The Body in Bioethics
Alastair V Campbell
London: Routledge, 2009, 150 pp, £27.99, ISBN-978-1-84472-056-9 (pbk)
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DOI:
10.2966/scrip.070110.226 |
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The central thesis of The Body in Bioethics is that a disjunction has occurred in our approach to the body, not just in bioethics, but in society more generally. Whereas many people would imagine the body and its appropriate conceptualisation and treatment to be at the heart of bioethics, in fact, most bioethical writing diminishes its value, relegating it to relatively insignificant and contingent physical carrier of the self-aware moral agent, and this tendency is mirrored in a number of social conditions and practices. Campbell, a bioethics veteran who founded the venerable Journal of Medical Ethics and who has served as President of the International Association of Bioethics and as Chair of the Ethics and Governance Council of the UK Biobank, argues that this is a flawed (and potentially fatal) approach to bioethical and broader thinking and acting.
In Chapter 1, “Why the Body Matters”, Campbell attributes the desacralisation of the human body to Descartes, and argues that the rational and intangible (i.e. the disembodied will) has been favoured at the expense of the physical by a line of philosophers concerned with agency, and this trend has continued in modern bioethics despite the variety of theories available (p 3). The irony, of course, is that modern medicine is armed with knowledge generated from the physical (i.e. largely the cadaver), and it explores and treats parts of the physical. In any event, while there is a millennia-long history of viewing the body and its sensations with suspicion and characterising it as a prison or a tomb for the soul, it cannot be separated from our experience, and the tendency of modern bioethics to do so is wholly inappropriate. Drawing on various scholars,1 Campbell attempts to reorient bioethics to the “embodied self” (i.e. to a bioethics that acknowledges the fullness of human nature, both mental and corporeal), so that it might lead to a “more humane and genuinely therapeutic medicine” (p 10).
In Chapter 2, “My Body: Property, Commodity or Gift?”, Campbell engages with the debate about property in the human body. After finding some bases on which a property paradigm might be defended, he argues that, certainly with respect to the whole body, which is in a state of dynamic interactiveness with the environment, the utility of this approach can be questioned (p 15). With respect to commodification of the body more generally, Campbell says:
The embodied self is very far removed from the Kantian abstraction of the rational will, and the uniqueness of individual persons, whose “lived bodies” each have their own history, is a central feature of this approach. Thus we cannot brush aside concerns about commodification of the body and its parts merely by rejecting as meaningless claims about the uniqueness of individual persons. Perturbation about a trade in body parts relates to more than worries that it may be symptomatic of treating persons as mere means (though this, of course, is one aspect of our concern). It relates to a potential de-humanization of the self, by treating it as no more than a rational negotiator in a society dominated in all aspects by market values, including the monetizing of parts of the human body. If we are to avoid such compartmentalisation, then we need a “thick” theory of the self. (p 18)
This more nuanced theory of the self demands that the self be understood expansively to include the contextual aspects of personhood,2 and Campbell charges that bioethics must do justice to this called-for richness and diversity of values when considering the body in different biomedical settings.
In Chapter 3, “Body Futures”, Campbell considers market approaches to body parts (blood and transplantable organs) in greater detail. After considering a variety of sources, he suggests that paid and voluntary systems cannot coexist without a loss on the voluntary side (p 33). Moreover, there is no convincing argument supporting a paid system as morally superior, whereas, on the contrary, a solid moral argument can be made against a paid system on the basis of both exploitation and commodification. He concludes that Titmuss (who conducted a seminal study of blood donation in the US and UK) was substantially correct when he pointed out that a market is dangerous and inefficient;3 what is needed is a sustained effort to provide structures in which the drive to voluntarily help others in need can be effectively deployed, thereby making our bodies a source of connection with others (p 53).
In Chapter 4, “The Tissue Trove”, Campbell begins by acknowledging that modern biomedical research (and concomitant medical practice) has generated a massive demand for human tissue and a massive tissue-based industry. He then considers two contexts – the provision of oocytes for research and the establishment of tissue collections in health research biobanks – with a view to “seeking conceptualizations of the ‘tissue trove’ that safeguard its human origin and its basis in altruism, without naively imagining that we can exclude all commercial elements from the exploitation of this vast resource” (p 71). Without settling on any one solution for enhancing the position of the embodied self in these contexts, Campbell suggests that debates around UK Stem Cell Bank practices and benefit sharing offer some directions that might be taken to safeguard respectful and effective use of human tissue and our common humanity.
