Historical Development of Bioethics as a Cultural Domain of Inquiry

Bioethics emerged in the 1960s in response to myriad factors including: biotechnological developments, namely hemodialysis, organ transplantation, and mechanical ventilation; the civil rights movement; the backlash against physician paternalism; and revelations about abuses in human subjects research (Beecher, 1966; Fox, 1990; Rothman, 1990). Technological developments, for instance, raised questions about allocation of scarce resources and whether quality or quantity of life should figure in decisions about the use of life-prolonging interventions. Patients' rights efforts challenged physician authority to know what is in patients' best interests and paved the way for greater patient involvement in medical decision-making. The revelations of experimentation atrocities committed during World War II against human prisoners, against human subjects in the course of clinical practice in the 1960s, coupled with ongoing revelations of abuses such as the syphilis study in Tuskegee, GA, and human radiation experiments conducted in the 1940s-1970s, have opened the door to new protections of human subjects participating in scientific research (Advisory Committee on Human Radiation Experiments, 1996; Jones, 1993).

Though some early work appeared in the 1980s (Kunstadter, 1980), anthropological interest in bioethics began to take root in the early 1990s. Medical sociologists' earlier works inspired anthropological theories about moral worlds within biomedicine (Bosk, 1979; Fox & Swazey, 1978, 1984). Anthropological interest in bioethics grew out of the work in anthropology of biomedicine. Within the biomedical health care setting, ethical or moral dilemmas arise every day since biomed-icine is fraught with uncertainty and medical decisions must be made. Medical decisions, particularly those at the end of life and beginning of life, are informed by a host of moral values about doing what is considered best for the patient, particularly preventing suffering (Kleinman, 1995a, 1995b) and ensuring an acceptable quality of life. Similar issues within the study of biomed-icine also drove the study of bioethics, especially concerns about how power dynamics affect the relationship between doctors and patients. Thus, anthropologists studying bioethics examine how issues come to be defined or established as moral quandaries, people's grounded experiences of engagement with and responses to ethical dilemmas, and the cultural values, beliefs, and social structural dynamics that contribute to ethical decision-making. Additionally, just as medical anthropologists have examined the cultural values underpinning biomedical theory and practice (Gordon, 1988; Hahn & Gaines, 1985), anthropologists have similarly turned their attention toward examining the cultural assumptions of normative principles of bioethics (we will explore this theme later on). Through these efforts, anthropologists have been leaders in the development of empirical bioethics (Frank et al., 1998; Gordon, 2001a;

Levin, 1988; Marshall, Koenig, Barnes, & Davis, 1998; Siminoff & Chillag, 1999).

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