The author argues that bioethics ought properly to be regarded "both" as a consulting profession that counsels health practitioners in dealing with the individual problems they face "and" as an academic discipline that defines problem areas on its own and includes attention to the institutional and social aspects of health care. The argument is conducted by means of a brief history of bioethics and comparison of its development with that of history of medicine and sociology of medicine. Several examples of (...) the social issues in bioethics are examined. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Virtues, Obligations, and the Prophetic VisionRoy Branson (bio)Ethics at its best is only bad poetry—that is, it seeks to help us see whatwe see every day but fail to see rightly...If ethicists had talent, they might be poets,but in the absence of talent, they try tomake their clanking conceptual anddiscursive chains do the work of art.—Stanley HauerwasThe speaker was so severely bent over that his congenitally deformed back had (...) to be supported. He was a young Ph.D. in history. We were some 50 physicians, lawyers, health care administrators, and ethicists studying the ethics of organ transplants. Before he arrived, the conference had discussed different understandings of equal access and the nuances of federal policies governing organ transplant distribution. 1 In his lecture, our guest matter-of-factly described his own condition. He then pointed out that not only in ancient civilization but in American history as well, the disabled had been killed just because they were disabled. Indeed, even now, he said, they were not being allowed to live.In the question and answer session, he was immediately challenged by nationally prominent transplant surgeons. He responded by asking the surgeons: If two people could avoid death and anticipate significantly prolonged life from receiving an organ transplant and the only difference between them was that one was disabled and the other not, who would receive the life-saving transplant? The surgeons’ initial, spirited defense of excluding the significantly disabled person died down as they began to realize that, as far as they were concerned anyway, they might not have allowed the lecturer to live. They were stunned by the realization that they had not felt the disabled were fully persons. In the silences between their sentences, the participants sensed that they had passed beyond the discussion of economic, medical, and legal terms to glimpse new horizons of responsibility. [End Page 361]The conference was experiencing the truth of William F. May’s claim that moral quandaries must be placed within “a fresh and liberating vision of the world;” within “metaphysical horizons” (May 1983, pp. 15, 19).Pastoral VirtuesIn the late sixties, André Hellegers, the dynamic physician and Catholic layman who founded the Kennedy Institute of Ethics and who claimed that he had invented the word bioethics, focused bioethics elsewhere—on virtue. “As the caring branches of medicine were gradually pushed aside by the curing ones,” Hellegers said, “there seemed to be less use for the Christian virtues.” We must, he declared, “recapture the Christian virtues of care” (cited in McCormick 1985, p. 111). In a subsequent essay on the conceptual foundation of bioethics, Hellegers, writing with Albert Jonsen, did not invoke the word pastor, but he did argue that the codes drawn up for the ethical practice of medicine were, among other things, guides for the cure of physicians’ souls (Jonsen and Hellegers 1976, pp. 35–36).In 1969, at the same time that André Hellegers was in the process of establishing the Kennedy Institute, Edmund Pellegrino, then a medical school dean, led in the founding of humanities programs within American medical schools. Pellegrino, like Hellegers, a physician and Catholic layman, also focused on virtue. Obligations are not irrelevant for Pellegrino, but in biomedical ethics “one starts always with one’s commitment to be a certain kind of person and then approaches clinical quandaries, conflicts of values, and patient interests as a good person ought” (Pellegrino 1988, p. 123). Pellegrino knows that the classical and Christian tradition of Aristotle and Aquinas, a tradition with which he identifies, is concerned with the whole gamut of ethics. But for Pellegrino, that tradition teaches that “no matter to what depths a society may fall, virtuous persons will always be the beacons that light the way back to moral sensitivity” (p. 123). He freely acknowledges that “a virtue-based ethics is inherently elitist, in the best sense, because its adherents demand more of themselves than does the prevailing morality” (p. 123).Hellegers and Pellegrino added to the need of physicians acquiring professional skills their responsibility to become the embodiment of the moral ideal in the patient-physician relationship by caring for the patient... (shrink)