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In The Triple Helix: The Soul of Bioethics, Lisa Bellantoni explores philosophical theories of persons and their moral worth within the context of various bioethical issues such as end-of-life decision-making, cloning, and biological enhancements to human capacities. The Triple Helix has three major aims distributed over nine chapters. After stating these aims, this review explains them in some detail while offering critical reflections about them, and concludes with an overall appraisal of Bellantoni's book.
Bellantoni first identifies, describes, and criticizes two dominant views about the nature of persons: the culture of rights and the culture of life, or the "cult of rights" and the "cult of life" (pp. 2-3). Second, she develops her own view, arguing that we are essentially embodied agents with inherent privacy, and that bodily health and function are natural values. While pursing these first two aims, Bellantoni frequently contrasts the two cults' views with her own view. Third, she draws out the implications of the three views for a host of bioethical issues.
The cult of life holds that persons are immaterial souls of inherent moral worth, but contingently embodied. This view has its philosophical pedigree in the work of Plato and others. The value of (human) life is inviolable and untouchable, and must be preserved at all costs, even against the will of the one who has, or is, the soul in question. So, for example, voluntary active euthanasia is typically not permitted on this view. But Bellantoni contends that medical or biotechnological interventions involving humans should be of no concern to cult of life advocates, because such choices and events do not matter to the worth of persons on their view: "[…] the soul once embodied can neither increase nor decrease its absolute worth through its actions" (p. 82). However, it is a good bet that many followers of the cult of life would disagree. In particular, believers of various religious creeds who are part of the cult of life tend to believe that the worth of a person (an immaterial soul) necessarily depends, at least partly, on the choices and events that person makes in his or her embodied life. Embodiment is part of a maturation process and test for the person that is a soul.
The cult of rights maintains that "[…] our absolute moral worth attends our unfettered autonomy" (p. 5). This view has its philosophical pedigree, in different manifestations, in the work of Immanuel Kant and Jean-Paul Sartre. We are self-authoring, self-legislating individuals, but we can only enact these powers from a position of autonomy executed under fairly strict conditions that are not always achievable. When we do not possess autonomy (or are incapable of fully exercising it), our choices are not authoritative.
Bellantoni points out what are, at least, necessary conditions for personhood and individual moral worth on the two cults' views (having a soul, or having autonomy). But this is where representatives of the cult of life and the cult of rights can challenge her characterization of their views: they could argue that, although these conditions are necessary, they are not sufficient to determine the moral worth of a person. This is because, as advocates of the two cults might argue, lived experiences and choices influence the worth of persons, as indicated above with regard to various religious views that follow the cult of life. If they took this strategy as a response, they could thereby coopt some of the features of Bellantoni's own view of persons and their value, which we now come to.
Bellantoni's view issues a re-understanding of the limits and recommendations of bioethics, opening many more possibilities than either the cult of rights or cult of life allows. Bellantoni aims to put the bio firmly in bioethics: no transcendent properties allowed, because we are biological entities with natural biological goods that ground our moral worth. There are two aspects to her view, one about how we come to be, and one about what we are. Both are connected to what is of value in living. First, what we are: Bellantoni emphasizes the importance of the "cultivation of individual human lives in their particulars – their bodily interiority, their psychic subjectivity, their agency – particulars apart from which persons would require no more defense" (p. 6). Our personal nature presents boundaries against others. However, the particular features of our personal natures come into being via our connections and relations to others. The creation of persons is a process. So the second aspect of her view is this: "Persons are born of embodied persons […] and embody others' genes, others' histories, others' values, and others' affects" (p. 5). It follows that "All of us are […] person makers" (p. 6), given our capacities to reproduce, influence, and value others.
What is of fundamental value to us, given our embodied nature, is not an immaterial soul (cult of life) or a transcendent property of autonomy (cult of rights), but bodily health and functionality (p. 191). These serve to ground the "[…] bodily interiority, first-person subjectivity, and agency apart from which human organisms could not value distinctively human lives at all" (p. 191). Moreover, persons and their value are in biological motion, so to speak, unlike the views promulgated by the cult of rights and cult of life. "Goodness, like health, is simply not a static, transcendent property that we bear by definition," Bellantoni contends (p. 222). Furthermore, her view calls for us not to just maintain healthfulness as a natural good, but to improve and enhance it through biotechnological innovations (p. 193).
In contrast to the cults of rights and the cult of life, Bellantoni's view brings our agency and personhood down to earth. She draws our attention to the phrase "human person" (p. 206). For the cults of life and rights, what is important is what "person" refers to--an immaterial soul or an autonomous being. But for Bellantoni, what is important is what "human" refers to: our distinctive biological nature and private experiences in relation to others that take shape in living. Thus, she offers an embodied theory of agency, and thus an embodied theory of human value. The dominating themes of Bellantoni's view are tied up in a "triple helix" consisting of time, love, and memory (p. 210). These three features, which Bellantoni weaves throughout her monograph, are inextricably tied to our personal and interpersonal experiences. Only through "[…] an intertwining of time, love, and memory, may we make of human persons objects of moral regard and subjects of moral agency" (p. 211). It is in these features, not the "timeless ideals" (p. 211) of the cult of rights and the cult of life, that our agency and value are found.
The view of life and value one takes clearly has profound implications for how to assess various bioethics issues. The cult of rights and the cult of life--because they separate what is essential to persons from their lived, embodied experience, and because they classify persons as something that transcends their biological constitution--end up committing some of the same errors, according to Bellantoni. Both cults are paternalistic, allowing others to control an individual's life at certain junctures: for example, at points where life may not be valuable to a particular person anymore, the cult of life insists it is, and at points where that person does not make choices under autonomous conditions, the cult of rights insists upon denying that person the right to exercise his or her will. Bellantoni's view rejects these paternalistic outcomes.
There is much to like in Bellantoni's book. Although it will appeal mostly to philosophers with interests in bioethics, those coming with a philosophical bent from psychology, sociology, and other fields should find value in it too. Bellantoni successfully pushes the debate forward on a variety of bioethics issues through the lens of different conceptions of personhood, while simultaneously engaging in a kind of meta-bioethics by critiquing current bioethics practices.
However, some aspects of Bellantoni's discussion are overly drawn out and repetitive, and the intricate interweaving of the book's three aims is occasionally dizzying. Additionally, some characterizations of her opponents' views are underdeveloped, and it would be nice to see more connections made to other scholars dealing with the same kinds of issues. She does, to be sure, discuss the claims of opponents such as Daniel Callahan, Francis Fukuyama, Hans Jonas, Leon Kass, and others. But more thorough discussion of the relevant literature would be welcome; there are just twenty-eight bibliographic entries (for twenty-two authors) in this 230-page book.
Despite these criticisms, The Triple Helix possesses several useful and innovative features. The mapping out of theories of persons, agency, and moral worth is interesting. The discussion of grief subtly reveals key features of the different views of persons (chapter 1). There is a novel and helpful discussion of "biofallacies" or informal errors in reasoning in bioethical contexts (pp. 126-136). Most importantly, Bellantoni's emphasis on lived, concrete experience, emotions, and social relations as essential to our sense of personhood, identity, and moral value is a welcome perspective in bioethics.
© 2013 William A. Bauer
William A. Bauer, Ph.D., is a Teaching Assistant Professor of Philosophy at North Carolina State University, with research and teaching interests in metaphysics, philosophy of science, and bioethics.