Medical Ethics - Study Materials

The bioethics of H. Tristram Engelhardt, Jr. presents a challenge. On the one hand, his grasp of this moment in the history of philosophy, the post-modem period, and its impact on the intersection of morality, medical practice, and public policy is incredibly precise. On the other hand, his direction for the remedy -- a philosophical position anchored in the choices of mutually consenting, rationally developed adults -- and, as a consequence, some of his particular conclusions are seriously flawed. In both his direction for the remedy and in the particular conclusions his work resembles the rule of the irascible Queen of Hearts in the Wonderland Kingdom encountered by Alice in her journey through the looking glass. In his general position, Engelhardt constructs a community in which only fully developed, self-conscious human beings count as persons, while in her domain the Queen permits only red roses. Engelhardt allows the conferral of personhood on lesser humans by fully developed, self-conscious human beings and the Queen allows the non-red roses to be painted red. In his conclusions, Engelhardt, like the Queen, wants to deliver the sentence -- death -- before he allows for the sufficient examination of the evidence and the determination of the verdict.

In his response to the contemporary moment, Engelhardt takes up the task of fashioning an ethic for biomedical problems that can speak with rational authority across a plurality of moral viewpoints present in this historical period which, in his view, is post-Christian, post-scientific, and post-humanist. In the absence of faith and the failure of reason to discover a content-full moral framework, Engelhardt articulates his theory, "The Will to Morality" which, he claims, provides "a moral framework that can be shared by moral strangers in an age of both moral fragmentation and apathy."¹ The central notions that constitute the matrix of "The Will to Morality" are the following:

• (1) a content-full secular morality cannot be discovered;
• (2) we are moral strangers;
• (3) peaceful negotiation is the only possible way to secure a general moral framework;
• (4) only human beings who are autonomous, i.e., fully developed, rational, and self-conscious are persons:
  • (a) personhood is a matter of accomplishment;
  • (b) only persons are bearers of rights in the strict sense; and
  • (c) human non-persons are vulnerable.

While Engelhardt is partially correct in regard to (1), (2), and (3), his philosophy of person (4) is inaccurately framed and inadequately developed. This paper will briefly respond to the incompleteness of (1) and (2) and, then, will develop a more complete response to (4), the inadequate philosophy of person. From within the context of these responses, a more structured matrix will be fashioned to facilitate and to direct (3), the negotiation of the possible peaceful community. The response suggests that human beings live their lives in various relationships and in varying degrees of dependency. And it further suggests that if there is to be peace, the vulnerable are in need of protection. In summary, Engelhardt has an inadequate epistemology which results in an incomplete metaphysics which yields an improper ethics.

Engelhardt moves too quickly from his assessment that a content-full secular morality cannot be discovered to the conclusion that there is not some content available to be discovered. Two notions need to be developed here. One has to do with the activity of reason; the other has to do with the objects of reason. Between an understanding of the role of reason as limited to discovering "the already out there now reality" and an understanding of the role of reason as empowered to construct reality there is a middle position. The middle position holds that sometimes reason discovers and sometimes reason creates. Reason is directed, and sometimes constrained, in constructing by that which reason discovers, that is, reason is fettered to truth. Reason is guided in discovering and creating by its own method -- the ongoing, recurrent, related, cumulative, corrective set of operations employed in every cognitional enterprise yielding results that are cumulative and progressive.² This method moves from experience, to inquiry, to understanding, to judgment. It moves from the quid sit question that initiates inquiry to the an sit question which demands verification and does not rest until that verification is accomplished.³ It is this method which guides human inquiry within a horizon that has expanded beyond the classical worldview of the past to the contemporary cultural moment with its historicist context. This method does not guarantee the possession of truth but lays out a path toward truth not as certain knowledge of the necessary, the essential, the universal, but as the probable affirmation of the particular and concrete.

