BIOETHICS CENTERS

Although there have been concerns involving medical ethics since ancient times, bioethics is an invention of the late twentieth century. The first freestanding center devoted to bioethics was created in 1969. By the beginning of the twenty-first century, most major American institutions of higher learning and most American medical schools had centers, institutes, or programs devoted to the study of biomedical ethics. The bioethics center is no longer a uniquely American institution but an international phenomenon, with new centers continuing to be established all over the world.

Hastings Center

The first bioethics center resulted from the work of a newly minted Harvard Ph.D., the philosopher Daniel Callahan. In the late 1960s, while writing a book on abortion, Callahan found himself engaging with a complex interdisciplinary literature that took him outside the boundaries of traditional philosophical inquiry. As a result of the sharp disciplinary boundaries of that time, Callahan was forced to investigate areas of law, social science, public policy, and medicine. Realizing that advances in science and medicine would continue to generate ethical dilemmas that would require interdisciplinary study and reflection, Callahan set out to create a place where those issues could receive serious, focused attention from multiple perspectives and academic disciplines.

Because that type of center would attempt to cross disciplinary boundaries, it had no natural academic home. To realize the vision of being truly interdisciplinary—bringing together individuals from the fields of theology, philosophy, law, medicine, and science—the new institute would have to be a freestanding institution that was not constrained by the boundaries of traditional academic disciplines. Callahan presented his proposal to a casual acquaintance and fellow resident of the town near New York City where he lived, Hastings-on-Hudson. The physician-psychoanalyst Willard Gaylin, a professor at the Columbia University College of Physicians and Surgeons, thought that the idea for a new institute was timely and appropriate. Together they sought financial support from individual donors and foundations to establish an institute that would examine ethics and the life sciences, and in 1969 the Hastings Center was founded. Originally called a Center for the Study of Value and the Sciences of Man, the Hastings Center opened in September 1970.

Kennedy Institute

In the same year a similar dialogue took place at Georgetown University in Washington, DC. Dr. Andre Hellegers, a faculty member in the department of obstetrics and gynecology in the School of Medicine, was concerned that discussions of the ethical issues in reproductive medicine were being relegated to conferences and professional meetings rather than being the subject of sustained and concentrated scholarship. He proposed the creation of a center to study reproductive ethics to the president of Georgetown, Reverend Robert Henle. In December 1970 they sought support from the Kennedy Foundation. In July 1971 the Kennedy Institute of Ethics opened at Georgetown University. Unlike the Hastings Center, which avoided academic ties for fear of losing its interdisciplinary orientation, the Kennedy Institute embraced its connection to Georgetown University. The institute established faculty chairs and a degree program run in conjunction with the university's philosophy department.

Although different in organizational structure, the Hastings Center and the Kennedy Institute quickly became crucial entities in the creation of the field of bioethics. Both institutions created libraries, issued publications, amassed grants, set out research agendas, and brought together scholars who became the early leaders in the field.

Expansions

Over the next thirty years dozens of bioethics centers and institutes were created. Almost all were housed within universities. By the 1980s many were established in academic medical centers.

Early bioethics centers were populated mostly by philosophers and theologians. In the 1970s those scholars were joined by lawyers and physicians as well as a few nurses, social scientists, and economists. The shift toward locating bioethics centers in academic medical centers reflected both the increasingly large role played by physicians in bioethics and the increasing legitimacy of bioethics as an area of inquiry important to the health sciences.

Beginning in the mid-1990s, a greater emphasis on what Arthur Caplan called empiricized bioethics emerged. Pressure to conform to the norms of academic medical centers meant that faculty members and students at bioethics centers had to be able to publish in leading medical and scientific journals. As a result, the empirical study of ethical issues and norms became a key aspect of the responsibilities assigned to bioethics centers. By the early 2000s social scientists and empirically trained clinicians held significant numbers of faculty positions in those centers, in some cases constituting the majority of their membership. Many bioethics centers continue to be shaped by the criteria for scholarship and promotion that prevail at medical schools in the United States and Europe. Whereas normative analysis once dominated bioethics discourse within and outside centers, many bioethicists have begun to speak in the language of descriptive facts, economic realities, and culturally based moral practices.

The location of bioethics centers in academic institutions has had another professionalizing influence on the field: the creation of professional degree programs. In 2003 there were over sixty master's programs in bioethics, and most of those degrees were granted through the centers in conjunction with the schools of which they were a part. Scholars who joined the field in its early days were all "immigrants," entering from disciplines as diverse as anthropology, sociology, philosophy, theology, medicine, law, public policy, and religion. Because of their institutional structure, centers provided appropriate homes for persons with very different disciplinary backgrounds. However, bioethics scholars in the future will be required to have specific bioethics credentials, either master's degrees or doctorates in the field. Increasingly, they may be employed in academic departments rather than in centers or institutes.

Assessment

The extent of the influence of bioethics centers on science, technology, and ethics is hard to gauge. Unlike traditional academic disciplines or centers whose goal is erudite scholarship, bioethics centers see as their mission not only the creation of new scholarly knowledge, but also engagement with professional groups, the public, and public officials who set policies. Bioethics centers commonly have elaborate outreach programs that include websites, newsletters, a strong media presence, public conferences, writings for the lay press, and distance learning programs. Many members of bioethics centers are public figures, scholars whose work extends beyond their academic base. They have shaped policy and public opinion on issues as far-ranging as informed consent, stem cell research, abortion, euthanasia, cloning, organ donation, research ethics, patenting, and genetically modified foods.

Bioethics centers first appeared as a response to emerging moral challenges, often technologically driven, in American health care. They became the locations where interdisciplinary work on complex moral problems could be done. Their future is uncertain. Bioethics has matured and become a discipline with journals, encyclopedias, awards, and book series. Although new ethical concerns continue to emerge in health care in the United States, in Europe, and internationally, the future of bioethics centers is not clear. With the emergence of a "professionalized" discipline that is both empirical and normative, it is likely that the work done in bioethics increasingly will be accomplished in academic departments. The success of the early bioethics centers and institutes may have created a field that has outgrown its older institutional structures.

ARTHUR CAPLAN
AUTUMN FIESTER

SEE ALSO Bioethics;Bioethics Committees and Commissions.

BIBLIOGRAPHY

Callahan, Daniel. (1973). "Bioethics as a Discipline." Hastings Center Studies 1: 66–73.

Fox, Daniel. (1985). "Who Are We?: The Political Origins of the Medical Humanities." Theoretical Medicine 6: 327–341.

Jonsen, Albert. (1998). The Birth of Bioethics. New York: Oxford University Press.

Post, Stephen G., ed. (2004). The Encyclopedia of Bioethics, 3rd ed. New York: Macmillan Reference USA.

Potter, Van Rensselaer. (1971). Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall.

Reich, Warren. (1994). "The Word 'Bioethics': Its Birth and the Legacies of Those Who Shaped Its Meaning." Kennedy Institute of Ethics Journal 4: 319–336.