The modern field of bioethics emerged in the 1950's and 1960's
and represents a radical transformation of the much older, and
traditional domain of medical ethics. The
Dalhousie Department of
Bioethics defines bioethics as the "critical analysis of emerging
moral issues in health". A good overview is presented in the section
"Bioethics" in the Encyclopedia of Bioethics. Rev. ed.
Toronto : Macmillan : Simon & Schuster Macmillan ;
Prentice Hall International, c1995. Kellogg Library call no.:
REF W 50 E56
The term "bioethics" was first used by the biologist Van Rensselaer Potter
(Potter, Van Rensselaer. Bioethics: bridge to the future.
Englewood Cliffs, N.J.: Prentice-Hall, 1971. DALKIL QH 333 P66).
Potter used the term to refer to a new field devoted to human
survival and an improved quality of life. Gradually, the term
"bioethics" came to refer to "the broad terrain of the moral
problems of the life sciences, ordinarily taken to encompass
medicine, biology, and some important aspects of the environmental,
population and social sciences. The traditional domain of medical
ethics would be included within this array, accompanied now by
many other topics and problems." (Encyclopedia of Bioethics.
1995. p. 250)
Four general areas of inquiry can be identified:
- Theoretical bioethics which deals with the intellectual foundations of the
field.
- Clinical ethics which refers to the day-to-day moral
decisions confronted in caring for patients.
- Regulatory and policy bioethics which seeks legal and
policy solutions for moral problems concerning life and death. Examples of
issues falling into this area would be use of fetal tissue in
research, defining death, guidelines for do-not-resuscitate (DNR) orders
in hospitals, euthanasia, cloning, rationing health care
resources, and so on.
- Cultural bioethics
which considers ethical questions in relation
to the historical, ideological, cultural, and social contexts in which
they are expressed.
The moral questions of bioethics can also be viewed within
broader theories of ethics, such as utilitarianism. A utilitarian
approach asks which consequences of a choice or action or a policy
would promote the best outcome. In this view, the broader good might
be deemed the greatest good. The utilitarian view would, in the
context of health care rationing, for example, look for the collective
social benefit rather than advantages to individuals.
A deontological perspective, on the other hand,
would argue that "good consequences may have to be set aside
to respect inalienable human rights". An example would be
subjecting individuals to medical research that may do harm
to that individual, while providing the potential to help
others.
"Other moral theories, such as that of Aristotle, stress
neither principles nor consequences but see a combination of
virtuous character and seasoned practical reason as the most likely
source of good moral judgement." (Ibid., p. 252)
The approach of casuistry is to carefully examine individual cases
in the solving of practical moral problems, and to let principles
emerge from these over time. This process is similar to case-based
English common law.
Robert Veatch, in his 1981 book, A Theory of Medical
Ethics (DALWKK W 50 V395t 1981),
proposed a new social contract between medicine and society. This
"contract comprises basic ethical principles for society as a whole,
a contract between society and the medical profession about the latter's
social role,and a contract between professionals and laypersons that
spells out the rights and prerogatives of each". (Ibid., p. 253)
"Contemporary feminist approaches to bioethics reject...
the top-down rationalistic and deductivist
model of an ethic of principles." This approach puts much more
emphasis on the context of
moral decisions, on human relationships, and on the importance of
feeling and emotion in making a moral decision.
(Sherwin, Susan. No Longer
Patient: Feminist Ethics and Health Care. Philadelphia:
Temple University Press, 1992. DALWKK W 50 S554 1992)
Daniel Callahan suggests (Encycopedia of Bioethics,
1995, p. 254) that "the first task of bioethics...is to help
clarify what should be argued about. A closely related
task will be to suggest how these issues should be argued
so that sensible, moral decisions can be made. Finally, there will
be the more advanced, difficult business of finding and justifying
the deepest theories and principles." He suggests that there will
be contention in each of these stages, but perhaps over time broad
agreement on many issues will/can be reached. He points to such
concepts as "patient rights", "informed consent", and "brain death",
all hotly debated at one time, have now achieved widespread
acceptance.
Callahan identifies two kinds of fundamental questions that
bioethics asks (Ibid., p. 255):
- "First, what kind of medicine and health care,
what kind of stance toward nature and our environment, do
we need for the kind of society we want?"
- "The second question reverses the first: What kind of a
society ought we to want in order that the life sciences will be
encouraged and helped to make their best contribution to
human welfare?"
