The birth of bioethics

As late as 1946, the ethics of both bedside medicine and bio-medical research were something physicians and scientists sorted out for themselves, or, at least, amongst themselves. Fifty years later, biomedical ethics was neither private, nor restricted to clinicians and scientists. It was a well-publicized field dominated by scholars trained in the humanities, law, and social science (including history). The American Society of Bioethics and Humanities now has a membership of over 1,500 individuals, holding positions in almost 200 centres, departments and programmes, and publishing the 3,620 books, essays, and articles listed annually in the Bibliography of Bioethics. In The birth of bioethics, Albert Jonsen, the first person to be denominated a "Professor of Bioethics", offers a comprehensive chronicle of the rise of bioethics, from its tentative beginnings in a few casual conversations to its formal institutionalization in centres and institutes. Part One focuses on individuals, offering representative biographies of key theologians and philosophers who became "bioethicists", and offering detailed accounts of the activities of the government commissions on which these individuals served-a service that transformed them into bioethicists. Part Two focuses on the issues before these commissions, which eventually became the subject matter of the new fielddeath and dying, ethical issues in genetic research, human subjects research, new reproductive technologies, and organ transplantation. In Part Three, Jonsen moves beyond chronicle-the record of who did what, when and whereto the questions of why bioethics was conceived, why the movement took the form of ethics, and why it was born in America. Jonsen helpfully distinguishes between bioethics as a discipline-a specialized field supported and recognized as such by academic institutions-and bioethics as a discourse, a widely-accepted way of discussing ethical issues in bio-medicine. Canonization as a discipline began when the Library of Congress recognized it as such on the basis of a 1973 article written by Daniel Callahan, co-founder of the Hastings Center. Unfortunately, having once made this observation, Jonsen's concerns as a practising bioethicist distract him from his duties as a historian. He becomes entangled in the issue of whether a field that lacks settled and distinctive methodology can properly be called a "discipline", and concludes that bioethics is a "demi-discipline". After reaching this conclusion, however, Jonsen loses sight of the issues he set out to address: why did a select group of scholars denominate themselves "bioethicists", and, perhaps more importantly, how did they convince the rest of the world to accept their selfcharacterization, with its implicit claims to expertise. Jonsen is more insightful about the development of bioethics as a discourse. In conference after conference bioethicists challenged the "techno-speak" of medical and scientific savants, deriding the tradition of "doctor knows best" as paternalism, and reparsing abstruse technical issues in the populist language of patients' rights. Bioethical discourse attained clinical legitimacy by penetrating the medical school curriculum; it invaded the corridors of the clinic via the ethics committee; and the public became acclimatized to bioethical discourse as the media turned to bioethicists for comments on the issues and scandals of the moment. Ultimately bioethical discourse dominated both public and professional discussions of moral issues in biological science and medical practice. In explaining the triumph of bioethics as a discourse, Jonsen turns to the work of three historians: Daniel Fox, Stanley Reiser (Medicine and the reign of technology, Cambridge University Press, 1978), and David Rothman (Strangers at the bedside: how law