BODY, SOUL, And BIOETHICS by Gilbert C Meilaender, PhD, Univ of Notre Dame Press, Notre Dame, IN, 1995, 134 pps.
Review by Del Meyer, MD
Dr Meilaender, Professor of Bioethics at Valparaiso University, speaks to a number of important issues in this book, Body, Soul, and Bioethics. He examines what began as a bioethics movement some 30 years ago and eventually became its own discipline, and he states that "its not entirely benign." He questions the increasing emphasis on public policy that obscures the importance of background beliefs and destiny, and in turn prevents us from clearly identifying what is at stake in many of our debates.
The bioethics movement is generally thought to have begun with Henry Beechers 1966 article exposing abuses in human experimentation. The critical formative decade concluded with the Quinlan decision by the New Jersey Supreme Court in 1976. During this ten year period, physicians increasingly became "strangers" to their patients, and, simultaneously, a new set of strangers--bioethicists--established their role as authority figures near the bedside. Meilaender feels that after a quarter century of development, the time has come to reexamine the current status. Does our current bioethical approach focus too much on rights that give us little real insight about how patients ought to live and die? Meilaender thinks that to "do" bioethics without unpacking our collection of background beliefs is ultimately futile. He then delves into the deeper metaphysical and religious concerns about bioethics that often have been obscured.
Although the rise of bioethics was due, in part, to a perceived arrogance in traditional medical practice, Meilaender doubts that we really want physicians to understand themselves simply as technicians. "We want a profession with something to profess, with the ability to maintain a certain critical distance from the larger society. Indeed, the ancient professions such as medicine and law--like religious communities and like the family--give a person a standing ground with civil society. The good person, holding membership in such mediating structures, cannot simply be presumed equivalent of the good citizen."
Meilaender continues, "The Hippocratic tradition pictured medicine as a profession with its own internal goals and norms, providing the necessary and sufficient ingredients for a coherent medical ethic from within the culture of medicine itself." He quotes another author who argues that doctors must not kill, that to kill patients violates the essential meaning of the practice of medicine. It will not suffice to respond by noting that some physicians disagree. That there will always be such disagreements within a profession seems likely, but this is not terribly significant. A profession does not consist simply of the sum total of its members, nor does the definition of virtuous professional practice depend solely on the opinions of current practitioners. Gaps will always exist between the opinions of individual practitioners and the purposes said to be inherent in the profession itself. If the gap becomes too large, we are rightly concerned. If it persists, one might conclude that the profession should be reconceived. But that reconceptualization would require normative argument, not surveys of current opinion.
Meilaender then carefully traces the development of bioethics against a background of traditional medical ethics--from an internalist view of medical morality being confined to the internal practice of medicine to the externalist view that the ends of medicine must be determined from without, by the morality of the larger society--by public policy.
Meilaender seems to have focused on a significant issue of the day as government, HMOs and others control what we do in the care of our patients. As our stack of official HMO memos & newsletters becomes more voluminous than our stack of medical journals, it is really worth the effort to occasionally take in an important treatise such as Meilaenders, to reflect on our profession and where it is headed.