Fifteen Eighty Four

One of the terrible ironies of life is that ethics blooms in times of disaster. With the corona virus sweeping through the world, bioethics has moved to center stage. In high-income countries such as Italy and Spain, tough decisions have had to be made about who gets what by way of medical care. In New York, emergency medical technicians make triage decisions when they decide on whom to take to the hospital and whom to leave at home.

The ethical challenges cut even deeper. As the epidemiologist Larry Brilliant has said, “outbreaks are inevitable, pandemics are optional.” It is a devil’s brew of human action and inaction that produced a virus that so far has killed nearly 300,000 people around the world, nearly a third of them in the United States. We can only imagine what the toll will be in the poorer countries of the Southern Hemisphere once the virus arrives in force. In considering these questions and our responses we move beyond the challenges of clinical medical ethics to larger questions about justice.

Yet the ethical questions cut deeper still. What produces viruses like Covid-19 and allows them to host in the world’s most populous and mobile large mammal is the massive, unprecedented human transformation of nature. This human transformation of nature affects everything from the distribution of plants and animals to the composition of the atmosphere, and gives rise ethical challenges from climate change to extinction to the deployment of CRISPR technologies.

It is this insight – that destroying the natural world risks destroying ourselves — that gave rise to the term “bioethics.” Van Rensselaer Potter (1911-2001), who coined the term in 1970, was an oncologist who spent his entire career at the University of Wisconsin. Potter characterized bioethics as a new discipline devoted to “the science of survival,” which he saw it as a “bridge” between the two cultures of science and the humanities. His vision was to create knowledge that would make possible “a rational but cautious participation in the processes of biological and cultural evolution.” The goal of this discipline was “not only to enrich individual lives but to prolong the survival of the human species in an acceptable form of society.” As an oncologist working at one of the most environmentally-minded universities in the world, Potter viewed human and environmental health as deeply entwined. He was an expansive, secular-minded thinker, whose vision of bioethics was global in scope. His last book, Global Bioethics, was subtitled Building on the Leopold Legacy, in homage to the great environmental thinker Aldo Leopold, his colleague at the University of Wisconsin (though apparently they never met).

Within months of Potter coining the term, it was being used in quite a different way by André E. Hellegers, a Dutch obstetrician-gynecologist, who was the founding director of the Kennedy Institute of Ethics at Georgetown University in Washington, DC. Hellegers had come to the attention of the Kennedy family through his work on the Pontifical Commission for the Studies on Family, Population and Birth, created by Pope John XXIII during the time of the Second Vatican Council. Although within the church Hellegers was regarded as a liberal, the institute he founded was guided by a Catholic moral agenda, primarily focusing on questions of reproductive ethics and justice in the provision of health care. The “Georgetown model” (as it came to be called) introduced a notion of bioethics focused on concrete medical dilemmas, primarily in three fields: (1) the rights and duties of patients and health professionals; (2) the rights and duties of research subjects and researchers; and (3) the formulation of public policy guidelines for clinical care and biomedical research.

Whereas Potter saw bioethics as a new discipline that would combine scientific and philosophical knowledge, the Georgetown model saw bioethics as part of an old discipline, philosophy—in particular, as a branch of applied ethics. Potter was convinced of the potentially strong and influential links between science and ethics, but the Georgetown model emphasized the autonomy of ethics and its independence from science. While Potter called for broad, new thinking about the human condition, the Georgetown model sought to resolve concrete moral problems regarding the practice of medicine through the coherent application of already widely shared ethical principles. Potter was a loner in this field, and his periodic publications could not compete with the Kennedy Institute in influence. In contrast, Hellegers benefited from his base at the Kennedy Institute, a supportive university setting, and a coherent intellectual agenda. Hellegers’ conception of bioethics quickly became dominant.

Yet now we find ourselves squarely in the world that Potter imagined: the Anthropocene, when human action does not keep to itself, when causation is not linear, and both our actions and their consequences ramify through global systems. Effectively confronting the problems of the Anthropocene will require giving up entire epistemologies that are based on neat little categories that nature refuses to acknowledge. Recovering the term “bioethics” as the name of the field that confronts these challenges is a small step we can take in expanding our thinking—and also, along the way, in honoring a man whose thinking was decades ahead of his time.