Bioethics: What was lost …. what might be gained
Main Article Content
Abstract
Background: Since its inception bioethicists have advanced an ideal of medicine with both a clinical ethics and a more general organizational perspective on medicine in society. The two have been entwined from the start with, as Hastings Centre co-founded and bioethicist Daniel Callahan said, a market-based ethos
Objective: Bioethics central focus on the autonomous individual discretely able to independently make relevant decisions on health and healthcare is examined, critiqued, and reviewed from the perspective of the practitioner and as a social construct.
Methods: Bioethical literatures from the 1970s to the present were reviewed with special attention to the work of of Hastings Centre cofounder and a leading American bioethicist, Daniel Callahan. With this, attention was paid to both the social framework and the clinical perspective of both practitioner and patient.
Conclusions: Bioethics successfully sought to replace a relational practice of care and a view of the practitioner as a social critic and “guardian” in a manner that limits the service of practitioners to both patients and society. The return to a relational ethic of care would thus be the palliative better serving the patient, the practitioner, and society at large.
Keywords:
Cross-border healthcare, Health governance, Collaborative governance, Health information exchange, Integrated care, European health integration, Institutional quality, Health policy
Article Details
How to Cite
KOCH, Tom.
Bioethics: What was lost …. what might be gained.
Medical Research Archives, [S.l.], v. 14, n. 1, jan. 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7142>. Date accessed: 16 mar. 2026.
doi: https://doi.org/10.18103/mra.v14i1.7142.
Section
Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Weil S. The Need for Roots: Prelude to a Declaration of Duties Towards Mankind. Trans. A.F. Wills. London: Routledge & Kegan Paul Ltd; 1949:3.
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6. Bakewell S. Ibid.
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8. Blumenthal-Barby J, Aas S, Brudney D, et al. The place of philosophy in bioethics today. American Journal of Bioethics. 2021;22(12). https://doi.org/10.1080/15265161.2021.1940355
9. Thomasma D. The Asbury Draft Policy on Ethical Use of Bioethics. Cambridge Quarterly of Healthcare Ethics. 1997;8(2):249.
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11. Ravidsky V. The Future of Bioethics: Challenges, Visions and Opportunities. Columbia University; 2024. https://sps.columbia.edu/events/future-bioethics-challenges-visions-and-opportunities
12. Jaworska A, Tannenbaum T. The grounds of moral status. In: Zalta EN, Nodelman U, eds. The Stanford Encyclopedia of Philosophy. 2023. https://plato.stanford.edu/archives/spr2023/entries/grounds-moral-status/
13. Elliott C. Sisyphus gets a prescription. Hedgehog Review. 2021;23(3). https://hedgehogreview.com/issues/authenticity/articles/sisyphus-gets-a-prescription
14. Ray K. Ending unequal treatment requires a shift from inequitable health care to social inequities. Hastings Bioethics Forum. 2024. https://www.thehastingscenter.org/tag/ending-unequal-treatment/
15. Mammas IN, Spandidos DA. Paediatric virology in the Hippocratic corpus. Experimental and Therapeutic Medicine. 2016;12(2):541-549. doi:10.3892/etm.2016.3420
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18. Kuriyama S. The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. New York: Zone Books; 1999:262.
19. Beauchamp TL, Childress JF. Principles of Bioethics.
20. Bakewell S. At the Existentialist Café.
21. Beauchamp TL, Childress JF. Principles of Bioethics.
22. Vest M. Bioethics as a language game: probing the quality of moral guidance in principlism. Theoretical Medicine and Bioethics. 2025;46(1):51-65.
23. Fins JJ. On the lingua franca of clinical ethics. Journal of Clinical Ethics. 2013;24(4):323-331.
24. Clouser KD, Bert B. A critique of principlism. Journal of Medicine and Philosophy. 1990;15:219-236.
25. Beauchamp TL. The principles approach. Hastings Center Report. 1993;23(6):S9.
26. Jaworska A, Tannenbaum T. Op. cit.
27. Rothman D. Rationing life. New York Review of Books. 1992.
28. Callahan D. What Kind of Life: The Limits of Medical Progress. New York: Simon & Schuster; 1990.
29. Stigall W. The Hippocratic Oath. Linacre Quarterly. 2022;89(3):275-286.
30. Blackwell S. Op. cit.
31. Weil S. The Need for Roots.
32. Krieger N. A vision of social justice as the foundation of public health. American Journal of Public Health. 1998;88(11):1603-1606.
33. Mol A. The Body Multiple: Ontology in Medical Practice. Duke University Press; 2022:171.
34. Rosen G. From Medical Police to Social Medicine. New York: Science History Publications; 1974:138.
35. Mitman G, Numbers RL. From miasma to asthma. History and Philosophy of the Life Sciences. 1993;25(3):391-412.
36. Rosenberg C. Airs, Waters, Places: A status report. Bulletin of the History of Medicine. 2012;86(4):661-670.
37. Krieger N. Spirit of 1848. Critical Public Health. 1998;8(1):97-103.
38. Callahan D. Why America accepted bioethics. Hastings Center Report. 1993;23(Suppl):S8-S9.
39. Reichlin M. Observations on the epistemological status of bioethics. Journal of Medicine and Philosophy. 1994;19(1):79-102.
