Sociogenesis of Bioethics

Daniel Soutullo
IES Monte da Vila

Abstract
This chapter analyses the factors which have contributed to the appearance and subsequent development of bioethics. We also investigate the reasons which led to the broadening of medical ethics and to becoming what is now nown as bioethics. !mong these factors" we analyse the problems derived from the application of biological sciences to solve human problems. The analysis starts by considering the problems originated by the negative historical e#perience of application of eugenic doctrines. We then review the importance of techno$scientific development in the fields of physics" medicine and biology and how it has contributed to form the hori%on and the worries and problems that crystalli%ed in the birth of bioethics. In physics" we will comment the influence of the development of nuclear energy with military purposes and its repercussions on the conscience of the scientific community. In medicine" we will value the historical e#periences of abuses in the e#perimentation with human beings and the development of new ways of therapeutic and surgical interventions. In biology" we focus on the development of molecular biology and embryology over the second half of the &' th century and their enormous biomedical consequences" although it is also noted that their social (real or potential( implications in diverse orders )eugenic" industrial and economic* and how these have affected the advance of bioethical thought. +inally" we attempt to identify the social conditions of plurality and respect for human rights necessary for the birth and flourishing of bioethics to have ta en place.

Keywords: Eugenics, techno-scientific development, informed consent, medical experimentation, biotechnology, human rights.

1. Introduction ,ver the last few decades" the field of bioethics has developed rapidly. The proliferation of committees and commissions under the heading of ethics or bioethics" and putting laws and other legal measures in place" at both a national and international level )within Europe and worldwide*" give some idea of the significance of this e#pansion. In this chapter we review the social factors that have contributed to the appearance of bioethics and its subsequent proliferation. We set out to identify the social changes and the main events which brought about the ethical reflection which culminated in its birth. In our investigation" we focus on the evolution of the most relevant scientific disciplines and their applications in human beings and the consequences for the development of bioethics. We also attempt to reflect the social conte#t where these changes could be fruitful.

!lthough many te#ts have dealt with these issues and there is a widespread agreement among the ma-ority of them over the principal social mutations" which have acted as catalysts in the emergence and historical development of bioethics" this study still has an outstanding importance and interest as the reason for thought" not only for the present of bioethics as a discipline" but also to analy%e the trends that may appear in the future with the development of biotechnological research and its possible applications in different areas" especially in the biomedical field. 2. The birth and the field of bioethics !lthough the birth of bioethics is usually dated bac to ./0'" when Van 1ensselaer 2otter II employed the term for the first time in his article Bioethics, the Science of Survival )2otter" ./0'*" and a year later in his boo Bioethics, Bridge to the uture )2otter" ./0.*" its earliest precedents are to be found in the 3ippocratic ,ath of 4'' 5.6. )Vidal" .//7*" or even earlier" to the medico$legal laws of 8r$9amun" &'4' 5.6. )Villala:n" &''.*" although these historical cases" and all other subsequent references until recent times" constitute codes of medical deontology rather than bioethics as we understand it today" since they deal fundamentally with the codes of conduct which medics should follow in the e#ercise of their profession" in particular the attitude which they should adopt towards their patients and the way in which they should treat them. It was not until .;'< when the 5ritish doctor Thomas 2ercival uses the term =medical ethics> for the first time" and carries out the first modern adaptation" although very limited" of the principles of the 3ippocratic ,ath )Mart:n Mateo" ./;0*. The bioethics of today encompasses a much wider field than that of medical or biomedical ethics" although these represent a very important element within it" as much for their practice in the form of ethical committees in hospitals as for the influence which the inspirational principles of medical ethics have e#ercised" and continue to e#ercise" within bioethics as a whole )5eauchamp and 6hildress" .//7*. So much so that" even today for some authors" bioethics is little more than an updating of medical ethics" and the problems with which it is concerned are limited to those posed by the development of modern medicine )?olas" &''.*. 9evertheless" a broader conception" and one which we believe to be more in tune with the social requirements of the discipline which has evolved under the umbrella of bioethics" e#tends its range of application to the problems generated by the enormous scientific and technological development" in particular in the field of applied human biology" but with additional branches in other areas" such as the repercussions on other living beings or the environment" covering a significantly wider range of sub-ects than medical Ethics alone.. The -ourney followed by bioethics since its inception does not correspond e#actly with the original idea of 2otter" one which was close to 3uman Ecology" in which
.

