The first history of American medical ethics published in more than a half century, Before Bioethics tracks the evolution of American medical ethics from colonial midwives and physicians' oaths to current bioethical controversies over abortion, AIDS, animal rights, and physician-assisted suicide.
The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)
Bioethicists function in an environment in which their peers - healthcare executives, lawyers, nurses, physicians - assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts (...) that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. (shrink)
Standard bioethics textbooks present the field to students and non-experts as a form of "applied ethics." This ahistoric and rationalistic presentation is similar to that used in philosophy of science textbooks until three decades ago. Thomas Kuhn famously critiqued this self-conception of the philosophy of science, persuading the field that it would become deeper, richer, and more philosophical, if it integrated the history of science, especially the history of scientific change, into its self-conception. This essay urges a similar reconceptualization for (...) bioethics, arguing that the analysis of moral change ought to be integral to bioethics (and to ethics generally). It proceeds by suggesting the sterility of the ahistoric, rationalist applied ethics model of bioethics embraced by standard bioethics textbooks. It also suggests the fecundity of alternative conceptions of the bioethics that focus on the history of successful and failed attempts to negotiate moral change, and the history of multifaceted relations between moral philosophy and practical ethics. (shrink)
Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, can learn (...) from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded. (shrink)
Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two (...) historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced. (shrink)
Although bioethics societies are developing standards for clinical ethicists and a code of ethics, they have been castigated in this journal as “a moral, if not an ethics, disaster” for not having completed this task. Compared with the development of codes of ethics and educational standards in law and medicine, however, the pace of pro-fessionalization in bioethics appears appropriate. Assessed by this metric, none of the charges leveled against bioethics are justified. The specific charges leveled against the American Society for (...) Bioethics and Humanities and its Core Competencies report are analyzed and rejected as artifacts of an ahistoric conception of the stages by which organizations professionalize. For example, the charge that the ASBH should provide definitive criteria for what counts as “medical ethics consultation” antecedent to further progress towards professionalization is assessed by comparing it with the American Medical Association's decades-long struggle to define who can legitimately claim the title “medical doctor.” Historically, clarity about who is legitimately a doctor, a lawyer — or a “clinical ethicist”— is a byproduct of, and never antecedent to, the decades-long process by which a field professionalizes. The charges leveled against ASBH thus appear to be a function of impatient, ahistoric perfectionism. (shrink)
Bioethics and human rights were conceived in the aftermath of the Holocaust, when moral outrage reenergized the outmoded concepts of and renaming them and to give them new purpose. Originally, the principles of bioethics were a means for protecting human rights, but through a historical accident, bioethical principles came to be considered as fundamental. In this paper I reflect on the parallel development and accidental divorce of bioethics and human rights to urge their reconciliation.
The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, (...) which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names. (shrink)
The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to ‘universalise the best’. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the ‘done thing’ without explicit policy directives and in a manner largely invisible to patients, (...) to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. (shrink)
I was the graduate student that Albert Jonsen so aptly describes. Bronx born and educated at the City College of New York, I emigrated to the Midwest to study at the Minnesota Center for the Philosophy of Science, where May Brodbeck, Herbert Feigl and other “logical positivists” were engaging in an ongoing dialogue with postpositivists like Paul Feyerabend and Karl Popper. In this environment, I studied philosophy of science, epistemology, and metaethics—the epistemology and logic of ethical concepts and language. I (...) even wrote my thesis on the ur-text of the metaethical turn, G. E. Moore's Principia Ethica. Then, like other epistemologists and metaethicists, “a public disaster, the American military involvement in Southeast Asia,” as well as the burgeoning civil rights movement, drew me into the sphere of public debate. (shrink)
: Medical ethics often is treated as applied ethics, that is, the application of moral philosophy to ethical issues in medicine. In an earlier paper, we examined instances of moral philosophy's influence on medical ethics. We found the applied ethics model inadequate and sketched an alternative model. On this model, practitioners seeking to change morality "appropriate" concepts and theory fragments from moral philosophy to valorize and justify their innovations. Goldilocks-like, five commentators tasted our offerings. Some found them too cold, since (...) they had already abandoned applied ethics; others too hot, since they still find the applied ethics model to their taste. We reply that the appropriation model offers an empirically testable account of the historical relationship between moral philosophy and medical ethics that explains why practitioners appropriate concepts and fragments from moral philosophy. In contrast, the now fashionable common morality theory neither explains moral change nor why practitioners turn to moral philosophy. (shrink)
(2002). On Being a Bioethicist: A Review of John H. Evans Playing God?: Human Genetic Engineering and the Rationalization of Public Bioethical Debate. The American Journal of Bioethics: Vol. 2, No. 2, pp. 65-69.
