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Bioethics yearbook vol. 1: Theological developments in bioethics 1988–1990
Book Reviews action research and the importance of co-determination such as found in Norway. Although the book focuses on research and labor policies within the Scandinavian countries, Part IV discusses strategies for developing labor policies tailored for the United States, Australia, and Canada. The early chapters appear to earmark the book as rooted in quantitative research. However, observational and case studies are well represented later on, which explain much of the quantitative data. This book is particularly insightful since it looks at the issues of work and health from a multidimensional perspective that includes the political, social, and organizational dimensions that influence working experience, as well as the more immediate issues of physiological and psychological responses of employees to their work environment. The fundamental premise underlying this work is that the key psychosocial aspects of work are decision latitude, psychological demands faced by workers, and social support by others (Fig. 1, p. 126; Figs 1-4, pp. 177-180). This is explored in the first two articles that focus on the relationship between social status and disease. The articles that follow examine health in terms of occupational characteristics, physiological reactions, political participation, gender, and worker control. Low social class limits one’s opportunities to low paying unskilled jobs involving little creative challenge. Workers gradually respond to this context with depression and the adoption of behaviors such as smoking, lack of intellectual and physical activities, and poor diets. These may become the immediate factors increasing blood pressure, adrenaline, cortisol, and adrenocorticotropic levels, which over time, increase the probability of cardiovascular disease (Figs I and 2, pp. 52-53). Simply stated, people who are most happy in their work have sufficient life opportunities, work autonomy, and challenge, thus providing the circumstances facilitating better health. However, one caveat that should be observed with this line of reasoning is that while this data helps explain the relationship between poor job experience and health that many people commonly observe, it may lead us to believe that we can come to objectively understand working experience. This is not so. For example, identical biochemical levels or changes in several individuals may be interpreted differently by each, resulting in different stress levels. Furthermore, specific occupational changes are likely to produce radically different biochemical reactions within each individual. Tesh (1988) discussed this problem in her account of the air traffic controllers’ strike in the United States in 1980. Using stress as their basic grievance, experimental endocrine studies of controllers found no significant evidence that the controllers experienced stress. This facilitated the Reagan Administration in firing those controllers who refused to return to work, and the breaking of their union. Physiological studies are useful in explaining how the social interacts with the biological but they do not explain human experience in any objective sense This problem is also related to the issue of gender and stress. The vast majority of stress research has been conducted on men. Ellen Hall’s article discusses how women may interpret specific stress factors differently because their endocrine systems tend to be less reactive than men’s,
Bioethics Yearbook Vol. 1: Theological Developments in Bioethics 19884990, Edited by BARNCHA. BRODYet al. Kluwer Academic Publishers, Lancaster, 1991.219 pp., 599, f60.
587
Furthermore, since women are located within a different social context than men, they often respond to events differently. The classic example would be the tendency of men to shift conversational topics to sports or sex in the presence of women as a means of asserting their dominance, producing a source of stress that men do not usually experience. Another interesting point raised in Part I shows that workers in monotonous jobs tend to be more physically and mentally tired at the end of the day. They respond to their jobs by learning to be helpless, and passive socially and politically. This is not only unfortunate in terms of their social relationships, but it also limits their political participation. This poses problems both for the continued wellbeing of a democratic society and for the issues raised in Gunnela Westlander’s article in Part II indicating that successful substantive change can originate only with the active involvement of the workers. This requires that they vocalize their demands and organize for action, both of which require time and activism. As a result, many workers tolerate their deadening jobs because they do not feel they have the means of successfully pressing for change. Part III provides case studies of work place democratization within the Scandinavian countries. Particularly interesting is Bjorn Gustavsen’s discussion of Norway’s model of co-determination, which focuses more on the active involvement of the workers than does the Swedish model. The articles in Part III demonstrate how all aspects of social life impinge on any one sphere. Thus, in order to change the organization of work it is necessary to rethink the notions of efficient and hierarchical control, the importance of economies-of-scale, the balance of power between management and labor, and the concept of democracy itself. The book is timely because the deadening experience of working that many people face in industrialized countries is indefensible within an ever widening democratic world. From a utilitarian perspective, improved mental and physical health would reduce the costs of production while improving innovation, and slow the escalating costs of health care. In conclusion, I found the book to contain a collection of important articles. One minor criticism is that some themes become overly repetitive towards the second half of the book. This could have been minimized if the editors replaced some discussions with brief reference to the relevant discussion in a prior article. Overall, the text is stylistically clear and minimizes the use of jargon. The statistics presented are, for the most part, readily interpreted by most readers and suitable for policy makers, labor activists and students at the graduate and undergraduate levels. Department
o/ Sociology Geneseo Geneseo, NY 14454, U.S.A.
