The subject of medical ethics is always current and offers an inviting theme, particularly for anyone who has spent his life in medical practice. But the subject of ethics is impossible to deal with unless one first asks its purposes. Therefore, this book is divided into two parts, the first comprehends theoretical considerations and the second, pragmatic and empirical data on, and discussions of, current problems. Part One will be of greater interest to moral philosophers, philosophers and historians of science, and social scientists. Part Two should have greater appeal to physicians, medical students and medical planners. Nevertheless, it is hoped that the latter will look into Part One for the justification of the conclusions the author could reach on the material presented in Part Two. Likewise, it will become obvious why it is believed the solutions of many, if not most, ethical dilemmas are not always discernible at a given moment in time. Also, those who are more concerned with the theoretical material of Part One might find its application to current real-life problems interesting. It should not be too much to hope that the entire book will appeal to many general readers. The bio-ethical problems presented are of frequent and growing personal concern, and are discussed almost daily in the news media.

Before Bioethics narrates the history of American medical ethics from its colonial origins to current bioethical controversies over abortion, AIDS, animal rights, and physician-assisted suicide. This comprehensive history tracks the evolution of American medical ethics over four centuries, from colonial midwives and physicians' oaths to medical society codes, through the bioethics revolution. Applying the concept of "morally disruptive technologies," it analyzes the impact of the stethoscope on conceptions of fetal life and the criminalization of abortion, and the impact of the ventilator on our conception of death and the treatment of the dying. The narrative offers tales of those whose lives were affected by the medical ethics of their era: unwed mothers executed by puritans because midwives found them with stillborn babies; the unlikely trio-an Irishman, a Sephardic Jew and in-the-closet gay public health reformer-who drafted the American Medical Association's code of ethics but received no credit for their achievement, and the founder of American gynecology celebrated during his own era but condemned today because he perfected his surgical procedures on un-anesthetized African American slave women. The book concludes by exploring the reasons underlying American society's empowerment of a hodgepodge of ex-theologians, humanist clinicians and researchers, lawyers and philosophers-the bioethicists-as authorities able to address research ethics scandals and the ethical problems generated by morally disruptive technologies. To access the companion website for Before Bioethics: A History of American Medical Ethics from the Colonial Period to the Bioethics Revolution, please visit: http://global.oup.com/us/companion.websites/9780199774111/

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.

D.--from the Introduction "Canadian Bulletin of Medical History"

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then, medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue.

David Rothman gives us a brilliant, finely etched study of medical practice today. Beginning in the mid-1960s, the practice of medicine in the United States underwent a most remarkable--and thoroughly controversial--transformation. The discretion that the profession once enjoyed has been increasingly circumscribed, and now an almost bewildering number of parties and procedures participate in medical decision making. Well into the post-World War II period, decisions at the bedside were the almost exclusive concern of the individual physician, even when they raised fundamental ethical and social issues. It was mainly doctors who wrote and read about the morality of withholding a course of antibiotics and letting pneumonia serve as the old man's best friend, of considering a newborn with grave birth defects a "stillbirth" thus sparing the parents the agony of choice and the burden of care, of experimenting on the institutionalized the retarded to learn more about hepatitis, or of giving one patient and not another access to the iron lung when the machine was in short supply. Moreover, it was usually the individual physician who decided these matters without formal discussions with patients, their families, or even with colleagues, and certainly without drawing the attention of journalists, judges, or professional philosophers. The impact of the invasion of outsiders into medical decision-making, most generally framed, was to make the invisible visible. Outsiders to medicine--that is, lawyers, judges, legislators, and academics--have penetrated its every nook and cranny, in the process giving medicine exceptional prominence on the public agenda and making it the subject of popular discourse. The glare of the spotlight transformed medical decision making, shaping not merely the external conditions under which medicine would be practiced (something that the state, through the regulation of licensure, had always done), but the very substance of medical pract

Jonsen (medical history and ethics, U. of Washington Medical School) addresses the conflict between altruism and self-interest, which he believes is built into the structure of medical care and woven into the fabric of physicians' lives. Ranging through history from the mythical Asclepius to the lat