O. Carter Snead’s What It Means to Be Human dismantles bioethics’ reliance on expressive individualism, tracing its roots to Enlightenment thought and critiquing Roe v. Wade (1973) for framing abortion as a clash of atomized strangers rather than a relational crisis. He argues law must prioritize embodied vulnerability—like tax policies supporting care networks over lethal "autonomy"—and warns against reducing end-of-life decisions to rigid, ableist frameworks, advocating instead for context-sensitive guardianship. The book’s defense of communal ethics challenges modern fragmentation, urging legal reforms that honor mutual dependence over absolute choice. [Automatically generated summary]
So a descriptor that is too often used is thought-provoking.
People say a book is thought-provoking, but actually when something is thought-provoking, it's very powerful.
I just finished a book called What It Means to Be Human, The Case for the Body in Public Bioethics by O. Carter Sneed.
It is a genuinely good book, a book that is changing the way I think about things.
Carter Sneed is professor of law and director of the De Nikola Center for Ethics and Culture at the University of Notre Dame.
This book was called one of the 10 best books of 2020 by the Wall Street Journal, What It Means to Be Human.
Carter Sneed, are you there?
I'm here.
Thanks for having me.
There you are.
First of all, it's terrific to meet you.
I just cannot tell you how much I enjoyed this book.
It really is a deep and interesting book.
And the Wall Street Journal is right.
It's one of the 10 best books of last year, if not more than that.
Let's talk first of all.
Can you explain what bioethics is?
What are we talking about?
Yeah.
Well, bioethics is a field of intellectual inquiry that emerged in the United States in the late 60s and early 70s that relates to the ethical questions that arise from advances in biomedical science and biotechnology and also in the clinical practice of medicine.
The field that I'm dealing with in the book is what I call public bioethics, which is the governance of science, medicine, and biotechnology in the name of ethical good.
So it's the point at which the law and public policy come into contact with these very deep and vexing questions.
So you have this term that you use, expressive individualism, and you say that our laws governing bioethics, the kind of what doctors should do and can do, is governed right now by expressive individualism.
What does that mean?
Yeah, it sounds highfalutin, but it really is pretty, should be familiar, I think, to anybody who is an American in the year 2021.
It's a vision of the human person and human flourishing that grows out of, well, you could read the book.
There's an entire intellectual genealogy that stretches back to Rousseau to figure out where this comes from.
But what the ultimate sort of conclusion is, it's a vision of ourselves and what our thriving is that conceives of us really fundamentally as disembodied, atomized individual wills.
The thing that's most important and essential and defining about you and me is the fact that we are a will or a mind that can formulate future-directed plans, formulate desires, and then configure our life plans accordingly to express them and to configure our lives in pursuit of those goals.
Those goals and those truths come from inside.
That's where the sort of expressivism conception comes from.
It's from interrogating the depths of the interior of the self to find what's unique in there.
And it's not surprising that this really became popular with literary figures in the 18th century.
And there actually is something very deep and important about interrogating the depths of the self to find authentic and original truths.
But the concept of expressive individualism holds that that's all that we are.
Everything else in the world, our relationships with other people, our bodies, the natural world are purely instrumental to be bent and harnessed in service of the projects of the will that come from inside.
Robert Bella, famous sociologist, wrote a book in 1985 called Habits of the Heart, in which he surveyed hundreds of Americans and asked them sort of how they thought of themselves and their life plans.
And he's the one that coined this phrase.
Complex Relationships Involved00:06:21
And he found this kind of very self-centered vision that strips away and abstracts the person from all his or her attachments to family or community or anything.
And that's basically, it's an anthropology.
I mean, it's not in the sort of academic sense, but in the old sense of what it means to be and flourish as a human being.
So can you describe, given like a concrete example, maybe abortion, whatever you want, of how that operates in law?
How does the law use expressive individualism to decide how we should do things?
Yeah, and abortion is sort of the best example.
So, in the context of abortion, abortion law in the United States is made by the Supreme Court.
1973, the court in Roe v. Wade took upon itself the responsibility, really claimed for itself the sole authority to be the arbiter of abortion policies and laws in the United States, which distinguishes us, by the way, from almost every other developed nation in the world where they resolve these questions through the legislative process.
They basically prevented us from doing that in 1973 under a very specious reading of the 14th Amendment, which we can talk about if you want to.
But the more important piece for your question is: how did they invent a right to abortion in 1973?
