In Bioethics as Practice, Judith Andre eloquently describes how the philosophical concept of “practice” can be applied to work. Written predominantly from a first-person perspective, the book begins with a glimpse into one week of Andre's day-to-day activities as a bioethicist. This personalized account provides a model of bioethicists' typical role responsibilities while also serving as a model for how bioethicists should ideally act and the virtues to which they should aspire.

Andre expands on the philosophical concept of “practice” developed by Alasdair MacIntyre as “a coherent and complex set of activities, socially constructed. It has distinctive goals and standards of excellence that help make the practice what it is, and that cannot be fully understood apart from it” (p. 61). Andre proposes that, as a practice, bioethics requires virtues such as courage, justice, and honesty, in terms of being able to balance the internal and external goods of bioethics. For instance, she identifies as a virtue carefully prioritizing research topics in consideration of limited resources.

As I read through Bioethics as Practice, a couple questions emerged: Who is the intended audience? And, what is to be gained by calling bioethics a practice? At first glance, it did not seem like the book was targeted for bioethicists—people who Andre identifies as “those who write, those who consult or are engaged in similar activities (task forces and commissions, for example), and those who create exemplary practices (for instance, model hospice units)” (p. 14). This is because discussions of, for instance, the difficulties junior faculty face in getting started or the limited job prospects available to individuals with a Master's degree in bioethics could be considered common knowledge among bioethicists. Another hint that Andre may have been targeting a lay audience is her description of the process of practices, such as ethics consultations (p. 18), of which many bioethicists generally have a firm understanding.

Yet, on further reflection, Bioethics as Practice appears targeted for bioethicists as a way to increase awareness of their role in society and emphasizes bioethics' importance by demonstrating how bioethics practice contributes to the world (see pp. 61, 63). Raising this point in conjunction with identifying the youthful qualities of bioethics as a relatively new field reflects a certain degree of insecurity about bioethics practice. As such, Bioethics as Practice is about bioethics' coming of age. An allegorical chapter (chap. 3) comparing frontier territory settlement with the development of bioethics demonstrates this point. In other words, now that bioethics has developed as a young field, it is high time for its constituents to engage in self-reflection about how bioethicists have come to be who they are and how to resolve some of their internal tensions.

The tensions center predominantly around the multidisciplinary character of the field. Like an American teenager, eschewing labels and striving to identify and establish his or her own uniqueness, those who do bioethics, Andre writes, are generally reticent to don the appellation “bioethicist.” Doing so could overshadow distinct disciplinary qualities by grouping together individuals with diverse backgrounds. Like an inquisitive child, the field of bioethics may ask, “Where do I come from?” Certainly, many disciplines—medicine, theology, and philosophy—have claimed bioethics as their own offspring. To address this question, Andre purports, somewhat defensively, that bioethics is not a subset of philosophy but is rather the product of all these influences. Like a gawky adolescent entering high school, bioethics, Andre claims, still does not fit well in traditional academic departments and academic conventions (p. 23). As a result, bioethics has developed its own language, much like a pidgin (chap. 4), yet such trade in disciplinary language conventions generates additional tensions. For instance, tensions emerge when disciplines maintain different meanings for the same terms—“autonomy,” “futility,” and “relativism,” for instance—which contributes to cross-disciplinary communication problems within bioethics. Such tension about communication conjures up the image of a frustrated teenager complaining to her mother, “You just don't understand!”

Andre's remedy for such tensions and insecurities takes us to the core of her argument about practice. She states, “Practical ethics, then, is by nature interdisciplinary” (p. 69). Andre promotes interdisciplinary work as a virtue because multiple perspectives are required in order to do a practice well and make an informed impact on the world (p. 184). She therefore advocates working within a community of bioethicists to enable growth, yet cautions about pitfalls in doing such work—for example, having a shallow understanding of phenomena from multiple perspectives. Given the prominence of virtue in her thesis, it is worth mentioning that some virtues required of doing interdisciplinary work include open discussion of disagreements and longevity to overcome shallow understanding (p. 199). Moreover, just as socialization helps to unify cohorts of individuals, so too does giving a group a unified (though recognizably not static) goal, which Andre posits as “mak[ing] health care, health policy, the biological sciences, and our shared understandings of them more deeply moral” (p. 40). Giving a common name—“bioethicist”—to all those who contribute to bioethics practice (as previously noted), is a welcome touch to facilitate a unified identity considering that the multidisciplinary basis of the field can be like a centrifugal force pulling people away from appreciating, learning from, and contributing to the work of others in bioethics (p. 45).

Although unifying bioethicists by outlining their commonly performed practices can help to forge a more solid role for them within the worlds of academia and healthcare, there is still a question of relevance. Like many bioethicists, Andre openly expresses uncertainty about whether ethics consultations benefit the patients, families, and the healthcare team involved in them, and whether society more broadly benefits too (pp. 4–5, 74–5). Yet she addresses this concern by emphasizing how all bioethics practices, when considered as a whole, become routinized into patterns, which in turn, can change hospital service structures and/or the culture of medicine. Such a potential impact is a worthwhile cause.

Andre's own disciplinary background likely shaped how she understands bioethics as practice. To what extent would the book have been different if it had been written by a nonphilosopher, such as a social scientist? Perhaps there would have been a discussion of the cultural basis of the “work” that bioethicists perform—a question that anthropologists might ask. An anthropologist might also ask how does the practice of bioethics in the United States differ from the practice in other countries? Or, a sociologist might inquire into the relationship between bioethics practice and the semiprofessional status of the field.

As a social scientist (anthropologist), my primary concern about the book was its methodology. Throughout her book, Andre reported sections of interviews she had conducted with various bioethicists. Although Andre states she did formal interviewing for one year (p. 171), she does not describe how it was done. Various questions emerge: How rigorously did she sample the population of bioethicists? How many people did she interview? Did she use a survey? Or were random questions asked unsystematically of various people? Ultimately, we are left uncertain as to the generalizability of her respondents' perspectives.

Overall, however, Bioethics as Practice is well written, a joy to read, and a valuable contribution to understanding the professional identity of bioethicists within a growing field.