Bizarre Bioethics: Ghosts, Monsters, and Pilgrims By Henk A.M.J. ten Have, Baltimore: Johns Hopkins University Press, 2022. $34.95. ISBN: 9781421443034

Henk A.M.J. ten Have's Bizarre Bioethics presents itself as an extended criticism of the way focus on exceptional (or “bizarre”) cases distorts bioethics. The discussion of this, however, occupies only a small part of the overall book. Bizarre Bioethics is more accurately viewed as a sweeping indictment of what ten Have sees as the failure of bioethics to grapple with the discontents of modernity as these manifest in contemporary biomedical research and health care. It does not advance much novel argument, instead presenting an overall view by assembling a set of ideas and points that ten Have finds compelling. It is argument by collage—in this case, a collage of ideas that ten Have has pursued over the course of his career in a large set of books and other publications. Bizarre Bioethics covers a wide range of topics, from medical tourism to biobanks to the replication crisis in biomedical research, but ultimately its purpose is polemic: for ten Have, bioethics has failed to offer an alternative to the -isms (neoliberalism, capitalism, scientism) that collectively, as he puts it in the concluding chapter, create “The environment of injustice and inequality [which] frequently denies the fruits of science and medicine to many people” (p. 210). There are two big themes that form a common thread and connect the seemingly unconnected subjects discussed in the book. The first is the alleged acceptance by bioethics of the larger social, economic, and cultural context in which contemporary medicine operates, which ten Have calls “neoliberalism” and “scientism” and which sets, as he puts it in a later chapter, the “moral vocabulary dominating current bioethics debate” (p. 190). A tired example of this, which ten Have rehearses in the book's “Relics” chapter (Ch. 7), is the prevalence of property language in discussion of biobanks and human biological materials. A more interesting and subtle discussion comes in the “Pilgrims” chapter (Ch. 5), where ten Have considers medical tourism and claims that a kind of uncritical acceptance of globalization, “neoliberal” conceptions of choice, and a framing of patients as consumers is behind a failure of bioethics to properly come to terms with medical tourism as a phenomenon. The second major theme is about imagination, and the way that metaphors and narratives structure our thinking about and interactions with medicine. The book is divided into chapters exploring different metaphors (“ghosts”, “monsters”, “pilgrims”, “prophets”, and “relics”) that ten Have finds salient for investigating different parts of the subject matter of bioethics. Each of the chapters brings together seemingly disconnected subject matter via its central metaphor. For example, in the “Ghosts” chapter (Ch. 3), he attempts a unified discussion of research misconduct, overmedicalization and “disease mongering”, counterfeiting of medicines, and the use of placebo by casting these as contemporary “ghost phenomena”. Sometimes this is a bit strained (the “Ghosts” chapter, e.g.), sometimes this works very well – in particular, the use of the idea of a “relic” to discuss biobanks and human biological materials, and the discussion of medical tourism as a kind of “pilgrimage” are particularly interesting. The use of these metaphors for bringing disparate subject matter together is not just a narrative device. For ten Have, the role of the imagination in structuring how we think and experience medicine points to a liberatory possibility for bioethics, and the failure to take up this possibility underlies his polemic. The book sees the field as trapped within a set of methodological ground rules and philosophical presuppositions that obscure the ultimate origin of ethical issues in medicine. The way out of this mess is in the exercise of “moral imagination”. In the book's final chapter, ten Have approvingly quotes Bruce Jennings' and Angus Dawson's definition of this as “…‘the capacity to take a critical distance from the given, to think reality otherwise’” (p. 214).1 It is the failure to exercise this capacity and instead to take the world and medicine as it is that ten Have excoriates throughout the book. This, he claims, needs to change: “Critiques of the dominant scientific and economic worldviews that have moved out of mainstream bioethics should move back in” (p. 214). Though the book has some rich discussion, it also has several flaws. Even though it contains exhaustive and thorough citations, Bizarre Bioethics will never be mistaken for a careful treatment of the literature. There is a frequent resort to hyperbolic statements: for example, “In fact, bioethics has rarely said no to new technologies and medical interventions” (p. 27). Anyone familiar with the debates about and the voluminous critical literature on cloning, gene editing, enhancement, synthetic biology, xenotransplantation, brain-computer interface, and AI in health care would find that claim puzzling, to say the least. The book frequently uses locutions like “bioethical debate” or “mainstream bioethics” (whatever that could mean) to give the impression there is something like consensus out there about the topics covered in the book, eliding the enormous dissension and debate that constitutes the literature on these topics. Anyone who has been to a recent ASBH meeting can tell you that characterizations of “mainstream bioethics” are hard to come by and always will be riven with exceptions. The ultimate interest of the book, however, is not in any rigor of argument or analysis, but rather in the overall vision. Bizarre Bioethics brings numerous strands from the long tradition of skepticism about modernity to bear on contemporary issues in bioethics and links debate about these issues with this tradition. For ten Have debates about issues such as consent for banking tissue or genetic information are ultimately about the metaphysics of the person, and reducing the ethical issues here to troubles about consent involves accepting the reductionist, mechanist metaphysics that takes persons to be “complexes of basic components with causal relations between these components” (p. 190), with our bodies as “components” instead of “the material vehicle of personhood” (p. 191).2 These ideas have a venerable history. Much of what ten Have presents in the book has roots in romanticism—for example, Goethe's organicism and rejection of mechanistic reductionism, Mary Shelley's criticism of scientific hubris and its potential to dehumanize (including in regard to treatment of the “corporeal relics” of the deceased) in Frankenstein, and Wordsworth's polemics against creeping industrialization and urbanization and their detrimental effects on the natural world all have echoes in different parts of Bizarre Bioethics. In its emphasis on the moral centrality of imagination, its argument that contemporary bioethics neglects the interconnections between humans and nature that underlie health and flourishing, and its aspirations for liberating persons from dehumanization at the hands of technology and instrumentalist conceptions of practical reason, Bizarre Bioethics can be considered a kind of romantic bioethics treatise. Whether the polemic is ultimately convincing will likely depend on whether the reader has already accepted the broad contours of ten Have's views about “neoliberalism” and “scientism”. Convincing or not, the idea that bioethics needs to make room for an exploration of the deeper metaphysical and political structure of medicine and its place in contemporary life is compelling, as is the idea that the field can sometimes suffer from a lack of imagination (moral or otherwise) in how it conceives its subject matter and lays out its problems. If nothing else, Bizarre Bioethics tries to do something that is both welcome and needed—it is an attempt at a systematic treatise that presents an overall view about medicine and its philosophical investigation. Successful or not qua polemic, as an idea of what the subject matter of bioethics should be and an example of a way to treat it systematically and holistically, Bizarre Bioethics is itself an exercise of the imagination that takes a critical distance from the field and thinks it otherwise.3 The author has nothing to report.