Life-And-Death Matters

Abstract

When I grow up, I want to be a bioethicist. It would give me the opportunity to weigh in on all manner of life-and-death matters, mostly for liberal foundations and health care companies that are, in the main, irritated by the fact that we spend too much money on health care. The only thing stopping me is that in the end, as bioethicist Daniel Callahan calls for in What Price Better Health? I would be left supporting antismoking campaigns instead of research on a cure for spina bifida. According to Callahan, the research imperative is a philosophical view that regards medical research as more important than any other moral value or as a justification for certain “wrongs,” which for him is the “high” (we never find out relative to what) price of pharmaceuticals. In other words, Callahan believes that people (such as I) who see medical progress as the key to increasing life span, improving the quality of life, easing pain, and boosting productivity also believe that medical research has an absolute moral value that cannot be trumped by other concerns. He explains: “As health has improved, and mortality and disability declined, the drive for research has increased, not decreased. There seems to be no such thing as enough, no level of...health that leads to a reduction in research aspiration. A naive witness to discussions of American health might think that we have never been worse off, with a long...list of miseries still to be dealt with” (p. 33). On the one hand, Callahan believes that the research imperative is really fueled by a foolish desire by people who are not really sick, who are really healthy, to become absurdly and wastefully healthier still. But what about the fact that most of the research dollars in both the public and private sectors are devoted to finding better ways to prevent, treat, or cure diseases such as AIDS, Alzheimer’s, cancer, heart disease, diabetes, and mental illness? Or that genetic research is allowing scientists to more quickly translate molecular disease mechanisms into potential drugs or vaccines? On the other hand, Callahan believes that “as the success of research...portends, oldfashioned fatalism seems to have, so to speak, received a fatal blow.” There is no reason to accept any disease or disability with stoicism, more’s the pity, according to the author. Either way, Callahan seems to believe that the research imperative moves medical research in a wrong-headed direction: We spend too much money on health care in general instead of more socially useful things. But I digress. The research imperative, Callahan asserts, is to blame for people mistreating human subjects and lab animals alike in medical experiments. In making this assertion, he ignores a whole body of psychological research on the effects of environment on behavior (remember the Zimbardo prison experiment?), let alone the horrific “research” conducted by Nazi scientists on Jews without the research-imperative excuse. But this is not Callahan’s big beef. Rather, he has it in for drug companies, which he complains make way too much money, charge prices that are way too high, and try to get away by invoking the research imperative. B o o k R e v i e w s