting a person’s intentions for end-of-life care. Every state legislature has designed and approved specific forms that empower a surrogate decision-maker—usually a loved one—to make choices according to the patient’s values in light of the actual medical situation. The changes to the law and medical practice that Snead calls for to take human embodiment seriously have already taken place. It is hard to explain why Snead does not celebrate these developments. His readers deserve a more current picture of how these decisions are made. With an outdated picture, people may neglect to bless their families by documenting their intentions for medical care at the end of life.[4]

What It Means to be Human is a valuable resource for people eager to understand how abortion law changed so quickly in less than one generation. It is also a concise summary of recent efforts to diagnose a key element in the spirit of the age (Expressive Individualism) and to explain the alternative vision for human flourishing offered by critics of Enlightenment Individualism such as MacIntyre, Taylor, and Sandel. Snead’s argument that American public bioethics is ultimately rooted in Expressive Individualism is less convincing. Weaker, more pluralistic explanations are available, and some recent developments in the law and medical practice suggest that Americans are taking vulnerability and concern for others more seriously: End-of-life law and practice is one area; the rising acceptance of COVID-19 mask and vaccine policies that put the public good ahead of individual rights is another.

As a final word, it is worth noting that Snead assumes that the purpose of the state is to protect and provide for human identity and flourishing (269). Consistent with this understanding of the extent of the state’s mandate, Snead would remedy our current situation by giving the state the authority to “create, maintain, and nurture the networks of unconditional giving and grateful receiving,” to inculcate the virtues of dependence, and to cultivate the “moral imagination” of citizens (274). He would give the state the authority to “step in” whenever these networks and virtues do not result in care for the needy. It is hard to see biblical warrant for giving the state this kind of power. God’s Word gives the state a clear role (to maintain order and to punish wrongdoers), but responsibility for shaping the moral imagination, forming virtuous people, and nurturing the God-created networks of mutual accountability are the work of the church, the family, and other voluntary mid-level institutions between individuals and the state. If the state intervenes wherever it sees an unmet need, it is likely to cause individuals and these institutions to withdraw from making the sacrifices involved. Rather than strengthening biblically sound networks and virtuous character traits, giving a coercive power the authority to enforce them will in fact weaken the networks and virtues that are nothing if they are not voluntary.

Snead’s willingness to give the state such a large role, though, comes from his frustration that no one is stepping up to protect the vulnerable and provide for their needs. He does not mention the church or any other institutions, instead placing the blame on Expressive Individualism. If families, communities, and, most of all, churches were caring for the vulnerable—including pregnant women and their babies—Snead would not have to propose that the state take on the task. I agree with Snead that the law is doing too little to protect the unborn. I also agree that the vulnerable need more than protection and that the networks, virtues, and moral imagination that he commends should be nurtured in order to promote flourishing. State coercive power cannot do that effectively. The church, however, can and should.

Endnotes

[1] Charles Taylor, Sources of the Self: The Making of the Modern Identity (Cambridge, MA: Harvard University Press, 1989). Taylor develops his analysis in Modern Social Imaginaries (Durham, NC: Duke University Press, 2004) and A Secular Age (Cambridge, MA: Belknap Press of Harvard University Press, 2007).

[2] Alasdair MacIntyre, Dependent Rational Animal: Why Human Beings Need the Virtues (Chicago: Open Court Publishing, 1999) and Michael J. Sandel, The Case Against Perfection: Ethics in the Age of Genetic Engineering (Cambridge, MA: Harvard University Press, 2009).

[3] Carl Trueman, The Rise and Triumph of the Modern Self: Cultural Amnesia, Expressive Individualism, and the Road to Sexual Revolution (Wheaton, IL: Crossway, 2020).

[4] Spurred by the 1989 PCA Study Committee Report on Heroic Measures at the End of Life, I have written on the biblical basis for the use of Advance Directives and what God’s law says directing how they may be used faithfully. See Bill Davis, Departing in Peace: Biblical Decision-Making at the End of Life (Phillipsburg, NJ: P&R, 2017).

William C. Davis is a professor of philosophy at Covenant College in Lookout Mountain, Georgia and a member of Lookout Mountain Presbyterian Church (PCA). Ordained Servant Online, April 2021.