Bioethics in America: Origins and Cultural Politics (review)

Bioethics in America: Origins and Cultural Politics. By M. L. Tina Stevens. Baltimore: Johns Hopkins Univ. Press, 2000. Pp. 204. $39.95

It isn't often that a reviewer gets to look at an interpretation of the development of her professional life over the course of 35 years from the perspective of a younger scholar who is distanced by age from the events under analysis. Bioethics in America: Origins and Cultural Politics provides just such an opportunity. Author M. L. Tina Stevens' thesis is provocative and essentially correct. She believes that the bioethics movement, necessitated by the advances of medicine and technology in post World War II America, was an aid to physicians and biomedical researchers because it fostered the illusion of lay ethical oversight, but that it in fact served the needs of newly emerging biomedical technologies.

The first chapter presents prewar issues in science and technology concerning the development of the atomic bomb and genetic advances in human engineering, as well as the critical response to the ethics of their use and continuing scientific advancement. Stevens describes the horror expressed by Lewis Mumford after the bombing of Hiroshima and Nagasaki, and his belief in the new Pentagon of power reinforced by the "megamachine" that was created by the technology of the bomb. The megamachine became the "driving force behind mankind's technological progress" and the rapid acquisition of the good life in the 1950s for war-weary Americans.

Throughout the 1950s and 1960s, the public became aware of Nazi atrocities in the name of science, and Mumford and other social critics, such as Marcuse, Ellul and Roszak, warned of the dangers of technocracy and the loss of humanism. The idealism and humanistic focus of the 1960s, coupled with a flourishing biological revolution, demanded that the advances of science be ethically examined by the intellectual "non-scientific" community. Gordon Taylor, in Biological Time Bomb, warned that only "a few imaginative scientists had attempted to examine the implications of their work" and that others were not accepting their responsibility to do so. In words that are prescient, historian Donald Fleming ("On Living in a Biological Revolution") warned more than 60 years ago that the scientific ideal "is the manufacture of man": "control of numbers by foolproof contraception; gene manipulation and substitution; surgical and biochemical intervention in the embryonic and neonatal phases; organ transplants or replacements at will." "General acquiescence" to these goals, Fleming said, would lead to "a chilling type of human perfection."

By the end of the 1960s, the terms bioethics and bioethicist have come into use. An understanding of the scope of bioethics differs according to its proponents. One of the early founders of the Hastings Center, Renee Fox, was highly critical of the bioethical movement for its lack of social and political orientation. Fox saw the "bioethics focus on individualism as reductionist and conservative"; her critic, social historian David Rothman, considered this "commitment to individual rights" as "the core of its success." Simply put, the elevation of "individual rights, autonomy and self-determination as a non-negotiable virtue" led, according to Fox, to a lack of concern with social problems such as "who benefits?" and at what cost to under-served groups. Interestingly, Rothman's interpretation of bioethics recognizes social inequalities, but does so by relating bioethics to the civil rights movement and the wresting of power by vulnerable minorities to achieve equity. Civil rights applied to bioethics allows patients (a vulnerable minority) to exercise autonomy and have the power to make medical decisions.

Bioethicists with theological backgrounds, such as Joseph Fletcher and Paul Ramsey, changed the nature of the debate from the individual vis-à-vis society to mankind in relation to God. Fletcher saw man as an enlightened partner with God, making rational decisions about increasing biological choices; Ramsey cautioned that man was playing God and overstepping human boundaries.The need for a moral understanding of scientific advancement was recognized as a...