@ilbert 3ottois has proposed the following list of fundamental themes of bioethicsA interventions in human procreationB interventions in genetic patrimonyB interventions in aging and dyingB interventions in the human bodyB manipulation of the personality and intervention in the brainB e#perimentation with human beingsB interventions in living beings and non$human living media )3ottois" &''4*.

demographic growth and environmental problems play a very important role in the survival of the human species" the underlying motif of his conception )@afo" .//;*. !lthough these problems form part of the corpus of contemporary bioethics" such as in the problematic of genetically modified cultures" this has developed" above all" in the conte#t of the social and moral problems provo ed by techno$scientific development" in particular in the application of the biomedical sciences to human beings. This conception is closer to that formulated by !ndrC 3ellegers" another of the fathers of bioethics and founder of the Doseph and 1ose Eennedy Institute for the Study of 3uman 1eproduction and 5ioethics" one of the first university centres to pioneer the study of bioethics. 3ellegers conceives this as =a branch of ordinary ethics" applied to the ingdom of biomedicine"> which applies =its closest attention to biomedical questions> )+errer and Flvare%" &''<*. This conception is that which" with certain distinctions" has predominated in the development of bioethics in the west. Various definitions have been proposed" in line with this broad conception of bioethics directed towards biomedical problems. 3ottois considers that =the word GbioethicsH designates a set of research wor s" discourses and practices" generally multi$disciplinary in nature" which aim to clarify or resolve ethical questions raised by the advance and application of the biomedical techno$sciences> )3ottois" &''.*. ,n the other hand" the Encyclopedia of Bioethics" edited by Warren T. 1eich" defines bioethics asA =the systematic study of the moral dimensions (including moral vision decisions" conduct" and policies( of the life sciences and health care" employing a variety of ethical methodologies in an interdisciplinary setting> )+errer and Flvare%" &''<*. This broad conception of bioethics" rooted in the scientific and technical development of biomedicine" is that which we will adopt in our study of the social factors which brought about its birth. 3aving located our sub-ect conceptually and historically" we move on to analyse the social factors that have influenced its emergence and development. These too shape during the course of the &'th century" in particular in the second half" when the techno$ scientific industry accelerated spectacularly to the point of constituting one of the most characteristic phenomena of the scientific" industrial and social development of advanced capitalist countries. +or Davier Echeverr:a" =true Techno$science emerges in the ./;'Hs in the 8nited States" although this does not undermine the fact that it has important earlier precedents> )Echeverr:a" &''<*. @iven that we have established the birth of bioethics around ./0'" if Techno$science emerges in the ./;'Hs" it is difficult to see how it could e#ercise a significant influence over the birth of a discipline which ma es its appearance at least a decade earlier. It is important to specify in this regard" that" for the purposes of this analysis" we can clearly situate the development of Techno$ science throughout the whole second half of the &'th century" in what Echeverr:a refers to as the Gearlier precedentsH. It is possible that the characteristics of the techno$ scientific revolution had not been fully established during this period but" in as much as some of the definitive traits of contemporary Techno$science have significantly deeper roots and have social consequences which" as we will see" are translated into moral concerns that contribute to the subsequent birth of bioethics" it is necessary to har bac to these dates to identify the influence of Techno$science in its genesis.

