From the Womb to the Tomb: Issues in Medical Ethics
McLachlan, Hugh V. and Swales, J. Kim
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From the Womb to the Tomb is a collection of 24 essays and previously published articles that cover a wide range of controversial legislative and public morality issues. As the title suggests it is all about "human body politics". Fourteen chapters are the sole work of Dr. McLachlan, Associate of the Centre for Ethics and Public Policy and Corporate Governance at Glasgow Caledonian University. The other 10 are co-written with Professor Swales from the University of Strathclyde (Glasgow) where he is Research Director of the Fraser of Allander Institute.
An introductory Preface by Udo Schuklenk, Co-Editor of Bioethics commends the 30-year contribution to bioethical debate, and perceptively notes that, in their wide ranging contributions, McLachlan and Swales have given 'proof that good academic analysis does not always have to be hidden away from public view in academic journals'. Indeed the collection republishes items from The Scotsman newspaper, Contemporary Review and Scottish Affairs and these indeed hold their own with republished 'academic' articles from Analysis, Health Care Analysis, Human Reproduction and Genetic Ethics, International Journal of Sociology and Social Policy and Journal of Medical Ethics. All in all, it is a very enjoyable read. The authors know how to present careful and cogent argument and write as skilful debaters, keep the interest of their readers. These are excellent, well crafted essays, and together they constitute a welcome contribution to the analysis of the public debate about 'body politics' and its presuppositions. It should also be noted that the enjoyment of this book is enhanced by the publisher's presentation. The typeface, layout and font size makes for a pleasant read.
The book's contents are arranged in six sections: Abortion; Embryology and Human Cloning; Surrogate Motherhood; Altruism and Blood Donation; Health and Health Care - Justice, Rights and Equality; Posthumous Insemination and Consent. To provide some sense of the subtlety of the legal and moral arguments put forward by the authors, I will offer a brief comment on their jointly written final two essays. This will give potential readers a sense of the book's 'flavour'. Chapter 24 'Posthumous Insemination and Consent: A Reply to Mrs Blood' (pp. 264-267) is the reply of the authors to a 2004 article by D. Blood 'To Correct the Record: The Continuing, Troubling, Inaccurate Account of My Case' in Human Reproduction and Genetic Ethics 10:1 pp. 2-4. D Blood's article replied to a 2003 article in that same journal (9:1 pp. 7-12), which is found here as Chapter 23 (pp. 253-263). The authors justify the use of the word 'troubling' by explaining the legal principle that written consent must be given for any removal of sperm from a comatose and dying husband. In their view the legal argument that the dead man's widow be inseminated without his consent comes down to the view that one has a legal or moral right to something one wants purely because one has a profound desire for it. In their comment on the case, this straight forward view is articulated: 'That which one wants, no matter how profoundly does not automatically become something to which one has a legal (or moral) right.' (2003, p. 262). In their further response to Mrs Blood, the principle is reiterated in these words: 'Wanting to do something is not the same as consenting to do so; wanting something to happen is not the same as consenting to its being done ...'(2007, p.266).
The book provides the reader with an interesting window into the 'body politics' debate in Scotland, whether that is the debate about embryo research, surrogacy and cloning or the other health-care issues. McLachlan explicitly professes his Christian faith in 'Human Embryos, Clones and Public Policy: a Critique of the Church of Scotland's Views'. For him the Church's argument against cloning is 'not so much Christianity as a misunderstanding and misapplication of Kantianism' (p. 61). He explains that what is always morally wrong is not the same as what should be made illegal. This is a refrain which recurs throughout the essays - debate about the many and varied issues of "body politics" must rightly distinguish between legality and morality and the authors accept that it is their special public duty as medical ethicists to examine and unravel the various positions that are put forward to justify legislative action whichever way the moral argument may turn. By identifying weaknesses in the moral arguments it becomes possible to pinpoint the way in which important legal issues are glossed over.
It is also interesting to note how the discussion gives due recognition to the importance of 'philosophical anthropology' without going into systematic elaboration of philosophical theories. Scottish philosophy in particular appears in a discussion about the church's appeal to Genesis 1 and Psalm 139 to justify its opposition to embryo research and cloning (p.52). Here, McLachlan refers in a footnote to the 'brilliant, succinct and fascinating account' of Scottish philosophy by Alexander Broadie's Why Scottish Philosophy Matters (2000). Broadie explains 'the differences between the philosophies of human action of David Hume and Thomas Reid. It is interesting to note that the views of the [Church's] Study Group seem more in accord with those of Hume, the celebrated atheist and mine are more like those of Thomas Reid, as well as being a better although not a better-known philosopher than Hume was also a Church of Scotland minister' (p.64).
This is not a diversion from the issues raised in this book, but a strong clue to the way in which the authors, via what appears to be a commitment to a specific philosophical anthropology, contribute to the discussion about human embryos and cloning (Chapters 5&6) and surrogacy (Chapters 9-14 and especially Chapter 11 'Scotland, the Church and Surrogate Motherhood'). In these discussions the human body in its development from conception is explicitly and decidedly distinguished from the human person. It would be worthwhile to examine their moral and legal arguments further in a careful and methodical manner to ascertain how Reid's 'Common Sense Realist' anthropology (involving a dichotomy with two distinct substances - soul and body) is alive and well in this important Scottish contribution to the global debate, and the analysis of this debate, about 'body politics'.
Bruce C Wearne
Point Lonsdale, Australia