Humanism has a long history, beginning around the second half of the fourteenth century and eventually leaving its mark in the modern period. This philosophical movement placed emphasis on the fundamental worth and dignity of the human and situated humans in relation to nature. Humanism is credited with being one of the values that helped advance science. This book, Biomedical Ethics, takes up some of the central values of humanism and relates them to bioethics. In defining bioethics as an ethic of care, where concern for the integrity of patients, family, and community is paramount, this book suggests that bioethics is inherently humanistic. 

Philip Regal takes up that point by arguing that life science conglomerates and the insidious relationship between economics and power significantly have compromised bioethics.   Vern Bullough concretizes Regal's argument by showing how pharmaceutical companies rushed to get contraceptives on the market at the expense of the patient. An example Bullough didn't discuss but is relevant is the marketing of antidepressants that were known to carry a risk of suicidal ideation in adolescents (cf. Healy 2006). Another chapter that deals with an overwhelming problem in bioethics is written by Robert Tapp. Tapp begins by suggesting that bioethicists need to reorient ourselves to different values by focusing on the needs of the very poor. He identifies structural violence as collective forces that allocate resources according to social and economic poor. But his chapter, on such an important subject, would have been much stronger if he had unpacked the idea of structural violence and gave examples of bottom-up values. Furthermore, Tapp cites the Tavistock principles as an example of what he means, but those values were developed by health care providers, not the poor in societies. Readers interested in structural violence may want to read Paul Farmer's Pathologies of Power (2004), where Farmer presents story after horrific story about what structural violence looks like and what it does to the poor (Tapp does mention Farmer.) And readers who want to learn more about how the organizational aspects of health care undermines individuals' ability, or even desire, to be ethical, might be interested in Daniel Chambliss's wonderful book, Beyond Caring (1996).

Carmela Epright's critique of the "Georgetown Four," especially the principle of autonomy, is important in that many medical students leave medical school treating autonomy as a mantra, something near-sacred. Her chapter on the sometimes conflicting values of autonomy and care argues that ethical conflicts in the clinical setting are a far cry from what is taught in medical ethics courses. (Paula Chen, author of Final Exam (2007), would surely agree). Epright's later chapter analyzing the Terri Shiavo case is lucid and helpful, although she doesn't explicitly make a connection with humanism.

More often, though, the connections of humanism to bioethics seem tenuous and, I might add, the connections of most of the authors to the field of bioethics.  Bioethics is a complex field that includes scholars in the areas of law, social work, medicine, genetics, brain sciences, technologies, psychiatry, and psychology as well as philosophy. In other words, it is interdisciplinary, and that characteristic makes bioethics rich and diverse. Chapters such as Andreas Rosenberg's, which presents a flippant and very simplistic discussion of ethics, or Mason Olds, who claims he is drawing upon situationist ethics to illuminate questions about abortion–"What makes a fetus a person; when does a fetus become a person?" (p. 131)–do an injustice to the field of bioethics.

The rationale behind this book, according to editor Howard Radest, is to open up questions that ought to be addressed by students, practitioners, citizens, and patients. Keeping that in mind, I read with an eye to identifying some of those questions. Frankly, I didn't see new questions in bioethics being opened up; in general, I didn't see any serious and thorough discussions of bioethical issues other than Epright's two chapters. If this book's audience is humanists who want to dabble in issues of bioethics, some of the chapters will give them that. But if this book is indicative of humanist scholarship today, I would say that humanism is in serious trouble.

References

Chambliss, Daniel. 1996. Beyond caring: Hospitals, nurses, and the social organization of ethics. Chicago: University of Chicago Press.

Chen, Paula. 2007. Final exam: A surgeon's reflections on mortality. New York: Knopf.

Farmer, Paul. 2004. Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press.

Healy, David. 2006. Let them eat Prozac: The unhealthy relationship between the pharmaceutical industry and depression. New York: New York University Press.

© 2007 Nancy Nyquist Potter

Nancy Nyquist Potter teaches medical ethics to nursing and medical students and is a core faculty member of the University of Louisville's new Interdisciplinary Masters Program in Bioethics.

Categories: Ethics