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Thieves of Virtue

Thieves of Virtue: When Bioethics Stole Medicine

Tom Koch
Series: Basic Bioethics
Copyright Date: 2012
Published by: MIT Press
Pages: 376
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  • Book Info
    Thieves of Virtue
    Book Description:

    Bioethics emerged in the 1960s from a conviction that physicians and researchers needed the guidance of philosophers in handling the issues raised by technological advances in medicine. It blossomed as a response to the perceived doctor-knows-best paternalism of the traditional medical ethic and today plays a critical role in health policies and treatment decisions. Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch argues that bioethics has failed to deliver on its promises. Instead, he argues, bioethics has promoted a view of medicine as a commodity whose delivery is predicated not on care but on economic efficiency. Koch questions the "founding myths" of bioethics by which moral philosophers became practical ethicists who served as adjudicators of medical practice and planning. High philosophy, he argues, does not provide a guide to the practical dilemmas that arise at the bedside of sick patients. Nobody, he writes, carries Kant to a clinical consult. At the heart of bioethics, Koch writes, is a "lifeboat ethic" that assumes "scarcity" of medical resources is a natural condition rather than the result of prior economic, political, and social choices. The idea of natural scarcity requiring ethical triage signaled a shift in ethical emphasis from patient care and the physician's responsibility for it to neoliberal accountancies and the promotion of research as the preeminent good. The solution to the failure of bioethics is not a new set of simplistic principles. Koch points the way to a transformed medical ethics that is humanist, responsible, and defensible.

    eISBN: 978-0-262-30553-2
    Subjects: Health Sciences, Technology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Series Foreword
    (pp. vii-viii)
    Arthur Caplan

    Glenn McGee and I developed the Basic Bioethics series and collaborated as series coeditors from 1998 to 2008. In fall 2008 and spring 2009 the series was reconstituted, with a new editorial board, under my sole editorship. I am pleased to present the thirty-third book in the series.

    The Basic Bioethics series makes innovative works in bioethics available to a broad audience and introduces seminal scholarly manuscripts, state-of-the-art reference works, and textbooks. Topics engaged include the philosophy of medicine, advancing genetics and biotechnology, end-of-life care, health and social policy, and the empirical study of biomedical life. Interdisciplinary work is encouraged....

  4. Acknowledgments
    (pp. ix-xii)
  5. Introduction
    (pp. xiii-xx)

    Bioethics was supposed to be about you and me, about people and the medicine they receive, or desire. It was to be a tool with which individuals and the societies they inhabit could answer questions of medical practice and the research that sometimes put those politely called “human subjects” at risk. Born in the 1960s, it was to be a public service that brought a specific kind of analytic, moral philosophy to questions of medical care and healthcare delivery. In the end, bioethics was an experiment in a method of philosophically grounded, practical ethics that promised simplicity in a world...

  6. 1 Dead Germans and Other Philosophers: Ethics as a Professional or a Public Occupation
    (pp. 1-20)

    The most interesting students are in the middle rows, slouched in aisle seats from which they can make a rapid escape from the classroom if the lecture is intolerably dull. In front of them are well-socialized notetakers content to record whatever is said so it can be repeated on an exam page. They do not question overmuch and are never excited about the issues. In the back rows are mainly students whose interest is limited to passing a course with the minimum of study. They are about, as their parents would say, “getting the job done,” and in the main...

  7. 2 Something Old: A Brief Review
    (pp. 21-54)

    There is nothing particularly mysterious about ethics, an attempt to formulate principles of conduct and practice in our lives. As a noun the word “ethics ” tumbles down the language tree from the old Greek wordethos, sometimes translated as “moral custom”¹ and sometimes as “character.”² Is this or that choice the act of a “good” character, a person whose behavior we admire? The things we admire are those adhering to a moral custom, to ideas about the goodness or badness of specific acts. As custom, ethics and its moral valuation carry a shared meaning and a social history. Because...

  8. 3 Something Newer: Supply-Side Ethics
    (pp. 55-80)

    In the 1960s, a group of medical amateurs trained in a specific tradition of moral philosophy joined as citizens a national discussion on how best to allocate a scarce medical resource in the United States. Debate began in neither medical writings nor philosophical tracts but in the November 1962 issue ofLife Magazine. Reporter Shana Alexander’s story described the deliberations of a Seattle committee whose task it was to select a few from among the many patients seeking entry into what was then a new kidney dialysis program in that city. Just as poliomyelitis patients in the early 1950s had...

