Thieves of Virtue: When Bioethics Stole Medicine

by Tom Koch

Overview

An argument against the “lifeboat ethic” of contemporary bioethics that views medicine as a commodity rather than a tradition of care and caring.

Bioethics emerged in the 1960s from a conviction that physicians and researchers needed the guidance of philosophers in handling the issues raised by technological advances in medicine. It blossomed as a response to the perceived doctor-knows-best paternalism of the traditional medical ethic and today plays a critical role in health policies and treatment decisions. Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue , Tom Koch contends that bioethics has failed to deliver on its promises. Instead, he argues, bioethics has promoted a view of medicine as a commodity whose delivery is predicated not on care but on economic efficiency.

At the heart of bioethics, Koch writes, is a “lifeboat ethic” that assumes “scarcity” of medical resources is a natural condition rather than the result of prior economic, political, and social choices. The idea of natural scarcity requiring ethical triage signaled a shift in ethical emphasis from patient care and the physician's responsibility for it to neoliberal accountancies and the promotion of research as the preeminent good.

The solution to the failure of bioethics is not a new set of simplistic principles. Koch points the way to a transformed medical ethics that is humanist, responsible, and defensible.

Product Details

ISBN-13:	9780262526784
Publisher:	MIT Press
Publication date:	08/29/2014
Series:	Basic Bioethics
Pages:	376
Product dimensions:	8.40(w) x 5.60(h) x 0.90(d)
Age Range:	18 Years

About the Author

Tom Koch is Adjunct Professor of Medical Geography at the University of British Columbia, a consultant in ethics and gerontology at Alton Medical Centre, Toronto, and Director of Information Outreach, Ltd. He is the author of fourteen previous books, including Thieves of Virtue: When Bioethics Stole Medicine (MIT Press).

Table of Contents

Series Foreword vii

Acknowledgments ix

Introduction xiii

1 Dead Germans and Other Philosophers: Ethics as a Professional or a Public Occupation 1

2 Something Old: A Brief Review 21

3 Something Newer: Supply-Side Ethics 55

4 Lifeboat Ethics: Scarcity as an Unnatural State 81

5 Biopolitics, Biophilosophies, and Bioethics 111

6 Principles of Biomedical Ethics 139

7 Bioethics and Conformal Humans 165

8 Research and Genetics: "For the Benefit of Humankind" 197

9 Choice, Freedom, and the Paternalism Thing 225

10 Complex Ethics: Toward an Ethics of Medicine 249

Notes 259

Bibliography 295

Index 323

What People are Saying About This

Walter Wright

An original, well-researched, and provocative book. Thieves of Virtue offers a fundamental and probing critique of the core premises undergirding contemporary bioethical theory in its several forms. Tom Koch's investigation suggests that the roots of bioethics are deeply problematic, and require thorough reassessment.

Harry R. Moody

"I'm overwhelmingly impressed by Thieves of Virtue. I've been worrying about the direction that bioethics has taken over the years, and Koch's book has put this into words much better than anyone I know. A remarkable piece of work."

M. Therese Lysaught

If lifeboat ethics sinks, will bioethics drown? In Thieves of Virtue, Tom Koch incisively exposes the myths and mystifications fostered by bioethics, unpacking not only the philosophical inconsistencies but equally the critical externalities—both theoretical and factual—that are conveniently masked and bracketed by the discipline. He convincingly demonstrates that bioethics crafted a mythos of scarcity, covertly allying itself with neoliberal economics, at the expense of the moral core of medicine and well-being of persons and patients, especially those with disabilities. This book provides an important new account of bioethics for serious scholars as well as for students new to the field.

Endorsement

An original, well-researched, and provocative book. Thieves of Virtue offers a fundamental and probing critique of the core premises undergirding contemporary bioethical theory in its several forms. Tom Koch's investigation suggests that the roots of bioethics are deeply problematic, and require thorough reassessment.

