Vulnerable Subjects: Ethics and Life Writing (review)

Thomas Couser's Vulnerable Subjects: Ethics and Life Writing explores the moral perils of speaking for those who either cannot speak for themselves or can give no meaningful consent to being depicted by others. The range of cases Couser entertains is remarkably broad, and many of them are fascinating. He begins with Jeffrey MacDonald, accused of three murders, who on the eve of his trial invites a journalist to write a book about him. The journalist, Joe McGinniss, becomes his close friend, leading MacDonald to believe that despite his conviction on all three counts the book will exculpate him. Instead, Fatal Vision portrays MacDonald as guilty as charged and a narcissist to boot. Equally fascinating is the story of Black Elk Speaks, which Couser claims to be one of the most influential depictions of Lakota culture but whose author was careful to suppress any mention of Black Elk's conversion to Christianity or other evidence of assimilation into European ways of life. Couser devotes an entire chapter—in my view, the best in the book—to Oliver Sacks's representations of his patients and, in a later chapter, of people such as Temple Grandin, the autistic professor of veterinary science, in whose neuropathies Sacks takes an "anthropological" interest. Couser then turns to two stories of high-stakes decision making, each written by the parent of a young man who broke his neck in a swimming accident and lived, but as a quadriplegic. The focus here is less on the ethics of representation than on the ethics of end-of-life choices: one father opts for his son's death, while the other is persuaded that his son should be allowed to live. The final chapter of the book, "Genome and Genre: DNA and Life Writing," likewise has little to do with the ethics of representation, exploring instead how, with advances in genetic knowledge, human DNA functions as a kind of script for people's lives.

The ethical questions Couser raises in the chapters that deal with morally troublesome depictions of vulnerable lives are worth considering: Did the subject give consent, and was that consent fully informed? Did the author have his or her own axe to grind? Was the subject treated solely as a means to the author's ends? Did the author patronize or fail to value properly the lives of subjects with disabilities? Important as these questions are, however, even more important is the theory that guides which ones to ask and how to think about answering them, and it is here that Couser falls down.

He adopts a rather crude version of Tom Beauchamp and James F. Childress's famous "middle-level" bioethical principles, arguing that "biomedical ethics is perhaps the most highly developed version of normative ethics available today" (15). In fact, biomedical ethics is seriously underdeveloped. Most bioethicists tackle moral problems by swapping intuitions when they can and appealing to Kant, Locke, and Mill when they must. The normative moral theories of these Enlightenment philosophers arose at a specific time and place for the purpose of putting morality on a secular footing and freeing men of property from undue interference from the state; they were not designed to shed moral light on familial relations or friendship, or to evaluate anything so particularistic as the story of a life.

Because Couser adopts the "middle-level" principles derived from Enlightenment moral and political philosophy, he leaves the unwary reader with the impression that ethics is primarily concerned with consent. Of Oliver Sacks he says, "If his patients have consented to having their stories told, there is no violation of their autonomy and no appropriation of their stories" (77), as if the doctor-patient relationship were one in which the parties bargain from positions of equality to maximize their own self-interest. Of the possibility that others may profit from the subject's story he says, "[A]lthough we have the right to commodify ourselves, we do not have the right to commodify...