| Chapter 1: | Introduction |
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The term “bioethics” was first published in 1970 (Potter, 1970), and broadened the scope of “medical” ethics to include biology generally, as well as aspects of environmental, population, and social sciences. Furthermore, bioethics is more interdisciplinary in approach than is medical ethics, drawing from law, public policy, cultural studies, religion, and the social sciences; bioethics has likewise become a fixture in the popular media (Callahan). What influence has bioethics wielded over the last 3 decades? To what extent has bioethics made biomedicine more socially accountable? At the same time, to what extent has bioethics been made into a public relations tool for academic and corporate biomedicine?
Several victories are claimed for bioethics in the protection of human research subjects and in expanding patient autonomy in medical care. Two former federal commissions with notable bioethicists among their membership are generally regarded as having been influential in these areas: the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission), and the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (President’s Commission).
The work of the National Commission in the mid-1970s, in response to the Tuskegee Study scandal,1 is credited with having transformed the climate of U.S. research, through regulations that it recommended in the Belmont Report (see Bulger, Bobby, & Fineberg, 1995). Jonsen (1998b) argued that the National Commission’s work laid out the moral structure of research, making research a public enterprise.
During the early 1980s, the President’s Commission issued several reports on a variety of issues, most notably “Deciding to Forego Life-Sustaining Treatment,” which has been widely cited in court cases, bioethics literature, and medical ethics education (see Bulger et al., 1995; McAllen & Delgado, 1984). Furthermore, a study of state trial court judges finds that many judges with a variety of informational aids at their disposal regard ethicists’ testimony as useful (Hafemeister & Robinson, 1994).