HISTORY OF BIOETHICS
Geraldine S. Canete, MAN, RN
Bioethics is derived from the two words bio (life) and ethocs (behavior). To study the behavior of human
life comes under the umbrella of bioethics.
Till 1970s the term bioethics was not take until the scientist Van Renssealaer Potter used the term
bioethics for the first time in 1971. He is a medical oncologist who defines bioethics as a combination of
biological knowledge and human values.
Bioethics was born as a response to scientific and social progress. Such progress resulted to threatening
conditions and critical concerns that also raised doubts about human’s ability to survive.
The turning point was when the medical profession had to confront new questions, raised directly as a
result of extraordinary progress being made in biomedical sciences.
Threatening conditions in history
Several highly publicized abuses in the field of human experimentation
1930 -1970 - TUSKEEGEE, ALABAMA, US GOV’T HAD SYPHILIS EXPERIMENT AMONG 400 BLACK
AMERICANS (1947) WHO WERE NOT TREATED DESPITE THE DISCOVERY OF PENICILIN
1947 - Nuremberg Code. Condemned all experimentation on human subjects without their consent in
response to Nazi’s experiments.
1963 - tumor cells were injected without consent to elderlies at the Jewish Chronic Disease Hospital in
Brooklyn New York
1965-1971 - Studies on viral hepatitis immunization at Willowbrook State Hospital in New York where
handicapped children were inoculated with the virus.
Discoveries in genetic engineering which brought the potential for manufacturing biological weapons
and altering the very constitution of life forms, species and individuals.
Critical Concerns
Human experimentation
The discovery of genetics
Organ Transplants
The beginning of life and human procreation
End of life issues
Changes that gave birth to the need for Bioethics
The following changes gave rise to the need of bioethics:
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Chapter 3: History of Bioethics
1. because of perennial issues, dilemmas & problems
2. because of legal dimension- To address legal problems in health care with ethical
concerns
3. Emergence of ethical practice in health care
4. to provide awareness to the health team of the do’s and don’ts of nursing practice
5. To enrich one’s competence by understanding that the patient is a person and holistic
individual
6. To make clear to us why one act is better than the other
7. Enable us to live and have an orderly social way of life
8. Scientific Advances
9. Inequalities in socio-economic, educational and political positions
10. Finitude of resources
11. Changes in the doctor-patient relationships
12. Rampant unethical behavior
DEVELOPMENT OF BIOETHICS
Individual scholars began to legitimize bioethical issues as questions deserving rigorous academic study.
But bioethics solidified itself as a field only when it became housed in institutions dedicated to the study
of these questions.
The first institution devoted to the study of bioethical questions was a freestanding bioethics center,
purposely removed from the academy with its rigid demarcations of academic study.
The institution was the Hastings Center, originally called The Institute of Society, Ethics and the Life
Sciences, which opened its doors in September 1970.
1969 -HASTING’s CENTER – founded by the Philosopher Daniel Callahan and the Psychiatrist Willard
Gaylin. The purpose was to study and formulate the norms especially in the context of research and
experimentation in the biomedical field. At that time the term bioethics was not yet used.
1970 -1971 – Van Rensseler Potter introduced the term bioethics in two publications:
Bioethics : The science of survival (1970)
Bioethics : Bridge to the Future (1971)
According to Potter, Bioethics is broader in scope than traditional medical ethics.
The second institution that helped solidify the field of bioethics was the Kennedy Institute of Ethics,
which opened at Georgetown University in 1971.
1970 – ANDRE HELLEGERS – a young obstetrician as an expert in fetal physiology, was asked in 1971 to
direct the KENNEDY Institte for the Human Reproduction and Bioethics of Georgetown University.
Academic bioethics was born with the creation of the "bioethics center.”
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He proposed a maieutic (Socratic) dimension of bioethics that understands values by way of the dialogue
and contrast between medicine, philosophy, and ethics which paved the way for an interdisciplinary
method.
The objective of bioethics he identified is the ethical aspects implicit in clinical procedures.
Hence bioethics became ethics applied to biomedicine which is a restricted scope as compared to
Potter. But maintained that the direct study of biological problems causes ethics to progress and that
the clinical bioethicists are more expert than the traditional moralists.
From these modest beginnings, the field of bioethics exploded, with dozens of universities following
suit, creating institutions whose sole function was the study of bioethical issues.
Bioethics was now permanently on the academic map and central to public discourse.
INTERPRETATIONS OF BIOETHICS:
“The systematic study of human conduct in the area of life sciences and health care, in so far as this
conduct is examined in the light of moral values and principles.” (W.T. Reich, Encyclopedia of Bioethics,
1978)
“The systematic study of moral dimensions – including the moral visions, decisions, conduct and policies
etc – of the life science and healthcare, employing a variety of ethical methodologies in an
interdisciplinary setting.” (Reich, Encyclopedia of Bioethics, 1995, 2004)
On pluralistic bioethics that is also relativistic: This new discipline cannot be understood as a simple
comparison of the different opinions and the various positions that exists; rather it must propose
standards, values and effective decision-making approaches providing objective answers based on
rationally valid criteria.
The search for adequate answers demand an interdisciplinary approach to the problem, which is one of
the unique characteristics of bioethics.
“A discipline with a rational epistemiological status that is open to theology, which is understood as a
separational science, the ultimate authority and the horizon of meaning. Starting from the definition,
description of the scientific, biological and medical data, bioethics rationaly examines the liceity of man’s
interventions on man.” (Sgreccia, L. Personalist Bioethics, 2014)
BIOETHICS AS THE CRITICAL CONSCIENCE OF TECHNOLOGICAL CIVILIZATION
From this perspective, bioethics is configured as a philosophical activity, regardless of who is actually
conducting the inqury, because questions (the formal object) encountered by the technological sciences
(material object) are by nature philosophical and concern the significance of how human identity is
construed within the technological activity. (Pessina, A, Bioethica: L’ uomo Sperimentale)
Four Areas of Bioethics Competency
1991 - The ERICE Document
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Chapter 3: History of Bioethics
Refers to the contents of the 1978 Encyclopedia of Bioethics and recognize four areas in which bioethics
has competence.
