Bioethics: All That Matters

[sawyl]

A shift into something close to genuine intellectual territory with Donna Dickenson's breezy and informative Bioethics: All That Matters, as recommended by Steven Poole in the Guardian. I rather enjoyed it, although I had a couple of understandable and predictable quibbles with the closing chapter. I liked the refusal to accept the existing euphemistic jargon for various forms of reproductive technology and the clear and precise explanations of some of the technologies involved. So here are a few highly uncritical notes gleaned from first quick read through.

The book opens with a general case for bioethics, noting that circularity of the "playing god" and "unnatural" arguments. It also questions the idea, put forward by John Harris, that we have a positive moral duty to participate in scientific trials by noting that the benefits of scientific trials are usually unevenly distributed, with the drug companies benefiting ahead of the worst off. This introduces one of Dickenson's key themes: that science is not being held back by religion or bogus ethical claims, but the forces of capitalism.

We then move on to a discussion of reproductive ethics and the way women in general, but especially in poorer countries, are encouraged to sell their eggs or to act as surrogates mothers — Dickenson refuses to pull her punches, referring to this as baby-selling. Yes, surrogacy may be a better way to make money than prostitution or, for example, crushing glass for 15 hours a day. But as the standard (Marxist?) critique has it: it still counts as exploitation if you're taking advantage of someone else's lack of realistic survival choices to get them to do what you want.

This discussion is followed by a chapter on enhancement, trait selection and an examination of pre-implantation genetic diagnosis (PGD) and trite idea that parents might want to produce a "designer baby" — unlikely given that it require the horrors and hassles of IVF in order to allow the embryos to be screened! This segues into a brief overview of utilitarianism and the general problem of reducing the idea of a flourishing human existence to a handful of genetic markers. (As an aside, the conditions of happiness may not be what people think: Flaubert, rather facetiously, claimed that stupidity was a necessary precondition for happiness!)

At which point it makes sense to consider the degree to which we are our genes, the extent to which we own our genetic material — some cultural groups hold that because much of the material is common, it is part of their shared existence and can't be sold for scientific research. Much is made of the claims made by the founders of the human genome project or, subsequently, various other branches of genetic research, of their ability to revolutionise medicine, most of which have yet to come to anything.

After a short departure into the murky world of gene patenting — something Dickenson clearly believes to be deeply suspect — we're into the final stages with an investigation into the ethical problems of stem cells, an area that touches on core questions about abortion, feminism, and womens' rights to determine what happens to their bodies. This features a good overview of the different sorts of stem cells, their associated ethic and political problems, and their possible therapeutic uses (still largely potential rather than actual).

The expositionary material rounds out with a discussion of a set of famously unethical human experiments that all started at more or less the same time: the nazi research on concentration camp victims; the US Public Health Service infecting groups of Guatemalan prisoners and mental patients with syphilis; and the notorious Tuskegee experiments. This leads to a discussion of the Nuremberg Code, the question of whether the (US) scientists of the 1940s thought their work might be justified, and whether, with drug trials being conducted in the developing world, things have really changed as much as we might hope.

The final chapter concludes with a very brief examination of question raised right at the very beginning: are science and religion in conflict with one another? Or is capitalism, with its patented genes and its lawyers and its strangleholds on areas of research, the enemy? Needless to say Dickenson believes that religion and science can be friends, while capitalism is the irreconcilably enemy. Here I find myself slightly at odds with the book. Not so much with the comments about the problems of the profit motive and the train-wreck that is modern patent law, but with accomodationist attitude towards religion. Thus Dawkins is criticised for claiming that the scientific project has been debauched by religion because the Vatican doesn't own big pharma, however Dawkins' point in the section of The God Delusion being cited is that religion undermines science by demanding adherence to a particular dogma regardless of the actual evidence. I'm also not convinced that capitalism and religion are as mutually exclusive as Dickenson implies: it's perfectly possible to have a world where gene patents limit certain forms of treatment and where children in schools are taught that the world is 6,000 years old and evolution is just a theory...