Book Review

Thieves Of Virtue: When Bioethics Stole Medicine

Tom Koch
The MIT Press
ISBN 978-0-262-01798-5

This is a much needed critique of the contemporary bioethics movement. The author, a bioethicist and gerontology consultant, argues that the Hippocratic tradition was unjustly ousted by the new bioethics movement which promised much and has failed to deliver. The theories of Beauchamp and Childress are assessed and are found to be wanting.

The new bioethics emerged in the 1960's, based on the belief that doctors needed philosophers to help them handle the complex issues resulting from technological advances. It was intended to counter the doctor knows best paternalism of the past. However, it emphasized economic efficiency over care and it has been used by governments to rationalize their cost cutting exercises. The author thus argues that bioethics is not ultimately about ethics but about money and power. This contrasts with the approaches taken by past philosophers from Plato to Kant, who were critics of the State's disregard of the most vulnerable in our society. Bioethics is now all about risk management and cost cutting but not really about care.

At the heart of bioethics lies a "lifeboat ethic" that assumes scarcity of resources requiring some people to be sacrificed for the sake of others.  That explains why most bioethics departments are run by utilitarians.

So how ought we move on from the bioethics mess?  We do not need another set of principles but we do need to return to a more humane set of values.  The author is a remorseless critic of the bioethics movement and rightly so.  One is less convinced by his remedy.

This is a timely wake-up call for all of us in health care.

REVIEWED BY DR PRAVIN THEVATHASAN