3. Eugenics 9evertheless" we will begin our analysis in the dawn of the &' th century" long before the development of modern Techno$science. It is from this period that the practical application of eugenics dates. This was the doctrine founded by +rancis @alton in the previous century" in an attempt to scientifically plan human reproduction with the aim of genetically improving humanity by selecting the best specimens )Soutullo" .//0*. The ideas of @alton were initially inspired by Iarwinian natural selection. 3owever" his 9orth !merican followers" who were the first to put his doctrine into practice" were more notably influenced by the emerging Mendelian genetics )Eevles" .//4B Soutullo" &''J*. This practical application of eugenics ultimately too the form of laws which legitimated the forced sterilisation of people considered to be carriers of undesirable characteristics" in the belief that these characteristics were hereditary due to the fact that they were genetically determined. The first of these laws was passed in ./'0" in the State of Indiana )8S!*" and was aimed at =incorrigible criminals" imbeciles and outlaws> )@oi oet#ea" .//;*. 5y ./4'" << states had passed similar laws due to which =4'"./< sterilisations had been officially carried out> )@ayon" .//0*. 9evertheless" over time" the ma-ority of these laws were abolished or simply ceased to be applied" above all after the Second World War. The last of these laws" in the State of Virginia" remained in force until ./0&. Even at such a recent date as =Duly ./0<" a 8.S. Senate Investigation 6ommittee" presided over by Edward M. Eennedy" obtained testimony from the Iepartment of 3ealth" Education and Social Security that at least .J"''' women and ;"''' men had been sterilised by the +ederal @overnment in ./0& K...L a high proportion of which were blac )in relation to the percentage of the population who were blac *> )Woodward" ./;&*. Eugenic sterilisation laws were also passed and put into practice in various European countries" especially in @ermany and the Scandinavian countries )Soutullo" &''J*" than s to which thousands of people were sterilised without their consent or by means of deceit or duress. 3istorically" the practical application of eugenics highlighted problems and worries which have influenced the subsequent development of bioethics. !mong the characteristics which favoured this influence we can quote the followingA eugenics" at least on the paper" attempted to tranfer the scientific nowledge of the theory of evolution and genetics to human beings and ma e them into a ind of social engineering which conditioned" or even determined future social evolution. Its practical application meant the violation of human rights" both of individuals and of whole groups" with racist" #enophobic or classist nuances" depending on the countries and the periods concerned. This violation" although with different degrees of intensity" was carried out both in totalitarian countries )for instance" in 9a%i @ermany* and in countries of liberal and democratic tradition" such as Scandinavian countries or the 8nited States" where moral concerns in relation to these practices were more li ely to settle and flourish. These applications of eugenics had a legal translation in the form of laws" which entailed an important precedent for the reflections and discussions of what over time" has become the relationship between bioethics and law. In this regard" the sentence in the case of 5ac vs. 5ell" given by -udge ,liver Wendell 3olmes" where he -ustified the eugenic sterili%ation of the young woman 6arrie 5uc with the argument that =the principle which supports the compulsory vaccination is too wide as to -ustify the

ablation of the +allopian tubes>" to conclude that =three generations of imbeciles were enough> )Smith" .//<*" is nown for its negative connotations. Eugenics and its consequences aroused a steam of opposition" even from the core of the eugenic movement itself" which has been called the stream of reforming eugenics" which began to appear some time before the atrocities committed by the 9a%is came to light )Eevles" .//4*" opposition provo ed both by its lac of scientific nature and by the social discrimination which it brings about" this last aspect being particularly important in relation to the worries of a bioethical nature. Eugenics openly created questions of a moral order" such as if it is legitimate to violate the rights of individuals in the interests of the hypothetical benefit of present or future society. These characteristics of eugenics" here presented succinctly" and the lasting social impact they had" above all in the countries where it was applied" were an important watershed for the subsequent bioethical thought" not only in relation to the historical e#perience of eugenics itself" but also" and not less importantly" in relation to the potential future consequences of the development of biotechnology" genetics and molecular biology applied to human beings" what some authors have termed neoeugenics )1omeo 6asabona" .///*. This last aspect has become so important that these potential eugenic consequences comprise one of the most important references of bioethics today. 4. Physics !s we have indicated previously" the development of new technologies associated with the techno$scientific revolution and its social consequences" present andMor future" were an essential element in the appearance of a moral conscience" first" and in the birth and rise of a real discipline such as bioethics" subsequently. This is especially evident in the fields of physics" medicine and biology. The paradigmatic e#ample of the terrible consequences that the technological development can have for man ind is nuclear energy used for military purposes. Since the start of the Manhattan 2ro-ect and its culmination with the launch of the atomic bombs over 3iroshima and 9agasa i" the moral concerns due to the tragic consequences were clearly present. 8ntil that very moment" it was still possible for some naNve scientists to maintain that science and politics could be independent" that science had an internal logic and some priorities of research derived from that logic and that the application of scientific discoveries with a social scope especially belongeg to the field of politics" which had some wor ing rules and some needs which differ from the ones in scienceB in short" science could go one way and its applications another. This viewpoint had already been seriously queried when" during World War I and the following years" the European Scientific 6ommunity" especially the one of the physicists" was completely divided when the overwhelming ma-ority adopted warmonger and nationalistic attitudes. The e#plosion of the two atomic bombs over the civil population and the destruction and death that they provo ed had an enormous impact on the conscience of many scientists" who noticed more clearly than ever the direct and disastrous consequences

