Bioethics in Historical Perspective by Sarah Ferber (review)

Errata

During the 1960s and 1970s ethical issues raised by the development of the ventilator, in vitro fertilization, and other morally disruptive medical innovations, and media revelations about researchers' exploitation of minorities and women as unwitting "human guinea pigs," prompted American foundations, professional societies, and governmental bodies to convene investigative committees. Some philosophers and theologians were sprinkled into these committees to augment their gravitas. Many of these philosophers and theologians later assumed roles as advisers at the bedside and watchdogs of the benchside, creating the field that came to be known as "bioethics." Several historians have explored this phenomenon,¹ and one might expect that Australian historian Sarah Ferber's Bioethics in Historical Perspective would proceed along these lines. Ferber has no such ambition. Instead Ferber "explores … examples from modern bioethics history to suggest that the practice of bioethics … can best be undertaken with awareness not only of important historical facts, but of the role of history in our thinking" (p. 7).

Ferber's book evolved from lectures for undergraduate courses on history and biomedical ethics. Its prefatory chapters introduce the field's subject matter and examine its rhetoric; subsequent chapters summarize recent historical scholarship on the long history of such bioethical subjects as eugenics, euthanasia, and experimentation. Each chapter ends with an analysis of the relevance of history to current bioethical debates. Thus Ferber debunks the invocation of the Nazi analogy in debates over assisted suicide, and euthanasia, highlighting differences between the Fascist culture that fomented the Holocaust and neoliberal democratic societies. In a similar vein, she notes disanalogies between earlier eugenics movements aimed at improving humans as a race and current developments in targeted genome editing (e.g., CRISPR) which target improving the health of individuals. Her observations on converting the-done-thing into "scandalous" conduct (p. 129) are particularly astute. Historians teaching undergraduate bioethics courses who wish to emphasize the utility of historical methodology for analyzing current bioethical debates will find this book useful.

Ferber's long-distance observations on American bioethics, however, sometimes fall short of the mark. Thus Ferber mistakenly indenitifies Sargent Shriver as a "philosopher" rather than a politician (p. 1) and chides American bioethicists for indifference to the Groningen neonatal euthanasia protocol (p. 65) when, in fact, Hilde Lindemann's defense of that protocol sparked a major controversy.² More important, Ferber mischaracterizes American bioethics as "political in its essence" (p. 9) and as "one of the defining political arenas of the twenty-first century" (p. 164). This may reflect Ferber's personal experience in FINRRAGE, the Feminist International Network of Resistance to Reproductive and Genetic Engineering, where she "worked on … submissions to government inquires … [although] none of this work helped make any difference to policy or regulation in Australia" (p. x). However, insofar as American bioethics has an "essence," it is, as its name indicates, "ethics." Bioethics began in America as a moral reform movement that precipitated what Ferber characterizes as "an ethical shift" (p. 129). As historian David Rothman writes, "No one document better illustrates … new social attitude … than the Patient Bill of Rights … [which] came, fittingly enough, from the National Welfare Rights Organization (NWRO)."³ Such reformist movements, however, are impotent to effect ethical shifts unless they are reinforced by a critique of the conceptual foundations of accepted moral conventions, an ancien régime with its accompanying normative authority and mechanisms of enforcement.

American bioethics began when a hodgepodge alliance of intellectuals, acting in reaction to scandals and in support of welfare mothers—"proto-bioethicists," so to speak—developed and articulated a new biomedical ethics that critiqued traditional conceptions of the physician-patient and researcher-subject relationships as "paternalism." They contended that all patients and "research participants," including welfare moms and illiterate black farmers in the rural South, should be respected as persons whose "autonomy"—to use a word they interjected into traditional medical discourse—is protected by a penumbra of rights that cannot be breached without their informed voluntary consent. Deconstructing...