Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

This book both consummates and demonstrates the basic thrust of Jonas's thought: the inseparability of ethics and metaphysics, the reality of values at the ...

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

The place of philosophical medical ethics in medical education and clinical practice has recently been questioned. Although partially valid, the criticisms do not warrant abandoning the enterprise. Instead a reappraised model, based on Aristotelean concepts of intellectual and moral virtue is suggested.

Lawrence Johnson advocates a major change in our attitude toward the nonhuman world. He argues that nonhuman animals, and ecosystems themselves, are morally significant beings with interests and rights. The author considers recent work in environmental ethics in the introduction and then presents his case with the utmost precision and clarity. Written in an attractive, nontechnical style, the book will be of particular interest to philosophers, environmentalists and ecologists.

An article by Warren Reich in the December 1994 issue of this journal concludes that the word "bioethics" and the field of study it names experienced a "bilocated birth" in 1970/1971 under Van Rensselaer Potter, at the University of Wisconsin, and André Hellegers, at Georgetown University. Further historical inquiry confirms (1) that there were, from the start, some major differences—even clashes—between the Potter and the Hellegers/Georgetown understandings of bioethics; and (2) that the Hellegers/Georgetown approach came to be the more widely (...) accepted meaning of the term, while Potter's idea of bioethics remained largely marginalized. However, this inquiry also results in a third, unanticipated, conclusion: that Hellegers (in contrast to the dominant model offered by the Georgetown scholars) actually proposed a global approach to bioethics, bringing his vision much closer to Potter's evolving view than previously has been acknowledged. (shrink)

Extensive historical sleuthing reveals that the word "bioethics" and the field of study it names experienced, in 1970/1971, a "bilocated birth" in Madison, Wisconsin, and in Washington, D.C. Van Rensselaer Potter, at the University of Wisconsin first coined the term; and André Hellegers, at Georgetown University, at the very least, latched onto the already-existing word "bioethics" and first used it in an institutional way to designate the focused area of inquiry that became an academic field of learning and a movement (...) regarding public policy and the life sciences. A further comparison of the Potter and the Hellegers/Georgetown understandings of bioethics and the relative acceptance of the two views will appear in the March 1995 issue of this journal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Revisiting the Launching of the Kennedy Institute: Re-visioning the Origins of BioethicsWarren Thomas Reich (bio)Twenty-five years ago, on October 1, 1971, at a press conference held at Georgetown University, the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, later called the Kennedy Institute of Ethics, was officially inaugurated. To revisit that event—and the Institute’s five founding collaborators who spoke at it—provides an opportunity to (...) re-vision some of the most significant intellectual, moral, cultural, and political factors that shaped both this Institute and the then-nascent field of bioethics.Eunice Kennedy Shriver, who spoke at the press conference, was intensely committed to a new sort of philanthropy that would effect socio-political change in favor the dignity and well-being of the mentally disadvantaged. As executive vice-president of the Joseph P. Kennedy, Jr. Foundation, she had already applied the Foundation’s vision and resources to the task of harnessing the best of the “biological revolution” of the 1960s to prevent developmental disorders. Prompted by the values at stake in the care of the disadvantaged, she turned the Foundation toward the creation of the Institute in 1971.Just prior to the opening of the Institute, Mrs. Shriver had produced and appeared as introducer in a highly influential film, “Who Shall Survive?”, which dealt with a “mongoloid baby” who was allowed to die in the newborn clinic because of its condition. Showcased at a highly publicized symposium involving 2000 people (Editorial 1971) and widely discussed in the press, the film helped to establish neonatal ethics as paradigmatic for the emerging field of bioethics (Bedeviling Question 1971; Rothman 1991, pp. 190–221). Undoubtedly under the influence of her involvement in the publicizing of those issues, Mrs. Shriver commented at the press conference that she hoped the Institute would re-emphasize the value of children in face of the widespread feeling that children are a burden (Kennedys 1971, p. 19).At the press conference, then president of Georgetown University, Robert J. Henle, S.J., announced the Kennedy Foundation’s grant of $1.35 million to establish the Institute. Henle was undoubtedly alert to the fact that certain issues, such as abortion and terminating the lives of infants, would be perceived [End Page 323] as highly controversial when raised at a Catholic university. Not surprisingly, reporters at the press conference raised provocative questions about how Georgetown University would reconcile Catholic moral doctrine with the Institute’s broadly-based inquiries. Henle replied tersely that the Institute “will be a ‘truly ecumenical and catholic effort,’ defining catholic in its classical meaning of universal” (Helping 1971). The reporters might have found it quite ironic that within a few years Georgetown’s ecumenical vision had provided the intellectual environment that permitted the Institute to become famous for development of the first systematic, secular (principle-based) approach to bioethics (Reich 1995).Father Henle was probably also aware that by launching the Kennedy Institute he was creating the first institute principally devoted to ethics research ever established at a university. It took a special sort of university to take this first step into bioethics research and policymaking. In 1971, ethics was regarded as belonging to religion, and religion was generally regarded as suspect academically. While it was difficult, in that atmosphere, for a nonreligious university to take such a bold step, Henle’s Georgetown University offered a promising setting that could scarcely have been found in any other university. It departed from the common mold of Catholic-college-as-indoctrination-center, yet it had an explicit and unashamed commitment to the investigation of religious and secular values in an environment of academic freedom. It was an increasingly cosmopolitan university, committed to developing the best of secular scholarship. Furthermore, Henle was willing to experiment with as-yet unproven interdisciplinary studies.Sargent Shriver—god-father of the Kennedy Institute, chairman of its first Advisory Board, and a constant dialogue partner of his friend and the Institute’s founding director, Dr. André Hellegers—was intensely interested in linking scientific progress with religious belief, unfettered moral debate, and commitment to disadvantaged humans.At the inaugural event, the new Institute was described as... (shrink)

