Bioethics Forum Essay
An Evergreen Metaphor: Strachan Donnelley, Dan Callahan, and Environmental Ethics
As I was watching the devastation that Hurricane Ida left behind, it struck me that my friend, the late Strachan Donnelley, was right. Strachan, the third president of The Hastings Center, was an unabashed proponent of a larger vision of bioethics beyond the medical ethics paradigm, which so dominated much of the Center’s work and bioethics writ large. In Strachan’s view we were more than patients–and doctors. We were creatures embedded in nature. And nature, not the hospital or the clinic, should be the object of our inquiry as bioethicists. We were bigger than that and part of a far bigger ecosystem.
When Strachan hosted his project meetings on humans and nature, biologists, philosophers, and policymakers convened at the Center. These folks were unknown to us Hastings regulars, except to Strachan and his colleagues Bruce Jennings and Greg Kaebnick, who worked closely with him. Their discourse was different and their concerns seemingly esoteric to the rest of us Hastings staffers. They discussed everything from endangered snakes to land use and biodiversity.
It wasn’t the usual cast of bioethics characters whom we all knew well and whose names were recognized in the articles and texts we had read and sometimes critiqued. And they seemed, at least then, to be a field apart with distinct methods and concerns. They were easily dismissed by most bioethicists as being on the fringe.
The friendly disciplinary schism between what I’ll call the traditional versus the naturalist bioethicists is illustrated by what may be an apocryphal bit of Hastings Center lore. The story involved Strachan and Dan Callahan, his predecessor as president, and the disposition of a huge evergreen on the Center’s great lawn overlooking the Hudson River. It’s a magnificent specimen, tall and thin and over a hundred feet tall. But it obstructed the river view. Dan thought it should come down. Strachan disagreed. It was a tree in nature and should remain. Strachan prevailed and the tree survived.
He wasn’t as lucky with humans and nature. That work remained on the periphery of the field of bioethics. Even though Strachan and his naturalist colleagues were true to Van Rensselaer Potter’s 1970 definition of bioethics, which linked value choices to ecology. Nonetheless, Donnelley and his concerns were on the margins, often dismissed by many mainstream bioethicists.
Clearly most of us were wrong. With over two decades of hindsight, I must confess that I wish I had paid more attention to what they were talking about. It seemed like niche bioethics at the time, far less pressing than the dramas I was negotiating in the hospital. But clearly, I was wrong. Strachan and his clan of naturalists were doing work whose relevance today is clear.
The prescience of their deliberations is now obvious amid pressing concerns about climate change and the pandemic. Despite all our technical advances, these past months have revealed that we are in nature and not apart from it. We have been victimized by a single-stranded RNA virus, strong winds, and, depending on whether you live in New Orleans or in Nevada, subjected to too much or too little rain.
I thought of Strachan after reading a front page article in the New York Times about the flooding in Louisiana after Hurricane Ida. The piece was poignant for its mix of triumph and tragedy. The good news was that the $15 billion levees built to protect New Orleans after Katrina held. The city was spared the extreme flooding that had crippled it 20 years earlier. The bad news: only the city was protected. Outlying less populated rural areas were inundated. Those rural parishes, already impoverished and living on the edge, were devastated. Their poverty was long-standing and the consequence of structural forces associated with race and class. The flooding they sustained was a consequence of the same and more recent decisions about levee placement–utilitarian choices necessitated by limited resources. Not everyone and everything could be saved and protected.
As much as this is an ecological challenge, the language of priority-setting sounds a lot like typical bioethics discourse. Who lives and who dies? What can be accomplished with prevention and more levees? And if more are built, how do we set priorities with limited resources? This was a focus of Dan’s and The Hastings Center’s work in the 90’s when places like Oregon were trying to set limits to contain health care costs and increase access to care. Indeed, Setting Limits was one of Dan’s most important books.
Applying all this to the environmental triage that we will inevitably have to do is not a big leap. Which neighborhoods or parishes will live or die? Which ones will be protected with levees, which will go unprotected? Are these choices any different than who is being protected against Covid-19 by vaccination and who remains vulnerable? The choices are eerily familiar.
I wish Dan and Strachan were here to have conversations about environmental triage. It would be a more consequential discussion than whether the tree behind the Center would live or die. Dan would have warned against putting too much faith in technology to get us out of this fix. He would suggest that we need to clarify our goals – establish a telos — before we embark on an allocation scheme. But it would have been Dan with a new twist: in the last years of his life, he developed a sense of urgency about the environment. He had written about climate change as one the Five Horsemen of the Modern World, his last book, published 2016. Notably in June 2019, weeks before he died, Dan convened his last Hastings Center meeting on exploring what bioethics could do to mitigate the threat of climate change. Strachan would have been thrilled, but he still would have cautioned us not to bet against nature. He would have urged us consider natural remedies to climate change. Instead of more levees, might the long-term restoration of wetlands be a sounder choice?
The evergreen behind the Center still stands and now a lovely bench sits under its lofty branches dedicated to Strachan’s memory. It’s a good thing. In the coming debates over environmental triage and distributive justice we will need both Strachan’s and Dan’s legacies to make wise choices, not to mention the shade offered by a majestic tree that still blocks the view of the Hudson.
Joseph J. Fins, MD, is the E. William Davis Jr. M.D. Professor of Medical Ethics and a professor of medicine at Weill Cornell Medical College and a visiting professor of law at Yale Law School. He is a Hastings Center Fellow and a member of its Board.