Few people can be said to have originated a new field of intellectual endeavor; pioneering bioethicist Daniel Callahan is one of those people. Callahan died yesterday at age 88. In the late 1960s, Callahan and psychoanalyst Willard Gaylin founded the world's first bioethics think thank, the Hastings Center.
Callahan was a leftwing thinker whose chief ethical commitment was establishing social and economic equality, particularly with regard to providing equal access to health care. Given his paramount commitment to equality and mine to liberty, our worldviews were bound to clash.
Callahan was a fierce critic of the quest of "perfect health" and efforts to dramatically increase healthy life spans on the grounds that achieving such goals would widen inequality by making some people (the rich) better off than others.
For example, in his 1998 book, False Hopes Callahan complained that "the criteria for normality are constantly raised, keeping in step with medical possibilities. No longer is sixty-five thought to be a reasonable age after which death is not 'premature.' No infant mortality rate, however low, is good enough. No ache or pain should go unrelieved if relief is desired. Most important, what would have been accepted as a decent level of health in one generation is unacceptable in the next."
Callahan evidently believes, I retorted in my review: If it was good enough for granddaddy, it should be good enough for you.
In False Hopes, Callahan added, "If we had exactly and only the same range of technologies as were available twenty or thirty years ago, there would be no problem in equitably allocating resources. We could readily afford that level of medicine and health care."
In my review, I countered that "it would be even cheaper, of course, if we returned to using rattles and beads as remedies."
Callahan's focus on trying to ensure that everyone has equal access to equally bad medicine never flagged.
Over the years, Callahan and I occasionally interacted as fierce, but friendly, antagonists in various bioethical controversies. For example, Callahan and I participated in a panel discussion on "the research imperative" at the Biotechnology Industry Organization's 2006 conference. In a setup article outlining what was at stake in that discussion, I noted that
Callahan despairs that the more healthy life Americans enjoy, the more we want. He inveighs against this "abolition of fatalism," nostalgically noting, "In the past we reconciled ourselves to aging and death because we could do nothing." He adds, "It seems to me that the whole trajectory of modern medical research has been basically to treat [death] as if it were an accident. As far as I know, there are no fatal diseases that the NIH (National Institutes of Health) finds acceptable. The NIH is not in favor of immortality, at least officially, but there are no diseases that kill people that it is prepared to tolerate."
I quipped: Sounds about right to me.
Callahan and I engaged in an online debate at Cato Unbound back in 2007 addressing the question: Do We Need Death?
Callahan's answer was an emphatic yes. "Nature knew what it was doing when it arranged, through natural selection, to have all of us get old and die," he argued. "That is the price of species survival and vitality, and it has worked well. I don't think we humans can invent a better scenario, but we can surely do much harm in trying." One of his main arguments for applauding the grim reaper was that healthy long-lived oldsters would stand in the way and stymie the progress of the young.
I just as emphatically answered no. "The highest expression of human nature and dignity is to strive to overcome the limitations imposed on us by our genes, our evolution, and our environment," I countered. "Future generations will look back at the beginning of the 21st century with astonishment that some well-meaning and intelligent people actually wanted to stop biomedical research just to protect their cramped and limited vision of human nature. Our descendants will look back, I predict, and thank us for making their world of longer, healthier lives possible."
A towering figure in bioethics, Callahan greatly sharpened the thinking of those who partook in the roiling ethical debates over public policy issues such as access to medical care, organ transplantation, cloning, and life extension.
In his contribution to the Cato Unbound debate, Callahan, then 77 years of age, observed
"And while I hope in my more self-regarding moments that my friends and families will wail and gnash their teeth at my funeral, I doubt at my age they will do so; and I can, so to speak, live with that. I will get old and will die, an ancient story, but not a tragic one."
I may not gnash my teeth, but I do mourn the passing of this man of integrity.