This Is Bioethics. Udo Schüklenk
chapter covering issues in research ethics (Chapter 7). The morality of animal experimentation4 has been debated controversially for many decades. There are also issues at the interface between species, such as xenotransplantation. You might also wonder why we are seemingly unconcerned about our natural environment5. Isn’t the destruction of the Amazon rainforest, for instance, an ethical problem? Well, we are not, strictly speaking, unconcerned, however, what is true is that we will focus in this book on environmental issues only insofar as they affect human health and human well‐being. Environmental ethicists have taken on the task of addressing challenging environmental ethics questions6. We shall by and large stay clear of those in this book. Our main focus in the remaining chapters of this book will be – broadly – on challenging ethical questions that arise frequently at the beginning and end of our lives, questions that arise in the context of clinical research involving human participants, the ability of genetic research findings to dramatically change who we are, as well as ethical challenges posed by population and global health issues.
3.5 A lot and very little could be said about the history of bioethics. Historically it certainly grew out of medical ethics7. Traditionally medical ethicists were concerned about normative questions that arise in the health care professional patient relationship. Medical ethics covered many clinical ethics8 issues such as informed consent in the doctor‐patient relationship and professionalism in medicine, but also more contentious issues such as the morality of abortion or euthanasia. It is probably fair to say that varying histories of bioethics as an academic and professional discipline could be written, depending on what country you are looking at. For instance, bioethicist cum historian Robert Baker9 has written a superb volume on the history of medical ethics in the United States leading up to what he calls, quite appropriately, the ‘bioethics revolution’ (Baker 2013). It is well worth a read if you are interested in how medical ethics evolved over the centuries prior to the rise of bioethics. There are fascinating stories to be found, such as that about J. Marion Sims10, the founder of US American gynecology. He shot to fame during his time for the perfection of surgical procedures, but is much more notorious today for achieving this task by undertaking surgery on enslaved African women – without anesthetic or voluntary first person informed consent (Sartin 2004). This might remind you of the kind of ethical relativist questions that we mentioned in Chapter 1, specifically the second type: should J. Marion Sims be judged by the ethical standards of his times or by today’s standards? Well, thankfully this is not actually at issue in this instance. Reportedly one of his competitors, Edinburgh based James Simpson11, noted in those same years, ‘I took occasion to make an extensive series of experiments … upon the relative qualities of different metallic threads … [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform12’ (Sartin 2004, 505). He found it appropriate to use anesthetics even on the animals he used for his experimental surgery, very much unlike his colleague in the United States who thought nothing of abusing enslaved African women during his research. The ethical relativism question doesn’t arise then, because Sims’ work was already controversial and criticized by colleagues during his times.
3.6 A few books about the beginnings of bioethics have been written (Jonsen 1998; Rothman 1991; Evans 2012). Not unexpectedly these accounts of the birth of bioethics were not written by philosophers but by professionals hailing from other disciplines. Most of these histories are fairly United States’ centric. Whether they are reflective of how bioethics came of age in other countries or cultural contexts is unclear as these histories still need to be written. Having acknowledged this, North‐American bioethics and its conceptual frameworks have proven to be very influential the world all over. We will stick in this chapter, for the purpose of sketching a brief history of bioethics, by and large to the United States. It is reasonable to assume – with variations – that similar phenomena led to the birth of bioethics in other relatively resource‐rich countries.
3.7 Bioethics as we know it today is in many ways a creation of the 1970s. Robert Baker writes that the political and cultural changes sweeping through the United States from the mid 1960s created the ideological ground for the birth of bioethics (Baker 2013: 275). Well, what exactly happened during those years? A number of things occurred nearly concurrently. Scandals in scientific research rocked the country. Henry K. Beecher13, a Harvard based medical doctor, published in 1966 an article in a top‐flight medical journal, the New England Journal of Medicine14, flagging fairly outrageous unethical research practices in some 22 or so medical studies, many of which were funded by United States’ government agencies (Beecher 1966). Beecher’s article led subsequently to a US government investigation and a whole slew of policies and regulations addressing ethical standards in biomedical research were introduced and eventually implemented. This wasn’t a uniquely United States’ problem. Two years earlier Maurice H. Pappworth15, an English physician, blew the whistle16 on scandalous research ethics failings in the United Kingdom (Harkness 2001, 366). You will hear more about these episodes in the history of bioethics in Chapter 7.
3.8 Both medical professionals as well as patients saw also the advent of revolutionary medical technologies, such as dialysis machines, ventilators and in‐vitro fertilization (IVF). IVF in particular gave rise to a whole host of controversial normative questions about ‘new ways of making babies’. Traditionally understood medical ethics was simply ill‐equipped to deal with these issues. Meanwhile various groups demanded specific liberties from oppressive medical practices for themselves. The psychiatrist