The ethics of scientific research
is certainly a topic of common interest for ethicists and philosophers of
science alike, even if many among them still adhere to Merton’s conventional
wisdom about scientists being communitarian, universalist and disinterested
agents. In other words, not particularly controversial (and even rather
exemplary) from a normative standpoint. The advancement of biomedical research
ethics, among other disciplines, shows that the pursuit of truth might not
always be morally virtuous, as this collection of case studies illustrates at
length.

Timothy Murphy has drawn cases from
various sources that sometimes go far beyond our ordinary understanding of
bioethics in order to achieve a thorough view of the normative dilemmas
involved in biomedical research. Of the nine chapters of the compilation, three
address general bioethical issues in the context of clinical research
("Informed consent", "Embryo, Fetuses and Children",
"Genetic Research"); two other ones present more circumscribed topics
(such as "Oversight and Study Design", "Selection of
Subjects", "Use of Animals") and another three explore frontier
domains: "Conflicts of Interests", "Social Effects of
Research" and "Authorship and Publication". Tracing such a
wide-ranging disciplinary map counts among the most significant achievements of
this book.

The book is explicitly intended as a "text
for instruction" and this certainly accounts for its organization. Each
chapter compiles on average 15 case studies, which adds up to 150 cases. Each
of these is normally kept to a one-page length, and is presented with an
introductory paragraph signaling its point, a couple of references citing
sources or further readings when necessary and a few questions intended for
discussion. Most cases are already known (some are indeed classical), though a
reasonable proportion is relatively new. Most of them are real and, save for a
few exceptions; almost all are drawn from the wide realm of biomedical
research. Each chapter opens with a brief introduction that summarizes the
dilemmas covered in the cases subsequently presented. There is also a general
introduction in which Murphy briefly covers the development of biomedical
research ethics and provides some considerations about the utility and risks of
case-based discussion.

The proof of a textbook is always
use in class, so at this point I can only offer a very preliminary assessment.
The instructor should take into account that the information provided in each
case is most often just a summary restating the case from the original source
with a view to emphasize the implicit moral dilemmas. These are now easier to
grasp for the student, but some additional background may sometimes be
necessary to illustrate its real complexity — or just to bridge the cultural
gap with a non-American audience. The cases are presented without ethical
guidelines for discussion: no particular normative stance is assumed by the
author (nor on the part of the reader), so a certain familiarity with a number
of moral doctrines is a pre-requirement to make a fruitful use of this text.
These and other minor caveats aside, we may expect it to become a very useful
reference for future courses.

What I miss is a more explicit
discussion of the connection between what we may consider positive medical
science and the associated normative dilemmas. Once we assume, as the author
does, that clinicians may often act as self-interested agents, sometimes as
plain rent-seekers, we should consider to what extent the various methodologies
applied in medical research are immune to their particular bias. It has been
noticed, for instance, that a certain correlation exists in clinical tests
between the source of funding (public or private) and their result (for or
against new therapies). Should we strengthen the procedures of statistical
review to protect the public against some private interests? In spite of its
status as the golden rule of clinical research, randomization has been severely
contested by Bayesian statisticians on a purely methodological basis, and this
certainly would have an impact on the patients when it comes to granting
informed consent to take part in a test: should we make the statistical
foundations of our methodology explicit for them? Normative dilemmas in
biomedical research provide indeed a good opportunity to reconsider its
scientific status and reassess the underlying positive/normative dichotomy that
often separates bioethicists and philosophers of science.

© 2005 David Teira

David Teira, Ph.D., University of Salamanca, Spain

Categories: Philosophical, Ethics