Daniel Callahan & Bioethics
In the summer of 2003, the renowned bioethicist Daniel Callahan testified before President George W. Bush’s Council on Bioethics, which was gathering material for a report on stem-cell research. Stem-cell research holds a therapeutic promise so enormous that even some prolife advocates support it, despite its use and destruction of embryos. The scientists on the council, like most of the researchers who testified that day, seemed to feel an obligation to move ahead with it. Would Callahan, one of the founders of the field of bioethics, go against the grain of this consensus?
As it happened, I was scheduled to present a report to the council later that morning, and I had arrived early in order to hear Callahan’s testimony. Though we’d only met in passing, Callahan’s work had been important in shaping my own thinking about bioethics, and I expected his comments to be provocative. He did not disappoint. The seventy-three-year-old Callahan was emphatic: It is a mistake, he told the council, to think that we have an obligation to pursue stem-cell work—or medical research generally, for that matter. Medical progress is certainly an important social good, but it must be weighed against competing social goods, such as education or decent housing. What’s more, Callahan insisted, many of the diseases that stem-cell research might address, like cancer and heart disease, are illnesses of the old, and we must ask whether extending the human life span by a few more years through new treatments for these diseases is worth the cost. Some of the scientists on the council seemed fairly stunned that Callahan would suggest fixing public education instead of attempting to cure cancer, or would de-prioritize research on treatments for diseases afflicting the elderly. After all, here was a founding father of bioethics, an elected fellow of the American Association for the Advancement of Science, and a member of the Institute of Medicine of the National Academy of Science, the recipient of numerous honorary degrees, a finalist for a Pulitzer Prize—in short, someone who should be able to understand how crucial their research is—and he was calling it comparatively unimportant.
Yet, no one who has followed Daniel Callahan’s long and distinguished career would be surprised at his comments. Indeed, for nearly forty years Callahan has been writing and lecturing about medicine’s need to accept human finitude and recognize competing moral and social-justice claims. Almost every one of the shelfful of books he has published since the early 1970s has explored these themes in one way or another. Whether he is stressing the social implications of bioethical decision making, the need to emphasize caring rather than curing, or the importance of foundational questions of meaning over questions of procedural justice, Callahan has sought to explore the folly of what he calls the “gospel of medical progress”—namely, the idea that medicine brings the good news of liberation from death and dying. If it is possible to speak of modern idolatry, Callahan says, medicine’s spurious promise of an infinitely postponed mortality is it.
Although Callahan’s comments to the bioethics council were not really surprising, there was something about watching him casually deflate the self-importance surrounding many in the room that made me want to know more about the man and his work. A good place to start is with his 1990 critique of the American health-care system, What Kind of Life, a book that contains most of the recurring themes in Callahan’s work. In it, he sets out systematically to demythologize medicine by showing how, distracted by the “glamour” of curing patients, medicine has lost sight of the surpassing importance of caring for the sick and vulnerable. Callahan reminds us that the suffering caused by sickness and death can be reduced but never overcome, and that the best that medicine can do is to be committed unequivocally to care. He is eloquent about what caring requires. “At the center of caring,” he writes, “should be a commitment never to avert its eyes from, or wash its hands of, someone who is in pain or is suffering, who is disabled or incompetent, who is retarded or demented; that is the most fundamental demand made upon us.”
There is an irony in the fact that this language of uncompromising concern for the weak and the vulnerable—language that has a decidedly Catholic feel—comes from a self-described agnostic. But Callahan was not always such a secular writer. Many readers will remember his work as an editor of this magazine in the 1960s, and more recent readers will also be familiar with the work of his wife, Sidney, a longtime Commonweal columnist. But the details of Callahan’s biography are less well known. He was born in Washington, D.C., in 1930 to an upper-middle-class Catholic family in which a commitment to faith co-existed comfortably with the surrounding secular culture. Educated in Catholic schools, Callahan was a good student and also a dedicated competitive swimmer; indeed, it was his love of swimming, more than his love of books, that took him to Yale for college—at that time, a national powerhouse in the sport. But the grueling demands of collegiate competitive swimming proved too much, and Callahan soon abandoned it; by age nineteen, as he puts it, “there was nothing left to occupy his mind but education.”
