Aletheia in Ethosland

Author: Andreea-Iulia Someșan
Originally published in: Studia Universitatis Babeș-Bolyai Bioethica, vol. 59, nos. 1-2, 2014, pp. 123-126
Section: Reviews – Book Reviews
Original language: Romanian
Note: The review published in the journal was written in Romanian. The present text is an English translation prepared for the English section of the personal blog Aletheia in Ethosland.

Overall, as its subtitle suggests, the book attempts to provide a monograph on the “historical roots of the contemporary environmental crisis” (p. 9). Thus, these pages examine how, in an environment lacking the mechanisms necessary to ensure safety, the Industrial Revolution became the source of numerous abuses with profound implications for human health and environmental security. The Industrial Revolution is therefore portrayed as initiating a long process through which new technologies and innovations were made acceptable to the population. To achieve this objective, they tried to present their introduction in the most favourable terms possible.

A major issue was therefore the establishment of a framework for the use of the products of industrialisation, whose main principle would be precaution. For this reason, “the crucial question would be that of technological choice, risk assessment, and the evaluation of the procedures (democratic and transparent) that must be established to guide this choice and these assessments” (p. 19).

The book analyses the issue of technological risk gradually throughout its six chapters. The discussion begins with the introduction of the notion of risk in the 1720s in relation to inoculation, when risk was understood, in this context, as the application of probability theory to life. With the introduction of vaccination, attention shifted to finding a strategy for minimising risk and developing a perspective on risk that would increase vaccination acceptance among the population.

From this point, the discussion moves towards the relationship established between the body and the surrounding environment, addressing topics such as the emergence of the chemical industry before turning, towards the end of the book, to the considerable scale of the risks generated by industrialisation. Here, attention is drawn to issues such as those observed in the case of gas lighting. In this context, establishing legal and procedural norms became indispensable to maintaining “the principle of individual responsibility in a technological society” (p. 22), so accidents could be attributed solely to human error.

However, the book’s relevance to bioethics also derives from its emphasis on the mode of action used in the absence of a legal framework and well-regulated procedural norms. These actions aimed to ensure that technologies directly associated with the preservation of individual health would find as permissive a setting for development and as broad a space for implementation as possible, unrestricted by the refusal of those regarded as their potential beneficiaries. The production of the smallpox vaccine may be considered a good example in this regard. In that context, a philanthropic perspective was invoked to justify the necessity of producing the vaccine. Unfortunately, however, this understanding of philanthropy gave rise to numerous social injustices.

Thus, one of the first objectives of researchers was to demonstrate the safety of the new prophylactic techniques, in stark contrast to inoculation, a highly unsafe method that raised numerous questions concerning the possibility of infection. One consequence was that those promoting vaccination fell into the trap of presenting it as perfectly benign, which became the source of many of the accidents associated with its use. Nevertheless, the policy applied in this context was no longer based on coercion, as in the old regimes, but on indirect mechanisms aimed at subtle persuasion.

In addition to the fact that vaccines were initially presented as entirely free of risk, another problem at that time concerned the very way in which experimental practice was understood. This was therefore a century in which experiments were regarded in a manner almost analogous to dissection: “as long as the bodies subjected to experimentation were already legally dead” (p. 81), experiments could generally be carried out only on persons sentenced to death or on the physicians involved themselves. In the case of vaccination, however, this restriction was overcome by extending experimentation to disadvantaged groups within society on the basis of the anticipated benefits for this social class. For physicians who were continually searching for individuals willing to be vaccinated, foundling children represented indispensable reservoirs for maintaining the chain of vaccination.

Through the intervention of the Minister of the Interior, beginning in 1801, hospices became available for vaccination: researchers could conduct their activities there even in the face of a possible refusal by the prefect. Although, within a properly regulated framework, such a decision might also have produced benefits, the pages of the book describe numerous actions and treatments that failed to take the health of these children into consideration and could even place them at risk because of abusive practices carried out in the absence of a proper legislative context. The perspective adopted by many researchers towards these children was strikingly similar to that applied to a body subjected to dissection: they constituted a field for study and experimentation displayed before the public, with some studies even being conducted in conditions lacking the necessary hygiene. All these actions were carried out in the name of philanthropy. They concerned the procedures used to obtain the vaccine, the appropriate age for vaccination, and measuring the duration and quality of the immunity obtained after these immunisations. Nevertheless, accumulated experience over time, which later caused genuine indignation among physicians, led to the withdrawal of permission, giving researchers easy access to hospices. Yet, holding a philanthropic spirit, it was not halted by the introduction of regulations. Thus, one proposal made by Dr Duchanoy, a member of the hospice administration, was to introduce into these institutions physicians who were genuinely convinced of the unquestionable benefits of vaccination. This solution was legally acceptable and, according to the book’s author, would have made any experiment conducted in this context lawful.

