This Is Bioethics. Udo Schüklenk
is bioethics : an introduction / Ruth F. Chadwick, Udo Schüklenk.
Other titles: This is philosophy (Series)
Description: Hoboken, NJ : Wiley‐Blackwell, 2020. | Series: This is philosophy | Includes bibliographical references and index.
Identifiers: LCCN 2020029285 (print) | LCCN 2020029286 (ebook) | ISBN 9781118770740 (paperback) | ISBN 9781118770795 (adobe pdf) | ISBN 9781118770733 (epub)
Subjects: MESH: Bioethical Issues | Bioethics
Classification: LCC R724 (print) | LCC R724 (ebook) | NLM WB 60 | DDC 174.2–dc23
LC record available at https://lccn.loc.gov/2020029285 LC ebook record available at https://lccn.loc.gov/2020029286
Cover design: Wiley
ABOUT THE AUTHORS
Ruth F. Chadwick is Professor Emerita, Cardiff University and Visiting Professor, University of Leeds. She co‐edits the journal Bioethics and has served on numerous bodies including the Council of the Human Genome Organisation. She is Fellow of the Academy of Social Sciences, the Hastings Center, New York, the Royal Society of Arts, the Royal Society of Biology and the Learned Society of Wales.
Udo Schüklenk holds the Ontario Research Chair in Bioethics in the Department of Philosophy at Queen’s University at Kingston, in Canada. He is a Joint Editor‐in‐Chief of the journal Bioethics. Born in Germany, his academic career has included teaching and research appointments in Australia, South Africa, and the UK.
PREFACE AND ACKNOWLEDGMENTS
Jeff Dean, our then Commissioning Editor at Wiley‐Blackwell, suggested to one of us in 2014 to produce a bioethics introductory text. It’s always easier to agree to do a thing, then to actually do it, and so it took a ‘mere’ six years – on and off – to write this volume for you. Marissa Koors, Jeff Dean’s successor at Wiley, and Steven D. Hales, our long‐suffering series editor for the This is Philosophy series at Wiley‐Blackwell, showed an unusual degree of patience with us, our book, and our seemingly never‐ending delays. There is a German saying along the lines that a good thing takes time. You be the judge on This is Bioethics. Last but by no means least, we owe a great deal of gratitude to Nivetha Udayakumar, this book’s Production Editor, for a job very well done.
Both of us have spent our academic careers in the field of bioethics, we jointly have been Editors of Bioethics, arguably the top philosophical bioethics journal, for more than two decades. Still, as we discovered, it’s one thing to successfully author and publish peer reviewed research content, and it’s quite another to write content specifically for introductory, and for teaching purposes. We deliberately did not review other bioethics textbooks to decide on what to include or not to include as far as the book’s content is concerned. This book reflects what we think a student of bioethics, who takes an introductory course, should – at a minimum – have read and thought about. Quite deliberately we kept the tone informal, aiming to strike a conversational tone. We also quite deliberately avoided technical jargon where that was possible. Some of the external reviewers of an earlier draft of this manuscript had mixed feelings about this. We hope it works for you!
How should you go about reading this book? For one thing, we included plenty of links to sites that we hope won’t have disappeared by the time you read this. Check them out if a particular issue catches your interest, and you want to know more. Definitely read Chapters 1–4, in that order, the other chapters can mostly be read independently of each other, even though we have taken care to cross‐reference relevant content in other chapters where that was appropriate. We have also added guiding questions at the end of each chapter. We strongly recommend that you take a moment to reflect on these questions. Thinking about defensible answers will assist you in using the concepts and arguments you read about, and so you will gain a better understanding of them and their respective strengths and weaknesses. If you choose to do so, you would likely find yourself in a better position to defend your views on any number of current‐day contentious issues, based on sound ethical analysis.
For any bioethics book you hopefully will – you should! – wonder where the authors ‘are coming from’, what their prior ethical commitments are, and to what extent those commitments influence the content you are reading. Scholars with religious commitments are likely to produce content and arguments that differ from those who are atheists, philosophical utilitarians will differ in their writings from philosophical deontologists, and so on and so forth. We were cognisant of this issue and tried to give views a fair shake, as it were, that we disagree with. We also included references to further reading written by authors whose views we do not necessarily share. Make use of that information, reflect on the arguments given, and form your own considered views.
Ruth F. Chadwick
Udo Schüklenk
1 INTRODUCTION TO ETHICS
1.1 Imagine you were running a medical non‐governmental organization (NGO) established to preserve the lives of poverty‐stricken people in resource poor countries. Your NGO is also usually among the first to provide emergency assistance in case natural emergencies such as tsunamis strike. However, you did notice that agencies evaluating your efficiency1 give you a below‐average ranking. That is a worry to your fundraising staff, mostly because you rely on donations and such ratings are said to impact eventually negatively, on your capacity to raise cash. You investigate what the problem is, and it turns out that the ratings agency is critical of your policy of responding mostly in cases of high‐impact disasters such as earthquakes, floods or civil wars, because they invariably require a highly resource intensive intervention. The agency’s verdict is that, on the same capital outlay, you could preserve more lives in developing countries if you aimed at establishing medium‐ to long‐term health delivery solutions, including setting up primary health care facilities, beginning vaccination programs, and other such relatively low‐cost means. Chartering private jets to fly emergency teams in response to disaster also preserves lives deserving to be rescued, the ratings agency says, but it demonstrably results in a substantially lower number of lives preserved than you could preserve if you dropped such actions in favor of working toward better health care delivery infrastructure in the countries you usually serve.
1.2 So, if your objective is to preserve lives in developing countries, the ratings agency might be correct in saying that you only preserve a suboptimal number of lives. You could do better. Should you change your policy though? After all, what the ratings agency proposes implies, if you were to act on it, is that those in most dire need, say those living in war‐torn countries with minimal health care infrastructure, should be toward the bottom end of your list of priorities, because assisting such people would cost more – per life preserved – to succeed. All other things being equal, more lives could be preserved if the NGO focused on preserving not those most in need but perhaps those whose lives are also threatened but who could be helped with the deployment of fewer resources. Should we only care about the number of lives preserved then, or do other factors matter, too, such as for instance that some people, possibly due to no fault of their own, live in particularly abysmal conditions? Should we factor in the amount of resources required to nurse such people back to a life that would permit them to live independently? Should the age of the to‐be‐rescued matter? Should it matter whether they have a family dependent on their support? Questions such as these are fundamentally ethical questions. And this chapter is about ethics, it is about right and wrong, good and bad, and how we can go about judging alternative courses