The orientation of this collection
is at once encyclopedic, introductory and synthetic. It seeks to be
comprehensive with respect to the range of issues, concepts and dilemmas within
the contemporary field of bioethics.  In
addition, the articles introduce the novice to dilemmas in the contrasting
philosophical approaches to ethics generally as well as their applications to
bioethics. Finally, rather than being confrontational, for the most part the
tone of the articles is synthetic in an effort to balance and unify the
differential approaches to varying specifics within current controversies.

The types of approaches discussed
and evaluated in the context of particular ethical dilemmas include
Aristotelian virtue ethics, feminist-based care ethics, Kantian deontological
‘duty’ ethics, act consequentialism, principalism, casuistry, narrative
approaches, phenomenological and hermeneutic. Two of the more adventurous and
unusual approaches in this field are the narrative and the phenomenological and
these are not often referred to or investigated in such studies.

The narrative approach seeks to understand illness
and healing in terms of stories. In some cases this is comparative as one
relates the story of the patient and of being ill or becoming so to culturally
established normative tales that depict parallels in their journeys. The
dangers here are evident as one can be tempted to blame the victim or one may
find unsuitable parallels which do not aid in the recovery. The story of
illness and healing is significant here as it relates to a broader narrative of
the life of the patient and helps to contextualize and situate the current
issues so as to provide meanings beyond the immediate.

The phenomenological approach is
also a descriptive one but in these cases it seeks to document the experience
of the patient as one undergoes illness, recovery and in some cases dying. At
issue here are not the facts of the illness but the way it is experienced and
this from the standpoint of the patient in particular. Much work in palliative
care seeks to explore this direction but it can be expanded to many other areas
of bioethics generally.

In addition to applications of a
wide variety of philosophical principles and systems to specific bioethical
issues, this text includes articles that address many of the key concepts used
in bioethics today. These include’ the following: informed consent, patient
autonomy, advanced directives and issues related to ethics committees often
used in hospital settings which oversee and assist in patient care and
treatment options. These terms although pragmatic and in use today carry with
them many controversies when explored philosophically and in depth. They are by
no means univocal or self-evident and these articles delve into some of these
controversies.

Finally, in an effort to sum up the
most general and wide-ranging divide explored throughout this work, an analysis
is given of the differences between a scientific approach based on ‘the spirit
of abstraction’ versus a more contemporary one based on ‘description’. The
former is considered the traditional method of the sciences where several
salient features of the topic or field of investigation are abstracted and
analyzed either in an isolated fashion or in relation to the same features
found elsewhere. On this basis science can expand its knowledge and at the same
time use an economy of information by excluding the data or facts that are
deemed either subservient, supplementary or in some way irrelevant to the
research. The process of choosing which features are to be abstracted is
however problematic and can in later scientific experiments be shown at times
to have blinded the research. By contract, the descriptive method of science
used today in such fields as anthropology and geology, for instance, seeks to
describe and observe whatever and all that is available to the researcher. No
foregrounding and backgrounding of the information is done and thus no
abstraction is needed. The phenomenological and narrative approaches in
bioethics are examples of this type of approach as well. What is argued in this
paper is not that one approach should be chosen over the other but that a
synthetic combination of the two is needed so as to generate a new philosophy
of the (whole) person.

If there is one weakness to this
text as a whole it would be the generally uncritical manner in which the
attempt to synthesize all differences of approach undergirds virtually every
article. In some cases, different approaches are reserved and preferred for
particular issues and others for the remainder but simply seeking to balance,
synthesize or unite differences does not fully appreciate in some cases the
radical nature of the divergences. If one does not choose, one also does not
necessarily address the harsh nature of the differences involved here.  To be sure, the text never lapses into full
relativism or absolutism but in always seeking balance and synthesis of
positions it at times fails to face the confrontations needed to advance the
truly novel solutions that still await us.

©
2006 Irene Harvey

Irene E. Harvey, Ph.D., Philosophy
Dept., Penn State University

Categories: Philosophical, Ethics