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Book Review

The Ethics of Bioethics: Mapping the Moral Landscape

Barry Morenz, MD

Published: February 15, 2010

The Ethics of Bioethics: Mapping the Moral Landscape

edited by Lisa A. Eckenwiler, PhD, and Felicia G. Cohn, PhD. Johns Hopkins University Press, Baltimore, Maryland, 2007, 320 pages, $50.00, $25.00 (paper).

Eckenwiler and Cohn have done the evolving field of bioethics a great service by assembling 25 thoughtful and erudite essays into this excellent book. These essays address questions of where the field emerged from, where it stands today, and where it could go in the future. The authors have varied backgrounds; most have doctorates, and some are physicians or lawyers. The authors are spread across the country in philosophy departments, law schools, history departments, medical schools, and ethics institutes.

Bioethics is a relatively new field with roots in the 1960s during the Vietnam War era, a period of social movements for greater rights for women, blacks, homosexuals, and other disaffected groups. This was also a time of putting a man on the moon and tremendous technological advances, including advances in medicine such as dialysis machines and organ transplantations. With these social and technological advances, a variety of ethical issues arose, such as when you could turn the ventilator off on a dying patient and who should be next on the list for a kidney transplant. The Kennedy Institute at Georgetown University and the Hastings Center in New York were established to try to address the many unprecedented ethical issues that were arising. Organizations such as the Society for Health and Human Values, American Society for Bioethics, and the Society for Bioethics Consultation were created and later coalesced to form the American Society for Bioethics and Humanities, which now has over 1500 individual and institutional members. A diverse cadre of thoughtful professionals including physicians, philosophers, lawyers, clergy, and others were contributing to the growing and important field of Bioethics. Eckenwiler and Cohn’s book fills a need for reflection about a field that is still in development and that can flourish but could become stunted by narrow academic minutiae, political forces, and corporate interests.

The book follows a logical progression, but each of the essays stands alone and the essays do not have to be read in sequence. This is not a textbook of bioethics or a how-to guide, but rather a collection of intelligent essays that ask searching questions about the shape of the field today and what its priorities should be for tomorrow. The book is divided into 6 parts, with the 25 essays spread among the 6 parts. The first part is entitled "Situating Bioethics: Where Have We Been? Where Should We Be Going?" The 2 essays in this section look in some detail into how the field of bioethics emerged over the last 50 years and whether the field should have its own code of ethics as do other applied fields in health care. The second part is entitled "Bioethics and the Problems of Expertise." The 2 essays in this section ask questions about who is a bioethics expert and whether it is desirable to have a professional class of bioethics experts. These essays ask if bioethics experts have some special moral authority and if they should be seen as a kind of secular clergy.

The third part, "Contributions and Conflicts: Policy and Politics," consists of 5 critical essays looking at political aspects of bioethics. These essays consider topics such as how President George W. Bush’s appointments to the President’s Council on Bioethics had an impact on public policy and research priorities in medicine. The essays also debate the complexities of how commissions and committees operate and are subject to subtle influences that render some committees dysfunctional and very narrow. These essays question whether it is time for bioethics to take a more active role in public policy formation rather than contenting itself with academic debate and a focus on the ethics and morality of individual choices. The fourth part, "Contributions and Conflicts: Consultation in the Clinic and the Corporate World," has 3 essays on the perils associated with bioethical consultation to private biotechnology and pharmaceutical companies. The essays ask probing questions about whether disclosure of conflicts of interest is enough for bioethicists to maintain their objectivity. There is also an interesting essay on a unique approach to ethical consultation and patient advocacy in the AbioCor artificial heart trial.

The fifth part has 7 essays. "Integrity" in bioethicists is explored in detail in one essay, and another describes a novel concept of "hospitality" or how bioethicists might want to get more involved in the messy thick of trying to provide for the hungry or those needy children who don’ t have decent foster care. This section asks important questions about whether the field of bioethics should be paying greater attention to issues such as how homelessness and poverty affect people’s health versus a focus on ethical issues raised by nanotechnology or genomics. There is also an essay in this section on mentoring and obligations to future bioethicists. The final part is entitled "Assessing Bioethics and Bioethicists." The 3 essays in this section debate whether there should be some type of standards set for the field of bioethics and whether bioethicists should be certified through prescribed courses and examinations. There are also important questions raised about how the institutions that bioethicists are part of can have a major influence on the bioethicists’ views and priorities.

Anyone with significant interest in bioethics should read this book. It is provocative and stimulating and may help change your views about what is most important for medicine in the 21st century.

Barry Morenz, MD

Author affiliation: Department of Psychiatry, University of Arizona College of Medicine, Tucson. Potential conflicts of interest: None reported.

Volume: 71

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