Critique of Practical Reason and Other Works on the Theory of Ethics, 6th edition, trans. T. K. Abbott (London, 1909). Public domain. This essay was first published in a Berlin periodical in 1797.
79 Joseph Collins, “Should Doctors Tell the Truth?” pp. 320–326 from Harper’s Monthly Magazine 155 (August 1927).
80 Roger Higgs, “On Telling Patients the Truth,” pp. 186–202 and 232–233 from Michael Lockwood (ed.), Moral Dilemmas in Modern Medicine (Oxford: Oxford University Press, 1985). Reproduced with permission of Oxford University Press.
81 John Stuart Mill, “On Liberty,” first published in 1859. Public domain.
82 Justice Benjamin N. Cardozo, Judgment from Schloendorff v. New York Hospital (1914), p. 526 from Jay Katz (ed.), Experimentation with Human Beings: The Authority of the Investigator, Subject, Professions, and State in the Human Experimentation Process (New York: Russell Sage Foundation, 1972). Reproduced with permission of Russell Sage Foundation.
83 om L. Beauchamp, “Informed Consent: Its History, Meaning, and Present Challenges,” pp. 515–523 from Cambridge Quarterly of Health Care Ethics 20: 4 (2011). © 2011 Royal Institute of Philosophy. Reproduced with permission of Cambridge University Press and Tom L. Beauchamp.
84 Ruth Macklin, “The Doctor–Patient Relationship in Different Cultures,” pp. 86–107 from Against Relativism: Cultural Diversity and the Search of Ethical Universals in Medicine (New York: Oxford University Press, 1999). © 1999 by Oxford University Press, Inc. Reproduced with permission of Oxford University Press, USA.
85 Maura Priest, “Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well But Cause Harm,” pp. 45–59 from American Journal of Bioethics 19 (2019). Reproduced with permission of Taylor & Francis.
86 Carl Elliott, “Amputees by Choice,” pp. 208–210, 210–215, 219–223, 227–231, 234–236, 323–326 from Better Than Well: American Medicine Meets the American Dream (New York and London: W.W. Norton, 2003). © 2003 by Carl Elliott. Reproduced with permission of W. W. Norton & Company, Inc.
87 Julian Savulescu, “Rational Desires and the Limitation of Life‐Sustaining Treatment,” pp. 191–222 from Bioethics 8: 3 (1994). Reproduced with permission of John Wiley & Sons.
88 Elizabeth Barnes, “Valuing Disability, Causing Disability,” pp. 88–113 from Ethics 125 (2014). Reproduced with permission of University of Chicago Press.
89 Greg Bognar, “Is Disability Mere Difference,” pp. 46–49 from Journal of Medical Ethics 42 (2016). Reproduced with permission of BMJ Publishing Group Ltd.
90 Adrienne Asch, “Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy,” pp. 1649–1657 from American Journal of Public Health 89: 11 (1999). Reproduced with permission of American Public Health Association.
91 Renata Lindeman, “Down Syndrome Screening Isn’t About Public Health. It’s About Eliminating a Group of People,” from Washington Post, June 16, 2015. Reproduced courtesy of Renata Lindeman.
92 Ruth Marcus, “I Would’ve Aborted a Fetus with Down Syndrome: Women Need That Right,” Washington Post, March 9, 2018. Reproduced with permission of Washington Post / PARS.
93 Neil Levy, “Neuroethics: Ethics and the Sciences of the Mind,” pp. 69–74 (extract) from Philosophy Compass 4: 10 (2009). Reproduced with permission of John Wiley & Sons.
94 Anders Sandberg and Julian Savulescu, “Love Machine: Engineering Lifelong Romance,” pp. 28–29 from New Scientist 2864. © 2012 Reed Business Information. Reproduced with permission of Tribune Content Agency.
95 Francesca Minerva, “Unrequited Love Hurts: The Medicalization of Broken Hearts is Therapy, Not Enhancement,” pp. 479–485 from Cambridge Quarterly of Healthcare Ethics 24: 4 (2015). Reproduced with permission of Cambridge University Press.
96 Walter Glannon, “Stimulating Brains, Altering Minds,” pp. 289–292 from Journal of Medical Ethics 35 (2009). Reproduced with permission of BMJ Publishing Group Ltd.
97 Felicitas Kramer, “Authenticity or Autonomy? When Deep Brain Stimulation Causes a Dilemma,” pp. 757–760 from Journal of Medical Ethics 39 (2013). Reproduced with permission of BMJ Publishing Group Ltd.
98 Sara Goering and Rafael Yuste, “On the Necessity of Ethical Guidelines for Novel Neurotechnologies,” pp. 882–885 from Cell 167 (2016). Reproduced with permission of Elsevier.
Introduction
The term “bioethics” is often mistakenly ascribed to the biologist Van Rensselaer Potter, who used it in the 1970s to describe his proposal that we need an ethic that can incorporate our obligations, not just to other humans, but to the biosphere as a whole.1 However, a historically correct account should probably give credit for coining the term to Fritz Jahr, a German Protestant pastor, who in 1927 published an article called “Bio‐Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants.”2 Jahr tried to establish “bioethics” both as a discipline and as a moral principle. Although the term is still occasionally used in the sense of an ecological ethic, it is now much more commonly used in the narrower sense of the study of ethical issues arising from the biological and medical sciences. So understood, bioethics has become a specialized, although interdisciplinary, area of study. The essays included in this book give an indication of the range of issues which fall within its scope – but it is only an indication. There are many other issues that we simply have not had the space to cover.
Bioethics can be seen as a branch of ethics, or, more specifically, of applied ethics. For this reason some understanding of the nature of ethics is an essential preliminary to any serious study of bioethics. The remainder of this introduction will seek to provide that understanding.
One question about the nature of ethics is especially relevant to bioethics: to what extent is reasoning or argument possible in ethics? Many people assume without much thought that ethics is subjective. The subjectivist holds that what ethical view we take is a matter of opinion or taste that is not amenable to argument. But if ethics were a matter of taste, why would we even attempt to argue about it? If Helen says “I like my coffee sweetened,” whereas Paul says “I like my coffee unsweetened,” there is not much point in Helen and Paul arguing about it. The two statements do not contradict each other. They can both be true. But if Helen says “Doctors should never assist their patients to die” whereas Paul says “Sometimes doctors should assist their patients to die,” then Helen and Paul are disagreeing, and there does seem to be a point in their trying to argue about the issue of physician‐assisted suicide.
It seems clear that there is some scope for argument in ethics. If I say “It is always wrong to kill a human being” and “Abortion is not always wrong,” then I am committed to denying that abortion kills a human being. Otherwise I have contradicted myself, and in doing so I have not stated a coherent position at all. So consistency, at least, is a requirement of any defensible ethical position, and thus sets a limit to the subjectivity of ethical judgments. The requirement of factual accuracy sets another limit. In discussing issues in bioethics, the facts are often complex. But we cannot reach the right ethical decisions unless we are well‐informed about the relevant facts. In this respect ethical decisions are unlike decisions of taste. We can enjoy a taste without knowing what we are eating; but if we assume that it is wrong to resuscitate a terminally ill patient against her wishes, then we cannot know whether an instance of resuscitation was morally right or wrong without knowing something about the patient’s prognosis and whether the patient has expressed any wishes about being resuscitated. In that sense, there is no equivalent in ethics to the immediacy of taste.
Ethical relativism, sometimes also known as cultural relativism, is one step away from ethical subjectivism, but it also severely limits the scope of ethical argument. The ethical relativist holds that it is