Bioethics: past, present, and an open future.

The development of bioethics, spurred by the Nazi era and initiated in recent times largely in the United States, appears to be taking hold across at least the Western world. To date it lacks the necessary trappings of a true profession: that is, it lacks self-definition, criteria, and a method of assuring that those who call themselves bioethicists not only have appropriate training but function appropriately. Partly this is because the very term "appropriate" has not been defined! These are tasks that the new guard, with perhaps the advice and help of those of us from the old guard, will have to address. The development of bioethics has been mainly focused on those who had good access to healthcare. Those with a lack of access have been given short shrift. Basic healthcare provided to all within a given society has been the case in virtually all industrialized countries except for the United States since at least World War II, and even longer in most cultures. Here in the United States, our main bioethics societies, and bioethicists as individuals, have tended to concentrate on individualistic ethics and its problems (euthanasia, abortion, termination of care, IVF, etc.) and have, to a large measure, practiced "rich man's ethics." The lack of access to healthcare as well as many other faults have been labeled "system errors" and are in general considered to be beyond the responsibility of the bioethical profession. They tend to be shrugged off. We have been inclined to "join the establishment" and in so doing have often forgotten our own mission. We have spent a good deal of time discussing the ownership of a dead man's sperm and have made relatively little contribution to an equitable distribution of healthcare. In many respects, we have sold out. In my view, this is an evasion of social responsibility--social responsibility being one of the hallmarks of an honest profession. Until we come to terms with our mission--a mission that cannot merely be self-serving--we shall not be regarded as a profession. And that is a shame.