Profession of Conscience: The Making and Meaning of Life-Sciences Liberalism (review)

Robert Hunt Sprinkle’s book is an episodic survey of various topics involving medical ethics, designed to persuade his fellow physicians to commit themselves to humanitarian causes. The term “life sciences” throughout the book refers exclusively to science as related to medicine. Liberalism as applied to medical ethics is defined as a philosophy that respects individual rights, understands human differences as “arising naturally,” is international in its outlook, and is activist in its approach, seeking appropriate solutions to tractable problems. Sprinkle argues that liberalism, as applied to medical ethics, had ancient roots but was codified only in the mid-twentieth century and, despite various onslaughts on liberal values in the 1980s, is alive and well. His notion of which individuals, points of view, and texts constitute exemplars of liberalism is somewhat idiosyncratic; he does not approach a comprehensive discussion of liberalism as it may relate to the life sciences. But he does identify liberalism with scientific method, that is, with a method in which the search for objectivity is taken seriously. He defines the essence of liberalism broadly as having a “clinical” method and being “historically fastidious, observationally acute, free of unwarranted conclusion, and plainly argued” (p. 114).

The book has a broad scope, starting with ancient Greek medicine and ending with the current debate about health care in the United States. Sprinkle profiles three “great men” of liberalism: John Locke, William Osler, and Albert Schweitzer. He denounces certain movements, such as eugenics, as ill-advised turns away from true liberalism. He amasses a grab bag of recent and current issues involving the politics of health care, including the unethical use of human subjects in wartime, the development and control of biological weapons, debate about the role of the World Health Organization, mercury poisoning in Japan, the commercial promotion of infant formula in poor nations, and health care reform in the United States. The book draws heavily on existing scholarship—fortunately for the reader, because the discussions are often so brief and allusive that the reader will need to be familiar with the literature to understand them.

The historical analysis is based on a positivistic concept of science (Sprinkle is careful to point out which past ideas were “correct” or “incorrect”) and is at times so circular that it is hard to be sure what is being argued. An example occurs in the chapter on Locke as the founding father of medical liberalism: Sprinkle insists that Locke’s “natural law theory” must be consistent with modern science, including modern Darwinism, and therefore he interprets Locke as having discerned “correctly, or almost correctly” the idea of natural selection (p. 61). Oddly enough, despite this Procrustean attempt to make Locke into a Darwinian precursor, and despite Sprinkle’s claim that evolutionary sociobiology should be studied intensively for its explanatory power as regards human behavior, the book contains no discussion of exactly how evolutionary biology forms a key element of life sciences liberalism.

Sprinkle claims that the method of liberalism should be “historical and plain” (p. 213), drawing on no authority beyond good reasoning. This book is not a model of such a method. The eclectic mix of issues does not, in the end, add up to a coherent argument, even if we feel that Sprinkle’s heart is in the right place. Although his exhortation to physicians to be less selfish and more active on humanitarian issues strikes a high moral note, the book ends with an instance of unintended self-parody that can only fuel the tired complaint about liberalism’s wishy-washy core. Arguing that liberalism is a “discovery, not an invention,” Sprinkle concludes: “There must be more still to find, and there is surely more to make, and some of what now seems to mean this or that may on maturing reflection be seen to mean the other” (p. 214). In this conclusion it is hard to find guidance for confronting the pressing medical issues of...