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The Left Atrium
A few false notes
The ethical canary: science, society and the human spirit
Long before the term was coined, miners used a kind of "bioassay" approach to monitor threats to their lives. Sensitive to plummeting oxygen levels, canaries kept in the mines would cease their singing, and often die, signalling to underground workers that it was time to save themselves by retreating. In The Ethical Canary: Science, Society and the Human Spirit, Margaret Somerville explores the ethical hazards born of the science, technology, practice and policy of postmodern health care. Her accounts are lucid, engaging and persuasive — sometimes dangerously so.
If the aim of this text is to educate, its framework for bioethical analysis is seriously flawed; if the aim is to provoke, we must applaud its success. Where one expects a complex opus, the counterpoint is not even hummed; rather, its existence is unstated or ignored. This is my principal complaint with this important work: arguments are presented as rigorous where, in fact, fundamental aspects of the score are absent. The book proceeds to examine myriad domains of ethical debate, each of them headline grabbers. Chapters are devoted to the explication and analysis of far-ranging topics, including assisted human reproduction, euthanasia and male circumcision. Each of these is cogently penned, yet there is unevenness between and within accounts.
In writing on the ethics of human reproduction, Somerville makes the important point that children born as a result of new reproductive technologies ought to placed at the centre of our deliberations about those technologies. A great deal of the analysis is devoted to her reservations about assisting same-sex and single parents to have children. Although Somerville stresses that she does not wish to reinforce negative stereotypes of these groups (as if they were monolithic!), she repeats her concern that to use reproductive technologies to help these people is problematic. This is on the grounds that the resulting children may not have both a female mother and a male father to parent them; that there is "evidence" of failure in parenting male children by single mothers; and that, although it would be wrong to prohibit such people from establishing families without the aid of technological assistance, we need to be wary of the values our policies support. Given our uncertainty about what constitutes good, let alone the best, families, I would have been more interested in Somerville's analysis, from her child-centred perspective, of the impact of what seems to be the inevitable commercialization and commodification of bringing children into the world.
In a chapter dedicated to the euthanasia debate, much attention is given to the problem that failure to provide adequate pain control contributes to the desire of some terminally ill people to end their lives. This is a documented problem that merits attention; shocking examples of failure to provide palliative medication to dying patients are contained in this chapter. Unfortunately, the author takes a narrow view of pain, one that is preoccupied with its physical or nociceptive dimensions. Although Somerville cites Balfour Mount, his compelling work on the concept of "total pain," which includes physical, psychosocial and existential suffering at the end of life, is ignored. An exploration of this concept and its implications for ethical care at the end of life would have strengthened Somerville's position against the voluntary euthanasia of competent patients. It would also have demanded that she address the suffering of terminally ill patients that is not ameliorated by narcotics.
By contrast, a chapter devoted to the very controversial issues around routine male circumcision is more balanced, and clearly articulates the ethical problems in rationalizing the alteration of little boys' genitals for nonmedical reasons. This is a subject to which Professor Somerville has dedicated a great deal of research and reflection, and concerning which she has endured much rebuttal. Interestingly, the balance lies in her conclusion that the issues are complex and nuanced, and that sweeping prohibitions against the practice as it relates to deeply held religious belief and to ethnic traditions are problematic. Had the same level of rigour been applied to other chapters, we might have gleaned a very important lesson from this work: that dogmatic approaches to complex ethics are very difficult "where the rubber meets the road."
This is a book to be read, but not uncritically. The text provides important stories reflecting some of the rich landscape of our ethical challenges. The subtext provides stories at least as important for our reflection.
Michelle A. Mullen Lifeworks Missing persons My grandfather discovered that he was going to die while sitting across a desk from his doctor. Apparently the doctor reviewed the test results, looked up, and said, "You have lung cancer. You're going to die." At least that's how my grandmother remembers it. My 77-year-old grandfather spent the winter cross-country skiing and the spring playing golf. Six months after the doctor's pronouncement, he was dead.
I knew the influence my grandfather had on my life; what I wasn't prepared for was the effect of his absence. As I looked at Robertson's Sofa that absence was recalled to me. This piece is as much about what isn't there, as about what is. A large-scale pencil drawing of a couch shrouded in a white sheet, Sofa is true to its realist style right down to the Ken Danby-like detail in the parquet flooring. It could easily be mistaken for a photograph. Yet a closer look reveals scratches and folds in the paper. These conscious imperfections remind the viewer that this picture is a painstakingly rendered construction. The result is strangely dramatic and understated. The viewer is left to draw from personal experience and insert an absent body onto the couch and into the drawing. Les Levine's series of untitled photo-based aquatints on paper is equally vigil-like, but laments the missing body more overtly than Sofa. Each of the eight images contains a circle of candles; inside each circle is a different piece of clothing: eyeglasses, a bandana, sweater, jacket, T-shirt, a man's underwear, socks and shoes. Reaching the end of the series, the viewer is almost able to construct an image of this person on the basis of his clothing selection, and consequently to postulate ethnicity, character and social status. Again, the actual individual is missing. Except here the substitute is someone imagined rather than known. Before the experience of this exhibition becomes too morose, the curator includes several works over 20 years old that reflect the decades they were created in. Jasper Johns' The Critic Sees (1967) adds a subtle edge of levity to the show. Johns, an American with links to the Pop art movement of the 1970s, has created a primarily white piece of paper with a pair of embossed eyeglasses in the centre. On each eyepiece is a sheet of acetate containing the word "mouth." Trapped Shirt (1977) by Andrew Smith is a white shirt pressed into handmade paper and encased behind glass. The artist calls this process "pulp painting." This piece echoes Levine's preoccupation with clothing (rather than the physical self) as a source of identity.
If Sofa is the opening line of this exhibition, Geneviève Cadieux's work is the exclamation point. Known for her work with large-scale colour photographs of human body parts, Cadieux makes a natural addition to (No) Vacancy with untitled (Dos) (1994), a close-up photograph of a human back. Gender is not clear, but judging by the gray hair the subject is older. What we see is a clinical view of a person's back, complete with imperfections and flaws so different from the airbrushed images we are used to seeing in magazines. What we also see in Cadieux's work is vulnerability, and this is true of the entire exhibition. Any art show concerning the body can't help but include references to the limitations of our physical selves. Mortality is the great unifier, not only because we will all eventually die, but more importantly because we all know someone who has.
Sherri Telenko
Copyright 2001 Canadian Medical Association or its licensors |
Somerville posits two warning signs that she argues must guide ethical deliberation in a postreligious era. A decision or action is "inherently wrong" if it "fails to show respect for life, in particular human life" or if it "puts at serious risk or harms the human spirit." Respect for life and the human spirt defines what Somerville names the "secular-sacred." These values are indisputably important, but Somerville develops her argument in a way that reduces any position that does not accommodate instrinsic values to a form of ethical relativism (whereby ethical values are seen as merely culturally and historically situated phenomena). This sleight of hand diminishes the depth and nuance of a centuries-old discourse between deontologists and utilitarians. From this perspective, the question of whether something "does any good" is discounted by a concern with whether it is "inherently wrong" rather than balanced by the question, "What or whom does it harm?"
