The Roots Of Bioethics

Daniel Callahan's life time work in bioethics has again and again returned to the root problems of health, progress, technology, and death. How we think about each of them individually and in relation to each other will shape the way we approach and deal with the most common dilemmas of modern medicine. They are at the roots of the field.

Daniel Callahan---whose cofounding of The Hastings Center in 1969 was one of the most important milestones in the history of bioethics--has written on an uncommonly wide range of issues over a long career. They have moved back and forth between clinical care of individual patients and the ethical problems of health care research and delivery. Through his many writings, four core problems have recurred in all of his work, and influence each of the others. What is health and how has its understanding been shaped by medical progress and the culture of medicine and society? What is progress, a deep value in modern health care and how should we judge it? What kinds of technological innovations that come out of the drive for progress are really good for us-and what do we do when there is a clash between individual good and social good in the use of expensive technologies, a problem now evident in the unsustainable high costs of health care? How should our understanding of the place of an inevitable death in all our lives, and its place in medicine, help us to better think of the goals of medicine and the goals of our life in seeking a good death? Those four questions have been with bioethics from its beginning and will remain with it for the indefinite future. They are the roots of bioethics.

Evans closely examines the history of the bioethics profession.

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.

The Origins of Bioethics argues that what we remember from the history of medicine and how we remember it are consequential for the identities of doctors, researchers, and patients in the present day. Remembering when medicine went wrong calls people to account for the injustices inflicted on vulnerable communities across the twentieth century in the name of medicine, but the very groups empowered to create memorials to these events often have a vested interest in minimizing their culpability for them. Sometimes these groups bury this past and forget events when medical research harmed those it was supposed to help. The call to bioethical memory then conflicts with a desire for “minimal remembrance” on the part of institutions and governments. The Origins of Bioethics charts this tension between bioethical memory and minimal remembrance across three cases—the Tuskegee Syphilis Study, the Willowbrook Hepatitis Study, and the Cincinnati Whole Body Radiation Study—that highlight the shift from robust bioethical memory to minimal remembrance to forgetting.

Legal/Ethics

The Cambridge World History of Medical Ethics provides the first global history of medical ethics.

In Bioethics in America, Tina Stevens challenges the view that the origins of the bioethics movement can be found in the 1960s, a decade mounting challenges to all variety of authority. Instead, Stevens sees bioethics as one more product of a "centuries-long cultural legacy of American ambivalence toward progress," and she finds its modern roots in the responsible science movement that emerged following detonation of the atomic bomb. Rather than challenging authority, she says, the bioethics movement was an aid to authority, in that it allowed medical doctors and researchers to proceed on course while bioethicists managed public fears about medicine's new technologies. That is, the public was reassured by bioethical oversight of biomedicine; in reality, however, bioethicists belonged to the same mainstream that produced the doctors and researchers whom the bioethicists were guiding.