STEPHEN L. FIELDING
SUNY College at
REFERENCE
Tesh S. N.
Hidden Arguments: Political Ideology and Disease Prevention Policy. Rutgers University, New Bruswick,
NJ, 1988.
The editors of this symposium are to be congratulated on their good idea in inviting responses from a wide variety of religious traditions to a standard list of bioethical questions. The topics chosen were: new reproductive technologies,
588
Book Reviews
abortion, maternal-fetal conflicts, care of severely disabled neonates, consent, confidentiality, equitable access to health care, active and passive euthanasia, the definition of death, and organ donation and transplantation. The religious traditions include the mainline Christian denominations plus Hinduism, Buddhism, Islam, Judaism and Mormonism. With one exception each is represented by a single author, the majority ofwhom are based in the United States. The book thus has a strong American slant, but not exclusively so, and provides a conspectus of opinion not easily available elsewhere. Its designation as Volume 1 gives promise that it will be regularly updated, and it could prove to be a most valuable continuing resource for those whose main work is in this field. The years under review are supposed to be 198881990, but in fact most of the authors look back over a longer history of thinking on these topics within their own traditions, and also provide useful introductory summaries of the way in which their tradition customarily tackles ethical issues. These were for me the most interesting parts of the book as the actual discussions of the topics themselves tend to be somewhat repetitive. Anybody but a reviewer would be well advised to read these introductory sections, and then dip into the body of the text to compare the different approaches to individual topics. The two essays which stand out from the rest are, as might be expected, those on Hinduism and Buddhism. Medical ethics in India has to make its way in a context where neither the medical nor the religious leaders have so far voiced much concern, and where most debates are conducted in the mass media. The problems are not those faced in more affluent Western societies, and mostly centre on poverty, health education and preventable diseases in a system of medical care dogged by bureaucracy and corruption. The overwhelming value placed on fertility legitimates all means of securing progeny, especially males, and it is estimated that between 1983 and 1988 78,000 abortions were performed in the interests of sexual selection in Bombay alone. Buddhist ethics is almost wholly non-analytic and, apart from asserting a profound respect for life, has little contribution to make to the problems as they present themselves in other cultures. interestingly the concept of brain death is criticized as being incompatible with a holistic understanding of the person. All the other traditions, with their roots in Judaism and Christianity, have strong family resemblances. There is a spectrum of opinion on abortion, for instance, both between religious traditions and within them, but a widespread recognition of the extreme difficulty and seriousness of the moral choices which have to be made in this area. None see
it in terms of a simple apposition between pro-life and pro-choice. Almost all the traditions condemn active euthanasia, but almost all accept the significance of brain death and are willing to approve organ transplantation. The Latter Day Saints seem to have overcome their fear that transplantations might create problems when the time comes for bodily resurrection, which is an important element in their belief. In uirro fertilization receives cautious approval, and there is a well-argued critical account of the Roman Catholic Church’s official condemnation of all techniques which threaten the integrity of the whole procreative process from love-making to birth. Curiously there is little discussion of embryo research, and many of those who support IVF seem unaware of its dependence on such research. AID is universally condemned, mainly for its intrusion of a third party into the marriage relationship. AIH, by contrast, creates no moral problems. When all the summarizing has been done, however, the question remains, how representative are these essays? The Roman Catholic essay, for instance, is less of a summary than a critique. The same is true of the essay written on behalf of the Baptists and Evangehcals by an author who appears to be