Bioethics Grows Up

W hen I taught my first course in bioethics to first-year students at Columbia University's College of Physicians and Surgeons in the spring semester of 1981, bioethics was still in its formative years. There were scant few textbooks around and even fewer anthologies, and I could not assume that any of my students had ever read anything by a bioethicist or about bioethics. The key institutions in the field at that time, barely over a decade old, and only one journal devoted to bioethics had been publishing for a significant period of time. Most major medical and biomedical journals were wary of publishing pieces on ethics, because the editors did not think that articles on a soft and mushy subject such as ethics were appropriate for journals of medicine and science. An instructor in those days really had to scramble to find and assemble the best writings and be ready to incur a hefty Xeroxing bill. These days when I organize a class, I can expect that nearly every student at the University of Pennsylvania School of Medicine will have taken at least one course in bioethics as an undergraduate. Some will even have had a course or some exposure to the field in high school. Today, the challenge isn't finding material to teach but choosing from among the ever-growing abundance of readers, textbooks, articles, journals, and guides on bioethics. At least a dozen impressively hefty anthologies have appeared in the last three years from highly regarded publishing houses, edited by readily recognizable names in the field. They are fighting for sales in what has become a lucrative bioethics market. In fact, there are so many books out there now that new publications have begun to specialize, in the hope of minimizing competition by carving out a sub-niche. Some readers and texts target clinicians, researchers, undergraduates, or high school students while others take explicitly religious approaches, or explore bioethics from feminist, international, or legal perspectives. Singer and Viens' The Cambridge Textbook of Bioethics does not take the specialty turn. It is big—554 pages. It is broad, with sections on end-of-life care, genetics, research ethics, the ethics of health systems, clinical ethics, and religious perspectives on bioethics. It is brassy, with articles on neuroethics, alternative medicine and ethics, anesthesiology ethics, and aboriginal bioethics. And it is… Canadian. A huge number of the contributors, more than have ever been assembled inside one …