This book deal with recent debates within medical ethics. It is
concerned with matters such as organ donation, cloning, payment
for surrogate mothers, patenting of genes and medical futility.
In the preface, Pence warns the reader not to expect impartiality
from him. This is a polemical book and intended as such, not a
neutral analysis of the issues with which it is concerned. However,
it is one thing forthrightly to advance the views one believes
to be true. It is quite another systematically to misrepresent
those to which you are opposed. Unfortunately, such misrepresentation
is just one of the many flaws which characterize Pence's work.
Pence is best-known for his defense of human cloning, especially
for the book Who's Afraid of Human Cloning? (Rowman &
Littlefield, 1998). When I read that work, I suspected that its
faults-clumsy writing, non-sequiturs, fallacious arguments-could
be explained, at least in part, by the rush to publish while the
issues it dealt with were still in the forefront of public consciousness.
But many of the same faults plague this book. Pence never pauses
to check a fact, or think through an argument. For instance, Pence
claims that Richard Titmuss (who he inexplicably calls Kenneth)
'assumed that scientific technology would never be able to detect
HIV'. Titmuss made no assumptions whatsoever about HIV, since
he died in 1973.
Pence is a libertarian, which is to say he believes that all goods
should be distributed by the market, with a minimum of government
interference. Having read one or two of his chapters, one can
predict the rest. Organ donation? Let the market provide! Cybermedicine?
No problem! Surrogate mothers. Not the government's business!
The same arguments and argumentative strategies reappear from
chapter to chapter, with wearisome predictability. Pence justifies
his views by invoking the distinction famously drawn by John Rawls
in his Theory of Justice, between the right and the good.
The right refers to the public realm, in which individuals
have claims against one another and in which notions of fairness
are paramount. The good refers to each person's conception
of the good life, of the kind of life most worth living. Liberalism
classically regards the good as a private matter. It is up to
each of us to decide for ourselves how we ought to live. The state
ought only to concern itself with the right, with ensuring that
distributions are fair and with enforcing the rights of individuals
against those who would invade them. Pence argues that all the
matters with which he is concerned fall within the purview of
the good, and are therefore matters for individual choice. No
one ought to dictate to others how they should live, so no one
has the right to impose their (usually religiously-inspired, according
to Pence) objections to commodification upon those who would sell
their organs and their bodies.
However, it is just a mistake to think that all the questions
with which Pence is concerned fall neatly on the side of the good.
It is striking that he ignores questions of just distribution,
which for Rawls fall so clearly within the appropriate sphere
for government regulation. Like all libertarians, Pence fails
to register the importance of so-called third-party effects: effects
that a transaction can have on people beyond those engaged directly
in it. Thus, for instance, Pence might be right to believe that
individual women benefit from the opportunity to sell their reproductive
labor to wealthy couples prepared to employ them as surrogates,
but permitting them to do so nevertheless might have deleterious
effects on all women: it might reinforce the view that women are
essentially wombs, and that reproduction is their primary task.
Pence's contention that paid surrogacy 'recognizes and values
the unique contribution of women' leads the reader to suspect
that he himself has not escaped the influence of such attitudes.
Similarly, Pence's contention that if drugs become available that
are able to enhance the intelligence of children, it is no one's
business but their parents whether these drugs are used ignores
third-party effects. Since intelligence has to be understood relationally,
as well as absolutely, those unable to afford the drugs could
be much worse off if they are made available. A good society might
well wish to ban such drugs, or provide them publicly.
Pence accuses those who oppose any of the measures he suggests
of suspecting the average person of being a closet Nazi. This
is but one of the many straw men he constructs and gleefully destroys
in the course of this book. Economists and philosophers have done
a great deal of work over the past thirty years, demonstrating
how individually rational, and even well-intentioned, actions
can have very negative effects on everyone. Individual motivations
are not the only factor to consider in deciding upon the permissibility
of a policy.
This is not to say that there is nothing good in this book. The
chapter on cloning, a much reworked summary of Pence's book on
the topic, is generally well-argued, as is the chapter on patenting
human genes and his brief consideration of the future of bioethics.
In these chapters, Pence refrains from misrepresenting his enemies,
and instead assesses their views. Even the quality of the writing
here is much improved. If the whole book were of this quality,
I would not hesitate to recommend it. As it is, I suggest that
those interested in these topics dip into these three chapters.
For the rest, it is not worth the investment of time.
© 2001 Neil Levy
Dr Neil Levy is a fellow of the Centre for Applied Philosophy and Public Ethics at Charles Sturt University, Australia. He is the author of two mongraphs and over a dozen articles and book chapters on Continental philosophy, ethics and political philosophy. He is currently writing a book on moral relativism.