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by Gregory E. Pence
Rowman & Littlefield, 2000
Review by Neil Levy, Ph.D. on Oct 20th 2001

Re-creating MedicineThis 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.