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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied 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UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting 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ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy 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 People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law 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Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe End of Stigma?The Essentials of New York Mental Health LawThe Ethical BrainThe Ethical Dimensions of the Biological and Health SciencesThe 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SphereThe Price of PerfectionThe Price of TruthThe Problem of PunishmentThe Prosthetic ImpulseThe Psychology of Good and EvilThe Psychology of Good and EvilThe PsychopathThe Purity MythThe Pursuit of PerfectionThe Relevance of Philosophy to LifeThe Right Road to Radical FreedomThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Routledge Handbook of Philosophy of Animal MindsThe Routledge Handbook of Philosophy of EmpathyThe Rules of InsanityThe Second SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley 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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 VicesVoracious Science and Vulnerable AnimalsVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat are you staring at?What 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 his introduction to this collection of essays Christopher Cowley identifies its aims. Firstly, it aims to challenge the mainstream understanding of what the discipline of medical ethics is. Secondly, it aims to show the relevance of Continental European philosophy to medical ethics. A third point he mentions is that the book is aimed at a general reader. The essays are all clear and accessible, so this last aim is certainly achieved. It is less clear how well the book's two primary aims are achieved, however, largely because the book is fairly short (including 15 chapters and an introduction in 234 pages) and its contents uneven in terms of how far from the mainstream they venture. Considered not as a challenge but simply as a contribution to medical ethics, though, the book is a success.
Without going into detail on each chapter, it is probably worthwhile to give an overview of the book's contents, which are divided into four parts. Part one focuses on patients and their bodies. This part includes the essays by Alastair V. Campbell and Gaëlle Fiasse that I discuss in more detail below. Part two focuses on problems relating to old age, dying, and mental illness. Part three looks at autonomy and autonomous decision-making. And part four is about professional medical ethics and the law. Examples throughout tend to come from Europe, especially the United Kingdom, but not in a way that should pose any special problems for readers from other continents.
The need for a challenge to mainstream medical ethics is perhaps made clearest in the first chapter, an essay by Campbell on the idea of the body and its organs as property or commodities. This way of thinking about the body has certainly been challenged before (the work of Leon Kass comes to mind, and Campbell's essay itself is based on earlier work of his), but such challenges are not as mainstream as one might expect. Campbell begins with the case of Alder Hey Children's Hospital in Liverpool, England, where thousands of organs from bodies were removed and retained without authorization between 1988 and 1995. The families of the deceased were outraged, and indeed the discovery caused a national scandal, but some prominent medical ethicists have treated this reaction as a puzzle and as irrational and even wicked if it hinders medical science. Campbell diagnoses this kind of reaction as a symptom of Cartesian dualism (which treats the body as distinct from, and lesser than, the mind), and argues against it that we should treat patients not as dualities, nor as consumers, nor as collections of commodities, but as persons in need of help. In effect he takes the side of common sense, and it is hard to disagree, even if one might question the relevance of dualism (which long predates the commodification of the body) and the degree to which Campbell's is a non-mainstream view, even if some people within the mainstream think differently.
The case for bringing more Continental European philosophy into medical ethics is perhaps best made in Fiasse's essay. This essay is a sympathetic introduction to Paul Ricoeur's work on medical ethics, explaining his three-pronged ethics, his additional Kant-inspired morality, his emphasis on the Golden Rule, his three precepts for the medical profession, his three norms governing medical consultation, the three paradoxes he highlights in medicine, and so on. Fiasse can offer little more than a sketch of Ricoeur's views, but they come across as both rich and plausible, in a way that is likely to make readers want to investigate further.
If the collection has any weaknesses they are visible in what has been said already. Essays of about 15 pages cannot go into much depth or detail (Campbell tellingly refers the reader to two earlier works of his "for a fuller account of some of the arguments briefly outlined here," p. 235). Essays on such subjects as respecting patients' religious beliefs (D. K. Levy's contribution) and the questionable wisdom of physician-assisted suicide for people with depression (Cowley's other contribution in addition to the introduction) are well worth reading, but not quite trail-blazing. Nor is Continental philosophy as evident as one might expect from the introduction. There Cowley names Husserl, Heidegger, Merleau-Ponty, Foucault, and Ricoeur as the people he especially has in mind, but none of these thinkers is discussed more than two or three times in the whole book. The discussions in question are usually brief, often more mentions than discussions. In a book aimed at a general audience this is hardly surprising. Continental philosophy is often dismissed unfairly, and one reason for this is that it can be hard to read. Its practitioners have reasons for writing as they do, and their work is likely to be distorted by any attempt to translate it into easier terms. Ramplin and Hughes, in their first essay, use Heidegger to shed light on some of the ethical dilemmas involved in dealing with mental illness, but they have so little space in which to do so, and Heidegger's work is such difficult material to work with, that a sense of only scratching the surface, at best, is hard to avoid. Something similar could be said about Kristin Zeiler's use of Merleau-Ponty in Chapter 3.
Although it is not likely to change the face of medical ethics, the book does make valuable contributions to several debates within the field. It also brings out some of the problems with common ways of thinking about medical ethics, such as the idea that the end can justify the means, the desire to ignore as much as possible the religious beliefs of patients and medical practitioners, and the attempt to separate ethics from both legal and professional judgment, carving out areas of technical expertise where ethics supposedly does not belong. It could almost be said that the aim of the book is to bring ethics back into medical ethics. Certainly the way it points is worth exploring.
© 2012 Duncan Richter
Duncan Richter, Department of Psychology and Philosophy, Virginia Military Institute
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