Historical and Philosophical Perspectives on Biomedical Ethics
Williams, Stephen N., Ethics & Medicine
Historical and Philosophical Perspectives on Biomedical Ethics Andreas-Holger Maehle and Johanna Geyer-Kordesch, Editors Burlington, VT: Ashgate, 2002 ISBN 0-7546-1529-4, 159 PP., HARDCOVER, $69.95, £42.50
This volume is a contribution to the 'Ashgate Studies in Applied Ethics'. Drawing largely on papers presented to a conference in the United Kingdom (Durham) in 1998, it falls roughly into two unequal parts. The first consists of five essays focusing on historical accounts. Three of these (by Andreas-Holger Maehle, Lutz Sauerteig, Cay-Rudiger Prull and Marianne Sinn) concern Germany in particular: the emergence of medical professional ethics there, the ethics of its sickness insurance system, and the 'Problems of Consent to Surgical Procedures and Autopsies' in the twentieth century. They more or less illustrate transitions from more paternalistic or professionally self-interested medical ethics towards practices that reflect the social emergence of increasingly autonomous agents. These essays are flanked by an account of the work of the Central Ethical Committee of the British Medical Association in the first half of the twentieth century (Andrew Morrice), again illustrating the emergence of autonomy against the background of increasing interest in human rights. A fifth essay (Ulrich Trohler) describes the path from national to international regulation of human research, with the important conclusion that the development of protection of participants in research on human beings has been lamentably slow.
This account of the first five essays is bland, but the essays are not so, and convey very useful information. Only those experts in the particular areas will be able to judge their detailed merits, but the arguments are consistently well-researched and plausibly presented. The logic has to be carefully scrutinised, of course, as in the case when general conclusions are drawn about early twentieth century German pathologists' greater interest 'in using the human body for medical science than in acknowledging lay views on respecting the dead' (p.78). The conclusion itself is manifestly probable, but it is hard to argue that the particular case cited 'clearly' demonstrates it (p.77). The essayists draw out effectively the significance of their research. The first essay raises the question of what has constituted 'medical ethics' over time; the second asks what Nazism has to do with the connection between medicine and public welfare; the third offers conclusions on the lack of connection between mortality rates and health care expenditure; the fourth compares the relative historical immunities of surgery and pathology against public criticism; the fifth indicates what is unsatisfactory about the development of the code of ethics of the World Medical Association. …