Sophie’s Choice is a movie starring Meryl Streep. It is based on a novel by William Styron written in 1979. In the movie version, Sophie played by Meryl Streep must choose between the lives of her two children, son Jan and younger daughter Eva, while they are imprisoned in the Nazi concentration camp at Auschwitz. She is presented with an impossible choice. Sophie must choose one child to live and go to a concentration camp while the other would go to certain death by being gassed. There is no time to decide. She must quickly make her choice. The Nazis don’t permit a possible choice of Sophie making a decision where she can go in place of one of her children. If she doesn’t decide, both children will be killed. She chooses Jan to go to the concentration camp. Later she indicated that she felt in the moment that Jan was stronger and would be more likely to survive in the camp. Eva goes to her certain death. This decision has to be made in seconds.
This scenario is the prototype in ethics of the most difficult decisions that have to be made. It defines ethics as being about choiceless choices, choices that have to be made when we would rather have a sense of more real choice. Notice there is key factor that Styron places as the context of the decision. There is no time. Sophie must make her choice on the spot. The choice also involves a family.
One of the classic bioethics decisions that a mother had to make was similar to Sophie’s choice. A mother learns that she has cancer while she is pregnant. She is given a choice between receiving chemotherapy which would cure her and the fact that the chemotherapy would cause her unborn child to be aborted. In this case, the mother chooses the life of the child who is born, and the mother died shortly after the birth.
This kind of difficult choice occurs when an organ transplant is needed by an older parent and the only candidate to be the organ donor is a younger member of the immediate family. Should age play a role in the decision? Notice the above examples involve a parent and a child which is the context for the most difficult decisions. The family context adds an intensity and difficulty to ethical challenges.
We have seen this played out today in three areas of ethical concern, one is regarding vaccinations, one is regarding what is currently happening to Afghanistan families, and the third involves front line workers. Most parents that I know would give up their lives to save the life of their child which adds another emotional component to the decision.
What has been the decision-making process for parents who decide not to be vaccinated and put the life of their children at risk? What has gone into the decision-making of families who will not have their children vaccinated? In what may be the most unbearable of decisions are those made by medical people and others on the front line as they wrestle with their Hippocratic Oath to take care of those who require their services and being responsible to their families at home during the pandemic? Whether it is a doctor, teacher, or grocery store worker, they fear bringing that virus home.
We read about the Afghanistan families who must turn over their children who are girls to much older men in marriage to receive payment so that the rest of the family could be saved from starvation. Some of the girls are as young as seven. It is Sophie’s Choice in a different context.
My point is that ethics achieves an even higher level of intensity and struggle when it happens in the context of family life. Decisions that are unbearable become even more unbearable.
I saw this trauma first hand when the Head of the Science Department at EA and I took 24 faculty to the Penn Center for Bioethics one summer for a two-week crash course in bioethical decision making. When the course was completed, I asked how the faculty felt about the experience. Their response was two-fold. They indicated that their eyes were opened to a new way of making difficult decisions and “they were depressed as hell.”
When ethical decisions of life and death need to be made, particularly with family issues, we can, in the words of a song by Tom Petty, feel as though we “stand at the gates of hell.” I know this because I and many others have stood there.
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