One day Daniel Callahan accompanied his friend Paul Desjardins to the dry cleaners. As they were leaving the shop, Desjardins, a World War II veteran working on a doctorate degree in philosophy, turned to Callahan, an 18-year-old student at Yale, and asked, “How do you think I did?” The befuddled Callahan stammered, “What do you mean?” “Well, did I treat the laundry man in the right way?” Desjardins asked.
Callahan had no idea what his friend was talking about. “But the point is it was one of my first experiences with ethics,” Callahan said. “One had to think about how one lived one’s life, even at that trivial level. Of course, Paul Desjardins didn’t believe it was trivial. He thought it told a lot about you as a person in that encounter.” At the time Callahan was attending Yale on a swimming scholarship and philosophy was about the furthest thing from his mind.
In his senior year he took a course in the work of Thomas Aquinas, the great twelfth-century Catholic philosopher, taught by John Courtney Murray, S.J., a prominent theologian and intellectual. It changed the direction of his life: Callahan decided to become a professional philosopher.
After serving three years in the U.S. Army, Callahan earned a graduate degree in philosophy at Georgetown University. In 1955 he married Sidney deShazo, a psychologist. Together, the couple had five children.
A Journalist Philosopher
“Originally, I thought I wanted to teach philosophy but I discovered I didn’t like teaching much,” Callahan, 79, said. Instead, he combined philosophy and journalism and went to work in 1961 at Commonweal, the Catholic journal of religion and politics.
While at Commonweal, he and an impressive cadre of Catholic thinkers and writers engaged the secular culture in a robust discourse on the political and moral issues of the day. They included Peter Steinfels, Wilfrid Sheed, Michael Novak, John Leo, with occasional articles by Thomas Merton, Dorothy Day, Eugene McCarthy, Michael Harrington and Leon Kass.
Over the next seven years he wrote 300 editorials, 30 articles, and nine books covering a wide range of social, political and religious issues and concerns, albeit from a decidedly Catholic viewpoint. In 1968 Callahan, then executive editor, decided to leave the distinguished journal. It proved to be a double departure: he also walked away from his faith, a step that caught family and friends by surprise.
In a 2005 Commonweal article Paul Lauritzen described Callahan’s loss of faith as a slow, gradual process. “He found himself losing a sense of the mystery and wonder of the faith,” Lauritzen said. “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.” [1]
By the late 1960s Callahan had become attracted to emerging ethical issues in the converging fields of medicine and biology, which were being driven by rapid advances in biological research, medical technology and pharmaceutical therapies. These controversial topics included abortion, contraception, genetic counseling, organ transplant, population control, and sterilization.
“People kept bringing up these issues,” he said. “They were popping up all over the place in magazines.” But Callahan has been fixated on health care since childhood.
“As a child in the 1930s, I spent a good deal of my time in the offices of doctors and operating rooms of hospitals,” he said. “For reasons I never learned, I was subject to recurrent infections, which went from my arms and legs to my lymph nodes. The only cure in those days was to lance the nodes and allow them to drain. Time and again I was dragged, screaming and struggling, to an operating room where an ether mask was forced over my face; the sense of smothering was palpable. I awoke, vomiting, to face weeks of bed rest and painful daily changing of bandages.” [2]
A Research Center Is Needed
Although eager to work on biomedical issues, Callahan realized he needed a research organization to help him achieve his ambitious goals. Unfortunately, one didn’t exist.
“So between 1967 and 1969 I got the idea of creating the Hastings Center,” he said. With funding from the National Endowment for the Humanities, the Rockefeller Foundation, and several individuals, he and his neighbor psychiatrist Willard Gaylin founded the organization in 1969.
The field was so new it even lacked a name, although it would acquire the hybrid designation of “bioethics.” In those days theologians held center stage in dealing with the ethics of medical dilemmas. Two of the most prominent were Joseph Fletcher and Paul Ramsey. But bioethics soon became secularized as more philosophers, social scientists and lawyers entered the field, and it’s not a change Callahan welcomes.
“Bioethics today is out of step with much of American culture, despite its emphasis on individualism,” he said. “It overvalues biomedical progress at the expense of what it means to be human.”
Over the past 40 years Callahan has become one of the foremost thinkers in the U.S. on biomedical issues and the Hastings Center is one of the preeminent research centers of bioethics in the world. During this time Callahan has explored some of the most difficult and controversial ethical problems of modern medical progress. His concerns about fair and equitable health care, patient safety in clinical research, and compassionate care of the dying are just a few of the thorny issues he has grappled with in some of the 41 books he has written or edited.
