In Search of the Good: A Life in Bioethics

Basic Bioethics

by Daniel Callahan

One of the founding fathers of bioethics describes the development of the field and his thinking on some of the crucial issues of our time. Daniel Callahan helped invent the field of bioethics more than forty years ago when he decided to use his training in philosophy to grapple with ethical problems in biology and medicine. Disenchanted with academic philosophy because of its analytical bent and distance from the concerns of real life, Callahan found the ethical issues raised by the rapid medical advances of the 1960s--which included the birth control pill, heart transplants, and new capacities to keep very sick people alive--to be philosophical questions with immediate real-world relevance. In this memoir, Callahan describes his part in the founding of bioethics and traces his thinking on critical issues including embryonic stem cell research, market-driven health care, and medical rationing. He identifies the major challenges facing bioethics today and ruminates on its future.Callahan writes about founding the Hastings Center--the first bioethics research institution--with the author and psychiatrist Willard Gaylin in 1969, and recounts the challenges of running a think tank while keeping up a prolific flow of influential books and articles. Editor of the famous liberal Catholic magazine Commonweal in the 1960s, Callahan describes his now-secular approach to issues of illness and mortality. He questions the idea of endless medical "progress" and interventionist end-of-life care that seems to blur the boundary between living and dying. It is the role of bioethics, he argues, to be a loyal dissenter in the onward march of medical progress. The most important challenge for bioethics now is to help rethink the very goals of medicine.

Hardcover

First published October 12, 2012

Reviews

[Barron Lerner · Rating 5 out of 5]

This book is a must for anyone interested in the history of bioethics or those who are interested in some of the key medical topics of our era: abortion, end-of-life technologies, patients' rights, etc. That's because Callahan, a co-founder of the prestigious Hastings Center, was there when all of these issues "went public" in the 1970s. Callahan's recollections provide a sort-of behind-the-scenes account of how bioethics emerged as a profession. As might be imagined, what seems like a linear triumph of autonomy and informed consent becomes more complicated in his rendering. Part of this alternative narrative comes from Callahan's own history of being something of an iconoclast within the field. He has been very critical of the Harvard philosophy department where he obtained his Ph.D. as well as the "principles" approach that has guided much of modern bioethics. Callahan also has written provocative books about our overuse of medical technology, most notably "Setting Limits" (1987), in which he argued that those over 80 years of age should decline aggressive medical measures so that they might instead be used by those who would benefit more. Having reached 80, Callahan deftly dodges the question of whether he would now personally decline such technologies. Instead, as he has so productively throughout his career, he uses this question to get his readers to explore a provocative, philosophical and deeply human question.

[Samuel Brown · Rating 4 out of 5]

Callahan's a great thinker, and this memoir (while susceptible to the usual criticisms of memoirs written late in life) provides a useful sense for how the field of bioethics evolved from its origins in the mid-1960s to the present day. A quick and pleasant read.

[Bonnie · Rating 4 out of 5]

Part memoir, part history, part philosophical musings, this book gives the reader an up-close look at of the beginnings of bioethics and the man who helped to found the field. By any standards, Callahan is amazing. As just one example of his extraordinary energy, he became the editor of a major magazine, Commonweal, and published two books -- all before finishing his PhD dissertation.
Although Callahan trained as an analytic philosopher at Harvard, he does not think much of that way of doing philosophy. In particular, he rejects thought experiments which he regards as “the worst and irreducibly most slack way of pursuing philosophical knowledge.” Instead, he prefers a richer, more contextual approach that takes into consideration cultural and social factors. I agree that often thought experiments are too removed from ordinary experience to help clarify our intuitions. However, properly constructed, they can tease out the essential elements of a situation, and lead to the making of important distinctions.
Consider, for example, Callahan’s rejection of the violinist example in Judith Thomson’s “A Defense of Abortion.” Callahan writes, “I never found her argument persuasive, if only because her thought experiment is not at all analogous to that of sexual relationships.” (p. 84) He goes on to say that it works well enough in the case of rape but does not appear to realize the significance of that achievement. Many conservatives would like to make an exception in the case of rape, but cannot do so on the traditional view, expressed in Catholic doctrine, which maintains that abortion is not permissible, even in the case of rape, since the wrongful act of the father does not justify killing the innocent child. The relevance of the violinist example is that it demonstrates that having a right to life does not by itself give anyone a right to the use of someone else’s body, without that person’s consent. That the argument may not serve as a full-fledged defense of abortion does not take away from that extremely important point.
Callahan’s antipathy to thought experiments also explains his lack of enthusiasm for John Rawls. Callahan regards Rawls’s device of the original position as a “dubious starting point,” writing “He might more profitably have spent many of the years he took writing that book to travel around the world as an anthropologist or psychologist might, inductively gathering what different cultures and modes of thought and emotion made of the concept, rooting justice in human experience.” (p. 97) However, that would have been an entirely different book. Rawls’ central idea is that justice is best understood as fairness, and the device of the veil of ignorance is used to elaborate that idea. Deprived of knowledge about our specific traits and conditions, we are prevented from choosing principles that would advantage us. We could not rationally choose the institution of slavery, since we might be slaves in the resulting society, something few would be willing to risk. Had Rawls followed Callahan’s advice, he no doubt would have found that many societies see nothing unjust in treating women as property or giving people of color second-class status.
Callahan acknowledges that his Catholic background may sometimes influence his moral views. This seems likely to be in his rejection of sperm donation, which he regards as irresponsible, just as it would be to impregnate and then abandon a woman. The analogy is not apt. A sperm donor doesn’t abandon the woman who uses his sperm, nor does his action lead to the resulting child growing up fatherless. Rather, he transfers his rearing rights, usually to another man, who will raise the child. It is hard to see what is objectionable in a practice that has enabled so many children to be born, and so many couples to become parents. Some of these children do want to know more about, or even meet, their sperm donors. But that’s an argument for greater transparency in sperm donation, not for banning the practice. Or so it seems to me.
In addition to providing an insider’s account of what Al Jonsen has called “the birth of bioethics,” the book ranges over topics such as the goals of medicine, genetic enhancement, euthanasia, and health care economics, to mention just a few. It also includes wonderful personal anecdotes. Perhaps Callahan’s greatest contribution to the field has been his unrivaled ability to predict the important issues of the future. A mentor to generations of bioethicists, Callahan’s intellectual and moral integrity are clearly evident in this book. He wrestles with himself as much as he wrestles with others and regards civility and respect for others in intellectual debates to be as important as the ideas themselves.
Review of Metaphysics 67 (2) December 2013: 425-427.

[Ricardo Moreno Mauro · Rating 3 out of 5]

En este libro Daniel Callahan, cuenta su vida, como llegó a fundar el primer Instituto de Bioetica a nivel mundial, y como se vió involucrado en diversos temas, que hasta ahora resultan controvrsiales. Es interesante su vida, y como el ve le futuro de esta disciplina.