Xenotransplantation and speciesism
by Peter Singer
Transplantation Proceedings , 1992, vol 24 No 2 (April) (728-732)
Prologue
In the Netherlands a few years ago, an observer reported on the lives of some people confined in a new kind of institution. These people were not at all impaired physically, but intellectually they were well below the normal human level; they could not speak, although they made noises and gestures. In standard institutions, they had tended to spend much of their time making repetitive movements, and rocking their bodies to and fro. This institution was an unusual one, in that its policy was to allow the inmates the maximum possible freedom to live their own lives and form their own community. This freedom extended even to sexual relationships, which led to pregnancy, birth and child rearing.
The observer's report was long and detailed, and I can only give you a few relevant highlights. First, the behaviour of the inmates under these circumstances was far more varied than in the more conventional institutional settings. They rarely spent time alone, and they appeared to have no difficulty in understanding each other's gestures and grunts. They were physically active, spending a lot of time outside, where they had access to about two acres of relatively natural forest, surrounded by a wall. They cooperated in many of these activities, including on one occasion - to the consternation of the supervisors - an attempt to escape that involved carrying a large fallen branch to one of the walls, and propping it up as a kind of ladder that made it possible to climb over the wall.
The observer was particularly interested in what he called the "politics" of the community. A defined leader soon emerged. His leadership - and it was always a "he" - depended, however, on the support of other members of the group. The leader had privileges, but also, it seemed, obligations. He had to cultivate the favour of others by sharing food and other treats. Fights would develop from time to time, but they would usually be followed by some conciliatory gestures, so that the loser could be readmitted into the society of the leader. If the leader became isolated, and allowed the others to form a coalition against him, his days as leader were numbered.
A simple ethical code could also be detected within the community. Its two basic rules, the observer commented, could be summed up as "one good turn deserves another" and "an eye for an eye and a tooth for a tooth". The breach of one of these rules apparently led to a sense of being wronged. For example when N was fighting with L, P came to L's assistance. Later, N attacked P, who gestured to L for assistance, but L did nothing. After the fight between P and N was over, N then furiously attacked L.
The mothers were with one exception competent at nursing and rearing their children. The mother-child relationships were close, and lasted many years. The death of a baby led to prolonged grieving behaviour. Because sexual relationships were not monogamous, it was not always possible to tell who the father of the child was, and in fact fathers did not play a significant role in the rearing of the children.
In view of the very limited mental capacities that these inmates had been considered to possess, the was impressed by instances of behaviour that clearly showed planning, and a high degree of self-awareness. In one example, two young mothers were having difficulty in stopping their small children from fighting. An older mother, a considerable authority figure in the community, was dozing nearby. One of the younger mothers woke her, and pointed to the squabbling children. The older mother made the appropriate noises and gestures, and the children, suitably intimidated, stopped fighting, The older mother then went back to her nap. On another occasion, after a fight, it was noticeable that the loser limped badly when in the presence of the victor, but not when alone; presumably by pretending to be more seriously hurt than he really was, he hoped for some kind of sympathy, or at least mercy, from his conqueror. A good deal of deceit also focused around sexual relationships, and to observers of human nature, this will come as no surprise. Although, as already mentioned, sexual relationships were not monogamous, there were occasions on which flirtations, leading up to sexual intercourse, were conducted with a good deal of discretion, so as not to attract the notice of a leader who would have been likely to claim exclusive sexual rights over one of his favourites.
In order to see just how far ahead these people could think, the observer devised an ingenious test of problem-solving ability. One inmate was presented with two series of five locked clear plastic boxes, each of which opened with a different key. One series of five boxes led to a food treat, whereas the other series led to an empty box. It was necessary to begin by choosing one of the two boxes that were the first in each series, and to succeed, one had to work through the five boxes to see which initial choice would lead one to the box with the treat. The inmate was able to succeed in this complex task.
Now I would like you to consider a proposal. Suppose that in view of the scarcity of organs for medical purposes, it was proposed to select some members of the community I have just described, given then an anaesthetic, and then remove their hearts for transplantation into human beings whose mental capacities were normal, but who were suffering from a diseased heart and could only survive with a transplant. What would you think of such a proposal?
