Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 (gloebe@midwestern.edu) regarding books they would like to see reviewed or books they are interested in reviewing.
One of my colleagues at the medical school where I teach is a Jesuit physician. Every year, he asks the incoming students at the annual white coat ceremony three brief but very important questions: “Who am I? What am I doing? Where am I going?” These same three questions seem to undergird many if not most of the essays in the impressive new book The Ethics of Bioethics: Mapping the Moral Landscape. As a field, bioethics is still relatively young. One may think it to be rather premature for such a youthful discipline to subject itself to such intense reflection. Yet, like our first-year medical students, it is really never too early to ask these questions of ourselves and of the community we are a part of. In fact, every author in this book seems to be asking these same questions, in one form or another.
The editors, Lisa Eckenwiler and Felicia Cohn, describe themselves “as two professionals now in the early middle of our careers working in bioethics.” As their subtitle suggests, they serve as bioethical cartographers of sorts in their selection of scholars and topics. Eckenwiler is an associate professor of philosophy and director of healthcare ethics at the George Mason University Center for Health Policy Research and Ethics. Cohn is an associate professor and the director of medical ethics at the University of California, Irvine, School of Medicine and an adjunct professor at the George Washington University Medical Center. The contributors are a veritable who's who of bioethicists: Judith Andre, Tod Chambers, James Childress, Tristram Engelhardt, Mark Kuczewski, James Lindemann Nelson, Jonathan Moreno, Laurie Zoloth, and many others. The authors are trying to critically reflect on a number of salient issues in our field: our history, what constitutes expertise, politics, consultation, values, and self-assessment, of course.
What makes this collection so vibrant and interesting is the variety of analyses and reflections presented. Some chapters tread on familiar territory (what counts as expertise in bioethics, for example), whereas others offer personal reflections that are novel (e.g., Orentlicher's reflections on working as a state representative in the Indiana legislature, Mary Faith Marshall's poignant narrative of her experience working at University of South Carolina Medical Center during a very troublesome time in that institution's history). Perhaps what is most alluring about this collection is the intensely personal nature of so many of the essays, some of which start off with very personal reflections: “When I was in medical school and first began seeing hospital patients, there was something about the way the patients behaved that embarrassed me” (Elliott, p. 43), “I just got off the phone with my colleague Steve Miles. He's helping me with a poetry compilation on the downside of war.” (Marshall, p. 135), “While delaying the preparation of this essay on mentoring in bioethics—and wondering why, in a moment of weakness, I had blithely agreed to write it—I had opportunities to interact with several former graduate students, as well as a few former teachers, and these interactions reminded me just how much I have benefited from both sets of relationships.” (Childress, p. 260).
This is not to say that these essays lack rigor or a strong point of view. We have sharply contrasting contributions from scholars as varied as Griffin Trotter, who argues that a distinct left bias exists in bioethics, and Alta Charo, who lambasts the current President's Council on Bioethics for its “wealth of deep connections many of its staff and members have to the neoconservative movement.” (Charo, p. 98).
An interesting dichotomy that emerges in the works presented here is a majority view that espouses a virtue-based approach to doing bioethics and a minority view committed to developing a formalized code of ethics for bioethicists. Baylis writes about courage as a cardinal virtue for the bioethicist; Zoloth eloquently champions a theory of hospitality. Andre wants to encourage “moral development in ourselves and in those we serve” (Andre, p. 221). Childress writes about the virtues of mentoring and Lindemann discusses our obligations to each other with regard to publication. Even Chambers writes about the importance of the ethicist's character when assessing a particular argument or point of view. Contrast this majority view with the view of someone like Bob Baker, who is an ardent supporter of a formal code of ethics for bioethicists. For Baker, the existence of a code allows members of the field to more seriously assert their integrity in the public square; if we are reluctant to transparently convey our own professional values, why should anyone treat us with any modicum of trust or respect? Similarly, Virginia Ashby Sharpe argues for formal standards of disclosure, in that “robust disclosure of financial ties should be a minimum requirement of all bioethicists in all venues where they teach, write, or make statements to the public” (p. 178) Leaving such decisions to the individual character of each bioethicist is insufficient for Sharpe; formal standards would make disclosure more uniform and would strengthen the public's trust in the pronouncements of bioethicists.
Overall, The Ethics of Bioethics is a rich compendium of thoughtful reflection, analysis, and debate. I laud the editors and contributors for tackling such an array of challenging issues facing our field. In particular, I was encouraged by the inclusion of commentators such as Leigh Turner, who has been exhorting bioethicists to pay more attention to issues related to global health and justice, Lisa Parker, who cogently explores the activist role of bioethicists, and Cat Myser, who writes forcefully of the dominance of “whiteness” in bioethics discourse. If I have one very small quibble with the book it is the noticeable absence of voices from various religious traditions. Having worked in a Catholic medical school for several years now, I have learned a modest amount about Catholic bioethics and the tradition behind it. This already fine book would have been strengthened with one or two selections by theologians such as Kevin O'Rourke, Ron Hamel, or Jim Walter. As Alta Charo describes bioethics as a “creature of theologians,” it would have been a fitting tribute to the pioneers of our field to have them participate in this rich and wonderful dialogue about our field.
Nonetheless, The Ethics of Bioethics is a sterling contribution to the ongoing debate in bioethics regarding who we are, what we do, and what we are becoming. I would strongly encourage its use for educators in bioethics who want their students to engage in these ongoing dialogues. As Nancy King nicely puts it in the final chapter of the book (“The Glass House: Assessing Bioethics”), “Whether the audience for bioethics discussion or advice is industry, the media, students, health professionals, or those requesting ethics consultation, we must remain aware that the teaching endeavors of bioethics are continual and various” (p. 308).