VII

The next aspect of moral responsibility for health we are likely to forget is the affective component in moral conviction. Judgments of the moral "ought," what I as a Christian should do or

avoid, and action upon such conclusions, originate not simply in rational analysis, book learning, or exposure to sociological fact. They have deep roots in our sensitivities and emotions. This has particular relevance where the health needs of the elderly and dependent (fetuses, infants, retarded, the poor) are concerned.

What I mean to suggest here is the difficulty we experience in a media culture in remaining sensitive to human hurt, deprivation, and injustice. The efficiency of the media means that human suffering and loneliness are dished up to us both frequently and mediately. By "mediately" I mean that we learn of the sickness, suffering, starving, death, and isolation of others several levels removed from the happening--often enough in a cozy chair with a glass of standard swank Beefeaters ready to soften any overly severe blows and to soothe our quivering ganglia. Thus the body counts in Vietnam night after night had inevitably the effect of chipping away at our moral horror at what was happening. Being surrounded by sickness, pain, and death, we get hardened to it. The phenomenon has been noted in nurses frequently. I speak as an American when I say that in far too many areas it is true to say that "the feeling has gone out of it." "Oh just another rape" is a phrase that, God forbid, can become as common as a comment on the weather.

I will pursue this for a moment, because it is utterly essential. What is so often lacking in contemporary life is passion. For example, couples talk of affection and tenderness and read manuals of marital gymnastics to find them. The more they desire feeling and passion, the more it escapes them. We are the clinicians of quality where quality escapes the mere clinician. We talk about the poor, their terrible situation; yet we eat well, drink well. We get mad (passionate) at injustice only when it hits us or our family. Those who get mad when it hits others (the neighbor as the self, so to speak) are often viewed as marginal characters.

Passion is the beginning of any true moral responsibility and therefore of responsibility for health. It is the inner identification with the suffering and the downtrodden. It is that personal startup that gets us off-center a bit-self-center-and propels us to examine our consciences, comforts, and priorities. To develop genuine passion and concern, I believe we have to he exposed to those who suffer. There is a qualitative difference in the approach of those who have seen, touched, and hugged a hydrocephalic child and those who have not. There is a qualitative difference in the concern of those who have companied with the dying and those who only write statistics and articles about the experience. Those who have seen some retirement homes know in a dimensionally different way the health problems of the elderly; those who have seen know, for example, how our society has failed to come to grips with this problem.

Moral responsibility for health means, far more than we have admitted in our lives and policies, firsthand exposure to the problems of health; for without such experience, we are likely to remain without passion-and therefore without one of the basic ingredients of moral responsibility.

VIII

The next point to advert to in unpacking the notion of "moral responsibility" is the cultural shaping of our grasp of basic human values. In the first chapter I adverted to the fact that we are corporately homo technologicus in our attitudes. This prethematic shaping tends to affect profoundly our moral judgments.

Something of a highwater mark in this technological bias is reached in the writings of Joseph Fletcher, as I note in Chapter 15. For instance, Fletcher writes: "Man is a maker and a selector and a designer and the more rationally contrived and deliberate anything is, the more human it is." On this basis he continues: "Laboratory reproduction is radically human compared to conception by ordinary heterosexual intercourse. It is willed, chosen, purposed, and controlled, and surely these are among the traits that distinguish Homo sapiens from others in the animal genus. . . . Coital reproduction is, therefore, less human than laboratory reproduction."⁶

My only point here-but it is a very serious point and one we are likely to overlook-is that responsibility for health demands that we attend to and lift out those cultural leanings and biases that may distort our grasp on the basic values and hence prejudice our notion of what moral responsibility means and requires.

IX

My final point in dealing with health and care for health is that our responsibility must be "holistic," Otherwise it begins to suffer erosion and is simply incredible as a form of witness to others. By holistic I mean that responsibility must be conceived and spoken of as covering all of those things that affect life and health. It must be part and parcel of an attitude toward persons that defends their rights, is strongly prophetic about warfare, about poverty, about quality of life in all aspects and at all ages. Why is this important? Because without such a reach and universality, our own sense of responsibility begins to erode by being selective. One cannot responsibly care for the person-the self of others-by caring for only a single aspect of the person.

We know this notionally, but it is terribly hard to make it part of ourselves, to know it evaluatively. I recall a panel I was on at Georgetown University on the problem of abortion. Three of us participated: a pro-abortionist, a prolifer, and I. The students were, by and large, strongly opposed to abortion, but the language used by the prolife lawyer involved all but "turned them off." At one point I noted that we must also be concerned with what happens to children once they are born. We must be concerned about whether they are starving, are beaten, are abandoned in gutters and on front steps. "Otherwise," I argued, "our abortion stand is selective and one-eyed." To my consternation, the lawyer responded: "That has nothing to do with the problem of abortion." I submit that it has everything to do with it, with our own sense of responsibility and with our credibility. This same tunnel vision can overtake us as we reflect on our responsibilities for health.

These are but some of the things we are likely to forget when discussing "man's moral responsibility for health." I am sure there are many more. But if one details too many things we are likely to forget, one becomes a self-fulfilling prophet and all but guarantees our memory failure.

⁶Joseph Fletcher, "Ethical Aspects of Genetic Controls," New England Journal of Medicine, 285(1971), 776.