Governments, health professionals, patients, research institutions, and research subjects look to bioethicists for guidance in making important decisions about medical treatment and research. And yet, argues Jonathan Baron in Against Bioethics, applied bioethics lacks the authority of a coherent guiding theory and is based largely on intuitive judgments. Baron proposes an alternative, arguing that bioethics could have a coherent theory based on utilitarianism and decision analysis. Utilitarianism holds that the best option is the one that does the most expected good. Decision analysis provides a way of thinking about the risks and trade-offs of specific options. Like economics, utilitarian decision analysis makes predictions of expected good in complex situations, using data when possible, and focusing human judgment on the issues relevant to consequences. With such a guiding theory, bioethics would never yield decisions that clearly go against the expected good of those involved, as some do now.
Baron discusses issues in bioethics that can be illuminated by such analysis, including "enhancements" to nature in the form of genetics, drugs, and mind control; reproduction; death and end-of-life issues, including advance directives, euthanasia, and organ donation; coercion and consent; conflict of interest and the reform of internal review boards; and drug research. Although Baron opposes current practice in bioethics, he argues that by combining utilitarianism and decision analysis, bioethics can achieve its aims of providing authoritative guidance in resolving thorny medical and ethical issues.
"Ignore the title. Baron doesn't want to get rid of bioethics, but to show us how we can do it better. His acute diagnosis of the pervasive errors of deontological approaches to bioethics deserves a wide readership."
—Peter Singer, Ira W. DeCamp Professor of Bioethics, University Center for Human Values, Princeton University
"Against Bioethics is a well-written, lucid, nontechnical exposition of how utilitarianism and its technical cousin, decision analysis, can be applied to a variety of bioethical problems including assisted suicide, informed consent, and the justifications for 'going against nature' (a particularly intriguing chapter on genetic engineering and stem cell research). For the most part, the book avoids the computational complexities that have limited the audience for a decision-analytic view of these problems. Instead, it focuses on the philosophical principles at stake and works out their implications for action. Its critique of specific solutions recommended by applied bioethicists deserves serious consideration."
—Arthur Elstein, Professor Emeritus of Medical Education, University of Illinois at Chicago, past president, Society for Medical Decision Making
"In this provocative book, Jonathan Baron calls on bioethicists to base their ethical judgments on explicit, quantifiable, utilitarian principles. Aware of the resistance to this approach, he demonstrates its strengths in a broad overview of a range of bioethical debates. Will assisted suicide laws for terminally ill patients lead to a slippery slope? Will genetically modified plants cause harm to the environment? Will new reproductive technologies cheapen the meaning of parenthood? Baron's utilitarian approach, based as it is on decision analysis, offers a powerful tool to inform these decisions."
—Peter A. Ubel, Director, Center for Behavioral and Decision Sciences in Medicine, University of Michigan
"Baron's diagnosis is correct: much is lacking in how bioethics has been translated into policy and practice. His proposed therapy, greater reliance on utilitarianism and decision theory, may not be a complete answer, but it moves the field in the right direction. Baron's critique, and his proposed solutions, deserve a wide readership."
—Barbara A. Koenig, Professor of Medicine, Mayo College of Medicine