Bioethics was preceded by medical ethics, which focused primarily on issues arising out of the physician–patient relationship. The ancient Hippocratic literature (which includes but is not limited to the Hippocratic Oath) enjoins physicians to use their knowledge and power to benefit the sick, to heal and not to harm, to preserve life, and to keep in the strictest confidence information that ought not to be spread about. These basic values remain an essential part of contemporary bioethics. However, after the Second World War it became clear that the old medical ethics was not sufficient to meet contemporary challenges.
Unprecedented medical advances, such as the use of penicillin and immunization against childhood diseases, have saved literally millions of lives. So have open heart surgery and cardiac catheterization, chronic hemodialysis, and organ donation. At the same time, many of the methods of modern medicine are very expensive, and thus out of the reach of many who might benefit from them. Medicine’s success thus led to a debate about how to pay for healthcare. In most industrialized countries, the provision of healthcare is viewed as the government’s responsibility, comparable to the obligation to provide public education. By contrast, in the U.S. many still regard payment for healthcare as an individual responsibility, or at least something that employers, not the state, should provide. Among those who agree that some kind of national health insurance is both fair and fiscally sound, a debate continues between egalitarians, who insist that no care should be provided unless it is available to all who need it, and those who favor a tiered health care system that allows some medical services to be distributed by the market.
Medicine’s success in the post-war years raised another issue: the value of preserving life. Respirators were originally invented for people who were expected to recover and be able to breathe on their own. Within a short period of time they began to be used on people in persistent vegetative states, forcing medical professionals to ask whether this was an appropriate use of technology. Should people who are permanently and irreversibly unconscious be kept alive indefinitely? A similar issue resulted from the development of neonatal intensive care units (NICUs), which have saved the lives of many premature babies who would have died in earlier decades. Many of these babies go on to have normal, healthy lives, but many face a lifetime of severe disabilities and serious health complications.
Thus, NICUs raise the question: Ought life to be preserved regardless of the nature or quality of that life? And if there are times when life should not be preserved, who should be authorized to make these decisions?
During the 1960s these questions began to be debated at academic conferences and in scholarly journals, giving birth to the field of bioethics.
In 1969 the Hastings Center in Garrison, NY, an independent, nonpartisan, and nonprofit bioethics research institute, was founded by Dan Callahan and Willard Gaylin to explore fundamental and emerging questions in health care, biotechnology, and the environment. Its journal, the Hastings Center Report, first appeared in June 1971. In July of that year the Kennedy Institute of Ethics at Georgetown University opened, with two research scholars: LeRoy Walters, who soon became its Director, and Warren Reich, who was the editor of the first edition of the Encyclopedia of Bioethics, published in 1978.
The term ‘bioethics’ was coined in the early 1970s by biologists who brought to the public’s attention two pressing issues: the need to maintain the planet’s ecology, on which all life depends, and the implications of advances in the life sciences toward manipulating human nature. In his book, Bioethics: Bridge to the Future, published in 1971, Van Rensselaer Potter focused on the growing human ability to change nature, including human nature, and the implications of this for our global future.
Although the term ‘bioethics’ has referred almost exclusively to problems in biomedicine, in recent years the field has returned to ‘the wider context provided by the life scientists of the early 1970s, including their environmental and public health concerns’.
While bioethics has been interdisciplinary since its inception, theology played a foundational role in its creation. It continues to have a profound influence today, as reflected in the careful analysis and defense of the rule of double effect by Daniel Sulmasy. Three theologians in particular were instrumental in the birth of bioethics: Joseph Fletcher, an Episcopal minister; Paul Ramsey, a Methodist minister; and Richard McCormick, a Jesuit moral theologian.
The theologians were soon joined by philosophers who rejected the emphasis in contemporary analytic ethics on meta-ethics, to the exclusion of normative ethics.
Events in the 1960s—opposition to the Vietnamese war, the civil rights movement, and other social movements it spawned, such as the women’s movement, the disability rights movement, and the gay and lesbian rights movement—played a role in the revitalization of normative ethics, and philosophical interest in applied ethics. Students began to demand that their courses were ‘relevant’, and professional philosophers also became interested in writing on the issues of the day.
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