Are Human Rights Important In Bioethics?

Abstract

Book Review Health AffairsVol. 25, No. 1: U.S. Hospitals: Mission Vs. Market Are Human Rights Important In Bioethics?Robert M. VeatchPUBLISHED:January/February 2006Free Accesshttps://doi.org/10.1377/hlthaff.25.1.287AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSEthicsHealth lawAccess to careLegal and regulatory issuesAmerican Bioethics: Crossing Human Rights and Health Law Boundaries by George J. Annas (New York: Oxford University Press, 2005), 264 pp., $35 George Annas is a national treasure—a passionate advocate for human rights in health care, with the sophistication and scholarly reliability to warrant not only regular publication in the New England Journal of Medicine but also the collection of those articles plus three others by the top English-language bioethics publisher, Oxford University Press. The twelve chapters of American Bioethics cover a range of the most controversial and timely legal and moral issues in medicine today. They are woven together with Annas’s central theme: that American bioethics needs to turn its attention to more universal social dimensions. The volume can be read either as an engaging collection of analyses of important legal cases in health care or as a commentary on the current state of American bioethics. As the former, the book comments on some of the most important recent national and international legal developments. These include patent restrictions on the right of access to nevirapine as a generic drug for low-income South Africans; the capital punishment sentence of the mentally retarded murderer, Daryl Renard Atkins; the British litigation about the separation of conjoined twins Michaelangelo and Rina Attard against their parents’ wishes; and the U.S. legal fight over attempts to make so-called partial-birth abortion illegal. It also discusses a California in vitro fertilization case involving a child with six potential parents—the two providing the sperm and egg cells, the two planning to raise the child, and the gestational mother and her husband. The court—foolishly in Annas’s judgment—declared the child “parentless.” Annas, a professor of health law, bioethics, and human rights at Boston University, also has the courage to report the details of the case of Catherine Shine, who, after calling Massachusetts General Hospital to be assured that she would not be placed on a ventilator during an asthma attack, was forcibly placed in four-point restraints and intubated. He uses the case to comment on current law regarding the use of patient restraints and, along the way, to provide ample opinion on this preeminent hospital’s quality of care.For the typical reader without theoretical interests in bioethics, human rights, and health law, these legal analyses alone make the book a provocative read and a learning experience. But for the theoretically inclined, the book offers a deeper layer of commentary on the complex relationship among these three interlinked fields. The story is not always easy to follow. But this much is clear: Annas perceives a tension between American biomedical ethics and human rights. Sometimes he presents them as being at odds: “Human rights is a much more powerful language for good than is medical ethics” (page 25). Sometimes he sees the two as separate entities, with “rights” being the more robust: “Both modern bioethics and the modern patient rights movement can be seen as reactions to medical paternalism—but, in America at least, the patient rights movement has been considerably more powerful” (p. 95). The theme of Annas’s work is that “[b]ioethics is in danger of losing its relevance. American bioethics must cross boundaries, both philosophical and geographic, to reclaim its international human rights heritage by returning to its birthplace, Nuremberg, in U.S.-occupied Germany, the site of the trial of the Nazi doctors” (flyleaf). With such an effort, bioethics and human rights can become symbiotic (p. 25) and critical consorts (p. 26).I am not sure that most bioethicists would see it quite that way. No doubt, American bioethics in its critical period from 1970 until about 1985 gave great emphasis to the individual rights of patients being abused by paternalistic physicians—as Annas interprets the Mass General case. Thus, I am not sure why Annas thinks that American medical ethics has “not promoted or embraced” (p. 97) consent and the right to refuse medical treatment. Bioethicists, early on, were pushing both doctors and the legal system as hard as they could to develop a health law more respectful of patients’ rights.Likewise, American bioethics has been pushing toward a more global and universal perspective for decades. Since the early 1970s, the Hastings Center (the oldest and most prominent nonuniversity bioethics research center in the world) has had a research group on ethics and health policy that addresses human rights and equitable access issues. It has worked closely with the United Nations on projects oriented to human rights. During the intervening decades, many bioethicists have tried to push the discussion in the direction of social ethics at the global level. This raises a question, however, that is important to theorists. Must the universal or global ethical agenda oriented to the problems addressed in Annas’s volume—terrorism, responsible use of technology, and equitable access to health care—be developed in the language of human rights as Annas suggests? Most ethicists would consider the human rights agenda to be an integral part of the disciplines of normative ethics, but many choose to carry on that discussion in other terms. Right in the Boston area, for example, John Rawls’s students oriented to bioethics (such as Harvard philosopher Norman Daniels) have for years focused on the just distribution of health care. Daniels’ Harvard colleagues, Dan Wikler and Dan Brock, have long worked with the World Health Organization (WHO) and the Council for International Organizations of Medical Sciences (CIOMS), pressing for equity in health care. And Lisa Cahill, a theologian at Boston College, recently published Bioethics and the Common Good, whose central theme is that there needs to be a globalization of bioethics carried out in the name of the “common good” and greater priority placed on the world’s poor. 1 None of these figures dwells on the language of human rights. Some philosophers insist that other linguistic approaches avoid problems of rights language. Philosopher Ruth Macklin, for example, has argued for the language of duties, but she is a leader in the movement toward an international focus on oppressed populations of the world. 2 Annas is on target in American Bioethics. Bioethics, human rights, and health law need to work symbiotically to deal with the critical need for a global public health ethic. The Universal Declaration of Human Rights and other international codifications—whether they use rights language or some other terminology—need to emerge to greater prominence. American Bioethics advances that effort dramatically. Robert Veatch ( [email protected] ) is a professor of medical ethics and former director of the Kennedy Institute of Ethics, Georgetown University, in Washington, D.C. NOTES1 L.S. Cahill , Bioethics and the Common Good (Milwaukee: Marquette University Press, 2004 ). Google Scholar 2 R. Macklin , “Moral Concerns and Appeals to Rights and Duties: Grounding Claims in a Theory of Justice,” Hastings Center Report 6 , no. 5 ( 1976 ): 31 –38. Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 January 2006 InformationCopyright 2006 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited ByThe Aging Network and Managed Long-Term CareThe Gerontologist, Vol. 48, No. 5