Eric Cohen


Given the close connection between bioethics and biomedical technology, it is hardly surprising that bioethicists often think about the future. There is a certain prophetic pleasure that comes with predicting the problems ahead, and a strong inclination to believe that our ethical thinking needs to "keep pace" with our technology, constantly updating its moral vision of man in light of the material possibilities of the age. In some sense, of course, this is true: Our ethics does need to keep pace with our changing technological condition. New problems arise for which old thinking is inadequate. Yet, to see the future clearly, it might also help to recover what is first in bioethics - first in the sense of the discipline's origins and first in the sense of man's perennial problems and possibilities. To invite such a recovery is the aim of this Commentary.

In one sense, bioethics - at least American bioethics - began in the 1960s and 1970s, with a group of philosophers, theologians, and physicians interested in the future of human life in the budding age of biotechnology and advanced medicine. They held meetings. They wrote articles. They advised government bodies and influenced judicial decisions. They debated issues ranging from endof- life care to organ transplantation to research with human subjects to the initiation of human life in the laboratory. Through their labors, a new discipline and myriad new institutions were born: think-tanks, journals, degrees, commissions, committees, consultants, and media stars.

Yet many of the questions these first bioethicists were asking were in fact very old, and so were many of the conflicting answers. New technological possibilities - such as in vitro fertilization, genetic testing of the unborn, the biochemical manipulation of psychic experience, the extended preservation of bodies between life and death, the transfer of body parts from the newly dead to the still living - were altering some of the fundamental experiences of being human. But these technical possibilities made us anxious because the image of man himself seemed to be at stake, with all the old conflicts and perennial problems about the good life and good death taking on a new, dramatic shape. Recovering this clash of images is the first step toward understanding the origins and thus the future of bioethics.

In a very modest way, I'd like to attempt such a philosophical recovery in two parts: first, by exploring certain permanent alternatives in man's quest to live well with death, which is the problem that stands at the heart of many modern bioethical quandaries; and second, by looking at the founding framework for addressing such moral questions in America, namely the Declaration of Independence, with its mysterious teaching about human equality and human happiness. That mortality and equality should be considered together seems only fitting: In death, our ultimate equality is restored; in the circumstances of death, the inequities of nature and chance are sharply revealed; in seeking to conquer or ameliorate the sting of death, we are tempted to set the democratic ideal of equality aside. Only by recovering a deeper wisdom about mortality and equality can we consider wisely the future of bioethics - and, in particular, how new technologies and new social conditions will re-open, yet again, in ever novel ways, those inescapable problems that are inherent to being human.