by Terry O'Neill
Greenhaven Press, 1999
Review by Valerie Gray Hardcastle, Ph.D. on Feb 26th 2002
I am guessing that this book is targeted at middle school
students. I am pretty sure that my
eleven year-old daughter could read this book and understand most of it, but I
think my ten year-old might be lost.
Anyone over eighteen reading this book should be bored.
On the one
hand, I want to applaud writing a book on philosophical issues directed toward
the youth of today. There simply isnt
enough material out there that challenges teen-agers to think critically about
their lives or their environment.
Writing about issues in biomedical ethics should be especially important
since it is becoming increasingly impossible to live a modern life without
having to make some sort of sophisticated, controversial, and difficult
decision about ones own or a loved ones health. Im glad someone has taken the time and effort to try to reach an
important segment of our society.
I have to say that this book is pretty bad.
It covers what the author takes to be the most popular issues in
biomedical ethics today: research on animals, informed consent, organ
transplantation, genetic testing, gene therapy, and human cloning. Striking in their absence is any discussion
of end-of-life or beginning-of-life issues.
This is particularly unfortunate, since these are the sorts of issues
most likely to touch us today. Whether
I should clone myself might be a decision I have to confront many years down
the line (though I doubt it), but whether and when I should disconnect the
life-support systems from a relative or whether and when I should discontinue a
pregnancy are decisions that are becoming almost mundane. It would have been nice had the author tried
to give her readers some tools to think about these items.
largest complaint concerns how the topics discussed are handled. This book, as are all the books in the
Greenhaven Opposing View Digest series, is written by a single author, who is
supposed to outline the pros and cons of whatever topic the book covers. In this particular case, the author writes
one chapter articulating one position concerning, e.g., informed consent, and
then follows the chapter with a second one, articulating the opposing view. This might be a good way to proceed if (1)
the presentations were equally thoughtful, germane, and balanced, and (2) the
author did not give her own position away.
In this book, we find arguments largely off-topic (and generally highly
inflammatory), and each section concludes with the author stating her position
There is a
pattern of argumentation throughout this book (the exception is the final
chapter, which I will discuss below) that I find particularly distasteful. I
shall illustrate argumentative strategy by looking at ONeills treatment of
medical research using human subjects.
In the pro chapter, ONeill rightly points to the past successes of
using human subjects in refining drug use for all sorts of ailments. She discusses the history of informed
consent and how such a procedure should avoid exploiting anyone. So far, so good. In the con chapter, though, she outlines three cases where informed
consent allegedly failed. One is a case
in which a subject had a serious, chronic, adverse reaction to the drugs
ingested; the second is the notorious Tuskegee syphilis study; and the third is
a proposed AZT study on pregnant African women. I have problems with using any of these examples to discuss the
morality of informed consent.
first case, the subject was informed of all the risks and he agreed to
them. No one is suggesting that he was
mistreated in any way. While I am
deeply sorry that he had and continues to have an awful time, his situation is
exactly what informed consent is all about.
He knew and appreciated the risks and then decided that they were
acceptable. One might want to argue
that any risk is too great, but then of course, the first patients who receive
any drugs would then just form the group of human guinea pigs. Medical treatment is not without risks, but
my view is that it beats no treatment on average and over the long run.
case, while well known and horribly tragic, took place before any official
policies regarding informed consent were dreamed of. This does not excuse what happened in Macon, but it does rule out
using this case to discuss the morality of current incarnations of our policies
since the third case is a proposed study and the author never tells us whether
the drug company sought informed consent nor whether the women consented to the
trial procedures, we have no way of evaluating the example. If the company didnt seek consent, then
like the Tuskegee case this example would fall outside the purview of the
discussion. If the company did seek
consent, but the women didnt give it, and the company ran the experiment
anyway, then again, the case would fall outside the scope of the chapter. If the company sought consent, the women gave
it, and then the company issued AZT as a prophylactic against AIDS in unborn
children, the case might fit the profile needed for the chapters discussion,
but without knowing what the outcome of the trials were, it is hard to know
what to say about the case itself.
basis of these three examples, ONeill concludes that the regulations for
medical research must be made much stronger, and failure to follow them should
lead to a severe penalty (p. 38). Huh? How did she arrive there?
ONeill doesnt say, just as she
doesnt say how she can conclude since animal testing is an inhumane process,
its results are unreliable, and effective alternative experimental methods are
available, medical use of animal testing should be banned (p. 28). And she comes to this conclusion after
detailing in the previous chapter all the successes science has had through
using animal models in its experiments!
strategy of arguing that while in theory or even in practice something
might be a good idea, it also might be abused by people with evil intentions,
therefore that thing should be banned is beyond conservative. Worse, it is a bad philosophical
argument. What she says is true: evil
people can figure out how to abuse just about anything. But that fact, in and of itself, doesnt
persuade me of much. At the least, we
would have to know how likely such abuses are and then do some sort of
cost-benefit analysis to decide what to do.
worst aspect of this book is that ONeill doesnt even follow her own
argumentative strategy consistently.
The final chapter concerns the morality of cloning humans. Surprisingly, she comes out in favor of such
a thing (even though she is against genetic testing and gene therapy), noting
that potential benefits might outweigh any potential harms. Her final conclusion is that we might get
benefits from human cloning that we havent even dreamed of yet! Of course, she is right, but why wasnt this
argument just as applicable in the chapters on genetic testing or gene
therapy' They might give us untold
benefits -- things we cant even imagine yet -- but she thinks we shouldnt
disheartened by the poor quality of argumentation in this book. I worry that such is the level of discussion
in middle schools around the country. I
hope not, and I take comfort in the fact that most of the children I know would
recognize the bad arguments for what they are before they got too far in them.
© 2002 Valerie Gray Hardcastle
Valerie Gray Hardcastle, Ph.D., Program in
Science and Technology Studies, Department of Philosophy, Virginia Tech