Another alarming situation presented in the book, with implications for bioethics, concerns workers in chemical factories who worked in genuinely hazardous environments without adequate protective equipment. The case described in the volume occurred in England, but it faithfully reflects the general conditions prevailing in such enterprises during their early development. Thus, workers not only lacked adequate equipment, although some attempted to construct their own means of protection against the harmful effects of these substances, but were also not truly aware of the risks involved in their work, while the actual incidence of accidents was considerably underestimated. In interviews conducted to examine how workers perceived acid splashes, one interviewee spoke about the accident in which he had lost an eye and the frequency of this kind of incident: “No, mine [referring to the acid splash] was an accident that should happen once in a century” (p. 196). Nevertheless, we subsequently learn that another acid splash had occurred in the same factory only two days earlier. As for the causes of these accidents, even the workers themselves attributed them to negligence and to the haste with which they attempted to complete their work. They consequently assumed full responsibility for the accidents that occurred, perhaps also because they lacked objective, statistically grounded knowledge of the existing risks. Moreover, they reassured themselves with the belief that, although the evidence indicated otherwise, accidents occurred only extremely rarely. Over time, industrial hygiene was nevertheless introduced, while worker rotation and selection on the basis of medical examinations were also regulated. Naturally, in this new situation, the risks faced by workers were considerably reduced. However, one cannot speak of the disappearance of mortality resulting from occupational illness. Rather, as the book emphasises, it became much harder to trace because medical examinations and worker rotation allowed factories to retain only those individuals who were genuinely fit for this type of work and whose health had not yet deteriorated. In many cases, however, their health worsened, and death frequently occurred only some time after they had left the workplace. Consequently, records of these cases, as well as compensation for the workers or their relatives, remained extremely inadequate.

Another problem arising from the lack of a genuine understanding of the pathology of occupational diseases resulted from the introduction of the concept of “acclimatisation”, according to which these symptoms were regarded merely as “temporary pathologies resulting from the process of acclimatisation” (p. 199). The aspects outlined above show that these workers were uninformed or, in some situations, perhaps even misinformed about the risks to their health, the environment in which they worked, and their actual state of health. It should also be emphasised that, at that time, the legislative and scientific conditions were such that the necessity of improving these workers’ conditions through the introduction of specific protective equipment and regulations was not yet fully recognised.

These two cases may provide a brief picture of the early period of industrialisation and of the ethical problems in medicine to which it gave rise. Reading this volume, however, offers a clearer understanding of the context in which many early experiments associated with industrialisation were conducted, as well as the reasons behind many failures and the high incidence of harmful consequences. As the first two chapters of the book show, the initial steps in the development of modern medicine were taken within a similar context. Conducted during a period characterised by a legislative, normative, and scientific vacuum, many of these studies, although some were motivated by philanthropic intentions, failed to achieve their proposed goals and instead became a source of risk for those they were meant to benefit. This picture may therefore be understood in two ways. First, it may, of course, be regarded strictly as a monograph on the turbulent past of industrial development. At the same time, however, it may also be viewed as an action–outcome model for medical studies conducted in innovative fields that are not yet adequately regulated by legislation and whose implications for human health remain insufficiently understood. Thus, the cases presented in this volume and the issues they raise may provide a better understanding, through the examination of past failures, of why a degree of prudence is necessary in the conduct of such studies, as well as why a legislative framework is required that protects all social groups equally and genuinely makes the individuals concerned aware of the possible implications of these procedures and treatments for their health.

ANDREEA-IULIA SOMEȘAN

APA Reference

Someșan, A.-I. (2014). Jean-Batiste Fressoz, L’apocalypse joyeuse – Une histoire du risque technologique, Éditions du Seuil (L’univers historique), 2012 [Book review]. Studia Universitatis Babeș-Bolyai Bioethica, 59(1-2), 123-126.