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What bioethics brought to the public.

Arthur Caplan is a prominent spokesman for bioethics.

I've come to believe that there is no point in doing bioethics if, ultimately, some of it doesn't take place in public. The road to "taking place in public" in this culture is through the media.

It is often assumed that the media's bioethics relationship is a recent phenomenon. I don't think that's true. we started this conference with Shana Alexander and a video documentary about the dialysis committee making hard choices. It seems to me the media have in some ways not only been hanging around bioethics, but arguably played the key role of midwife in helping to bring bioethics into existence.

The Shana Alexander story in Life magazine in 1962, lots of abortion articles in the mid-1960s, and stories in the Washington Star and the New York Times were the key to the beginning of the discussion about Tuskegee and later to the establishment of the National Commission and the regulations that emerged from the Belmont Report and its appendices that we've heard so much about at this conference.

Let me describe some sociologic features about that period, say 1962 to the time of Quinlan, the late 1970s. The early relationship between bioethics and the media was based upon scandal--Tuskegee--as well as other outrages such as Willowbrook, or wrenching dilemmas fraught with human interest. Those were the kinds of things that captured the media's attention and seemed to result in publicity. I think that early perception of scandal was partly formed in the crucible of the media and never has really left the minds of those who began this field. In some ways we are still dealing with the legacy of scandal today.

The second comment I would make about those early days is that dilemmas attracted attention. We often believe that bioethics is a field that is too dilemma driven. I think that if you look back to see what the public face of bioethics was during this earlier ear, it was very much the hard choice, who will live, who ought to die types of problems. I don't think it's an accident that much of the literature in bioethics addressed those questions, because the public seemed to be interested in them.

What happened in the 1980s? Consider the stories that pop up on my computer as generating the most attention through that decade: test tube babies; the birth of Louise Brown--I'm cheating a bit here because that was 1978, but that's really where I think you see a big wave of media attention and public dialogue about developments in medicine--Baby Fay; the artificial heart; Baby Doe, Baby Jane Doe and the Baby Doe Rules; and, at the end of the decade, Cruzan.

What is interesting about these stories is that they were technology driven. We may not feel that bioethics should be driven by technologies or only try to grapple with the way some newfangled gizmo or gadget works, but it's clear that the public face of bioethics has been driven by transplants and artificial devices and making babies in test tubes.

Bioethics in this era is still reactive, still becoming involved in public controversy and public comment from hindsight. The theme that emerges throughout all these stories is that ethics is struggling to keep up with technology. No matter how hard you think and no matter what you do, you're trailing behind Dr. Edwards, Dr. Jarvik, Dr. Bailey, or Dr. Starzl.

Brief comment about the 1990s. I think the ma or new dilemma about talking publicly, getting involved in public arenas, trying to make public presentations about bioethics, whether it's sound bites or going in front of commissions or talking at length in interviews and so on about bioethics questions, is that we are now stuck as a field with a terrible ambivalence. Bioethicists are torn in two directions. The public face of bioethics makes Americans nervous because they hate ethical experts. And the people who are in the role of being called upon as experts are nervous because they know that without consensus about the foundations of the field, there may be a hole at the center of the enterprise.
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Author:Caplan, Arthur L.
Publication:The Hastings Center Report
Date:Nov 1, 1993
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