Heretical Ideas
In one seminal book, Setting Limits: Medical Goals in an Aging Society, Callahan cautioned against spending precious financial resources to extend the life span of the very elderly at the expense of the entire health care system, in particular improving the health care of the very young.
He believes we need a health care system that balances sensible aspirations with sensible limitations. “The proper question is not whether we are succeeding in giving a longer life to the aged,” he said. “It is whether we are making of old age a decent and honorable time of life. Neither a longer lifetime nor more life-extending technology is the way to that goal.” [3]
Of course, some critics say he unfairly targets the elderly.
In another seminal book, What Kind of Life: The Limits of Medical Progress, he cast a cold eye on technological advancement. “The very nature of medical progress is to pull to itself many more resources than should rationally be spent on it, often more than can be of genuine benefit to many individuals, and much, much more than can be socially justifiable for the common good.” [4]
For example, Callahan believes it is no accident that during the past 30-40 years of unprecedented growth in health care spending public school education has deteriorated. He believes underfunding of public education is one reason why American students have fallen below, often well below, test-score averages in science and mathematics compared to students in a number of foreign countries.
Ironically when Callahan wrote What Kind of Life in 1990, health care spending was about 11.5 percent of gross domestic product (GDP). In 2008, the United States spent about 17 percent of its GDP on health care. It is projected that the percentage will reach 20 percent by 2017. [5]
Again, critics cry foul, claiming he seeks to turn back the clock on medical progress.
Confusion over Ends and Means
Callahan believes health care reform is misfocused on means and not ends. “Most people go after the problem as if it were a management problem: if we could just organize things better, get it more efficient, get rid of the waste, then we could have perfectly successful health care,” he said.
“We have accepted a view of medicine that is infinite in its aspirations and as a result we’re unable to set limits or boundaries of any kind. I think we need to learn how to do that and to me that requires a revolution in how we even think about health care.”
The revolution Callahan has in mind would redirect the misguided course of modern medicine. For starters, he would scrap health care’s current, faulty paradigm. “I sometimes talk of an ‘infinity model,’ and this infinity model means that however healthy we are we keep raising the standard of health,” he said.
“The net result is we’re constantly dissatisfied with the state of our health. We always want more. First of all, this desire for more creates lots of economic problems. One reason we need reform is because we have this outlandish ambition without any goals of final success. Secondly, we have a misleading view of ourselves, of our human nature, that we want this type of endless progress.”
Callahan suggests that endless medical progress distorts our view of ourselves. It treats dying and death, not as the last stage of growth and a natural phase of life, but as an embarrassing failure.
The motive behind endless medical progress may be our deep-seated fear of death. “[A]s long as I can buy this to fix that, I sustain an illusion of permanence,” said Arthur W. Frank. “So long as there is more to buy, whatever needs fixing will be fixed, and I will continue to be.” [6]
Given American’s love of technology and progress, Callahan admits sparking a revolution in health care is an uphill battle. “But it’s a battle that needs to be fought,” he said.
Today, Callahan is Senior Research Scholar and President Emeritus of the Hastings Center. He served as the Center’s President from 1969-1996. He is also a Senior Scholar at Yale. Callahan has honorary degrees from the Charles University in Prague, the University of Colorado, Williams College, Oregon State University, the State University of New York, and the University of Medicine and Dentistry of New Jersey.
Looking back on his life, Callahan said he hopes he is remembered as “someone who trained in philosophy, became interested in problems of modern medical progress, and believed that modern health care required a fundamental revolution in its own self concept.”
Endnotes
1. Luaritzen, Paul. “Daniel Callahan & Bioethics: Where the Best Arguments Take Him,” Commonweal, Vol. 134, June 1, 2007, p. 2
2. Callahan, Daniel. What Kind of Life: The Limits of Medical Progress.“(Washington, DC: Georgetown Unversity Press, 1990), p. 21
3. Daniel Callahan. Setting Limits: Medical Goals in an Aging Society. (Washington, DC: Georgetown University Press, 1984), p. 224
4. Callahan, Daniel. What Kind of Life: The Limits of Medical Progress.“(Washington, DC: Georgetown Unversity Press, 1990), p. 9
5. Keehan, S. et al. “Health Spending Projects through 2017.” Health Affair Web Exclusive W146: February 21, 2008.
6. Frank, Arthur W. The Wounded Storyteller: Body, Illness and Ethics. (Chicago: University of Chicago Press, 1995), p. 86
Copyright © 2009 by Vince Reardon
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August 31, 2009 at 10:17 am
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