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Against Bioethics (Basic Bioethics)

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Having worked on the Ethics Committee of the Hospital of the University of Pennsylvania, Jonathan Baron became concerned that bioethicists were neglecting decision analysis. He writes, "In practice, bioethical advice tends to be based on tradition and intuitive judgments. Often its advice is reasonable and leads to good outcomes." But in other cases, judgments `override considerations of consequences'. So he asks, "If the consequences of a decision are expected to be worse - as in the case of testing a therapy on healthy adults instead of babies who had nothing to lose - where do bioethicists get the authority to cause harm?"

He advocates that decision-makers adopt the utilitarian approach to problems, judging decisions in terms of their consequences. Decision analysis is, he contends, very close to applied utilitarianism: both hold that the best option is the one that does the most expected good.

In this book, he presents an outline of what applied bioethics might look like if it took utilitarian decision analysis more seriously. In subsequent chapters he applies this approach to matters of end-of-life, the value of life, coercion and consent, conflicts of interest, drug research and allocation of health resources.

Baron opposes relying on the intuitive appeal to bioethical principles. "These include naturalism, bias towards harms of omission as opposed to those of action, confusion of coercion with predictability of choice, elevation of rules of thumb to absolutes (such as the necessity of consent or equality in allocation), and confusions about quantitative issues in allocation."

For example, some assert that `going against Nature' is wrong, as an argument to dismiss cloning, genetically modified foods and genetic modification of people. But such dogmas are far too sweeping: they would dismiss every invention. Similarly, the European Union's `precautionary principle', whereby new technologies are not adopted unless they are proven to be risk-free, stifles innovation. He urges us to weigh expected risks against expected benefits.

In all, Baron makes a persuasive case for making utilitarian decision analysis the basis for our judgments about health matters.