The Development of Bioethics: Bringing Physician Ethics into the Moral Consensus

Abstract

This chapter analyzes the prehistory and early development of bioethics as a practice and scholarly discipline. It proposes that bioethics emerged in the 6-year period surrounding 1970 and resulted from a unique confluence of scientific and cultural developments related to medicine and the biological sciences. Setting this period within a larger historical context, the chapter retraces some of the major historical developments in “physician ethics” and “medical ethics” and explains how they gradually gave way to “bioethics.” Crucial to this analysis is the role that humanists have played in informing the ethical thinking of both physicians and the wider public. Where communication between physicians and humanists has been close (here Veatch cites the Scottish Enlightenment specifically), the connection between medical ethics and the wider ethics of society has also been tightly fitted. However, when cultural and scientific changes produce divisions between physicians and ethicists, the guiding ethic of medicine detaches from and conflicts with the wider cultural ethic. Bioethics emerged when physicians and humanists were brought back together by the collapse of an “isolated professionally-articulated medical ethics” that was out of touch with the dominant moral thinking of the nineteenth and early twentieth centuries and unable to withstand the strong scientific and cultural trends of the 1960s. This collapse was precipitated by the emergence of chronic disease as the dominant concern of medicine, which left patients in a unique position to question the decisions of physicians, as well as by the general challenges to authority that were prevalent in the various protests and countercultural movements of the time period. Bioethics emerged to fill the resulting void, offering a cross-disciplinary dialogue better suited to address the new moral issues and ethical domains opened up by rapid advances in medicine and the life sciences.