It was during this period that Callahan discovered F. Scott Fitzgerald—like himself, a romantic and ambitious Catholic both attracted to and repelled by upper-crust WASP culture. Reading Fitzgerald, and later Graham Greene, awakened an interest in Catholic intellectual life, and Callahan began a course of study, both formal and informal, of the Catholic philosophical tradition. Studying Thomas Aquinas during his senior year with John Courtney Murray, SJ, then a visiting professor at Yale, Callahan found his vocation: he wanted to be a philosopher. Later, as a philosophy graduate student at Harvard, he extended his “Catholic” education by serving as teaching assistant to the great English historian Christopher Dawson, author of Progress and Religion, among many other books.
While Murray’s love of argument and the rigorous pursuit of truth attracted Callahan to philosophical inquiry (and led him to graduate degrees at Georgetown and Harvard), it was his own conviction that this critical philosophical reflection needed to inform Catholic intellectual life that led him to the staff of Commonweal. The period of his tenure (1961-1968) was enormously productive, both for the magazine and for Callahan himself. At Commonweal he was surrounded by a remarkable group of people, including John Leo, Wilfrid Sheed, Richard Gilman, James Finn, James O’Gara, Michael Novak, and Peter Steinfels. He learned the discipline of writing on deadline, and his output was prodigious. While at Commonweal, Callahan wrote or edited nine books, including The Mind of the Catholic Layman, Honesty in the Church, and The Catholic Case for Contraception. Indeed, his engagement with Catholic intellectual life during his time at the magazine was so profound that historian Rodger Van Allen described him as “perhaps the most influential Catholic layman of the 1960s.”
Yet, near the close of that tumultuous decade, Callahan somewhat unexpectedly resigned from the magazine. Looking back at his work from this period, it is hard not to feel like a light switch had been turned off and another one turned on. In 1965 he could write that he was committed “to the church, to my work in the church, to the world which Christ came to redeem” and that he “could not imagine being anything but a Catholic.” By 1970, however, there is scarcely a mention of any explicitly Catholic concerns in his writings. What was once the unimaginable had become the reality: Callahan no longer considered himself a Catholic.
Last fall, Callahan agreed to sit down with me to talk about his career, and so I traveled to New York to spend an afternoon and evening with him. A compact man, Callahan radiates energy even while sitting still. At seventy-six he still has a full head of curly hair and a characteristic look of intensity that might be mistaken for a scowl. I found him extremely engaging as we talked in his office at the Hastings Center, the ethics center he co-founded with Will Gaylin in 1969 after leaving Commonweal.
Because his conflicted relationship with the church somewhat parallels my own, I was particularly eager to ask him about it. I reminded him of the famous story about Bertrand Russell, in which the mathematician and philosopher was out riding his bicycle one day when he suddenly realized that he no longer loved his wife. I asked Callahan, Was his leaving the church like that? Did he just wake up one morning and realize he no longer believed? On the contrary, he said; his loss of faith was a slow process. He found himself losing a sense of the mystery and wonder of the faith. He found it increasingly difficult to pay attention in church. He couldn’t bring himself to read the Bible. He just slowly drifted away. Today, Callahan is most comfortable being described as a Stoic.
Callahan cites no intellectual or moral disagreements with the church as reasons for leaving, but clearly such disagreements were crystallizing at the time. During this period he wrote his groundbreaking book Abortion, Law, Choice, and Morality, a finalist for the National Book Award in 1970. It is perhaps a measure of how much Catholic intellectual life has changed since then that the book, which was highly critical of Catholic teaching on abortion, won the Thomas More medal that year, and was more vigorously criticized by prochoice feminists than by Catholic opponents of abortion.