40. Mol A. Op. cit.
41. Zuckerman S, Kimsma G, Devisch I. Surprising pandemic experiences. Journal of Evaluation in Clinical Practice. 2023;29(7):1100-1107.
42. Kuczewski M. Taking it personally: reflections on living bioethics. ASBH Reader. 2010:3-9.
43. Fins JJ. Rights Come to Mind. Cambridge University Press; 2015.
44. Arrow K. Uncertainty and the welfare economics of medical care. American Economic Review. 1963;53(5):941-973.
45. Blumenthal D, Galfin R. The vocabulary of our discontent. JAMA. 2025.
46. Ibid.
47. McCullough LB. Introduction. Theoretical Medicine. 1983;4(2):227-229.
48. Veatch RM. Hippocratic, Religious, and Secular Medical Ethics. Georgetown University Press; 2012.
49. Jacobs J. Systems of Survival.
50. Ray K. Ending unequal treatment requires a shift from inequitable health care to social inequities.
51. Callahan D. In Search of the Good.
52. Ibid.
53. Ibid.
54. Koch T. Seeking Medicine’s Moral Centre. London: Ethics Press; 2025.
55. Barwise AK. Ethicists as a force for institutional change. Hastings Bioethics Forum. 2020.
56. Smith DM. Human Geography: A Welfare Approach. New York: St. Martin’s Press; 1977.
57. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. New York: Routledge; 1996.
58. Marmot M. The Health Gap. Bloomsbury; 2015.
59. Berwick DM. The moral determinants of health. JAMA. 2020;324(3):225-226.
60. Jotterand F, Derse A, Spellecy R, et al. Practical wisdom and clinical judgment. Journal of Medicine and Philosophy. 2025.
61. Zuckerman S, Kimsma G, Devisch I. Surprising pandemic experiences.
62. Haidt J, Joseph C. Intuitive ethics. Daedalus. 2004;133(4):55-66.
63. Blackwell S. Op. cit.
64. Blackwell S. Op. cit.:163.
65. Levinas E. Totality and Infinity. Duquesne University Press; 1969.
66. Held V. The Ethics of Care. Oxford University Press; 2006:10.
67. Nussbaum M. Public philosophy and international feminism. Ethics. 1998;108:762-796.
68. Bubeck D. Care, Gender, and Justice. Oxford University Press; 1995:121.
69. Held V. The ethics of care. In: Olsaretti S, ed. Oxford Handbook of Distributive Justice. Oxford University Press; 2018:213-234.
70. Mackenbach JP. Politics is nothing but medicine at a larger scale. Journal of Epidemiology & Community Health. 2009;63:181-184.
71. Koch T. Thieves of Virtue: When Bioethics Stole Medicine. MIT Press; 2012:35-36.
2. Weil S. The Need for Roots: Prelude to a Declaration of Duties Towards Mankind. Trans. A.F. Wills. London: Routledge & Kegan Paul Ltd; 1949:3.
3. Arrow K. Uncertainty and the Welfare Economics of Medical Care. American Economic Review. 1994;53(5):941-973. https://assets.aeaweb.org/asset-server/files/9442.pdf
4. Jacobs J. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics. New York: Vintage Books; 1992.
5. Bakewell S. At the Existentialist Café: Freedom, Being, and Apricot Cocktails. New York: Other Press; 2016.
6. Bakewell S. Ibid.
7. Beauchamp TL, Childress JF. Principles of Bioethics. New York: Oxford University Press; 1979:1.
8. Blumenthal-Barby J, Aas S, Brudney D, et al. The place of philosophy in bioethics today. American Journal of Bioethics. 2021;22(12). https://doi.org/10.1080/15265161.2021.1940355
9. Thomasma D. The Asbury Draft Policy on Ethical Use of Bioethics. Cambridge Quarterly of Healthcare Ethics. 1997;8(2):249.
10. Callahan D. In Search of the Good: A Life in Bioethics. Cambridge, MA: MIT Press; 2012:77.
11. Ravidsky V. The Future of Bioethics: Challenges, Visions and Opportunities. Columbia University; 2024. https://sps.columbia.edu/events/future-bioethics-challenges-visions-and-opportunities
12. Jaworska A, Tannenbaum T. The grounds of moral status. In: Zalta EN, Nodelman U, eds. The Stanford Encyclopedia of Philosophy. 2023. https://plato.stanford.edu/archives/spr2023/entries/grounds-moral-status/
13. Elliott C. Sisyphus gets a prescription. Hedgehog Review. 2021;23(3). https://hedgehogreview.com/issues/authenticity/articles/sisyphus-gets-a-prescription
14. Ray K. Ending unequal treatment requires a shift from inequitable health care to social inequities. Hastings Bioethics Forum. 2024. https://www.thehastingscenter.org/tag/ending-unequal-treatment/
15. Mammas IN, Spandidos DA. Paediatric virology in the Hippocratic corpus. Experimental and Therapeutic Medicine. 2016;12(2):541-549. doi:10.3892/etm.2016.3420
16. North M. The Hippocratic Oath. Bethesda, MD: National Institutes of Health; 2002. https://www.nlm.nih.gov/hmd/greek/greek_oath.html
17. Bakewell S. At the Existentialist Café. New York: Other Press; 2016:87.
18. Kuriyama S. The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. New York: Zone Books; 1999:262.
19. Beauchamp TL, Childress JF. Principles of Bioethics.
20. Bakewell S. At the Existentialist Café.
21. Beauchamp TL, Childress JF. Principles of Bioethics.
22. Vest M. Bioethics as a language game: probing the quality of moral guidance in principlism. Theoretical Medicine and Bioethics. 2025;46(1):51-65.
