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But was it bioethics?

Judith Swazey, with Renee Fox, wrote the first sociological study of the Seattle dialysis program, The Courage to Fail.

One of the many lessons I learned doing graduate work in the history of science is that it is difficult to determine precisely when a new field, discipline, or subspecialty comes into being. Whatever the emerging sphere of intellectual endeavor--whether it is molecular biology, medical sociology, or bioethics, for example--persons are already working in that area well before it is institutionally recognized is such. Some of these precursors are retrospectively considered to be "pioneers," and similarly, certain moments, phenomena, or events are designated in hindsight as marking the origin of the field in question. But seen in the participant-observer, historical, and sociological perspectives that Renee Fox and I bring to this conference, we would contend that the creation of the Seattle Kidney Center's Admissions and Policy Committee and Shana Alexander's November 1962 account of it in Life magazine, occurred in the pre-bioethics era.

This is not to say that no concentrated or systematic reflection on ethical, social, and religious dimensions of medical, scientific, and technological progress was taking place in the 1950s and '60s within the medical profession or in other social contexts. The extent and depth of the daily, lived-in reflections and copings of one medical research group and their patient-subjects involved in experimental treatments, including kidney transplantation and acute dialysis during the early 1950s, for example, were chronicled by Renee Fox in Experiment Perilous. By the late 1960s, an important element in the changing social context of biomedical research was a diminishing of the once strong conviction that such research would be an unqualified good for human health and welfare. A variety of biomedical research analysts and commentators, journalists, members of Congress, and in turn the general public began expressing concerns about the possible negative social, ethical, legal, economic, and political implications of new and prospective advances in areas such as behavior control, genetic engineering, and human experimentation, as well as organ replacement. In 1968, for example, healings about a proposed National Commission on Health and Society presaged the later formation and mandates of bodies such as the National and President's Commissions, and the emergent interest in what became known as "bioethics."

One of the major points that we want to emphasize by these glimpses into what we call the pre-bioethics era of contemporaneous biomedicine is that physicians and others did acutely experience and seriously ponder what we currently identify as questions of biomedical ethics before the interdisciplinary field of bioethics was institutionalized and attained societal stature. In those now long-ago years when chronic dialysis began, the terms bioethics and ethicist were not yet heard in the land. Institutions like The Hastings Center, the Kennedy Institute, and the Society for Health and Human Values had not been established, and perhaps--a point some of you here today could answer--not even envisaged. The Public Health Service Guidelines for research with human subjects had not been formulated, the Harvard Ad Hoc Committee to Examine the Definition of Brain Death had not been convoked, and the National Research Act creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research had not been drafted. It would be more than a decade before cases like that of Karen Ann Quinlan and Roe v. Wade would begin to appear in the U.S. courts. Medical school courses in medical ethics were a rarity. Moral philosophers, predominantly trained in Anglo-American analytic philosophy (currently referred to with some ambivalence by the bioethical community as "principlism"), who specialized in medical ethics had not come into prominence in philosophy departments and medical centers, nor were their pronouncements avidly sought by the mass media. And the first volumes of the Encyclopedia of Bioethics and the Bibliography of Bioethics were many years away. These are some of the indicators that lead us to the conclusion that, at best, the hybrid entity called U.S. bioethics may have been in a gestational phase in 1962 but was several years away from its institutional and societal birthing.

Finally, irrespective of whether bioethics has an exact birthdate, and if so, what it might be, our conception of the kind of phenomenon that it constitutes is more encompassingly social and cultural than the biomedically and technologically deterministic definition of bioethics as "the study of the ethical implications of medical technology." In this prospect we share the view of the field and its genesis articulated by Paul Ramsey at a 1973 conference, "Health Care and Changing Values," held by the Institute of Medicine:

If there are moral dilemmas in

modern medicine, if, as some

would say, there is a moral crisis in

the ethics of the medical profession,

this does not result from recent

triumphs in medical research

or the great promise and

grave risks stemming from medical

technology. The fundamental

reason is the continuing moral

crisis in modern culture that

generally reverberates through

all professions. It can no longer

be assumed in the human community

that we are agreed on

moral action guides, the practice

of virtue, the premises and principles

of the highest, most

humane, most bracing ethics, or

what a moral agent owes to anyone

who bears a human countenance.
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Author:Swazey, Judith P.
Publication:The Hastings Center Report
Date:Nov 1, 1993
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