Bulletin of the History of Medicine 78.1 (2004) 257-258
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M. L. Tina Stevens. Bioethics in America: Origins and Cultural Politics. Baltimore: Johns Hopkins University Press, 2000. xvi + 204 pp. $39.95 (0-8018-6425-9).
M. L. Tina Stevens's book aims to explain how and why bioethics became prominent in American culture. These questions bear sharp scrutiny, given the growth of bioethics as a field, its prominence in political deliberations, and the attention given to it by the media.
Prior histories of bioethics placed its birth in the turbulent 1960s, with labor pains as far back as the Nuremberg trial of Nazi doctors.1 Stevens finds that the real progenitor of an "original bioethical profile" (p. 1)—skepticism about runaway technology—is an older American tradition of ambivalence about the proper scope of science and technology (as expressed by, for example, Jefferson, Thoreau, and Stuart Chase). This ambivalence resurfaced in the post-World War II "responsible science movement" (p. 7), which surveyed the ethical dimensions of atomic war, social control of nuclear energy, and use of genetic engineering. Stevens's main thesis is that "bioethics—wittingly or unwittingly—helped to transform the [current] era from the radically charged, confrontational cultural milieu of the 1960s to an age in which ethical experts manage problems generated by a technology that is seen, ironically, as value-neutral in its creation, even while it is problem-causing in its outcomes" (p. 45). She relies mainly on the story of the Hastings Center, founded by Daniel Callahan and Willard Gaylin in 1969, to illustrate this explanation. [End Page 257]
Stevens's account is not entirely accurate or complete. Bioethics is not one single phenomenon—namely, the by-product of a war of ideas and tactics between militants in a cultural revolution and technological elites who co-opted a once-free critical force to guard their hegemony. Rather, it is a chimera of many public and scholarly activities. Any history of bioethics is weaker without inclusion of the legacy of Roman Catholic moral theology, especially as advanced by André Hellegers, a force of nature at Johns Hopkins (1963-68) and at Georgetown after 1968. It was Hellegers and friends who borrowed the term "bioethics," coined by V. R. Potter,2 to describe the shape of their vision.3 And it was Hellegers whose multidisciplinary standards for the study of human reproduction and development were incorporated into the formation of the Kennedy Institute of Ethics (created in 1970-71). Stevens does refer to Georgetown (p. 169), but she overlooks its role as "leader of leaders" in university-based bioethics centers, which are very different animals from free-standing centers. The Hastings Center has enjoyed some celebrity, but Georgetown has had more influence than Hastings on national policy in human subjects research, beginning with policy on fetal research. Stevens overlooks the fact that it was Georgetown bioethicists who in 1975 shaped a national research policy emphasizing the protection of the fetus.
The impact of medical humanities prior to bioethics also deserves—but does not receive—Stevens's attention. Without the medical humanities movement, it is doubtful whether bioethics could have been as successful in its teaching role. Stevens's book is nevertheless entirely accurate on two scores. The first is her critique of blind spots that prevent social, economic, and political factors from having some weight in ethical analysis. The second is her focus on the issue of integrity, especially in clinical and corporate settings: economic pressures and scarcity of resources can take a toll on critical distance and freedom to initiate policy studies.
In sum, this book explains what are probably the greatest moral faults of organized bioethics. It is not an adequate history of why or how bioethics emerged.
University of Virginia (emeritus)
1. David K. Rothman, Strangers at the Bedside (New York: Basic Books, 1991); Albert R. Jonsen, Birth of Bioethics (New York: Oxford University Press, 1998).
2. Van R. Potter, "Bioethics, the Science of Survival," Perspect. Biol. & Med., 1970, 14: 127-53.