Beginning with the assumptions that genetic technology will make possible the enhancement of some significant human capacities and that our society will have self-evident reasons to pursue such enhancements, this essay suggests less evident reasons to proceed with extreme caution. The essay asks: Will we, in our attempts to enhance humans by reducing their subjection to chance and change, inadvertently impoverish them? It explores how technologies aimed at enhancement might affect the good that is our experience of some forms of (...) the beautiful and the excellent, the good that is relationships of care, and the good that is diversity across the life span. In the end, it speculates about the fundamental philosophical difference that underlies the disagreement between those who would tend to embrace a project to enhance human capacities and those who would tend to criticize such a project. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical EthicsLaurence B. McCullough (bio)Those of us who work in the field of bioethics tend to think that, because the word “bioethics” is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724–1773) did bioethics just as we do it, at least two centuries before (...) we thought to do it (Gregory 1772). He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume’s moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory’s accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.Gregory’s “Problem List”Gregory wrote his medical ethics as a response to the then current state of medicine in Britain. We now follow Gregory in our writing of bioethics and clinical ethics in response to the problems of our time. A great deal that we now take for granted did not then exist. 1There was not, as there is now, any uniform pathway into medicine. Nor did there exist universal licensure. The Royal Colleges did attempt to assert, but failed to achieve, monopoly control of medical practice. The concepts of health and disease were themselves contested and therefore competed for their success in the market place. There was a marked oversupply of practitioners who competed fiercely—very fiercely indeed—in the medical market place for their concepts of health and disease, their treatments, and therefore their livelihoods. Patients had their own concepts of health and disease, engaged in “self-physicking” or self-care, and often traded physician’s prescriptions.Medicine exhibited little scientific discipline in its accounts of disease and in determining the efficacy of treatments, a fact that Gregory (1743) laments as a [End Page 329] medical student. There was no marked improvement when he began to give his medical ethics lectures nearly a quarter of a century later. Treatments failed as often, perhaps more often, than they succeeded in benefiting patients. The sick usually sought out the help of a physician after trying self-physicking.Physicians, Gregory taught, could not hope to control human biology, though they could aim to manage its processes well. When nature underresponds to disease the physician should assist her processes; when nature overresponds, the physician should tamp down nature’s responses, to lessen their “violence”—in both cases always attentive to the limits of medicine’s capacities in treating disease.Physicians attended the well-to-do sick at home, and the sick person summoned and dismissed physicians, surgeons, or apothecaries at will. A physician therefore might find himself—no women had yet been admitted to the ranks of university-trained physicians—summoned before, after, or simultaneously with a competitor, with his concepts and diagnosis and treatment put to the acid test. In this setting, there existed only a patient-physician relationship, not a physician-patient relationship.Physicians left off the care of dying patients, a practice that was made a matter of duty by Friederich Hoffmann (1749). One would suffer punishing economic consequences if one had a high mortality rate. Better, then, to label the patient incurable, withdraw, and turn matters over to clergy. Gregory attacks this practice as intellectual fraud and calls for the physician to continue to attend the dying. Indeed, he says, “It is as much the business of a physician to alleviate pain, and to smooth the avenues of death, when unavoidable, as to cure diseases” (Gregory 1772, p. 35). He does not explicitly address what we now call physician-assisted suicide; neither does he condemn it, and he is quick to condemn some things—e.g., sexual abuse of female patients or “sporting” with patients in the Royal Infirmary by using experiments as the first line of treatment.The Royal Infirmary was established to care for the deserving, working poor, who received free care... (shrink)

The author offers personal reflections on the development of research ethics in the United States, primarily during the 1960s. He explores the efforts of the pioneers in the field of human experimentation ethics to raise and discuss issues such as the value conflict between the acquisition of knowledge and respect for the autonomy of research subjects and the crucial importance of disclosure in the informed consent process.