23. Fins JJ. On the lingua franca of clinical ethics. Journal of Clinical Ethics. 2013;24(4):323-331.
24. Clouser KD, Bert B. A critique of principlism. Journal of Medicine and Philosophy. 1990;15:219-236.
25. Beauchamp TL. The principles approach. Hastings Center Report. 1993;23(6):S9.
26. Jaworska A, Tannenbaum T. Op. cit.
27. Rothman D. Rationing life. New York Review of Books. 1992.
28. Callahan D. What Kind of Life: The Limits of Medical Progress. New York: Simon & Schuster; 1990.
29. Stigall W. The Hippocratic Oath. Linacre Quarterly. 2022;89(3):275-286.
30. Blackwell S. Op. cit.
31. Weil S. The Need for Roots.
32. Krieger N. A vision of social justice as the foundation of public health. American Journal of Public Health. 1998;88(11):1603-1606.
33. Mol A. The Body Multiple: Ontology in Medical Practice. Duke University Press; 2022:171.
34. Rosen G. From Medical Police to Social Medicine. New York: Science History Publications; 1974:138.
35. Mitman G, Numbers RL. From miasma to asthma. History and Philosophy of the Life Sciences. 1993;25(3):391-412.
36. Rosenberg C. Airs, Waters, Places: A status report. Bulletin of the History of Medicine. 2012;86(4):661-670.
37. Krieger N. Spirit of 1848. Critical Public Health. 1998;8(1):97-103.
38. Callahan D. Why America accepted bioethics. Hastings Center Report. 1993;23(Suppl):S8-S9.
39. Reichlin M. Observations on the epistemological status of bioethics. Journal of Medicine and Philosophy. 1994;19(1):79-102.
40. Mol A. Op. cit.
41. Zuckerman S, Kimsma G, Devisch I. Surprising pandemic experiences. Journal of Evaluation in Clinical Practice. 2023;29(7):1100-1107.
42. Kuczewski M. Taking it personally: reflections on living bioethics. ASBH Reader. 2010:3-9.
43. Fins JJ. Rights Come to Mind. Cambridge University Press; 2015.
44. Arrow K. Uncertainty and the welfare economics of medical care. American Economic Review. 1963;53(5):941-973.
45. Blumenthal D, Galfin R. The vocabulary of our discontent. JAMA. 2025.
46. Ibid.
47. McCullough LB. Introduction. Theoretical Medicine. 1983;4(2):227-229.
48. Veatch RM. Hippocratic, Religious, and Secular Medical Ethics. Georgetown University Press; 2012.
49. Jacobs J. Systems of Survival.
50. Ray K. Ending unequal treatment requires a shift from inequitable health care to social inequities.
51. Callahan D. In Search of the Good.
52. Ibid.
53. Ibid.
54. Koch T. Seeking Medicine’s Moral Centre. London: Ethics Press; 2025.
55. Barwise AK. Ethicists as a force for institutional change. Hastings Bioethics Forum. 2020.
56. Smith DM. Human Geography: A Welfare Approach. New York: St. Martin’s Press; 1977.
57. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. New York: Routledge; 1996.
58. Marmot M. The Health Gap. Bloomsbury; 2015.
59. Berwick DM. The moral determinants of health. JAMA. 2020;324(3):225-226.
60. Jotterand F, Derse A, Spellecy R, et al. Practical wisdom and clinical judgment. Journal of Medicine and Philosophy. 2025.
61. Zuckerman S, Kimsma G, Devisch I. Surprising pandemic experiences.
62. Haidt J, Joseph C. Intuitive ethics. Daedalus. 2004;133(4):55-66.
63. Blackwell S. Op. cit.
64. Blackwell S. Op. cit.:163.
65. Levinas E. Totality and Infinity. Duquesne University Press; 1969.
66. Held V. The Ethics of Care. Oxford University Press; 2006:10.
67. Nussbaum M. Public philosophy and international feminism. Ethics. 1998;108:762-796.
68. Bubeck D. Care, Gender, and Justice. Oxford University Press; 1995:121.
69. Held V. The ethics of care. In: Olsaretti S, ed. Oxford Handbook of Distributive Justice. Oxford University Press; 2018:213-234.
70. Mackenbach JP. Politics is nothing but medicine at a larger scale. Journal of Epidemiology & Community Health. 2009;63:181-184.
71. Koch T. Thieves of Virtue: When Bioethics Stole Medicine. MIT Press; 2012:35-36.