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Case Studies in Biomedical Research EthicsReview - Case Studies in Biomedical Research Ethics
by Timothy F. Murphy
MIT Press, 2004
Review by David Teira, Ph.D.
Jul 17th 2005 (Volume 9, Issue 28)

The ethics of scientific research is certainly a topic of common interest for ethicists and philosophers of science alike, even if many among them still adhere to Merton's conventional wisdom about scientists being communitarian, universalist and disinterested agents. In other words, not particularly controversial (and even rather exemplary) from a normative standpoint. The advancement of biomedical research ethics, among other disciplines, shows that the pursuit of truth might not always be morally virtuous, as this collection of case studies illustrates at length.

Timothy Murphy has drawn cases from various sources that sometimes go far beyond our ordinary understanding of bioethics in order to achieve a thorough view of the normative dilemmas involved in biomedical research. Of the nine chapters of the compilation, three address general bioethical issues in the context of clinical research ("Informed consent", "Embryo, Fetuses and Children", "Genetic Research"); two other ones present more circumscribed topics (such as "Oversight and Study Design", "Selection of Subjects", "Use of Animals") and another three explore frontier domains: "Conflicts of Interests", "Social Effects of Research" and "Authorship and Publication". Tracing such a wide-ranging disciplinary map counts among the most significant achievements of this book.

The book is explicitly intended as a "text for instruction" and this certainly accounts for its organization. Each chapter compiles on average 15 case studies, which adds up to 150 cases. Each of these is normally kept to a one-page length, and is presented with an introductory paragraph signaling its point, a couple of references citing sources or further readings when necessary and a few questions intended for discussion. Most cases are already known (some are indeed classical), though a reasonable proportion is relatively new. Most of them are real and, save for a few exceptions; almost all are drawn from the wide realm of biomedical research. Each chapter opens with a brief introduction that summarizes the dilemmas covered in the cases subsequently presented. There is also a general introduction in which Murphy briefly covers the development of biomedical research ethics and provides some considerations about the utility and risks of case-based discussion.

The proof of a textbook is always use in class, so at this point I can only offer a very preliminary assessment. The instructor should take into account that the information provided in each case is most often just a summary restating the case from the original source with a view to emphasize the implicit moral dilemmas. These are now easier to grasp for the student, but some additional background may sometimes be necessary to illustrate its real complexity -- or just to bridge the cultural gap with a non-American audience. The cases are presented without ethical guidelines for discussion: no particular normative stance is assumed by the author (nor on the part of the reader), so a certain familiarity with a number of moral doctrines is a pre-requirement to make a fruitful use of this text. These and other minor caveats aside, we may expect it to become a very useful reference for future courses.

What I miss is a more explicit discussion of the connection between what we may consider positive medical science and the associated normative dilemmas. Once we assume, as the author does, that clinicians may often act as self-interested agents, sometimes as plain rent-seekers, we should consider to what extent the various methodologies applied in medical research are immune to their particular bias. It has been noticed, for instance, that a certain correlation exists in clinical tests between the source of funding (public or private) and their result (for or against new therapies). Should we strengthen the procedures of statistical review to protect the public against some private interests? In spite of its status as the golden rule of clinical research, randomization has been severely contested by Bayesian statisticians on a purely methodological basis, and this certainly would have an impact on the patients when it comes to granting informed consent to take part in a test: should we make the statistical foundations of our methodology explicit for them? Normative dilemmas in biomedical research provide indeed a good opportunity to reconsider its scientific status and reassess the underlying positive/normative dichotomy that often separates bioethicists and philosophers of science.

 

 

2005 David Teira

 

David Teira, Ph.D., University of Salamanca, Spain


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