Cathy Lynn Grossman: Bioethics Today and Its History
Any given Sunday morning, a bioethicist somewhere in America suits up for a TV appearance on the hot issue of the day or stands by a hospital bed to consult on a wrenching dilemma.
Should doctors prolong the life of a baby born without a brain? Should they be allowed to help the terminally ill kill themselves by prescribing a lethal drug dose? Should there be limits on embryonic stem cell research?
But who are these people opining on what we should do?
"Anyone who wants to," says Arthur Derse, chairman of Veterans' Health Administration's National Ethics Committee.
He's president of the American Society for Bioethics and Humanities, which draws most of its 1,600 members from medical schools and academics in ethics and philosophy. Lawyers, theologians, clergy members, sociologists and others staff scores of bioethics centers and work in the pharmaceutical industry as well.
There are no standards or certification procedures, says Derse, an emergency medicine physician. And rarely are bioethicists questioned about the basis for their views or who pays for their work.
...
"Like business and journalism, these are unregulated professions in an uncredentialed field," says Daniel Callahan, who in 1969 co-founded the oldest such center, The Hastings Center in Garrison, N.Y.
"The good side of this is that it's not excessively rigid, so you can have a great variety of people raising important questions. Raising questions is what bioethicists do best," Callahan says.
The field emerged to address questions raised by major medical and technical advances that arose since the 1960s, including kidney dialysis, the widespread use of ventilators and cardiopulmonary resuscitation. Demand for organ transplants soared after the first heart transplant in 1967, prompting discussion over who is "dead" enough to donate a vital organ and who should have access to transplants.
Social changes such as Medicare, established in 1965, reordered how Americans use medicine and where, raising questions about the just distribution of limited resources. Research ethics also came under scrutiny, with questions raised about informed consent for drug development and new surgical techniques.
Originally, bioethics was cultivated by Catholic medical schools and theologians. But, says Ronald Numbers, historian of science and medicine at the University of Wisconsin-Madison, "those voices were marginalized as the field came to rely more on principles that appear to transcend specific religions."
This may have begun with the seminal textbook Principles of Biomedical Ethics, first published in 1979 by Tom Beauchamp and James Childress of the Kennedy Institute for Ethics at Georgetown University. It details four major principles: autonomy, non-maleficence (the obligation not to do harm), beneficence (the obligation to do good) and justice (what is fair, equitable and appropriate). God is mentioned on just six of 431 pages in the 2001 edition.
Should doctors prolong the life of a baby born without a brain? Should they be allowed to help the terminally ill kill themselves by prescribing a lethal drug dose? Should there be limits on embryonic stem cell research?
But who are these people opining on what we should do?
"Anyone who wants to," says Arthur Derse, chairman of Veterans' Health Administration's National Ethics Committee.
He's president of the American Society for Bioethics and Humanities, which draws most of its 1,600 members from medical schools and academics in ethics and philosophy. Lawyers, theologians, clergy members, sociologists and others staff scores of bioethics centers and work in the pharmaceutical industry as well.
There are no standards or certification procedures, says Derse, an emergency medicine physician. And rarely are bioethicists questioned about the basis for their views or who pays for their work.
...
"Like business and journalism, these are unregulated professions in an uncredentialed field," says Daniel Callahan, who in 1969 co-founded the oldest such center, The Hastings Center in Garrison, N.Y.
"The good side of this is that it's not excessively rigid, so you can have a great variety of people raising important questions. Raising questions is what bioethicists do best," Callahan says.
The field emerged to address questions raised by major medical and technical advances that arose since the 1960s, including kidney dialysis, the widespread use of ventilators and cardiopulmonary resuscitation. Demand for organ transplants soared after the first heart transplant in 1967, prompting discussion over who is "dead" enough to donate a vital organ and who should have access to transplants.
Social changes such as Medicare, established in 1965, reordered how Americans use medicine and where, raising questions about the just distribution of limited resources. Research ethics also came under scrutiny, with questions raised about informed consent for drug development and new surgical techniques.
Originally, bioethics was cultivated by Catholic medical schools and theologians. But, says Ronald Numbers, historian of science and medicine at the University of Wisconsin-Madison, "those voices were marginalized as the field came to rely more on principles that appear to transcend specific religions."
This may have begun with the seminal textbook Principles of Biomedical Ethics, first published in 1979 by Tom Beauchamp and James Childress of the Kennedy Institute for Ethics at Georgetown University. It details four major principles: autonomy, non-maleficence (the obligation not to do harm), beneficence (the obligation to do good) and justice (what is fair, equitable and appropriate). God is mentioned on just six of 431 pages in the 2001 edition.