unsympathetic towards the mainstream thinking in both traditions. I must confess to a particular disappointment over the essay on Anglicanism, the tradition I know best from within. Admittedly it is not easy to gauge opinions in a world wide body which has no strong central authority. Nevertheless the two authors of this essay seem to have adopted a hit-and-miss technique which has led them to ignore some of the most substantial work on the range of topics under discussion. The Church of England, for instance, is represented ludicrously by a few quotations from a church newspaper. Furthermore, in what is supposed to be a world survey, it is strange to find no mention of the Australian churches, given that that is where some of the most far-reaching work on reproductive technology has been done. Such omissions are perhaps forgivable in a first attempt to survey a complex scene. The basic idea behind the book seems well worth pursuing further. In subsequent volumes it would be helpful if the authors could avoid repeating the large amount of material from church reports, summarized rather breathlessly in these tightly packed pages, and look more deeply into the reasons how and why religious traditions adopt their distinctive ethical standpoints. Archbishop of York York England
JOHN HABGOOD
Bioethics Yearbook Vol. 1: Theological Developments in Bioethics 19884990, Edited by BARNCHA. BRODYet al. Kluwer Academic Publishers, Lancaster, 1991.219 pp., 599, f60.
587
Furthermore, since women are located within a different social context than men, they often respond to events differently. The classic example would be the tendency of men to shift conversational topics to sports or sex in the presence of women as a means of asserting their dominance, producing a source of stress that men do not usually experience. Another interesting point raised in Part I shows that workers in monotonous jobs tend to be more physically and mentally tired at the end of the day. They respond to their jobs by learning to be helpless, and passive socially and politically. This is not only unfortunate in terms of their social relationships, but it also limits their political participation. This poses problems both for the continued wellbeing of a democratic society and for the issues raised in Gunnela Westlander’s article in Part II indicating that successful substantive change can originate only with the active involvement of the workers. This requires that they vocalize their demands and organize for action, both of which require time and activism. As a result, many workers tolerate their deadening jobs because they do not feel they have the means of successfully pressing for change. Part III provides case studies of work place democratization within the Scandinavian countries. Particularly interesting is Bjorn Gustavsen’s discussion of Norway’s model of co-determination, which focuses more on the active involvement of the workers than does the Swedish model. The articles in Part III demonstrate how all aspects of social life impinge on any one sphere. Thus, in order to change the organization of work it is necessary to rethink the notions of efficient and hierarchical control, the importance of economies-of-scale, the balance of power between management and labor, and the concept of democracy itself. The book is timely because the deadening experience of working that many people face in industrialized countries is indefensible within an ever widening democratic world. From a utilitarian perspective, improved mental and physical health would reduce the costs of production while improving innovation, and slow the escalating costs of health care. In conclusion, I found the book to contain a collection of important articles. One minor criticism is that some themes become overly repetitive towards the second half of the book. This could have been minimized if the editors replaced some discussions with brief reference to the relevant discussion in a prior article. Overall, the text is stylistically clear and minimizes the use of jargon. The statistics presented are, for the most part, readily interpreted by most readers and suitable for policy makers, labor activists and students at the graduate and undergraduate levels. Department
o/ Sociology Geneseo Geneseo, NY 14454, U.S.A.
STEPHEN L. FIELDING
SUNY College at
REFERENCE
Tesh S. N.
Hidden Arguments: Political Ideology and Disease Prevention Policy. Rutgers University, New Bruswick,
NJ, 1988.
