Biomedical Ethics

I am guessing that this book is targeted at middle school students.  I am pretty sure that my eleven year-old daughter could read this book and understand most of it, but I think my ten year-old might be lost.  Anyone over eighteen reading this book should be bored.

            On the one hand, I want to applaud writing a book on philosophical issues directed toward the youth of today.  There simply isn’t enough material out there that challenges teen-agers to think critically about their lives or their environment.  Writing about issues in biomedical ethics should be especially important since it is becoming increasingly impossible to live a modern life without having to make some sort of sophisticated, controversial, and difficult decision about one’s own or a loved one’s health.  I’m glad someone has taken the time and effort to try to reach an important segment of our society.

            That said, I have to say that this book is pretty bad.  It covers what the author takes to be the most popular issues in biomedical ethics today: research on animals, informed consent, organ transplantation, genetic testing, gene therapy, and human cloning.  Striking in their absence is any discussion of end-of-life or beginning-of-life issues.  This is particularly unfortunate, since these are the sorts of issues most likely to touch us today.  Whether I should clone myself might be a decision I have to confront many years down the line (though I doubt it), but whether and when I should disconnect the life-support systems from a relative or whether and when I should discontinue a pregnancy are decisions that are becoming almost mundane.  It would have been nice had the author tried to give her readers some tools to think about these items.

            But my largest complaint concerns how the topics discussed are handled.  This book, as are all the books in the Greenhaven Opposing View Digest series, is written by a single author, who is supposed to outline the pros and cons of whatever topic the book covers.  In this particular case, the author writes one chapter articulating one position concerning, e.g., informed consent, and then follows the chapter with a second one, articulating the opposing view.  This might be a good way to proceed if (1) the presentations were equally thoughtful, germane, and balanced, and (2) the author did not give her own position away.  In this book, we find arguments largely off-topic (and generally highly inflammatory), and each section concludes with the author stating her position authoritatively.

            There is a pattern of argumentation throughout this book (the exception is the final chapter, which I will discuss below) that I find particularly distasteful. I shall illustrate argumentative strategy by looking at O’Neill’s treatment of medical research using human subjects.  In the “pro” chapter, O’Neill rightly points to the past successes of using human subjects in refining drug use for all sorts of ailments.  She discusses the history of informed consent and how such a procedure should avoid exploiting anyone.  So far, so good.  In the “con” chapter, though, she outlines three cases where informed consent allegedly failed.  One is a case in which a subject had a serious, chronic, adverse reaction to the drugs ingested; the second is the notorious Tuskegee syphilis study; and the third is a proposed AZT study on pregnant African women.  I have problems with using any of these examples to discuss the morality of informed consent.

            In the first case, the subject was informed of all the risks and he agreed to them.  No one is suggesting that he was mistreated in any way.  While I am deeply sorry that he had and continues to have an awful time, his situation is exactly what informed consent is all about.  He knew and appreciated the risks and then decided that they were acceptable.  One might want to argue that any risk is too great, but then of course, the first patients who receive any drugs would then just form the group of human “guinea pigs.”  Medical treatment is not without risks, but my view is that it beats no treatment on average and over the long run.

            The second case, while well known and horribly tragic, took place before any official policies regarding informed consent were dreamed of.  This does not excuse what happened in Macon, but it does rule out using this case to discuss the morality of current incarnations of our policies regarding consent. 

            Finally, since the third case is a proposed study and the author never tells us whether the drug company sought informed consent nor whether the women consented to the trial procedures, we have no way of evaluating the example.  If the company didn’t seek consent, then – like the Tuskegee case – this example would fall outside the purview of the discussion.  If the company did seek consent, but the women didn’t give it, and the company ran the experiment anyway, then again, the case would fall outside the scope of the chapter.  If the company sought consent, the women gave it, and then the company issued AZT as a prophylactic against AIDS in unborn children, the case might fit the profile needed for the chapter’s discussion, but without knowing what the outcome of the trials were, it is hard to know what to say about the case itself.

            On the basis of these three examples, O’Neill concludes that “the regulations for medical research must be made much stronger, and failure to follow them should lead to a severe penalty” (p. 38).  Huh?  How did she arrive there? 

O’Neill doesn’t say, just as she doesn’t say how she can conclude “since animal testing is an inhumane process, its results are unreliable, and effective alternative experimental methods are available, medical use of animal testing should be banned” (p. 28).  And she comes to this conclusion after detailing in the previous chapter all the successes science has had through using animal models in its experiments!

            O’Neill’s strategy of arguing that while in theory – or even in practice – something might be a good idea, it also might be abused by people with evil intentions, therefore that thing should be banned is beyond conservative.  Worse, it is a bad philosophical argument.  What she says is true: evil people can figure out how to abuse just about anything.  But that fact, in and of itself, doesn’t persuade me of much.  At the least, we would have to know how likely such abuses are and then do some sort of cost-benefit analysis to decide what to do.

            But the worst aspect of this book is that O’Neill doesn’t even follow her own argumentative strategy consistently.  The final chapter concerns the morality of cloning humans.  Surprisingly, she comes out in favor of such a thing (even though she is against genetic testing and gene therapy), noting that potential benefits might outweigh any potential harms.  Her final conclusion is that we might get benefits from human cloning that we haven’t even dreamed of yet!  Of course, she is right, but why wasn’t this argument just as applicable in the chapters on genetic testing or gene therapy'  They might give us untold benefits -- things we can’t even imagine yet -- but she thinks we shouldn’t pursue them.

            I am disheartened by the poor quality of argumentation in this book.  I worry that such is the level of discussion in middle schools around the country.  I hope not, and I take comfort in the fact that most of the children I know would recognize the bad arguments for what they are before they got too far in them.

© 2002 Valerie Gray Hardcastle

Valerie Gray Hardcastle, Ph.D., Program in Science and Technology Studies, Department of Philosophy, Virginia Tech