In regard to possible concrete objects of reason, there are, between the emptiness of abstract heuristic guidelines such as "do good; avoid evil" or "be a peaceable member of a willed moral community" and the richness of content laden particular moral traditions such as that which can be found in the narrative schools of thought, specific markers to be discovered which place limits on and give direction to moral theory. Engelhardt has developed one -- the will of the autonomous rights-bearing isolated individual. There is at least one other. This marker lies in our nature as related beings. It is the source of the principle of beneficence and the activity of intersubjectivity. Furthermore, it lies latent in Engelhardt's treatment of mutual respect, of beneficence, and of intersubjectivity. This being-in-relation counters Engelhardt's categorical claim that we are moral strangers and attenuates his elitist philosophy of person. While we are moral strangers in one sense -- in the sense that we are holders of different moral traditions whose possible points of convergence we have chosen to ignore -- there is another sense in which we, as related beings, are not moral strangers. We exist in real relationships to one another. And from these specific relationships to each other, concrete duties to each other arise and are defined. In addition, the human beings who anchor these relations possess individual identity, that is, their lives do not receive definition only in terms of the relations. They have significance in themselves quite apart from the relationships. An adequate moral theory attends both the beings who constitute the relationships and the link which defines the relationships. Engelhardt misses the linkage entirely and errs in his segregation of some human beings who anchor specific relations into classes of person and non-person.

Human relations vary. Some are quite close -- even intimate. Some are distant -- so distant that it takes a concerted effort to experience them. Some are problematic; some are so effortless as to appear natural. Some of these relationships are physical; some are moral. Some are freely chosen; others occur without choice. Some are symmetrical; others are asymmetrical. Some of the more obvious relationships are those of husband and wife, mother and fetus, parent(s) and family, family and community, physician and patient, attorney and client, experimenter and subject, teacher and student, the community of scholars . . . membership in the world community. These relationships suggest definition and give content to our responsibilities and duties. These relationships limit and structure the activity of "the willing" in peaceful negotiation. It is our existence as related beings that is the source of our traditions of community and hospitality, of mutual respect, and of liberty as ordered. These relationships constitute the links in the web of sociality. Insufficient attention to these links provides only a partial sense of reality. And we are guilty of insufficient attention to these links.

An examination of human lives as embedded in relationships suggests the following: (a) autonomy is always a limited accomplishment achieved over time after a long period of dependency and often followed by another period of dependency; (b) living the rich human life often places human beings in asymmetrical relationships of varying degrees of dependency throughout life; (c) autonomy is constrained by the relationships which define one's life; and (d) relationships to others sometimes require the acceptance of disadvantages for the sake of the other.

This understanding of human life as woven in relationships gives direction, even substance, to the negotiation of the guidelines for the peaceable community. In the absence of a common moral authority, in the absence of the discovery of a final, rational, canonical perspective, and in the presence of individuals whose limited autonomy is temporary and defined by specific relationships, we, who live together, must both create and discover solutions to the moral problems we encounter. Whether or not we choose to solve our moral problems is dependent on our choice -- hence the "will to morality" is crucial. However, the deliberation that guides the will must be informed by the reality discovered. The goals of peace and the emergence of the community require great protection for those who are dependent. Those who have achieved relative autonomy or those who exercise specific autonomy are required to protect those in conditions of dependency. Here the values of care, nurture, and relation, espoused by some feminists have a powerful role to play. This same observation has also been made by communitarians such as Mary Ann Glendon who wrote in Rights Talk:

As mothers and teachers [women] have nourished a sense of connectedness between individuals, and an awareness of the linkage among present, past, and future generations. Hence the important role accorded by many feminists to the values of care, relationship, nurture, and contextuality, along with the insistence on the rights that the women's movement in general have embraced. Women are still predominately among the country's caretakers and educators and many are carrying insights gained from these experiences into public life in ways that are potentially transformative. Their vocabularies of caretaking are important sources of correctives to the disdain for dependency and the indifference to social bonds that characterize much of our political speech.⁴

Knowledge of human relations and the beings who are the terms of the relationship does not depend on belief in a creator God as the source of nature as normative. Furthermore, knowledge of these relationships does not depend on a privileged intuitive power to recognize a nature as morally normative. Knowledge of these relationships and their terms arises from the concerted and ongoing work of experience, inquiry, understanding and judgment, followed by more experience, inquiry, understanding, and judgment. Knowledge of the relations and terms provides a foundation to derive prescriptions from descriptions in the same way that knowledge of the role of a quarterback offers direction to the aspiring athlete or the knowledge of the role of the Snow Queen offers guidelines to the fledgling ballerina or knowledge of the nature of the heart offers direction to the surgeon.

Pregnancy provides an example of human lives embedded in relationship. The relationship is constituted by two human beings variously described as woman and fetus or mother and child. They exist as really related to each other. An adequate morality requires that attention be directed both to the relationship and to the beings who constitute the relationship. Directing attention to the relationship reveals the union to be asymmetrical. Directing attention to the beings in the relationship reveals an isomorphic symmetry, that is, each related being is a human being at a particular point on the human development trajectory.

