University
of Nebraska Press
Shofar
- Books Received
Shofar
- Advertising &
Mailing List Info
Shofar
- Book Reviews |
A Life (Un)Worthy of Living: Reproductive Genetics in Israel and Germany, by Yael Hashiloni-Dolev. Series: International Library of Ethics, Law and the New Medicine, Vol. 34. Dordrecht, the Netherlands, Springer, 2007. 195 pp. € 94.95.
This is a very interesting and useful book. It exemplifies how two modern societies, Israel and Germany, employ scientific, legal, and ethical reasoning differently. Beyond the specific findings relevant to both countries, namely that Israeli geneticists are shown to be extremely enthusiastic about the personal and social uses of reproductive genetics while their German colleagues are found to be extremely cautious, its contribution lies in the more general argument that acceptance and application of modern technology are not automatic but preconditioned by national, cultural, historical, religious, and moral forces and the interaction between them. The author shows how the research findings are explained not only by the German history of the Holocaust with its feelings of guilt and shame but also more generally by German attitudes towards science and progress and towards children and fertility, Catholic influences, and Kantian philosophy. Likewise, she explains the selectivity characteristic of Israeli society by means other than collective body ideals and anti-disability sentiments, specifically by addressing the more immediate meanings of the practices of reproductive genetics in Israel.
The book covers a whole range of issues. It starts with a discussion of the area of reproductive genetics in Israel and Germany and highlights the ways in which actors involved in this area shape a different perspective to the value of life which is worthy/unworthy of living. The author explores how genetic counselors’ practices resonate with their cultural and religious contexts, thereby challenging the philosophy behind and our understanding of the psycho-social and cultural dimensions of that profession. Next, the book compares the different practices and laws of selective and late abortions (however, some of the discussion of abortion law in Israel, such as on pages 86, 90, 101, is outdated, as new regulations on late abortions were issued on 19 December 2007) and the treatment of wrongful life and wrongful birth lawsuits in both societies. It demonstrates that late selective abortions are far more common in Israel than in Germany and that Israeli genetic counselors are far more accepting than their German colleagues of the idea that some forms of life may be harmful to their subjects. The book examines the different approaches of counselors in both countries on whether or not abortions can be justified on the grounds of sex chromosome anomalies (leading to future infertility). It additionally focuses on societal concerns, e.g., whether people with disabilities burden or contribute to society, or whether parents should choose to accept children with genetic abnormalities and carry those pregnancies to term. Theoretically, the book emanates from and explores the sociological discussions of Foucault, Douglas, Rose and Agamben on the construction of the notion of life (and death) through modern technologies and bodily techniques and its regulation by biopower. More significantly, it adds a unique and novel cultural context to explain the inclusion/exclusion of such a notion in modern societies, thereby critically challenging the separation between the zones of bios and zoe.
Hashiloni-Dolev’s research is based on varied methodological foundations, both quantitative and qualitative analyses as well as textual investigation. The analysis in the book and discussion of its main findings are organized in nine relatively short chapters, although only in a few does the author provide sufficient examples from the empirical work to support her arguments. The book’s focus on attitudes of experts, specifically those of genetic counselors, is noteworthy, although the author did little to review other studies on such a professional group (see p. 66). Moreover, the methodology for such focus may have some substantial limitations. First, only 88/295 questionnaires are from the years 2000–01 while the remaining questionnaires (70%) are from the beginning of the 90s. This is especially disturbing given that the second most effective influence on genetic counselors’ practice is the passing of time (p. 80). Second, the first round of questionnaires were distributed only to MD geneticists, and their number was very small (30). Third, respondents in the second round of questionnaires might also have responded to the first one. Fourth, only 35% of questionnaires distributed in Germany were returned. Fifth, the Israeli sample might suffer from underestimation of counselors’ permissiveness in selectively aborting abnormal fetuses. Sixth, German counselors might seem to be more cautious than they really are given the fact that they were approached by an Israeli. Seventh, interviews in Germany were mostly conducted in one province. Eighth, the Israeli sample focuses on Israeli-Jewish culture and not on Palestinians living in Israel or Palestine. Likewise, the German sample includes only Christian or non-religious interviewees.
Regardless of these limitations, the effect of which may have partly reduced by the combination of different methodologies, comparing the practices of both countries explores some interesting and surprising findings deserving future examination. These findings relate, for example to the non-critical thinking about medical genetics that characterizes Israeli disability activists (in contrast to their German counterparts) (pp. 34, 126–29), and to the explanation that “Israelis’ intolerance towards the disabled follows a Jewish logic which sees no point in suffering” (p. 128).
Yet, throughout the book the author postulates and occasionally also argues some statements without any sufficient treatment or support, resulting in confusion or misunderstanding. Examples of such statements include: “religious Jews and genetic counselors in Israel share the same implicit logic concerning prenatal diagnosis” (p. 48); “in Israel no feminists have argued against prenatal genetic diagnosis or selective abortions” (p. 51); “in Israel the public is generally trustful of science and progress” (in contrast to Germany) (pp. 57, 144); “prenatal genetic diagnosis goes hand-in-hand with abortion to avoid ‘birth defects’” (p. 84); “in Israel the only right the Israeli fetus holds . . . is the right not to be born handicapped” (deriving from controversial case law on wrongful life) (pp. 101, 124); and “the dominant Israeli-Jewish culture does not perceive the technological manipulation of ‘life’ itself as either ‘playing God’ or as threatening to human dignity or rights” (p. 152), etc.
One of the weaknesses of the book is that the author does not take any position on the many issues described, leaving no room for ethical or policy guidelines. This is most disturbing especially since she admits that social agents—the object of her study—employ moral reasoning and build on their “value worlds” (p. 16). Another disadvantage is that the whole project leaves the impression that the author makes sometimes simulated efforts to sharply differentiate the Israeli from the German position, for example in its discussion of the legal treatment of wrongful life and wrongful birth. It is assumed that more similarity exists between both societies.
The book’s index is too short and concise. An elaborated index is recommended for future editions. Overall, the book is written in an eloquent and easy-to-read way, and will be of great interest to advanced readers. Its contribution to the literature on the sociology of health and the study of cultural bioethics is more than evident.
Daniel Sperling
Federmann School of Public Policy
Braun School of Public Health
Hebrew University, Jerusalem
|
