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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting 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DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse 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Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Character GapThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe 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Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtue of Defiance and Psychiatric EngagementThe Virtues of FreedomThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVoracious Science and Vulnerable AnimalsVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat are you staring at?What Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy Does Inequality Matter?Why I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
In this book Johnson addresses some issues he regards as central to bioethics, including clarifying the concept of a human life, defining where it begins and ends; identifying what it is to be a person; and considering what is good for a person. He approaches these issues by first criticizing some existing concepts and presumptions found in bioethics literature. He argues that some concepts are unclear, which results in a lack of clarity when thinking about bioethical issues. He continues to present some alternative biocentric (life-centred) concepts and argues that these provide a greater understanding of bioethical issues. He defines biocentric as being concerned with life process, coherent effective functioning, and the moral significance of all living beings. He then applies his biocentric approach to specific issues such as euthanasia, abortion, and genetic engineering.
The book is aimed at all who are interested in matters of life and death, not just academic philosophers working on bioethics.
The first section of the book is dedicated to setting out some background to the history of philosophy, ethics, concepts of the good, and language. This will be fairly basic for professional philosophers, but useful background for the more general non-specialist reader.
In Chapter Six Johnson moves towards his positive argument, defining what it is to be alive. He defines life as an ongoing processing of a flow of energy used in self-maintenance and self-organization, within a range of appropriate states, in a high-level response to the environment (p. 132). This seems essentially correct, but there will of course be grey areas where it is not clear whether or not something is alive. He continues in Chapter Seven to use this definition of being alive to ground a conception of what our good is; that is, our good lies in coherently maintaining all aspects of our lives in healthy operating or functional condition. As he rightly points out, ‘healthy’ is a complicated concept, which he characterizes as including not just the physical, but also the mental and social (p. 149). In Chapter Eight he links the concepts of being alive and being healthy to a virtue ethical approach, on the grounds that he thinks ‘affirming’ life is necessary for both a healthy life and an ethical life and that cultivating the traditional virtues are the best means of doing this. By ‘life affirmation’, he means the protection and promotion of the coherent functioning of life (p. 223).
Having defined these central concepts of ‘being alive’ and ‘healthy’, Johnson moves to using these concepts to address specific issues within bioethics. He first argues that death is not normally in a person’s best interests, because, according to his definition, life is an ongoing self-organizing, self-maintaining process and death, of course, ends this process. (pp. 188-212). However, Johnson points out that defining when death occurs is problematic, as some life processes can continue when others have stopped, and there is a difference between the human being alive and the person being alive (pp. 213-222). He argues that in some cases death may be in a person’s best interests and applies this to specific issues such as euthanasia abortion, genetic modification and biomedical research, which he argues can be right when life affirming, protecting the individual from the disintegration of life. His general conclusion is that his biocentric concept of life affirmation will not provide a principle that will decide all bioethical issues, but that it does provide us with a basis for thinking about particular issues.
I am sympathetic to the overall project of arguing that bioethical issues cannot be resolved with the simple application of principles or rules, but I will raise a couple of issues. First, it is not clear exactly how Johnson’s biocentric approach has the advantage over a traditional virtue ethical approach. He in places implies that all the traditional virtues are reducible to the virtue of life affirmation or that the traditional virtues are the means to life affirmation. If the latter, it is unclear how this differs from a traditional virtue ethics, grounding the virtues in the concept of eudaimonia (flourishing). If the former, it is not clear how the reductive account improves on the traditional account. The central issue that needs more thought is how to define health or life affirmation if this is what is grounding the virtues. It is unclear how Johnson’s biocentric account would deal with the objection that although in general the virtues are life affirming, particular actions in accord with a particular virtue may not be, so on what grounds should we do such actions? Although Johnson is happy to admit that the concept of health is indeterminate with no one description it appears that a stronger definition may be needed if the concept is to play this foundational role (p. 362).
Secondly, again, I am sympathetic to the idea that one cannot apply a decision-making procedure to all bioethical issues that may arise and that rather one must assess each particular case. However, it is not clear that this is a practical approach. There are too many issues faced on a daily basis within a medical setting for every single case to be considered individually. This is not an insurmountable problem with Johnson’s biocentric approach as it is not incompatible with his approach to develop an account that derives general rules from his virtue of life affirmation; even if these do not provide a decision-making procedure for every issue, they will provide action guidance in the more straightforward day-to-day cases.
In summary, this book provides an account of how one can approach bioethical issues from a different perspective rather than relying on the common consequentialist or deontological approaches to such problems and will be of interest to those who are dissatisfied with these approaches.
© 2011 Lisa Grover
Lisa Grover is a URC Postdoctoral Research Fellow at the University of the Witwatersrand. Her research interests include ethics, bioethics and moral psychology.
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