The American Journal of Bioethics

The title of Jane Maienschein's (2002) perceptive article "What's in a Name" alludes to Juliet Capulet's well-known reflections on naming. Juliet was tragically aware that names are more than just names, "Romeo, Romeo," she protests, "wherefore art thou 'Romeo!' Deny thy father and refuse thy name!" "Romeo" is caught in what philosophers call a nomonological network. His is a Montague name. Like all names, it divides our world into dichotomous but interconnected categories. Names are important, not only in Shakespearean tragedies but also, as Maienschein details in her analysis of our evolving definitions of blastocytes, clones, embryos, and pre-embryos, in scientific and public policy. How we name things affects matters of life and death.

From Charles Sanders Peirce to Hilary Putnam, pragmatists hold that the nominological nets we cast upon the world represent our own interests and needs as much as they do the nature of the world. "Juliet" and "Romeo," are gendered names because the feminine-masculine divide is important to humans--and, of course, because they are, in fact, female and male. Because nominological nets mirror both the world and our interests in it, pragmatists argue that we must ensure that the interests served by nominological nets are democratic, pluralistic, and, to underline the core pragmatist insight, useful. In these comments I contrast this pragmatic approach to an approach that, for want of a better term, I call ontological. Ontologists hold that nominological networks ought to mirror differences in the world independently of our needs and interests.

These two contrasting approaches to nominological networks become significant when social or scientific change obsolesces accepted nominological networks. In 1819, for example, René Laennec invented the stethoscope, thereby opening the way for a definitive determination, prior to quickening, of an independent fetal heartbeat. This, in turn, undermined the older Aristotelian embryology, which portrayed prequickened fetuses as vegetative, becoming animate and rationally ensouled only post quickening. According ontological status to the new embryology, in 1869 Pope Pius IX reformulated it in moral theology, jettisoning, in the process, the biologically obsolesced distinction between formed and unformed fetuses He also proclaimed first trimester abortion a serious crime and an excommunicable offense.

Pius IX's ontological approach contrasts with the pragmatic approach taken by Pope Pius XII. This case of nominological destabilization was inadvertently initiated in Copenhagen, in 1954, when anesthesiologist Bjorn Ibsen invented the mechanical ventilator to save the lives of adolescent patients during a polio epidemic. By exporting respiratory functions to a machine, the new invention became the first in a series of innovations (closed chest coronary massage, heart-lung machines, etc.) that destabilized cardiopulmonary definitions of death. As early as 1957, Austrian anesthesiologist Bruno Haid petitioned Pius XII for guidance about a new definition of death for irreversibly "unconscious" ventilator patients. The Pope's answer was pragmatic, "Normally, one is held to use only ordinary means [to save life]--according to the circumstances of persons, places, times, and culture." Pius XII observed further that definitions of death were "not within the competence of the church" (Pius XII 1977) This observation set the stage for the 1968 redefinition of death by the Harvard Ad Hoc Committee to Examine the Definition of Death. Like Pius XII, the Ad Hoc Committee offered primarily pragmatic reasons for redefining death: the burdens irreversibly comatose patients place on families, the demand for the ICU beds they occupy, and the legal impediments to transplantation raised by "obsolete criteria for the definition of death."

The Ad Hoc Committee's pragmatic redefinition of death appears successful. The definition is accepted in law and medicine, legitimating transplant operations and the disconnection of the ventilators of brain-dead patients. By acknowledging that science's nominological network lies outside the competence of the Church, Pius XII made peace with science, focusing the Church's moral authority on defending the principle of respecting human life--once life's boundaries had been drawn. In contrast...