Editors Wanda Teays, John-Stewart Gordon, and Alison Dundes Renteln have assembled the works of an interdisciplinary, international team of experts in bioethics into a comprehensive, innovative and accessible book. Topics covered range from torture and lethal injection to euthanasia, sex selection, vulnerable human subjects, to health equity, safety and public health, and environmental disasters like Bhopal, Fukushima, and more.
At the center of_ In Dark Again in Wonder_ are readings of René Char and George Oppen. Both of these poets achieved recognition at a young age, Char among the French surrealists in the 1930s, Oppen among the American objectivists in the same decade. Both were independent individuals who, having found their way to communities of inventive writers, stepped back and shaped their own idiosyncratic paths. Both responded decisively to the social upheavals of the 1930s and ‘40s. Oppen committed himself (...) to radical politics in the ‘30s, a decision that, as it turned out, led to his not writing poetry for nearly twenty-five years. Char fought in the Resistance in the '40s. Both, in their mature work, developed a kind of poetry that is at once a love poetry, a meditative poetry, and a poetry of encounter. The concluding chapter of the book places the questions raised by Char’s and Oppen’s work in a larger context, tracing the cultural history that shapes our modern experience of inhabiting a tension between an historical and a metaphysical horizon of experience, or, as this appears in a different but related light, a tension between a sociological and an existential understanding of our lives. Char and Oppen are both poets concerned with the old philosophical questions that are still with us—the nature of spiritual freedom, the gathering of the self in relation to death, the meditation on the whole, the turn to Nature as the open space of the whole under the conditions of modernity, the clarification of the ground of vision in eros and love, and the search for the good life—while at the same time they fully engage the social predicaments and promises of their world. "A brilliant, philosophical, and aesthetic approach to twentieth-century poetry that casts important light on the great poetic works of René Char and George Oppen. Revealing the ongoing role of wonder in the post-Romantic tradition, it points to two remarkable poets whose work embodies imagination in the knowledge of inevitable loss, renewal in the awareness of despair. This is a book worth reading for its insight into two poets and the larger literary and philosophical currents in which they lived and worked." _—Sandra L. Bermann, Princeton University_ "This is a brilliant, erudite, beautifully written, and compelling book, one that makes an important contribution to our understanding not only of the two poets on whom it focuses but of the period they inhabit and that we, as their inheritors, continue to inhabit. Robert Baker wears his considerable learning lightly, but he has deep knowledge both of the history of European and American poetry and of the history of philosophy. He has thought deeply and passionately about poetry, philosophy, history, and the ways in which they intertwine." —_Henry Weinfield, University of Notre Dame_ "Robert Baker has written a fine and unusual book: a study of two remarkable poets, one French and the other American, and a concluding reflection of considerable literary and intellectual reach on the gap between history and metaphysics in which both poets found themselves and in which we still subsist. Bake'rs style is synthetic, magisterial, drawing on a capacious knowledge of literature and the history of ideas." —_Kevin Hart, University of Virginia_. (shrink)
Do human beings share a common morality? Natural Law: A Lutheran Reappraisal presents engaging essays from contemporary Lutheran scholars, teachers, and pastors, each offering a fresh reappraisal of natural law within the context of historic Lutheran teaching and practice. Thought provoking questions following each essay will help readers apply key Bible texts associated with natural law to their daily lives.