OTROS ASPECTOS A CONSIDERAR

As with most developments in language, the birth of the term “bioethics” is instructive. According to Warren Reich, “the field of bioethics started with the word bioethics because the word is so suggestive and so powerful; it suggests a new focus, a new bringing together of disciplines in a new way with a new forum that tended to

73 _{Veatch, 2003: 68.}

74 _{Veatch’s first contract begins on a broad level where “societies” are expected to} gather in seeking moral norms; the second contract takes place between the public and members of the medical professions; the third contract exists between an individual patient and a healthcare provider (Veatch, 2003: 70-75). Within the framework of these three contracts, Veatch envisions the possibility for articulating principles and ethical norms to navigate medical ethics. Veatch claims to address inherently problematic metaethical issues (e.g., secular vs. religious ethical traditions) by positing his theory, and yet he does not seem to note the assumption that a neutral, non-particular theory will bypass its own metaethical tradition, whatever that may be. The three elements of Veatch’s contract are revealing in this regard as a layer of prior assumptions and habits that undergird his theory.

neutralize the ideologic slant that people associated with the word ethics.”75 _{To grasp} the significance in this new term, it is helpful to recall some of the prominent individuals and organizations involved in the birth of bioethics. By the end of the 1960s, Jonsen notes that the focus on medical ethics conferences shifted to three nascent bioethics centers: The Institute of Society, Ethics and the Life Sciences (The Hastings Center, 1970), the Kennedy Institute of Ethics (1971), and The Society for Health and Human Values (1969). Dan Callahan, protestant theologians Paul Ramsey and James Gustafson, and Robert Veatch were influential in the launching of The Hastings Center. Formed within Georgetown University, The Kennedy Institute of Ethics benefitted notably from André Hellegers’ vision and the support of Eunice Kennedy Shriver and the Joseph P. Kennedy Foundation. By medical training, Hellegers was an obstetrician and gynecologist, but given his interests in philosophy and theology, Hellegers found “the atmosphere of the Jesuit university congenial,”76 and as with The Hastings Center, theologians were influential in these early years. In 1971, the Kennedy Institute’s first two research scholars were Mennonite theologian LeRoy Walters and Warren Reich, formerly a moral theologian at Catholic University. Other theologians soon followed, including Charles Curran, Richard McCormick, Gene Outka, John Connery, and in 1975 James Childress, also a theologian by training, came

75 _{Reich, 1993.}

76 _{Jonsen, 1998:22. One of the significant projects to emerge from the Kennedy} Institute for Ethics emerged from Hellegers’ push for Reich to organize and map this newly emerging field. Reich accepted this challenge, and with the financial support of the National Endowment for the Humanities published a four volume Encyclopedia of

Bioethics in 1978. For an emerging field so recently named “bioethics,” it is remarkable

to see the knowledge and structure of bioethics organized so quickly as an encyclopedia.

from the University of Virginia.77 _{In 1998, The Society for Health and Human Values} (SHHV) merged with the Society for Bioethics consultation to form the American Society for Bioethics and Humanities (ASBH). As with the Kennedy Institute and the Hastings Center, ASBH’s roots were theological and religious as the SHHV first originated in the mid-60s as a collaboration of Methodist and Presbyterian Churches’ efforts in medical education and theology.

Within Jonsen’s widely referenced history of bioethics (Birth of Bioethics, 1998), the founders and scholars of these three institutes figure prominently, and Jonsen’s narrative implies a natural transition of a new medical ethic within these structures for a new, post-WWII medicine, significantly marked by the new term “bioethics.” Reflecting almost two decades after the advent of bioethics, Engelhardt notes:

A new word often allows us to name elements of reality in a way that conveys new control over our cultural environment. It is often not the precision of a word that is the source of its power and usefulness. In fact, it is often the imprecision, the lack of clarity, that allows us to name and bring together at one time many areas of interest. An apt word can assemble a rich set of images and meanings and thus help us to see relations between elements of reality that were previously separated in our vision and thought of only as disparate.... This has been the case with 'bioethics.'... The word 'bioethics' [has done] brilliant service in bringing together a wide cluster of important cultural concerns. The term [is] profoundly heuristic.78

The popular viewpoint represented by Jonsen is that the term bioethics had a “bi- located birth” between 1970-1971, with two notably different visions for what the term bioethics would entail.79 _{Jonsen points to research oncologist Van Rensselaer Potter as}

