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The field of bioethics, as distinct from medical ethics, has existed since the 1960s. Unlike medical ethics, which for centuries has examined the duties and responsibilities of physicians to their patients and to other doctors, the development of bioethics can be traced to the rapid progress in technology and science experienced in the United States in the 1960s. Organ transplantation, chemotherapy, kidney dialysis, respirators, the contraceptive pill, genetic screening, and intensive care units were extraordinary medical breakthroughs that were seen as highly beneficial but also costly and sometimes harmful. This explosion of technological success brought in its wake a set of daunting ethical dilemmas that medicine, academics, legislators, and the public had never previously been forced to face.
In the wake of these developments, issues of healthcare access and rationing, withdrawal and withholding of lifesaving care, dignity in dying, and how to define death and manage the high cost of medical care now loomed large as urgent ethical quandaries. At the same time, societal changes placed greater emphasis on individual autonomy and rights, which prompted the public to press the field of medicine for more patient involvement and control over medical treatment. The ethical dilemmas generated by these advances in science and medicine required interdisciplinary study and reflection that traditional academic disciplines were ill-equipped to handle. In response to these pressing ethical problems, scholars began to venture outside of their traditional subject matter to discuss, debate, and write about these new dilemmas, and bioethics became a new area of academic attention.
Some of the original dilemmas are still at the core of bioethics today. The field now focuses ethical problems in clinical, preventive, and research medicine that involve truth telling, informed consent, confidentiality, end-oflife care, conflicts of interest, nonabandonment, euthanasia, and substituted judgment for incompetent persons. Bioethics has established both the right to informed consent and the right to control one’s medical treatment as key tenets of American law and ethics. With each new technological breakthrough, the field of bioethics expands its scope to address new ethical dilemmas, most recently those involving the human genome project, stem cell research, artificial reproductive technologies, the genetic engineering of plants and animals, the prospect of human reproductive cloning, preimplantation genetic diagnosis of embryos, nanotechnology, and xeno-transplantation. Bioethics has also more recently begun to reflect on the health-care challenges faced in developing nations, such as whether national or local standards should govern the conduct of medical research or the problems of rationing access to innovative treatments in nations besieged by devastating epidemics such as malaria or AIDS.
Since the 1960s, the field of bioethics has gained legitimacy as an independent academic discipline, and that new status has brought significant changes in the structure and institutions of the field. Originally, the institutions of bioethics were independent think tanks. Today, the trend is the creation of academic bioethics departments, either within a medical school or school of arts and sciences. The professionalization of bioethics has taken it from the academic margins to an accepted place within universities, hospitals, regulatory bodies, the media, and industry.
- Callahan, Daniel. 1973. Bioethics as a Discipline. Hastings Center Studies 1 (1): 66–73.
- Fox, Daniel. 1985. Who Are We: The Political Origins of the Medical Humanities. Theoretical Medicine 6: 327–341.
- Jonsen, Albert. 1998. The Birth of Bioethics. New York: Oxford University Press.
- Potter, Van Rensselaer. 1971. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice Hall.
- Reich, Warren, ed. 1978. Encyclopedia of Bioethics. New York: Free Press. 3rd ed., 2004. Ed. Stephen G. Post. New York: Macmillan.
- Reich, Warren. 1994. The Word “Bioethics”: Its Birth and the Legacies of Those Who Shaped Its Meaning. Kennedy Institute of Ethics Journal 4: 319–336.
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