The birth of bioethics.

Albert R. Jonsen, ed., of Bioethics, Special Supplement, Hastings Center Report 23, no. 6 (1993). On 23-24 September 1992, of Bioethics, held at University of Washington, Seattle, gathered many of pioneers of new ethics of medicine to review its history and project its future. A pioneer was defined as one whose name had appeared in first edition of Bibliography of (1975) and who had continued to work in field. Some sixty persons made cut and, of these, forty-two came to Seattle. The occasion of this conference was thirtieth anniversary of publication of an article in Life magazine, They Decide Who Lives, Who Dies (9 November 1962). That article told story of a committee in Seattle whose duty it was to select patients for entry into chronic hemodialysis program recently opened in that city. Chronic dialysis had just been made possible by Dr. Belding Scribner's invention of arteriovenous shunt and cannula in 1961. It quickly became apparent that many more patients needed dialysis than could be accommodated. The solution was to ask a small group, composed mostly of nonphysicians, to review dossiers of all medically suitable candidates and sort out those who would receive lifesaving technology. Thus, committee was faced with unenviable task of determining suitability on grounds other than medical. Should it be personality? finances? social acceptability? past or expected contribution? family dependents and support? While committee was anonymous, word of its existence appeared in New York Times. Life correspondent Shana Alexander travelled to Seattle to cover what she described at Birth of Bioethics as the most fascinating story of [her] career. As professor of ethics in medicine at University of Washington, I thought that thirtieth anniversary of appearance of that article was worth commemorating. My university would claim a birthright and, more seriously, those who had worked for some years in bioethics could reflect on origins and evolution of our work. Quite shamelessly, I entitled event of Bioethics although, as any decent historian knows and as many of conference participants declared, dating time and place when any social movement begins is perilous and near impossible. Still, interesting events in Seattle were worth recalling, and features of those events that presaged full-grown bioethics movement were worth pointing out. Whether Seattle events were a birth, a conception, or merely a gleam in someone's eye, I thought it a good time for early workers in field to gather, reminisce, and perhaps, begin to make a history. has matured into a minor form of moral philosophy practiced within medicine. Today, soundly reasoned articles on a variety of ethical questions appear regularly in major medical journals. In almost every American medical school, students study, in one form or another, new medial ethics. Twelve thousand persons subscribe to Hastings Center Report. Ten special government employees of Hillary Rodham Clinton's Health Care Task Force were identifiable as bioethicists. The effect of these developments on medicine and health care has been remarkable. The first historian of bioethics movement, Professor David Rothman of Columbia University, writes in his Strangers at Bedside: The record of bioethics' influence ... makes a convincing case for a fundamental transformation in substance as well as in style of medical decision making.[1] Where did this new ethics of medicine, or bioethics, come from? What events occasioned its origins? What form has it taken? Who elaborated it? Who pays attention to it? What is its significance for modern medicine, health care, and health policy? Those who work in this new field are only now beginning to reflect on these questions. …