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Abstract

Bioethics appeared as a new discipline in the early 1970s, led by a little group of American theologians, philosophers, and physicians, fondly called “the founding fathers.” They were the constituents of the “ﬁrst generation” of bioethicists. Around the 1990s, a second generation entered the scene, clearly different from the ﬁrst: they were living and thinking spread all over the ﬁve continents that made them aware of the moral importance of cultural differences. Instead of considering bioethics as an American phenomenon, they thought it in a broader perspective. And global bioethics appeared.

Introduction

Excluding some incidental allusions, the expression “founders of bioethics” appeared in the year 2010, when the James F. Drane Bioethics Institute of Edinboro University convened an international congress under this title. After that, it has been used frequently, always applied to the ﬁrst generation of American bioethicists, those who began the movement in the early 1970s of the past century. The journal Theoretical Medicine and Bioethics published 2 years later, in February 2012, a special issue under the title: “Founders of bioethics: concepts in tension, dialogue, and development.” In the introduction to the volume, James F. Drane explained the reasons why he organized the meeting: “As the years passed and some of those originally involved with the discipline passed away, I was pushed to start on the project” (Drane 2012, p. 1). The goal of the meeting of Edinboro was to meet together the remaining members of the ﬁrst generation of American bioethicists, in a moment in which the baton has passed on the hands of a new generation.

Consciously or unconsciously, the expression “bioethics founders” has been coined following the model of the “founding fathers,” those who promoted the Declaration of Independence and signed the American Constitution. In both cases, they lead processes of emancipation from previous servitudes. In this later case, liberating America from the British crown, and in the former, liberating ethics from the traditional religious obedience, custody, or tutelage. This last one is the process known with the name of “secularization,” essential in the birth of bioethics as a movement (Callahan 2012, p. 16).

Secularizing Body And Life

By the word secularization we mean the process of emancipation of these activities that, being different from the religious one, were traditionally linked with it and subordinate to it, like law, politics, medicine, or ethics. They were all confused with religion in many archaic or primitive cultures. The rational interpretation of the world, initiated by the old Greek philosophers, was the ﬁrst process of secularization. At the beginning of modern times, secularization reached a second step, due to the emancipation of politics from the previous religious or ecclesiastic tutelage. After the liberal revolution of the eighteenth century, both political theory and practice were conceived as completely independent from religious norms and interdicts. Now, two centuries later, from the second half of the twentieth century onward, a third process of secularization is taking place, as a consequence of the liberation of all things related with the management of the human body from the previous religious interferences. Each one of these processes has had important ethical consequences. In the ﬁrst case, the consequence was the birth of ethics as a rational discipline. In the second, the consequence was the theory of the social contract and the new and secularized social and political ethics. In the third, ﬁnally, the novelty has been the birth of bioethics, that is, the ethics of life in general and especially of human life, understood as the secular and autonomous reﬂection and management of life and death, body, and sexuality, by human beings.

From Moralists To Ethicists And Bioethicists

Traditionally, a strict distinction was established between “ethics” and “moral.” The ﬁrst was conceived as a philosophical matter, focused on the rational foundation of moral judgments, while the second was thought as a private ﬁeld of theologians and pastors, called when working in this speciﬁc ﬁeld, “moralists.” The secularization that took place in the second half of the twentieth century changed completely the state of affairs.

On one hand, theologians began to be interested in questions traditionally reserved to philosophers, like the rational foundation of moral judgments. And on the other hand, philosophers were challenged by moral conﬂicts to ﬁnd practical solutions. This means that ethics invaded the ﬁeld of morals and the opposite. The consequence being that it was necessary to coin, in the image and likeness of the old term “moralist,” the new terms “ethicist” and “bioethicist,” to name the activity of the secular people who were now working in the normative ﬁeld traditionally reserved to theologians and priests. In fact, “ethicist” is a word that was not in our vocabulary 40 years ago.

This process of secularization took place ﬁrst of all in the Protestant world, and this is one of the reasons why bioethics began in the United States. The ﬁeld was prepared by some inﬂuential Protestant theologians, like Paul Ramsay, James M. Gustafson, and Joseph Fletcher (Jonsen 1998, pp. 34–64). Some members of the ﬁrst generation were either direct or indirect disciples of them. This is the case of Stanley Hauerwas, James F. Childress, and Robert Veatch. A little later Catholic theology began to renew their traditional views, due to thinkers, like Karl Rahner, and moral theologians as Josef Fuchs, Richard McCormick, Bernard H€aring, Franz Böckle, Alfons Auer, or Bruno Schuller. This process was assumed, at least partially, by the II Vatican Council (1962–1965).

