Bioethics: All that Matters

The title of this book implies that it will provide an introduction to "all that matters" in bioethics, but anyone who buys it believing that it offers an overview of the modern discipline will be disappointed. If, however, you are interested in exploitation, especially the exploitation of women in the area of health, this is the text for you.

Bioethics scholar Donna Dickenson has for many years ploughed a particularly rich furrow exploring how patients and research subjects are exploited and coerced in modern healthcare, and how this exploitation in general affects women more than men. The book provides an accessible and readable introduction to these issues and to Dickenson's particular take on them.

The text, part of Hodder's new series of concise works on topical issues, covers a wide range of exploitation issues in research and science, and considers reproductive, stem-cell and global ethics. The general approach throughout is to introduce a suitably juicy real-life example of exploitative practice; to show that the claims relating to the benefits of this practice are overblown and/or unsubstantiated; and then to show that it mainly disadvantages or exploits women.

It is the claim of the differential effect on women that is particularly Dickensonian. Many feminists have of course pointed out that women are relatively powerless in patriarchal society and that this makes them vulnerable to exploitation; but Dickenson pursues a different argumentative strategy. Based on a robust Lockean account of the relation between labour and property, she claims that women's labours, especially in the field of reproduction and related areas (eg, stem-cell research), are systematically devalued. This means that women are not properly rewarded for their labour and that others illegitimately appropriate property that really belongs to them. If, for instance, we analyse commercial surrogacy, especially as it is practised in India, we will see that the surrogates take all the risks and provide all the reproductive labour. However, the fruits of that labour are appropriated by doctors and the couples commissioning the surrogacies, without recognition of the magnitude of the labour provided by the surrogates - and without suitable recompense.

Like most of the interesting work in bioethics, Dickenson's research has always been controversial and this book is no exception. The most general criticism of her analysis is that it does not explicitly follow the argument all the way through, and if it did, the conclusions would be counterintuitive and bordering on a reductio ad absurdum of the argument itself.

A further problem that recurs in several places is an elision between legal and ethical rights, where legal pronouncements concerning property rights in particular are stated as settling ethical issues. A particular problematic use of this argumentative strategy is in a discussion of cord-blood banking, where it is claimed that what is stored is "the mother's blood", referring to legal advice received by the Royal College of Obstetrics and Gynaecology relating to the ownership of the cord blood (in England and Wales). But this is highly misleading: biologically the blood is the blood of the newborn, and even if it weren't, no ethical question would be settled by a purely legal allocation of ownership under English law. Nevertheless, this is a timely and provocative read that will challenge the reader to produce his (or more likely her) own counterarguments.