The birth of bioethics

Albert R. Jonsen, ed., "The Birth of Bioethics," Special Supplement, Hastings Center Report 23, no. 6 (1993). On 23-24 September 1992, "The Birth of Bioethics," held at the University of Washington, Seattle, gathered many of the "pioneers" of the new ethics of medicine to review its history and project its future. A pioneer was defined as one whose name had appeared in the first edition of the Bibliography of Bioethics (1975) and who had continued to work in the field. Some sixty persons made the cut and, of these, forty-two came to Seattle. The occasion of this conference was the thirtieth anniversary of the publication of an article in Life magazine, "They Decide Who Lives, Who Dies" (9 November 1962). That article told the story of a committee in Seattle whose duty it was to select patients for entry into the chronic hemodialysis program recently opened in that city. Chronic dialysis had just been made possible by Dr. Belding Scribner's invention of the arteriovenous shunt and cannula in 1961. It quickly became apparent that many more patients needed dialysis than could be accommodated. The solution was to ask a small group, composed mostly of nonphysicians, to review the dossiers of all medically suitable candidates and sort out those who would receive the lifesaving technology. Thus, the committee was faced with the unenviable task of determining suitability on grounds other than medical. Should it be personality? finances? social acceptability? past or expected contribution? family dependents and support? While the committee was anonymous, word of its existence appeared in the New York Times. Life correspondent Shana Alexander travelled to Seattle to cover what she described at the "Birth of Bioethics" as "the most fascinating story of [her] career." As professor of ethics in medicine at the University of Washington, I thought that the thirtieth anniversary of the appearance of that article was worth commemorating. My university would claim a birthright and, more seriously, those who had worked for some years in bioethics could reflect on the origins and the evolution of our work. Quite shamelessly, I entitled the event "The Birth of Bioethics" although, as any decent historian knows and as many of the conference participants declared, dating the time and place when any social movement begins is perilous and near impossible. Still, the interesting events in Seattle were worth recalling, and the features of those events that presaged the full-grown bioethics movement were worth pointing out. Whether the Seattle events were a birth, a conception, or merely a gleam in someone's eye, I thought it a good time for the early workers in the field to gather, reminisce, and perhaps, begin to make a history. Bioethics has matured into a minor form of moral philosophy practiced within medicine. Today, soundly reasoned articles on a variety of ethical questions appear regularly in the major medical journals. In almost every American medical school, students study, in one form or another, the new medial ethics. Twelve thousand persons subscribe to the Hastings Center Report. Ten "special government employees" of Hillary Rodham Clinton's Health Care Task Force were identifiable as bioethicists. The effect of these developments on medicine and health care has been remarkable. The first historian of the bioethics movement, Professor David Rothman of Columbia University, writes in his Strangers at the Bedside: The record of bioethics' influence ... makes a convincing case for a fundamental transformation in the substance as well as in the style of medical decision making.[1] Where did this new ethics of medicine, or bioethics, come from? What events occasioned its origins? What form has it taken? Who elaborated it? Who pays attention to it? What is its significance for modern medicine, health care, and health policy? Those who work in this new field are only now beginning to reflect on these questions. …