The Background Of The Founding Fathers

The amount of theologians, priests, and pastors in the beginning of bioethics is impressive. In the case of the Catholic priests, many of them studied moral theology in Europe, especially in Rome, knowing ﬁrsthand the new theology. During the 1960s, they took part in the debates about natural law, contraception and abortion, and freedom and moral autonomy, and as a consequence, some suffered a crise de conscience, which obliges them, in some cases, to abandon their activities as teachers in Catholic seminars and universities and others to leave their Roman Catholic priesthood. From Catholic theology to bioethics came David C. Thomasma, Albert R. Jonsen, James F. Drane, and Charles Curran, among others. As Jonsen has stressed, “theologians were the ﬁrst to appear on the scene” (Jonsen 1998, p. 34).

The second group of founders came from philosophy. It was not easy, because philosophy, and especially American philosophy, was in that moment oriented in a completely different way. Stephen Toulmin described the situation in this terms in his inﬂuential paper “How medicine saved the life of ethics”:

From the mid-nineteenth century on, British and American moral philosophy treated ethics as a ﬁeld for general theoretical inquiries and paid little attention to issues of application or particular types of cases [.. .] And this was still the general state of affairs in Anglo-American moral philosophy in the late 1950s and the early 1960s, when public attention began to turn to questions of medical ethics. By this time, the central concerns of the philosophers had become so abstract and general –above all, so deﬁnitional or analytical – that they had, in effect, lost all touch with the concrete and particular issues that arise in actual practice, whether in medicine or elsewhere. (Toulmin 1982, pp. 748–749)

Shifting from the third person to the ﬁrst person, here is the description of Daniel Callahan:

After 3 years in the army during the Korean War and an M.A. in philosophy from Georgetown, I entered the Harvard department of philosophy in the fall of 1956. It was anything but a congenial department. Moral philosophy in that analytic mode focused almost entirely on the struggle between utilitarianism and deontology, but even that struggle was submerged beneath the even greater interest in metaethics, mired in the uses and status of moral concepts and language. Normative ethics was almost entirely absent. That kind of analytic ethics turned out to be tiresome fare for someone who had been drawn to philosophy by the example of Socrates, who asked large and annoying questions not in the academy but in the marketplace. Of that kind of ethics, we heard little, just as we heard practically nothing of Aristotelian ethics. We were warned against existentialism and continental philosophy, which were dismissed as not philosophy at all. (Callahan 2012, p. 12)

Analytical philosophers, the most prominent in the academic life of mid-twentieth century, were not interested in normative questions, they considered far from philosophy, especially in America. And something similar can be said from the third discipline, together with theology and philosophy, in which some other founding father were trained, medicine. Unlike Europe and other parts of the world, physicians have, and especially had, a so high standard of living in America that they weren’t interested in general in spending time and energy in questions like ethics. This is the reason why the number of physicians graduated also in philosophy is so low in the United States and also why the amount of physicians between the founding father is so little. The exception to the rule were Edmund Pellegrino, Mark Siegler, and H. Tristram Engelhardt Jr.

The Technological Revolution

Secularization was only one root of the tree of bioethics. It was, at least another, the astonishing development of biological sciences and medical technology in the second half of the twentieth century. During its ﬁrst half, discoveries in micro and atomic physics transformed the idea of inorganic matter, making possible the rise of a new type of energy, the atomic one, with multiple military and paciﬁc applications. Similarly, during the second half of the century, the revolution took place in the ﬁeld of the organic matter, with the discovery of the molecular base of life and the development of new technologies, like genetic engineering, cloning, assisted reproductive technologies, contraception, etc. All these were related with the origin of life. But no less impressive and important were other novelties that deal with the end of life, like organ transplantation, life-support technologies, new deﬁnition of death, etc. And in between of these two limits, many other medical technologies and devices appeared, changing importantly the exercise of medicine.

And Bioethics Appeared

All these changes were the origin of many value conﬂicts. Everything that is technically possible is not necessarily ethical or moral. This was one of the causes of the birth of bioethics, as Potter explained. He coined the word bioethics to integrate the new biological discoveries with the values that were at stake. Potter was thinking in the long run, because the survival of mankind could be in danger. But there were conﬂicts also in the short run, especially in medicine, where physicians were taken vital decisions continuously. In fact, the members of the ﬁrst generation of bioethicists, the generally known as founding fathers of the discipline, were especially interested in the solution of the short-run decisions that physicians must take every other day. The interest and the sensitivity for the consequences of the long run decisions have been much higher in the members of the second generation than in the founding fathers. Topics like globalization, environment, quality of life of future generations, etc., are more proper of the second generation than of the ﬁrst one. This is the reason why the inﬂuence of Potter over this second generation is being higher than it was on the members of the ﬁrst.

