Bioethics:where are we?

In 1927, Fritz Jahr coined the name bioethics (bio + ethik) to characterize the ethics that should be applied in relation to all living beings – not only human beings (1). But by many authors the creation of the word bioethics was attributed to the biochemist Van Rensseler Potter, since it was he who first used the word in English. In 1971, Potter wrote the book Bioethics: A Bridge to the Future in which he argues that the culture of science and the culture of humanities "seem unable to speak to each other"(2). So he proposed that a bridge - bioethics - be built to join the two cultures, because interplay between them would perhaps be the way to guarantee the survival of man on the planet. Potter had already used the same word in the article Bioethics, the Science of Survival of 1970, the title of which succinctly defines the author´s concept of bioethics (3). 

 However, the term bioethics was appropriated by medicine. The Kennedy Institute of Ethics was founded in 1971 to "bring expertise to the new and growing ethical problems in medicine" according to André Hellegers, its founder and first director. The institute was first called the Joseph and Rose Kennedy Center for the Study of Human Reproduction and Bioethics and greatly contributed towards the propagation of the word bioethics in medicine, mainly because its outstanding faculty, renowned library resources and notable publications (4). 

On the other hand, indignation against abuses in medicine also contributed to spread the word bioethics. In 1972, following a public outcry, the Tuskegee syphilis experiment was brought to an end: it was an infamous clinical study that had been conducted since 1932 in order to study the natural progression of untreated syphilis in rural African American men. In the same year, the book Experimentation with Human Beings (5) published by Jay Katz caused much concern among doctors about the possible impact on society of abuses committed by researchers that worked in the biomedical fields.

      In 1978, Tom L. Beauchamps and LeRoy Walters edited a book – Contemporary issues in bioethics – in which they claim that developments in medicine led to considerable perplexity about the rights and duties of researchers and participants in clinical studies (6). In the same year, the government of the United States of America published a document - the Belmont Report - elaborated by an ample and multidisciplinary commission (the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research), which defined the ethical basis for the protection of human beings submitted to biomedical research (7). Therein, three principals were recognized: beneficence, respect for people and justice. These principles, often repeated in contemporary medical literature, are similar to those proposed later by Tom L. Beauchamp and James F. Childress in the book Principles of Biomedical Ethics (8), of which the first edition came out in 1979. In it, the American authors propose four principles: beneficence, respect of autonomy, non-maleficence and justice. Although similar terms are used to refer to the principles established in the Belmont Report and in the text by Beauchamp and Childress, the definitions of these diverge (9).

Therefore, the debate on bioethics in that time occurred mainly in the biomedical fields. So, it is not surprising that the Encyclopedia of Bioethics, whose first edition dates from 1978, Warren T. Reich defined bioethics as “the systematic study of human conduct in the area of the life sciences and health care, insofar as this conduct is examined in the light of moral values and principles” (10). Hence, the term bioethics - even though it was created to provide an interface between different areas of knowledge - was mainly associated with medicine for a very long time. 

Probably because of the appropriation of the term by medicine, Potter chose the title Global Bioethics (11) for his book published in 1988. Therein he defined global bioethics as “biology combined with varied humanistic knowledge forging a science that sets a system of medical and environmental priorities for acceptable survival." The author´s objective was to broaden the scope of discussions, which were being restricted to areas of health, so that they would include environmental challenges based upon the work of Aldo Leopold, who in 1949 published the book Sand County Almanac and Sketches Here and There (12).

The Encyclopedia Britannica (13) realized this revision, defining bioethics as a “branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being, though it sometimes also treats ethical questions relating to the nonhuman biological environment. (Such questions are studied primarily in the independent fields of environmental ethics)”. But the terminology global bioethics did not spread out.

 However, there is still a hiatus between bioethics and law and this has determined a quest for bio-law. An example of this is the project BIOMED, once again an initiative of medicine, in which various European countries participated (14). The aim of the project was to recognize the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four values of importance for bioethics and bio-law in Europe. As was to be expected, the conclusion was that those basic ethical principles could not be understood as universal and permanent ideas or transcendental truths, but rather as guidelines for reflection on the values of European culture.