77 _{Jonsen, 1998: 23.}

78 _{Engelhardt, preface to Potter, 1988: vii.} 79 _{Jonsen, 1998: 27.}

the first who began writing of bioethics in a 1970 article80 _{that was followed by a book} in 1971, Bioethics: Bridge to the Future. Potter’s vision should be seen as an extension of Aldo Leopold’s land ethic to include all elements of human environment, and the opening of Bioethics: Bridge to the Future quotes from Leopold on three modes of ethics: the first between individuals (e.g. the Decalogue); the second between individuals and society (e.g. the Golden Rule); the third consists of an extension of this sequence to ecological considerations. Bioethics as Potter envisioned should focus on much more than medical ethical questions by rather taking into consideration all biological, communal, relational issues of man within the ecology of the natural world. Pursuing such a harmony, Potter sought to unite the “two cultures” of science and the humanities. This involved both an expansion beyond both mechanistic interpretations of biology and immaterial views of ethics. Biology and wisdom hence are intimately connected for Potter, and he did not shy away from connecting these pursuits to the survival of humanity currently hell-bent on technologically and economically consuming the finite resources of the physical world.81 _{Potter weaves together} observations from 30 years of oncology research alongside environmental philosophy and spiritual-scientist philosophers such as Teilhard de Chardin. For many familiar only with bioethics literature from the last decade, it is likely that Potter’s “Bioethics Creed for Individuals” will seem entirely disjointed from contemporary bioethics. Potter’s credo integrated five statements of belief and commitments regarding: (1) personal acceptance of global, ecological crises; (2) mankind’s role in these crises; (3) the uniqueness of the individual-society relationship; (4) the inevitability of human

80 _{Potter, 1970.}

suffering with the commitment to not passively accept further suffering caused by humanity; (5) acceptance of finitude and finality of life as necessary to further generational life. In short, for Potter:

[Bioethics] would attempt to generate wisdom, the knowledge of how to use knowledge for social good from a realistic knowledge of man’s biological nature and of the biological world. To me, a realistic knowledge of man is a knowledge that includes his role as an adaptive control system with built-in error tendencies. This mechanistic view, which combines reductionist and holistic elements, would be totally incapable of generating wisdom unless supplemented with both a humanistic and an ecological outlook…the present world is dominated by military policy and by an overemphasis on production of material goods. Neither of these enterprises have given any thought to the basic facts of biology. An urgent task for Bioethics is to seek biological agreements at the international level.82

Further within Jonsen’s narrative, André Hellegers was the second figure to inaugurate the term bioethics, and, not surprisingly, his use of the term is the one that gained recognition within the field. Rather than viewing ethics as a broad, inclusive term that addresses ecology, biology, philosophy, and spirituality as did Potter, Hellegers and others at Georgetown saw ethics as “a rigorous examination on the grounds for moral norms.”83 _{The Hellegers/Georgetown model became such the assumed framework,} moreover, that many of the early essential works in bioethics—including Reich’s

Encyclopedia of Bioethics (1978), Daniel Callahan’s Bioethics as a Discipline (1973), LeRoy

Walters’ Bibliography of Bioethics (1975), Beauchamp and Walters’ Contemporary Issues in

Bioethics (1978)—all but fail to mention Potter’s vision for bioethics.84 _{The difference} between the two visions is strong, and it is easy to focus on Potter’s vision as a cosmological or global ethics while Hellegers/Georgetown focuses on narrow medical

82 _{Potter, 1971: 26.} 83 _{Jonsen, 1998: 27.} 84 _{Reich, 1995: 24.}

ethics, but as Reich demonstrates, the matter is more complicated. First, Potter used the term “global” bioethics in an ambiguous way that could:

(1) relate to or involve the whole earth: a worldwide ethic for the good of the world; (2) entail the comprehensive inclusion of all ethical issues in the life sciences and health care (both the “biomedical” and the “environmental” issues of this classic debate); and (3) utilize a comprehensive vision of methods for approaching these issues: expansively incorporating all relevant values, concepts, modes of reasoning and disciplines.85

Potter seems to have emphasized all three of these aspects of global bioethics as bioethics at difference times while the Hellegers/Georgetown model unmistakably treated medical ethics as bioethics, narrowing the focus considerably. Further, Potter’s experience in oncology no doubt influenced his desire to look for preventative measures, environmental health, agricultural policies, as well as global, health education, and broadly speaking these aims align with Hellegers’ work on “the worldwide disequilibrium between the powerful and the powerless” as well as global human infertility amidst social and economic problems in developing countries.86 _{Reich argues} that Hellegers’ overarching message addressed much more than surface, procedural questions and that the developing ways of formulating bioethics debates “begged the question of why we are in medicine in the first place.” In short, “implicitly and indirectly,” Hellegers acknowledged “shortcomings” in the Georgetown model of bioethics even while “enthusiastically taking part in it.”87 _{No doubt in part due to the} strength of the Georgetown University name and the funding grants Hellegers

85 _{Reich, 1995: 24.}

86 _{Reich, 1995: 25.} 87 _{Reich, 1995: 28.}

successfully secured, bioethics became a neologism primarily associated with the problems of biomedicine.

