What is "Bioethics"? pg.2

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B. Evolving "ethics":

Evolving too during this period were the different concepts of "ethics", and the possible roles which ethicists and theologians should play in such critical discourse. In the Ciba conference, most speakers espoused ethical relativity. As Francis Crick expressed it, although there might be some agreement of values, "they do not necessarily coincide ... for practical purposes ... there is bound to be a conflict of values. ...I think that in time the facts of science are going to make us become less Christian."30 However, Paul Ramsey, in his Nobel conference presentations and later debates, was undaunted, analyzing the issues from his position of distinctly expressed theological principles and values.31 Similarly, theologian James Gustafson pushed hard for broader participation in deliberations about scientific advances (the term"broader" meaning "with theologians and other academics"), and he called for a clearer formulation of values to be served by those advances, preparing the way for one of the major methods to be used in bioethics -- "consensus".32

In short, such weighty issues should not be left up to just the scientists and physicians. Input from experts in philosophy and theology should be brought to the tables to provide an evaluation of the "broader values" involved. In that spirit, many conferences that were to follow incorporated distinguished speakers who lectured on the possible roles of theologians and philosophers in these debates.

However, the ultimate conclusions of such discussions seemed to lead instead to the secularization of those very same traditional philosophical and theological values -- under the misguided assumption by some that a "secular ethics" could not in any way be "normative" (i.e., take a principled stand on what is right or wrong). The search was on for a "neutral" ethics (even though there is no such thing), identifiable through the use of "consensus".33 For example, in 1966 Reed College of Portland, Oregon, held a conference entitled, "The Sanctity of Life", featuring sociologist Edward Shils' lecture, "The Secular Meaning of Sanctity of Life, and St. John-Stevs's lecture, " Law and Moral Consensus".34 On the other hand there were those like Daniel Callahan who suggested a non-theological normative formulation along moral philosophy lines, as in his early article, "The Sanctity of Life".35 The secularization of religious and theological values, the use of "consensus" in moral discourse and in law, and the emerging skills of the secular philosophers -- especially analytical philosophers -- would become major characteristics of the new field of normative "secular" bioethics yet to come.

V. The Centers

In the 70's, the debates, and their participants, moved from conferences to permanent centers with the founding of the Hastings Center, the Kennedy Institute of Ethics at Georgetown University, and the Society for Health and Human Values. The ideas, literature and people involved in these early "think tanks" eventually identified the nature, the subject matter, and the methods peculiar to the new field of secular bioethics as we know it today, and especially how and when it is to be applied in public policy.

A. The Hastings Center:

In 1969, Willard Gaylin and Daniel Callahan (long time member and Director of the American Eugenics Society)36 founded the Hastings Center, funded primarily by the individuals John D. Rockefeller III and Elizabeth Dollard, as well as by the National Endowment for the Humanities and the Rockefeller Foundation. Pioneers of the field who came to work at and with the Hastings Center included: Henry Beecher, Robert Coles, Theodore Dobzhansky, Andre Cournand, Rene Dubos, Renee Fox, Robert Morrison, Art Caplan, Paul Ramsey, James Gustafson, Robert Veatch, Marc Lappe, Robert Neville, Peter Steinfels, Bruce Hilton, Martin Golding, and Senator Walter Mondale. The first 4 "research groups" at the Hastings Center addressed issues such as death and dying, behavior control, genetic engineering, genetic counseling and population control, and the conjunction of ethics and public policy. In 1971 the first volume of the Hastings Center Report appeared -- a publication which was to become the early bible of secular bioethics. As Jonsen noted, "The index of the Hastings Center Report over the next years defined the range of topics that were becoming bioethics and constituted a roll call of the authors who would become its proponents."37

B. The Kennedy Institute of Ethics:

The Kennedy Institute of Ethics at Georgetown University was also spawned during this time period. Andre Hellegers was a Jesuit-trained Dutch physician who was working at Johns Hopkins in research in fetal physiology and the reproductive sciences -- eventually earning him a Fellowship from the Joseph P. Kennedy, Jr. Foundation. In 1967 he came to Georgetown University School of Medicine, and was also the Director of Georgetown's Center for Population Research which was funded by a Ford Foundation Grant.38

Hellegers excitedly discussed with Fr. Henle, then President of the college, the need for founding a center at Georgetown to study the ethical issues surrounding his own areas of research. Henley enthusiastically endorsed such a mission. In 1970 a proposal to fund such an institute was submitted to the Kennedy Foundation -- funds later came from the NIH National Library of Medicine (where Jonsen later served as a Fellow). The institute was originally called the Kennedy Center for the Study of Human Reproduction and Development. In 1971 the name changed to The Joseph and Rose Kennedy Center for the Study of Human Reproduction and Bioethics, and finally changed to the Kennedy Institute of Ethics. It opened with 2 research scholars -- LeRoy Walters, a Mennonite theologian, and Warren Reich, a Catholic theologian from Catholic University. Soon to follow were: Charles Curran, Richard McCormick, Gene Outka, John Connery, Tom Beauchamp, Terry Pinkard, Robert Veatch, William May (Protestant theologian), Tris Engelhardt, James Childress, and later Edmund Pellegrino.39

