The following appeared in Volume 98, Number 1 (Fall, 1998) of the APA Newsletters

Arthur Caplan—with assiduous effort, unflagging energy, encyclopedic knowledge, and imposing talent—has become America’s most visible commentator on bioethics. Caplan, director of the Center for Bioethics at the University of Pennsylvania, has voraciously pursued nearly every ethically interesting issue in health care with eagerness to address such issues publicly as they arise. His views are widely sought for their insight and, especially by the news media, because he is always ready with a catchy quip of the sort they love. His penchant for slang expressions, facile and provocative metaphors, and summary judgments leads his critics to see him more as performer than scholar; his fans, many from academia, see that as envy of his success at reaching large general audiences.

To review these two recent books is essentially to review Arthur Caplan.

Am I My Brothers’ Keeper?, a collection of 19 short essays, covers a wide array of issues in bioethics grouped under five topical headings -- emphasizing the importance of trust "as a vital necessity for Americans faced with the daunting task of navigating our way around the bedside and the boardroom, through situations that determine how we live and how we die."  Due Consideration collects 111 very brief pieces -- most just 1.5 pages -- on an even wider array grouped under eleven headings such as "Abortion and Birth Control", "Genetics", and "Managed Care".

Due Consideration primarily collects newspaper columns; the sources, irritatingly, are not acknowledged. Some of the essays have compelling titles -- for example, "Giving Birth in a Coma", "Defrost a Fetus?", "Why Must I live So Long?", and "Should Smokers Adopt?". Some have compelling arguments. All have compelling subjects. In My Brother’s Keeper, a more scholarly book, the essays bear more ponderous titles: "The Intrusion of Evil: The Use of Data from Unethical Medical Experiments", "Hard Cases Make Bad Law: The Legacy of the Baby Doe Controversy", and "Am I my Brother’s Keeper? Ethics and the Use of Living Donors". Together, these books better represent Caplan’s multifaceted work than either does alone.

Among many adjectives that come to mind as one hears Caplan, sees him quoted (sometimes accurately), or reads these books are eloquent, glib, insightful, careless, wise, erroneous, iconoclastic, humane, funny, unwarranted, persuasive, profound, precipitous, probing, and powerful. Short pieces like this review cannot do justice to complex subjects; these books, like Caplan and like the topics he addresses, are complex indeed. It is impossible to assess 130 essays here, but not impossible to illustrate how they prompt such diverse reactions. Marvelous passages grace these books. Consider: "Kevorkian ... [has] firmly secured his place in history as a dangerous nut." (Due Consideration) Withholding information about emergency contraception in the name of virtue is a sin." (Due Consideration) After lucidly clarifying distinctions too often blurred: "In matters of life and death, words count. Crucial decisions about when to stop treatment and when to try to resuscitate someone hinge on the difference between coma, permanent vegetative state, and brain death." (Due Consideration) And, "Health care ethics must place the virtues requisite for trust at the core of the duties owed to those who require care." (My Brother’s Keeper)

Other passages startle by their hyperbolic excess or lack of polish. Thus, "Congress...believes that the only safe place for an FDA official or an OSHA inspector is the unemployment line." (Due Consideration) And this, which I would not accept from an undergraduate: "Excuse me. Did I hear someone whisper that it really might not be such a bad thing if more people live longer? Duh. Well, hey, don’t be expecting a job as a congressional staffer..." (Due Consideration) Or, regarding data that are unambiguous, "In the end, the data is not ambivalent." (My Brother’s Keeper)

What causes this range of quality (apart from lax editing by the publishers) is that ideas flow from the lightening-fast Caplan in a cascade which goes, with little or no revision, directly to print. He does not invest the care that finely crafted prose requires.

And just as flashes of eloquence are sometimes juxtaposed to lamentable passages, rigorous and persuasive arguments are accompanied by analyses that do not bear scrutiny.

Consider, as illustrative, "Will Dr. Kevorkian Kill Hospice?" (My Brother’s Keeper). Caplan argues that support for physician-assisted suicide threatens the viability of hospices. There is more assertion here than evidence, and much of that assertion is implausible or erroneous. Thus, "When hastening death becomes an option, the trust necessary to make hospice function as a place where death is an unhurried, humane affair is in jeopardy."

Perhaps, but Caplan provides no persuasive case for believing that, and there is ample reason to doubt it. Then, Caplan describes the "...momentous holding by two federal appellate courts that the constitutional protections of liberty, privacy, and equal protection establish the right of competent persons to assistance in suicide and prohibit states from enacting laws to the contrary..." More careful scholarship would have noted that neither court found what Caplan claims they both did, that the 2nd and 9th circuit court rulings disagreed, and that the impact on hospices could have been quite different had the Supreme Court upheld just one of these fundamentally different opinions. Caplan says later that most Americans "understand that they can be kept comfortable and pain free if they receive even minimally competent medical treatment while dying." (My Brother’s Keeper) Yet fear of pain in terminal illness is a reality for many, medical response to pain often falls far short of the best available practices, there is a growing national movement to improve the medical profession’s response to pain, and this movement, which will enhance palliative care in America, has been stimulated by the advocacy of physician-assisted suicide. And so on. The thesis of this essay is not convincingly supported, its many astute and humane passages notwithstanding.

Despite this example, Am I My Brother’s Keeper? provides more probing inquiry, sustained rigorous argument, and persuasive reflection than Due Consideration -- the title of which ironically suggests that the book provides due consideration, when it does not. A more charitable interpretation takes that title as exhortative, affirming that its many important topics are due consideration. They are, and the essays, understood as provocative rather than authoritative, can effectively and intriguingly prompt it.

Caplan characterizes the best bioethics as forward looking, considering "not only the latest developments but those that are coming just down the road." (Due Consideration) Yet much is gained by thoughtfully reconsidering what we have done and might have done, as some of Caplan’s best essays show. And Caplan claims that most ethicists "seem to be wearing a permanent frown" as they contemplate "innovations in biomedicine" (Due Consideration), although he does his own full share of frowning. But he frowns about, and then illuminates, matters that concern us all. Each of these books is a good read about the frontiers and some of the important recent history of modern health care and health policy. One wishes often that there were morecareful analysis and writing, but taken as a catalyst for further—and in many cases deeper—consideration, they reward their readers well.

This review first appeared in The Philadelphia Inquirer Book Review, March 29, 1998.