R M Green. Oxford University press, 2001, £22.50, $US29.95, pp 231. ISBN 0195109473

• Green RM. The Human Embryo Research Debates: Bioethics in the Vortex of Controversy

United States ethicist Ronald M Green approaches the issue of embryo research (ER) in the very accessible form of a “philosophical memoir” (xv). Reporting in detail from his experience of serving on several high level ethics advisory boards, focusing mostly on his membership of the National Institutes of Health’s (NIH) 1994 human embryo research panel, Green portrays both the functioning of this increasingly more influential form of institutionalised ethics, as well as the social and political dynamics governing its (in)effectiveness. The author also covers extensive ground regarding the subject matter of ER itself and familiarises the reader with the technical issues and conceptual conundrums (potentiality, moral status, harming future persons) involved.

Green states in the title of The Human Embryo Research Debates: Bioethics in the Vortex of Controversy, that he is concerned with a plurality of debates. Examining the discourse in the US, he first deals with the different areas in which ER is debated: of the book’s eight chapters, chapters one and four stress the relevance of ER for the fields of in vitro fertilisation (IVF) research, the study of birth defects, and the development of contraceptive methods. Chapter 6 deals with the relation of ER to reproductive cloning; Green formulates a comprehensive criticism of the National Bioethics Advisory Commission’s (NBAC) 1997 report on cloning, claiming that it contributed significantly to the neglect of ER in US public policy. Chapter seven covers NBAC’s 1999 report on stem cell research, stresses the importance of ER on the form of so called “therapeutic cloning”, and again takes a critical stance towards NBAC’s shaping of the discourse.

As the above issues are of relevance to groups with radically differing interests, throughout the book Green also deals with a second level of ER debates. This concerns the complex interplay of the interests of scientists, patient groups, the medical industry, policy makers, politicians, legal professionals, ethicists, theologians, and religious pressure groups with regard to the different forms of ER. In light of the fact that the author is chair of Dartmouth College’s department of religion and former president of the Society of Christian Ethics, one might expect that he would attempt to settle the arguments by siding with the restrictive conservative party in discourse. This, however, is not the case. Rather, he points out with frustration that a powerful conservative minority has effectively managed to obstruct and stall ER since the mid 90s. Emphasising the negative consequences resulting from ER being forced to take place almost exclusively in the private sector he argues fiercely and outspokenly in favour of a comprehensive federally funded exploration of the potential medical benefits at hand. Given the dramatic clash of interests of the involved parties, the author is centrally interested in isolating an ideal procedure suitable for governing negotiations between the conflicting parties. Here, Green draws strongly on the Rawlsian concept of overlapping consensus and urges discourse participants to be willing to abide by public reason and to set aside their individual special concerns out of respect for other individuals and the common good (page 61, page 155, page 169 and following pages).

Because of the significant impact of religious pressure groups in ER debates in the US, Green dedicates considerable attention to religiously motivated arguments and in particular to the frequently encountered claim that human life (and tacitly implied: full moral status) begins “at the moment of conception”. In chapter two he cites detailed current biological evidence, forcefully showing that even on the biological level this claim is difficult to uphold. Setting forth “a Copernican Revolution in our thinking about ethical issues related to the life sciences” (page 26, without mention of the Kantian origin of this metaphor) Green argues (a) that it is difficult to talk of one objective point of conception and that biological occurrences are best understood as processes rather than events. Hence, as nature does not provide us with clear cut boundary markers, he suggests analogously to the current practice of brain death that (b) the determination of threshold points involves deliberate choice and decision on our part in such a way that a reasonable compromise is achieved between the benefits and harms associated with the choice of a specific boundary marker, both for the wider public and health related research as well as for the entity under consideration. Arguing further against any kind of “single criterion approach” to determine the status of the embryo Green champions a “pluralistic and pragmatic approach” characterised by the belief that “a variety of criteria interact and work together to lead to a mounting sense of concern and ultimately to judgments of protectability about entities “(page 63 and pages following). Therefore, in Green’s view, the issue of the embryo’s moral status is essentially a political question and “translates into the question of just how much protection it is reasonable and fair to give it at each point in its development” (page 39). Less detailed is an argument in chapter six attempting to establish that the concept of harm is, contrary to Parfit’s “non-identity argument”, meaningfully applicable in the context of wrongful life cases (pages 126–128).

In the age of the “globalisation of ethics” (John Harris) in which ethics commissions and advisory boards are more and more setting the agenda in bioethical policy making, the strength of Green’s book is that it presents a transparent and valuable case study of this practice. Questions regarding, for example, the criteria for selecting a competent and representative panel; how much power these institutions should be granted; what kind of standards and methodology for published reports is necessary; what degree of public participation is desirable, and how to deal with minority views, have obviously not been settled once and for all with Green’s book, but it is a stimulating and clear account which shows that these issues are just as important, difficult, and necessary as thorough academic debates on—for example, the relation of facts to values. The book will be of interest to anyone who is interested in the mechanics determining the interaction of bioethics and the political sphere; it requires no previous familiarity with the topic and can thus also be recommended to the general reader.