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Edited by Helga Kuhse and Peter Singer, Oxford and Malden, Blackwell, 1999, 600 pages, £18.99/$39.85 (sc) £60/$74.95 (hc).
It has often been remarked that developments in science and technology proceed at a pace which far outstrips efforts to understand or control them. This clearly applies in the field of bioethics. Scarcely a day goes by without the newspapers being filled with the latest genetics scare story or medical controversy. So Blackwell's latest anthology is certainly a book whose time has come. The question really is not whether it will find a market, for there are many, both students and professionals, who will find this tome an invaluable reference, but whether the editors have managed to strike a suitable balance between their own, avowedly utilitarian approach, and approaches of those who place a greater emphasis on notions of rights and duties.
Kuhse and Singer introduce their admirably comprehensive collection by noting that we humans owe a duty not just to other humans–but to the “biosphere”, and that applied ethics is rooted in a need (as argued by R M Hare) to find general rules and principles which can then be applied universally. The anthology follows the same pattern as their earlier and popular Companion to Bioethics, yet allows additional space for papers on topics where the “Companion” was weak, particularly debates surrounding new reproductive technologies.
The anthology is grouped into eleven main categories. Part one, Before birth, deals with abortion, including Judith Jarvis Thomson's famous violinist in need of a loan of a woman's life-support system. Part two, Issues in reproduction, looks at IVF, “Dolly” the sheep's experience and fertility treatment. A very brief piece by Hope, Lockwood and Lockwood, uses the rather fatuous claim that it is (almost) always better to exist than not to exist, to argue that IVF treatment should be made available without judgment as to the suitability or otherwise of the would-be parents. Jennifer Jackson argues that because “a century ago” life expectancy was 47 for women and no one objected to motherhood being embarked upon by women in their late 20s, no one should object to women twenty years off the current life expectancy figure at age 58 being aided in conception–apparently unaware of the statistical irrelevance of that figure of 47 years.
Part three deals with The new genetics and includes an article by Nicolas Agar on Liberal eugenics and an appeal for Hippocratic non-directive counselling by Beno Muller-Hill. Part four, Life and death issues, starts with Jonathan Glover's piece, The sanctity of life, reproduced from his book, Causing Death and Saving Lives (Penguin 1990) with its chilling reminder of the I G Farben chemical company's memo to the camp at Auschwitz: “Received the order of 150 women. Despite their emaciated condition, they were found satisfactory. We shall keep you posted on developments concerning the experiment ... the tests were made. All subjects died. We shall contact you shortly on the subject of a new load.” But what does Glover make of his historical survey? “Given the company of the right people, I would be glad of the chance to sample a few million years and see how it went.”
This section on life and death issues is the heart of the anthology and includes among twenty selections, no fewer than three of which are the editors' own contributions: Kuhse on the “myth” that letting die is not equivalent to intentionally causing death, her article on “Why killing is not always worse–and sometimes better–than letting die”, and Singer's piece, Is the sanctity of life ethic terminally ill?, which cites the case of Tony Bland.
Parts five and six look more briefly at resources and organ donation, whilst parts seven and eight offer some thoughts on experimentation with, in a significant choice of sequence!, human subjects and animals.
Finally, contributions on issues in the practice of health care such as truth-telling and consent, conclude the volume along with four papers on ethicists and ethics committees, to the effect that, as Dan Brock puts it, professional philosophers of health care ethics are a bad thing, whilst occasional academic visits into the arena, by those whose primary interests remain outside, are best.
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