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2 A History of Codes of Ethics for Bioethicists
- Johns Hopkins University Press
- Chapter
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c h a p t e r t w o A History of Codes of Ethics for Bioethicists r o b e r t b a k e r , p h.d. I see no a priori reason for thinking that clinical ethics is so complicated, confusing or delicate an enterprise that it alone among professions should be without a shared and public understanding of the moral dimensions of its practice. Nor do I think that ethicists are so clear thinking and saintly a group as to be without need of such a code; nor that they are so vicious and/or closeminded as to render one otiose. Clinical ethics is neither above nor below the need for a code. —Freedman 1989, 137–38 Bioethicists1 function in an environment in which most of their peers embrace codes of professional ethics.2 Some bioethicists challenge this claim on the grounds that bioethics is really an academic discipline and such disciplines do not usually subscribe to codes of ethics (Lantos 2005). Although it is true that such humanities fields as English and philosophy lack codes of ethics, professors in these fields are protected by the American Association of University Professors (AAUP) Statement on Professional Ethics, which applies in all academic fields; similarly, professors in medical colleges are protected by the American Association of Medical Colleges (AAMC) Guidelines. Codes of ethics are also common in the physical sciences (biochemistry and molecular biology, chemistry, geology , mathematics, meteorology, nuclear science, physics) and in the social sciences (anthropology, archeology, history, political science, and sociology). More importantly, virtually every applied field, and almost all fields involved with health care, subscribe to a code of ethics.3 Economics may be the sole major social science field lacking a code of ethics, but professional codes regulate the activities of its applied versions (financial analysis, financial planning, health care management , and health care management and information systems). Bioethics is thus unique and uniquely vulnerable. It is an applied health care field that functions without guidance from, and without the protections a¤orded by, a code of ethics. Yet anti-code skeptics believe that bioethics has no need for a code of ethics. A formal code of ethics seems to them unnecessary and, given the field’s diversity, unachievable. Many bioethicists believe, moreover, that any e¤ort to create a code of ethics for bioethics would not only prove divisive but, by emphasizing duties and rules, would distract from fundamental issues of character that should lie at the heart of morality. The brief historical survey in this chapter will show that bioethics societies have been responding to situations that require professional ethics standards for a decade. It will also show that, in part because of anti-code skepticism, they have had to “make do” with ad hoc task forces’ reports and preliminary or draft codelike instruments that attempt to serve as ersatz substitutes for a formal code of professional ethics. This analysis lays the foundations for the argument that the real question facing bioethics is not whether to adopt a code of ethics, but whether to continue “making do” with ad hoc code substitutes of uncertain utility and authority or to replace them with a more authoritative and e¤ective professional code of ethics. the skeptical response to benjamin freedman’s proposal (1986) The year 1986 was important to bioethics: ELSI (Ethical, Legal, and Social Issues of the Human Genome Project) was funded; the proposed “Common Rule” regulating U.S.-government-funded human subjects research was published for comment; and the Society for Bioethics Consultation (SBC), the first formal organization dedicated to clinical ethics consultation, was founded. It was also the year in which Canadian bioethicist Benjamin Freedman (1952–97) issued what appears to be the first public call for a code of ethics for bioethicists engaged in clinical ethics consultation.4 In his call Freedman argued that such a code would clarify the range of permissible conduct in complex contexts, create “a useful tool in professional education . . . generate discussion among professionals concernc o d e s o f e t h i c s f o r b i o e t h i c i s t s 25 [3.136.97.64] Project MUSE (2024-04-18 00:44 GMT) ing the moral dimensions of their work,” and “clarify the profession’s sense of what may reasonably be expected of a competent ethical practitioner” (Freedman 1989, 129–30). Freedman’s timing was o¤. He was urging a fledgling...