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Building Bioethics–Conversations with Clouser and Friends on Medical Ethics
  1. Søren Holm
  1. Institute of Medicine, Law and Bioethics, University of Manchester & Centre for Medical Ethics, University of Oslo

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    Edited by Loretta M Kopelman, Dordrecht, Kluwer Academic Publishers, 1999, 250 pages, £72.00.

    We sometimes forget that medical ethics has a history, and that many of the issues we discuss today have already been discussed many times previously. As the field grows older, and the pioneers retire, we are, however, given some opportunity to recognise that there is in fact such a history, and that we could learn much from paying attention to it. A number of histories of bioethics have been published, and collections centred around the work of major figures are also starting to appear.Journal of Medical Ethics 2001;27:206–214

    The present volume is a collection of papers centred around a critical discussion of the contribution of K Danner Clouser to the development of bioethical theory, and to the teaching of bioethics. The authors include Tom Beauchamp, Dan Callahan, Al Jonsen, H Tristram Engelhardt, Bob Veatch, and other well-known names from the first wave of American bioethics. The contributions, and the responses from Clouser, fall in to two groups. The first group is concerned with Clouser and Gert's famous critique of principlism (a term they initially coined in a 1990 paper). Tom Beauchamp and Bob Veatch argue in separate papers that the critique is misguided, partly because it misinterprets the views of principlists, partly because Clouser's own ethical views seem to be open to exactly the same kind of critical arguments concerning lack of theoretical foundation, lack of problem-solving power, and underdetermination of the ethical framework. Not surprisingly, Clouser, in a response co-authored with Bernard Gert denies that his framework has the flaws he identifies in the principlist approach, and he further refines the definition and critique of principlism.

    The second major group of papers is concerned with the pedagogics of medical ethics. What is the purpose of teaching medical ethics (making medical students good problem-solvers or good people)? What are the core elements of the curriculum? And, what is the best method of teaching? The editor of the book, Loretta Kopelman, has written one of these papers, and she puts her finger on the dilemma of how to define the goal of medical ethics teaching. Can we really say that we only provide students with problem-solving skills within the field of ethics, and that we do not care whether they use these skills for good or bad purposes? Will we not have to admit that we also (at least partly) aim at making some of them better persons?

    This book is more successful than most in the genre of Festschrifts. It contains a fair number of personal anecdotes about K Danner Clouser, but they are never allowed to substitute for a frank and critical assessment of his contributions to medical ethics. The responses from Clouser are also very well written and contain important clarifications of his position. I have therefore no hesitation about recommending the book. It will be especially valuable for three groups of people, those interested in: 1) the history of bioethics; 2) the discussion about the theoretical basis of medical ethics, or 3) the problems inherent in teaching medical ethics.