—Walter Wright, Professor of Philosophy, Clark University

From the Publisher

If lifeboat ethics sinks, will bioethics drown? In Thieves of Virtue, Tom Koch incisively exposes the myths and mystifications fostered by bioethics, unpacking not only the philosophical inconsistencies but equally the critical externalities—both theoretical and factual—that are conveniently masked and bracketed by the discipline. He convincingly demonstrates that bioethics crafted a mythos of scarcity, covertly allying itself with neoliberal economics, at the expense of the moral core of medicine and well-being of persons and patients, especially those with disabilities. This book provides an important new account of bioethics for serious scholars as well as for students new to the field.

—M. Therese Lysaught, Department of Theology, Marquette University

In Thieves of Virtue Tom Koch compares the 2,500-year-old Hippocratic Oath with the medical ethics proposed to replace it by contemporary bioethicists. It's not just that he finds the new ethics wanting: Koch makes it clear that it is ethics at all in only the narrowest, most technical sense. His painstaking, case-by-notorious-case critique is devastating. His dispassion may not allow him to say it, but I can: as currently advocated, bioethics is simply unethical.

—Denis Wood, author of Everything Sings

An original, well-researched, and provocative book. Thieves of Virtue offers a fundamental and probing critique of the core premises undergirding contemporary bioethical theory in its several forms. Tom Koch's investigation suggests that the roots of bioethics are deeply problematic, and require thorough reassessment.

—Walter Wright, Professor of Philosophy, Clark University

Denis Wood

In Thieves of Virtue Tom Koch compares the 2,500-year-old Hippocratic Oath with the medical ethics proposed to replace it by contemporary bioethicists. It's not just that he finds the new ethics wanting: Koch makes it clear that it is ethics at all in only the narrowest, most technical sense. His painstaking, case-by-notorious-case critique is devastating. His dispassion may not allow him to say it, but I can: as currently advocated, bioethics is simply unethical.

Editorial Reviews

I'm overwhelmingly impressed by Thieves of Virtue. I've been worrying about the direction that bioethics has taken over the years, and Koch's book has put this into words much better than anyone I know. A remarkable piece of work.—Harry R. Moody, Vice President and Director of Academic Affairs, AAR—

Koch provides and interesting history of bioethics.

—London School of Economics Review of Books—

Koch's book is thought provoking and raises important issues….valuable critique of dominant bioethics theories.

—Review of Politics—

An important book….a robust, refreshing and informed reflection….grippingly readable.

—Social History of Medicine—

A brilliant and insightful critique.

—Journal of American Physicians and Surgeons—

From the Publisher

An important book….a robust, refreshing and informed reflection….grippingly readable.

Social History of Medicine

Koch's book is thought provoking and raises important issues….valuable critique of dominant bioethics theories.

Review of Politics

Koch provides and interesting history of bioethics.

London School of Economics Review of Books

I'm overwhelmingly impressed by Thieves of Virtue. I've been worrying about the direction that bioethics has taken over the years, and Koch's book has put this into words much better than anyone I know. A remarkable piece of work.

Harry R. Moody

An important book….a robust, refreshing and informed reflection….grippingly readable.

—Social History of Medicine

Reviews

This insightful but at times overly polemical book is a scathing critique of contemporary bioethics since the 1960s. Koch (Disease Maps: Epidemics on the Ground) claims that, prior to the rise of bioethics as a discipline, doctor-patient relationships were governed only by a concern for the patient's well-being. Now economic and social factors are brought into play, such as "the myth of scarcity," which, he claims, creates situations in which social concerns trump the needs of the individual. He argues, perhaps with some merit, that anxieties about the scarcity of medical care exist only because the United States has created a system that does not allocate the necessary funds for adequate health care. While Koch sometimes reads his opponents uncharitably and seems to simplify their positions to fit his critique of them, he makes valid, thoughtful points. VERDICT Despite his controversial tone and arguably unfair readings of those he considers his opponents, Koch raises important questions that bioethics and health policy scholars (his intended audience) would do well to attend to.—Aaron Klink, Duke Univ., Durham, NC

Library Journal