The Birth of Bioethics - Softcover

In The Birth of Bioethics Jonsen has written an in-depth review of bioethics, including a historical analysis of the field. But this is also a book about heroes.

Jonsen presents the growth of bioethics from 1947, when the Nuremberg Code was drawn up, to 1987. He does so in three chapters on the religious, philosophical, and governmental aspects of the subject. He covers five major areas of bioethics, including research and death and dying, and deals with bioethics as a discipline and as a topic of discourse. In the final chapter, he gives his explanation of why bioethics arose in this country.

The history he presents includes advanced ideas, such as H. Tristram Engelhardt's concept of ethics as an "enterprise in controversy resolution" and Robert Veatch's criticism of the assumption of moral authority by persons with technical competence or what he calls the "generalization of expertise." This material should inform even sophisticated readers. Comprehensive footnotes and illuminating cross-references reflect Jonsen's consummate knowledge of theology, philosophy, history, and literature. He cites Homer and Shakespeare, and he makes the history of bioethics come alive, because he was there.

For instance, I have taught bioethics to medical students for 20 years using a well-known film about a baby born at Johns Hopkins Hospital with Down's syndrome and an intestinal blockage requiring surgery. I learned only from this book that the chairperson of the pediatrics department at Johns Hopkins had had two children with developmental disabilities and that the person who portrayed the baby's doctor in this film had actually been an intern then and had felt a sense of moral outrage at the time.

Jonsen's depictions of the pioneers in bioethics whom he knew and worked with are vivid. Joseph Fletcher, for instance, stood in picket lines, and "turned to... bioethics because everything else was so vicious." Paul Ramsey had this to say about a conference held in the Valley of the Moon in Sonoma, California, to determine whether neonates with severe defects should ever be allowed to die: "The symbolism... should not be lost: a valley on a dead satellite of our mother earth." Warren Reich and George Kanoti, while they were nontenured professors at the Catholic University of America, expressed unpopular views that resulted in their being invited to resign. But Jonsen is with them: "It began to dawn on me that as a newly minted moral theologian, I would not be comfortable or conscientious teaching the traditional doctrine on abortion and contraception."

Jonsen's own beliefs, no doubt, influence which areas he chooses to emphasize. He pays particular attention to the influence of Catholic religious doctrine and of the theologians Joseph Fletcher, Richard McCormick, and Paul Ramsey. Yet Jonsen sees no major issue in American bioethics in which religious and philosophical ethics did not collaborate and sees this "trinity" of theologians as having presided over the birth of bioethics.

Jonsen's unique insights, infused by the compassion he obviously feels, recommend this book strongly. Jonsen's own words are compelling. In regard to choosing whether to allow neonates to die, he states, "The hope seems so great and the loss so devastating to parents that the decision... is particularly agonizing." About the rise of bioethics in the United States he says, "My hypothesis is that the American ethos is strongly tempted to endow various aspects of life with moral meaning in a capricious way." And, with respect to the new forms of technology that have been developed to help women bear children he states, "The difficulty of unraveling the ethics of reproductive technology may be due to our impoverished ability to recognize and appreciate what is normal about being human."

Reviewed by Edmund G. Howe, M.D., J.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.