Is There An Ethicist in the
House? is a collection of fifteen articles and essays representative of
Jonathan Moreno’s writings from 1988 – 2003 on clinical ethics in general and
the role of the hospital philosopher in particular.  Currently professor of
biomedical ethics and director of the Center for Biomedical Ethics at the
University of Virginia Health System, Moreno has logged over twenty-five years
as a teacher, researcher, and practicing professional in the field.  However,
he gently warns us at the outset that his book is not an introduction to the
field of bioethics but rather a reframing of the subject from the perspective of
a philosophical naturalist.  To the more academic reader, this confession
confirms the author’s "struggle with the limitation of particularity in a
way that never hampered the great universal metaphysicians, at least in their
treatises (32)."  However, to the general reader, Moreno emerges as a
contemporary "public philosopher" in the Deweyan tradition, and his
book reveals "that bioethics is a personal subject in a way that other
professional ethics fields are not" (3).

Part One, "A Hospital
Philosopher," is a somewhat autobiographical account of the author’s
transformation from a classroom humanities professor to a clinical bioethicist,
the "ethicist in the house or a ‘hospital philosopher’."  Part Two, "Naturalizing
Bioethics in Theory and Practice," is more philosophical as Moreno
reflects on the emerging tasks of the clinical bioethicist.  Here he proffers
the intriguing conclusion that "bioethics has an undeniably American
flavor and that bioethics is mainly an American field in it origins"
(51).  Unable to find the field’s roots in either the analytic or Continental
philosophical traditions, Moreno turns to the tradition of American philosophic
naturalism.  Here he discovers a parallel between the key bioethical themes of
moral autonomy and pluralism and ideas in ethical naturalism. To show that
bioethics is American as well in its style, he concludes this section with an
essay on "Ethics by Committee" which critically discusses the
adoption of the consensus model by most hospital ethics committees.

In Part Three, "Human Use,"
Moreno turns to the ethics of clinical trials, a field that currently bears his
own distinctive mark.  His over-arching objective is to discuss the difficulty
in crafting a just public policy for the use of human subjects in research.  In
the first essay chosen for this section, Moreno offers a brief but dense
history of the use of human subjects in research and the resultant dilemma
between the individual interests of the research subject ("individual good")
and scientific progress ("public good").  While the historical
argument weighs heavily against the  investigator’s discretion ("weak
protectionism"), Moreno cogently raises a moral red flag against an
emotionally opposing response of "strong paternalism." Such a
regulatory move, he argues, could result in the investigator’s taking what
Josiah Royce has referred to as a "moral holiday."  Splitting the
extremes, Moreno’s solution is a "moderate protectionism [which] accepts
the importance of personal virtue but does not find it sufficient" (126).

In the next essay, Moreno narrows
his focus to the historical and practical issues that accompany the use in
medical research of so-called "convenient and captive populations"
such as prisoners, institutionalized children and adults, military personnel,
and students and staff.  Although a general "protectionist" attitude
has emerged regarding the participation of such vulnerable subjects, Moreno
argues that a more refined concept of justice needs to be developed "[b]ecause
these groups are not convenient or captive – or even vulnerable – in the same
ways" (130).

The concluding piece in this
section examines the neglected topic of biomedical and behavioral research
involving subjects with "decisional impairment that is chronic rather than
acute, and pathological rather than associated with ‘normal’ youth or aging"
(153).  Blending personal experiences with regulatory history, Moreno again
finds himself in a Spock-like dilemma between "the good of the one"
and "the good of the many." Facing such diverse requirements of
ethical research, Moreno reiterates the need for "an exquisitely delicate
balance" (172).

The nineteenth century religious
philosopher Soren Kierkegaard once remarked that "we live forwards but
understand backwards."  In the fourth section of his book, "The
Meanings of Nuremberg," Moreno, always the philosophical naturalist,
places such proposed wisdom within an historical context and offers an
alternative.  At least with respect to the history and ethics of biomedical and
behavioral research, he argues, we may have lived forwards, but we have misunderstood
backwards!  Drawing upon his unique experiences with the President’s Advisory
Committee on Human Radiation Experiments in 1994-95, his "dream job for an
archives groupie," he argues against the received understanding that the
revelations of Nazi medical crimes and the Nuremberg Code "had a
tremendous influence on American medicine and our experimental practices"
(176). In the papers collected for this section of the book. Moreno offers an
intriguing and important corrective to the traditional scholarship on the
history and ethics of human research.

The concluding section, Part Five: 
"New Directions," highlights the challenges faced by contemporary
bioethicists and is well worth the read.  It opens with the author sharing an
engaging "forty-ish twinge." In the opening article, Moreno’s
fortieth birthday spurs a personal reflection on his own genetic status as well
as on new developments regarding "cancer, truth, and genetics."

He then examines "Neuroethics:
An Agenda for Neuroscience and Society."  In this specially commissioned
2003 article, he asks whether traditional philosophy of mind or "’folk
psychology,’ the commonsense means at our disposal to explain behavior with
reference to beliefs, desires, expectations, goals, and so on," (223) may
be reduced to neuronal states or replaced by discussions about "the
extrastriate visual cortices in the fusiform and superior temporal gyri"
(220)?  Rather than answering this and other related questions directly, Moreno
demonstrates instead that such questions are not all that different from more
traditional and familiar bioethical issues.  Once again he draws historic
analogies to show "that neroethics is in some ways old wine in a new bottle"
(232).

"Bioethics after the Terror"
is a rather poignant confirmation that the field of bioethics is a set of
social practices as well as a body of moral theory.  Written just two weeks
after the attacks on the World Trade Center, Moreno proffers that the resultant
"sense of group vulnerability and patriotic unity" may lead to a "sentiment
of social solidarity" 238).  And he muses that such a sentiment might
eventually mature into a "principle of community" that could even
ascend to the pantheon of bioethical principles.

In a concluding and tantalizing
chapter written for this book, Moreno begins by drawing a parallel between
psychoanalysis as "the impossible profession" and his  work as a
bioethicist.   However, he is more sanguine about his profession, and he
sketches a ‘mission possible’ for bioethicists.   For example, in response to
those who condemn bioethicists for their work as so-called "ethicists-for-hire"
with industry, Moreno argues that bioethicists are professionals, too. 
Therefore, their expertise should be fee-for-service to the institution that
hires them as with any other professional.

            Drawing upon his own experiences on governmental
advisory committees, Moreno distinguishes politics, "not a bad
thing at all," from politicization, "the distortion of those
normal and useful functions by allowing particular ideologies to run away with
the process" (247).  However, rather than retreating to the familiar
bashing of the politicization of bioethics, Moreno wants to enter the fray.  He
challenges bioethicists "to locate themselves ideologically" and not
be averse to "c]hoosing up sides between conservative and liberal on at
least some issues" [250].  However, he does not tell us which issues he
has in mind.

In this timely collection of writings,
Jonathan Moreno demonstrates the maturity of the field of bioethics, "well
into its fourth decade as a self-conscious area of study (at least in the
United States)" (212).  Indeed, it has been twenty years since bioethics "saved
the life of ethics," as Stephen Toulmin once concluded.  However, if "bioethics
itself has become part of the establishment, as have those who profess it "
(234), as Jonathan Moreno concludes, one must wonder why the title calls for an
"ethicist" rather than a "bioethicist"?

 

© 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