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Koterski, Life and Learning X: University Faculty for Life, , pp. It is the apparent belief that bioethics is somehow the same as, or to be equated with, ethics per se, or at least with medical ethics per se. I have even heard it referred to as Roman Catholic medical ethics per se. Repeatedly, when I ask a group to define "bioethics", I usually get the same sort of response. I hope with this essay to disenfranchise people of this belief. Contrary to "popular opinion", bioethics, as predominantly practiced today -- especially as embedded in formal governmental regulations, state laws and a myriad of other documents, committees, guidelines, guidebooks, etc. Academically it is actually a sub-field of ethics, and stands alongside many other theories of ethics, e. And like all ethical theories, bioethics is by no means "neutral" -- there is no such thing as a "neutral ethics". In fact, bioethics defines itself as a normative ethical theory -- i. Nor is bioethics to be equated with "medical ethics", as that term is still generally understood. Nor is it the same as Roman Catholic medical ethics, or any other such subsystem of ethics that could be used to determine the rightness and wrongness of human actions within the medical or research contexts. As we will see, bioethics understood as "principlism" is an academic theory of ethics which was formally articulated for the first time in by the Congressionally-mandated member National Commission in their Belmont Report. That Report, as Congressionally mandated, identified three bioethics principles: As will be demonstrated below, the Commission defined these three bioethics principles in less-than-traditional terms. Nor is bioethics restricted to the medical context, but extends to all of the 'bios", or "life" issues. Nor has bioethics ever even considered abortion a serious issue of debate although the definitions of a "human being" and of a "human person" concretized in the Roe v. Wade decision has reverberated throughout the bioethics and legal literature since then -- especially in the issues concerning human embryo and fetal research, human cloning, and human embryonic and fetal stem cell research. At least this much must be clear before anyone enters these public "bioethics" dialogues. My purpose in this paper is simply to provide historical confirmation of what bioethics is, who the Founders, theorists and practitioners are, identify just some of the major issues addressed particularly those concerning research using human embryos and fetuses , and touch on some of the more salient inherent problems of and concerns about this "theory". As the formal body of bioethics literature is enormous -- extending over 30 years or more -- it will be impossible in this essay to properly evaluate in detail all of the ramifications of this "bioethics edifice". My method will be primarily historical -- in terms of relating, only in the briefest of outline form, the short but extensively referenced and hectic history leading up to the actual articulation of the three bioethics principles of autonomy, justice and beneficence in the National Commission's Belmont Report. Because many of you are probably not familiar with those who have and still play major roles in bioethics, I will list as many of them as is reasonably feasible in the main text. Secular bioethics generally considers the following as ethical: Probably the only issues on which they both agree is that the use of extraordinary means, e. How is it that these two different ethical systems lead to such opposite and contradictory ethical conclusions? The answer is rather predictable. Every academic ethical theory has its own idiosyncratic ethical principles. Deducing from different ethical principles necessarily leads to different ethical conclusions. For example, Roman Catholic medical ethics is grounded on the ethical principles embedded in the Moral Law a combination of natural law philosophical ethics, the Divine Law, and the teachings of the Magisterium. Secular bioethics, as predominantly understood and applied, is grounded in the three bioethics principles of respect for persons now referred to as autonomy , justice and beneficence as articulated in by the National Commission in their Belmont Report. Deducing from these two very different sets of ethical principles leads inexorably to the different ethical -- and therefore medical ethical -- conclusions noted above. In short, there is really no such thing as just "ethics per se", or as just "medical ethics per se". There are different kinds of ethics, and therefore there are different kinds of medical ethics -- each with its own unique ethical principles, subject matter, method epistemology , and squadrons of "experts". It is these inherently different characteristics of different ethical theories that are compared and contrasted in ethics or medical ethics classrooms or at least should be. Likewise, different ethical or medical ethical theories have their unique historical records. The "history" of bioethics is no exception, although its "history" is rather recent. To understand how bioethics is not ethics per se, or even medical ethics per se, it is helpful to start by tracing some of its historical roots in the ancient medical tradition of Hippocrates. Although Jonsen presents the history of bioethics from within his own idiosyncratic perspective and his own important role in that history, his book is a wealth of historical information and extensive, often unique and difficult to access, documentation. The book does help to explain a great deal of some of the historical roots of bioethics, precisely what bioethics is, and the "experts" who founded it and are currently plying this trade. Jonsen a trained philosopher and former Jesuit priest starts his "history" of bioethics by outlining its roots in the ancient Hippocratic tradition, and then moves chronologically through the mediaeval and modern periods of medical ethics. He marks the contemporary events leading to the formal "birth" of bioethics as beginning about , and extends his depiction of bioethics to It is of note that he stops the "history" there -- and the burning question is "why"? Jonsen's presentation of the "pre-history" is already familiar enough to many of you, so I will only reiterate it quite briefly and in simplistic outline here. He traces the literature of "medical ethics" back to the Hippocratic School between B. It was concerned with the qualities of "the good physician", the decorum and deportment a doctor should exhibit towards patients. The "good physician" was the "virtuous physician" -- gentle, pleasant, comforting, discreet, firm, etc. In other words, physicians should reflect true virtues. The duties of a good physician were incorporated in oaths, and in rules dictated by church, state or profession. They included benefiting the