My guess is that your reaction to this proposal might vary according to the mental image you formed of the inmates of the community just described. I referred to them as "people", and I believe that the use of this term is justifiable, in view of the long philosophical tradition that, since at least the 17th century British philosopher John Locke, has been prepared to apply the term "person" to a rational and self-conscious being, irrespective of whether that being was a member of our own species. If, however, you were led by my use of that term to assume that the people I have described were human beings suffering from some intellectual disability, you will probably have been shocked at the suggestion that we consider killing them in order to make use of their hearts. But in fact the description was not one of human beings, but of chimpanzees, living in the Amsterdam Zoo (1). If you were able to guess this, you may not have been so shocked by the proposal. But why not? Should we be any less disturbed by the proposal, now that we know that it is not members of our own species who will be killed? That is the question I shall explore.
The exploration is in two parts. I begin with a summary statement of the principles of animal liberation, as I understand them. I shall then turn to the specific issue of the use of animals as organ donors.
Animals and ethics
Animal liberation is a new movement, dating back to the mid-1970s, and growing out of the same period of ferment that gave rise to feminism and modern green politics. Until that time, though there were many animal welfare groups and anticruelty societies, they were built on the assumption that the welfare on nonhuman animals deserves protection only when our interests are not at stake. Animals remained "lower creatures". Human beings were seen as quite distinct from, and infinitely superior to, all forms of animal life. If our interests conflict with theirs, it is always their interests that have to give way.
Animal liberationists question the right of our species to assume that our interests must always prevail. they want to extend the basic moral ideas of equality and rights - which we apply to all human beings - to animals as well.
At first this sounds crazy. Obviously animals cannot have equal rights to vote, or to free speech. But the kind of equality that animal liberationists wish to extend to animals is a special kind: equal consideration of interests . And the basic right that animals should have is the right to equal consideration. This sounds like a difficult idea, but essentially it means that if an animal feels pain, the pain matters as much as it does when a human feels pain - if the pains hurt just as much. Pain is pain , whatever the species of being that experiences it.
Many people make a sharp distinction between humans and other animals. They say that all human beings are infinitely more valuable than any animals of any other species. But they don't give reasons for this view. When you think about it, it is not difficult to see that there is no morally important feature which all human beings possess, and no nonhuman animals have.
To a dispassionate Martian, it would be amusing to see how determinedly the human species, or more specifically the Western element of that species, has tried to distance itself from the other species with which it shares the planet. Only humans, we used to say, are made in the image of God, and only humans have an immortal soul. When it became apparent that those ideas lacked any basis in reason or science,we switched to saying things like: "Only humans can use tools". then we found that chimpanzees use sticks for digging out insects, some seals will use rocks in order to break open shellfish, and various birds use thorns or small sticks to probe insects out of bark. So we said: "Only humans make tools ". Then we discovered that chimpanzees do shape their sticks, by stripping off leaves and small branches until they get the right kind of implement for the task. So we switched ground and said: "Only humans use language" - just before several studies proved that chimpanzees and gorillas could learn hundreds of signs in the sign language used by the deaf, and could communicate in quite complex ways. Of course, we then upped the requirements for what it was to use language ... and so the story goes.
But all of these attempts at drawing lines are really quite irrelevant to the question of justifying the things we do to animals. After all, even if no animals could use tools, or communicate by means of signs or words, we could not use these abilities to draw line between all humans and the nonhuman animals. for there are many humans, too, who cannot use tools and have no language. All humans under 3 months of age, for a start. And even if they are excluded, on the grounds that they have the potential to learn to use tools and to speak, there are other human beings who do not have this potential. Sadly, some humans are born with brain damage so severe that they will never be able to use a tool or learn any form of language.
If it would be absurd to give animals the right to vote, it would be no less absurd to give that right to infants or to severely retarded human beings. Yet we still give equal consideration to their interests. We don't raise them for food, or test new cosmetics in their eyes. Nor should we. But we do these things to normal animals who show greater abilities in using tools, or learning language, or doing any of the other things that use those capacities of reason that we like to believe distinguish humans from animals.
Once we understand this, it is easy to see the belief that all humans are somehow infinitely more valuable than any animal for what it is: prejudice. Sadly, such prejudices are not unusual. Racists have a similar prejudice in favour of their own race, and sexists have the same type of prejudice in favour of their own sex.
Speciesism is logically parallel to racism and sexism. Speciesists, racists, and sexists all say: the boundary of my own group is also the boundary of my concern. Never mind what you are like, if you are a member of my group, you are superior to all those who are not members of my group. The speciesist favours a larger group than the racist, and so has a large circle of concern; but all of these prejudices are equally wrong. They all use an arbitrary and morally irrelevant fact - membership of a race, sex,or species - as if it were morally crucial.
The only acceptable limit to our moral concern is the point at which there is no awareness of pain or pleasure, and no preferences of any kind. That is why pigs have rights, but lettuces don't. Pigs can feel pain, and pleasure. Lettuces can't.
Until now the human species, especially so-called "Western civilization", has regarded out planet as a resource to be plundered for its own immediate benefit. The animal liberation movement, together with much of the environment movement, is seeking to change this attitude; to get us to see that we share the planet with other species, and that we have no God-given right to exploit them for our benefit. The change is a fundamental one, and one that threatens all the major economic forces in our society. It will not be brought about quickly or easily. But the effects of change are already visible, and the movement is growing. It rests on an argument that is so simple, and so plainly sound, that it can only continue to spread.
Animals and organ donation
The idea of using animals as a source for organ donation is an example of speciesism, premised as it is on the idea that animals are things for us to use as best suits our own interests, without much concern for the interests of the animals themselves. Perhaps the easiest way to see this is to ask yourself the following question: why should we be prepared to accept the use of organs from animals, but not be prepared to take them from human infants who are, and always will be, less intellectually developed than the nonhuman animals?
The human infants I have in mind fall into two categories. first, there are the anencephalics - those born with no brain, other than perhaps some brain stem. Next are the cortically dead - infants who, perhaps as a result of a bran haemorrhage soon after birth, have irreversibly lost all function in their cortex. At a recent conference at Melbourne's Royal Children's Hospital, I heard a paediatrician tell of a time when, in the hospital's intensive care ward, he had two young patients. One was healthy in every respect except one - an irreparable and lethal heart defect. The only possible treatment was a heart transplant, but no suitable donor was available, nor likely to become available. (In Australia, with a population of only 16 million, it is very rare to be able to find a suitable donor for an infant with a heart defect.) The other infant in the ward had suffered a massive brain haemorrhage and was cortically dead. The thought crossed the mind of the paediatrician that if he could take the heart from the cortically dead baby, he could save the other one, and at least one of his patients would survive. He thought that if he asked the parents, they might see this as a way of salvaging some good out of the tragedy that had befallen their baby. But he knew that he could not do this: though a cortically dead baby can never become conscious, it is not legally dead, and to cut out its heart is, under present law, clearly murder. So the paediatrician could see the the inevitable result was going to be that both babies would die; and that is indeed what happened.
What kind of ethic can tell us that it is all right to rear sentient animals in barren cages that give them no decent life at all, and then kill them to take their organs, while refusing to permit us to take the organ of a human being who is not, and never can be, even minimally conscious? Obviously, a speciesist ethic. And that is essentially what is wrong with the present situation. My objection is not that we value the life of a normal, self-aware human being, one with a vivid awareness of the future and a desire to continue to be around next week, next month and next year, ahead of the life of an animal who lacks self-awareness and is incapable of any such future-oriented desires. Such an evaluation can be defended, without invoking an arbitrary preference for our own species. My objection is to the fact that we disregard the interests of nonhuman animals by ranking them as less worthy of our concern and respect than any member of our own species, no matter how limited in capacities and potential.
I therefore suggest that, before you endorse or accept the use of animals as organ sources, you ask yourself whether you are prepared to endorse or accept the use of anencephalic and cortically dead human infants. I know that there are some who do endorse this, or at least some part of it. Arthur Caplan, for instance, has persuasively argues in favour of the use of organs from foetuses and anencephalic infants (2). He does not extend his argument to cortically dead infants. I am not sure why; perhaps he is troubled by the difficulty of establishing that cortical death really has occurred, and I know that there is still room for debate on this topic. That may be a reason for not implementing the proposal to use organs from the cortically dead until further careful study of current methods of diagnosing this state, but such obstacles have never deterred philosophers from considering the issues in a hypothetical manner, on the assumption that the technical difficulties can be overcome.
Another reason for reluctance to use cortically dead infants, even if there are no doubts about diagnosis, is that, while the cortex may be dead, the infants are, by any normal definition of the term, not dead. They are warm, pink, they breathe, sometimes unaided, they respond to touch, and so on. Of course, those who are legally brain dead satisfy many of these criteria too, although they do not breathe without assistance. But cortical death is not brain death, and I am not proposing that a cortically dead infant should be though, legally, ethically, or in any other sense, as a dead human being. After all, when we take a heart from a baboon, it is a warm, pink (underneath the fur) breathing animal we are killing in order to remove the heart. so if we are prepared to kill a baboon in an attempt to save the life of a human being, why aren't we prepared to kill a human being, with no potential that comes even near to equalling that of the baboon, for the same purpose?
I can think of only two ways in which someone might try to defend the view that it is better to kill the baboon than the cortically dead infant. One is that the parents of the infant may be upset by what happens to their infant in a way that the parents of the baboon will not be. Now we should not ignore the fact that baboons are mammals, and baboon mothers may and probably do suffer considerably when their infants are taken from them. But even if we overlook this fact, it remains the case that often - as in the case I mentioned - the human parents of the cortically dead infant would welcome the opportunity for some good to emerge from the death of their child. We know that this feeling has been expressed by the parents of anencephalic infants when the possibility of the infant becoming a donor was raised (3). So this objection does not apply to all cases in which the organs of a cortically dead infant might be used to save a life.
The second way of defending the view that it is better to kill the baboon than the cortically dead infant is by a frank defense of speciesism. This has been attempted by some of my recent critics - among them, Jeffrey Gray, Head of the Department of Psychology at the Institute of Psychiatry, University of London (4-6). Gray's defense of speciesism is, in essence, that just as we properly give preference to our own children over the children of strangers, so we may properly give preference to the interests of members of our own species over the interests of members of other species. In passing, I note that Gray and others who use this kind of argument do not, for obvious reasons, make use of an intermediate step that, in other times and places, would surely have been seized on as further evidence of the case in favour of speciesism. Some of us can easily imagine our forefathers saying, just a generation or two ago: "Just as we properly give preference to the interests of members of our own race over the interests of members of other races ..."
I agree, naturally, that parents are likely to prefer the interests of their own children to those of strangers. No doubt this preference has a biological basis. I also agree that it can be morally justifiable, under certain circumstances. Similarly, humans are likely to prefer the interests of members of their own species to those of members of other species. Maybe this too has a biological basis. But so what? The question is not why this preference exists, but whether this preference is justifiable.
The preference for the interests of our children can be defended on the grounds that, in recognising the special duty of parents to look after their interests, we are promoting the greater overall welfare of children. Children thrive best in a family environment - not in large institutions, looked after by impersonal bureaucrats. Thus our support for the idea that parents should look after their own children before they look after the children of strangers works for the good of children as a whole. If we look at the fate of animals today, whether in the wild, in laboratories, or in factory farms, we cannot think that putting the interests of members of our own species ahead of the interests of members of other species works out better for all sentient beings. This naked bias in favour of our own is simply a reflection of our power over the other animals and our lack of consideration for their interests.
So the second defense of our preference for killing a baboon rather than a cortically dead infant in order to obtain a heart is no more successful than the first. I conclude that this preference is indefensible. That does not, of course, prove that it is always wrong to kill a baboon in order to obtain a heart with which one can save a human life. It might be that it is justifiable to kill both cortically dead infants and baboons in order to do this, or it might be that it is justifiable to kill neither, or it might be that it is justifiable to kill cortically dead infants but not to kill baboons. How we answer these questions, now, might also depend on the prospects of success of the transplant in each case. But if we imagine that the transplants had a very high chance of saving a life in each case, and we assume also that the parents of the infant have freely consented to the donation of the heart, then my own preference would certainly be to use the cortically dead infant before using the baboon, and I would base this preference on the higher level of awareness of the baboon.
