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Re-creating Medicine: Ethical Issues at the Frontiers of Medicine
  1. J McMillan

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    G Pence. Rowman and Littlefield Publishers, 2000, US$22.95 (hb), pp 207. ISBN 0-8476-9690-1

    In essence this is a book about some of the most important and pressing problems facing medicine and the relationship of bioethics to these problems. By focusing upon issues such as organ donation, reproductive technologies, the internet, and genetics Pence ensures that this book is highly topical. It is a book that will be, for most readers, controversial. Pence seems to be on a mission to dispel commonly held misconceptions about a number of important issues. One issue that comes in for lengthy analysis, for example, is the claim that payment can “commodify” practices or persons in undesirable ways. There is an extended discussion of whether surrogacy may end up commodifying any resulting children, that is a substantial contribution to this on going debate. An area that benefits from similar treatment in the book is the claim that payment for organs and blood cannot be justified because of worries about the incentives that this would provide. On issues such as these Pence consistently challenges commonly held views. The topicality and provocative nature of this book alone are sufficient to recommend it. However, given the fact that Pence is trying to convince his reader that bioethics falls short of the mark in quite a general way it is notable that at times, the reader's assent is gained more by rhetoric than argument. This of course is not in and of itself a bad thing; if the arguments are adequate then a little rhetoric may aid the appreciation of the full power of an argument, but there are points where the rhetorical force of a particular point derives from a selective use of the facts and a stereotype of what is in fact a complicated phenomenon. Pence complains about “. . . the customary, patronizing tone of English/European writers—'Ohlook   -   what   -   those   -   silly   -   crass    -    warmongering-Americans-came-up-with-now'”(page 186). This comment plays little role in his analysis and is unlikely to improve the quality of any resulting discussion. Ironically, given Pence's apparent dislike of stereotypes, he also offers a crude characterisation of Australian reactions to a headline in Australia's Sunday Herald Sun about attempts to sell embryos on the internet. “In this story, it helped that older Australians for some years had been feeling that they had fallen behind in the computer revolution and that the internet-via-computers was the purveyor of this evil. It also helped that the site of evil was the United States, which the Australian media loved to criticise for its excesses of commercialism. ... For traditional Australians, bewildered by a changing world ... the reductio ad absurdum was right there” (page 66). While it might be the case that there is something to this stereotype it can only ever be considered a crude characterisation of a fairly complicated phenomena and does not add much to the point Pence wants to make. This is a book for those interested in the big present and future issues. Furthermore those interested in reflecting upon bioethics and its present state likewise should consult this book. This recommendation should be tempered, however, with the warning that by the end of this book what began as a fresh and invigorating challenge to bioethics and its position on the problems of the day may become a bit irritating in its tone; a shame as this is otherwise a challenging book.