- Getting Agreement:How Bioethics Got Started
Bioethics is under siege. From the left and the right, from within and without, questions are being raised about its conduct, its nature, its raison d'être. One of the founders of its professional society, the American Society of Bioethics and Humanities, resigned last year to protest the organization's failure to develop formal mechanisms for protecting the professional autonomy of members and standards of professional conduct—accreditation and competency standards, a code of professional ethics, and the like. Critics from without point to the same lack of standards, observing that bioethicists serve as ethics consultants to the very parties who sign their paychecks and pay their consultation fees. In the absence of any professional standards of accountability or responsibility, critics allege, these financial arrangements suggest that a field that originally envisioned itself as a watchdog, protecting patients, research subjects, and the public against the powerful and the privileged, has become the paid poodle, the lap dog, of the very powers it set out to watch.
Addressing the critics' challenge requires, among other things, some reflection on the history of bioethics. Unfortunately, though, the field has been so fixated on present and future problems in biomedicine that it has tended to neglect its own past. Only four monographs on its history have been published. David Rothman's Strangers at the Bedside (Basic Books, 1992) and Albert Jonsen's The Birth of Bioethics (Oxford, 1998) offer a "watchdog" narrative, portraying a field conceived as a constraint on a technologically driven biomedical and research establishment run by a professional elite unresponsive to concerns of patients and the public. Two accounts by sociologists offer "lap dog" narratives. M.L. Tina Stevens argues that "the growth in bioethics does not represent a genuine shift in who rules medicine. It represents [biomedicine's] endeavor to limit potential threats to its ultimate control" (Bioethics in America, Johns Hopkins, 2000, 107). John Evans concurs, "there seems not to have been a single moment when a mainstream scientist wanted to conduct an experiment and bioethicists said no . . . [except] out of concern for safety" (Playing God? Chicago, 2001, 195).
Not surprisingly, bioethicists envision their past—and thus their present and future—differently. Who is correct? Few publications have addressed these questions to those who founded the field. Fortunately, in spring 2002 two graduate students at Georgetown University, Jennifer Walter and Eran Klein, organized a conference celebrating the thirtieth anniversary of the Kennedy Institute of Ethics, at which they asked founding figures to reflect on their own work and on the field generally. More fortunately still, Richard Brown, director of Georgetown University Press, entrusted these two graduate students with editing a book based on the conference. The result is a handsome, carefully edited, and thoughtfully indexed volume offering authors' reflections on their seminal works. Contributors include Tom Beauchamp, Lisa Cahill (for Richard McCormick), Jim Childress, Charles Curran, Tris Engelhardt, Patricia King, William May, Ed Pellegrino, Warren Reich, and Bob Veatch—with an insightful postscript on the history of the Kennedy Institute and its founder, André Hellegers, by LeRoy Walters.
To anyone interested in the history of bioethics, or looking for insights into seminal works that guided the field during its first three decades, this is a "must read." The chapters by Cahill, Curran, and Walters, for example, illuminate one of the least understood aspects of the history of bioethics—its Catholic heritage. Before the presidency of John F. Kennedy, Catholics, like Jews, "Negroes," and other minorities, were excluded from the mainstreams of American life. To cite one instance, when Edmund Pellegrino, director of the Kennedy Institute of Ethics from 1983 to 1988, applied to medical school, "a letter from one Ivy League school . . . declined his application stating that he would be 'happier with his own kind.'" Pellegrino's academic advisor remarked that "Italians . . . were no more welcome than Jews in the major medical schools, and he might fare better if he changed his name. Pellegrino refused" (see the profile of Pellegrino by Karen Geraghty, available at http://www.ama-assn.org/ama/pub/category/6572.html).
The Story of Bioethics: From Seminal Works to Contemporary Explorations. Edited by Jennifer K. Walter...