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The philosophy of medicine: framing the field
Social Science & Medicine 56 (2003) 2241–2242
Book review The philosophy of medicine: framing the field H. Tristram Engelhardt Jr. (Ed.); Kluwer Academic Publishers, Dordrecht/Boston/London, 2000, 250 pp. $112 hardbound This book, in honor of Stuart F. Spicker, who has helped in shaping the field of philosophy of medicine, is a welcome addition to recent debates on the nature and scope of bioethics. With rapid developments in biotechnology and other medical technologies, there is a need to reflect on the origins and goals of bioethics, and to consider how insights from this field may inform public debate about the object of medicine, and the changing concepts of the body, health, illness, and disease. The book is the 64th volume of a series on Philosophy and Medicine, published by Kluwer, the beginnings and development of which owe much to Spicker. A number of chapters aim to address concerns which were specifically addressed by Spicker himself during the formative period of ‘bioethics’—a term which was coined as recently as 1971. The chapters cover a broad range of topics, and reflect continuing debates about the proper object of bioethics and appropriate methodologies and contributing disciplines. Chapter 1, by Tristram Engelhardt, offers a useful introduction to the origins of the field of bioethics, describing historical struggles between medicine and philosophy, and identifying contributing philosophical traditions, supportive structures, and a number of key figures in the emergent field. As is pointed out, the contemporary field of bioethics incorporates scholarship from many nations and a diversity of approaches, a number of which are represented in the chapters that follow. These chapters are divided into three sections: The Philosophy of the Body and Bioethics; Euthanasia, Secular Priests, and the Centrality of Choice; and Fundamental Categories: the Mind, Equity, the State, and Time. The theme of the lived, experienced body, which has been the focus of much of Spicker’s work, runs through a number of the chapters, and most explicitly those in Section 1. As Ten Have points out, ‘The unique object of medicine is the human embodied being, as person having as well as being a body’ (p. 33; emphases in original). However, the question of what medicine is, Have points out, cannot be answered by medicine itself, but requires anthropological exploration, and philosophical reflection on what it is to be a human being and to be treated PII: S 0 2 7 7 - 9 5 3 6 ( 0 2 ) 0 0 0 8 5 - 0
as a human being. As Wartofsky indicates, in a discipline which is as reductionist as medicine, and which has increasingly focused on replaceable body parts, how one conceives the relationship between the parts and the whole and between bodies and the persons whose bodies they are, is crucial to the question of personal identity. The 3rd and last chapter in this section, by Mark Cherry, addresses philosophical issues pertaining to the sale of body parts, a topic which has provoked strong responses from professional organisations on the grounds of violation of such ethical principles as ‘the dignity of the individual’ and ‘respect for persons’. In the chapter, Cherry explores some of the complexities underlying the arguments, and draws implications for the concept of personhood, the nature of embodiment, and normal functioning. The chapters comprising Section 2 focus largely on mechanisms for regulating medical practice, namely supportive legislation, ethical expertise, and norms of research. In this chapter, Thomas Halper examines the Dutch experience of euthanasia: the conditions giving rise to legislation supporting passive euthanasia; current policy and practice; and contemporary debates. Notwithstanding stereotypes about the Dutch experiment, as Halper argues, this continues to be a highly contentious area of medical practice, with the current situation perhaps best characterised as involving an accommodationist consensus. In the following chapter, George Agich raises the question: why should anyone listen to ethics consultants? He explores the conditions and nature of authority, and the importance for consultants to gain authority by earning respect, rather than by relying on formal rules, procedures, or qualifications. Next, Loretta Kopelman traces changing views on paternalism in research, with particular reference to responses of AIDS activists, who have rejected protectionism, and explores the implications for the research process. The chapter raises questions about unjustified paternalism in research and its effect on public confidence in research and the decisions of researchers. The chapters in Section 3 broaden the discussion to encompass the fundamental categories of the mind, equity, the state, and time. K. W. M. Fulford examines psychiatry from historical, conceptual, and bioethical perspectives, drawing attention to determinism in psychiatric thought and practice, resulting from the influence of the biomedical model. As Fulford explains,
2242
Book review / Social Science & Medicine 56 (2003) 2241–2242
psychiatry has been relatively neglected as a field of analysis in bioethics, in favour of the more high profile problems of technological medicine. However, with the breakdown of the mind–body dualism, bioethics needs to widen its gaze, drawing on a diversity of theoretical perspectives. In the next chapter, Bernard Dickens examines equity and the health effects of urbanisation, and discusses future options and emergent issues. The chapter explores implications of urbanisation for national and international equity in health care; for example, the transmission of AIDS, and the impact of the clearing of land for human habitation. Thomas Bole then offers an account of Engelhardt’s views on Kant’s moral foundations and Hegel’s category of the state, which is followed by a critical response from Engelhardt. Finally, by way of an Epilogue, Akio Sakai analyses Spicker’s thought on the theme of the use of the past for examining contemporary bioethical issues.