Examination of the pregnancy relationship reveals several things. There is a physical union -- a union of being. There may be a moral union -- a union of purpose. That there is a physical union there is no doubt. However, this relation is more complex than most physical unions. If it were a kind of relationship that characterizes most physical unions, that is, a relationship of whole to part where the part is not necessary for the continuation of the whole and where it may be the case that the part threatens the life of the whole, there would be very little to discuss. However, since pregnancy is a temporary relationship between two physically whole human beings, one immature and the other more mature, a more complicated set of questions arises.

This temporary physical union is also a moral union -- a union of purpose. Neither of the human beings who constitute the relationship is determined to accomplish the totality of existence within this relationship. Since each of the two entities has meaning outside the relationship, then the discussion of problems within the relationship cannot be resolved only in the limited examination of the relationship. The woman is a relatively autonomous being. Her life is characterized by a set of ends that extend beyond the pregnancy. For the duration of the pregnancy the fetus is a radically dependent being. While the growth and development of the fetus is intrinsically directed, the continued existence of the fetus is possible only within the nurturing environment supplied by the woman. The accomplishment of the ends of the fetus which lie outside the pregnancy require the cooperation of the woman. When the union is chosen either explicitly or implicitly, its status and the obligations of the more powerful member are less problematic from an ethical perspective. The more powerful accepts the disadvantages which occur for the sake of the more dependent. When the union occurs without implicit or explicit consent a more problematic relationship is constituted. The obligations that arise from a nonvoluntary relationship are a function of the need fulfilled by the relationship and the status of the beings who constitute the relationship. In attending to that relationship as a physical union the appropriate question may be: what obligations might be claimed to arise where the life of one human being is so radically dependent on the other for such a limited period of time? In attending that relation as a moral union the appropriate question may be: what limitations may be placed on the activities of the more powerful when they find themselves in relationships that are not of their own choosing? Attending those questions might defuse the prevailing rights-claiming and rights-trumping that marks the contemporary abortion debate and might facilitate peaceful negotiation. However, the approach to these questions requires more knowledge of the beings who constitute the relationship. And it is here that Engelhardt' s philosophy of person enters into the discussion.

When Engelhardt turns his attention to the beings who form the bases of the relationship, he applies his philosophy of person to them. In that philosophy, he segregates human beings by degrees of autonomy into categories of personal human life and non-personal human life. His core claim is that only human beings who are fully developed, rational, and self-conscious are persons. The elements that shape his view are (a) personhood is a matter of accomplishment; (b) only persons are bearers of rights in the strict sense; (c) human non-persons may have rights conferred upon them by human persons; and (d) human nonpersons are vulnerable. When applied to the beings involved in the pregnancy relationship this means that the woman is a person and the fetus is a nonperson. The woman may be a bearer of rights and the fetus has rights only if the woman so chooses.

This philosophy of person with its division of human beings into two classes -- "[p]ersons, not humans, are special"⁵ -- and with its claim of significant moral difference -- "[a]dult competent humans have much higher intrinsic standing than human fetuses or adult frogs"⁶ -- receives a multifaceted defense. The defense is tied to the principle of autonomy and it derives from Engelhardt's assessment of the fetus in terms of potentiality and probability. An exposition of Engelhardt's defense will be followed by a response to its inadequacies.

To be a person, Engelhardt claims, one must be autonomous. Only autonomous beings are capable of mutual respect. The constitution of a moral community requires personal beings. The required characteristics for the status of person are "self-conscious, rational, free to choose, and in possession of a sense of moral concern."⁷ Those who do not have these characteristics are non-persons. Engelhardt says: "[f]etuses, infants, the profoundly mentally retarded and the hopelessly comatose provide examples of human non-persons. Such entities are members of the human species. They do not in and of themselves have standing in the moral community."⁸ And, even more forcefully, he says:

[I]t is nonsensical to speak of respecting the autonomy of fetuses, infants, or profoundly retarded adults, who have never been rational. There is no autonomy to affront. Treating such entities without regard for that which they do not possess, and never have possessed, despoils them of nothing. They fall outside the inner sanctum of morality.⁹

In developing his position, Engelhardt chooses the language of potentiality and probability to frame his dismissal of the fetus from the category of personhood. He presents an undifferentiated understanding of potentiality with a distinction between abstract and concrete potentiality, between material continuity and substantial discontinuity, and a deficient discussion of probability.

Engelhardt presents potentiality as a rather simple affair. If one is potentially something, then one is not yet that something. It is an all or nothing affair. He says: "[i]f fetuses are potential persons, it follows clearly that fetuses are not persons . . . If fetuses are potential persons they do not have the rights of persons."¹⁰ By way of analogy he argues that "if X is a potential president, it follows from that fact alone that X does not have the rights and prerogatives of actual presidents."¹¹

In describing the fetus as possessing abstract potentiality, he contrasts the potentiality of the fetus with the concrete potentiality of the sleeping person. In this limited discussion of concrete potentiality versus abstract potentiality, framed in terms of states of consciousness, he says:

[T]he potentiality of the sleeping person is concrete and real in the sense of being based upon the past development of a full blown person. Unlike the fetus, the sleeping person has secured the capability of being fully human and has exercised it in the world. Far from a promissory note, the potentiality of the sleeping person to awaken is presented in concrete actuality in the physical substratum of that person, in his intact and functioning cortex. In this case the concept of person and personal presence depends heavily upon an intact normally developed brain; it presupposes some doctrine of the concomitance of mental personal life with an appropriate physical substratum. Further it requires recognizing the singular role of this intact substratum in weaving together the otherwise discontinuous life of the mind. . . . The discontinuity of sleep...is bridged and woven together in mental life.¹²

Further, he maintains that the human person emerges from the human animal in a process best described in terms of material continuity and substantial discontinuity. This discontinuity, Engelhardt claims, is based on the development of new properties. He says: "it is easier to construe the situation as a development from biological properties to personal properties with a consequent and substantial change in the significance of the bearer of properties."¹³

Finally, in his application of the notion of probability to preborn beings, he claims that because research reveals that forty to fifty percent of human zygotes do not survive to become fully developed self-conscious rational human beings, it is more appropriate to consider the human zygote a 0.4 probable person.¹⁴

When one becomes a fully developed self-conscious being one gains significance and becomes a bearer of rights which may not be transgressed. Before one accomplishes such significance, one is not a person in the strict sense. However, rights for non-personal humans may be socially derived, that is, rights may be bestowed on human animals by the activity of already existing human persons on the basis of a utilitarian or consequentialist calculus. In setting value to non-personal human life, Engelhardt says:

The value of animal life which is not the life of a person, must be determined by other persons. . . The value of an animal's quality of life is thus set by persons in two senses. First, if the animal has no developed conscious life, persons may find no intrinsic value in such life and the predominant value may be the value that the life has as an object for persons. Second, even if the animal has an inward life that in a prereflective sense has a value for that organism, persons must still compare the value with other competing values.¹⁵

Engelhardt's demarcation of biological human life from personal human life as determined by the relative accomplishment of autonomy and other characteristics of personhood is artificial, arbitrary and, even more, it is elitist. Its central error lies in his construal of the notion of potentiality. Potentiality does not simply describe a "have" or "have not" state of affairs. Potentiality is a rich notion with an ancient pedigree. Its legacy continues to the present.

The fetus is a human being in act. Within that being resides the potentiality -- active natural remote potentiality -- to become a more fully developed human being who may achieve a degree of autonomy or may accomplish whatever characteristics are used to define personhood. A nuanced explication of potentiality requires attendance to the distinctions of potentialities as active/passive, as natural/specific potentiality, and as remote/proximate. In active potency the being goes from not acting to acting and is also the agent of the action; for example, the human being may develop or go, by its own agency, from being not conscious to being conscious. In passive potency, a human being has the capacity to receive a modification but the agency of the modification is an external agent. The present reality of the fetus in relation to the adult human being is not that of passive potentiality which requires extrinsic agency for actualization. In the act that is the fetus there resides the active natural potentiality to become a more fully developed human being. Engelhardt's example of the potential presidential candidate who becomes president and enjoys presidential privileges is an example of a passive potentiality, that is, the extrinsic agency of the voters is required.

There are two distinct factors that make up the notion of active potentiality. One is constitution or nature and the other is tendency.¹⁶ The fetus is, by its constitution, determined as a human being and is, by tendency, determined to become -- in a fashion prefixed by its constitution -- rather than not. Since the tendency of the fetus in regard to fuller human development proceeds in a completely determined manner and since it cannot become something other than what the constitution determines it to be and since it cannot of itself not become, it may be said that the potentiality of the fetus for more fully developed human life is an active potency.

Active potentialities are designated either natural or specific. In the accomplishment of an active specific potency, the agent has a degree of freedom in the actualization of the potency. The agent may specify the manner in which to actualize the potency. Active natural potencies are accomplished in a completely determined manner. The agent is not free to choose whether or not to actualize the potency. In addition the agent is not free to specify the manner in which to actualize the potency. Factors external to the agent, such as the destruction of the normal environment or dismemberment, can inhibit the actualization but the agent cannot inhibit the actualization.

