Bette Anton, M.L.S., is Head Librarian for the Pamela & Kenneth Fong Optometry & Health Sciences Library of the University of California, Berkeley. This library serves the UC Berkeley School of Optometry and the UC Berkeley–UC San Francisco Joint Medical Program.

Although the precise birth date may be ambiguous, by anyone's count the field of bioethics has emerged from infancy and childhood and is now a young adult—a stage in time when making decisions for future directions is imperative. In this “Quo Vadis?” Special Section, we've invited bioethicists from various disciplines and stages in their careers to share their thoughts, not on where we are now, but where should we be going? Is reorienting ourselves in order? How would they chart the future of bioethics and what needs to be done to implement their visions?

In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded.Research for this paper was conducted, in part, during the Acadia Institute's Project on Bioethics in American Society, for which Dr. Swazey was the PI and Dr. Fox the CO-PI. The project was supported by grants from the Greenwall Foundation, the National Library of Medicine (RO1 LM 06893), and the National Science Foundation's Program on Societal Dimensions of Engineering, Science, and Technology (SBR-9710570). The views in this paper are the authors'.

Last year I published a short article urging bioethicists to carefully examine the question of what ought to constitute the canonical issues topics and questions driving research and teaching in bioethics. Why some subjects dominate the field whereas other topics are regarded as matters for scholars in other disciplines is a question that has intrigued me for nearly a decade. How are the boundaries of bioethics established? What factors influence research agendas and the creation of bioethics curricula? How do funding agencies, editors, and leading scholars shape the field of bioethics? These questions are increasingly receiving scrutiny from Charles Bosk, Raymond De Vries, and other researchers as they explore the sociology of bioethics and the “construction” of the “ethical enterprise.”

In a recent issue of The Lancet, the historian Roger Cooter predicted that the field of bioethics will soon die of self-inflicted wounds. “Conspiring against it,” he wrote, “is exposure of the funding of some of its US centres by pharmaceutical companies; exclusion of alternative perspectives from the social sciences; retention of narrow analytical notions of ethics in the face of popular expression and academic respect for the place of emotions; divisions within the discipline (including one over its origins and meaning); and collusion with, and appropriation by, clinical medicine.” Cooter's prognosis? “Hardly wet behind the ears, bioethics seems destined for a short lifespan.”

The growing interest in bioethics has given rise to a new group of experts: experts in bioethics. They come from different walks of life and their motives, claims, and qualifications for expertise are manifold. Various academic disciplines can be said to contribute to one's status as an expert in bioethics. Studies and research in, say, philosophy, law, anthropology, history, theology, and sociology with an emphasis on bioethical matters are often thought of as suitably qualifying a person as a bioethicist. In addition to these academic qualifications there are two routes to becoming a bioethicist. I will call these the self-nomination (self-styled) and the through-work-experience routes. Self-nominated expertise is most common with medics who have strong religious or other ideological views about ethical matters. Another path to self-nominated expertise starts with strongly held ideological views with interest in bioethical matters. For this category of bioethical experts there does not have to be any institutional acknowledgment of their status; they are experts because they think they are. The other nonacademic type of expert in bioethics emerges through administrative channels. When the various ethics committees and regulatory bodies that now abound were first founded, there were no experts in bioethics to sit on these committees. People became experts by serving in these institutions for sufficiently long periods of time. This still happens with ethics committees in which just a few of the members are experts in ethics. People join the committees as experts of other fields, but are thought to have become experts through the fact that they have served on such committees.

