From The New England Journal of Medicine
The field of bioethics has grown enormously over the past few decades. Consequently, people entering the field may try to acquire knowledge about it as rapidly as possible by learning only about current consensus and controversies. By doing so, however, they may not learn that accepted or controversial views concerning bioethics can reflect the time and circumstances in which they arose. Without this awareness, they may not realize that some of those who helped forge bioethics did so at considerable personal sacrifice. And without this awareness, they may not anticipate what they, too, must do if they believe that their views should be heard and should prevail.
In The Birth of Bioethics Jonsen has written an in-depth review of bioethics, including a historical analysis of the field. But this is also a book about heroes.
Jonsen presents the growth of bioethics from 1947, when the Nuremberg Code was drawn up, to 1987. He does so in three chapters on the religious, philosophical, and governmental aspects of the subject. He covers five major areas of bioethics, including research and death and dying, and deals with bioethics as a discipline and as a topic of discourse. In the final chapter, he gives his explanation of why bioethics arose in this country.
The history he presents includes advanced ideas, such as H. Tristram Engelhardt's concept of ethics as an "enterprise in controversy resolution" and Robert Veatch's criticism of the assumption of moral authority by persons with technical competence or what he calls the "generalization of expertise." This material should inform even sophisticated readers. Comprehensive footnotes and illuminating cross-references reflect Jonsen's consummate knowledge of theology, philosophy, history, and literature. He cites Homer and Shakespeare, and he makes the history of bioethics come alive, because he was there.
For instance, I have taught bioethics to medical students for 20 years using a well-known film about a baby born at Johns Hopkins Hospital with Down's syndrome and an intestinal blockage requiring surgery. I learned only from this book that the chairperson of the pediatrics department at Johns Hopkins had had two children with developmental disabilities and that the person who portrayed the baby's doctor in this film had actually been an intern then and had felt a sense of moral outrage at the time.
Jonsen's depictions of the pioneers in bioethics whom he knew and worked with are vivid. Joseph Fletcher, for instance, stood in picket lines, and "turned to... bioethics because everything else was so vicious." Paul Ramsey had this to say about a conference held in the Valley of the Moon in Sonoma, California, to determine whether neonates with severe defects should ever be allowed to die: "The symbolism... should not be lost: a valley on a dead satellite of our mother earth." Warren Reich and George Kanoti, while they were nontenured professors at the Catholic University of America, expressed unpopular views that resulted in their being invited to resign. But Jonsen is with them: "It began to dawn on me that as a newly minted moral theologian, I would not be comfortable or conscientious teaching the traditional doctrine on abortion and contraception."
Jonsen's own beliefs, no doubt, influence which areas he chooses to emphasize. He pays particular attention to the influence of Catholic religious doctrine and of the theologians Joseph Fletcher, Richard McCormick, and Paul Ramsey. Yet Jonsen sees no major issue in American bioethics in which religious and philosophical ethics did not collaborate and sees this "trinity" of theologians as having presided over the birth of bioethics.
Jonsen's unique insights, infused by the compassion he obviously feels, recommend this book strongly. Jonsen's own words are compelling. In regard to choosing whether to allow neonates to die, he states, "The hope seems so great and the loss so devastating to parents that the decision... is particularly agonizing." About the rise of bioethics in the United States he says, "My hypothesis is that the American ethos is strongly tempted to endow various aspects of life with moral meaning in a capricious way." And, with respect to the new forms of technology that have been developed to help women bear children he states, "The difficulty of unraveling the ethics of reproductive technology may be due to our impoverished ability to recognize and appreciate what is normal about being human."
Reviewed by Edmund G. Howe, M.D., J.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
Advance Praise for The Birth of Bioethics:
"Well-written and insightful, it wears its wide learning lightly and thus provides a wide range of potential readers with access to some complex matters in ways that they can readily understand...I learned much from this clear and interesting volume."--James Childress, Professor of Religious Studies, University of Virginia
"From very small, tentative beginnings, the field of bioethics has grown to an enormous, influential force in American medicine and health care. Albert Jonsen lays this out with enormous clarity and insight, and the record he presents of the development in recent decades is not only well worth reading, but immensely interesting as well."--Daniel Callahan, The Hastings Center
"Well-written and insightful, it wears its wide learning lightly and thus provides a wide range of potential readers with access to some complex matters in ways that they can readily understand... I learned much from this clear and interesting volume."--James Childress, Professor of Religious Studies, University of Virginia
"An amazing piece of work capturing the spirit and the details of the complicated history of bioethics. As one who lived through this period participating in many of the debates and attending many of the meetings discussed in this volume, I was moved by the accuracy and completeness of the account. At the same time, I learned a great deal about the period from the stylishly written, warmly sensitive account. Anyone who works in medicine, medical ethics or health policy after this crucial period of bioethics' birth and early generation, needs to know this story."--Robert Veatch, Georgetown University
"Albert Jonsen...is a gifted writer of clear and arresting prose, a trait not widely found in bioethics circles....a singular success."--Medical Humanities Review
"Bioethics, Albert Jonsen observes in the introduction to his important, highly personal, and readable book, did not begin with a bang. But what becomes very clear, as one reads his recollections of the origins of the field, is that it did not begin with people prone to emit whimpers....The story told in The Birth of Bioethics is organized around the cutting edge problems that defined the field in the late 1960s and 1970s....Jonsen brings an elephantine memory and deft pen to telling the story of what happened when the first theologians, philosophers, and physicians found themselves out on these ethical frontiers of medicine without much in the way of intellectual tools to help them."--JAMA
"Jonsen's unique insights, infused by the compassion he obviously feels, recommend this book strongly."--The New England Journal of Medicine
"Jonsen attends to the complexity of each debate and offers fair coverage of even contentious points....A 'must read' for all students of bioethics...and for anyone interested in contemporary American culture."--Religious Studies Review
"While this treatment of the theoretical roots of bioethics in theology and philosophy are likely to prove useful for many, the most engaging discussion is to be found in Chapters 5-9. Each of these chapters is a well-researched synopsis of the development of these important and complex subjects. Utilizing primary and secondary sources, the author provides a compelling and nyanced account of the persons and events that contributed to the development of these contentious topics. Presenting the first seious historical account of the field, he establishes not only the standard for future historical scholarship, but provides an insightful commentary on how bioethics has come to enjoy a public prominence. He admirably helps readers to understand the intellectual and ethical challenges that make bioethics such a vibrant part of contemporary medicine, science, and society." --Doody's