Yet the book clearly repudiates Catholic moral teaching on abortion. Callahan argues that because it places so much emphasis on the status of the fetus as a human life, and gives the right to life primacy over every other right, Catholic teaching cannot adequately account for the complexity of abortion. The Catholic position, he wrote, “offers no possibility whatever of responding to the needs of women whose crisis is not one of mortal conflict with their fetuses.” The problem, he argues, is that making physical life a supreme value effectively eclipses a whole network of other values and responsibilities. In fact, says Callahan, a pregnant woman may have obligations and responsibilities that compete with her responsibilities to the fetus.
If this conclusion was welcomed with enthusiasm in the secular press and among many of Callahan’s philosophical colleagues—reviewers called the book “masterful,” “indispensable,” “judicious,” and “exceptionally clear”—some of Callahan’s Catholic friends and admirers may have felt that he had lost his way. One such admirer was his wife, Sidney deShazo Callahan. Dan and Sidney had met during his senior year at Yale and they married in 1955. A passionate opponent of abortion and a distinguished scholar herself, Sidney pressed Callahan forcefully about his views on abortion, arguing with him every day of the four years in which he researched and wrote his book. (Both seem to take pride in the fact that their marriage survived the ordeal.) In the end, Sidney reluctantly accepted her husband’s prochoice views with equanimity, but his leaving the church proved deeply traumatic for her. His faith had inspired her—she had converted to Catholicism when she married him—and now he was leaving the church he had taught her to love.
Talking with the Callahans at their apartment in Ardsley-on-Hudson, New York, I could see that the pain of Dan’s loss of faith was still palpable for Sidney. She shook her head as if, thirty-five-years later, she still could not fully understand her husband’s decision; he in turn grimaced with regret when speaking of the pain this decision caused her. Yet they seemed as eager to engage one another in passionate discussion about serious ideas as they were when they debated abortion daily three decades ago. Dan says that the abortion book is his favorite, and one can’t help wondering if that’s because the book captures the complexity of the man, his life together with Sidney, and his conflicted relation with his former faith.
Callahan did not set out to write a prochoice book, but if one trait has characterized his entire intellectual career, it is the willingness to go wherever he believed the best arguments took him. Abortion, Law, Choice, and Morality is deeply interdisciplinary, ranging across an impressive intellectual landscape to reflect on legal codes in the United States and abroad, on embryology, moral theory and Catholic moral thought, and the psychological effects of pregnancy. It illustrates its author’s penchant for embracing seemingly contradictory positions, the hallmark of a thinker who is extraordinarily difficult to pigeonhole in any standard ideological matrix. Callahan is prochoice but considers many abortions morally irresponsible. He rejects natural-law arguments about the inseparability of sex and procreation, but also dismisses much in the world of reproductive medicine that flows from this separation. He rejects the view that the early fetus is a person with a self-evident right to life, but wonders aloud how destroying an embryo for research is compatible with showing the embryo “profound respect.” The Jesuit moral theologian Richard McCormick once said that at times Callahan sounds like a traditional Catholic, and at other times like an abortion-on-demand enthusiast; and Callahan himself acknowledges—with a hint of a smile—that he tends to anger conservatives and liberals alike.
Callahan’s fierce independence and his commitment to a broad interdisciplinary approach in tackling moral and social issues are hallmarks of the Hastings Center. The idea for the center—originally called the Institute of Society, Ethics, and the Life Sciences—came to him in 1968 and grew from a sense that the quickening pace of medical innovation and technological change promised to fundamentally change society and how humans think about their lives. Describing the origins of the center, Callahan likes to note how various streams in upstate New York come together to form the Hudson River. It’s an apt metaphor, not least because the Hastings Center now sits on a gorgeous piece of land overlooking the Hudson at one of the river’s deepest points.
The philosophical headwaters for the Hastings Center were the increased public scrutiny of medicine and other social institutions during the 1960s; the advances in medical technology represented by the onset of organ transplantation, prenatal diagnosis, artificial respirators, neonatal and adult intensive care units, and the like; and the conviction that philosophers and other scholars could make a meaningful contribution to addressing social and moral issues through sustained engagement with them. It is not an exaggeration to say that the confluence of these streams of thought formed the intellectual torrent that bioethics has become.