A further distinction is made between those potentialities which may be designated remote and those which may be designated proximate. This distinction is a function of time and development. The presence of the proximate potentiality allows the possibility of immediate realization. The presence of the remote potentiality allows the possibility of future activity and future realization. However, the remote precedes the proximate and is the necessary condition for the existence of the proximate in terms of both constitution and tendency. The proximate is the further developmental specification of the remote. In regard to specific functions characteristic of more developed stages of human life there exist in the fetus the remote potentialities which specify the proximate potentialities necessary for action. In the chromosomal material, there is all that is necessary -- in a relatively unachieved state of affairs -- for the becoming of the neocortex which serves as the proximate potency for higher mental processes.

These distinctions suggest the inadequacy of Engelhardt's position. Engelhardt's distinction between the concrete potentiality of the sleeping person for human activities and the abstract potentiality of the conceptus for human activities is a strange distinction. On one hand, it seems to embody the distinction used in medical practice in problems which arise in the allocation of scarce resources when the decision is to be made between the patient that the physician knows and has treated and the similarly situated patient whom the physician does not know and has not treated. The former is perceived as concrete, while the latter patient is perceived by the physician as abstract. On the other hand, the concrete/abstract distinction seems rooted in the person/personal consciousness distinction, that is, one is a person so long as one is conscious of oneself. From the perspective of the first distinction, the reality of each patient is the same; the difference lies in the relation of the physician to each of the patients. From the perspective of the second distinction, Engelhardt appears to be reducing the person to personal consciousness. He mistakes an attribute for the whole. He makes consciousness the determinant of the person, rather than viewing human beings as persons who have the capacity to be conscious. That is, human persons are beings who are (1) sometimes conscious, that is, accompanied by the awareness of the self as a subject, (2) sometimes conscious with the awareness of the self as an object, and (3) sometimes (a) in act -- as the fetus or as the sleeping person or as the person under anaesthesia -- or (b) in action -- so immersed in a problem or an activity or an encounter -- that awareness or consciousness of self is lost. These different states are states of one being who continues throughout the states. This condition has been described as:

The conscious life of the person is not the whole person; it is that in which the being of the person is actualized and this implies that a person is more than consciousness and that his or her body is to be distinguished from consciousness.¹⁷

From both perspectives, Engelhardt's analysis suffers from an inadequate notion of potentiality and from a lack of appreciation of the reality of the fetus. The fetus, or even earlier, the embryo or zygote, does exist and in its act resides the potentialities that may be actualized in the life of the individual. The potentialities are not in action but are present nonetheless. They may be abstract on the side of the observer but they are real and therefore concrete on the side of the fetus. In order for the activities of the higher central nervous system to be possible in the adult human being the cerebral cortex must be present (proximate potentiality). In order for the cerebral cortex to be present in the adult it must be present (remote potentiality) in the conceptus.

The description of the fetus as "an animal with great promise of becoming more than just an animal"¹⁸ suffers from the same inadequacies as the distinction between abstract and concrete potentialities, namely, an inadequate perception of the reality of the fetus and an inadequate notion of potentiality. The possibility of the fetus's becoming a human being, i.e., Engelhardt's fully developed self-conscious person, is more than just a promise. By virtue of its active natural potency, "which is a guarantee of the future insofar as the agent is concerned,"¹⁹ the fetus will develop itself (tendency) into an adult human (constitution).

Engelhardt' s questioning of the appropriateness of identifying the "what or the who that the fetus is" with the "adult 'who' which develops out of the fetus" is framed in terms of material continuity and substantial discontinuity. If there is discontinuity it seems appropriate to inquire as to the source of the properties of personal life and the subsequent change in the significance of the bearer of the properties. If discontinuity is maintained, the source cannot be the fetus. Engelhardt does not designate a somewhere or a someone else. His difficulty seems once again to stem from his impoverished notion of potentiality. For example, he maintains, "The genetic basis for the development of the physiological substratum of consciousness is not yet that substratum."²⁰ The genetic basis for the physiological substratum of consciousness may not yet be that substratum, but it is not nothing. It is not a simple case of have or have not. It, the genetic basis, is that from which will develop the physiological substratum of consciousness. In the genotype there is the remote potentiality -- an active natural potency -- that is the necessary condition for the emergence of the proximate potentiality -- the physiological substratum -- of consciousness. Personal properties are present in the reality of the conceptus, a being who is in the process of building a body of a particular kind, but whose organs are not yet in operation. This reality has been described in this fashion, "it would be proper to say that it is an actual human person with a body whose full development is already in dynamic process."²¹

