The History of Bioethics: An Essay Review

ROBERT B. BAKER, ARTHUR L. CAPLAN, LINDA L. EMANUEL, and STEPHEN R. LATHAM, eds. The American Medical Ethics Revolution. How the AMA’s Code of Ethics has Transformed Physicians’ Relationships to Patients, Professionals, and Society. Baltimore, Maryland, The Johns Hopkins University Press, 1999. xxxix, 396 pp., illus. $59.95.

ALBERT R. JONSEN. A Short History of Medical Ethics. New York, Oxford University Press, 1999. xi, 153 pp. $34.95.

According to Sargent Shriver, he invented the word "bioethics" in his own Bethesda, Maryland, living room one night in 1970. ¹ That evening he and his wife, Eunice Kennedy Shriver, met with physician Andrée Hellegers, the president of Georgetown University and a Jesuit philosopher,and others to discuss Kennedy family sponsorship of an institute for the application of moral philosophy to concrete medical dilemmas. Now bioethics is thirty years old, the traditional span of a generation, and has reached an anniversary that invites reflection.

No one has been assessing the first generation of bioethics more diligently than Al Jonsen, who studied moral philosophy and religion as a Jesuit priest before leaving the church in the mid-1970s for full-time work as a professor of bioethics. Like many foundational figures who have been present at the creation of their fields, Jonsen can recall reams of useful detail about his subject’s early life, which he did in his Birth of Bioethics (Oxford University Press, 1998). More recently, he goes backward in time, offering readers A Short History of Medical Ethics, which ends just when his first book begins. To those who might wonder why Jonsen, who makes no pretense of being a trained historian, would write a historical survey, he explains in the introduction that he intends Short History as a stop gap, an initial treatment of a field that, surprisingly, has not received sustained historical analysis.

The editors of The American Medical Ethics Revolution provide quite a different rationale for their compendium. The year 1997 marked the 150th anniversary of the Code of Ethics of the American Medical Association. To celebrate, the AMA funded a conference in Philadelphia, in collaboration with the Center for Bioethics of the University of Pennsylvania and the College of Physicians of Philadelphia, to review the past and present of American medical ethics. This volume serves as the conference proceedings. It contains twenty short chapters and an extensive appendix that includes iterations of AMA ethical codes and other AMA ethics texts from 1847 to the present. The chapters are organized into four sections, the first devoted to historical reflections on the AMA Code, and the balance dealing with the present and future of bioethics.

Taken together, these heterogeneous texts provide a wealth of information and viewpoints concerning the history, content, and professionalization of medical ethics and bioethics, primarily in an American context. Jonsen’s survey is short, and so are the chapters in AMA Revolution. Sixteen of the twenty-one authors (Jonsen’s work appears in both books) are leaders in the bioethics community, and some of them, like Jonsen, were active from the 1970s. The five other contributors, four prominent historians of medicine and an influential sociologist, provide external perspectives. The essays’ number, brevity, and diversity make detailed commentary impossible within the limits of this review; nonetheless, some interesting themes emerge.

One theme is that bioethicists and historians view the bioethics universe in ways that verge on the incommensurable. For example, one of the axioms of bioethics history according to bioethicists is that physicians, especially those doing research on humans, had few ethical standards until medical ethicists began developing some from the mid-1960s onward. According to the introduction to AMA Revolution, medical ethics were but the "personal character" of physicians until the 1847 code, for the eighteenth-century British university was not concerned with moral matters. When human experimentation became professionally important in the twentieth century, medicine had a "poverty...