The late nineteenth century and first half of the the
twentieth century revelled in an aura of triumphal positivism.
The predominant attitude was that science produced facts which
were solid, authoritative and didn't need to be questioned. Ethics
and values occupied a back room of intellectual pursuit, or fell into
the domain of religion.
Science and medicine in the past half century, however, in forging
new frontiers have exposed questions relating to human experience
that are soft, relativistic and personal. It is now generally
agreed that facts cannot be considered separately from values. Rachel
Carson in her book Silent Spring (1962) awoke society to the
environmental hazards which have been posed by the human appetite
for economic progress and the domination of nature.
Today, in the medical and health fields
health practitioners are frequently called on to make moral
decisions as well as medical decisions. Indeed, it may be held
that a good medical decision should be tantamount to a good
moral decision. It is in this context that the field of
bioethics has emerged as a vitally important field.
"What distinguishes ethics from science is not any special
kind of knowledge but merely desire. The knowledge required
in ethics is exactly like the knowledge elsewhere; what is
peculiar is that certain ends are desired, and that right
conduct is what conduces to them." (Russell, Bertrand. What I
Believe. New York: Dutton, 1925, pp. 19-24)
* Much of the material in this introduction is taken from the
section written by Daniel Callahan entitled "Bioethics" in the
Encyclopedia of Bioethics. Rev. ed.
Toronto : Macmillan : Simon & Schuster Macmillan ;
Prentice Hall International, c1995. Kellogg Library call no.:
REF W 50 E56
Select bibliography:
(DALWKK denotes Kellogg Health Sciences Library, Dalhousie
University.)
Beauchamp, Tom L., and Childress, James F. 2001. Principles of
Biomedical Ethics. 5th ed. New York: Oxford University Press.
DALWKK W 50 B372p 2001
Brody, Baruch A. 1988. Life and Death Decision Making. New York:
Oxford University Press.
DALWKK W 50 B8648 1988
_______________. 1995. "Bioethics" In vol. 1 of Encyclopedia
of Bioethics, pp. 247-256 Rev. ed. New York:
Macmillan : Simon & Schuster Macmillan ; Prentice Hall
International. DALWKK REF W 50 E56
Engelhardt, H Tristram, Jr. 1996. The Foundations of Bioethics.
2nd ed. New York: Oxford University Press.
DALWKK W 50 E57f 1996
Fletcher, Joseph F. 1954. Morals and Medicine: The Moral Problems of:
The Patient's Right to Know the Truth, Contraception, Artificial
Insemination, Sterilization, Euthanasia. Boston: Beacon.
DALLAW KB93 F61
The Hastings Center's Bibliography of
Ethics, Biomedicine, and Professional Responsibility. 1984
Frederick, MD : University Publications of America in association with the Hastings
Center.
DALWKK REF ZW 50 B5822 1984
Howell, Joseph H., and Sale, William F. 2000. Life Choices :
a Hastings Center Introduction to Bioethics. 2nd ed.
Washington, DC : Georgetown University Press.
DALLAW K 27.B6 L72
Jonsen, Albert R., and Toulmin, Stephen E. 1988.
The Abuse of Casuistry: A History of Moral Reasoning. Berkeley:
University of California Press.
DALKIL BJ 1441 J66 1988
Pellegrino, Edmund D., and Thomasma, David C. 1981.
A Philosophical Basis of Medical Practice: Toward a Philosophy
and Ethic of the Healing Professions. New York: Oxford
University Press.
Potter, Van Rensselaer. 1971. Bioethics: Bridge to the Future.
Englewood Cliffs, N.J.: Prentice-Hall.
DALKIL QH 333 P66
Sherwin, Susan. 1992. No Longer Patient: Feminist Ethics and Health
Care. Philadelphia: Temple University Press.
DALWKK W 50 S554 1992
Veatch, Robert M. 1988. A Theory of Medical Ethics.
New York: Basic Books.
DALWKK W 50 V395t 1981
Williams, John Reynolds. 2005 Medical Ethics Manual.
Ferney-Voltaire, France: World Medical Association.
DALWKK W 50 W724m 2005
[Online]
Zaner, Richard M. 1988. Ethics and the Clinical Encounter.
Englewood Cliffs, N.J.: Prentice-Hall.
DALWKK W 50 Z28e 1988
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