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by Ruth Ellen Bulger, Elizabeth Heitman, and Stanley Joel Reiser (Eds)
Cambridge University Press, 2002
Review by Christopher Newell, Ph.D. on Feb 10th 2003

The Ethical Dimensions of the Biological and Health Sciences

There are many resources dealing with a variety of the ethical aspects of the biological sciences.  However, if you want a readily accessible compendium that is really THE collection detailing, as the book title describes it, the ethical dimensions of the biological and health sciences, you need go no further.  This simply excellent second edition offers something for everybody. Indeed it is difficult to do such an excellent collection justice in this review.

This comprehensive 371-page book is edited by Ruth Ellen Bulger (Uniformed Services University of the Health Sciences), Elizabeth Heitman (University of Mississippi Medical Center and University of Texas Health Science Center at Houston) and Stanley Joel Reiser (University of Texas Health Science Center at Houston).  This collection has something to offer to ethicists, scientists, those involved in public policy, educators and students interested in the ethical dimensions of their studies.  It can be of assistance to both specialist and non-specialist in the biological and health sciences.  One of the most helpful aspects of the book is its division into sub-themes and chapter headings. This will assist people seeking an answer about a specific question or issue.  To this end there is also an impressive index.  Clearly designed for a variety of uses perhaps one of the most helpful aspects for those who will use this book for educational purposes is the inclusion of questions for discussion and recommended supplemental reading at the end of the twelve sections into which this book is divided.  They are not complex questions, but they help to get to the core of the articles in the various sections.

In necessarily only attending to the brief overview of the twelve sections, I do a disservice to the individual contributions made by chapter writers within those sections.  However, an overview of the contents of the sections helps to give an impression of the broad coverage of this book in a way that shows an appreciation of the insights of a variety of disciplines, from ethics and the history and philosophy of science through to a variety of the biological sciences.

Section I, “Introduction to the study of ethics in the biological and health sciences” includes an excellent account of the rise of “the ethics movement” in the biological and health sciences by Stanley Joel Reiser.  In his self-styled “voyage of discovery” Reiser charts four phases or episodes of the “ethics  movement”. These commence in 1945 with the Nuremberg war crimes trials at the end of World War II, with the fourth phase from 2001 onward involving the institutionalization of ethical discourse.  This chapter is indicative of a book which is enriched by a strong historical perspective coupled with an understanding of the socio-political dimensions of ethics and of science.

Such a strong foundation is built upon in Section II, dealing with “the roots of honor and integrity in science”.  As part of this, Bentley Glass’ short essay on “The Ethical Basis of Science” is a particularly noteworthy contribution.  This recognizes the importance of integrity by scientists, and moves beyond mere accounts of science as just an objective exercise.  His suggestion of the social and ethical responsibilities of scientists as being Four Commandments (to cherish truthfulness, avoid self-aggrandizement, fearlessly to defend freedom of scientific inquiry and opinion and to communicate findings) is to some extent simplistic. However, it does provide significant food for critical reflection.

Continuing that vein in Section III “The Responsible Conduct of Research” such topics as fraud in medical science, statistics and deception, and preventing scientific misconduct are covered.  As Douglas Weed notes in his chapter on “Preventing Scientific Misconduct”,  there is hardly an agreed upon definition of scientific misconduct.  Indeed, I couldn’t help reflecting that in all of these things misconduct is not only in the eye of the beholder, but has significant power dimensions as to who is defining misconduct.  However Weed makes an important point in observing: 

“We can accept (perhaps on faith) that the discussion of the role of ethics and the conduct of science in medicine should be expanded.  Those of us who act as mentors can and should conduct ourselves virtuously.  For the sake of those we train and especially for those whose lives are improved by scientific results, we must exhibit excellence, self-effacement, and perhaps above all, an unwavering commitment to the truth.” (p.84)

Not only is this a very important statement, but it also shows the depth of the thinking involved in this book in making an appeal to the virtues as opposed to the principalist accounts which tend to dominate books about ethics.