And the way the court does it, and it's amazing because it really is completely detached from the text, history, or tradition of the Constitution, or even the common law on which it rests.
It's completely made up.
And you don't have to take my word for that.
I mean, Ruth Bader Ginsburg has said as much.
Lawrence Tribe has said as much.
It's basically made up, but because it's such a positive development from their perspective, they're going to defend it to the death.
But essentially, what Justice Blackmun did in Roe v. Wade was to say, I'm going to think about what the context of abortion is and kind of frame it in a very particular way.
And he framed the question in the human context in which abortion arises as a struggle between two strangers, two individuated strangers, a mother who's clearly a person under the law, and something less than a person under the law, but clearly another individual, namely the unborn child, atomizes them, that is, abstracts them from their natural context, their natural interrelationship, and says, okay, what we have here is a conflict between two individuals, one's a person, one's not,
over scarce resources, the body and future of the mother.
How do we resolve this problem?
And they said, well, there must be a right to abortion somewhere in the Constitution.
They had this kind of concept of a right to privacy, which they created in 1965 in the context of Griswold v. Connecticut, a case about abortion, or sorry, about contraception used by married couples.
And they said, the burdens on a woman to her pursuing her open future are so significant, not just from the pregnancy, but from the parent, from unwanted parenthood itself, that we have to derive this right.
This right must be present in the Constitution.
And what does that right look like?
Well, when you frame the question as a struggle between two strangers fighting over scarce resources, including the body of one of the two parties, the answer you get is a right to lethal violence, a right to use lethal self-defense against the intruder that has no right to use your body and to imperil your future in that way.
And that is directly, I mean, that grows out of a conception of human personhood and human flourishing that is expressive individualism.
Again, radical individuated wills in struggle with one another to pursue their open futures, as opposed to the reality of the situation, which is a very complex and messy intertwining of two lives, but not any two lives, the lives of mother and child.
And if we reframe the question that way and say abortion is the human context in which abortion arises is in fact a very complex scenario involving a mother and her child, sometimes a tragic scenario, well, what you and I do in that situation or what the law does is not grant one of them a right to use lethal violence against the other one, but rather we strop what we're doing and we rush to the aid of that mother and child in crisis, right?
Any decent person, any decent community, any decent government is going to seek to help a mother and child in crisis.
Whereas if all we're talking about are two strangers fighting over something that really belongs to one of them, we're talking about violence.
So I want to get back to that concept of the decent society in a minute.
But before that, how is the idea of the body involved in this?
The fact that we are not floating wills, we are in fact flesh and blood and we're incarnated.
How is that involved in this decision?
So, expressive individualism as a theory of what a person is, is it fails?
I mean, as I said a moment ago, there are some truths in it, right?
We are individuated.
We do have free will.
It is valuable to interrogate the depths of ourself and to be original and so on.
But that's not the whole truth about who we are.
In fact, the whole truth of who we are is that we are a dynamic union of mind and body, that our bodies are essential to our identity.
And there are essential entailments about our lived reality because we're embodied beings.
We're fragile, embodied beings in time.
And in fact, our embodiment, I argue, situates us into a kind of relationship to one another because we are bodies, not just have bodies that are instrumental, but we are bodies.
It's essential to our identity.
We're vulnerable, which means we're mutually dependent upon one another, which means we're subject to natural limits, which means that there are certain that we are situated in these relationships that require, first for our survival as new babies, but also to learn the thing that we're supposed to be, which is to become the kind of person who can make the good of another our own good.
We depend on what Alistair McIntyre calls networks of uncalculated giving and graceful receiving.
Networks of people who are willing to make the good of others their own good, not expecting anything in return, but because that's what it means to be and flourish as a human being.
And the most pristine and obvious example of this is the parent-child relationship.
A parent doesn't take care of her child because she has a contract to do it or she has some prior obligation that she signed and gave her consent.
It inherent in the relationship itself that parents take care of children.
And similarly, children don't have to earn the right to be cared for by their parents or even to make it more dramatic, not to be killed by their parents because what it means to be a child to be in that kind of relationship is to have unchosen obligations and unearned privileges.
And those are entirely invisible to a theory of what it means to be a person, namely expressive individualism that only thinks of us as individuated wills out to seek our own future.
Law's Role in Generosity00:04:27
You know, one of the things that bothered me while reading the book, it didn't bother me about the book.
