Why America Accepted Bioethics

Article excerpt

Daniel Callahan, with Willard Gaylin, was the founder of The Hastings Center.

It is hard to recall these days that there used to be a great deal of suspicion about any public talk on the matter of ethics. Ethics was seen as a topic of great delicacy.

Even to suggest that we needed a public debate and discussion about issues of ethics ran into a fundamental problem. For many, particularly among educated people and particularly the educated elite, ethics connoted religion, and religion had been put behind them, at least within the universities.

There was also a significant number of people, particularly older physicians, who had been very powerfully influenced by the positivism of the 1930s. One felt that one was always hearing A-J. Ayer in the background--that there was science, which was solid and real and developed true knowledge, and there was ethics, which was religion, subjectivity, taste, emotivism, but not a subject for public discourse.

At the same time, the great 19th century tradition in American philosophy of speaking to a broad public had been entirely lost. Philosophy had become a very insulated, technical discipline. And even within the field of ethics the questions were highly technical and specialized. The great dilemma was whether the ethicist should be the prophet, the outside critic, the one who raises the hard and unpleasant questions against the establishment--or whether those in ethics should be friendly collaborators, one more set of experts or specialists among the medical team trying to be helpful and to resolve dilemmas.

How was the acceptance of bioethics in fact gained? I would say that the first thing that those in bioethics had to do--though I don't believe anyone set this as a conscious agenda--was to push religion aside. It was clear also that the model of the physician as sole decisionmaker would have to give way to a more complex picture of what the moral life is all about. What we began seeing was the movement of many in bioethics toward a different kind of moral language in the mainstream of public policy, toward a language of rights, worries about questions of pluralism, efforts to find moral consensus and moral strategies in the face of a diverse cultural situation. And particularly it was the need to find some way to cope with the hostility toward ethics in general.

The solution that gradually emerged, though I believe without any set or conscious plan, was for mainline bioethics to move in the direction of what I call "regulatory ethics." Instead of either going along the Joseph Fletcher route of totally blessing everything that came along, or the Paul Ramsey route of seeming to reject everything, bioethics chose a kind of middle course.

That middle course is regulation, regulation being the way we in the United States typically deal with controversial issues. On the one hand you avoid the extremes of simple prohibition of things, while on the other hand you show that you are serious add willing to be cautious. …