Observing Bioethics is a scholarly, encyclopedic memoire of bioethics as both a discipline and a “social movement.” Authors Renée Fox and Judith Swazey are longtime friends and collaborators, and they intend the book to be an empirically grounded study of the field since the 1950s. They argue that the discipline of bioethics is entrenched in its American origins, and that as a result the field is structured around 1960s political concerns and intellectual frameworks (from philosophy, law, and the social sciences). They also claim that scholars, practitioners, and members of the public have not fully recognized the distinctively American character of bioethics. Instead, they argue, we mistakenly regard the dominant version of bioethics as a universal bioethics. Although this American version of bioethics has its strengths, the authors explain how its prescriptions and practices also limit its effectiveness and sensitivity in sites outside the United States, and its usefulness as a toolkit for responding to issues such as growing health disparities.

The book is organized into four parts and includes eleven substantive chapters, plus an introduction and afterword. The analyses presented in the book are based on forty-five interviews with bioethics leaders (available online through Georgetown University’s Kennedy Institute of Ethics), and on an impressive review of recent secondary literature and of published primary sources. The authors supplement these sources with several chapters based on their firsthand experiences (e.g., chapters 3, 5, and 7), and personal correspondence in letters and emails (e.g., chapters 7 and 10).

Part I describes the landscape of postwar American bioethics in five chapters: the first (chapter 1) maps the traits of early leaders of the field; the following (chapter 2) categorizes the types of origin stories told about bioethics; and the remaining three chapters (3, 4, and 5) explore how bioethical topics have been pitched and received in the public sphere by recounting Fox’s experiences at the 1971 inauguration of the Kennedy Institute of Ethics, Swazey’s experiences at the commemoration of the Belmont Report’s twenty-fifth anniversary in 2004, and their collaborative reading of media coverage of the 1997 cloning of Dolly the sheep.

Part II includes two chapters on “social and cultural” understandings of bioethical issues. Their aim is to explain the key conceptual and methodological features of bioethics—and to demonstrate the field’s American character by documenting its lack of social and cultural flexibility (chapter 6). Commendably, the authors also give voice to their critics and to scholars, such as Daniel Callahan, who Fox and Swazey feel have made arguments similar to their own but have been received more openly by colleagues. On the whole, chapters 6 and 7 allow readers to understand and appreciate their critics’ concerns, for example, regarding the authors’ “romantic relativism” of people’s worldviews outside of the United States. The book might have been strengthened if the authors had engaged the content of their critics’ charges. Bewildered by the critiques, the authors instead account for their critics’ views by providing (the nonetheless provocative) details of the relationships, vendettas, and infelicities of personal email and letters revealed in published exchanges and the authors’ personal letters and emails.

Part III explores the diffusion of bioethics and provides capsules on the key texts, organizations, and training programs through which the American version of bioethics spread (chapter 8). Two chapters (9 and 10) offer case studies of bioethics in France and Pakistan based on the authors’ work with scholars from those countries. Taken together, the chapters suggest that religion might be a source of the endemic bioethics they advocate. At the same time, these chapters reveal how outside organizations, individuals, and governments actively sought information from American sources, such as the Hastings Center. They open questions about the extent to which (American) bioethics has been imposed by the United States or actively solicited by stakeholders outside of the United States—for sincere and for strictly symbolic reasons. Part III also highlights an analytic irony of the book: the authors accept and perpetuate in their own research a vision of the ethical world that is naturally carved into political boundaries. Thus, nations are the implicit unit of bioethical “cultures” for the authors, although legal systems feature little in their explanations of cultural difference. To say that bioethics should not be American but should be international recreates what would seem to be the problem of bioethics—whether American or international—which is that ethical imperatives tend to be tied to apparatuses of state regulation.

Part IV is composed of the book’s concluding chapter, in which the authors reiterate their main contention through an analysis of the “culture wars” surrounding bioethics. Their wrap-up demonstrates how the field was created in and bears the mark of a particular political and historical moment in the United States, which endures in both its federal laws and its international relationships. Paradoxically, the product of this particular American version of ethics in biomedicine denies the importance of locality and history.

What is at stake in this book is who should credibly be included in debates over bioethics—in terms of both its content and the telling of its history. The authors aim to show the pockets of ethical worldviews that get ignored by assuming that present-day bioethics is universal. The authors, perhaps unwittingly, build into their analysis a parallel point: some potential participants in bioethical debates (e.g., women like themselves) were discriminated against, both subtly and overtly, in academia and other professional fields during most of the period that they are writing about both as social scientists and as historical actors. Yet the authors do not address this important political fact that shaped their firsthand experiences, as well as the interviews that give the book its empirical credibility. The authors write on page 9 that many of their ideas over the past four decades “have been received with considerable ambivalence.” They elaborate that the harsh criticisms of their work in print were rather gentle compared to the bioethicists who “referred to us in more scurrilous terms in private, and for a time consigned us to a persona non grata status” (p. 9). The authors only hint at the implicit and explicit forms of discrimination they faced, but it is important to take this possibility seriously because it may have shaped their experiences and the experiences of other underrepresented groups in the field. Methodologically, it affected the evidence on which the book is based by creating a selection bias in the interviews, which were with their self-described “friends” in the field.

At the same time, the claim of marginalization allows the authors, who are no doubt leading figures in the field, to position themselves conveniently as both insiders and outsiders to bioethics. For example, Swazey saw herself as a “participant observer” (p. 126) at commemorations at the same time that she was invited to attend and comment as a “pioneer.” As insiders, Fox and Swazey anticipate that readers will be interested in their behind-the-headlines account of bioethics, given that excellent scholarship is already available on the topics they cover, which they generously cite. As outsiders, the authors are able to critique the field and yet remain immune from their own criticisms.

For scholars entering the field, this book will be useful because it documents the networks of people who harnessed themselves together to create the profession of bioethics in postwar America. In addition, the book draws together Fox and Swazey’s work over the past decades and presents it in their own terms to create a coherent narrative. The intellectual agenda of these indisputable leaders of bioethics culminates with the claim that the present-day profession of bioethics is an American product—with repercussions for good and ill that a new generation of scholars and practitioners have yet to address.