Book Brief: Worst Case Bioethics

George J. Annas
Oxford University Press (June 2011)
ISBN 9780199840717
335 pages
Available at

In Worst Case Bioethics: Death, Disaster, and Public Health, George Annas examines bioethics and ensuing policy through responses to the threat of crisis. In concentrating on bioethics responses towards avoiding or dealing with death and disaster, Annas explores the “radical changes in human rights, public health doctrine, and the application of constitutional law to the practices of medicine.” In the end, he concludes that worst-case scenario planning is often counterproductive to proper crisis preparation, causing us to deviate from human rights standards and our code of bioethics.

Annas explains that fear of death motivates us to plan for worst-case scenarios, which serves to warp emotions and ensuing policymaking. By systematically taking the reader through instances of bioethics and human rights violations, Annas gives a compelling case for why “only plausible scenarios deserve a place in world planning.”

In Part I, entitled Death and Disaster, Annas analyzes the American response to calamity, in regards to topics such as the American health care system, declarations of states of emergency, and views on bioterrorism. He analyzes the actions of American lawyers and physicians, motivated by a worst-case scenario mentality, in situations of duress that led to human rights and bioethics violations. In Part II, Death and the Constitution, Annas cites a number of bioethical controversies that have ended in court rulings, concentrating on cases where physicians had to make decisions regarding death. He backs up his argument that worst-case scenario planning distorts policy discourse and undercuts medical ethics, a core branch of bioethics. Annas then segues to Part III, Disaster and Public Health, extending this mentality over a population and introducing the growing field of health and human rights discourse. He argues that public health concerns are truly transnational and global in nature, but that US public health policy has become increasingly skewed as it moves away from health towards security concerns.

Annas concludes by suggesting an alternative route, a bioethics-minded “national prevention agenda,” which could protect civil rights laws and international human rights agenda while refocusing on the real health concerns at hand. He deftly highlights many of the most controversial cases of bioethics and policy, exposing the major flaws that can occur when a system is shaped by fear.