Beyond Jonsen’s history that speaks primarily of Hellegers and Potter, we may see an even earlier use of the term bioethics in a 1927 publication from Protestant pastor and philosopher Fritz Jahr, “Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants” (Kosmos: Handweiser für Naturfreunde 24:1, 2-4). Hans-Martin Sass sees Jahr’s message as a third possible direction for bioethics. Hellegers, Potter, and Jahr all sought a renewed vision “for ethics and morality in times of new technologies and changing cultures,” 88 _{butJahr differs from Potter and Hellegers in following a} distinctly theological and philosophical path to address the ethical implications inherent within all forms of life. Sass transposes Jahr’s language, “using Reich’s wording,” to articulate Jar’s view of “Bioethik” as “the systematic study of human conduct in the area of the life sciences and the personal, professional, and public moral commitment and conduct towards all forms of life, in as far as this conduct is examined in the light of moral values and principles.”89

This transposed language may sound familiar to contemporary bioethics, and yet what emerges primarily in Jahr is a close relationship to nineteenth-century thinking in the life sciences that could not be more distant from contemporary bioethics. Sass points to figures such as Wilhelm Wundt (Lectures on the Soul of Humans and Animals, 1863, 6th ed. 1919) and Theodor Fechner (Nana or the Soul Life of Plants, 1848; Elements of

88 _{Sass, 2007: 280.}

Psychophysics, 1860) as examples of a turn away from Cartesian body-soul dualism,

focusing instead on teleological aims and interactions “of and between living and sensing environments and living and sensing beings.”90 _{Alongside biophysics and} biochemistry, Rudolf Eisler (Workings of the Soul: Ideas Towards an Organic Psychology, 1909) proposed “Biopsychics” as a way to comprehend the willing activity of all forms of life.

Similar to these Austro-German figures, one may think of the French “spiritualist” Félix Ravaisson (1813-1900) who traced an ontological phenomenon of “habit” as a way to grasp the intimate relationship between being and virtue within nature. As things or subjects change, the familiarity of habits diminish resistance, while passivity (non-habitual activity) increases resistance. This seemingly simple observation in nature reveals much as Ravaisson seeks to further Aristotle’s search for “the immaterial reality of individual, particular things.” The goal is to see in all organic nature the “essence” of these things in their respective “noien thought,” and in this identification of spiritual or intellectual intuition within all organic-sense activity, the goal is to uncover the genuine unity of all being.91 _{Within such a framework, any hard distinction between ontology} and ethics is meaningless as the essence of a thing, in one way, inherently manifests or reveals its virtue, and, conversely, the virtue of a thing directly influences the ontological. Jahr’s bio-ethik hence may be seen as a fusion of biology and psychology, leading Jahr to gesture towards examples as varied as St. Francis of Assisi’s love for

90 _{Sass, 2007: 280.}

91 _{The editors of the English version of Ravaisson’s Of Habit, Clare Carlisle and Mark} Sinclair quote Henri Bergson on this point: “The unity joining beings to one another, the unity of a thought that we see, from inorganic matter to the plant, from plant to animal, from animal to man, until from concentration to concentration we should end in divine thought, which thinks all things in thinking itself” (“Preface” to Ravaisson, 2008: 2).

animals and Rousseau’s enthusiasm for nature. Such a context for bioethics is certainly far from contemporary bioethics literature, but Jahr emerged from this context into more familiar terrain by promoting Kant’s categorical imperative into a “bioethical imperative” founded on the a priori premise that all of creation is sacred. This bioethical imperative draws upon a love and compassion for all things, the Golden Rule (Matt. 7:12; Luke 6:31), and inherent moral duties to oneself under the banner of “personal health responsibility.” 92 _{Jahr draws heavily from Kant and yet differs from much of the} Kantianism in contemporary bioethics by embedding his Kantian-spiritualist methodology within an ontological unity and continuum of all things.

