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Book review

Galileo’s Middle Finger: Book Review

5 Aug, 15 | by David Hunter

I recently finished reading Galileo’s Middle Finger by Alice Dreger a medical historian and ethicist (although she may deny the title) and since I found it both thought provoking, terrifying and inspiring I thought I would share a few thoughts and hopefully convince you to read it, since I think some of its content is a must read for bioethicists and people who view themselves as in some way trying to make the world a better place.


Book Review: Kevin Yuill, “Assisted Suicide: The Liberal, Humanist Case Against Legalization”

3 Jul, 13 | by Iain Brassington

Basingstoke/ New York: Plagrave Macmillan, 2013; 188+xx pp

Can there be anything new to say on the subject of assisted death of one form or another?  One acquaintance of mine has suggested that there ought to be a five-year moratorium on papers about it, on the grounds that there almost certainly isn’t.  At the very least, the presumption should be against publication – and it should be a strong presumption at that.  I’ve got some sympathy, notwithstanding the amount of ink spilled by me on this very subject.  Ahem.

Kevin Yuill, an academic at the University of Sunderland and occasional contributor to Spiked Online (edited by hack contrarian-by-numbers Brendan O’Neill (q.v.), who also provides a foreword and the cover blurb to this book), came to Manchester a few years ago to give a paper that purported to be a libertarian case against assisted dying.  Now that looks new.  Libertarians – intuitively – are for… well, fewer things being against the law.  So for a libertarian to be arguing against legalisation of something, even when it’s consensual, could be an innovative move in libertarianism, or in assisted dying debates, or both at once.  Now, I have to admit that his paper wasn’t well-received by the students.  But a lot of time has passed since then, and it’s possible that the gaps in the argument have been filled, the weaknesses strengthened, and so on.

So then: how do things stand now?  Is this the kind of book that should be allowed to break the embargo? more…

Book Review: Tom Koch, “Thieves of Virtue: When Bioethics Stole Medicine

22 Oct, 12 | by BMJ

Cambridge, Mass: MIT Press, 2012; 352 + xx pp

Guest Post by Robert Rivers (PhD student, Interdisciplinary Graduate Studies Program, University of British Columbia)

Who benefits presenting scarcity as a natural state in health care? Who killed the Hippocratic Oath? Why are doctors portrayed as paternalistic? Why has patient care become a secondary concern to budgetary constraints? The answer is the bioethicists, according to Tom Koch in his newest book Thieves of Virtue: When Bioethics Stole Medicine.  The book piles scorn on the “practical philosophers” who arrived on the medical scene during the 1960s and, according to the author, have since become the neo-liberal agents who provide moral justification for putting state and commercial economic interests before patient care. more…

Passive Euthanasia: A Cri de Cœur

5 Oct, 12 | by Iain Brassington

Don’t worry: this isn’t another instance of me yammering on about the right to die or the right to induce death.

I’ve recently received a parcel; it contained a copy of this book by Leanne Bell, which happened to fall open at p 204.  On that page, you’ll find this passage:

Active euthanasia involves a deliberate act intended to kill […].  This is illegal in England and Wales because it satisfies the definition of ‘unlawful killing’ and will therefore either be murder or manslaughter depending on the mens rea (that is, the state of mind) of the doctor at the time.  He is likely to face criminal prosecution, regardless of whether the patient and/or the family requested or consented to it.  By contrast, passive euthanasia involves the withholding or withdrawing of treatment from the patient, i.e. an omission rather than an act, and, in certain circumstances, can be legal. [emphasis mine – IB]

No.  Wrong.  Wrong on two fronts.  Withholding treatment may be an omission, but withdrawing it isn’t.  More importantly, while the active/ passive distinction boils down to one between administration and non-administration, it is simply not true that non-administration is the same as passive euthanasia.

Euthanasia requires the intention to end life based on a motive of beneficence directed at the person who will die.  Neither withdrawing nor withholding treatment indicates the intention to end life.  Only if you’re withdrawing or withholding treatment with the intention that this should end life have you committed passive euthanasia.

