He applied the “Page 99 Test” to his new book, Thieves of Virtue: When Bioethics Stole Medicine, and reported the following:
From Page 99:Learn more about the book and author at Tom Koch's website.The metaphor [of lifeboat ethics] pretends to choice in that least democratic of environments.... The stark fact is that no good choices exist and some must die if any are to be saved. By the time lifeboat ethics is engaged all good solutions are gone. The 'moral philosophy' that the ethics was to engage was empty from the start of anything that might bear on the human condition, 'human flourishing,' or even simple justice (p. 99).Thieves of Virtue is about bioethics, a "demi-discipline" begun in the 1960's by medical amateurs skilled in moral philosophy who insisted they had the philosophical chops to provide ethical answers to issues of medical practice, research, and health delivery. Bioethicists argued from the start for the application (some would say imposition) of the "philosophical method," and its grounding values, as an antidote to the complexity of new medical sciences and the “paternalism” of traditional medical practice.
In fact, the book argues, the new ethic spoke not to complex social issues, or to medicine. Its purpose from the start was to be a cheerleader and supporter of a slew of neoliberal agendas, Reaganomics in particular. As "guests in the house of medicine," as one bioethicist put it in another quote, from the start bioethics was about money and power.
First and foremost, bioethics is about the lifeboat ethics. Page 99 describes the infamous drowning of passengers rescued to an overloaded longboat only to be later drowned by a crew who said, “some must die if any are to survive.”
The book argues first bioethics is about lifeboat ethics and second, it is insupportable. And if lifeboat ethics sinks then bioethics drowns with it. There are other, better ways to look at issues of medical care, delivery, and research.
“With equal facility the metaphor of the lifeboat might be transposed from a story of irremediable scarcity into a cautionary tale about what happens when profits are put ahead of lives.” In other words, change the story, change the thinking and we can change the ethic and its practice.
The necessity for that change, the failure of the philosophy and resulting ethics of the bioethics we have, is the book’s heart and soul and intent.
The real secret of lifeboat ethics is that scarcity is...unnatural. When it is not a short-term phenomenon it is almost always the result of choices we make that result in too few seats in the lifeboat, whatever the lifeboat-of-the-day may be. It is thus a choice and a conclusion and not a necessity unless we make it so.