My wonderful friend Mark Pickup has rerun an essay on his blog Human Life Matters by Dr. Dianne Irving on the history of bioethics. Irving was present at the birth of the field, dissents strongly from the direction in which it went, and was very helpful to me in researching my own critique of the field, Culture of Death: The Assault on Medical Ethics in America.
Her essay is well worth reading. But I want to focus on one small point she made early on, a question I am often asked in my own work: What is the difference between “bioethics” and “medical ethics?” From Irving’s “Bioethics: How Did We Get Into This Mess?”:
Like the word “Bioethics” itself, which formally dates only from the early 1970’s, the philosophical underpinnings of bioethics are completely different from those that underlie traditional medical ethics. Traditional medical ethics focuses on the physician’s duty to the individual patient, whose life and welfare are always sacrosanct. The focus of bioethics is fundamentally utilitarian, centered, like other utilitarian disciplines, around maximizing total human happiness.
Such factors as the feelings and preferences of other people the parents of a child with severe birth defects, the husband whose wife seems permanently comatose, or even the doctor who decides that an elderly Alzheimer’s patient would be better off dead along with the possible cost of treatment to society, can weigh in against and ultimately outbalance the afflicted person’s needs. Goodbye, Hippocrates; hello, Peter Singer.
Actually, I think bioethics has splintered since Irving wrote the essay. There were always dissenters from the mainstream utilitarian view. Now, some of the radicals she describes are actually the old dinosaurs left behind by their even more radical intellectual progeny.
But the point to remember is that medical ethics is primarily patient oriented. Bioethics is substantially—not totally—societal oriented. (But that’s like being a little bit pregnant.) And we should always remember that the movement’s best contribution (in my view) was individual-oriented, e.g., allowing people to say no to unwanted medical treatment even if it would likely result in death. But that was primarily Paul Ramsey’s The Patient as a Person and the hospice movement led by the late, great Dame Cecily Saunders, not the utilitarians. The problem today is that so many bioethicists believe in the non person human being.
Of course the big problem for a societal-focused bioethics rather than a patient-oriented medical ethics is that when the patient’s welfare interferes with the perceived overarching benefit to society, the patient is in danger of getting it in the neck.