  9. 4 Lifeboat Ethics: Scarcity as an Unnatural State
    (pp. 81-110)

    On the evening of April 19, 1841, an American sailing ship, theWilliam Brown, was making ten knots under full sail when, shortly after nine o ’ clock at night, it struck an iceberg several hundred miles off the Newfoundland coast. Ten minutes later it struck another. After the second collision, the holds filling inexorably with water, Captain George L. Harris gave the order to abandon ship. Almost half of the sixty-five immigrant passengers and all seventeen crew members were saved in two auxiliary boats quickly provisioned with several days’ rations of food and water. The captain and seven others...

  10. 5 Biopolitics, Biophilosophies, and Bioethics
    (pp. 111-138)

    The oft-repeated phrase “politics is applied ethics” at once implies way too much and yet not near enough.¹ Politics is the dress that philosophy wears when it seeks to be seen as useful, its subject something that is practical and real, and thus important. Philosophy is the dress that politics wears to insist upon its truth and the rectitude of its programs. The two are like a reversible coat of two colors. Philosophy is the general form within which ideas of “good” and “bad,” “right” and “wrong” are located as ethics. Politics is the manner in which the ethic of...

  11. 6 Principles of Biomedical Ethics
    (pp. 139-164)

    By the late 1970s bioethics had its agendas and the administrative nodes for their advancement. The Hastings Center and the Kennedy Institute of Ethics were principal foci of the valuators who assumed scarcity as a natural limit to healthcare and an impediment to research (not enough human subjects), and who more generally argued the failure of medicine’s traditional ethics of care. What bioethics lacked was a manifesto that would formalize its arguments and serve as an instructional document for the courses in bioethics that moral philosophers turned practical medical ethicists were increasingly teaching. Tom Beauchamp and James Childress remedied this...

  12. 7 Bioethics and Conformal Humans
    (pp. 165-196)

    “He insists he doesn’t want to kill me,” Harriet McBryde Johnson wrote of Princeton University bioethicist Peter Singer in 2003. “He simply thinks it would have been better, all things considered, to have given my parents the option of killing the baby I once was, and to let other parents kill similar babies as they come along and thereby avoid the suffering that comes with lives like mine and satisfy the reasonable preferences of parents for a different kind of child. It has nothing to do with me,” she continued. “I should not feel threatened.”¹

    That precise, lawyerly summation opened...

  13. 8 Research and Genetics: “For the Benefit of Humankind”
    (pp. 197-224)

    At least in theory, most bioethicists are, with Singer, “consequentialists” arguing an application of their understanding of what is good, right, and philosophically proper in relation to the science contributing to real situations they seek to order and regulate. Since its naming, bioethicists have claimed the necessity for a new medical ethic capable of managing issues arising from advances in the modern genetic science that began with James Watson’s and Francis Crick’s first description of the structure of DNA in the 1950s.¹ From them came the now famous double-helix structure in which two strands of sugar and phosphate molecules twist...

  14. 9 Choice, Freedom, and the Paternalism Thing
    (pp. 225-248)

    It may be that bioethics’ foundation myth is merely that, a myth, its research emphasis debatable and its broadly principled assertions at best insufficient. Certainly its promise of careful argument, critical thinking and “wisdom” seems to be grounded in a suspicious tendency to the unproved assertion. There is, for example, its declaration that the traditional medical ethic was obsolete without any real consideration of what that ethic was or a detailed explication of its practical inadequacy. And, of course, there is the lifeboat ethic embraced from the start as if it was a natural state, assuring in the process that...

  15. 10 Complex Ethics: Toward an Ethics of Medicine
    (pp. 249-258)

    What went wrong with bioethics and why has it been such a failure? That it is a failure is an opinion shared by many of its practitioners. Bioethics is in crisis, wrote Richard Ashcroft in a special issue ofBioethicsin 2010, its future in grave doubt because of weaknesses in its institutional form and a demonstrable lack of social relevance. “I don’t think this is merely my own personal view,” he wrote. “It is shared with many leading contributors to the field.”¹ The editor ofPublic Health Ethics, Angus Dawson, declared in the same issue that “bioethics has no...

  16. Notes
    (pp. 259-294)
  17. Bibliography
    (pp. 295-322)
  18. Index
    (pp. 323-350)
  19. Back Matter
    (pp. 351-352)