As it can be seen, bioethics is still very much influenced by medicine, even having been linked originally with ecological and environmental questions. The evolution of sensitivity concerning ecology and environmental sciences is recent, but has led to a veritable explosion of interest, with a marked increase in courses on these subjects all over the world (15). There is a greater commitment to social questions, to solving the problem of pollution and to sustainable development, as well as an increased consciousness of the need to preserve forests. None the less, there are still doubts. Charles Byk wrote in his Treatise of Bioethics that Potter´s expression bridge to the future symbolizes the desire to transform bioethics into a “regard pluriel entre l’individu et ses semblables, entre l’homme et l’environnement”(16). It is a dream.

 Scientific development gives rise to conflicting interests. People are not prepared - and will still not be prepared in the near future - to make decisions in situations of conflict between ethics and the advance of science. Scientists have personal interests and do not only seek to achieve scientific objectives when they ask questions. Rules and guidelines are necessary - and very often the force of law as well - to minimize the harm caused by all the activities conducted by man and with man. As wrote Engelhardt (17): "Bioethics succeeds, although it cannot deliver what it promises”.

                                References

1.    Goldim, J R. Bioética: origens e complexidade. Rev HCPA 2006; 26(2):86-92

2.    Potter, V R. Bioethics: bridge to the future. New York, Prentice Hall, 1971 

3.    Potter VR. Bioethics: the science of survival. Perspect Biol Med. 1970; 14:127-53. In: Funaro, M G. The Scientist Demanding Wisdom: The "Bridge to the Future" by Van Rensselaer Potter. Perspectives in Biology and Medicine, Volume 45, Number 1, winter, 2002, pp. 31-42 (Article). Published by The Johns Hopkins University Press. DOI: 10.1353/pbm.2002.0007

4.    Reich, W T. The "Wider View": Andre Hellegers Passionate, Integrating Intellect and the Creation of Bioethics. Kennedy Institute of Ethics Journal . Volume 9, Number 1, March 1999. 

5.    Katz, J. Experimentation with human beings. New York. Russel Sage Foundation.1972.

6.    Beauchamps, T. L. and Walters, LeRoy. Contemporary issues in Bioethics. Belmont, California, Wadsworth Publishing Company.2 ed. 1982.

7.    THE BELMONT REPORT: Ethical Guidelines for the Protection of Human Subjects. Washington: DHEW Publications (OS) 78-0012, 1978.

8.    Beauchamp T, Childress JF. Principles of Biomedical Ethics. 4ed. New York: Oxford, 1994.

9.    Beauchamp T, T. The “four principles approach” to Health Care Ethics. In: Ashcroft, R.; Dawson, A.;Draper, H.; McMillan, J. Principles of Health Care Ethics. Wiley. 2007.

10. Reich W T. Encyclopedia of Bioethics. New York: Free Press-Macmillan, 1978:116.

11. Potter, VR. Global bioethics: a tribute to Aldo Leopold

12. Leopold, A. Sand County Almanac and sketches here and there. New York, Oxford University Press, 1989.

13. Encyclopedia Britannica bioethics. www.britannica.com/EBchecked/topic/.../bioethics

14. Final Report to the Commission on the Project Basic Ethical Principles in Bioethics and Biolaw, 1995-1998,  Projeto Biomed II. www.cometc.ro/.../Basic_Ethical_Principles

15. Russo, G., and V. R. Potter, 1994. L’idea originaria di bioetica. Itinerarium 2:11–25.

16. Byk, C. Traité de bioéthique.Vers une nouvelle utopie civilisatrice ? Bordeaux Les Études Hospitalières. 2011.

17. Engelhardt Jr, H T. Why clinical bioethics so rarely gives morally normative guidance. In: Engelhardt Jr, H T (editor) Bioethics critically reconsidered: having second thought. New York, Springer, 2012.