The Birth of Modern Bioethics

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Advances in medicine and engineering at the UW in the early 1960s that made it possible to perform life-saving kidney dialysis at the same time spurred the development of the field of modern bioethics.

Before UW professor Belding Scribner and his team developed the arteriovenous shunt, end-stage kidney disease was always fatal. Use of the artificial kidney--"kidney dialysis"--to cleanse the blood of its toxic products meant that an artery and a vein were damaged every time the patient was hooked up to the machine. Doctors would run out of places to connect the machine to the patient. This limitation prohibited long-term treatment of chronic renal failure.footnote 1

The revolutionary device known as the Scribner Shunt was a U-shaped tube permanently installed between an artery and a vein of the arm so that the kidney machine could be attached as often as necessary.

Scribner developed the shunt in collaboration with Wayne Quinton, a biomedical instrument builder, and worked with chemical engineering professor Albert ("Les") Babb to refine the dialysis instrumentation.

In those early days of the technology, only a few patients could be treated, and even then at great cost. The demand greatly exceeded the capacity to treat patients, and some means of selection was needed. An anonymous panel of community members was formed to screen and select patients for treatment. The highly controversial decision-making process was the subject of an NBC documentary in 1965 entitled "Who Shall Live?" narrated by Edwin Newman. That gothic portrayal showed the faceless black silhouettes of the anonymous committee members against a stark white screen as they deliberated over the merits of each case. But on what grounds should patients be selected? Age, finances, family dependents, job title?

The situation "opened a new era for the ethics of medicine," writes Albert Jonsen, UW professor of biomedical history and ethics. The health care profession faced "an issue that the traditional ethics of medicine had not previously faced and for which it had no ready response."footnote 1 Jonsen, who has served as chair of the department since 1987, considers this event as the birth of the field of modern bioethics.

"Jonsen is one of the true founders of the discipline of bioethics, particularly the area of clinical ethics," notes James Whorton, historian in the department. "His book, The Abuse of Casuistry: A History of Moral Reasoning is a major contribution to the theory of clinical ethics." Another book by Jonsen, Clinical Ethics: A Practical Approach to Ethical Decision in Clinical Medicine, "has become the gospel for the practice of clinical ethics," says Whorton.

Jonsen notes that the teaching of ethics has a long history in the UW medical school. UW professor Robert Williams created a course in 1966, which issued in a book entitled To Live and To Die, published in 1974. "This was a pioneering effort to introduce medical students to the issues they would face in a world of scientific and technological medicine," affirms Jonsen. Twenty-three years later, Jonsen and colleagues Nancy Jecker and Robert Pearlman have published the latest text in the field, entitled Bioethics: An Introduction to its History, Methods and Practice.

As medical technologies continue to be developed, especially with the advent of new genetic testing methods and therapies, new challenges to our ethics and moral reasoning will arise. From concerns about protecting individual rights and access to benefits, to issues concerning organ transplantation, euthanasia, and aging, there will continue to be much to do in this evolving field.

  1. See volume one in this series entitled Pathbreakers: A Century of Excellence in Science and Technology at the University of Washington, Deborah L. Illman, Series Editor Alvin L. Kwiram, University of Washington, 1996.

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