Historical and Philosophical Perspectives
on Biomedical Ethics is a collection of five historical and three
philosophical essays.  The ethical
themes emphasized in the historical essays include autonomy vs. paternalism,
informed consent, and professional responsibilities.  Four of the historical essays focus on either the British or
German medical field during the late nineteenth century and early twentieth
century.  Most papers in this collection
were presented at a biomedical conference in the United Kingdom in 1998. 

Ulrich Tröhler’s essay, "Human
Research: From Ethos to Law, from national to International Regulations,"
is excellent for outlining concerns about experimentation prior to the Nuremberg Code and about the weaknesses
of international codes, such as the Declaration
of Helsinki, that followed in the wake of continued scandals and conflicts
with human research.  As the only
historical essay with an international focus, it shares with the other
historical essays richness in details and extensive references.  The references are very appealing to those
looking to escape the myopic view of medical ethics in the US literature.

            I found Lutz Sauerteig’s
essay, "Health Costs and the Ethics of German sickness Insurance
System," the most engaging historical essay.  Germany instituted the first social security system by
introducing the compulsory sickness insurance system in 1883.  The health care market has been struggling
ever since to control costs.  Attempts
to control costs by the institutions financing the health care market conflict
with a physician’s responsibility to offer the best treatment options and a
patient’s freedom to choose a physician. 
The problems are familiar.  It is
the longevity of the problems and the lack of reasonable solutions that is
sobering.

            "’Honour and
Interests’:  Medical Ethics and the
British Medical Association," by Andrew Morrice, and "The Emergence
of Medical Professional Ethics in Germany, by Andreas-Holger Maehle, are both
interesting and enjoyable to read.  
They discuss the rise of professional ethics in the UK and Germany,
respectively, in the early twentieth century. 
Medical organizations aimed at professionalizing scientific medicine and
marginalizing competitors by elevating the moral status of the physician.
Paternalism, it seems, was the product of a marketing strategy.

            Susan Lowe’s essay,
"Autonomous Agency and Consent in the Treatment of the Terminally
ill," is one of the three philosophical essays.  She argues that neither physician-assisted suicide nor voluntary
active euthanasia is justified on the grounds of autonomy.  The arguments are limited to those cases in
which a patient is incapable of committing suicide.  She argues that a lack of ability to carry out an autonomous
decision does not place an obligation on physicians to comply with such
requests.  Clearly, a patient who
requests an Americana Latte does not place a burden on persons administering to
her health.  Yet, a request for a glass
of water when thirsty does.  Lowe’s
criticisms of the claim that "obligations are incurred by society simply on the grounds of respect for
individual autonomy" are certainly correct, but misplaced.  If Lowe wants to convince her opponents, she
must show how a request for physician-assisted suicide is unlike those cases in
which we do place obligations on
physicians.  If a request for death can be a request for an improvement of
one’s health, then physician-suicide is more akin to a request for a glass of
water than for an Americana Latte.

            "The
‘Frankensteinian’ Nature of Biotechnology," by David Cooper, thinly uses
Mary Shelly’s Frankenstein as an opportunity to discuss our revulsion
toward some of the advances in biotechnology. 
Our revulsion toward biotechnology, according to Cooper, is grounded in
our sense that the biotechnology industry sometimes violates the integrity of
living organisms.  What matters in discussions
of such important issues as cloning and transgenic procedures is the
appreciation and acknowledgement of our sense of violation.  Otherwise discussion "will inevitably
continue in the same shrill, vituperative and unhelpful atmosphere which currently
surrounds it."

            Overall, the historical
essays were the most rewarding and reason enough to purchase Historical and Philosophical Perspectives on Biomedical
Ethics.  

©
2003 James Hitt

James Hitt is a Medical Ethics Fellow at Mount Sinai
School of Medicine.  He is a Ph.D.
candidate at the Graduate School and University Center in New York.  He can be reached at jmhcuny@yahoo.com.

Categories: Ethics