The Birth of Bioethics (review)

Albert R. Jonsen. The Birth of Bioethics. New York: Oxford University Press, 1998. xv + 431 pp. $45.00.

A generation ago, only a few physicians had written some English-language articles and books about the history of medical ethics. Even though medical history had become the most important humanities discipline in American medical schools by then, few historians addressed the subject of medical ethics. Today, medical ethics is the dominant humanities discipline in medical schools, and several scholars (such as Darrel Amundsen, Robert Baker, Lisbeth Haakonssen, Larry McCullough, and David Rothman) have offered various historical perspectives on the subject. Albert Jonsen, a former Jesuit priest who has taught bioethics at two medical schools, presents here an analysis of its origins and development between 1947 and 1987.

The book is divided into three parts. In the first, Jonsen claims that discontent about medical ethics spread to both professionals and the public after the Nuremberg trials in 1947. Alarms were sounded in several conferences during the next two decades. By the early 1970s, some formal organizations and academic programs had been established: the Institute of Society, Ethics and the Life Sciences (Hastings Center); the Kennedy Institute of Ethics at Georgetown University; and the Society for Health and Human Values. These groups supported some of the pioneer bioethicists: Daniel Callahan, Robert Veatch, LeRoy Walters, Warren Reich, and David Thomasma. Other pioneers were theologians (Joseph Fletcher, Paul Ramsey, Richard McCormick) and philosophers (Hans Jonas, Samuel Gorovitz, Dan Clouser, Stephen Toulmin) whose perspectives on the ethical problems of medicine were collectively labeled bioethics. Naming physicians, sociologists, lawyers, and others, Jonsen emphasizes that bioethics was thoroughly interdisciplinary from the beginning, symbolized by the multiauthored first edition of The Encyclopedia of Bioethics that appeared in 1978. Jonsen also traces the extensive responses of the federal government to bioethics, from the Mondale (1968) and Kennedy (1973) hearings, through the reports of two commissions: the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78) and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1980-83); he was a member of both.

In part 2, the author describes key developments that occurred as bioethicists addressed the ethical issues of research with human subjects, genetics, organ transplantation, death and dying, and human reproduction. These five chapters provide excellent summaries of the events that prompted extensive and passionate debates between the late 1960s and the late 1980s. Part 3 is a three-chapter reflection on bioethics as a demi-discipline, a public discourse, and a peculiarly American creation grounded in the country's culture of moralism, meliorism, and individualism.

The book's numerous autobiographical anecdotes properly exemplify Jonsen's pioneering presence during these birth events. His account is the story of the responses of mostly nonmedical professionals to the new circumstances of medical research and practice during the last half of the twentieth century. Their viewpoints and criticisms have certainly influenced the ways that medical professionals think about the moral values of medicine. What is much less clear is the extent to which the ideas and ideals of the bioethicists have become the central core of ethical beliefs among these professionals today. Surely, though, the responses of physicians and others to bioethicists will provide the central dialogues of the new century as bioethics moves beyond its birth. Jonsen's richly detailed narrative is a valuable vantage point for understanding and welcoming these dialogues.

Chester R. Burns
University of Texas Medical Branch, Galveston

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