The Making of British Bioethics by Duncan Wilson (review)

The late-20^th-century development of bioethics played a crucial role in determining medical behaviour and shaping public opinion on problems ranging from test-tube babies to the acceptability of euthanasia. Its evolution marked an important shift in medical power. Clinical decisions are no longer necessarily exclusively reached by doctors at the bedside. Indeed, the modern bioethicist does not necessarily require any clinical experience. Philosophers, academics, and sociologists can, potentially, stake a claim in the business of bioethics. To date, historians have focused overwhelmingly on exploring bioethics in American contexts at the expense of other geographical settings where specific social, political, and cultural circumstances mean that bioethics developed in different ways. In light of this background, Duncan Wilson’s The Making of British Bioethics fills an important gap. By examining the concerns, influence, and ideas surrounding modern British bioethics, Wilson persuasively argues that bioethics is not a unified field but, rather, one whose scope and influence was (and is) determined by its relations with other disciplines and specific sociopolitical climates.

Wilson maintains that bioethics was not firmly established in Britain, in contrast to America, until as late as the 1980s. His book draws upon a wide range of sources to explain this relatively late arrival–and to examine why bioethics subsequently became so influential in Britain–including public inquiries, university archives, private papers, television programs, and interviews. In addition, Wilson examines the individual biographies of leading bioethicists, making the convincing point that biographical analysis could still be of importance to medical historians (although we should by no means revert to the “great doctor” biographies penned in earlier decades).

In his opening chapter, Wilson provides an overview of the pre-history of modern British bioethics, convincingly arguing that a “club mentality” existed dating back to the 19^th century that encouraged doctors to guard the boundaries of medical decision making and exclude outsiders from issues in the preserve of the medical profession. It was only in the 1960s that doctors came under increasing scrutiny from outsiders in light of a broader criticism of professional society combined with controversies such as the birth of thalidomide babies. Nonetheless, as Wilson suggests, British doctors continued to hold jurisdictional control over their own practices to a greater extent than their American counterparts until as late as the 1980s.

Subsequent chapters focus on three key individuals: Ian Ramsey, Ian Kennedy, and Mary Warnock. During the 1960s and 1970s, prominent theologians such as Ramsey increasingly presented their ideas on matters such as in vitro fertilization (IVF) as an ancillary service to doctors. They provided guidance instead of seeking to intervene in medical decision making. In the late 1970s and 1980s, Kennedy, an eminent lawyer, played an active role in sparking public discussion on issues such as medical definitions of death, euthanasia, and the doctor–patient relationship. Wilson connects the acceptance of bioethics in Britain–as exemplified by Kennedy’s interventions–to the growth of politics that supported public accountability and strengthened the role of experts independent from the profession in question. This shift, Wilson maintains, helped create a demand for bioethics. Yet Kennedy sought to safeguard doctors rather than present a challenge to their authority. In contrast, Warnock promoted a more relevant, interventionist form of philosophy of relevance to modern ethical problems. Wilson details her role in attempting to find a middle way between experts with competing perspectives on ethical matters. Wilson presents her appointment as chair of an IVF inquiry as a critical moment in modern British bioethics, while situating her influence as been made possible by increasing demands for external oversight in neo-liberal forms of government.

The Making of British Bioethics continues with chapters on how bioethics increasingly infiltrated university curriculums, allowing interdisciplinary networks to develop. Yet, as a closing chapter demonstrates, a growing backlash occurred in the 1990s against bioethics and the broader “audit society” in which it had evolved and gained influence. In contrast to the previous decade, critics now claimed that external oversight actually damaged public trust. Overall, Duncan...