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 argues 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.
Koch questions the “founding myths” of bioethics by which moral philosophers became practical ethicists who served as adjudicators of medical practice and planning. High philosophy, he argues, does not provide a guide to the practical dilemmas that arise at the bedside of sick patients. Nobody, he writes, carries Kant to a clinical consult.
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.
About the Author
Tom Koch, a bioethicist and gerontology consultant in Toronto, is the author of Mirrored Lives: Aging Children and Aging Parents; Cartographies of Disease: Maps, Mapping, and Medicine; Disease Maps: Epidemics on the Ground; and other 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, Vice President and Director of Academic Affairs, AARP
“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