Bioethics

Bioethics is the study of the moral dimensions of the life sciences and health care, including medicine, nursing, and the allied health professions.As an academic discipline, bioethics emerged in the 1960s and 1970s amid public controversies involving the misuse of human subjects in medical research and disquiet about the morality and safety of recombinant DNA research. Subsequent media coverage of such issues as xenografting and human cloning made bioethics and bioethicists familiar to many Americans.

Before the advent of bioethics (a term coined in 1970–1971), such ethical issues as truth‐telling and the confidentiality of the doctor–patient relationship comprised part of a tradition of medical ethics going back to the Hippocratic oath of ancient Greece. In the United States, physicians had adopted ethical codes to guide practitioners in their relations with one another, with their patients, and with society. When physicians established the American Medical Association (AMA) in 1847, they followed the example of such earlier medical societies as the Boston Medical Association and the College of Physicians of Philadelphia in ratifying ethics codes for their members. Based on the ethical code written by the English physician Thomas Percival in 1792, the AMA code particularly addressed the relationships among physicians and offered explicit rules for consultations with nonorthodox practitioners, who actively competed for patients with AMA members.

In the nineteenth and early twentieth centuries, the ethical dimensions of medicine received little attention outside the medical profession. The clergy, especially Catholic theologians, occasionally offered ethical analyses of such practices as abortion and contraception. In the 1910s and 1920s, the leaders of the medical profession grew concerned about public accusations against physicians who performed experiments on such vulnerable groups as orphans and inmates of mental‐health institutions. But proposals to restrict such practices, introduced at both the state and federal levels, generally failed because most Americans trusted the medical profession to protect patients' interests and well‐being. Buoyed by startling medical breakthroughs—insulin (1920s) and penicillin (1940s)—the American medical profession continued to enjoy popular esteem and respect.

During the 1960s and 1970s, this trust eroded. In this era of the civil rights movement and the women's rights movement, proponents of the rights of patients challenged the medical profession's traditional authority to oversee patients' interests and to police itself. Revelations of scandalous abuses in human‐subject research, especially the forty‐year study of untreated syphilis in four‐hundred African American men (the Tuskegee Experiment) shocked the public and the U.S. Congress. In the wake of public hearings, President Richard M. Nixon in July 1974 signed the National Research Act, requiring institutions receiving federal aid to form institutional review boards to monitor proposals involving human research subjects. The act also created a National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to develop guidelines to protect human participants in biomedical research. Including physicians, lawyers, clergy, philosophers, and social scientists, the commission issued several reports from 1975 through 1978.

The broad spectrum of bioethical concerns in the 1970s and 1980s, including issues relating to brain death, severely “defective” newborns, and the maintenance of comatose patients on respirators prompted Congress to authorize a second commission. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, appointed by President Jimmy Carter in 1978, produced a series of papers between 1980 and 1983 on such issues as health‐care decision‐making, defining brain death, genetic screening, and decisions involving life‐sustaining treatment. In 1995, in the wake of revelations of human radiation experiments sponsored by the federal government during the Cold War, President Bill Clinton formed the National Bioethics Advisory Commission. Reflecting the growing interdisciplinary nature of bioethics, the eighteen‐member board comprised people trained in medicine, law, nursing, religious studies, history, and bioethics, as well as an advocate for the mentally ill. As one of its first duties, the board reviewed the ethical and legal implications of human cloning, prompted by the successful cloning of an adult sheep by Scottish researchers.

As an academic discipline, bioethics flourished in American medical schools and in such private institutions as the Hastings Center for Bioethics in Briarcliff Manor, New York, during the last quarter of the twentieth century. As interest in bioethics burgeoned, the courts increasingly played a role in medical decision‐making; between 1976 and 1988, for example, U.S. courts addressed fifty‐four cases involving the right to refuse life‐prolonging therapies. Another measure of the growing status of bioethics was its prominence in the media; by the 1990s, journalists routinely consulted bioethicists for pronouncements on biomedical issues.

A bioethics issue with political overtones involved medical researchers' use of human stem cells. Since stem cells are harvested from very early‐stage human embryos (called blastocysts) used in vitro fertilization, a method employed by couples experiencing reproductive problems, the issue became enmeshed in the abortion debate. In 2001 President George W. Bush, advised by his newly created President's Council on Bioethics, barred federal funding of medical research on stem cells harvested in the future.
See also Biotechnology Industry; Birth Control and Family Planning; Genetics and Genetic Engineering; Medical Education.

Bibliography

Donald E. Konold , A History of American Medical Ethics, 1847–1912, 1962.
Ruth R. Faden and and Tom L. Beauchamp , A History and Theory of Informed Consent, 1986.
George Weisz, ed., Social Science Perspectives on Medical Ethics, 1990.
David J. Rothman , Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making, 1991.
Susan E. Lederer , Subjected to Science: Human Experimentation in America before the Second World War, 1995.
Robert Baker et al., eds., The American Medical Ethics Revolution, 1999.

Susan E. Lederer

; Updated by

Paul S. Boyer