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Question: Why should sociologists concern themselves with bioethical issues? Why should bioethicists study sociology?
WEEK 12
CHAPTER SUMMARY
CHAPTER 13
ISSUES IN BIOETHICS
Bioethics is the study of ethical issues in biological sciences and health care. Many of the issues bioethicists ponder revolve, whether explicitly or not, around the use and impact of power—a central concern of sociologists.
Since its beginning in 1848, the American Medical Association has required all doctors to subscribe to its Code of Ethics. However, although earlier generations of doctors undoubtedly tried to relieve human suffering, much of their research and clinical practices would horrify modern bioethicists. Examples include J. Marion Sims’ use of black slaves to develop a surgical cure for vesicovaginal fistulae and Nazi doctors’ experiments on Jewish prisoners and murders of mentally disabled Germans.
Following the Nazi defeat, allied countries prosecuted 23 doctors as part of the broader war crimes trials held in Nuremberg and popularly known as the Nuremberg trials. These trials resulted in the development of the Nuremberg Code, a set of internationally recognized principles regarding the ethics of human experimentation, including the requirement for informed consent, taking measures to protect research subjects from harm, and only conducting research when there is a medically justifiable reason. Box 13.1: Principles of the Nuremberg Code describes the ten principles of that Code.
The Nuremberg trials had little impact on medical research or practices in the United States. Interest in bioethics would grow substantially during the 1960s, sparked by articles in the popular press on kidney dialysis selection committees and by an article in the prestigious New England Journal of Medicine regarding ethically questionable research that the journal had itself published.
Interest in bioethics continued to grow in the 1970s, sparked by the Willowbrook hepatitis experiments, the Tuskegee syphilis experiments, and the Karen Quinlan “right to die” case. The Willowbrook experiments highlighted issues surrounding informed and voluntary consent, the Tuskegee experiments highlighted abuse of power by federal agencies as well as individual doctors and medical researchers, and the Quinlan case signaled the entry of the legal system into health care decision making.
The 1980s and 1990s saw both further development of medical technology and further questions regarding whether medicine might have gone too far in its ability to control human life and death. Areas that rose to prominence included reproductive technology, setting priorities for and rationing medical procedures, and the ethics of enhancing human traits (through, e.g., cosmetic surgery or memory-enhancing drugs). In the twenty-first century, these issues remain, along with new ones such as the use of stem cells, the ethics of cloning, and the health risk of concussions sustained by athletes.
Contemporary Issues: Guinea Pigging discusses the recruitment of healthy individuals to test the safety of experimental drugs in clinical trials. Many of the subjects participate because they need the money. In exchange, they often face very unpleasant conditions and always place their health at risk. Additionally, the conditions of such for-profit research endanger members of the general public who may eventually have access to the health care technologies being tested.
In recent years, various institutional mechanisms have developed to ensure that bioethical principles will be followed in health care and health research, including hospital ethics committees, institutional review boards, community advisory boards, and professional ethics committees. An important new development is the use of for-profit research ethics committees, which tend to have more conflicts of interest than do federally funded, university-based researchers. Despite these issues, however, the rise of bioethics has substantially reduced the number of egregious human subjects’ abuses.
The growth of the bioethics movement and the institutionalizing of bioethics in U.S. hospitals and universities have made ethical issues far more visible in the health care world than ever before. These developments have led some observers to conclude that the bioethics movement has fundamentally altered the nature of medical work. Others, however, argue that hospital, research, and professional ethics committees serve primarily to offer legal protection and social support to researchers and clinicians, not to protect patients or research subjects. Further, they argue, while clinicians have become more concerned with and adept in documenting their allegiance to ethics guidelines, they have not become any more concerned with following those guidelines.