Although the Hastings Center is today recognized as among the most important institutes for bioethics in the country, if not the world, its origins are humble. It was originally run out of Callahan’s home, and the story goes that Callahan borrowed $250 from his mother-in-law to buy letterhead stationery, so that when requests for funding were sent out, foundations would not dismiss the center as a fly-by-night operation. Callahan himself fondly remembers talking to foundation heads from his study at home, with one or another of his six children shrieking underfoot.
Almost from the start, the center bore the deep stamp of Callahan’s convictions. His dissatisfaction with academic philosophy’s focus on linguistic analysis rather than on real-life issues bolstered an inclination not to affiliate with a university. His commitment to bringing many disciplines to bear on problems meant that the center attracted an extraordinarily diverse group of collaborators, including philosophers, lawyers, clinicians, psychologists, anthropologists, theologians, and political scientists. At Hastings, as earlier at Commonweal, Callahan was surrounded by an incredibly talented group of thinkers. The list of early figures associated with the center is a Who’s Who in what eventually became the field of bioethics: Sissela Bok, Alex Capron, Eric Cassell, Dan Clouser, Renee Fox, James Gustafson, Leon Kass, Paul Ramsey, Robert Veatch, and on and on. Within a decade, Callahan and his colleagues had gone a long way toward establishing a new academic field; they had launched a new journal, the Hastings Center Report, and the center itself had grown to a staff of fifteen with a budget approaching $1 million. (Today the staff stands at twenty-five, with a budget of $3 million.)
The Hastings Center succeeded partly because of Callahan’s remarkable work ethic. Sidney Callahan jokes that the only rough patches in their marriage have come when Dan was between books—not reading books, but writing them. The center also profited from his uncanny ability to anticipate pressing social problems before they arise. Callahan published his book advocating a compromise position on abortion three years before the Supreme Court handed down its Roe v. Wade decision. He was among the first writers to tackle the social problems associated with aging, among the first to challenge our infatuation with medical progress, and among the first to question the research imperative in medicine. Indeed, of the four topics on which the early founders of the Hastings Center decided to focus, three—death and dying, genetics, and reproductive biology and population issues—have preoccupied the field for decades. The fourth issue, behavior control, waned for a time, but erupted again in the 1990s with the introduction of Prozac, Ritalin, and other psychopharmaceuticals.
How to explain Callahan’s accomplishment—his prodigious output, his way of being in the right place with the right idea at the right time? Gilbert Meilaender, who holds a chair in Christian ethics at Valparaiso University, describes Callahan as “an old-fashioned American entrepreneur,” and that seems about right. Callahan had a very good idea and then almost single-handedly, and with tireless effort, made it happen. Successes like the center can in retrospect seem inevitable, but they aren’t at the time; they almost always represent someone’s brilliant intuition and dauntless hard work.
Callahan is proud of the Hastings Center and the movement that he helped launch, but there are also some regrets. One is that his original, expansive conception of the field is no longer the predominant one in bioethics. From the start, there were tensions between those who focused on questions of individual rights and the protection of human subjects, and those who, like Callahan, wanted to tackle larger questions. Where would various technological developments lead us as a society? What kind of persons and what kind of society do we want to be and to foster? The Canadian bioethicist Arthur Frank has described the latter model as “Socratic” bioethics; and if we think of bioethics in those terms, Callahan has certainly been the field’s Socrates.
Unfortunately, the “protectionist” model of bioethics has become predominant, and with it has come a tendency to frame all issues in terms of individual rights. But because rights language is typically understood in individualistic terms in our society, and because such language tends to reduce debate to narrow legal questions, it is not particularly conducive to formulating the difficult questions about how we ought to live our lives—or about how the pursuit of health fits into a good life. Callahan has said that the fundamental goal of his work is to get people talking about the common good, a concern that obviously has deep roots in his Catholic background. Attention to individual rights is well and good, but how will we live out our freedom once we have it?
