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Anglo-American Conference 2011, Health in History
Bioethics in Britain, 1960s-1990s
This session presents new perspectives on the emergence of bioethics in Britain from the 1960s to
the 1990s. Most histories of bioethics have tended to focus on the USA: the papers in this session
consider some of the links between bioethics in the UK and the US, but also point to a distinctive
narrative about the development of British bioethics. Specifically, these papers highlight the
involvement of a wide range of actors in the making of British bioethics.
David Reubi (London School of Hygiene & Tropical Medicine) examines the influence of the
bioethical thought collective – a network of philosophers, doctors and lawyers who attempted to remoralise medicine – on the regulation of British medical research. The meaning of morality in the
context of medicine is taken up by Duncan Wilson (University of Manchester), who considers the
contested notion of the ‘moral expert’ and the individuals who involved in public discussions about
bioethics. But ‘experts’ were not the only figures concerned with the development of bioethics: Alex
Mold (London School of Hygiene & Tropical Medicine) points out that there was a role for patients
too. Together, these papers represent a nuanced approach to the complexities of the history of
bioethics in Britain.
Paper 1: Re-Moralising Medicine: The Bioethical Thought Collective & the Regulation of the Body
in British Medical Research
The way the scientific and medical use of the human body is problematised and governed in the
United Kingdom was radically reconfigured over the last thirty years, changing from a logic of rule
articulated around ‘supply’ and ‘solidarity’ to one construed around ‘ethics.’ Drawing on the work of
Ludwik Fleck and others, this paper argues that one of the reasons for this reconfiguration was the
existence and influence of a network of philosophers, doctors and lawyers who sought, from the
1960s onwards, to re-moralise medicine: the bioethical thought collective. The paper first describes
the collective’s membership and organisation, focusing in particular on the form of the
interdisciplinary expert committee. It also describes some of the knowledge and practices that make
up the community’s thought style such as its moral concern about modern medicine and the notions
of respect for persons and informed consent. The paper then shows how these organisational forms,
knowledge and practices that characterise the collective have shaped the government of human
tissue research over the last fifteen years. By highlighting the important role played by moral experts
networks and both their knowledge and practices in the articulation of today’s government of
science, this paper makes an original contribution to the history and sociology of bioethics.
Dr David Reubi
London School of Hygiene & Tropical Medicine
15-17 Tavistock Place, London WC1H 9SH, United Kingdom
Paper 2: Philosophy, Public Policy, and the Contested Notion of ‘Moral Experts’ in the AngloAmerican history of Bioethics, c.1975–1985
This paper challenges the conventional Anglo-American history of ‘bioethics’ – the interdisciplinary
scrutiny of medical expertise and ethics. The emergence of bioethics in Britain is generally presumed
to have lagged behind the United States, where philosophers, lawyers and theologians became
involved in public discussion and regulation of medicine during the mid-1970s. But the British
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philosophers Stephen Toulmin and Alasdair MacIntyre were instrumental to the growth of bioethics
in the United States – serving on federal commissions and leading public debates. Examining their
work from this period also challenges the view that bioethics was widely endorsed by philosophers.
Toulmin believed philosophers could inform medical policies and act as ‘moral experts’. But
MacIntyre argued that the proliferation of equally valid but incommensurable standpoints on
particular issues (e.g. abortion) meant that moral dilemmas were ‘interminable’ and unsolvable. In
contrast to Toulmin, MacIntyre protested that the ‘moral expert’ was a dangerous fallacy that, if
anything, protected medicine from critical scrutiny. This view was endorsed as bioethics emerged in
Britain during the 1980s, when the philosopher Mary Warnock, a former colleague of MacIntyre,
publicly argued there was ‘no such thing as a moral expert’. Charting these disagreements on moral
expertise illustrate that bioethics was a contested enterprise from the outset, with criticism often
emanating from its participants. And this helps explain why bioethics is not a unified perspective or
field of inquiry, but has become a diverse network of actors, discourses and activities.
Dr Duncan Wilson
Centre for the History of Science, Technology and Medicine
University of Manchester, Faculty of Life Sciences, Simon Building, Oxford Road, Manchester, M13
9PL
Paper 3: Autonomy and the English Patient: Patient-consumer Groups and Patient Autonomy
During the 1960s and 1970s
Patient autonomy was a central concept within emerging bioethical thought in both the UK and the
USA during the 1960s and 1970s. New codes of conduct, such as the 1964 Helsinki Declaration on
ethical principles for medical research, emphasised autonomy and practices such as the seeking of
informed consent from patients before entering them into clinical trials. The role of a new group of
‘moral experts’ (bioethicists) has figured centrally in accounts of the making of patient autonomy:
but what of the patient him or herself? To what extent did patients themselves demand a greater
level of autonomy, and what kind of autonomy did they think that patients should be able to
exercise?
This paper will explore the development of the notion of patient autonomy in England from the
perspective of the patient by examining the activities of generic patient groups, organisations which
claimed to represent all patients, regardless of the condition they suffered from or the population
group to which they belonged. It will suggest that patient organisations such as the Patients
Association played a part in broadening out the notion of patient autonomy beyond the
experimental setting to encompass everyday treatment. Moreover, the notion of autonomy
developed by patient groups in this period was not solely concerned with the individual patient, but
also with greater representation for all patients. Drawing on notions of consumerism, and of social
citizenship, patient groups pressed for a kind of collective autonomy as well as for more say for the
individual.
Dr Alex Mold
Centre for History in Public Health
London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1 9SH