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Tom Koch Thieves of Virtue: When Bioethics Stole Medicine, Cambridge, MA, MIT Press, 2012, 323 pages. $29.95, £ 20.95, hardcover, ISBN: 978-0-262-01798-5.

This is an important book. Tom Koch provides a critical and historically contextualized account of how the contemporary discipline of bioethics evolved in response to the demand for philosophical guidance for physicians and researchers. He both identifies inconsistencies in the interpretation of the philosophical roots of bioethics and critically deconstructs the “myths of origin” that have shaped this evolution.

Koch contributes a compelling analysis of the internal and external forces defining the contemporary field of bioethics. He traces the movement away from the duty of care emphasized by the Hippocratic Oath and points to the trend to embrace neoliberal  interpretations emphasizing  triumphant life-saving, life-prolonging  technology in shaping  the contemporary role of bioethics. Koch provides an innovative exploration of the application by bioethicists of neoliberal economics in juxtaposing the principle of individual sovereignty with a parallel emphasis on resource scarcity that emphasizes the expanding care needs of an aging population. He explores bioethicists’ assertion of the limitations of the state's capacity to provide expanding care resources as they re-enforced their claim to provide theoretical guidance for the allocation of resources at an individual and collective level. In his exploration of “Supply-Side Ethics” Koch describes how medical practitioners in the United States selectively re-interpreted the Kantian tradition in moral philosophy to provide guidance on how to ethically allocate “scarce” resources for the expanding renal dialysis, organ transplantation, and mechanical ventilation.

Thieves of Virtue: When Bioethics Stole Medicine is not simply another book about bioethics. It provides the basis for interpreting the evolution and current role of bioethics that equals the transformative impact of social scientists’ critique of biomedicine over the past three decades. Initially, sociologists working within the field of medicine attempted to pragmatically solve medically defined problems. This contribution was superseded by the transformative contributions of the “sociology of medicine”, which applied critical theory and empirical research to improve theoretical, historical and political understandings of the structural factors that impact health and health care systems. Koch provides a historically grounded critique that parallels the contribution of the “sociology of medicine”. In so doing, it provides the groundwork for the future development of an “ethics of bioethics” and brings a critical understanding of the dynamics of power and structural determinants of the contemporary field of bioethics.

As a bioethicist himself, as well as a gerontologist and geographer, Koch brings both “insider” and “outsider” interpretations to explain how and when bioethics redefined virtue ethics in medicine. As an “insider”, he critiques the standard history and assumptions of this “demi-discipline”. As an  “outsider” whose work transcends conventional disciplinary boundaries, he provides a vision of a transformative  redefinition of the field that re-engages the roots of bioethics in broader humanist traditions of caring and social  justice. He effectively draws on his own extensive research and  major body of published work in engaging scarcity and justice in “lifeboat ethics” and the legacy of eugenics impacting ethical decisions about the quality of life and distribution of scarce resources that impact individuals living with disability.

The book is written in clear language accessible to the layperson and student, as well as to the professional and philosopher. It is well-illustrated with historical and contextual figures. Several chapters integrate areas of Koch’s previous work into a broader narrative account of the formation, fall from virtue, and potential reformation of bioethics.