Ethics and Policymaking

The ongoing public health crisis is a moment of reckoning for those of us who work in the field that has come to be known as bioethics. As R. Alta Charo notes in her interview (Issues, Summer 2021), the word was coined by Van Rensselaer Potter, a biochemist at the University of Wisconsin, her former institution. For Potter, bioethics signified the integration of biology and moral values for the sake of human survival. In those days there was an emerging awareness of the fragility of the ecosystem upon which human life on the planet depends, culminating in the first Earth Day in 1970 and in the publication of The Limits to Growth, commissioned by the Club of Rome, in 1972.

Oddly, though, the word was captured not by environmentalism (Potter later tried to rename his concept “global bioethics,” to no avail) but by another emerging field, one captured in the unwieldy original name coined by the Hastings Center in 1969 as the intersection of “society, ethics, and the life sciences.” When Georgetown University’s Kennedy Institute was founded in 1971, the word used was simply ethics, as continues to be the case in the formal name of the institute today. Perhaps an earnest archivist will connect the dots that led to the expedient adoption of “bioethics” by the original participants. What is certain is that by the mid-1970s the word was ensconced in the early literature and in a growing media presence.

Other dynamics in the late 1960s and early 1970s are relevant to the biography of the word bioethics. The full import of the Nuremberg Code’s insistence on “voluntary consent” was more evident as a series of research ethics scandals were reported in the media, tying into the contemporary civil rights movements. By the time the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research published its Belmont Report, in 1979, “respect for persons” (defined as respect for autonomy) was a core value, perhaps the primary principle. On the other hand, there was growing confidence in the benefits of mass vaccination, including the beginnings of the World Health Organization’s smallpox eradication program, allowing some optimism about ending the scourge of infectious diseases. In short, bioethics appeared as individual rights were gaining public interest and threats to public health seemed to be diminishing.

Now, with public health of immediate concern amid the COVID-19 pandemic, the “first among equals” standing of respect for autonomy requires closer examination. Too often opponents of elementary public health practices such as masking have exploited the legitimacy that the academic literature has granted appeals to individual autonomy. My own preference is for a greater role for reciprocity in the pantheon of bioethical values, and not limited to specific cases such as organ donation. For bioethics scholarship, there is much more work to be done to specify reciprocity in concepts of justice and fairness, in effect shifting the balance of power among bioethics principles.

Jonathan D. Moreno