Inheritance and environment's impact on ethics

Once discounted insights are now found important and have ethical consequences. Andrew Davison concludes his series on biology’s current developments.

Andrew Davison

Andrew works at the intersection of theology, science and philosophy. He is Canon and Regius Professor of Divinity at Christ Church, Oxford.

A wall tile shows a 1940s woman tend a stove below a washing line.

A commemorative tile honours Dutch woman who made 'something out of nothing. during the hunger winter.

Peter de Wit (FaceMePLS), CC BY 2.0, via Wikimedia Commons

There’s no more exciting work in biology at the moment than thinking about organisms in terms of their environment. That’s a crucial part of the lively current scene in evolutionary thought (which I described in my previous article), and part of how a new generation of fascinating writers is urging us to throw off the overly narrow perspectives of the twentieth century. It’s not that Darwin’s fundamental insights were wrong, just that some of his followers took them to rule out, or discount, features of biology that turn out to be real and important.

In fact, Darwin was often ahead of the game here. He was more interested in cooperation between species, for instance, than many writers who went on to champion his ideas. He wrote brilliantly about the relationship between moths and orchids, for instance, and between plants and earthworms. Similarly, as Jessica Riskin has recently pointed out, he never dropped the idea that what organisms do during their lifetime affects what they pass on to their offspring (what he called ‘use and disuse’). For much of the twentieth century, that idea, of passing on of acquired characteristics, was biological heresy, but today it’s making a comeback.

The excitement in contemporary evolutionary biology can usefully be gathered under two headings. Alongside ‘organism and environment’, there’s also ‘extended heredity’, although the two are closely related on some points. They’re both important as part of the sort of discussion presented on this site – run in conjunction with the Church of England, of all things – not just because it’s good for religious institutions to demonstrate enthusiasm for science, but also because they’re full of ethical consequences.

Passing on to the progeny

Take ‘extended inheritance’: extended, in the sense that there’s so much more that’s inherited from parent to child than just a DNA sequence. For one thing, every organism bequeaths a world to its progeny, which means a world that’s at least somewhat adapted: at least a little (as with some bacteria, although others are adept at ‘ecosystem engineering’) or massively, as when a beaver completely changes its surroundings by building a dam, or when human beings cover the Earth with marvellous and terrible things. The transformed landscape of the beaver and the human being, even of the bacterium, is part and parcel of what they each pass on to their progeny, and therefore part of biological inheritance. That really puts the environment back at the centre of our thinking about organisms and evolution.

Taking a wider view than genes-are-all-you-pass-on has no lack of consequences. In their accessible and endlessly fascinating 2018 book Extended Heredity, Russell Bonduriansky and Troy Day show that narrow-mindedness on that front has had terrible consequences. They see it behind the Thalidomide birth defect tragedy, for instance, and the strange unwillingness of medics, in the middle of the twentieth century, to take the dangers of foetal alcohol syndrome seriously. If it’s a matter of scientific dogma that all that matters is what genes parents give to their offspring, other factors – like bothering to monitor what effects alcohol have on pregnant women and developing child, or the effects on them of a new medicine – don’t look as important as they should.

Genes aren’t everything, especially in the developmental phase (from conception through childhood and adolescence). Throughout that period, in particular, genes and environment dance an intimate tango, with genes turning on and off in response to its experience of its environment, before and after birth. Moreover, recent science shows that what happens to you during your lifetime can even be passed onto your offspring, and even to their children after them.

That flies in the face of the idea that all you have to pass on is the genetic hand of cards you were delt at conception (or its equivalent, for instance for a plant). On that hallowed view, the most that life has to offer from that moment on is testing your ‘fitness’, to see whether you manage to pass those genes on, or not, or how abundantly. But that’s far too limited a picture. We don’t just pass on genes; we also pass on the pattern of how genes are tagged to be turned on or off, and that is changed by the conditions the organism has experienced.