My main criticism of the book is that some of the discussion is too ‘in-house’ in style and overly North American in its concerns and references. However, overall, the book is an interesting read that provides a succinct account of the history and concerns of bioethics. Those who are unfamiliar with the field, or who want insight into some major bioethical debates, will find much of value in this text. As many of the contributors acknowledge, the ethical implications of contemporary medicine are far reaching and require a multidisciplinary input and a wide-ranging discussion. This book offers not only a useful reference for past and current debates, but also valuable pointers for further exploration in the field of bioethics. Alan Petersen Department of Sociology, Faculty of Humanities, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
Book review The philosophy of medicine: framing the field H. Tristram Engelhardt Jr. (Ed.); Kluwer Academic Publishers, Dordrecht/Boston/London, 2000, 250 pp. $112 hardbound This book, in honor of Stuart F. Spicker, who has helped in shaping the field of philosophy of medicine, is a welcome addition to recent debates on the nature and scope of bioethics. With rapid developments in biotechnology and other medical technologies, there is a need to reflect on the origins and goals of bioethics, and to consider how insights from this field may inform public debate about the object of medicine, and the changing concepts of the body, health, illness, and disease. The book is the 64th volume of a series on Philosophy and Medicine, published by Kluwer, the beginnings and development of which owe much to Spicker. A number of chapters aim to address concerns which were specifically addressed by Spicker himself during the formative period of ‘bioethics’—a term which was coined as recently as 1971. The chapters cover a broad range of topics, and reflect continuing debates about the proper object of bioethics and appropriate methodologies and contributing disciplines. Chapter 1, by Tristram Engelhardt, offers a useful introduction to the origins of the field of bioethics, describing historical struggles between medicine and philosophy, and identifying contributing philosophical traditions, supportive structures, and a number of key figures in the emergent field. As is pointed out, the contemporary field of bioethics incorporates scholarship from many nations and a diversity of approaches, a number of which are represented in the chapters that follow. These chapters are divided into three sections: The Philosophy of the Body and Bioethics; Euthanasia, Secular Priests, and the Centrality of Choice; and Fundamental Categories: the Mind, Equity, the State, and Time. The theme of the lived, experienced body, which has been the focus of much of Spicker’s work, runs through a number of the chapters, and most explicitly those in Section 1. As Ten Have points out, ‘The unique object of medicine is the human embodied being, as person having as well as being a body’ (p. 33; emphases in original). However, the question of what medicine is, Have points out, cannot be answered by medicine itself, but requires anthropological exploration, and philosophical reflection on what it is to be a human being and to be treated PII: S 0 2 7 7 - 9 5 3 6 ( 0 2 ) 0 0 0 8 5 - 0
as a human being. As Wartofsky indicates, in a discipline which is as reductionist as medicine, and which has increasingly focused on replaceable body parts, how one conceives the relationship between the parts and the whole and between bodies and the persons whose bodies they are, is crucial to the question of personal identity. The 3rd and last chapter in this section, by Mark Cherry, addresses philosophical issues pertaining to the sale of body parts, a topic which has provoked strong responses from professional organisations on the grounds of violation of such ethical principles as ‘the dignity of the individual’ and ‘respect for persons’. In the chapter, Cherry explores some of the complexities underlying the arguments, and draws implications for the concept of personhood, the nature of embodiment, and normal functioning. The chapters comprising Section 2 focus largely on mechanisms for regulating medical practice, namely supportive legislation, ethical expertise, and norms of research. In this chapter, Thomas Halper examines the Dutch experience of euthanasia: the conditions giving rise to legislation supporting passive euthanasia; current policy and practice; and contemporary debates. Notwithstanding stereotypes about the Dutch experiment, as Halper argues, this continues to be a highly contentious area of medical practice, with the current situation perhaps best characterised as involving an accommodationist consensus. In the following chapter, George Agich raises the question: why should anyone listen to ethics consultants? He explores the conditions and nature of authority, and the importance for consultants to gain authority by earning respect, rather than by relying on formal rules, procedures, or qualifications. Next, Loretta Kopelman traces changing views on paternalism in research, with particular reference to responses of AIDS activists, who have rejected protectionism, and explores the implications for the research process. The chapter raises questions about unjustified paternalism in research and its effect on public confidence in research and the decisions of researchers. The chapters in Section 3 broaden the discussion to encompass the fundamental categories of the mind, equity, the state, and time. K. W. M. Fulford examines psychiatry from historical, conceptual, and bioethical perspectives, drawing attention to determinism in psychiatric thought and practice, resulting from the influence of the biomedical model. As Fulford explains,
2242
Book review / Social Science & Medicine 56 (2003) 2241–2242
psychiatry has been relatively neglected as a field of analysis in bioethics, in favour of the more high profile problems of technological medicine. However, with the breakdown of the mind–body dualism, bioethics needs to widen its gaze, drawing on a diversity of theoretical perspectives. In the next chapter, Bernard Dickens examines equity and the health effects of urbanisation, and discusses future options and emergent issues. The chapter explores implications of urbanisation for national and international equity in health care; for example, the transmission of AIDS, and the impact of the clearing of land for human habitation. Thomas Bole then offers an account of Engelhardt’s views on Kant’s moral foundations and Hegel’s category of the state, which is followed by a critical response from Engelhardt. Finally, by way of an Epilogue, Akio Sakai analyses Spicker’s thought on the theme of the use of the past for examining contemporary bioethical issues.
My main criticism of the book is that some of the discussion is too ‘in-house’ in style and overly North American in its concerns and references. However, overall, the book is an interesting read that provides a succinct account of the history and concerns of bioethics. Those who are unfamiliar with the field, or who want insight into some major bioethical debates, will find much of value in this text. As many of the contributors acknowledge, the ethical implications of contemporary medicine are far reaching and require a multidisciplinary input and a wide-ranging discussion. This book offers not only a useful reference for past and current debates, but also valuable pointers for further exploration in the field of bioethics. Alan Petersen Department of Sociology, Faculty of Humanities, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK