Medical Ethics To Bioethics: a Historical Journey

The field of medical ethics has undergone a significant transformation to become what we now know as bioethics. This shift from a religiously dominated area of study to a secular scientific field has had a profound impact on how we view and approach ethical issues in healthcare.

As Patrick Guinan, M.D. claims, “[m]edical ethics originated in prehistory when the shaman, or religious leader, became distinguished for the doctor or expert in physical healing.” The Hippocratic Oath (400 B.C.) became the foundation of medical ethics as medicine separated from religious leaders.

Biologist Van Rensselaer Potter first introduced the term bioethics in his book “Bioethics: the Bridge to the Future.” This change in terminology marked a significant milestone, as ethical decisions were no longer the sole responsibility of religious leaders. This allowed society as a whole needed to grapple with these issues. The shift to bioethics opened the door to a strictly secular approach.

Since the name change, the field has grown exponentially. Catholic healthcare ethics, which once dominated the field, now finds itself in the midst of competing views. Joint ventures between Catholic and non-Catholic facilities require value assessment to ensure moral alignment. Education and formation of healthcare professionals have become necessary to maintain their Catholic identity. But what was the foundation of this new “Bioethics”?

From Medical Ethics to Bioethics: The Role of Scientism

The eighteenth century’s Age of Enlightenment was marked by a shift from religious dogma to scientific investigation, creating what we now call the era of “The Age of Enlightenment”. As people began to lose faith in organized religion due to the wars between Catholics and Protestants, they turned to natural science as a means of understanding the world. This led to the emergence of “Scientism” – the ideology that asserts that we only know things through scientific investigation.

However, this notion did not align with the beliefs of renowned scientists of the time like Galileo and Newton who were also God-fearing believers. Nonetheless, the followers of Scientism claimed that Faith and Reason were in opposition to each other. It is this ideology that accelerated the shift from medical ethics to bioethics, where the values and ethics of science were now in focus.

Saint John Paul II’s Argument Against Scientism

Saint John Paul II (JPII) defines Scientism as “the philosophical notion which refuses to admit the validity of forms of knowledge other than those of the positive sciences; and it relegates religious, theological, ethical, and aesthetic knowledge to the realm of mere fantasy” (emphasis added). JPII offers a relevant critique of this ideology as follows:

“Science would thus be poised to dominate all aspects of human life through technological progress. The undeniable triumphs of scientific research and contemporary technology have helped to propagate a scientific outlook, which now seems boundless, given its inroads into different cultures and the radical changes it has brought. … And since it leaves no space for the critique offered by ethical judgments, the scientistic mentality has succeeded in leading many to think that if something is technically possible it is therefore morally admissible.”

This reduction of facts to only scientific discoveries leads to skepticism, where even the color of your computer cannot be determined without an experiment. But more devastating, scientism leaves no room for values like beauty that we experience in the world. If that was not enough, the ideology is self-refuting because the claim that knowledge is only known through science cannot be proven by science itself.

While scientific progress has been remarkable, Scientism reduces the facts, values, and ethics in favor of scientific investigation. Science must have boundaries set by philosophy and ethics to ensure that scientific progress aligns with human values.

The idea that we can only know things through scientific discoveries is a reduction of facts.

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From Medical Ethics to Bioethics: The Subjective vs Objective Dichotomy

The Enlightenment period saw the rise of two opposing ideologies – Scientism and Romanticism. While Scientism sought to reduce all human experiences to objective, measurable facts, Romanticism sought to imbue value into our experiences through aesthetics. This led to the creation of a false dichotomy between the objective and subjective, and ultimately the separation of science and humanities. The medical field also fell victim to this division, with medical ethics being placed in the subjective humanities category and medical practice in the objective scientific category.

But medical practice is not purely objective science. It is an art that uses science to achieve a value-based goal – the patient’s goal of care. The patient’s values and desires are integral in establishing this goal. The clinician’s role is to use their technical and scientific knowledge to reach that goal or create a life for the patient that is worth living. There is a technical skill involved, just as a painter needs technical abilities and knowledge to create art. In healthcare, A plus B does not always equal C, and the patient may not even want C but rather D. Medicine is anything but valueless!

The danger of thinking of medical ethics as purely subjective humanitarianism is that it reduces ethics to a matter of taste, or relativism. Each individual has their own set of values, and without objective criteria to judge moral values, each way is as good as the next. This leads to the proliferation of numerous value systems, each unique to a person’s individual taste. But relativism is problematic, as it leads to the denial of universal truths about the good. Conscience is no longer considered an application of the universal knowledge of the good in a specific situation, but instead, individuals independently determine criteria for what is good and evil. This individualist ethic leads to a denial of human nature and the very idea of universal truth.

The dichotomy between the objective and subjective is false and leads to the division of science and humanities. Medical practice is an art that uses science to achieve a value-based goal, while medical ethics cannot be reduced to subjective humanitarianism without undermining the concept of universal truth. The patient’s values and desires are integral in establishing the goal of care, and healthcare professionals must use their technical and scientific knowledge to achieve it.

Final Thoughts

As we’ve explored, the secularization of medical ethics into bioethics has been the natural progression from the Enlightenment. While traditional medical ethics may not be objective in the strictest sense of the term, it remains objectively true. It’s crucial to recognize that there’s a false dichotomy between “subjective” medical ethics and “objective” medical practice. Both are integral to the art of medicine.

It is false to think that subjectivity precludes a truth value from being assigned.

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Have you encountered a compelling argument against moral relativism or do you have a different perspective on the evolution of medical ethics into bioethics? Share your thoughts by tweeting me @PaulWagle or leaving a comment below. I’m eager to hear your insights and continue the conversation!

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