The Ethics of Fetal Research by Paul Ramsey (review)

6~4 BOOK REVIEWS The Ethics of Fetal Research. By PAUL RAMSEY. New Haven: Yale University Press, 1975. Pp. 125. $2.95 paper, $7.95 cloth. This is an excellent little book-" must " reading for anyone interested in bio-medical ethics. Professor Ramsey begins by classifying and explaining the various kinds of fetal research. A statement of method follows; and here Ramsey resolves to set the discussion " within the context of the existing standards of medical ethics." (p. xvi) With this as his method, then, Ramsey's first task is to determine what the existing standards of medical ethics are. But this is no easy procedure. As a first step, Ramsey informs the reader that it is medicine's primary duty to" do no harm." (pp. xvi, xiv) Still, this knowledge does not carry one very far. Is the duty to do no harm absolute or merely prima facie? Does the fetus's prenatal status negate or somehow "weaken" the duty? And what is the meaning of "harm " ? In an apparent attempt to answer these and similar questions, Ramsey does two things. First, he introduces three efforts to formulate official guidelines permitting fetal research (I) the Peel Report, or the British attempt to formulate such guidelines, (2) the provisional set of guidelines issued by our National Institute of Health in 1973, and (3) the revised set of NIH guidelines, proposed in 1974 but never accepted as official policy. And second, because living, pre-viable human fetuses bear certain resemblances not only to human infants but also to the dying, the condemned, and the unconscious, Ramsey examines the restrictions placed upon experimentation with these kinds of subjects and argues that they should be applicable also in the case of fetal human beings. The themes in ethical analysis having been introduced, Ramsey argues that the recent Supreme Court decision on abortion has skewed medical ethics in such a way that it gives rise to a twisted moral logic. In arguing for the moral propriety of fetal experimentation, Ramsey says, at least one author has held that" since we have given ourselves the right to medically unnecessary abortion (given ourselves the right to do the fetus. . .. ' unimaginable acts of violence' . , .) , then we have given ourselves the right to place the fetus at risk of lesser injury." (p. 42) But the fact that we have given ourselves the legal right to kill a fetus entails nothing so far as morality is concerned-" ought " cannot be derived from " is." If the canons of medical ethics specify that a doctor is to do no harm, medically unnecessary abortions are wrong. And to argue that because this wrong is permitted under the law one is morally right in performing a lesser wrong is to fall victim to a form of thinking which Ramsey calls the " one-wrongjustifies -a-lesser-wrong" fallacy. (p. 41) After examining the relationship between abortion and fetal research Ramsey evaluates the provisional and revised NIH guidelines, denouncing the latter as allowing almost any experimentation, just so long as it is BOOK REVIEWS 6~5 part of an abortion procedure. Once again, then, Ramsey finds the onewrong -justifies-a-lesser-wrong fallacy at work; only now its influence is being felt in molding public policy. Ramsey ends his book with a discussion of the doctrine of informed consent. There is problem enough with the doctrine of consent in ordinary doctor-patient-relationships; and when the issue concerns consent for fetal experimentation, Ramsey quite properly concludes that it would be "... an extreme moral paradox to designate a woman who is planning a medically unnecessary abortion to be the one charged with consenting or not consenting ' for ' the abortus and with protecting it from further avoidable harm." (p. 98) Ramsey's work is significant for many reasons: the reader is given the background necessary in order to fully understand the current controversy surrounding fetal experimentation; the layman is instructed concerning the various kinds or types of fetal research; and moral issues are sharply drawn. However, the real power of the book lies in its examples. One especially bears mention. Ramsey describes the following research project as one which was submitted for NIH funding: The objective was...