The History of Bioethics: Its Rise and Significance

Bioethics, the unique conceptualizing, analyses, andmanagerial methods that arose in response to discomfiting postwar developments in biology, medicine, and biotechnology, spawned a new profession and seeded novel social institutions. It has sown think tanks, educational programs or courses in universities, law and medical schools, hospital consultancies, research review committees, national policy commissions, professional associations, and generated a massive publication roster. A historiographic account of the unprecedented emergence and endurance of these phenomena awaits a body of publications based on meticulous research of the sprawling arenas into which bioethics expanded: clinical consultation, research oversight, public policy recommendations, and cultural influence. So far, professional historians have not systematically mined archives to produce a sizable body of such research. Most accounts of bioethics’ ‘birth’ have been penned by bioethicists themselves or by social scientists, some of whom were embedded with individuals who, as the field came into bold relief, became bioethicists. Even so, this article will characterize bioethics’ rise in the United States and its cultural significance. For bioethicist cum historian Albert Jonsen, early bioethicists were ‘pioneers’who “blazed trails into a field of study that was unexplored and built conceptual roads through unprecedented problems.” The field began as “an amorphous expression of concern about the untoward effects of advances in biomedical science and gradually form[ed] into a coherent discourse and discipline” (Jonsen, 1998: p. viii). The ‘showpieces of bioethics,’ according to Jonsen, are the products of the national commissions which “radically change[d] the practice of scientific research in America” (Jonsen, 2001: p. 44). The labor of early bioethicists yielded intended results that the new profession often celebrates (Fox and Swazey, 2008: pp. 123ff). Evidence suggests, however, that ‘mainstream’ bioethics’ legacy includes at least three notable collateral social transformations. First, it assisted in defusing incendiary political assessments about science and technology read widely during the 1950s and 1960s. It transformed political critique into an ethical query that facilitated civic management through guidelines and regulations rather than activism or advocacy. This transformation served to midwife technologies, then considered exotic and problematic into broad social acceptance. Second, it delegitimated religious counsel, prioritizing secular guidance based on principles culled from a presumptive universal or ‘common morality (see, for example, Engelhardt, 2003; Evans, 2002; Moreno, 2005). This mediated a secular society’s need for moral resolution in the face of bewildering biomedical developments and, as with the quelling of radical political critique, it enabled civic oversight of biomedical research. Third, along with other developments altering the professional culture of science, e.g., the rise of science entrepreneurs, (Press and Washburn, 2000) the institutionalization of bioethics contributed to the dissipation of the postwar responsible science movement’s influence. That influence saw a subsection of scientists and physicians seeking public involvement in interrogating research trajectories or clinical practice that they themselves found troubling. Instances of scientists or physicians seeking (nonbioethics mediated) public awareness or counsel about moral hazards accompanying technological developments largely subside with the bureaucratization of ethical scrutiny. The emergence of an infrastructure of bioethical examination (e.g., committees, commissions, guidelines, and regulations) assisted in disciplining professional discourse as well as framing public understanding. Recent developments reveal these transformations to be dynamic and changing. The success of the political right in influencing bioethical debate at the turn of the twenty-first century resulted in the fracturing of bioethics’ civil discourse based on principles asserted to have been universal. It exacerbated fissures across a liberal-conservative spectrum nascent within the profession but previously found manageable. Some commentators view the profession’s function as secular arbiter of moral questions pertaining to science, medicine, and 1 The term ‘profession’ is used loosely. For a consideration of professionalization in the context of bioethics, see Bosk (2008a): pp. 21–37. Bosk objects to licensing and certifying ethics consultants. See also, Wolpe (2010): pp. 109–118 (despite his mischaracterization of this article’s author as ‘from the right,’ p. 116). Wolpe predicts, “the future will see a new class of bioethicists with more firmly established professional identities” (p. 116). 2 For an analysis of these categories, see Evans (2012a): pp. xxvii–xxxv. 3 Accounts of the rise of bioethics from members of the founding generation include Jonsen (1998), Levine (2007), Callahan (2012), Drane (2012). Accounts from embedded social scientists include Rothman (1991) and Fox and Swazey (2008). On the topic of history and bioethics, see Rosenberg (1999), Brandt (2000), Belkin and Brandt (2001); Baker (2002), Stevens (2003), Short (2003), Belkin (2004), Wilson (2011), Emmerich (2011), and McWhirter (2012). 4 A number of commentators have begun referring to ‘mainstream’ bioethics as a way of distinguishing it from bioethics as practiced by those who influenced federal policy making in more religious ways as the ‘culture wars’ came to into effect. The term may also serve to distinguish feminist bioethics and ‘critical bioethics’ (see below) from the bioethics of the founding generation. Unless otherwise specified, the term ‘bioethics’ is meant to convey mainstream bioethics. 5 (Stevens, 2000). See also Bosk (2010), who writes that we need to understand “.how ethical expertise is deployed to transform social spectacles into organizational routines” (p. S143). Stevens’ critique has received a number of critical reviews from bioethicists. See, for example, Jonsen (2001) and the author’s rejoinder, Stevens (2001). 6 This observation warrants further investigation. See Stevens (2000) for a discussion that locates the modern roots of bioethics in the legacy of the responsible science movement. Also relevant is Evans’ consideration of how scientists sought to regain control of the debate over human genetic engineering by ‘thinning’ public discussion so as to avoid deliberation on the eugenic ends of genetic manipulations, shifting to talk of ‘gene therapy’ rather than genetic engineering (Evans, 2002). Distinguishable from the responsible science movement ethos are the 1975 moratorium on rDNA research (Asilomar) and the 2012 moratorium on genetically engineered H1N1 bird flu virus research. These are instances of scientists trying to subdue public concern, not generate public awareness or elicit debate.