Asking the disturbing questions often makes Callahan about as popular with the holders of conventional wisdom as Socrates was with those running Athens. His suggestion that society go slower on stem-cell research has been called “immoral” by Ronald Bailey, science correspondent for Reason magazine, who went on the PBS show Think Tank to charge that by “trying to slow that train [of stem-cell research] down,” Callahan and others are “endangering the lives of millions of people.” He has been vilified for arguing, in his 1987 book Setting Limits, that our insatiable desire for longer life is potentially disastrous socially and that we should consider rationing health care for the elderly. As the medical ethicist Larry Churchill wrote in a friendly review in the journal Ethics, critics castigated Callahan as “a nihilist advocating passive euthanasia for the elderly on utilitarian grounds.” (Churchill also observed that anyone who seriously believes this of Callahan “cannot have read Setting Limits at all.”)
Even on less explosive issues, Callahan tends to be a contrarian who raises uncomfortable questions. I think, for example, of a marvelous but vexing essay he wrote about how bioethics ignores men when questions of reproductive choice and assisted reproduction are discussed. The essay notes that reproductive-technology issues like surrogate motherhood, in vitro fertilization, or donor insemination have mostly been discussed in terms of procreative rights, not children or families, and almost exclusively women’s rights at that. Fathers and fatherhood, Callahan says, “are just absent from the discussion altogether.” In his view, discussing an issue like anonymous-donor artificial insemination—while leaving out any consideration of the obligations men have to their offspring—has perpetuated “the problem of feckless and irresponsible male procreators.”
Callahan is deeply concerned with foundational questions, and some consider him overly preoccupied with issues that touch on death and dying. One longtime friend ruefully notes, “When you think of Freud, you think of a preoccupation with sex; with Callahan, it’s always about death.” While it is true that Callahan has written extensively about death and dying, this view of him is badly mistaken, the friend suggests, calling it “a caricature.” True, Callahan is serious in wrestling with issues of human finitude, but he is not morosely obsessed with mortality. In fact, he can be quite playful and self-deprecating about it. In the preface to his book, What Kind of Life, he thanks Sidney for her willingness to talk about subjects like disease and sickness, aging and death. “Some couples,” he remarks, “have all the fun.”
And although Callahan is committed to legalized abortion, it is not a misreading to see him also as profoundly prolife. In 1984, he and Sidney edited a volume titled Abortion: Understanding Differences. In his chapter, Callahan wrote that what most clearly distinguishes a prolife position “is its willingness to live with—and accept—externally imposed tragedy as a part of life.” Unfortunately, says Callahan, a tragic view of life has never been very congenial to a secular liberalism that adopts an almost messianic view of human reason and its ability to overcome obstacles in the path of our desires. But a tragic view of life, one that condemns any resort to abortion for trivial or merely selfish reasons even as it defends legal access to the procedure, lies at the core of his own highly nuanced prolife position.
Indeed, a commitment to this tragic view of life explains much of Callahan’s work. It certainly explains his consistent opposition to unquestioning faith in medical progress. It also explains why he seems so deeply troubled by the fact that theological voices have all but disappeared from mainstream bioethics. Alas, most secular thinkers, whether conservative or liberal, shun a tragic view of life, with its recognition that we are not in control. As Callahan puts it in one of his best books, The Troubled Dream of Life, most of us cling to “illusions of mastery,” leaving almost no place in public discourse for a meaningful discussion of suffering, decline, and death as inevitable companions in life. The growing popularity of the hospice and palliative-care movements in this country may be evidence that Callahan’s call for greater public discussion of death and dying is being heeded—though it is worth noting that, for those terminally ill patients in Oregon who choose assisted suicide to end their lives, “loss of autonomy” is still the number-one reason cited.
Throughout his career, Callahan has sought to shine a light on the role of illness and death in human life, and to bring these difficult topics into our public conversation about health care and the human being. No one has done more to show us the problems that arise when we fail to do this. When we do not confront the proper place of illness, suffering, and death in human life, we too easily succumb to the dangerous illusion that, through technology, we can become as gods. It was precisely this conversation that Callahan was trying to spark in his testimony before the President’s Council in 2003. To assume that if we do not conduct stem-cell research, then the blood of those who die will be on our hands—an argument, he told the council, that molecular biologist and Nobel laureate Joshua Lederberg had made to him about medical research generally—is to surrender to the fantasy that we are god-like in our powers. This danger was what he was urging the President’s Council to discuss, and what the scientists in the room seemed not to comprehend.
