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Pain, Pleasure, and the Greater Good

From the Panopticon to the Skinner Box and Beyond

Cathy Gere

Pain, Pleasure, and the Greater Good

Cathy Gere

304 pages | 15 halftones | 6 x 9 | © 2017
Cloth $30.00 ISBN: 9780226501857 Published October 2017
E-book $10.00 to $30.00 About E-books ISBN: 9780226501994 Published October 2017
How should we weigh the costs and benefits of scientific research on humans? Is it right that a small group of people should suffer in order that a larger number can live better, healthier lives? Or is an individual truly sovereign, unable to be plotted as part of such a calculation?
These are questions that have bedeviled scientists, doctors, and ethicists for decades, and in Pain, Pleasure, and the Greater Good, Cathy Gere presents the gripping story of how we have addressed them over time. Today, we are horrified at the idea that a medical experiment could be performed on someone without consent. But, as Gere shows, that represents a relatively recent shift: for more than two centuries, from the birth of utilitarianism in the eighteenth century, the doctrine of the greater good held sway. If a researcher believed his work would benefit humanity, then inflicting pain, or even death, on unwitting or captive subjects was considered ethically acceptable. It was only in the wake of World War II, and the revelations of Nazi medical atrocities, that public and medical opinion began to change, culminating in the National Research Act of 1974, which mandated informed consent. Showing that utilitarianism is based in the idea that humans are motivated only by pain and pleasure, Gere cautions that that greater good thinking is on the upswing again today and that the lesson of history is in imminent danger of being lost.
Rooted in the experiences of real people, and with major consequences for how we think about ourselves and our rights, Pain, Pleasure, and the Greater Good is a dazzling, ambitious history.
Introduction    Diving Into the Wreck
1                      Trial of the Archangels
2                      Epicurus at the Scaffold
3                      Nasty, British, and Short
4                      The Monkey in the Panopticon
5                      In Which We Wonder Who Is Crazy
6                      Epicurus Unchained
Afterword       The Restoration of the Monarchy
Review Quotes
Alex Haslam | Nature
"In this thoroughly gripping science history of utilitarianism, Cathy Gere charts the trajectory of the ethical theory, which hinges on the ‘greatest good for the greatest number’. . . . Gere’s engrossing narrative takes us up to the 1973 hearings on the notorious Tuskegee Syphilis Study. For four decades, the US Public Health Service had observed the progression of the disease in hundreds of impoverished African American men, who were neither told they carried it nor given treatment. Medical claims of greater good were brought crashing down. Yet the study’s ethos resurfaces in behavioural economics, through nudges that, without consent, shape the many in the mould of the few — supposedly ‘saving’ us from some inherent irrationality. Gere rightly emphasizes that we should be wary of ‘noble’ ends justifying any means."
Literary Review
“Gere begins this wise, fascinating and original book in Tuskegee, Alabama, where a large public-health experiment was launched back in 1932…. Gere, who is nothing if not courageous, sets out to show that the furor over the Tuskegee experiment was ‘not a battle between good and evil, but rather a conflict between two conceptions of the good’. She defends her analysis over the next 300 pages or so in a series of masterclasses in the art of untying conceptual knots by means of astute historical analysis.”
Simon J. Schaffer, University of Cambridge
"In this powerful, intelligent, and often disturbing book, Cathy Gere shows clearly how nineteenth-century models of human nature nourished terrifying medical crimes during the twentieth century. The history laid out here shows how the utilitarian tradition set up a stern calculus of maximizing what was imagined as general welfare at the cost of individual citizens' rights and survival, and how that tradition in newer guises underwrote mechanistic and behaviorist images of how humans function. By tracing the telling links between seemingly abstract philosophical and psychological arguments and the violence of large-scale medical trials during and after the Second World War, Gere offers a welcome and remarkably timely warning about the ways in which ethics, psychology, and biomedicine interact. This will be an indispensable guide for all informed citizens to the most current issues in medical testing and welfare policy."
Lorraine Daston, Max Planck Institute for the History of Science, Berlin
"Cathy Gere has written a fundamental book. Her penetrating intellectual history of utilitarianism never loses sight of the real-world consequences of philosophical arguments, scientific theories, and medical policies, from Victorian poor laws to AIDS activism. Gere writes with verve and compassion about how the doctrines of pleasure and pain have become woven into the fabric of our lives, with unpredictable and sometimes dire consequences. This is urgent history, an account of the past that makes us rethink the present."
John Tresch, University of Pennsylvania
"This is a fascinating, beautifully-written history with genuine political and philosophical bite. Like a balanced and cheerful Foucault, or a literary Adam Curtis, Cathy Gere offers us a graphic genealogy of modern ethical reasoning in its benevolence and its blindness. Pleasure, Pain, and the Common Good shows how the upheavals of the 20th century set the stage for the rise of “informed consent”— respect for the autonomous choice and rights of the individual— as the gold standard of medical ethics. But where some have seen autonomy emerging within an ethical void, Gere explores the changing political and scientific stakes of its precursor: the utilitarian philosophy which provided the rationale for over two centuries of British and American medicine, and which connectsHobbes and Bentham to Sunstein’s Nudge and Kahneman’s Thinking Fast and Slow. Despite the victory of informed consent, she shows how utilitarian ethics, “bloodied but unbowed,” remains hardwired into medical policy. Gere grounds this doubled vision in architectures of surveillance and moral improvement, in the electric shocks and marshmallows of legendary experiments. Overflowing with lively characters and scenes, knotty puzzles and surprising laughs, this book is a sure spark for important discussions about how medicine justifies the pain it has provoked and the inequities it perpetuates. A gripping and eloquent, rigorous yet hopeful tour de force— immensely rewarding reading for anyone touched by the moral and political power of modern medicine and science."
"...a very well written and historically informed call for humanism in science and ethics that deserves a wider readership than specialists alone."

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