The field of bioethics concerns itself with the value issues that arise from human consequences of medical technology and practice. Though the field is young (early practitioners date its founding to the 1960s), it claims a heritage of moral theory and virtue ethics that dates to antiquity. Bioethics traces many lines of descent, from moral philosophers concerned with selfhood and theories of beneficence to protest movements that brought lawyers, philosophers, and theologians into debates about life and death, technology and its limits. Today the practice of bioethics is roughly divided between the roles of teacher-scholar in colleges of medicine, nursing, and arts & sciences, and clinical ethicists who are involved in consultation on individual patients and setting hospital policies.
Bioethics Teaching and Scholarship
Bioethics has evolved as both a subfield of moral philosophy and an interdisciplinary area of focus that brings together lawyers, philosophers, literature scholars, anthropologists, sociologists, historians and others who study a set of problems at the values at the interface of biology and human lives. Until recently, most bioethics has been focused on the individual doctor-patient relationship and the protection of patients from harm, mistreatment, or unintended consequences. Bioethicists have studied issues such as when life begins—debates brought on by the neonatal incubator and other technologies; termination of life-sustaining treatment—crystallized around ventilators and feeding tubes; allocation of scarce resources—in particular organs for transplant, but more recently broader issues in autonomy and informed consent; ethics of care; and values manifested in priorities in funding of medical care and public health. While traditional philosophical, theological, and legal reasoning, analysis, and critique remain central to bioethics, recent contributions in fields such as feminist ethics, narrative ethics, care ethics, and empirical bioethics have broadened the debates and subjected health policy, public health and health economics to ethical scrutiny. Empirical ethics brings social science methods to bioethics, using surveys, interviews, focus groups, and other techniques to study medical practice and the perspectives of patients, health care providers, and the general public into debates about the ethics of health and health care.
Clinical Ethics Consultation
Clinical ethics provides a structured approach to identifying, analyzing, and resolving ethical issues in clinical medicine. When physicians and patients endorse shared values, such as mutual respect, honesty, trustworthiness, compassion, and a commitment to pursue shared goals, medical practice is usually on sound ethical footing. Sometimes physicians and patients or families disagree about values or face choices that challenge their beliefs. Clinical ethicists can help to clarify the ethical principles at stake in a given patient encounter, and help participants to voice their experience, clarify their beliefs and values, bring to bear resources from ethics scholarship, law, or religious traditions that may assist, and mediate or support resolution of ethical dilemmas in individual clinical encounters.
Bioethics at Stony Brook
Stony Brook University’s commitment to bioethics started at the beginning of the school and of the formal bioethics movement. Noted bioethics scholar Edmund Pellegrino, MD, was the founding Dean of the School of Medicine and Vice President for Health Sciences, responsible for everything from the construction of the curriculum and the design of the buildings. Starting with the first class in 1970, the Stony Brook medical curriculum included substantial time and content in ethics, law, humanities, and the social sciences, a tradition continued in the four-year longitudinal curriculum in Medicine in Contemporary Society (MCS). More important, MCS focuses on the development of intellectual skills, such as conceptual analysis, logical reasoning, casuistry, explication of texts and creative writing. Peter Williams and Daniel Fox were responsible for teaching ethics across Stony Brook’s new schools of health sciences, as well as working with the Society for Health and Human Values, the earliest bioethics organization in the United States. As at most academic health centers, clinical ethics consultation on individual cases remained informal until local, state, and national controversies over care at the beginning and end of life led to a state-mandated perinatal ethics committee in the 1980s, followed by a national requirement in the 1990s that all hospitals have some mechanism for resolving ethical conflicts.