The Birth of Bioethics - Hardcover

Jonsen, Albert R.

Hardcover

ISBN 10: 0195103254 ISBN 13: 9780195103250

Publisher: Oxford University Press, 1998

Synopsis

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws.
This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues.

About this title

About the Author

Albert R. Jonsen, Ph.D., is Chairman of the Department of Medical History and Ethics and Professor of Ethics in Medicine at the School of Medicine, University of Washington. He is a member of the Institute of Medicine and the National Academy of Sciences, and has served on the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and the President's Commission for the Study of Ethical Problems in Medicine.

Reviews

The field of bioethics has grown enormously over the past few decades. Consequently, people entering the field may try to acquire knowledge about it as rapidly as possible by learning only about current consensus and controversies. By doing so, however, they may not learn that accepted or controversial views concerning bioethics can reflect the time and circumstances in which they arose. Without this awareness, they may not realize that some of those who helped forge bioethics did so at considerable personal sacrifice. And without this awareness, they may not anticipate what they, too, must do if they believe that their views should be heard and should prevail.

In The Birth of Bioethics Jonsen has written an in-depth review of bioethics, including a historical analysis of the field. But this is also a book about heroes.

Jonsen presents the growth of bioethics from 1947, when the Nuremberg Code was drawn up, to 1987. He does so in three chapters on the religious, philosophical, and governmental aspects of the subject. He covers five major areas of bioethics, including research and death and dying, and deals with bioethics as a discipline and as a topic of discourse. In the final chapter, he gives his explanation of why bioethics arose in this country.

The history he presents includes advanced ideas, such as H. Tristram Engelhardt's concept of ethics as an "enterprise in controversy resolution" and Robert Veatch's criticism of the assumption of moral authority by persons with technical competence or what he calls the "generalization of expertise." This material should inform even sophisticated readers. Comprehensive footnotes and illuminating cross-references reflect Jonsen's consummate knowledge of theology, philosophy, history, and literature. He cites Homer and Shakespeare, and he makes the history of bioethics come alive, because he was there.

For instance, I have taught bioethics to medical students for 20 years using a well-known film about a baby born at Johns Hopkins Hospital with Down's syndrome and an intestinal blockage requiring surgery. I learned only from this book that the chairperson of the pediatrics department at Johns Hopkins had had two children with developmental disabilities and that the person who portrayed the baby's doctor in this film had actually been an intern then and had felt a sense of moral outrage at the time.

Jonsen's depictions of the pioneers in bioethics whom he knew and worked with are vivid. Joseph Fletcher, for instance, stood in picket lines, and "turned to... bioethics because everything else was so vicious." Paul Ramsey had this to say about a conference held in the Valley of the Moon in Sonoma, California, to determine whether neonates with severe defects should ever be allowed to die: "The symbolism... should not be lost: a valley on a dead satellite of our mother earth." Warren Reich and George Kanoti, while they were nontenured professors at the Catholic University of America, expressed unpopular views that resulted in their being invited to resign. But Jonsen is with them: "It began to dawn on me that as a newly minted moral theologian, I would not be comfortable or conscientious teaching the traditional doctrine on abortion and contraception."

Jonsen's own beliefs, no doubt, influence which areas he chooses to emphasize. He pays particular attention to the influence of Catholic religious doctrine and of the theologians Joseph Fletcher, Richard McCormick, and Paul Ramsey. Yet Jonsen sees no major issue in American bioethics in which religious and philosophical ethics did not collaborate and sees this "trinity" of theologians as having presided over the birth of bioethics.

Jonsen's unique insights, infused by the compassion he obviously feels, recommend this book strongly. Jonsen's own words are compelling. In regard to choosing whether to allow neonates to die, he states, "The hope seems so great and the loss so devastating to parents that the decision... is particularly agonizing." About the rise of bioethics in the United States he says, "My hypothesis is that the American ethos is strongly tempted to endow various aspects of life with moral meaning in a capricious way." And, with respect to the new forms of technology that have been developed to help women bear children he states, "The difficulty of unraveling the ethics of reproductive technology may be due to our impoverished ability to recognize and appreciate what is normal about being human."

Reviewed by Edmund G. Howe, M.D., J.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Edition details

• Publisher: Oxford University Press
• Publication date: 1998
• Language: English
• ISBN 10: 0195103254
• ISBN 13: 9780195103250
• Binding: Hardcover
• Edition number: 1
• Number of pages: 431