It bothers me about the world.
But I didn't feel it was addressed in the book.
You talk about this Alastair McIntyre, and we're both enormous fans of McIntyre.
His book After Virtue is a life-changing, brilliant piece of work.
You talk about his idea of this generosity that we sort of learn as parents, that we expect from parents, and that we need a society that has that kind of generosity in a moment when, for instance, a woman finds herself pregnant and doesn't want to be pregnant.
We need to rush to the aid of both the mother and the children.
What do you say to someone who says, we don't live in that world?
If we live in a small community of like-minded people, you know, of people who share the same religion like the Mormons in Utah or the Jews in various places, they will turn to each other for help and receive that help.
But in this kind of big, sprawling, multi-ethnic, untrusting society, how can we make laws as if we live in this better world?
How do you, as a bioethicist, as a public bioethicist, how do you make a law for that moment?
It's a great question.
And I would say, as a lawyer and a law professor, I think that law bends and shapes culture and law bends and shapes understandings of people.
And the fact since 1990, abortion is not the only problem.
It's not the only reason we don't take care of each other the way that we should take care of each other.
But it does, in fact, shape behavior in the sense that if a woman, by virtue of the Supreme Court's interpretation of the Constitution, says, you're the sole arbiter of this situation, that creates a kind of momentum in the direction to isolate and leave and to abandon that woman.
I mean, how many times have you heard, I mean, you know, Dave Chappelle saying, you know, women should have total right to abortion, but a man shouldn't have to pay for anything.
That was an unbelievably interesting, subversive joke that he made in that recent comedy special that he did.
And it was a hush sort of fell over the room because people were cheering for the robust, unfettered freedom of abortion.
And then he said, But men should have not any responsibility at all.
It's good because it's her choice.
The law bends people's understanding.
The law shapes people's understanding.
And I think the law can do a has a pedagogical function that we need to attend to.
The law can't make people love each other, obviously, right?
But what the law can do is to sort of condition and shape our understanding of what we owe to each other in different ways.
And in fact, I think the law can create private spaces for private ordering and can incentivize certain forms of private ordering through, I mean, there's a whole, this would require a whole lot of thought to go into it to sort of articulate a comprehensive vision, but yet the law can create spaces where organizations like the Little Sisters of the Poor can actually take care of the elderly poor.
We can have, you know, we can have the revise the tax code.
We can do all kinds of stuff.
What I'm arguing for in the book doesn't necessarily commit us to an interventionist governmental solution to like make people be friends with each other, right?
Because as I say, the fundamental point of the book is by virtue of our embodiment, we're made for love and friendship.
And I think I'm making a claim about human nature that it's unnatural for us to retreat into these kind of private spheres, you know, augmented and made even more toxic by social media and virtual reality in a pandemic where we're not supposed to touch each other or look at each other, be within six feet of each other.
I think that the law has a role to play in shaping hearts and minds.
And it already has in a negative way in the context of abortion by telling people that you have a constitutional right and not just do you have a constitutional right, but in fact, it's sort of normatively good to exercise that right.
And we see this in the branding: shout your abortion, unapologetic.
I mean, there's not even any kind of sense that abortion is bad in those in those elite quarters.
I think people still have a sense that it's bad.
I mean, it's still a big deal when there's an abortion on television, right?
And Maude was a big deal when the abortion.
I mean, you can see in popular culture, we're still a little bit skittish about the idea of killing an unborn child.
I mean, getting more so, you know, we're talking about the book, What It Means to Be Human: The Case for the Body in Public Bioethics by O. Carter Sneed.
Really interesting, very well written, too, by the way, very clear in talking about some very complex ideas.
The law can be pedagogic, but the law is also a blunt instrument.
You talk about decisions about death, about assisted suicide.
Decisions About Death00:05:53
And I've been in hospitals and have seen with my own eyes that the doctors will come in or the nurses will come in and say, you know, we're going to up the, every hour, we're going to up the amount of morphine to make sure he's comfortable.
And what they're really saying is we're going to kill him.
We've run out of hope.
We can't do anything.
We're going to put him out of his misery.
And I've always feel that there's this kind of gray area that the human heart can go into that the law can't reach.
How do you feel that your idea of the embodiment of embodied ethics deals with end-of-life decisions?
Where do you come out on this?
Yeah.
