by Helga Kuhse and Peter Singer
Review by Antonio Casado da Rocha, Ph.D. on Jul 16th 2002
This comprehensive and
authoritative survey of philosophy was first published in 1998, when Peter
Singer was a central figure at the Centre for Human Bioethics at Monash University
(Australia), and just before his controversial appointment at the Princeton
University Center for Human Values. Helga Kuhse, who has co-authored with
Singer many titles on medical ethics, became Director of the Monash Centre in 1992.
Kuhses and Singers own contribution to this book, though, is limited to a
very short historical introduction to the field. The rest of the book comprises
45 specially written essays by a wide selection of scholars, whom present the
key issues and concepts in contemporary bioethics.
Although the growth of bioethical discussion
and practice has been huge in the last decades, the contents of the book
provide a good introduction to the whole of the discipline, from discussions
about the relationship between bioethics and law, culture, gender, or religion,
to a survey of the different approaches available in ethical theory. Standard
philosophical problems such as the mind-body dualism, or the psychological
features of being alive, are not devoid of interest for the bioethicist. After
all, professional practice faces her with the need to answer tough questions in
metaphysics, such as whether a human person is to be identical with its
organism (let us think of the famous case of Chang and Eng, the original Siamese
twins), or those about what makes possible to think of ones own continued
existence (a question crucial to discussions of brain death, cortical death, or
persistent vegetative states).
The central chapters are the devoted to issues
involving embryos and fetuses, human reproduction and the new genetics,
euthanasia and other life and death issues, resource allocation in health
care (with whole sections devoted to organ donations and AIDS), and issues
raised by experimentation, both with animals and humans subjects. This kind of
research involves interesting issues such as the psychologists dilemma
described in page 414: if animals are used as a model to study noxious
psychological states that are analogous to the same states in humans, why are we
morally entitled to produce those states in animals (such as pain, fear,
anxiety, addiction, aggression, etc) when we would not be so entitled to
produce it in humans? And if the animal state is not analogous to the human
state, why create it in the animal?
The last sections of the book are devoted to
ethical issues in the practice of health care. This is particularly relevant to
mental health, for psychiatrists deal with a number of relatively specialized
ethical questions about the care of mentally ill persons, many of which
intersect with legal issues: questions about the conditions under which a
patient accused of wrongdoing is competent to stand trial, or when a
psychiatrist is justified in breaching confidentiality, and when she has a duty
to warn the victims of a potentially violent patient. Health workers must also
consider the question of when it is justifiable to confine or treat an
incompetent patient against his or her expressed wishes -- for instance, with
antipsychotic drugs, or less commonly, with electroconvulsive therapy.
The fact that many mentally ill and disabled
patients live in long-term care institutions raises many questions of its own,
such as the effects of institutionalization on the quality of informed consent.
While there is still fierce debate on many of these issues, over the past
decades a fairly broad consensus has emerged in the bioethics literature about
two questions that are relevant to many incompetent patients: how competence
(or decision-making capacity) should be assessed, and how decisions should be
made for patients who are incompetent. In one of the final chapters, Carl
Elliott outlines the standard approaches to these questions and points out
several unsolved problems.
At last, the discussion is directed to special
issues facing nurses, teachers, and ethics consultants, providing a critical
review of how ethics committees work and how bioethics is being taught.
Together with an useful index and directory, and its accompanying volume of
classical texts Bioethics: An Anthology, also published by Blackwell in
1999, this book provides an ideal basis for course and committee use in this
field, and will be of interest to doctors, therapists, lawyers, journalists,
and philosophers alike. Not to forget, of course, patients -- a group we all
are likely to join at one time or another.
© 2002 Antonio Casado da
Antonio Casado da Rocha, Ph.D., teaches
Philosophy at the University of the Basque Country, Spain.