Book Review — Bioethics in America: Origins and Cultural Politics

March-April 2004


M. L. Tina Stevens
Johns Hopkins University Press, Baltimore, 2000, 224 pp., $39.95

This book considers four topics, and taking those topics one by one provides a useful way to give some idea of the propositions defended in the book.

In the first section, the author maintains that the origins of the bioethics movement in America are found more precisely in the ambivalence to technology generated by the development of atomic energy, than by an awakening of Americans in reaction to the paternalism present in medicine in the 1950s and '60s. The author maintains that science and technology, especially in regard to nuclear fission, presents its findings and developments as value neutral; it is only after some time that scientists and other concerned people start to ponder the ethical issues that result from their endeavors.

Stevens sees a carryover from the Second World War, especially from the devastation caused by the atomic bombs. A resulting doubtful attitude concerning science, the author maintains, gave rise to a doubtful attitude concerning the technology of medicine—and thus generated the "bioethics movement."

Stevens' explanation of the birth of bioethics in America is different from the genesis of the movement presented by most other persons who have considered this topic. For the most part, the birth of bioethics is presented as an outgrowth of the radical movements of the 1960s, particularly a desire to counteract the paternalism which had become endemic in the practice of medicine. Authors considering this topic often present as causes for the bioethics movement the violations of human dignity that occurred in various research protocols in the United States, such as the Tuskeegee Syphilis Study (see Peter A. Clark, SJ, PhD, "Prejudice and the Medical Profession," Health Progress, September-October 2003, pp. 12-23).

One schooled in the Catholic tradition of bioethics cannot help but observe that the birth of bioethics in the Catholic tradition started at the University of Salamanca in Spain some 400 years ago, and that the moral commentaries in the Catholic tradition always contained questions that today would be considered questions of bioethics. But if one wished to trace bioethics in modern times (as does Stanley Joel Reiser, an historian of medicine mentioned in this book), one could say that bioethics was born in 1957 when Pope Pius XII was asked by a group of anesthesiologists about the use of artificial devices to prolong life for the dying. As Reiser pointed out at the 1992 Seattle conference celebrating the birth of bioethics, the anesthesiologists' question was the first modern occasion in which physicians went outside their profession for advice on the ethical use of technology.

The second topic treated in the book is the history and influence of the Hastings Center, a pioneer institute in the development of bioethics. Stevens' most interesting assertion in this section is that the center, which has been known by different names during its history, did not develop a confrontational style in its various studies of medical and technological problems. Rather, it was more irenic in its approach, seeking to develop guidelines that could be used to direct the activities of the profession of medicine and its allied disciplines along paths that respected the rights of individuals and societies.

The Hastings Center "was and is an effort to grapple with a disturbing array of ethical dilemmas generated by technologies that seem value neutral in their creation, even while problem causing in their outcomes" (p.47). Daniel Callahan expressed some misgivings with this approach (pp. 66-71), and seems to sum up the position of medical ethics in the United States by stating that the National Institutes of Health would not have allotted 5 percent of the Human Genome Project to ethical, legal, and social issues "if there had been the slightest likelihood it would turn into a source of trouble and opposition, and it indeed hasn't" (p. 74).

The third topic considered is "Redefining Death in America," which proposes, persuasively, that the main reason for developing a description of death alternative to that traditionally employed (cessation of pulmonary function) was "the need for viable organs" (p. 87). Thus this section outlines the development of brain-death criteria for death. Although the treatment of this topic is interesting and challenging, more consideration could have been given to the fact that brain-death criteria are often used as the only criterion for death, even though an organ transplant is not anticipated. Because this is so, the suffering of moribund patients is often prolonged unnecessarily.

The book's final section is devoted to the "Sleeping Beauty," Karen Anne Quinlan. After reporting the difficulties that the Quinlan family encountered in having a respirator removed from their daughter, who was in a persistent vegetative state, especially insofar as various court hearings and publicity were concerned, Stevens wisely points out that Karen was not brain dead; and that the ultimate decision of the New Jersey Supreme Court did not give the physician permission to remove the respirator but merely stated that, if life support were removed at the request of the patient or her proxy, the physician would not be liable to "civil or criminal liability" (p.141).

One wonders why the case wound up in court in the first place, since withdrawing life support from people in Karen's condition was already customary medical practice (p.135), and why, once the decision of the court approving of the family's request was granted, the physicians caring for Karen took more than six weeks to wean her from the respirator (p.148), thereby sentencing her to another 10 years of life in persistent vegetative state.

Fr. Kevin O'Rourke, OP, JCD
Professor of Ethics
Stritch School of Medicine
Loyola University, Chicago