Hunger lessons

The most striking, but gruesome, example involving human beings is the ‘Dutch Hunger Winter’ of 1944–45, when occupying German forces starved the Dutch population in retaliation for resistance victories. Children conceived during that period grew up with poor metabolism (or, to be more accurate, metabolism that would be good at surviving starvation, but was not well-adapted to healthier post-war life nutrition, which is fascinating in itself). So much for genes being everything. More startling still was the observation that their children also had poor metabolism: the grandchildren of the starved pregnant women. We can pass on acquired characteristics, which really puts the cat among the twentieth century Darwinian pigeons. As the prophet Ezekiel put it, ‘The parents have eaten sour grapes, and the children’s teeth are set on edge’. This is full of ethical freight. The way we treat other people, and ourselves, affects those who come after us: yes, socially and culturally, which is significant enough, but even in how their bodies are programmed to develop.

A stimulating environment

There’s a similar ethical charge to what is perhaps my favourite part of the newly boisterous world of biology: phenotypic plasticity. That’s the simple idea that the same genes (the ‘genotype’) will produce a differently structured organism (the ‘phenotype’) in response to different environments. In one sense, it’s obvious enough. If I go to the gym for a year – a particular kind of environment – I’ll look different afterwards than if I’d spend an equivalent length of time on the sofa.

But it goes much further than that. Various plants will produce different sorts of leaves, for instance, depending on whether they grow in more or less shady situations. Sometimes, one species can be mistaken for two, as happened with fish, called cichlids, in Lake Tanganyika (between Tanzania and the Democratic Republic of Congo). What scientists had thought to be separate species, because their jaws are so different, turned out to be the same species. If a fish grows up at the bottom of the lake, it develops one mouth shape, with large, strong jaws, for munching shellfish; if a it with the same genes grows up at the top of the lake, it develops delicate jaws, useful for eating other kinds of food.

Again, the repercussions of ethics are enormous, and that brings us back to the ugly subject of eugenics, mentioned in the first of these articles. At root, eugenics is based on the assumption that some people just are healthy, and others just are sick, because some have ‘good genes’, while others have ‘bad genes’. You are either blessed with the former, or doomed with the later, and that’s set in stone, from conception. It’s then (supposedly) the ‘right thing’ to promote the former when it comes to reproduction and, at its most horrific, to restrain, sterilise, or even slaughter the latter. Eugenics cast its shadow over more of the twentieth century than we might like to admit. At one time or another, it was the darling of both the political right and the political left. It hasn’t gone away.

Before we say anything else, there’s a moral flaw in thinking that concern for the gene pool trumps concern for suffering individuals. More than that, though, the biology shows eugenics to be flawed even on its own, supposedly scientific, terms. We aren’t just blessed or doomed by the genetic hand of cards we’re delt at conception. Like those plants, growing in sunlight or shade, what our genes will mean is also determined by our setting. Like those African fish, our genes can run more than one programme, so the environment matters.

Eugenics presents the all-to-convenient picture that the sick will be sick, the weak will be weak, and that’s that. But we’re not just doomed or blessed by genes. It matters, for instance, what sort of housing we have, how we’re fed, and whether we have access to fresh air and places for exercise, and to stimulus for the mind, and companionship. Putting people into groups (healthy and sick, or worthy and unworthy), then writing off one of those groups might be politically and economically convenient, but it’s bad science, as well as bad morals.

Reason to be curious

I started this series by mentioning how important the theology and philosophy of the Middle Ages has been for me, in working between theology and science. In one of his little read works, Thomas Aquinas (1224–1274) defended having the expansive curriculum used in training Dominican friars like himself. (It helped that this curriculum was being drawn up, in part, by Albert the Great – perhaps the greatest polymath of his century, and later patron saint of scientists.) One should be open to knowing about everything, Aquinas argued, because you never know what will come in useful later on. We have an excellent, and timely example of that, in how something as obscure as phenotypic plasticity bears on eugenics, and the eminently practical question of proper housing.

Recently, in fact, the Church of England has been working hard on housing. The Bishop of Chelmsford, Guli Francis-Dehqani, has the new housing brief among the bishops. The church’s council for Mission and Public Affairs has also been busy, not least with the publication of Coming Home: Christian Perspectives on Housing in 2020. What might have seemed like rather abstract wranglings among biologists, over where to put the emphasis in their theories about nature, turns out to show how right it is to be passionate about good housing (and, it turns out, about keeping abreast of biology).

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.