BOOKS & ELECTRONIC MEDIA
Nikola Biller-Andorno
Ethicist, Ethics and Health Unit, World Health Organization, 1211 Geneva 27, Switzerland (email: billerandornon@who.int)
Everyday bioethics: reflections on bioethical choices in daily life
Author: Giovanni Berlinguer Publisher: Baywood, Amityville, New York, USA, 2003 Hb ISBN 0- 89503-225-2, price US$ 38 Pb ISBN 0-89503-231-7, price US$ 29
In recent years calls for a closer connection between bioethical analysis and social reality have become almost mainstream. The number of authors who have actually ventured to provide such an account is much more limited. Giovanni Berlinguer, the renowned Italian physician and bioethicist, is one of these few, as this publication clearly shows. It is in the Baywood "Policy, Politics, Health and Medicine Series", edited by Vicente Navarro.
Berlinguer contrasts his "everyday bioethics" with a "frontier bioethics" that focuses narrowly on new biotechnological developments. Many bioethics textbooks do indeed concentrate on the latter, treating issues arising from assisted reproductive technologies and pre- implantation diagnosis as typical ethical problems at the beginning of life, and physician-assisted suicide in intensive care units as representative of problems at the end of it. The broader perspective of the "everyday bioethics" that Berlinguer advocates includes thematic areas such as procreation and birth, population and equity, work and health, the human body as a commodity, and global health. He thus resists the widespread view that moral values are endangered mainly by technological development. As he puts it: "Human freedom must prevail over all limits and obstacles, whether due to social injustice, the manipulation of minds, or genetic predetermination."
His concern with power relationships and the real conditions of human beings helps the author to avoid the pitfalls of two theoretical positions, which are particularly strongly felt when issues of human procreation are being discussed. On the one hand there is the pitfall of liberalism which upholds theoretical options as choices where in reality there are none, at least for many people, and thus disregards the social embeddedness and real-life constraints of individual actions. On the other there is the pitfall of dogmatism which can lead to strangely detached and rigid positions that seem paradoxically to value potential or nascent human life and the multiplication of the human species more than the well-being and fulfilment of existing children and adults. In a debate that is sometimes so centred on the embryo that the fact that there is usually a woman around it is overlooked, it is heartening to see throughout the book the attention and respect given to women's and gender issues.
On other topics as well, like the sale of organs, a passionate yet thoughtful voice is speaking up for those who are far from enjoying the freedom the author proposes as a moral ideal. The book also escapes yet another danger to which essays on ethics are exposed: its argumentation deals with concrete circumstances on a factual basis. It does not treat the specific features of real situations as "technical" or "political" matters that can be happily disregarded in the development of high-minded theories.
This brings us to a second tension, beyond the one between everyday issues and "frontier issues", and that is the tension between ethical theory and moral practice. What is the relation between moral principles and the situational context? How can apparent tensions between moral ideals and real life be dealt with, without falling into denial, fatalism or cynicism?
Although the author succeeds admirably in keeping his balance between the demands of the ideal and the real, there is no theoretical discussion of these contradictions in the book. He does not spell out a "theory of everyday ethics", although central elements of such an ethics do become apparent: choice, freedom, respect, pluralism, equity, non-discrimination, concern for the disadvantaged, solidarity, and sharing of benefits brought about by advances of biomedical sciences and technologies. More academically minded readers might wonder how these elements could be brought together in a theoretical framework. In particular the concept of equity, which is of crucial importance for the whole volume, might have benefited from a more precise definition.
The richness of the book reflects the author's long and varied experience in medicine and public health, politics and ethics, notably as a member of the UNESCO International Bioethics Committee and the chair of the Italian National Bioethics Committee. His treatment of issues in this book is provocative without being polemical, clear without being offensive, focusing on the big questions without losing sight of details. It gives a sense of moral maturity, wisdom and good judgment that are rare assets in spite of the considerable amount being written in this field.
Everyday bioethics will be read with great gain by everyone involved in bioethics, whether as academics, students or the interested public. The question of what developments in biotechnology mean for the everyday lives of people in very different social and cultural contexts will be of particular interest for professionals working in public and international health. Although the book is certainly not limited to a specifically Italian background, it gives interesting insights into the peculiarities of national discussions. Its bibliographical references are up to date and go beyond publications in English, thus giving useful hints to important work that will usually not be cited in English-language publications.
Beyond the twists and turns that the public debate on bioethics can rapidly take, this book makes what seems destined to be a lasting contribution. It will remain valid long after the news about the latest spectacular biotechnological achievement has been superseded or forgotten. 