Ethical Deliberation in Multiprofessional Health Care Teams

Chapter 1. Historical Context: Deliberation and Methodology in Bioethics

Chapter 1 Historical Context: Deliberation and Methodology in Bioethics Hubert Doucet The revival of interest in ethical issues concerning biomedicine and health care in the mid-sixties was undoubtedly a search for meaning. Not only was it a protest against certain types of experimentation on human subjects, it also represented a desire to make medicine a more humane enterprise. Whatever interpretation the ethical project of the time took— for example, Van Potter and Andre Hellegers developed different approaches to bioethics—the revival was oriented toward a promotion of the kind of medicine that is moral. In this search for meaning, methodological issues could not be avoided. On the contrary, they were an essential facet of the ideal envisaged by the initial players in this revival. In 1970, the field was dubbed "bioethics," a name that represents one of its essential features, interdisciplinarity. The method was seen as an essential part of the nature of the enterprise. The Social Sciences and Humanities Research Council of Canada, in its 1989 report Towards a Canadian Research Strategy for Applied Ethics, confirms this interpretation. One of the main goals of the revival was to bring together people of different intellectual horizons to discuss major issues related to the development of biomedicine. In the first part of this paper, I will highlightsome facets of the interest in methodological issues raised at the origin of the bioethical movement . In the second part, I will focus on methodologies of the decisionmaking process that have been developed in order to help individuals or groups make a decision when faced with difficult problems. In the third part, I will explain the reasons behind our group working toward new or different avenues in the area of moral decision making. 13 ETHICAL DELIBERATION IN MULTIPROFESSIONAL HEALTH CARE TEAMS METHODOLOGICAL ISSUES ATTHE ORIGIN OF BIOETHICS Bioethics, by definition and understood in a broad sense, is interdisciplinary . It is clear when looking at the origin of the term that it was coined with a view to bringing two worlds that normally ignore one another into dialogue. As early as 1971, Van Potter, from the Wisconsin Medical School at Madison, Wisconsin, claimed that he had "invented a new word and a new scholastic enterprise called Bioethics" defined as "the combinationof 'biological knowledge and human values.'"1 Bio represented the science of living systems and ethics the knowledge of human value systems. His goal was to "build a bridge between the two cultures of science and the humanities."2 In the same year, Andre Hellegers established and directed, at Georgetown University in Washington, the Kennedy Institute of Ethics, which included a Center for Bioethics. He "believed that bioethics would be a uniquediscipline combining science and ethics."3 As early as 1968, he had invited the Protestant moral theologian Paul Ramsey to spend the first of two semesters at the Georgetown University Faculty of Medicine in order to generate dialogue with physicians concerned with ethical dimensions of their work.4 According to Warren Reich, Hellegers could also be considered the father of the expression "bioethics." Hellegers and Potter challenged the classical tradition of grounding ethics in the disciplines of philosophy and theology. Inspired by the work of Aldo Leopold, Potter developed a more comprehensive vision for bioethics that would draw upon the disciplines of evolutionary biology, ecology and cybernetics. His goal was to merge science and philosophy into a new discipline, "bioethics." Hellegers' vision would be to put the accent on a dialogue among diverse fields of research and scholarship,as well as different life experiences. As he indicated in an interviewin 1979, his was a truly ecumenical approach. In 1973, Daniel Callahan, the founder of the Hastings Center, wrote an article entitled "Bioethics as a Discipline." The article "authenticated and registered in the appropriate academic chronicles the birth of the word 'bioethics' and the discipline that bore the name."5 In his text, Callahan 1. Van R. Potter, "Bioethics for Whom?" Annals of the New York Academy of Sciences 196 (1972): 201. 2. Warren T. Reich, "The Word 'Bioethics': Its Birth and the Legacies of Those Who Shaped Its Meaning," Kennedy Institute of Ethics Journal 4 (1994): 321. 3. Reich, "The Word 'Bioethics,'" 323. 4. Paul Ramsey, ThePatient as Person (New Haven, Conn.: Yale University Press, 1970), xix-xx. 5. Reich, "The Word 'Bioethics,'" 331. 14 HISTORICAL CONTEXT: DELIBERATION ANDMETHODOLOGY IN BIOETHICS stated that a good methodology needs to "display the fact that...