Bioethics, the ethics of life, has bifurcated into medical ethics and environmental ethics. Can we reunite them?

Etymologically, the word “bioethics” means the ethics of life. But in practice, it has become the application of ethical principles to clinical work and research on humans. Writing in the American Journal of Bioethics, Lisa Lee, of the Presidential Commission for the Study of Bioethical Issues, calls for a return to the distant origins of bioethics.

The word “bioethics” was first used by the German pastor and theologian, Fritz Jahr in 1927. However, an American, Van Rensselaer Potter, re-coined the term in 1971 to express the need to bridge the gap between the humanities and the sciences. “Ethical values cannot be separated from biological facts,” he wrote. Today, we would probably say that he was searching for a vision which would integrate medical ethics with environmental ethics. Unhappily, Lee contends, these two fields have become strangers. What we now know as bioethics is merely an updated version of medical ethics.

How can we bring them together? Lee suggests that public health ethics is the bridge, with “health” being, as the World Health Organisation defines it: ““a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”.

Public health ethics requires us to address head-on the numerous conflicts that arise in the values that motivate our work through pluralistic engagement of affected communities and deliberative decision making. It straddles the highly individual focus of contemporary biomedical ethics and the broad ecosystem focus of contemporary environmental ethics, supporting public health's goal to improve the health and lives of all of the planet's inhabitants by integrating medicine, veterinary medicine, and environmental sciences…

From this position, public health ethics can serve as a bridge back to Potter's broad vision and reacquaint us with an integrated bio-ethic that values and considers all living things.

She criticises bioethics as medical ethics as excessively individualistic and insufficiently concerned with justice and solidarity. Its focus is the tension between autonomy and the common good. A healthier focus should be “recognition of the complexity and interconnection of our place among social and ecological systems”.

And so she concludes:

“Public health ethics has the potential to serve as a bridge back to the future, connecting 21st-century ideas of biomedical ethics, public health ethics, and environmental ethics to Leopold's and Potter's visions for an ethic that moves all of Earth's inhabitants toward a good life. Health, social, and ecological justice demands this of us.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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