Foundations of the field

The term bioethics comprises the Greek words bios—meaning life—and ethos—meaning habits, behavior or values. An academic dispute continues regarding whether or not bioethics counts as a scientific discipline, but I regard bioethics in this thesis as a discipline that is generally defined as the systematic study of the moral dimensions in the life sciences and healthcare realm, such as medicine and other biomedical sciences, including biomedical

engineering, genetic epidemiology, and more. (See, for example, Jonsen 1998; for argumentation about bioethics as a discipline, see also Saxén 2017.) Dickenson (2012, 2) more practically sums up bioethicists’ work as efforts “to make sure that the onward march of science doesn’t trample down vulnerable populations, to prevent harms from outweighing benefits, to ask whose interests prevail and to ask questions about whether justice is being served by new scientific developments.”

Bioethics thematically overlaps with medical ethics, yet bioethics should be conceptually differentiated from medical ethics. Bioethics represent a cultural breakage, a change of ethos, in comparison to the long history of medical ethics that came before it. Historian Albert Jonsen (2000) divides the developments of moral thinking in medicine into three phases: decorum, deontology, and politic ethics. Decorum refers to virtues and etiquette and puts weight on the physician’s character as a basis for moral conduct in medicine. This ethic is identified as being most prominent in Ancient medicine and the classical world. Deontology, developing especially in Medieval medicine, shifted the focus from the character of the healer toward shared rules and principles. Finally, politic ethics, the latest development in medical ethics, concerns the role of medicine in the context of the larger society and introduces questions of justice. The justice theme rarely appears in the early medicine of antiquity; Jonsen depicts it as starting to emerge with the professionalization of medicine during the Renaissance era. These phases, expanding from the classical era to the first half of the 20^th century, represent what Jonsen calls the “long tradition” of medical ethics. (Ibid.)

Traditional medical ethics centers more practically around the physician–

patient relationship and holds profession-based guidelines and the physician’s character to a high standard (such as the professional code of conduct). Bioethics, too, delves into physicians’ dilemmas and the physician–

patient relationship alongside traditional medical ethics, but in addition to this, bioethics is also concerned with external issues important to patients and society that go beyond the medical profession’s realm (Dzur 2008, 208). Emerging in the 1970s while connecting to the latest era of the long tradition—politic ethics—bioethics introduced interdisciplinary scholarship, a new characteristic unforeseen in the medical ethics tradition. As a result of

this cultural shift, bioethics welcomed people from outside of medicine into deliberations in councils, committees and commissions that, for the first time in history, included a variety of laypersons, professionals and interdisciplinary scholars (Jonsen 2000, 118–119). Bioethics, thus, takes the questions of medical ethics into greater interdisciplinary, societal and governmental dimensions. This shift of focus from inside the medical profession to outside of it is characterized in practical terms by bioethicists themselves: Many have, for example, theological or philosophical rather than medical training (Dzur 2008, 209).

Dzur (2008, 209) claims that, whereas traditional medical ethics is a form of self-control and self-critique for physicians, bioethics, instead, approaches the same ethical questions with a degree of public critique and control. This newer tradition of external versus internal control in the medical profession originally developed out of the concerns of ethicists who worried that “the old tradition of medical ethics was too frail to meet the ethical challenges posed by the new science and medicine” (Jonsen 1998, 3). Unlike the long tradition, the bioethics perspective decreases the weight put on profession-based codes or physicians’ character and focuses instead on interdisciplinary, topic-based discussions. This means experts from different fields—physicians, nurses, philosophers, theologians, and social scientists, for instance—gather to discuss topics such as defining when treatment is futile, the different methods of prioritization, healthcare justice, or forgoing life-support, for example.

The cultural shift from traditional medical ethics—emphasizing physicians’

character, behavior, solidarity, and educated competence—to the new bioethics reflected the greater societal changes of the post-World War II era in the Western world and more widely. Medical science advanced and medical interventions became more technical than before: Impersonal machines suddenly intervened in what had been thought of as the sacred doctor–patient relationship. Traditional duties such as the physician’s traditional command to

“do no harm” were challenged by the mere difficulty of telling what precisely the harm is: The question suddenly became whether sustaining life through a medical machine was, in fact, a benefit or a harm. (Jonsen 1998, 11.)

Bioethics as a field has both a practical and a scientific function: It is an effort not only to study and understand but also to influence the social life

and society around us. Differing from more traditional academic disciplines—

such as philosophy, history, or anthropology—the field of bioethics is unusual because of its increasing acceptance within the everyday practice of healthcare institutions, especially in North America, as well as its social prominence and media appeal (Churchill 1999, 254).

Bioethics consequently operates in the arenas of both knowledge and politics. These different purposes in the field are reflected in the vast array of roles that bioethicists take. Academic bioethicists analyze ideas, theories and concepts relevant to healthcare and the life sciences. Clinical bioethicists facilitate when moral conflicts arise in hospitals, discuss values and moral dilemmas with healthcare professionals and sit in ethics committees to participate in making decisions on topics such as hospital policy. In addition to these, bioethicists may provide legal advice, contribute to political healthcare decision making, serve as experts in institutional review boards (IRBs) or consult on topics such as risk management.