In lieu of an abstract, here is a brief excerpt of the content:Bioethics Reconsidered: Theory and Method in a Post-Christian, Post-Modern AgeH. Tristram Engelhardt Jr. (bio)A candid assessment of the moral significance of our post-Christian, post-modern era calls for a reconsideration of the very project of bioethics. For many bioethicists, concerns for theory and method are secondary. 1 These scholars presuppose a common morality and a reasonable, overlapping consensus regarding [End Page 336] an appropriate polity. They assume as well that (...) we, as humans, possess middle-level principles, casuistic capacities, and guiding intuitions that enable us, inter alia, to identify which allocations of health care are unfair, whether the purchase of organs from the poor is exploitative, and if physicians may require as a condition for treatment agreement on a professional standard for the disclosure of information in the acquisition of consent. In this account of bioethics, we are taken to share a content-full moral understanding. Theory may illuminate that understanding and method may resolve particular controversies, but neither is necessary to disclose the nature of the moral life in the domain of health care. The account presents us as bound by a content-full morality, about which we have pretheoretical knowledge and in terms of which we are able to reach appropriate decisions, even if we have competing theoretical understandings of that morality.This dominant account of bioethics has interesting similarities with Roman Catholic moral theology in assuming (1) the existence of a common canonical morality grounded in our nature, our sentiments, and/or our reason, as well as (2) the ability of reason, reflection, or analysis to disclose the substance of that morality. The difficulty is that there are diverse moral sentiments, sympathies, and visions. The depth of our disagreements can be gauged in our substantive disputes regarding abortion, physician-assisted suicide, and health care reform. Furthermore, no appeal to middle-level principles or to casuistry can bridge such differences when people really disagree. Such appeals only underscore what separates.Consider how an appeal to the principle of autonomy or justice in mediating disputes regarding the licensing of for-profit euthanatization services or the enactment of a health care proposal like that produced by the Clinton administration in 1993 (White House 1993) will only disclose how deep the disagreements are, if the disputants are a Rawlsian and a Nozickian (Rawls 1971, Nozick 1974). Or, consider an appeal to casuistry for the resolution of health care policy debates among parties, some of whom consider dumping and skimming to be morally exemplar acts of autonomy, frankness, and appropriate stewardship of resources (Engelhardt and Rie 1988), while the other parties regard them as exemplar acts of injustice. Such disputants will agree neither about the proper descriptions of the cases, nor about how to derive moral guidance from them, because they bring to the cases disparate moral senses and different understandings of moral rationality. In a world in which there are as many different accounts of fairness and justice as there are major religions, and where many may hold that exploiters are those who do not allow the poor to sell their organs to the rich, the presumption of a moral consensus or background morality (Bayertz 1994) serves more as an ideology than as a general authoritative moral disclosure. [End Page 337]In addition, it is not possible to choose among many 2 of the competing visions or accounts of justice, fairness, and appropriate behavior on the basis of sound rational argument. To choose authoritatively among competing content-full moralities or moral accounts, one must already have background moral guidance. If one is to choose the account that maximizes benefits over harms, one must be able to compare competing benefits. For example, in terms of consequences, one cannot compare liberty and equality outcomes without already knowing how to rank liberty and equality. One must already know the answer about which morality—e.g., the one that gives priority to liberty over equality, or the one that gives priority to equality over liberty—is authoritative. Nor will an appeal to preference satisfaction solve the difficulty of determining how to establish the canonical ethics and bioethics. One must first know how one should correct preferences, compare impassioned versus considered... (shrink)

In most Western European countries and North America, strategies to contain the spread of AIDS have emphasized civil liberties. This may be due more to the epidemiology of the disease than to moral progress.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

This review essay examines H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics, a contemporary nonfeminist text in mainstream biomedical ethics. It focuses upon a central concept, Engelhardt's idea of the moral community and argues that the most serious problem in the book is its failure to take account of the political and social structures of moral communities, structures which deeply affect issues in biomedical ethics.