Section IV has a variety of chapters dealing with “the ethics of authorship and publication”.  It includes some excellent discussion of issues to deal with plagiarism, irresponsible authorship and the publication of research results. A particularly important discussion of ethical issues for scientists is provided by Ward Pigman and Emmett B Carmichael in their chapter “An Ethical Code for Scientists.” I was at the same time disappointed as well as relieved that they do not spell out such a code. Rather, in their frank discussion they make a case for a code of ethics for scientists in general by discussing the problems of authorship. As they argue:

“We suggest that the establishment of a definite code of professional ethics and conduct by our major by our major scientific groups would have profound and favorable effects for science, society and the scientist.” ( p 103)

There is no doubt that this is the case. However further discussion is needed about the importance of fostering ethical culture and involving society in the establishment and regulation of such a code.

Section V deals with “Research with Human Beings”.  In addition to some excellent discussion there is also some important inclusions.  Specifically both the Nuremberg Code and the Declaration of Helsinki are incorporated.  Both of these are enormously important documents in the development of contemporary approaches to ethics.  There inclusion helps to provide an important benchmark against which other more contemporary codes need to be measured. 

In Section VI, “Ethics in Epidemiologic Research”, some of the challenges of epidemiology are explored, including ensuring protection of research subjects and the vexed issue of race in the study of disease causation. A.M. Capron makes a helpful contribution in identifying a difference between harming and wronging someone. Likewise , in a  discussion of the importance of informed consent in protecting against such wrongs and in stressing steps that can be taken in avoiding or minimizing harms associated with breeching privacy and confidentiality.

Section VII deals with the “Humane care and use of animals in research.”  Both Arthur L. Caplan and Elizabeth Heitman provide important chapters with regard to humane care and ethical issues in animal experimentation. There are also contributions provided by the American Veterinary Medical Association Panel on Euthanasia, and the American Association for Laboratory Animal Science. I couldn’t help here reflecting that on these and other ethical issues there are a variety of views. In this and other sections it is arguable that more attention could have been given to non-professional accounts of ethics with not only references to these but even the use of the voices of members of the community.

Section VIII deals with the increasingly important issues of “management of an access to scientific data”.  Ruth Ellen Bulger provides an important overview of “ethical issues in data acquisition, access, and management”.  Various practical issues are dealt with by a variety of individual and corporate contributors. The contribution by the Brain Tumor Research Center of the University of California, San Francisco , “Guidelines on Research Data and Reports” is a particularly valuable concrete example for readers seeking such guidance for their practice.

Inherently related to all of this is “the work of the academic scientist”, the subject of Section IX.  The realities recognized here, including in contemporary medical schools, are reflected in section 10 dealing with “the scientist and industry”.  There is a very interesting chapter provided by Eric  G Campbell, Karen Seashore Lewis and David Blumenthal dealing with corporate gifts and the support of life sciences research.  This arises from a survey of a stratified, random sample of 4000 life science faculty conducted between 1994 and 1995.  Such an evidence-based chapter raises important issues to do with the relationship between the scientist and industry. 

Likewise the issue of the interactions and relationship between the scientist in society are tackled in section XI.  To wrap it all up, Section XII deals with the use of cases in the study of ethics.  The chapter by Elizabeth Heitman on this topic provides a concrete chapter with instructors very much in mind. 

Of course, readers may well ask what is the relevance of this collection for Metapsychology readers, with a particular interest in mental illness?  The insights of this book can help people with an interest in psychology, ethics, mental illness and psychiatric disability to explore more fully the ethical dimensions of science and indeed to understand some of its limitations and relationships with broader society.  It will perhaps be most useful to many readers as a source of reference and as a resource for further exploration of particular ethical questions.

One of the noticeable omissions from such an eclectic collection is an explicit acknowledgement of markedly different accounts of ethics. A valuable addition would have been a coherent feminist perspective and critique of dominant accounts of ethics and science. Likewise, there is a markedly different perspective regarding science and ethics that can flow from a developing country perspective compared with the predominantly Western developed country account which dominates this collection.

There is no doubt however that this is an invaluable reference worthwhile for teachers, practitioners, researchers and administrators in a variety of biological and health sciences.  Certainly, an essential inclusion to any reading list for courses dealing with the ethical and social dimensions of the biological and health sciences.

 

© 2003 Christopher Newell

 

 

Christopher Newell, PhD, Senior Lecturer in Medical Ethics, School of Medicine, University of Tasmania, Australia