If you plan to read only one book
this summer on bioethics, Bioethics Beyond the Headlines by Albert R. Jonsen
is your book.    The author is one of the pioneers in the field of bioethics,
and his newest book is both engaging and readable.  As suggested by its
subtitle, it covers the important topics: Who Lives?  Who Dies?  Who
Decides?  It is up-to-date, and it moves easily from classic issues such as
forgoing life support in the case of Karen Ann Quinlan to contemporary concerns
about tube feeding and lessons learned from the recent Florida case of  Terri Schiavo. 

This stimulating book covers all
the major topics in bioethics.  Following a brief introductory essay in Part
I on the meaning and history of bioethics, Jonsen examines the disputes and
ethical issues involved in seven news stories that deal with the practice of
clinical medicine (Part II Clinical Ethics).  He looks at the
definitions of death; forgoing life support and quality of life issues; medical
paternalism, patient autonomy and informed consent; organ transplantation; 
euthanasia and questions involving aid-in dying or physician-assisted suicide; 
ART (assisted reproductive technologies), including recent concerns emerging
from preimplantation genetic diagnosis (PGD);  and abortion.  Each chosen
headline or case is relevant and appropriate.  For example, instead of
rehashing the issue of abortion as it appears in standard bioethics, Jonsen
focuses on the hotly debated procedure, called, medically, intact dilation
and extraction, and, politically, partial birth abortion.

Part III  Scientific Bioethics:
The Search for Benefit steps back to examine the scientific context for
clinical medicine.   Returning to the laboratory from the clinic, Jonsen
discusses the bioethics of bioscience in four areas:  research
with humans; genetics; neuroscience; and cloning and stem cell research.  
Initially, he examines the face-off between Kantian and utilitarian arguments
over the use of human subjects in research or the conflict between the good of
the individual research subject and the (re)search for a future, common good. 
Along the way he briefly charts the history of research ethics from the
atrocities of Nazi physicians during World War II to the more recent case of
eighteen-year-old Jesse Gelsinger, who died while participating in a clinical
gene therapy trial.  Jonsen shows that although a set of clearly defined
ethical principles has been  developed for research, "the tension remains
between the deontological arguments flowing from respect for individuals and
the utilitarian arguments flowing from common future goods" (94). 

  The next topic in this third part
concerns "genethics."  Here Jonsen deals with a set of ethical issues
that has emerged in the wake of advances in molecular genetics: genetic
diagnosis and testing, the old and "new" eugenics, genetic
engineering, and behavioral genetics.  The third topic discussed, "neuroethics,"
is perhaps the newest issue on the block.  In his discussion, Jonsen moves
quickly to the epicenter of the emerging debate over ethics, human nature, and
the brain: the very possibility of engaging in bioethics.  Looking briefly at
the discourses of philosophy about ethics and of science about the brain, he
considers whether ethics can be reduced to neuroscience as Sir Francis Crick, codiscoverer
of the helical structure of DNA, concludes or, as French phenomenologist Paul Ricoeur
claims, we are "dealing with two discourses of the body" (125).  The
last topic in this section, Cloning and Stem Cell Research, is designed
to show how reflection on previous bioethical issues such as scientific
research and the moral status of the human embryo might help guide a
conscientious person through the debate over stem cell research.

The term "bioethics" was
invented by the medical research scientist Van Rensselaer Potter in 1970.  He
coined this term to inaugurate "a new discipline that combines biological
knowledge with a knowledge of human value systems" (140).  True to the
"bio" [life] in bioethics, Jonsen devotes Part IV to The
Wider World of Bioethics.  First, he examines the problem of justice in the
healthcare system.  Distinguishing the concept of "fairness" from
that of "justice," he looks at both the microallocation problem
and the macroallociation problem. Then, after considering several
promising theoretical discussions of social justice, he proffers the
"rationing" experiment by the state of Oregon as an example of
"bioethics in practice" (152). 

The chapter on Cultural
Bioethics in Part IV raises the ever-lingering question of
relativism in ethics: "[I]s it legitimate to criticize and condemn the
moral standards of other cultures or to attempt to eradicate or reform
them?" (157).  Without directly responding to the question, Jonsen
considers both the philosophical and sociopolitical problems involved in
intercultural bioethics.  However, rather than simply stirring the dust of
seemingly irreconcilable cultural conflicts, Jonsen hints at ways the bioethics
discussion might broaden understanding.  

The last two topics treated by Jonsen,
animal ethics and environmental ethics, are not usually included in standard
bioethics.  To introduce animal ethics, he sets out the "moral polarities
[that] define the debate: animal activists repudiate any use of animals in
research; researchers defend the use of animals as essential to scientific and
medical progress" (164).  Always alert to the practical, he reminds the
reader of the oversight of animal protection committees that are legally
required at all institutions that use animals in research.  Related to the work
of these committees, he discusses the concept of the  "Three Rs,"
replacement, reduction, and refinement, that often guides the work of such
committees.  Consideration of the Three Rs with respect to the use of an animal
or the species is offered as one attempt to find a practical and philosophical
middle ground "between an enhanced respect for animal life and the moral
imperative to improve human life" (165).

Genetically Modified Organisms
(GMOs) headline the final chapter on environmental ethics.  Jonsen includes
such issues in a bioethics text because he takes seriously English philosopher
G. J. Warnock’s practical view that ethics is about the amelioration of the
human predicament. He argues that GMOs and other related ethical issues that
appear as humans use and abuse their environment concern should concern bioethicists. 
Since many issues in environmental ethics affect not only the health of the
"land" but of humans as well, Jonsen wants to push the reader beyond
the traditional health care ethics to "a larger bioethics, sensitive to
the biosphere" (140).       

Unlike the encounter with similar
texts, one’s reading should not conclude with Jonsen’s Conclusion.  Appendix
A includes a Precis of Moral Philosophy.  Here Jonsen presents an
engaging tour of the history of Western ethical thought with a slight nod to
Eastern traditions.  Appendix B offers a Precis of the History of
Medical Ethics.  It traces the history of the ethics of medicine from the
"school" of Hippocrates to the new ethics of medicine, bioethics.  A
brief but intriguing reflection on Mary Shelly’s nineteenth century novel Frankenstein
as an early text of bioethics highlights Appendix C The Frankenstein Analogy.  
Even the text’s concluding Glossary is unique.  Not only is it friendly
to the lay reader, but it defines relevant terms sequentially, as they appear
after each of the four parts in the text.

Bioethics Beyond the Headlines
actually gets behind the headlines to introduce the salient concepts and
key issues in the field.  "Bioethics," argues Jonsen, "is an
attempt to show how reason can be enlarged and sympathies extended as we search
for the betterment of the human predicament in the world of biomedical  science
and medicine" (14).  True to his vision, Jonsen shows how we can use the
techniques of reason and the insights and sympathies of practicing bioethicists
to understand the persistent questions not just of bioethics but of our human
predicament:  Who lives?  Who dies?  Who decides?

© 2006  Larry
D. Hultgren

Larry Hultgren
describes himself as follows:

A.B. Grinnell College majoring in Philosophy and
Religion; Ph.D. Vanderbilt University in Philosophy. Currently Professor of Philosophy
at Virginia Wesleyan College, Norfolk, VA.
Since I am at a liberal arts college, my teaching runs the gamut of philosophy
offerings. I am especially interested in interdisciplinary pursuits, and I
direct the college’s Social Ecology Program and our innovative PORTfolio
Project, which attempts to bring the liberal arts to life for our students by
connecting the classroom with real world experiences. I also serve on the
Bioethics Committee of the Children’s Hospital
of the King’s Daughters in Norfolk, VA, and serve on the Board of Directors
of the Bioethics Network of Southeast Virginia.

Categories: Ethics