Bioethics in Historical Perspective

During the last month Australia and Thailand have had to confront the implications of a terrible medical dilemma, when news broke of ‘Baby Gammy’, the Downs syndrome twin left behind by an Australian couple who paid a Thai woman to carry their child. When the mother found she was having twins, she allegedly refused to abort the pregnancy because of her Buddhist beliefs. The genetic parents subsequently took the ‘good twin’, a girl, back to Australia with them, leaving the boy behind with a mother too poor to pay for his medical treatment. A lot of this is still ‘alleged’ – but just when it seemed the story couldn’t get any worse, it turned out that the new father had formerly been convicted of child abuse. Both Thailand and Australia have been hastily rushing through new regulations on child surrogacy.

Many medical issues have an ethical dimension. Some, like surrogacy, are self-evidently vexed. Others are subtler.

In the current Ebola epidemic, for instance, why does an American patient get flown home for treatment that is not available for Africans? What are the ethics of administering treatment that is still experimental? And why is the language in which the disease is discussed so charged? There has been a lot of talk about how uneducated Africans don’t obey the scientists when they are told to abandon their traditional burial rites and not touch Ebola victims, or wash the bodies of their dead relatives. Yet the said American patient subsequently credited Jesus, not the scientists, for his recovery.

It is against this background that I’ve recently been reading Sarah Ferber’s Bioethics in Historical Perspective (Palgrave, 2013).  As Sarah says in her introduction, bioethics is a political minefield, starting with just what the discipline is and who ‘owns’ it – doctors? philosophers? policy makers? Historians would not be the first port of call for anyone thinking of the ethics of medicine, but putting medical debates in a historical context is very valuable, and this book does that well.

The book starts with Sarah confronting her first bioethical issue:

As a 17-year-old I went to work over the summer in a Catholic psychiatric hospital [in the days of R.D.Laing and the anti-psychiatry movement]. My job as it turned out – and as I had half hoped – brought me close to the medical treatment of electroconvulsive therapy (ECT or ‘shock treatment’). My specific task was to hold anaesthetized patients in a stable position while they underwent the treatment and then monitor them afterwards: I lasted a full thirty minutes. The kindly mother-superior asked me to pause with her in the chapel on the way out so she could ‘put a bit of religion’ into me. This appears not to have worked. [ix-x]

After this challenging opening, the book becomes what it is designed to be: a textbook for bioethics courses. How grateful we should all be that such courses exist, especially for medical and other students who will go out to deliver health care after graduation.

Anyone who quotes George Orwell’s essay on the English language is my friend for life, and I really loved the chapter dealing with language, and also the fact that this chapter was so early in the book, and sets the scene for what comes later. Is organ transplantation ‘a gift of life’, or ‘a trade in spare parts’, for instance? In different circumstances, of course, it is both. I was reminded here of work that has been done on blood, which is donated free in some countries, but sold in others.

In a series of subsequent chapters Sarah looks at various issues from relatively recent history. I won’t elaborate on each of them, for the titles are self-explanatory: ‘Euthanasia, the Nazi Analogy and the Slippery Slope’; ‘Heredity, Genes and Reproductive Politics’; ‘Human Experimentation’; ‘Thalidomide’.

Despite the complexity of much of this material, Sarah writes with great clarity. The only slight irony, I thought, was that given Orwell is so critical of the passive mode, after her introduction she writes always as an omnipresent narrator, and I wondered whether she could have inserted herself into the debate just a little. This is probably a necessary evil of the textbook format.

What I particularly like about this book is its moderate tone. Sarah is dealing with such fraught issues, and there’s such possibility for hysteria in many of those topics, but she takes a cool and thoughtful perspective on them. (Much cooler and more thoughtful than my deliberately emotional lead paragraph – sorry Sarah!)

The following sentences seem to sum up the way she thinks and writes:

What is most difficult, when confronting either abhorrent or dubious practice, is to try to find a way to accommodate them analytically, even if one rejects them as a matter of instinct. Nothing is ameliorated solely by condemnation or distancing. Most unethical practices lie on some kind of continuum with normal aspirations.’ (127)

That’s terrific: clear, cool, non-judgmental and I’m pleased to report that though hysteria usually sells much better, this thoughtful, balanced account is selling rather well so far. Let’s hope her insights have an impact on policy decisions.

Note: Sarah is a personal friend of mine, which is why I refer to her as Sarah, not Ferber, throughout. We’ve discussed this book over the years, and I’m mentioned in the acknowledgements page, so I am probably not the most objective reviewer – but hey, my blog, my rules!

There is an interview with Sarah about the book on YouTube here.

This review is written as a contribution to the Australian Women Writers Challenge 2014.