When comparing and contrasting Hellegers, Potter, and Jahr, more of a similarity can be drawn between Jahr and Potter’s broad implications of the term bioethics, and yet both visions have fallen to the wayside. A “new” ethic drawing together cosmic harmonies of the quadrivium has not emerged with the term bioethics. Hellegers’ biomedical focus for bioethics, rather, has gained supremacy as evidenced by Potter’s vision later rebranding under “global bioethics” (Global Bioethics: Building on the Leopold

Legacy, 1988). There are, no doubt, other ways to analyze further the legacy of this

neologism, but it is imperative to note the secular and theoretical order that accompanied Hellegers’ use of bioethics, regardless of his intentions. As noted above, the secular dilemma with bioethics is parallel to the dilemma of modern moral philosophy as Anscombe had identified some two decades past—the dilemma of moving forward in modern moral philosophy as though analysis of moral concepts and presuppositions can take place when the fundamental existence of those concepts and

presuppositions remains in question. Such a maneuver reduces modern moral philosophy to an examination or analysis of justice or virtue in light of certain “facts” that remain unexamined, and the whole endeavor operates on the level of thin theoretical analysis while suspending judgment on the “facts” undergirding such analysis. In other words, modern moral philosophy and bioethics are postured as tools of analysis amidst a neutral environment with suspended values. Hence Anscombe notes in such arguments that “‘wrong’ of course is explained as meaning ‘morally wrong’ and all the atmosphere of the term is retained while its substance is guaranteed quite null.”93 _{To this we may consider Engelhardt’s description of what occurred when} bioethical visions such as Jahr’s and Potter’s were abandoned:

For the most part, the term bioethics has been taken to identify the disciplined analysis of the moral and conceptual assumptions of medicine, the biomedical sciences, and the allied health professions. As such, it has become a special area of philosophy of ethics, even though all of its practitioners have not been formally trained in either area.94

Enframed within secular and theoretical modern moral philosophy, bioethics proceeds not due to its “factuality” but due to its “acceptance,” an acceptance based on what Koch describes as bioethics’ “foundational myth.” The myth more or less follows Jonsen’s narrative as described above that from the 1960s and 1970s bioethics arose as a capable replacement for traditional ethics of medicine that failed to keep up with new technological and scientific realities. Bioethics then exists primarily as a set of analytical tools “accepted” or selected by the powers that be, and the context for this acceptance is a “neoliberal, modernist order.” By modernist, Koch means turning from “worship” of past traditions and authorities to a future pursuit of projected goods, pleasures, and

93 _{Anscombe, 1958: 17.}

freedoms. By neoliberal, he means an order “in which consumerism and transactional thinking are advanced, in the name of individual autonomy, over values of community and communal responsibility. The result is not morally rich but instead ethically blank, a bookkeeper’s recording rather than a moralist’s recording.”95 _{Bioethics in this way} becomes a mere transaction and interchange of theories intended to guide and regulate scientists, physicians, and others engaging matters of bios.

Moreover, supporting the foundational myth of bioethics are select deep roots within Western philosophy promoting the simplistic notion that reason guides the will towards a set of applicable moral laws that are “out there.” Mark Johnson calls this “the Moral Law folk theory,” and the poster child for this is inevitably Immanuel Kant given his arguments for the autonomous, rational individual who may through reason perceive the moral law. 96 _{What emerges is not necessarily Kant himself but rather a} Kantian move to place moral authority in autonomous reason removed from cultural, social, and religious traditions. Such a narrow approach to bioethics as a neutral, theoretical analysis ignores numerous layers of complexity, not to mention the fundamental insight from figures such as Hegel, Wittgenstein, and Charles Taylor that there is no direct line of rationality between the transcendent and the immanent or mundane. The complexity of cultures, psychology, religious belief and more create a scenario that calls for much more in bioethics than simplistic Moral Law folk theory or

95 _{Koch, 2012: 9.}

96 _{Koch draws from Mark Johnson’s Moral Imagination: Implications of Cognitive Science for}

Ethics (1993) to articulate Johnson’s Moral Law folk theory: “Moral reasoning is thus

principally a matter of getting the correct description of a situation, determining which moral laws pertain to it, and figuring out what action that moral law requires for the given situation” (as quoted in Koch, 2012: 10, 10-15).

thin appeals to the four principles of autonomy, beneficence, non-maleficence, and justice. Appealing to these few theoretical tools assumes some “pure humanity” existing within a supposedly neutral moral space or domain, and, hence, in effect bioethics is seeking to exist within a secular sociology when what we have forgotten is that “the secular is a domain that had to be instituted or imagined, both in theory and in