Perhaps their incomprehension reflected a discomfort at the religious implications of what they were hearing. The fact is, though Callahan understands himself as a secular ethicist, others may not. In the words of Gilbert Meilaender, who is a member of the President’s Council and sympathetic to Callahan, “Dan raises what are essentially religious questions.” (It should be noted that Meilaender is not “persuaded that Dan’s secular answers go as deep as the questions he’s raising.”) Joseph Fins, an associate for medicine at the Hastings Center, remembers giving a lecture once when someone in the audience dismissed him with, “You Hastings Center Catholics are all alike.” A secular Jew, Fins found the comment both amusing and complimentary; he assumed he was being compared with Callahan.
Given Callahan’s background as a deeply committed Catholic and his decade-long engagement with the best of the Catholic intellectual tradition, it is not hard to see the soil from which some of his deepest convictions grew. His insistence that death “is an enemy but not the enemy,” his conviction that the “flight from dependency is a flight from humanity,” his belief that caring is at least as important as curing—all were nurtured by his Catholic past, even if that is not what sustains them any longer.
Toward the end of The Troubled Dream of Life, Callahan warns that it is not enough to provide compelling arguments about the proper understanding of illness, aging, and death in human life; we also need new images of human mortality. We need the right image because in confronting our mortality we are dealing with a level of consciousness that is “deeper than that which can be wholly influenced by our logic and arguments.” This claim—somewhat surprising from someone so deeply committed to the role of reasoned argument in the formulation of public policy—has stuck with me. I’m not sure that Callahan has ever really provided the image we might substitute for that of modern medicine’s supremely powerful researcher overcoming the limitations of human embodiment.
Or maybe he has. Driving me from the Hastings Center to his apartment last fall, Callahan suddenly pulled his car over to the side of the road and parked in front of a church. He wanted to show me something, he said. As it turned out, he was taking me to the Union Church of Pocantico Hills, a church built by the Rockefeller family, where they worshiped for decades. We walked in. Past a simple but elegant exterior, the entranceway opened to a sanctuary of remarkable beauty. At one end of the nave was a stained-glass window designed by Matisse; at the other end, one by Chagall. Eight other stained-glass windows, all by Chagall, flanked the nave.
All these stained-glass windows are strikingly beautiful, but one exceptionally so. Commissioned by the children of John D. Rockefeller Jr. as a memorial to their father, the window sits in the narthex of the church, luminous with the brilliant blues for which Chagall’s windows are famous. The window struck me as providing just the kind of image for which Callahan’s entire work has called. It is not the image that one might associate with the aspirations of modern medicine—say, Lazarus being raised from the dead. Instead, the window depicts the parable of the Good Samaritan from the Gospel of Luke, with its recognition of our common humanity rooted in the fragility of human life. In the intersecting tracery of the window, Chagall has captured both the interdependency and the brokenness of human life. Yet the scene is one of hope, and of confidence in the face of great adversity. One sees both sadness and joy.
In Setting Limits, Callahan agues that by striving for “grace under adversity,” and by embracing a “communal spirit” and an “ethic of service,” the elderly can serve as role models for the rest of us. Perhaps it is this spirit and this care for the other depicted in the Chagall windows that draws Callahan to them. Yet, whatever it is that attracts Callahan to Chagall—two Chagall prints grace the walls of Dan and Sidney’s living room—the depiction of the story of the Good Samaritan in Union Church is in fact a window on Callahan’s whole career. As those who read his books will discover, the complexity, honesty, and beauty of Chagall’s Good Samaritan illuminate Callahan and his life’s work.
Read more: America's Blind Spot: Health Care & the Common Good, by Daniel Callahan
Related: Painter of a Lost World, a review of Chagall by Jackie Wullschlager