One of the founding fathers, Warren T. Reich, analyzing the origin of the word “bioethics,” coined the expression “bilocated birth,” because it appeared quite at the same time in two different American places, in Wisconsin, with Potter, a research oncologist at its University, and in Washington, when a physician, André E. Hellegers, was working as gynecologist (Reich 1995, 1999). The problem was not who coined before the expression. In fact, it was used by a German pastor and philosopher, Fritz Jahr, in 1927, and with a meaning closer to the one defended by Potter (Sass 2007). The problem is that each one understood the word bioethics in a different way. Potter conceived bioethics as the “science of survival” of mankind, while in Georgetown it was thought as the new face, due to the challenges of the new technologies, of the old medical ethics. In fact, the same Warren T. Reich deﬁned bioethics in his Encyclopedia of Bioethics as “the study of the ethical dimensions of medicine and the biological sciences” (Reich 1978, I, xix–xx). This was the concept assumed and defended by quite all the founding fathers.

Founding Institutions

The members of the ﬁrst generation founded the ﬁrst institutions devoted to cultivate and work in bioethics. This is another meaning of the expression “founders of bioethics.” The most outstanding institutions were three: one close to New York, the Hastings Center; the other close to Washington, the Kennedy Institute of Ethics; and the third was The Society for Health and Human Values, placed in Philadelphia. Renée C. Fox wrote in 1994 that these were “the three associations that virtually founded the ﬁeld of bioethics” (Fox 1994, p. 23).

The Hastings Center began in March 1969 as Center for the Study of Value and the Sciences of Man, a name that was changed to The Institute of Society, Ethics, and the Life Sciences in September the same year. Its leader was from the very beginning Daniel Callahan, “someone who have been drown to philosophy by the example of Socrates” (Callahan 2012, p. 12), and the center was immediately acquired between the members of the ﬁrst generation the category of reference center. Many of them were working in it for years, and others participated in their projects and meetings. In June 1971 appeared the ﬁrst issue of the Hastings Center Report, which immediately became the most outstanding journal of the new movement (Callahan 2012, p. 15). Robert M. Veatch was its ﬁrst staff member. To name the early ﬁgures associated with the center are the Who’s Who of the early bioethics: Sissela Bok, Hans Jonas, K. Danner Clouser, Alex Capron, Eric Cassell, Robert F. Murray, Dan Clouser, Renee Fox, Robin Williams, James Gustafson, Leon R. Kass, Paul Ramsey, Alexander M. Capron, William F. May, Ruth Macklin, Thomas Murray, etc. (Callahan 2012, pp. 13–14).

The Kennedy Institute of Ethics began its path on July 1971 as the Joseph and Rose Kennedy Center for the Study of Human Reproduction and Bioethics. Here the key person, André E. Hellegers, was helped by the two ﬁrst staff members, LeRoy Walters and Warren T. Reich. The ﬁrst was the promoter and director of the Bibliography of Bioethics, published for the ﬁrst time in 1975, and the second the editor of the Encyclopedia of Bioethics, appeared for the ﬁrst time in four volumes in the year 1978. During these years, this center gathered the most outstanding members of the ﬁrst generation of bioethicists: Albert R. Jonsen, Richard McCormick, H. Tristram Engelhardt Jr., Robert Veatch, William May, Tom L. Beauchamp, Edmund D. Pellegrino, etc. From the collaboration of a utilitarian philosopher, Tom L. Beaucham, and a deontologist, James F. Childress, came up the most representative work produced by the founding fathers, the Principles of Biomedical Ethics, appeared in the year 1979. Its “four principles theory” (autonomy, beneﬁcence, nonmaleﬁcence, and justice) became immediately canonical, and some “tyranny of the principles” also began. These principles were described by the authors of equal importance or of the same level, but, “when they are parsed, all come back to autonomy, the most powerful and dominating of the principles. This was bioethics as the natural child of American individualism” (Callahan 2012, p. 18). Due to the wide acceptation of its “principlism” during the 1980s and part of the 1990s, this book introduced a common language, sometimes called the “lingua franca” or the “moral Esperanto” of bioethics. Their critics referred to it as the “mantra” of bioethics. In any case, the founding fathers produced other synthetic books, like the one published by Albert R. Jonsen, Mark Siegler, and William J. Winslade in the year 1982 with the title of Clinical Ethics (Jonsen et al. 1982).

The third important institution was the Society for Health and Human Values, founded in the year 1969 in order to promote the so-called medical humanities (art, philosophy, history, literature, etc.) in medical education. Here the importance was placed in medical teaching and therefore in the development of programs of humanities in schools of medicine. Many members of the ﬁrst generation of bioethicists entered to take part of it through this way: Edmund Pellegrino, Ron Carson, Larry Churchill, Loretta Kopelman, Mark Siegler, David Thomasma, Warren Reich, Peter Williams, and Larry McCullough.