There’s a simple test you can run here: When withdrawing or withholding treatment, would it be coherent to hope for the patient’s survival – however miraculous – without further intervention?  It would not be coherent in cases of euthanasia, because you can’t intend that life should end and yet hope that it doesn’t.  It could be coherent otherwise.

Or another version of the same test: If you are considering withholding or withdrawing treatment and the patient does not die, would you see this as contrary to your intention?  If yes, you’re considering passive euthanasia; if no, you aren’t.

Bell is by no means alone in getting PE wrong.  The mistake is all over the place – both in the clinical ethics literature, and in the wider public domain.  I’m not wholly sure where it’s come from, but I suspect it may derive from Rachels having made it in”Active and Passive Euthanasia“, and then a little more explicitly in “Killing and Letting Die“:

Many people believe that “passive euthanasia” – allowing terminal patients to die, rather than pointlessly prolonging their lives – is sometimes permissible; but they also believe that killing patients is always wrong.

I’ve got a lot of time for Rachels, and much of what he says on killing and letting die in these essays is good.  But this is wrong.  Even good essays can have wrinkles in them; and this is a big one.  And if it’s the source of the same mistake being made elsewhere, that’s quite serious. more…

Book Review: Nie Jingbao, “Medical Ethics in China”

1 May, 12 | by BMJ

London: Routledge, 2011; 263 + xiii pp

Guest Post by Yonghui Ma

For those who have a particular interest in cross-cultural bioethics, Nie’s book, Medical Ethics in China, is an absolute feast.  Luckily, I am one of them and it more than satisfied my appetite for the subject.  It brings us much closer to a fascinating but complex topic through a multi-disciplinary approach to address ethical issues and a trans-cultural interpretation far beyond the Chinese context.

 This book covers many key topics in bioethics (some are quite sensitive to Chinese) in the Chinese socio-cultural context – topics such as attitudes towards the foetuse, sexuality, medical truth-telling by medical professionals, informed consent, professional medical ethics, health promotion, human rights, and theories on personhood.  Nie examines these issues from a wide range of perspectives, from the traditional Chinese doctor’s to the modern feminist’s.  What distinguishes this book from other works is Nie’s perspective, which lies outside the mainstream of contemporary Chinese bioethics. They are based on his academic experiences in and outsideChinaand, more importantly, his in-depth understanding of the relationship between culture and ethics.  His own angle is rather unique as, in Robert Veatch’s words in the foreword of the book, he can “seriously claim to be at home as an insider in both Chinese and Western thought” rather than most others who are “rooted in one culture and communicate to others as outsiders.”  This not only makes Nie investigate medical ethics from a Chinese-Western comparative perspective but has helped him to avoid stereotypes and develop a theory of “trans-cultural bioethics”.  Overall, the book is a triumph as an exploration of transcultural medical ethics and sophisticated philosophical argument.

The book is divided into four parts and in the first two Nie identifies and proposes approaches to challenge some popular myths and stereotypes on Chinese medical ethics and culture, and Chinese-Western cultural differences. more…

Henrietta Lacks and “Enchanting Rhetoric”

7 Feb, 12 | by Iain Brassington

Note: There’s a couple of errors of interpretation in this post.  I’m not going to re-write it, because I wrote what I wrote, and it’s in the public domain, and I don’t think it’s all that dignified to pretend that one never makes blunders; it’s better to acknowledge them, take the hit, and move on.  But please do have a look at Rebecca Skloot’s response in the comments, and at my answer to her. – IB, 8.ii.12

*     *     *     *     *

Since I read it in the autumn, there’s been a few things nagging at the back of my mind about Rebecca Skloot’s The Immortal Life of Henrietta Lacks.  A few things that don’t seem quite right somehow; and prompted by Pär Segerdahl’s post on The Ethics Blog, I’m tempted to see if I can put them into words.