Since 1974 the KIE at Georgetown University has sponsored very popular "intensive summer courses" in bioethics for health care workers, hospital administrators, politicians, lawyers, public policy makers, philosophers, theologians, sociologists, indeed scholars across the academy, government and the private sector. (There are now "advanced" programs, and programs specifically for German, Latin American, Asian and other nationalities). Of significance also was their creation of the National Reference Center for Bioethics Literature, the Encyclopedia of Bioethics, The Bibliography of Bioethics, a joint J.D./Ph.D bioethics program between Georgetown University Law School and the Department of Philosophy/KIE, and a Ph.D. program in the Department of Philosophy with a concentration in bioethics.40 (This is where I entered the field in 1979, as a doctoral graduate student in philosophy and future member of what is now referred to as the "First Generation" of bioethicists.)

C. The Society of Health and Human Values:

In 1965, discussions by the Committee on Medical Ethics and Theology of the United Ministries in Education, a collaboration of the Methodist and Presbyterian Churches, eventually led to the Society of Health and Human Values in 1970. It was funded by the National Endowment for the Humanities (the "munificent benefactor of bioethics", as Jonsen notes)41 and the Russell Sage Foundation. The Society soon established its Institute on Human Values in Medicine, with Dr. Edmund Pellegrino as chairman of its first Board of Directors. Others included Thomas McElhinney, Ron Carson, Larry Churchill, Lorretta Kopelman, Mark Ziegler, David Thomasma, Peter Williams, Warren Reich and Larry McCullough.42

All three of these organizations contributed scholars and ideas to the federal activities in bioethics that ushered in the formal birth of "bioethics".43 Many of them provided "expert" testimonies at many Congressional and Senate hearings to come, and served on a plethora of governmental and private commissions, committees, conferences, and other organizations and activities.


The concrete formal birth of bioethics began with several years of hearings before Congress, hearings which were called to address an increasing number of knotty and bewildering problems especially being generated by medical research and the abuse of human subjects.

A. The Congressional hearings:

The formal birth of bioethics really began by Congressional mandate! Hearings by Sen. Mondale,44 (a founding Hastings Center scholar) in 1968 were designed to commence a national debate on the directions that medical science would take in America. These hearings were particularly concerned with such issues as genetic engineering and organ transplantation, behavior control, experiments on humans, and the financing of research -- and later, with research using live fetuses and in vitro fertilization (IVF) research45 (a form of human embryo research).

Experts in the various disciplines were called before the Committee to testify, including many of those already mentioned before, as well as others who would also take their place in the brave new world of bioethics, e.g., Tris Engelhardt, Alexander Capron, Gernard Barker, Kenneth Vaux, Fr. Albert Moraczewski, Jay Katz, Michael Debakey, James Watson, Arthur Kornberg, Joshua Lederberg, Christian Barnard, Henry Beecher, etc.46

Another series of senate hearings to take up these same rapidly emerging and controversial issues were called by Senator Ted Kennedy during 1973. One of the most contentious issues involved research using live whole fetuses. A Washington Post story had reported that the NIH had released a recommendation from one of its advisory panels, the Human Embryology and Development Study Section, that "encouraged the use of newly delivered live fetuses for medical research before they died."47 Although initially NIH tried to deny the report, several research projects using live whole human fetuses funded by NIH to American scientists in Finland, Denmark and Japan were being reported.48 The news spurred Eunice Kennedy Shriver to contact Georgetown's Dr. Hellegers, a member of that NIH advisory panel, to solicit his support to stop this research.49 To add to the urgency, several hearings began investigations into the abuse of human subjects in medical research during the Tuskegee Syphilis Study (a Public Health Service research project). Senator Ted Kennedy held a series of hearings on these same issues. Eventually there were calls from several House and Senate committees for the establishment of some sort of a governmental commission to respond to these continuous reports of research abuse of human subjects. Various and numerous bills from both House and Senate subcommittees were drafted and redrafted.50

B. The National Research Act and The National Commission:

Despite disputes between the House and Senate versions of the bill,51 eventually these hearings resulted in Congress passing the National Research Act in 1974, which among other things Congressionally mandated the establishment of an 11-member National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The National Research Act mandated this Commission "to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and develop guidelines that should be followed in such research.".52 As Jonsen, a member of that National Commission, profoundly noted, "No legislation had ever before charged a government body 'to identify basic ethical principles', as did Public Law 93-348."53

And the inevitable questions arise. By what Constitutional or other power or authority can the Congress of the United States mandate the appointment of any federal commission or group to identify "what is ethical"? Why should the normative ethical positions of Kant, Mill, Sidgwich, Longergan, Gustafson, Beauchamp, Childress, Callahan, Clouser, Hellegers, McCormick, Jonsen, Ramsey, Veatch, Engelhardt, Pellegrino, Thomasma, or any of the many other ethical "theories" proposed54 be imposed undemocratically by the government on any members of a democratic society?