The Financial Support

All this was possible due to the economic support of many private institutions, among others the Rockefeller, the Kennedy, and the Ford Foundations and the public administration, especially through its National Endowment for the Humanities, established by Congress in 1965 to promote studies in the humanistic disciplines. President Nixon included between its goals both comparative religion and ethics, and after that, the National Endowment for the Humanities supported new academic units and the research activities of some of the most outstanding founders of bioethics. “Without the National Endowment for the Humanities, bioethics would have been penurious and possibly died at birth. NEH Chairman Joseph D. Duffey was the presiding benefactor whose largess watered the ﬁeld of bioethics” (Jonsen 1998, p. 26).

An American Phenomenon?

The founding fathers conceived bioethics as an American discovery of universal value. It could only appear in North America: “Bioethics is a native grown American product, which did emerge elsewhere but ﬁnd uniquely fertile ground in the U.S.” (Jonsen 1998, p. 377). “There is an American ethos that shapes the way in which Americans think about morality, and that ethos transformed the response to American medicine into a discipline and discourse called bioethics” (Jonsen 1998, p. 389).

Bioethics is an American product but of universal validity. It could be applied in each part of the world, because, as Beauchamp and Childress stressed, autonomy, beneﬁcence, non-maleﬁcence and justice are second-order principles (Beauchamp and Childress 1979, p. 5) or mid-level principles, in which all human beings can agree, no matter the values and beliefs they were defending in the so-called ﬁrst level. Therefore, these principles are conceived as universal, irrespective of the values and beliefs of each particular community.

The Turning Point Of The 1990s

The criticism about this idea of bioethics gained force at the beginning of the 1990s, when the second generation entered the scene and analyzed it as a movement. Looking back with her sight of anthropologist, Patricia Marshall described in 1992 American bioethics this way:

The ﬁeld of bioethics has been dominated by the tenets and assumptions of Western philosophical rationalistic thought. A principles and rights-based approach to discussions of moral dilemmas has sustained and reinforced a pervasive reductionism, utilitarianism, and ethnocentrism in the ﬁeld. (Marshall 1992, p. 49)

Similar was the perception of the sociologist Renée C. Fox during these same years:

The secular rationality of U.S. bioethics in combination with its autonomous individualism has contributed to the narrowing of its outlook… It downplays communal values and qualities of the heart, like caring, kindness, devotion, compassion, generosity, service, altruism, sacriﬁce, and love. These values involve recognizing and responding to close and distant others in a self-transcending way –to ‘neighbors’ and ‘strangers’, members of future generations in distant lands, as well as ‘sisters’ and ‘brothers’ who inhabit this time and this familiar place. (Fox 1994, p. 53)

These two criticisms were done at the beginning of the 1990s and inside the United States. Outside, the perception was similar. From the European point of view, Henk ten Have criticized the conceptual ground of bioethics, which seemed “too limited and even reductive when seen from the perspective of the tradition of philosophical ethics itself” (Ten Have 1994, p. 104). And from an Asian perspective, Pinit Ratanakul stressed that the isolation of individuals from the social context

reﬂects the dominant American cultural mentality of individualism. This cultural commitment is philosophically and historically base on the assumption that inalienable ‘rights’, possessed by all individuals from birth, exist antecedent to the establishment of any social organization. Within this cultural orientation, ‘good’ is a matter more of personal than of collective concern. (Ratanakul 1994, p. 124).

Conclusion

Renée C. Fox placed this change “at the inception of the 1990s,” when “several intellectual events signaled the entry of U.S. bioethics into a new stage of development.” In her opinion, the 1990s was the “coming of age” of bioethics (Fox 1994, p. 22). It became an international phenomenon, with people engaged all over the world. The situation was quite different from the previous one. New leading institutions appeared in different parts of the world. In the year 1987 the European Society for Philosophy of Medicine and Healthcare was founded, which 10 years later, in 1998, began to publish the journal Medicine, Healthcare, and Philosophy: A European Journal. The Federation of Latin American and Caribbean Institutions of Bioethics (FELAIBE) appeared in the year 1991, the Eubios Ethics Institute in 1990, which publishes since 1995 the Eubios Journal of Asian and International Bioethics, and the Asian Bioethics Association was founded in 1997 (Castro 1999). The International Association of Bioethics appeared in 1992, with the journal Bioethics, ﬁrst appeared in 1987, as its ofﬁcial journal. During the 1990s, also, the most important international bodies, like UNESCO and WHO, began to work in bioethics. The UNESCO Bioethics Programme was created in 1993, and between its activities it was the promoter of the Universal Declaration on Bioethics and Human Rights, adopted by the General Conference on 19 October 2005. And in October 2002, the World Health Organization launched its Ethics and Health Initiative. As a consequence of all of that, bioethics is today a “global” issue, and, the same as in the 1970s, the novelty was the word “bioethics”; today the goal is global, and the new expression is “global bioethics.”

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