There is, however, a more difficult question for me to answer. Suppose that we need a heart for a child who is, apart from the heart defect, healthy and much loved by her parents. Suppose that there is no anencephalic or cortically dead infant hearts available. Suppose it is a question of killing a baboon and taking her heart, or allowing the child to die? What do I say then?
Before I answer, one observation. A society that accepts the rearing of pigs in miserable conditions in intensive farms, and then allows them to be killed just because some people prefer pork to tofu, would be very odd indeed if it did not accept imposing similar suffering and death on baboons in order the save the life of a human being. That is why I have spent so much of this talk trying to put the issue of xenotransplantation in the context of a nonspeciesist ethic,, one that takes seriously the interests of nonhuman animals. If anyone thinks that it is wrong to attempt to use the body parts of animals for transplantation purposes, but alright to use them for breakfast, then their way of thinking has nothing in common with mine.
Now what do I say about the case of the child or the baboon? I find it genuinely difficult. As I have already suggested, it is not speciesist to prefer the life of a being who is self-aware, and sees herself as existing over time, and who is capable of having complex future desires, to the life of a being who lacks these capacities. And it may be that a child does have these capacities and a baboon does not have them, or does not have them to nearly as high a degree. It may also be true that the family of the child will suffer more intensely and for a longer period if she dies than any of the baboon's family group will suffer if it dies. So considering the hypothetical choice from this perspective alone, it seems defensible to kill the baboon to save the child. At the same time, choosing the child over the baboon reinforces the attitude that animals are just things for us to use - and this is an attitude that we should strive to change. that is one reason why I do not want to see us come to rely on organs from animals as a cheap way of overcoming our health problems. Another reason is that, while in the example just given I have compared simply the death of the child with the death of a baboon,, in the real world we can expect that, once organs from baboons become suitable for use in humans, there will be large colonies of baboons kept in whatever conditions can most economically be devised, as long as they are compatible with keeping the baboons alive and their organs usable. Finally, let us remember that,if we are prepared to use a baboon as a source of organs, we should be prepared to use a human of equal or inferior capacities, as long as there is no family who has greater ties to the human than the family of the baboon has to the baboon.
In a world that needlessly rears several billion animals in factory farms each year and then kills them to satisfy a mere preference of taste, it is difficult to argue persuasively against the rearing and slaughter of a few thousand animals so that their organs can be used to save people's lives. that, however, is not a reason for using animals; it is, rather, a reason for changing our views about animals. In a better world, a world that cared properly for the interests of animals,m we would do our utmost to avoid choices that pit the essential interests of animals against our own, so that the issue of "the child or the baboon" does not arise. This might involve more effective ways of obtaining organs from humans who are brain dead, or cortically dead. It might involve the development of artificial organs. Or it might involve using our limited medical resources to educate people in looking after the organs with which they were born. These are ethically preferable paths to pursue.
I shall end with a quotation from Isaac Bashevis Singer, one of the great writers of our time. the passage epitomises what is wrong with the attitude to other animals that allows us to think of them as just so much beef, or bacon - or a reservoir of hearts and kidneys:
As often as Herman had witnessed the slaughter of animals and fish, he always had the same thought: in their behaviour toward creatures, all men were Nazis. The smugness with which man could do with other species as he pleased exemplified the most extreme racist theories, the principle that might is right. (7)
References
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de Waal F: Chimpanzee Politics. London: Jonathan Cape, 1982
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Caplan A: Bioethics 1:119, 1987
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Caplan A: Bioethics 1:128, 1987
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Gray JA: Behav Brain Sci 13:22, 1990
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Gray JA: Behav Brain Sci 14:759, 1991
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Gray JA: Psychologist 4:196, 1991
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Singer IB: Enemies, a Love Story. New York: Farrar, Straus & Giroux, 1972





