The Logic and Legitimacy of American Bioethics By Mary R. Leinho ...

The early history of the Hastings Center, the first bioethics institute in the United States, reveals the challenges of remaining an independent voice and stalwart critic to biomedicine in the face of constraints stipulated by powerful biomedical resource providers. Stevens argued that the landmark Karen Quinlan case, which recognized the legal right to refuse life-sustaining medical treatment, served to bolster biomedical interests and strengthen bioethics’ foothold in the cultural milieu. Although it is often remembered as a challenge to physicians’ authority, the highly publicized Quinlan case may be better understood as a reduction of organized medicine’s liability (In re Quinlan, 1976).⁴ Altogether, Stevens’ (2000) examination of bioethical issues and events of the 1970s provides a foundation for further exploration of the cultural and institutional contexts of bioethics in more recent years. Her work invites further investigation, closing with the question, “will it [bioethics] be able to free itself from the sources that help generate the dilemmas it seeks to resolve?” (p. 159).

A few studies have examined the roles of governmental bioethics commissions in public policy and the institutionalization of bioethics. Essays commissioned for the Institute of Medicine’s Society’s Choices: Social and Ethical Decision Making in Biomedicine (Bulger et al., 1995) provide comparative analyses of the National Commission and the President’s Commission (Gray, 1995), national- and state-level ethics bodies (Brody 1995), and national bioethics commissions in France and the United States (Charo, 1995). Other, sociohistorical investigations, have explored the political motivations behind the Atomic Energy Commission’s precursory introduction of informed consent in the 1940s (Moreno & Hurt, 1998), the President’s Commission’s review of human genetic engineering in the 1980s (Evans, 1998), and the role played by expertise in the workings of the Human Fetal Tissue Transplantation Research (HFTTR) Panel in the 1990s (Kelly, 1994).

Evans and Kelly examined more recent federal ethics bodies as the scene of jurisdictional conflict between biomedicine and bioethics over the management of biomedical progress. Both scholars consider the relationship between the nature of panel deliberations and resource allocation.