For those familiar with the first edition, it should be no surprise that Blackwell’s Companion to Bioethics 2^nd Edition remains the standard for any student, instructor or layperson interested in bioethics.  For those unfamiliar with it, this Companion, comprising 13 sections and 49 articles, provides a comprehensive overview of the field.  The articles range from introductory material on the relation of bioethics to other facets of life like law and religion, to substantive questions about abortion, euthanasia, and brain death, as well as several new topics, specifically those related to global bioethical issues.  Of the 49 articles, at least 10 are new or substantially revised from the previous edition.

After a brief historical introduction by the editors, the first section analyzes the relation of bioethics to normative ethical theory, culture, gender, religion and law.  Eric Gregory’s newly included piece, “Religion and Bioethics,” is representative of this section and argues convincingly for a fruitful dialogue between the two fields, highlighting the importance that religious thinkers and ideas play in secular bioethics discussions.  My only reservation about Gregory’s piece is his focus — admittedly so — on the Christian tradition.   At times, he tends to reinforce rather than problematize commonplace and perhaps superficial differences between Catholic and Protestant ethical stances.

Overall, Blackwell’s companion is well-balanced and consistent.  Most of the collection is accessible to a wide range of audiences, although some exceptions do exist.   For instance, R.M. Hare’s piece on Utilitarianism, which is a classic and tersely argued piece, strikes a bit of a discordant note due to presupposing some familiarity with the theory.  It also lacks an overview and survey of the literature that the other normative summaries provide.  Justin Oakley’s article is a good contrast as it not only provides an illuminating, clear and concise account of virtue ethics; it also includes a comprehensive survey of the literature as well as the leading critiques of virtue ethics.  Oakley also directly connects this normative account with its importance to bioethics, citing and discussing numerous virtue ethics accounts applied to issues in bioethics.

Hare and Oakley’s articles are good examples of the section that provides a summary of several important normative ethical theories.  Also included in this section are articles on a deontological approach, care approach, principle-based approach, and a case-study approach.  Barring Hare’s piece, most of these articles illustrate the strengths and weaknesses of each normative approach and connect this directly to the study of bioethics.  These preliminary sections provide enough background for novices but are also worthwhile for those with a good grasp of the theories, in particular by pointing out important recent developments in each approach.

Sections IV-XVIII focus on particular topics in bioethics, including pre-birth and reproductive issues, euthanasia, genetics, health care, organ donation, experimentation on humans and animals, and concludes with a section on the practice and teaching of health care.  As this companion shows, bioethics is not only alive and strong, but growing in sophistication and breadth.  A number of new and important issues in this second edition address genetic enhancement, health care, and infectious diseases.

Julian Savulescu’s “Genetic Enhancement” should be praised for its accessibility and scale.  Savulescu’s efficient sorting of a significant quantity of recent scientific research is impressive.  As Savulescu points out, no longer is genetic enhancement a part of science fiction:  “there is no reason in principle why we could not create humans with the vision of a hawk, the hearing and smell of a dog, the sonar of a bat, the balance and grace of a cat, the speed of a cheetah…” (220). Genetic enhancement has become a live possibility, and this provides just one example of how new technology creates new moral dilemmas.  Many people have a general aversion for genetic enhancement and find it morally reprehensible.  But when critics of genetic enhancement attempt to formulate a position for why enhancement should be impermissible, most of their arguments are weak and unsubstantiated and rely on a normatively loaded account of what is “natural”.   This leads Savulescu to dismiss these intuitive and emotional responses and argue strongly in favor of pursuing genetic enhancement. 

Kevin Outterson and Donald Light’s “Global Pharmaceutical Markets” and Michael Selgelid’s “Infectious Disease,” although less vigorously argued than Savulescu’s piece, provide a more balanced overview of their particular debates.  Both articles involve questions of justice and distribution.  The former presents the emerging problem of cost and distribution of life-saving pharmaceuticals to an economically unequal world.  The latter is a welcome contribution to an often-overlooked and ignored problem in bioethics, one that the author quite rightly claims should be at the forefront of bioethical debates simply due to its “almost unrivaled” consequences in terms of “morbidity and mortality” (430).  Both pieces illustrate the way bioethics has expanded beyond more localized issues like euthanasia and abortion, to cover global health issues and their potential consequences.

