Thieves of Virtue: When Bioethics Stole Medicine PDF Download
By Tom Koch (Author)
An argument against the “lifeboat ethic” of contemporary bioethics that views medicine as a commodity rather than a tradition of care and caring.
Bioethics emerged in the 1960s from a conviction that physicians and researchers needed the guidance of philosophers in handling the issues raised by technological advances in medicine. It blossomed as a response to the perceived doctor-knows-best paternalism of the traditional medical ethic and today plays a critical role in health policies and treatment decisions. Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch contends that bioethics has failed to deliver on its promises. Instead, he argues, bioethics has promoted a view of medicine as a commodity whose delivery is predicated not on care but on economic efficiency.
At the heart of bioethics, Koch writes, is a “lifeboat ethic” that assumes “scarcity” of medical resources is a natural condition rather than the result of prior economic, political, and social choices. The idea of natural scarcity requiring ethical triage signaled a shift in ethical emphasis from patient care and the physician’s responsibility for it to neoliberal accountancies and the promotion of research as the preeminent good.
The solution to the failure of bioethics is not a new set of simplistic principles. Koch points the way to a transformed medical ethics that is humanist, responsible, and defensible.
- Series:Basic Bioethics
- Hardcover:376 pages
- Publisher:The MIT Press; 1 edition (September 7, 2012)
Bioethics was supposed to be about you and me, about people and the medicine they receive, or desire. It was to be a tool with which individuals and the societies they inhabit could answer questions of medical practice and the research that sometimes put those politely called “human subjects” at risk. Born in the 1960s, it was to be a public service that brought a specific kind of analytic, moral philosophy to questions of medical care and healthcare delivery. In the end, bioethics was an experiment in a method of philosophically grounded, practical ethics that promised simplicity in a world that is multilayered, messy, and complex. The result would be, its progenitors promised, a set of generally applicable, universally accepted ethical guidelines at once intellectually and morally robust. 1 The realities of patient care and treatment (or nontreatment) were the medium of that experiment rather than the focus of its principals’ passionate concern. Medicine is about how to do things; bioethics was forged to decide whether we should do them and if so, when and to whom. The result was what Albert Jonsen called a “demi-discipline,” 2 an applicable ethical perspective based on philosophical principles that put philosophy at the service of social medicine. There was something out of joint from the start. Bioethics began with citizens engaged in a public debate over healthcare but quickly became a profession whose members spoke a language generally inaccessible to the average person. The bioethics profession trumpeted the right of patient choice but did so without considering the many ways in which those choices would be limited by its assumptions. Bioethics set up the medically untrained, philosophical adept as the adjudicator of clinical choices and the social organization that determined their boundaries. From the start those adepts were distanced from the bedside and the complexities of care. From the start bioethics promoted individual agency as an article of faith without attention to the socioeconomic constraints on individual choice. Experience as either a reality check or a teacher was not required. Who needs experience as either a reality check or a teacher? In situations fraught with ambiguity, emotion, and uncertainty, bioethics offered the philosopher’s stock in trade, a dispassionate rationality, as a panacea.