From ‘What is bioethics? A Historical Introduction’- Helga Kuhse and Peter Singer in (2001) ‘A Companion to Bioethics’, Blackwell Companions to Philosophy.
Bioethics is the result of, on the one hand, new developments in biomedical sciences and clinical medicine, on the other, the growing concern about the power of medical professionals. This is evident in ‘patent rights’ groups and community rights that aim to affect medical professionals’ decisions.
-older (un-termed) field of medical ethics: virtues of good doctor and the patient-doctor relationship
-1970 suggested term ‘science of survival’ – aimed at an interdisciplinary study of the preservation of the biosphere, by Van Rensselaer Potter
-‘bioethics’ as a term to address issues from health care and biomedical sciences but goes beyond the doctor-patient relationship. How:
- Its goal is not to set a code of precepts but a better understanding of the issues.
- Asks philosophical questions about nature of ethics, value of life, what is it to be a person, significance of being human.
- Embraces issue of public policy , directions and control of science.
Before Oath of Hippocrates (5th century BC), in tribal societies- Code of Hammurabi (Babylon 1750 BC)
Asclepias: that doctor equally serves slaves and rich.
The Oath establishes the principles of non-harm and benefit to patients. Sanctity of human life- and importance of Oath, linked to rise of Christianity.
Abortion has been central here, as the Oath prohibits it on the grounds of sanctity of human life. Later and in the thought of Thomas Aquinas, only the abortion of animated foetus was homicide. Other issues are care- especially as early as the Christians introduced the need to care and love neighbours, hence the development of monasteries as hospitals.
19th Century England- Florence Nightingale first nursing school: setting down the ethical precepts of nurses, esp. character
1899- International Council of Nurses , The American Journal of Nursing
1901- ‘Nursing Ethics for Hospitals and Private Use’ by Hampton Robb
At this point the gendered division of medical labour is already deeply established, with woman-nurse/ man-doctor and nurse is responsible to doctor
1965- ‘The International Code of Nursing Ethics’ Item 7: ‘The nurse is under an obligation to carry out the physician’s orders intelligently and loyalty’.
1973-Feminism-self-consciousness, self-assertiveness of nurses– primary responsibility to the patients. Challenge to male dominated ethics by feminist philosophers -Nell Noddings 1984 that ethics is not universal but relationship specific, based on concept of care.
1954- Joseph Fletcher and early work ‘Morals and Medicine’.
After the 1960s- shift of interests of philosophy to practical issues: euthanasia and abortion, ethics of war and capital punishment, animal rights etc. Bioethics a critical discipline (asked questions that had not been asked before).
1962- artificial kidneys in the US and the artificial kidney centre in Seattle- selection of patients for treatment (life and death) had a class bias.
1967- the first heart transplant by South Africal Christian Barnard – allowed by the introduction of respirators in hospitals in 1950s- realisation of difference between heart death and brain death- The ‘Harvard Brain Death Committee’ introduced the criterion of death as the absence of nervous system activity.
Also issues of prolongation of life, when patient unable to say ‘no’. Work at this point questioned the ‘sanctity of life’ approach vs. ‘quality of life’ for medical practice.
1969- ‘The Hastings Center Report’, by the Institute of Society, Ethics and the Life Sciences, founded by Daniel Callahan and Willard Gaylin
Henry K. Beecher and ethics of human experimentation- the cases and the public attention led to changes –>
1973- National Comission for the protection of Human Subjects of Biomedical and behavioral research: regulations to protect the rights and interests of subjects of research.
Belmont Report: Respect for persons , beneficence and justice—> Principles of Biomedical Ethics.
1976- the landmark US case of Karen Ann Quinlan, that doctors had no legal duty to prolong life. Respirator assisted comatose condition- doctors refused family’s wish to end her life, so brought to New Jersey Supreme Court.
About the themes of the book: The Companion to Bioethics divides the interests of bioethics to Before Birth(embryos and fetuses), reproduction (population, cloning, assisted reproduction), genetics, life and death (medical decisions, voluntary euthanasia, disability), resource allocation, organ donation, AIDS, experimentation with human subjects, experimentation with animals, health care practice, and the teaching of ethics. Of these my primary interest is reproduction, before birth andnew genetics.