Mechanism and Morality: On Bioethics in Context

Abstract

One can hardly ignore the widely-shared conviction that we are living through a period of crisis in health care. And that crisis is more than economic and administrative — though its most egregious symptoms present in these interrelated forms. One need only pick up a newspaper or magazine to be reminded of the omnipresent and multidimensional nature of the problems confronting Western medicine. Many of these perceived dilemmas turn on rapid technical change and the difficulty of creating an institutional, economic — and moral - context in which these new clinical, policy, and research options can be managed. Not surprisingly, bioethics is often invoked — as both symptom and possible remedy — in discussions of these disheartening realities. How are we to think about this enterprise? site it in social space? understand its several interrelated identities? It is no easy task. Contemporary bioethics constitutes a particularly elusive and seemingly novel challenge for the historian. Value assumptions have always shaped medicine as a social enterprise, yet these values have been often implicit and unspoken, the moral common sense of each generation interacting with technical, professional , institutional, and economic factors to configure a place and time-specific set of clinical realities.