In Chapter 5, “The Branded Body”, Campbell explores the ways in which humans experience the “discomfort of embodiment”, focusing on branding and image, and the negative and positive signals and associations they give. He considers the body viewed as alien (and rejected) by the person embodied therein, focusing on body image identity disorder, transsexualism and anorexia, and then considers the body viewed as image and beauty (and rejected) by society, focusing on Down Syndrome sufferers and the cosmetic/aesthetic surgery industry. He concludes with a lament for the embodied self, noting the precipitous challenges imposed on accepting difference and diversity and the natural transitoriness of the human condition.
In Chapter 6, “Gifts from the Dead”, Campbell argues that life and death are intertwined. Revisiting the retained organ controversy in the UK, he demonstrates that the body, even after death, retains a personal, familial and social value that is both emotional and practical. He advances the idea that dead bodies give us “gifts”: the gift of knowledge, through educational dissection and post mortem examination (pp 107-110); the gift of life, through organ harvesting (pp 111-114); and the gift of memory, through the treasured recollections of those who survive (pp 115-118). Though this last gift may be seen as transitory, Campbell argues that it is fundamentally important:
The offence of the well-meaning palaeontologist who dates the bones of our forebears is that, in common with so much in our age, the information extracted tells us nothing of real use to us, nothing about how our past may help us now, nothing about how it may live on in us in a positive way. Instead, our being as individual persons is reduced to a string of numbers rather like the identity card codes by which many modern societies track their citizens. The gift of memory can take us back to a physical place of our ancestors – a place transformed no doubt by all the rapid change in our era, so not the place they knew – yet still a place where we can reconnect to earth and, for a time, leave cyberspace. (p 117)
In short, it is Campbell’s argument (and desire) that dead bodies (can) help us to become rooted in the earth (again), an important function in the face of an increasingly disjointed reality where distance and diversity are shrinking.
In the very short Chapter 7, “Together at Last”, Campbell reminds us that we must be more considered and reflective of the body; in defending our positions, we need to be cognizant of the moral weight of the body, and that means coming to grips with the relativity of our bodies. He sums up by reflecting on three aspects of this reunion with the body, that relating to the self, to others, and to the earth. With respect to the latter, he implores us to exercise the wisdom and humility to know that we are earthbound and that we rely utterly on the health of the environment for our survival (as moral agents) (p 125).
Ultimately, and without offering solutions, Campbell engages with a number of lived experiences (or common bioethical problems) to demonstrate his point that the body can and should retain its value in the biomedical as well as the bioethical sphere. His point is that to ignore the bodily aspects of ourselves, or to treat them in a merely instrumental way (as a source of income, or social esteem, or scientific discovery) threatens the integrity of ourselves as individuals and as a community (p 103). This book does not expound a new body-centric theory. It is merely a call to recall the body and our inevitable position as vulnerable organic beings, anchored in time and space, when we undertake the bioethical exercise, and indeed our other social endeavours.
The Body in Bioethics is a brisk and insightful, if somewhat melancholic, read which consistently draws on equally interesting philosophical and literary works.4 Its aim is (arguably) modest, but its desired reach is sweeping, if also squarely against the tide of modern (Western) society. Its important message, accessible prose, short length and modest price make it a must read for anyone interested in bioethics projects, particularly those working “at the coal face” who would do well to remind themselves of this message.
This review forms part of the GET: Social Values project (ESRC Award No. RES-000-22-2678), which can be found at http://www.law.ed.ac.uk/ahrc/esrcvaluesproject/, and the author acknowledges the kind support of the Economic and Social Research Council.
Shawn H. E. Harmon
Research Fellow, ESRC InnoGen and AHRC SCRIPT
University of Edinburgh
© Shawn H. E. Harmon 2010
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1 In particular, D Leder, The Absent Body (Chicago: UCP, 1990) and A Damasio, Descartes’ Error: Emotion, Reason and the Human Brain (NY: GP Putnam, 1994).
2 In this regard, Campbell draws on E Anderson, Value in Ethics and Economics (Cambridge: Harvard U Press, 1993), and M Radin, Contested Commodities (Cambridge: Harvard U Press, 1996).
3 R Titmuss, The Gift Relationship: From Human Blood to Social Policy (London: George Allen & Unwin, 1970).
4 Including T Eagleton, The Illusions of Postmodernism (Cambridge: Blackwell, 1996), G Weiss, Body Images: Embodiment as Intercorporeality (London: Routledge, 1999), M Meyer, Thicker than Water: The Origins of Blood as Symbol and Ritual (NY: Routledge, 2005), D Dickenson, Property in the Body: Feminist Perspectives (Cambridge: CUP, 2007), and C Elliott, Better than Well: American Medicine Meets the American Dream (NY: WW Norton & Co., 2003), who is quoted as saying, “Life is a short sweet ride, and I am spending it all in the station”.