1 . Ethical Theory and Bioethics

The moral problems discussed in this book have emerged from professional practice in the fields of clinical medicine, biomedical research, nursing, public health, and the social and behavioral sciences. The goal of this first chapter is to provide a basis in language, norms, and theory sufficient for reading and criticizing the selections in the later chapters. Everyone is aware that ethics in the biomedical professions has had a distinguished history. Among the most influential sources of medical and nursing ethics are its traditions: the concepts, practices, and norms that have long guided conduct in these fields. The history and precise character of these traditions may be the logical starting point in reflecting on professional ethics, but great traditions such as Hippocratic ethics often fail to provide a comprehensive, unbiased, and adequately justified ethics. Indeed, the history of medical ethics over the last two thousand years is a particularly disappointing history from the perspective of today's concerns in bioethics about the rights of patients and research subjects. Prior to the early 1970s, there was no firm ground in which a commitment to principles outside of Hippocratic medical ethics could take root and flourish. Particular ethical codes written for the medical, nursing, and research professions had always been written by their own members to govern their own conduct. To consult persons outside the profession was thought not only unnecessary, but dangerous. This conception has collapsed in the face of the pressures of the modern world. Such a professional morality has been judged not adequately comprehensive, coherent, or sensitive to conflicts of interest. The birth of bioethics occurred as a result of an increasing awareness that this older ethic had become obsolete. FUNDAMENTAL PROBLEMS