We will argue here that after more than 30 years of talk, theory, and clinical practice, we bioethicists still know far too little about what patients, subjects, and healthcare professionals are up to, morally. Bioethics is still near the beginning in grasping what it means to understand, much less to honor fully, the moral power and perspicacity of those bioethics is designed to serve. This is, of course, a serious charge, but one we will endeavor to show has merit. However, we want to be clear from the start that we do not gainsay the important work that has been done in and through the influence of bioethics, both as a field of practical engagement and as a cultural movement, in improving how healthcare is delivered and how human subjects are treated. Thirty or 40 years—depending on how one marks the beginning point—is a very short time, and it is hard to imagine that wholesale changes, all of them in the right direction, could be the outcome for a field this young. Hence, we do not intend the title, “One Cheer for Bioethics,” as a wholesale indictment, but as an indication that there is a great deal of work yet to be done, and that following the currently dominant direction of the field is not likely to get us there. Our aim is to indicate just where future work should be focused, and to do so we will need to be critical of some of the preoccupations of the last three decades.The authors thank Lida Anestidou, Mark Bliton, Ellen Clayton, Stuart Finder, Elizabeth Heitman, Joshua Perry, Annabeth Schenck, and Lucia Tanassi for helpful comments on earlier presentations and drafts of the ideas in this paper.

“Globalisation is the Yeti of … newspapers. Everybody knows it, but nobody has ever seen it. What does it look like? Tall, monkeyish, hairy? Or rather weasel-like? With glasses? Like a ferret or a marten?” Globalization means different things to different people, a laudable development uniting humankind or an epidemic crushing the vulnerable peoples of the earth. Whether it is something we can control remains to be seen, but it is certainly upon us. The move to “go global” is such a strong force that hardly any human activity is exempt. We have global treaties, global media, global celebrities, global bookstores, and even a global antiglobalization movement!We thank the Centre for the Study of Global Ethics, University of Birmingham, UK, for inviting one of us (DS) to present this paper at their research seminar. The subsequent discussions were most helpful. Also, thanks to Dr. Armin Schmidt for comments on an earlier draft and to Tomi Kushner for inviting us to write this paper.

Predicting future trends in bioethics depends on the recognition of contemporary innovations. Because of the extraordinary challenges brought on by the HIV/AIDS pandemic, bioethics has had to undergo a critical examination of its own effectiveness. This essay examines 10 developments that have helped shape the future of bioethics in a time of HIV/AIDS.

American bioethics began in the late 1960s, stimulated by a plethora of new medical technologies and biological knowledge and by a scandal-induced interest in human subject research. Although it was understood that there would be ethical debate (which had already broken out between the theologians Joseph Fletcher and Paul Ramsey), no one thought the disputes would be ideological in character, as if part of one's voting pattern as liberal or conservative, Democrat or Republican. There were arguments, often sharp, but no culture wars.

These CQ Sources were compiled by Bette Anton and Judith Schaeffer Young.

David and I were at a conference on Amelia Island in Florida back in 1995. The meeting, sponsored by the University of Florida, was entitled, “Physician-Assisted Death: Implications for Patients, Care Providers, and Society,” a title that seems quaint given the controversy over the right to die engendered by the Schiavo case. But that's a different talk for a different time.

From the first days of conscription, physicians have declared their opposition to unjust wars by using their good offices to aid draft evaders.

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].

Those of us trained in clinical ethics often find that we lack sufficient background in organizational and business ethics to help our healthcare administrators solve broad institutional issues. Organizational Ethics in Health Care: Principles, Cases, and Practical Solutions, written by five individuals from the Park Ridge Center for the Study of Health, Faith, and Ethics, is a valuable resource for ethics professionals who want to broaden their organizational ethics competency and enhance their service to the institution. The book combines theoretical ethical analysis with case studies and practical advice. The authors argue that “an organization is a moral being with moral responsibilities that must be met in carrying out its mission” (p. 250). The focus and goal of organizational ethics is “the study of personal and organizational moral norms and choices as they contribute to the activities and goals of an organization and to the integral human fulfillment of persons and communities” (p. 15). Throughout the book the authors use a virtue ethics approach. They offer plausible examples of how institutions can embody virtues such as honesty, integrity, and commitment to justice. Meanwhile they refrain from oversimplifying the process or denying the arduous and often thankless task of implementing an organizational ethics program.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.