Finally, in Engelhardt's discussion of probability as it relates to the possibility of the human zygote's being born, he confuses predictions of the future with descriptions of present states of existence. He fails to distinguish between classical laws and statistical laws. Classical laws describe regularities -- a one to one causal relationship . . . "other things being equal."²² An example of a classical law in operation is syngamy -- the union of the human sperm and the human ovum with the restoration of the diploid number of chromosomes along the mitotic spindle which marks the beginning of a new human life. Here there is an anticipation of invariance, the mark of a classical law. Another is the law of gravity -- the anticipation of constant velocity. Statistical laws relate to probabilities, that is, assessments based on relative actual frequencies. The statement that only forty percent of fertilized ova survive to be born may be used to formulate a probability statement, that is a statistical assessment of the likelihood that a fertilized ovum will survive to be born. It says nothing of the nature of the surviving being. What one might conclude from this probability statement is that existence is precarious at this period in one's life. At the other end of the life continuum, it may be the case that only forty percent of those who reach the age of seventy-five live to be eighty. That does not make those who are now seventy-five only 40% persons. It simply means that those who have reached the age of seventy-five are rather vulnerable in a statistical sense.

Engelhardt's distinction between human biological life and human personal life is an artificial distinction without adequate philosophical foundation and cannot serve to segregate human beings into categories of non-vulnerable rights bearers and vulnerable non-rights bearers for the purpose of killing the vulnerable. The status of personhood as a matter of conferring value should include all members of the human community regardless of their degree of development. A more adequate philosophy of person holds that (a) all human beings have value, that is are rights bearers; (b) the human community is constituted by some humans who are dependent and some humans who are relatively autonomous; (c) autonomy, which is preceded and followed by states of dependency, is a matter of relative accomplishment; (d) the accomplishment of the peaceable community requires that dependent vulnerable beings, including the conceived but not yet born, be protected. The application of this philosophy of person to the physical union and the moral union of the nonvoluntary pregnancy would require the recognition that the relationship is constituted by two human beings possessing value. Each human being endures a degree of dependency. The woman is dependent on the larger community; the fetus is dependent on the woman. Care of both seems the appropriate response of the peaceable community.

And so, finally, sufficient attention to evidence changes the verdict and stays the death sentence for dependent vulnerable human beings.

Notes

{1} H. Tristram Engelhardt, Jr., Bioethics and Secular Humanism (Philadelphia: Trinity Press International, 1991), xi.

{2} Frederick E. Crowe and Robert M. Doran, ed., Bernard Lonergan, S. J., Insight: A Study of Human Understanding (Toronto: University of Toronto Press, 1992).

{3} Lonergan, Insight: A Study of Human Understanding.

{4} Mary Ann Glendon, Rights Talk (New York: Free Press, 1991), 174.

{5} H. Tristram Engelhardt, Jr., The Foundations of Bioethics (New York: Oxford University Press, 1986), 104.

{6} Engelhardt, Foundations, 104.

{7} Engelhardt, Foundations, 105.

{8} Engelhardt, Foundations, 107.

{9} Engelhardt, Foundations, 108.

{10} Engelhardt, Foundations, 111.

{11} Engelhardt, Foundations, 111.

{12} H. Tristram Engelhardt, Jr., "The Ontology of Abortion," Ethics 84, 3 (1974): 217-34.

{13} Engelhardt, "The Ontology of Abortion," 225.

{14} Engelhardt, Foundations, 111.

{15} Engelhardt, Foundations, 111.

{16} Gerard Smith and Lottie Kendzierski, The Philosophy of Being (New York: The Macmillan Company, 1961), 105.

{17} John F. Crosby, "The Personhood of the Human Embryo," The Journal of Medicine and Philosophy 18 (1993): 407.

{18} Engelhardt, "The Ontology of Abortion," 225.

{19} Francis Wade, "Potentiality in the Abortion Discussion," Review of Metaphysics 29 (1975): 245.

{20} Engelhardt, "The Ontology of Abortion," 226.

{21} Joseph T. Mangan, "The Wonder of Myself: Ethical -- Theological Aspects of Direct Abortion," Theological Studies 31 (1970): 130.

{22} Lonergan, Insight: A Study of Human Understanding, 88.