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the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before 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for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
In this book Johnson addresses some issues he regards as central to bioethics, including clarifying the concept of a human life, defining where it begins and ends; identifying what it is to be a person; and considering what is good for a person. He approaches these issues by first criticizing some existing concepts and presumptions found in bioethics literature. He argues that some concepts are unclear, which results in a lack of clarity when thinking about bioethical issues. He continues to present some alternative biocentric (life-centred) concepts and argues that these provide a greater understanding of bioethical issues. He defines biocentric as being concerned with life process, coherent effective functioning, and the moral significance of all living beings. He then applies his biocentric approach to specific issues such as euthanasia, abortion, and genetic engineering.
The book is aimed at all who are interested in matters of life and death, not just academic philosophers working on bioethics.
The first section of the book is dedicated to setting out some background to the history of philosophy, ethics, concepts of the good, and language. This will be fairly basic for professional philosophers, but useful background for the more general non-specialist reader.
In Chapter Six Johnson moves towards his positive argument, defining what it is to be alive. He defines life as an ongoing processing of a flow of energy used in self-maintenance and self-organization, within a range of appropriate states, in a high-level response to the environment (p. 132). This seems essentially correct, but there will of course be grey areas where it is not clear whether or not something is alive. He continues in Chapter Seven to use this definition of being alive to ground a conception of what our good is; that is, our good lies in coherently maintaining all aspects of our lives in healthy operating or functional condition. As he rightly points out, ‘healthy’ is a complicated concept, which he characterizes as including not just the physical, but also the mental and social (p. 149). In Chapter Eight he links the concepts of being alive and being healthy to a virtue ethical approach, on the grounds that he thinks ‘affirming’ life is necessary for both a healthy life and an ethical life and that cultivating the traditional virtues are the best means of doing this. By ‘life affirmation’, he means the protection and promotion of the coherent functioning of life (p. 223).
Having defined these central concepts of ‘being alive’ and ‘healthy’, Johnson moves to using these concepts to address specific issues within bioethics. He first argues that death is not normally in a person’s best interests, because, according to his definition, life is an ongoing self-organizing, self-maintaining process and death, of course, ends this process. (pp. 188-212). However, Johnson points out that defining when death occurs is problematic, as some life processes can continue when others have stopped, and there is a difference between the human being alive and the person being alive (pp. 213-222). He argues that in some cases death may be in a person’s best interests and applies this to specific issues such as euthanasia abortion, genetic modification and biomedical research, which he argues can be right when life affirming, protecting the individual from the disintegration of life. His general conclusion is that his biocentric concept of life affirmation will not provide a principle that will decide all bioethical issues, but that it does provide us with a basis for thinking about particular issues.
I am sympathetic to the overall project of arguing that bioethical issues cannot be resolved with the simple application of principles or rules, but I will raise a couple of issues. First, it is not clear exactly how Johnson’s biocentric approach has the advantage over a traditional virtue ethical approach. He in places implies that all the traditional virtues are reducible to the virtue of life affirmation or that the traditional virtues are the means to life affirmation. If the latter, it is unclear how this differs from a traditional virtue ethics, grounding the virtues in the concept of eudaimonia (flourishing). If the former, it is not clear how the reductive account improves on the traditional account. The central issue that needs more thought is how to define health or life affirmation if this is what is grounding the virtues. It is unclear how Johnson’s biocentric account would deal with the objection that although in general the virtues are life affirming, particular actions in accord with a particular virtue may not be, so on what grounds should we do such actions? Although Johnson is happy to admit that the concept of health is indeterminate with no one description it appears that a stronger definition may be needed if the concept is to play this foundational role (p. 362).
Secondly, again, I am sympathetic to the idea that one cannot apply a decision-making procedure to all bioethical issues that may arise and that rather one must assess each particular case. However, it is not clear that this is a practical approach. There are too many issues faced on a daily basis within a medical setting for every single case to be considered individually. This is not an insurmountable problem with Johnson’s biocentric approach as it is not incompatible with his approach to develop an account that derives general rules from his virtue of life affirmation; even if these do not provide a decision-making procedure for every issue, they will provide action guidance in the more straightforward day-to-day cases.
In summary, this book provides an account of how one can approach bioethical issues from a different perspective rather than relying on the common consequentialist or deontological approaches to such problems and will be of interest to those who are dissatisfied with these approaches.
© 2011 Lisa Grover
Lisa Grover is a URC Postdoctoral Research Fellow at the University of the Witwatersrand. Her research interests include ethics, bioethics and moral psychology.
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