The present work argues that
while the advances in human genetic engineering (HGE) have made the need for a
fundamental, or ‘thick’ discussion on the ends of these technologies all the
more pertinent, the public debate on these issues has become derivative or
‘thin’. We no longer debate the real ethical nature of HGE, only how to use it.
In this book, John Evans presents and criticizes two theories why this could
have happened, the expanding democracy-explanation and the macro-historical
explanation, but develops and argues for a third explanation. According to it,
the posited situation is the side effect of professional competition for the
jurisdiction over the issues related to HGE.

Evans’ work purports to
cover the public debate on HGE from the 1950’s to 1995. He starts out by
explaining the theoretical framework and the central terms needed, and then
devotes a chapter to four time periods, each of roughly equivalent amounts of
publications on HGE, and one chapter to the work of the U.S. government
advisory commission of the 1980’s. The final chapter includes some comments on
the debate after 1995. Here Evans also proposes alternatives to the current
situation and makes some predictions on how the jurisdictions of different
professions will develop.

The narrative of the work
can be briefly described as follows. The issue of human genetic engineering had
been discussed since the beginning of the last century but in the 1950’s, this
discussion started to gain momentum. At first, the debate was mostly carried
out by scientists, but in the mid 1960’s, theologians challenged the ends for
which the scientists seemed to be working. The scientists’ concern for
jurisdiction over this area of research prompted them to action. Their response
was to move the HGE-debate into the less democratic government advisory panels,
which eschew the fundamental debate forwarded by theologians, and instead
prefer to use only means-to-an-end calculations. This move has had at least two
results. First, the fundamental debate over the ends of HGE (and questions such
as ‘What ends should science serve?’) has reduced into a debate over which
techniques, i.e. means best serve the few pre-established ends (justice,
beneficence, non-maleficence, and autonomy). This culminated in the work of the
President’s Commission for the Study of Ethical Problems in Medicine and
Biomedical and Behavioral Research in the 1980’s and has been institutionalized
by the developments after it. The second result has been the birth of the
profession of bioethics, a profession that, according to Evans, has failed both
to challenge the scientists’ jurisdiction of HGE and address the fundamental
ethical questions involved.

Evans’ work has substantial
data, is well written, and is both thoughtful and thought provoking. Its
conclusions can inspire debate within the relevant professions. I would like to
raise just a few points. The focus of the book is on the institutional
parameters of the debate, which, given Evans’ sociological approach, is to be
expected. But from this viewpoint, Evans could have noted that the emergence of
bioethics was also connected with the rise of applied ethics in general, which
has been noted to have both academic (e.g. the decline of meta-ethical
subjectivism) and societal (e.g. the increase in civil activity in the 1960’s)
reasons. A closely related problem is, I submit, that a study that ignores the
content and the problems of the terms and arguments involved tends to give a
somewhat sketchy picture of the development of the debate. To highlight, let us
briefly examine the expression ‘playing god’. Although Evans’ treatment in no
way depends on this term, it is a good example of the problems involved. A
general complaint against this expression is that it is very hard to define and
apply in a meaningful way, because there is an array of alternatives. One end
of the spectrum is that any
manipulation of nature is an act of playing god, which would mean that we play
god on a daily basis. The other end is that to play god is to do something
supernatural, which would mean that, arguably, we could never play god. Yet, if
the term is to play a role in the debate on HGE, it must have some kind of
acceptable meaning. Otherwise, it cannot have argumentative value. Evans
touches on this issue in various places (e.g. p. 126) but seems to argue that
the force of this expression has been ignored because scientists were able
create an analogy between HGE and other, acceptable manipulation of nature.
Indeed, the analogy works for the scientist here, but Evans’ argument is a mere
argumentum ad hominem. The fact that
we do not seem to have a workable conception of ‘playing god’ remains
unaltered.

One last point that I will mention is the
distinction between the terms ‘thick’ and ‘thin’ debate, on which Evans’
treatment relies. These terms in turn relate to substantial and formal rationality:

a pattern of action is
substantively rational if it applies the "criteria of ultimate ends"
or "ultimate values" to acts or means. Therefore, a substantively
rational argument about HGE asks whether the means of HGE are consistent with the ultimate ends or
values. That is, ends and means are debated as a piece. A pattern of action is formally rational if it is calculated to be the most efficacious
means for achieving predetermined or
assumed ends. A formally rational argument about HGE ask whether the means
of HGE maximize, compared to other possible means, predetermined ends […] The
two different forms of argumentation are derived from this subtle yet basic
distinction. The substantive is thick, and the formal is thin. (p. 12)

Having set this basic definition, Evans
further elaborates the difference by discussing some components of these forms
of argumentation, such as the link between means and ends and the
commensurability of ends. In several places, his treatment gives the impression
that substantive rationality should be equated with the deontological
conception of norms (i.e. an act is right/wrong based on its intrinsic
qualities), and formal rationality should be equated with the consequentialist
conception of norms (i.e. an act is right/wrong based on its consequences):
"[f]ollowing substantive rationality, means are right and wrong for a
priori reasons — for their consistency with certain ends — not because of
their consequences. " (p. 21) However, a consequentialist can clearly
participate in the substantive debate just as well as a deontologist can, but
Evans waits until the 43^rd footnote of the third chapter before he
introduces the difference between the consequentialist and the deontological
conception at all. There he claims that autonomy and justice are deontological
principles, whereas non-malificence and beneficence are consequentialist terms.
But the deontological and the consequentialist theories are theories of what
makes an act good in general, not theories that select individual principles
(although they may). In addition, by Evans’ theory we could not use the
concepts of autonomy and justice at all anymore, because they would only be
meaningful in the substantial, thick debate.

In conclusion, I believe this work would have
benefited from some further conceptual development of its central terms.
Nevertheless, the book is of interest to philosophers and sociologists as well
as to the general audience. Its aim of keeping the general public involved in
the HGE debate is certainly something that the professionals of this field
should bear in mind.

© 2003 Juho Ritola

Juho Ritola, Lic.Soc.Sc.,
Part-time lecturer, University of Turku, Department of Philosophy

Categories: Genetics, Ethics