Friday, August 16, 2013

Book Review: Thieves of Virtue: When BIoethics Stole Medicine by Tom Koch.

Book Review: Thieves of Virtue: When Bioethics Stole Medicine, by Tom Koch, The MIT Press, Cambridge Massachusetts, 2012, [Dewey Number: 174.2 KOC], Hardcover, 257 pp.

This was a difficult review to write, not because of the topic of bioethics, nor because of the potential emotional impact of the subject, but because this book is hard to categorize.  Is it history, ethics, anthropology or philosophy?  It is in fact all this, because Tom Koch, a gerontologist and ethicist, is so far-ranging over this topic at hand.

His  basic thesis is simple: the promises of professional ethicists have not come true.  The reason is also simple: ethicists convinced us that traditional ethics of care first for patients has been hijacked in the favour of money and research.  This is a theme to which Koch returns time and again in his book.

For anyone interested in ethics, medical care, life issues or the patient experience in a theoretical perspective, this is a good book.  It helps that Koch is Canadian, because he has a Canadian awareness that is sometimes lacking in books of this type.  Koch takes us through a potted philosophy course, highlighting Kant and Mill, showing how these philosophers were misinterpreted to suit the ideology of ethicists in favour of research and money.

A criticism of this book is that I think it comes across as unsure of its audience in tone: technical words and jargon are used, but there are also times when it is clearly written.  It is somewhat unevenly edited, but this does not lessen the impact of what Koch is discussing.

Koch writes of the ethical myth that paternalistic medicine was an evil to be slain and discarded, and that the new ethics would be better.  He then goes on to provide concrete examples of why this is not so:  in one point he writes,

“The major distinctions along the continuum of personhood are nonperson, preperson, person and postperson, with many gradations in between.  Nonpersonal human life forms are those that do not possess the potentiality for personhood.” [p. 159]

He is quoting another writer, but that is a good a summation of how ethicists and more than a few people see the concept of humanity now, in the 21st Century.  In chapter seven, Koch analyzes a debate between McBride Johnson and Peter Singer, showing how the two people kept talking past each other.  For his part, Koch sides with McBride Johnson in her assertion that disability was not a reason for destruction.

Koch’s position is that ethics and medicine has been hijacked.  He does make some recommendations in the last part of his book: I would recommend the 10th chapter as an excellent summation of his position.  His other thesis is that Hippocratic medicine was not as bad as we were led to believe, but this was discarded for economic and ideological reasons.

I recommend this book:  it is well written and footnoted.  In addition, it is clear in its assertions and you are aware of how Koch is creating his arguments.  In fact, a few issues arose that I was already thinking of when I was in university (20 years ago now!)  My only complaint is that there are parts where Koch has apparently made spelling errors: I personally find them distracting as I read, but this can certainly be corrected in later printings.

Koch’s book Thieves of Virtue is a good antidote to the rhetoric of right to die societies; it is also a refreshing change to the ideological merchants of death and futility.  This is a must-read for anyone who wishes to understand Quebec’s position on Bill 52 and where that came from.  I highly recommend anyone read this who wants a good overview of the social context of the issues of life ethics.  Koch’s position is that life, in all its messiness, is worth that messiness and we should not allow ourselves to be driven to despair over what we are hearing.  That meshes with my personal position, and it was nice to know I was not alone in my thought.


  1. The field of Bio-ethics has grown since the 1991 Patient Self Determination Act was passed in the USA. The debate on life and death and ethics has been a lucrative exercise tor this new discipline that employs so many professionals.

    As a lay person on Medicare, I am amazed that the bio-ethicists have NEVER confronted the problem of fiscal futility for the hospitals when Medicare and the private insurers fail to reimburse for over treatment of the elderly, mistakes, errors and the complications thereof.

    Surely! they aren't naïve and must know that both over treatment and, then, under treatment of the elderly/disabled in a reality in US Hospitals.

    Certainly Medical Futility and Fiscal Futility are often a part of the same package.

    Are the bioethicists naïve or do they just support the for-profit structure of our health care system in their best interests the ethics of

  2. Carol, thank you for those comments: you certainly raise an excellent point about fiscal futility. Thank you for reading my blog, and I hope you are well...
    And bioethics is a new 'profession' - one that is still trying to find its 'way'...

  3. Thank you for your comment...I appreciate it!


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