Ethical problems in the health care profession.
Ethical problems arising in the field of human research even if it’s not directly therapeutic.
Social problems connected with national and international public health policies with health care jobs
and with family planning and population control policies.
Problems related to interventions on the life of other living things. (plants, microorganisms and animals)
and generally to anything having to do with the equilibrium of the ecosystem.
SUBDIVISIONS OF BIOETHICS
General Bioethics : Ethical formulations, discussion of values and first principles, documentary sources of
bioethics.
Particular Bioethics : Analyze the major problems always a s part of the general approach bot in the
medical field and in biology (genetic engineering, abortion, euthanasia, cloning. Artificial fertilization
etc.)
Clinical Bioethics: Application of ethical theories and accepted general principles to concrete clinical
cases seeking guidelines of actions.
REMOTE SOURCES OF BIOETHICS
The Hippocratic Oath and writings:
Do no harm and paternalism
Foundation of medicine
Greek Philosophers - personhood & virtues behavior
Hippocrates (5th cent. B.C.) Hippocratic Oath – “first do no harm”
“and abstain from whatever in deleterious & mischievous. I will give no deadly medicine to any one if
asked, nor suggest any such counsel; & in like manner I will not give to woman a pessary to produce
abortion.”
Christianity – Middle Ages
Foundation of the concept of person
Theological significance of Care
Oath of Maimonides (1200)
Look upon the sick with empathy & respect
Accept teaching of elders with med skills
Work for the benefit of the mankind
18th century
Particularly in Britain, the emphasis in medical ethics centered on proper, honorable behavior.
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Chapter 3: History of Bioethics
"Medical Ethics" and "A Code of Institutes and Precepts" by Thomas Percival. Percival’s Code 1794. 1st
code of medical ethics adopted by group of professional physicians. American Medical Association
Code - Duties & obligations of physician to pts & to the society & the field of medicine
American physician Benjamin Rush, a signer of the Declaration of Independence, was promoting
American medical ethics.
RECENT SOURCES OF BIOETHICS
Nuremberg Code (1947) condemned all experimentation on human subjects without their consent.
Alarm caused by several experiments in the USA – Tuskegee Experiment for Syphillis, The Jewish
Chronic Disease Hospital in Brooklyn experiment on tumor cells injected to elderly patients, the
Willowbrook State Hospital experiment in New York on injecting hepatitis virus injected on handicapped
children with consent coerced from parents.
Wolrd Medical Association – HELSINKI Declaration on clinical experimentation
THEOLOGICAL PRESUPPOSITIONS
1. The Dignity of the Human Person – unitotality of body and spirit and from faith perspective, image
of God.
2. Realism, Cognitism – The human person has the rational ability to know reality and the structure
of values (denial denial of relativism and nihilism)
3. A metaphysical view of reality – The human intellect is able to move from phenomenon to
foundation and to understand what ought to be from what is, it is necessary to vindicate the human
beings capacity to know the transcendent and metaphysical dimension in a way that is true and
certain, albeit imperfect and analogical (Fides et ratio, 1983, cited in Sgreccia, 2014)
RECENT HISTORICAL LANDMARKS
NATIONAL RESEARCH ACT 1974
National Commission for the Protection of Human Subject of Biomedical & Behavioral Research
BELMONT REPORT 1979
3 fundamental principles of biomedical research ethics
Respect for persons, Beneficence, Justice
Importance of INFORMED CONSENT
EVENTS INFLUENCING THE DEVELOPMENT OF BIOETHICS
Artificial heart transplantation
(1960) Dr. Denton Cooley’s artificial heart - w/o proper ethical & regulatory overview
1980: Dr. Copeland – quality of life
Xenotransplantation – non human to human
1960: Kidney Dialysis machine: “God Squad” – based from value – laden, social worth
New definition of Death by Ad Hoc Committee at Harvard University 1968
Discussion of Demographic Explosion
Contraceptive pill by Gregory Pinkus
Humanae Vitae 1968
Dramatic Shift to civil liberties and individual rights (1960 & 1970s)
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Women demanded greater Privacy in Reproductive Decisions
Patients demanded control over their treatment decisions
Artificial Reproductive technology
End of Life Issues:
Patient Self Determination Act of 1991
Advance directives & living will
Right to Die Movement
Oregon Death Dignity
In view of how Bioethics developed throughout history, Bioethics emerged truly as a new type of
wisdom. Potter (1970) considered bioethics as a new type of wisdom that would have to know how to
use scientific knowledge in order to safeguard the social good. With all the happened throughout
history, Bioethics indeed is a science of survival not only aimed solely of studying and explaining natural
phenomena but also discovering how to wisely use technological and scientific knowledge so as to
foster the survival of the human good, the human species and improve the quality of life of future
generations.
According to Potter, The only possible way of preventing catastrophe was to bridge between the two
cultures, one scientific and the other humanistic and moral, otherwise indiscriminate scientific and
technological process will endanger humanity and the very survival of life on earth. Moreover, Potter
suggests that bioethics should focus not only on Man but also on the biosphere in its entirety addressing
every scientific intervention by human persons/beings upon life in general.
REFERENCES:
Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine Edition:
Cengage Learning Asia Pte. Ltd.,.
Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical
Problems. Revised Edition. Manila: Sinagtala Publishers
Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc.
Rice, C. (1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,
Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 198
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