We are related, you and I.
According to genealogical analysis, the likelihood that we have recent common ancestors is significant. This is not theoretical descendance from Lucy or Eve. This is kinship based on twenty to thirty generations of historical probing.
Let that sink in. There is a good chance that you and I are connected, not just by species or culture, but by ancestry. You might be my cousin.
As demonstrated by commercially available saliva testing, newfound kinship catalyzes new perspective. Surprise siblingship can destabilize existing circumstances, yes. It can also spark wonderful new relationships. It’s an amazing experience to learn that someone with a different surname, skin color, language, or social affiliation is “related”. We feel differently about a person simply by learning that our family trees overlap.
Suppose we saw everyone that way? What might a 21st century bioethics look like if it considered everyone a cousin?
You may have cause for skepticism; family interactions are not always positive. Besides, bioethics should promote neutrality, shouldn’t it? Clinicians are taught not to care for relatives without establishing clear boundaries. A similar “social distancing” may seem appropriate for bioethicists. Lineage bonds can cloud judgment. Emotions can obscure reason.
“The heart has its reasons which reason knows nothing of,” Blaise Pascal famously penned. While the 17th century philosopher was specifically attuned to the human relationship with the divine, his insight into logic and feeling need not be interpreted only through a spiritual lens; intuition about morality may similarly spring from a place – le coeur – that we struggle to understand and to articulate. Yet struggle and articulate we should, and we must, for bioethics is about interrogating options in complex decision-making and giving reasons why alternative choices may or may not make ethical sense – a process that has vexed philosophers, healers, and social thinkers for many, many years.
Perhaps that is the ironic point: bioethicists are, by definition, inadequately equipped for ethical sense-making because we are, working as individuals, insufficiently qualified for the job. No one of us can irrefutably attest to the truth. As independent reasoners, we have limited insight into the big picture; like single cells within a human body, we are unable to definitively describe the larger living system in which we find ourselves. That need not be a problem as long as we accept our limitations for what they are: guideposts towards the inherently interconnected nature of existence.
We are each born to an interdependent whole. As bioethicists, we dynamically discern from within that whole. Approaching our discipline with any other mindset is to mistake individuated memory for metaphorical purpose. What matters is not how procedural sagacity may balance westernized autonomy with other things ethical. What makes a difference is why we care about being ethical in the first place, how we appreciate the interdependent nature of being when applying that care to ethical practice and policy.
Beliefs shape bioethical commitments. Although the term “metaphysics” has different connotations today than it did for Aristotle and the ancient Greeks, contemporary bioethicists don’t need to be experts in ontology, epistemology, or cosmology to appreciate the importance of the metaphysical in daily discernment. We need only recognize that how we view the self and its relationships with the non-self is foundational to how we understand bioethics – and how, in turn, we may acknowledge and engage with the inherently entwined nature of everything.
Yes, everything.
Now in the final trimester of life, I have spent decades resisting the vulnerability associated with complex social entanglement. No doubt this was influenced by the circumstances of my arrival into the world: my father was paralyzed by polio while my mother was pregnant with me. Consequently, my upbringing was grounded in self-reliance and effort-oriented values. Our household was unadorned, except for the powerful motivation of personal performance. Work.
But a funny thing happened on the way to getting older: I began opening to the mystifying reality of interdependent worth. Perhaps this was my quantum fate. Or perhaps some fortuitous decisions activated a latent potential for viewing myself as an inter-related awareness rather than an independent ego. Either way, my unfolding career – now fresh off a master’s degree in bioethics – lurches towards an acceptance of first principle grounding for our field. I don’t really know who I am. And I certainly don’t know who you are. Nonetheless, I am convinced that we are more than individuated pieces of a cosmic puzzle. We are inextricably connected manifestations of it. Call that declaration metaphysical, quantum physical, or just plain real, it doesn’t change my conclusion that we are, have been, and always will be related, with each other, with other living beings, and with our ecosystems.
Bioethics cannot advance justice, social potentiation, and the common good with self-oriented patterns of thought and action. Autonomy involves so much more than medicalized notions of separation. A street, neighborhood, or city is not just a collection of self-ruling individuals. It is a community, a vibrantly evolving social organism. It is our potential to be better than our isolated selves.
I bet you are dependable. But are you dependent? You must be. Because trust is not unilateral. It requires mutuality. Where is the bioethical equanimity of being dependable for others if you aren’t willing to depend on them in return? To be sure, there are unhealthy levels of reliance. But interdependence doesn’t happen in a zero-sum gain manner; our relationships are not some transferable tally of helpless need and steadfast accountability. There is a grand nexus of reciprocity and trust active in our lives. Your support for me enables my availability for someone else. This intimacy of belonging cannot be measured. It cannot be mandated. It must be experienced. Lived.
Interdependence is more than a quantifiable sum of transactional functions. It stands for our innate relativity. Attentiveness to others activates a continuous loop of service, learning, and love that can help us transcend self-centered behavior. And that transformative awareness can lead bioethics to a resolute embrace of our inexplicable inter-relationality.
This doesn’t mean we should expect bioethicists to practice idealized notions of generosity and service; far from it. Fidelity to a first principle of interdependence means only that, together, we should welcome the opportunity to nurture and care for each other. It means that our emerging bioethics should be one of kinship rather than clanship, kindness instead of competition, potential as opposed to improbability.
We are a quantum generation of bioethicists. As such, we must be prepared for the unpredictable, comfortable with the ambiguous, and authentically rooted in an ancestry of commonality, of family.
After all, we may actually be cousins.
Mark F. Carroll, MD, MS is a Transformational Fellow at The NARBHA Institute.