So the fundamental point that I make in the book across all three areas, abortion, assisted reproduction, and end-of-life decision-making, is that the law, in assuming that we are simply disembodied wills who are seeking to pursue our open future that we discover inside ourselves through introspection and abstracts us and isolates us from all connections and is actually false, right?
Like even people who seek abortions, even people who pursue various forms of assisted reproductive technologies, or even people want to seek assisted suicide, I'm not talking about them, right?
I'm not talking about their impulses, their views of themselves.
I'm talking about the law's assumptions about who they are, what the threats to them are, and what they need.
And in the context of end-of-life decision-making, the law, unfortunately, especially in assisted suicide, but it seems to be true also in simple questions of declining life-sustaining measures.
The law assumes what a person needs in that setting is to maximize their autonomy, right?
But as you've seen in hospitals, a person who's sick, a person who's dependent upon life-sustaining measures, generally is not hoping to maximize their autonomy and assert their unencumbered self.
They want help, right?
They're vulnerable.
They want help.
They want someone to take care of them who either loves them or who has their best interest at heart, who's trained as a professional to do it.
And so the one-size-fits-all momentum in the favor of binding yourself to some set of preferences that you articulate in a document that are applied after you've lost consciousness or the capacity to participate in your own decision-making is insufficient, right?
I mean, that's important.
It's important to honor people's wishes, but it's also important to have a person who accompanies them in those moments to try to make decisions that benefit the patient that this person is.
And the most sort of dramatic example of this, it was a fictional example in the book, but I've seen real examples of it coming out of the Netherlands.
You have a case where people sign an advanced directive when they're legally competent to do so, saying, if I ever get dementia, I don't want any life-sustaining measures.
I don't want antibiotics if I get pneumonia, right?
Something very easy, non-invasive, non-burdensome, not expensive.
And then they get dementia.
They fall into advanced stages of dementia and they are living a life which we would recognize as diminished.
They can't recognize people, but they seem happy, right?
They're talking to people.
They draw the same picture.
They listen to the same song, but they seem happy.
Then they get pneumonia and they say, I need something.
Can you please make me more comfortable?
And you say, okay, what do I do?
Do I honor the patient this particular individual is or do I just bind them unreflectively to this prior memorialized expression of their intention?
And the argument is, if all we care about is autonomy and the expressive individualism and the unencumbered self, we simply bind them to that prior statement.
But if we're more nuanced and we say, okay, by virtue of this person's defects of the body, they can't participate in their decision-making anymore.
What's the right way to help this person?
Is it simply to unreflectively apply this statement?
Or is it to actually take into consideration the person they now are, what their needs are, what their wants are, et cetera, et cetera.
And that requires a living person.
And so that's why, as a practical matter, I argue for durable powers of attorney who will be informed, of course, by prior statements like that, to try to make those kinds of complicated decisions.
But I also say it's really important to restrain ourselves from the temptation in those settings when we're making a decision for another person to project our lives as a healthy person into their particular state, because we're very bad at predicting how we will find meaning in diminished phases of our lives.
There have been all kinds of very interesting social science studies showing that we were bad at predicting how we'll react.
We're even worse at predicting how someone else should react, which is why disability rights organizations are very nervous about and generally opposed assisted suicide, because they worry that able-bodied people are going to make decisions for them to try to hasten their death in a way to try to end a life that they deem not to be worth living.
And that is too dangerous, in my judgment, to go down that pathway, which is not to say that the law should scrutinize and there should be a cop in every room asking how much morphine you've given them.
Why are you discontinuing life-sustaining measures?
The law is pretty granular.
And we've made the decision to allow decision makers and families to have the freedom to make choices about how to make these kinds of decisions about their loved ones and their end-of-life decision making.
And I think that that's a good thing.
I think it's good that we're not so invasive and we don't have the district attorney in the room with you when you say, well, why are you pulling the plug?
Is it because you want his inheritance or because it's a feudal or burdensome thing?
And there's a great Simpsons episode where Mr. Burns comes in and says, Homer's in the bed.
He's like, this man is costing me $5,000 a day.
I insist he die with dignity.
And so that's what we want to avoid.
Now, assisted suicide is different, right?
You can simply not authorize the direct self-killing of people and prescriptions.
I'm more comfortable with the government saying no to that than I would be with the district attorney in every room making decisions and scrutinizing the decisions of families.
I got a million more questions, but I'm out of time.
Unfortunately, the book is What It Means to Be Human, The Case for the Body in Public Bioethics.