The editors of this symposium are to be congratulated on their good idea in inviting responses from a wide variety of religious traditions to a standard list of bioethical questions. The topics chosen were: new reproductive technologies,
588
Book Reviews
abortion, maternal-fetal conflicts, care of severely disabled neonates, consent, confidentiality, equitable access to health care, active and passive euthanasia, the definition of death, and organ donation and transplantation. The religious traditions include the mainline Christian denominations plus Hinduism, Buddhism, Islam, Judaism and Mormonism. With one exception each is represented by a single author, the majority ofwhom are based in the United States. The book thus has a strong American slant, but not exclusively so, and provides a conspectus of opinion not easily available elsewhere. Its designation as Volume 1 gives promise that it will be regularly updated, and it could prove to be a most valuable continuing resource for those whose main work is in this field. The years under review are supposed to be 198881990, but in fact most of the authors look back over a longer history of thinking on these topics within their own traditions, and also provide useful introductory summaries of the way in which their tradition customarily tackles ethical issues. These were for me the most interesting parts of the book as the actual discussions of the topics themselves tend to be somewhat repetitive. Anybody but a reviewer would be well advised to read these introductory sections, and then dip into the body of the text to compare the different approaches to individual topics. The two essays which stand out from the rest are, as might be expected, those on Hinduism and Buddhism. Medical ethics in India has to make its way in a context where neither the medical nor the religious leaders have so far voiced much concern, and where most debates are conducted in the mass media. The problems are not those faced in more affluent Western societies, and mostly centre on poverty, health education and preventable diseases in a system of medical care dogged by bureaucracy and corruption. The overwhelming value placed on fertility legitimates all means of securing progeny, especially males, and it is estimated that between 1983 and 1988 78,000 abortions were performed in the interests of sexual selection in Bombay alone. Buddhist ethics is almost wholly non-analytic and, apart from asserting a profound respect for life, has little contribution to make to the problems as they present themselves in other cultures. interestingly the concept of brain death is criticized as being incompatible with a holistic understanding of the person. All the other traditions, with their roots in Judaism and Christianity, have strong family resemblances. There is a spectrum of opinion on abortion, for instance, both between religious traditions and within them, but a widespread recognition of the extreme difficulty and seriousness of the moral choices which have to be made in this area. None see
it in terms of a simple apposition between pro-life and pro-choice. Almost all the traditions condemn active euthanasia, but almost all accept the significance of brain death and are willing to approve organ transplantation. The Latter Day Saints seem to have overcome their fear that transplantations might create problems when the time comes for bodily resurrection, which is an important element in their belief. In uirro fertilization receives cautious approval, and there is a well-argued critical account of the Roman Catholic Church’s official condemnation of all techniques which threaten the integrity of the whole procreative process from love-making to birth. Curiously there is little discussion of embryo research, and many of those who support IVF seem unaware of its dependence on such research. AID is universally condemned, mainly for its intrusion of a third party into the marriage relationship. AIH, by contrast, creates no moral problems. When all the summarizing has been done, however, the question remains, how representative are these essays? The Roman Catholic essay, for instance, is less of a summary than a critique. The same is true of the essay written on behalf of the Baptists and Evangehcals by an author who appears to be unsympathetic towards the mainstream thinking in both traditions. I must confess to a particular disappointment over the essay on Anglicanism, the tradition I know best from within. Admittedly it is not easy to gauge opinions in a world wide body which has no strong central authority. Nevertheless the two authors of this essay seem to have adopted a hit-and-miss technique which has led them to ignore some of the most substantial work on the range of topics under discussion. The Church of England, for instance, is represented ludicrously by a few quotations from a church newspaper. Furthermore, in what is supposed to be a world survey, it is strange to find no mention of the Australian churches, given that that is where some of the most far-reaching work on reproductive technology has been done. Such omissions are perhaps forgivable in a first attempt to survey a complex scene. The basic idea behind the book seems well worth pursuing further. In subsequent volumes it would be helpful if the authors could avoid repeating the large amount of material from church reports, summarized rather breathlessly in these tightly packed pages, and look more deeply into the reasons how and why religious traditions adopt their distinctive ethical standpoints. Archbishop of York York England
JOHN HABGOOD