WHAT DOES BIOETHICS MEAN?

Van Rensselaer Potter, II

Editor's note: Dr. Potter is Hilldale Emeritus Professor of Oncology at the University of Wisconsin-Madison. In 1951 he demonstrated that "from the therapeutic standpoint, combinations of inhibitors . . . should be sought" to treat cancer patients ("Sequential Blocking of Metabolic Pathways in vivo"). It is now standard practice to use combination chemotherapy when treating cancer. In addition to his pioneering work in cancer research, Potter also has maintained an active career in bioethics, having published three books on the topic: Bioethics, Bridge to the Future (1971), Resources and Decisions (1974 co-author), and Global Bioethics (1988).

What does the term "bioethics" mean? I believe that I coined the word in 1970 when I used it in my article "Bioethics: The Science of Survival" (4) (italics added). This article preceded my book, Bioethics: Bridge to the Future, (5) which was dedicated to Aldo Leopold. I wrote then that I believed Leopold "anticipated the extension of ethics to bioethics," quoting Leopold at length in the dedication. When I used the term "bioethics," therefore, I clearly meant it to include not simply medical ethics, but environmental and agricultural ethics as well. Indeed, the word speaks for itself.

Thus it is with some surprise that I have watched the meaning of the term migrate from its initial usage. "Bioethics" has been seized upon by the medical profession which has overlooked its original scope and breadth. "Bioethics" must continue to mean the application of ethics to all life. As I recently wrote:

"From the outset it has been clear that bioethics must be built on an interdisciplinary or multidisciplinary base. I have proposed two major areas with interests that appear to be separate but which need each other: medical bioethics and ecological bioethics. Medical bioethics and ecological bioethics are non-overlapping in the sense that medical bioethics is chiefly concerned with short-term views: the options open to individuals and their physicians in their attempts to prolong life. . . . Ecological bioethics clearly has a long-term view that is concerned with what we must do to preserve the ecosystem in a form that is compatible with the continued existence of the human species" (7, p. 74).

In the 1971 book I claimed that "A science of survival must be more than science alone, and I therefore propose the term Bioethics in order to emphasize the two most important ingredients in achieving the new wisdom that is so desperately needed: biological knowledge and human values" (p. 2). This proposal was never recognized by any medical bioethicist to my knowledge, and the word bioethics was narrowly redefined by the medical people to mean clinical ethics (but cf. 16).

By 1975 I had begun to think of the process of bioethics as "humility, responsibility, and competence," and I presented a chart on content showing bioethics as a product of cross fertilization between the two branches "medical bioethics" and "ecological bioethics"(6). Not until 1996 did I realize that the issue of sustainable agriculture is a matter of agricultural ethics world-wide, indeed, a core issue in the expanded content of global bioethics.

By 1988 it was apparent that the word bioethics was completely out of my hands (see Foreword by Engelhardt in the book which I titled Global Bioethics: Building on the Leopold Legacy ([7]). I emphasized the two meanings of the word global as comprehensive in one sense and world-wide in another and, in 1990, again emphasized the survival issue by relating it to a "fatal flaw" in evolution. I mean that natural history has lacked foresight in evolving us (8, see also 9-15). Only in 1995 did I realize that global bioethics and human survival is what sustainable agriculture in a preserved and restored biosphere is all about. I emphasize that the word survival needs to be qualified with suitable adjectives to establish the goal as acceptable global survival.

The choice of the word survival in the naming of the new journal represents a praiseworthy ethical decision on the part of the editors and the publisher. There are millions of people in various parts of the world and within each country that are presently surviving in the various categories here described as mere, miserable, idealistic, irresponsible, and acceptable. The term acceptable survival is proposed as a bioethical goal of global survival, looking beyond the 21st century to the year 3000 and beyond. The frequent alternative is sustainable development but in most contexts this is an economic concept and does not imply any moral or ethical constraints except where these are spelled out.

Acceptable survival, in the broad sense, means acceptable to a universal sense of what is morally right and good and what will continue in the long term. The expanding dominant but irresponsible world culture is not an acceptable type of development because it cannot survive in the long term (11).

Only belatedly did I learn of efforts already underway and resources already available in the area, including The Journal of Agricultural and Environmental Ethics, the Bioethics Program at Iowa State University and its Ag Bioethics Forum; the journal from the U. of Florida Agriculture and Human Values (with both the Summer and Fall issues of volume 9 (1992) devoted to a broad perspective on "sustainability" and sustainable agriculture); and of books such as those by Paul Hawken on The Ecology of Commerce: A Declaration of Sustainability and The New Economy; of the Natural Step movement initiated in Sweden by Karl-Henrik Robert; and of the collaboration between Hawken and Robert with Herman Daly in The Natural Step News 1 (Winter 1996).

I believe that every question raised by recent articles in the pages of the Forum (e.g., Fullinwider in June 1993; Gert and Fullinwider in November 1993; Callicott and Russow in June 1994) leads to Russow's final seven lines of type. Disagreeing with Callicott she concludes,

". . . prairies do not have intrinsic value. That does not mean that we should not preserve and cherish them, but it does mean that we need a different moral foundation for that preservation."

I propose Russow's conclusion as a foundation, in the context of long-term acceptable survival, as a goal for "global bioethics." (In their concern for ethical theory I did not sense that either Gert or Fullinwider had provided a "moral foundation" for the preservation of prairies, or, indeed, for resolving "disagreements about Ag Biotech.")

In all humility, and recognizing that I am without credentials in philosophy, I propose that every moral proposition is an intuition, formulated in the subconscious on the basis of stored memory and experience, and forwarded to consciousness.


What Does Bioethics Mean?Continued...

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