For those who haven’t read the book, it deals with the story of how it was that an apparently immortal cell culture line, HeLa, was obtained.  The cells were taken from a cervical tumour that went on to kill one Henrietta Lacks, a poor black woman who lived near Baltimore.  During the course of her treatment, a sample of cancerous cells was taken for testing, as was a sample of healthy cells.  (“HeLa” gets its name from the convention of naming culture lines by contracting the name of the person from whom they’re derived.)  These biopsies were apparently unconsented.  But what’s important about them is that, whereas most cell lines at the time died fairly quickly, the cancer sample kept on dividing and dividing.  The HeLa strain proved to be important in all kinds of areas of research.  Doubtless, some of this research has made some people very wealthy.  Yet Henrietta’s descendents have seen none of this profit.  Indeed, many of them are not much more enfranchised today than a black woman would have been 60 years ago; they weren’t even aware that there was such a thing as HeLa.

So what’s the problem?

One of them is definitely stylistic.  I have problems with something that Skloot thinks is a virtue, which is that “dialogue appears in native dialects” (xi).  I don’t share the notion that it’s in any way dishonest to polish out people’s linguistic infelicities, just as one would polish out all the ums and ahs and placeholders in everyday speech.  And I can’t shake the feeling that the professionals who get speaking parts in the book have had their speech tidied; though it’s probably true that the higher your social status, the less susceptible you are to malapropisms, I don’t believe that the educated people directly quoted in the book were always grammatically perfect and never used colloquialisms.  But this is a minor quibble.

What’s more nagging – and potentially more interesting from an ethicist’s point of view – is a question about why any of this is particularly important. more…

Book Review: John Gray, “The Immortalization Commission”

8 Aug, 11 | by Iain Brassington

London: Allen Lane, 2011; 276 + xii pp

If some people are to be believed – not least certain former JME editors – saving lives is a duty that doesn’t stop with children drowning in ponds: it extends to there being a moral obligation to pursue scientific research so that death can be actively avoided for as long a time as possible, and by as many people as possible.  Ray Kurzweil and Aubrey de Grey both, in their different ways, have devoted significant chunks of their careers to not dying, too.  John Gray’s subtitle, “Science and the Strange Quest to Cheat Death”, hints that he’s going to offer us an investigation into the putative-and-possibly-real strangeness of this project.

He doesn’t. more…

Book Review: Pascal Bruckner, “Perpetual Euphoria”

21 Feb, 11 | by Iain Brassington

Woodstock: Princeton UP, 2010; 244 + xii pp

This has to be one of the most French books I’ve ever read.  Pascal Bruckner has written a whole book taking aim at happiness – a kind of obtuseness that is, on the face of it, the preserve of a particular kind of Gallic writer – and “the duty to be happy”.  It’s an interesting project, since – if it turns out to have any substance to it – it represents a possible counter to Millian aspirations about an hedonic calculus.

So what is Bruckner’s claim?   more…

Book Review: Norman Cantor, “After We Die”

30 Dec, 10 | by Iain Brassington

Washington DC: Georgetown UP, 2010; 372+x pp

“Here’s the story; it starts at the end,” says the dead narrator at the beginning of Ali Smith’s novel Hotel World.  It’s a bit of a cliche to say that the dead have stories to tell, but they do have stories to be told about them.  Among them are stories about what happens to them bioogically, and what happens to them legally.  It’s some of these stories that Norman Cantor seeks to tell in After We Die.

It’s worth stressing that it’s some of these stories that’s recounted.  On one level, that may be a problem with the book: it combines a bit of anthropology, a bit of legal history, a bit of social history, a bit of pathology, a bit of all manner of other things.  To some extent, this means that it’s neither fish nor fowl.  But if Cantor wanted to write, say, a law book proper, I assume that he’d have done so – as a legal professor, he’s more than qualified; and if he wanted to write a book on pathology, he’d have known that he, a lawyer, ought to let someone else do it.  So I think that the book’s best viewed as a set of essais, rather as a monograph that sets out to defend a particular hypothesis. more…

Book Review: Singer & Viens (eds.), “The Cambridge Textbook of Bioethics”

30 Sep, 09 | by Iain Brassington

Cambridge: Cambridge UP, 2009; 538+xv pp

£40, pb

A couple of months ago, Cambridge UP tried to post a cheeky advert for this book in the comments to one of the posts on this site.  I sabotaged the link, but offered to restore it in return for a freebie, which CUP asked me to review.  I’ve restored the link to the book’s webpage; but is it worth following? more…

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