A new article by Florencia Luna and Ruth Macklin, “Research Involving Human Beings” follows this trend in looking at the global implications of research on human subjects.  Ethical guidelines for human research has been an area of bioethics since its inception, but Luna and Macklin’s article goes beyond these debates by focusing on the ethical implications pertaining to research in developing countries.  Research in developing countries can often benefit those countries in numerous ways; for instance, by directly aiding the participants in a given study and by bringing beneficial drugs to these markets faster.  At the same time, questions of justice arise concerning whether there exists a ‘double standard’ between developed and developing countries.  Since the standards of normal treatment can vary tremendously between countries based on economic factors of each, this then effects the permissibility conditions of experimental design (463).  Furthermore, differences in cultural practices affect basic procedures of informed consent and full disclosure, making research more difficult and the possibility of exploitation that much greater in certain research settings in developing countries.  The authors offer no real solutions to these problems, but highlight how the reality is much more complex than is often assumed, and bring to light new challenges that the globalized health market creates.

Several other articles deserve recognition.  Michael Tooley’s discussion of personhood is thorough and well-articulated.  Since the concept of the person is so central to numerous issues in bioethics, the article bears re-reading.  Fortunately, Tooley carefully lays out the various positions in the debate and clearly explains what is at stake.  John Harris’ “Deciding Between Patients,” Raanan Gillon and Daniel Sokol’s “Confidentiality” and Roger Higgs “Truth-Telling” also deserve acknowledgment, since these issues and their implications apply to a variety of different scenarios and the presentation in each piece is clear and forceful. 

The last two articles of the collection aim at more practical considerations.  The first piece by Jonathan D. Moreno, “Ethics Committees and Ethics Consultants,” provides a substantially reworked essay from the previous edition and admirably explains the functions and aims of ethics committees and consultants, and each group’s ethical significance.  Moreno’s main point is that despite their visibility and wide acceptance, the purpose of these institutions is highly contingent on an ever-evolving field of bioethics, and therefore “beyond some generalizations there is little that can be said with confidence about their functions and goals.” (582)

The final essay, “Teaching Ethics in the Health Professions,” is Lynn Gillam’s attempt to articulate a vocational application of bioethics.  Gillam begins with the insightful claim that ethics teaching in health professions is very different than the study of bioethics in the academy.  However, it is unclear how far Gillam wants to claim this difference extends, and if it extends too far, how  this reconciles with the action-guiding aim of the rest of the collection:  Are these other pieces merely exercises in moral reasoning skills, or do they have a substantive aim as well to actually influence policy and action?  As this essay raises some very real practical and theoretical considerations that deserve greater attention, I was disappointed in its lack of bibliography.  Perhaps this is a reflection of the lack of work being done in connecting ethical theory to vocational practice in the way the author has in mind.  If this is the case, it explains some of the difficulties Gillam faces trying to reconcile the claim that teaching health practitioners is substantively different from teaching students with the thought that undergraduate bioethics courses is not simply a moral buffet.

With a few exceptions, each article has a sizable bibliography, sometimes including a section on “further reading”.  Overall, the collection is well-balanced and easy to use.  I would have preferred a more robust introduction by the editors, perhaps with some clarification on the rationale for the section divisions.  Their historical survey is interesting but feels incomplete and provides little philosophical introduction to the collection.  Since this is followed by James Rachels’ helpful introductory piece, perhaps the editors felt their own attempt might be redundant.

The Companion to Bioethics 2^nd edition complements Blackwell’s Bioethics: An Anthology, addressing roughly the same thematic issues.  The contributors are all experts in the field, and this shows in the quality and breadth of information provided.  Despite my few complaints, the Companion is still the best secondary source in navigating the complex and ever-evolving field of bioethics.

© 2010 Scott O’Leary

Scott O’Leary, Fordham University