Nevertheless, that is precisely what was done. By mandate of The National Research Act (1974), the 11-member National Commission55 (1974-1978) was appointed by the then-Secretary of Health and Human Services, Joseph Califano. The membership of this new Commission which was to determine what was "ethical" consisted of three physicians, two biomedical researcher, three lawyers, one public member and two philosophers.56 The appointed members, and some staff and consultants, of the National Commission were:

Chairman Kenneth Ryan (Chief of Staff at Boston Hospital for Women); Robert Cooke (Vice Chancellor for Health Sciences at University of Wisconsin); Donald Seldin (Professor and Chairman of the Department of Internal Medicine at the University of Texas at Dallas); Joseph Brady (Professor of Behavioral Biology at The Johns Hopkins University); Eliot Stellar (Provost of the University and Professor of Physiological Psychology at the University of Pennsylvania); Patricia King (Associate Professor of Law at Georgetown University); David Louisell (Professor of Law at the University of California at Berkeley); Robert Turtle(Attorney at VomBaur, Coburn, Simmons & Turtle, Washington, D.C.); Dorothy Height (President of National Council of Negro Women, Inc.); Karen Lebacqz (Assistant Professor of Christian Ethics at Pacific School of Religion); and Albert Jonsen (Adjunct Associate Professor of Bioethics at the University of California at San Francisco). Many of the staff were also to become influential in bioethics as well: Charles Lowe (NIH), Michael Yesley (Department of Commerce), Duane Alexander (NIH), Edward Dixon, Bradford Gray, Miriam Kelty, Robert Levine, Barbara Mishkin, Anne Ballard, Bernice Lee, Mary Ball, Pamela Driscoll, Lisa Gray, Marie Madigan, Erma Pender, Susan Shreiber, Charles McCarthy, William Dommel, Anthony Buividas, Tom Beauchamp, and Steven Toulmin.57

This legal mandate required the Commission to study the ethical questions raised in the use of several particular populations in research: the fetus, children, the institutionalized mentally infirm, prisoners, and psychosurgery. To aid their deliberations on fetal research, reports were commissioned by: Paul Ramsey, Joseph Fletcher, Richard McCormick, S.J., Arthur Dyck, Sissela Bok, Seymour Siegel, Leon Kass, Richard Wasserstron, Stephen Toulmin, LeRoy Walters, Marc Lappe, Maurice Mahoney, Richard Behrman, and Alexander Capron.58 To further aid the Commission in identifying the "ethical principles" to be used by the federal government, in 1976 a meeting was held at Belmont House, a conference center of the Smithsonian Institution at Elkridge, Maryland. Among those requested to present essays were: Kurt Baier, Alasdair MacIntyre, James Childress, Tris Engelhardt, LeRoy Walters, Stephen Toulmin, and Tom Beauchamp. The final three "bioethics principles" were, according to Jonsen, a combination of suggestions by Engelhardt and Beauchamp.59

C. The Belmont Report:

In its final report, The Belmont Report (1978),60 the Commission satisfied one part of its Congressional mandate by identifying three ethical principles for the government to use in evaluating issues concerning research using human subjects: respect for persons (which rapidly evolved to mean pure absolute autonomy), justice and beneficence - otherwise known as "the Belmont principles", "the Georgetown Mantra", or "principlism". In 1981 these three bioethics principles were used as the basis for the new federal regulations for use in government sponsored research using human subjects -- the OPRR federal regulations61 -- satisfying yet another part of that same Congressional mandate. Thus in 1979 bioethics was officially "born" -- by Congressional fiat -- and immediately applied to the federal government's regulations to determine the "ethics" of the use of human subjects in research.

This is "Bioethics" --, and the bioethicists and organizations who helped to found it. Bioethics, by definition, is clearly not "ethics per se", and hardly the same as the traditional medical ethics of Drs. "A", "B", "C", "D" or "E". Nor is it the same as Catholic medical ethics. This is a brave new "medical ethics", in which "Dr. F" (physician and/or researcher) -- along with members of medical centers and other health care facility staffs, hospital ethics committees, institutional review boards, hospices, government public policy makers, Congressional members and staffs, members of the legal bar and judiciary across the country, state legislators, politicians, university and college faculty and students "across the curriculum", journalists, administrators, bioethics committee members in organizations around the world, etc. -- would be taught and trained in order to be prepared to determine what was "ethical" or "unethical" on a host of issues (not all of them strictly "medical").

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