sick and doing them no harm, keeping confidences, refraining from monetary and sexual exploitation of patients, and showing concern for those in need of medical help even at risk to one's own health and wealth. The paradigm of these duties is found in the Hippocratic Oath -- an oath, by the way, which is no longer usually required of our contemporary medical students upon graduation; or students often just create their own "modified version" of it. By the middle ages, a more social view of medical ethics was incorporated in which the physician also defined himself in society. Physicians must show themselves as worthy of social trust and deserving of social authority and reward. The marks of the profession of medicine included now the privilege to educate, examine, license and discipline their members, and the tacit pledge of public service. The first book with the title of "Medical Ethics", written in by the English physician Thomas Percival, combined the traditional virtues of medical decorum with new injunctions about the behavior of physicians among themselves. Still, social concerns in medical ethics were to be found in the ethical codes of the American Medical Association since its establishment in In the United States, Dr. Richard Cabot initiated what has been termed "an ethics of competence", especially in the practice of medicine in the hospital setting. For example, he stressed the need for extensive cooperation between physicians and all other professionals involved in the care of patients; he required accurate record keeping of the number of patients and the evaluation of their care; and he required a limit to the number of patients per physician so as not to compromise good patient care. Patients should be informed of their diagnoses, and their treatments should be explained to them by their physicians. Patients should not be exploited for teaching purposes, nor should senior physicians exploit junior physicians, etc. For Cabot, moral practice was competent; incompetent practice was unethical. And in the rapid advance of scientific medicine, the practitioner's highest moral duty was mastery of that science for the benefit of the patient. Chaunsey Leake insisted that medical ethics should be concerned with the ultimate consequences of physicians' work on their individual patients and toward society as a whole. Professional ethics would be relocated in a foundation of moral philosophy! Of course, the question should arise as to which moral philosophy the profession of medicine should use as its foundations, given that by then there were multiple theories of ethics from which to choose? Medical ethics found itself increasingly confounded as medical science advanced and medical interventions became increasingly technical. Is it "harm" to experiment on a dying person to generate better ways of curing disease for the "benefit" of other patients, even if it wouldn't "benefit" that individual patient? How should the growing intimacy of medical practice and medical research with government, commerce, and the new technologies be handled? If some patients cannot pay for medical care, who should? Who should live, and who should die? How should the limited resources of health care be justly distributed? How should the benefits and burdens of research be justly distributed? How far could individual physicians, medical investigators and the government go in advancing scientific knowledge and providing for our national security? And, of course, who should decide the answers to these difficult questions? These were, after all, issues that philosophy, theology and the law had previously pondered, rather than medicine. These disciplines were about to find their new home in the new field of secular bioethics, but with a difference. There would be a major shift from considerations of standard medical care and practice to those of cutting-edge medical scientific research, thus eventually blurring the distinction between the respective subject matters, methods and goals of these two very different fields of endeavor, and between the roles of physician and researcher. Further, the traditional roots of "medical ethics" in the Hippocratic Oath, religion and theology would be drastically cut as attempts to secularize "ethics" were rapidly articulated -- especially for use in our "pluralistic, multicultural, democratic" societies. The conferences, issues, and thinkers: Starting in the 's, important conferences took place which provided much of the materials, subject matter and debates later conceptualized in contemporary bioethics. The shift in theorists and in interests was dramatic. Of particular concern at these conferences were issues such as population control, eugenics, artificial reproduction, thought control, sterilization, cloning, artificial insemination, and sperm banks. For example, the conference, "Great Issues of Conscience in Modern Medicine", held at Dartmouth College in , hosted distinguished medical scientists "to examine the issues of conscience in medical and scientific progress The conference was chaired by Rene Dubos, a scientist at Rockefeller Institute who had just published a popular book entitled, Mirage of Health: Utopias, Progress and Biological Change. Muller, Nobelist in physiology and medicine for his work in genetic effects of radiation , and George Kistiakowsky, Assistant to President Eisenhower for Science and Technology. Snow and Aldous Huxley represented the humanities. Issues at this conference included: As Jonsen notes, "The claim that medical advances had contributed to the population explosion and to the pollution of the gene pool became a common theme of the conferences during the s. Soon-to-be common themes of later secular bioethics debates emerged. It is worth quoting Jonsen directly: Rene Dubos called "prolongation of the life of aged and ailing persons" and the saving of lives of children with genetic defects "the most difficult problem of medical ethics we are likely to encounter within the next decade To what extent can we afford to prolong biological life in individuals who cannot derive either profit or pleasure from existence, and whose survival creates painful burdens for the community? It will be for society to redefine these ethics, if the problem becomes one that society is no longer willing or able to carry. A unique solution was offered by Nobelist Hermann J. Muller, who promoted his concept of a bank of healthy sperm, together with the "new techniques of reproduction" to prevent the otherwise inevitable degeneration of the race. Our purpose is to air problems But "it is not enough for scientists to make statements of the greatest possible truth; [scientists] must have the courage to carry those statements through because they alone know enough to be able to impress their authority upon a world which is anxious to hear.
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