that their researches might have. We all now the famous sentence by ,ppenheimer" director of The Manhattan 2ro-ect in ?os !lamos ?aboratory" in relation to 3iroshima and 9agasa i bombsA =In a crude sense" that no vulgarity" no humour" no e#aggeration can e#tinguish completely" physicians have nown the sinB and this is the nowledge they cannot get rid of> )6ornwell" &''<*. In the years that followed World War II" the civil applications of nuclear energy led to the concern of some important geneticists who defended eugenic pro-ects. The studies carried out on the medium and long term consequences of radioactivity provo ed" first" by bombs and" then" by the nuclear reactors of the power stations used for the production of electric power" made the 9obel 2ri%e Winner 3. Muller formulate the following pessimistic prediction derived from the combination of the dysgenic consequences of medicine and the effects of radiationsA =the future of the human race is finishing by having two inds of individualsA those who are hardly able to move" and those who are less affected but spend all their time loo ing after the first ones> )Stric berger" .//'*. The concept of genetic or mutational burden" which Muller had developed as a part of his contribution to the genetic of populations was translated" when it was applied to the human beings" into this dar outloo " what" according to his criterion he imposed the necessity of negative eugenic measures" as the only way to stop the unavoidable degeneration of the human race. MullerHs concerns have reappeared time and time again in different ways" motivated by the bioethical reflections which biomedical research has fostered. . !edicine If the use of 2hysics has motivated concerns and reflections of an ethical nature that" in a general sense" we can say are part of the social factors which preceded the birth of bioethics" medicine is at the centre of these concerns. !s we have already pointed out" the latest precedents of bioethics are found in medical deontology and ethics. These disciplines e#perienced a series of very significant changes during the second half of the &'th century" leaning on two fundamental pillarsA on the one hand" the appearance of new treatments and therapeutic and surgical possibilitiesB on the other hand" the changes of mentality in the conception of the patients as people with decision capacity" in particular the acceptance of the autonomy principle which is the basis of informed consent. The development of new treatments and therapies" as a consequence of scientific and technical progress" led to the appearance of dilemmas of a moral scope" which could not be found previously because they were not in the hori%on of what was practicable. In ./J'" Screibner was able to carry out repeated dialysis on people with serious renal disease in Seattle. In view of the limited capacity to pay attention to the large number of sic people needing treatment" in ./J& the Iialysis 6entre in Seattle ac nowledged the need to prepare some selection criteria for patients and" to solve this" they created a committee with the ma-ority participation of people not belonging to the health field. This was one of the first precedents for what was later to be nown as an ethics committee.

!nother landmar in the implantation of new therapies was the first heart transplants" e#ecuted by the South !frican cardiologist 6hristian 5arnard. ,ver and above the great impact in the media of these first transplants" this fact had important implications for bioethical reflection" since it led to a rethin of the criteria used to determine the death of the individual. 8nli e other organs" the heart must be ta en from the body of the deceased donor when still active" which raises the difficult problem of combining some criteria clear to determine when the individual is really and irremissibly dead" with the need that such determination is not too late to prevent the use of the organs for other transplants. Whereas the idneys can be removed from de donor soon after death" when there are no vital signs of activity" this is not possible with the heart. Iiscussions aimed at identifying clear" unified criteria to determine effective death" continue" to the e#tent that nowadays" brain death is mostly used in the ma-ority of countries" although it still has its detractors. The other pillar we have mentioned is the changes of mentality as regards the treatment given to the patients and the sub-ects of medical e#perimentation. !s early as ./.7" the sentence on =the right of self$determination of the patients> was given by Dudge 6ardo%o in the case of Scholendorff vs. Society of 9ew Oor 3ospitals. In it 6ardo%o wroteA =every human being in their adult age and in their right mind has the right to determine what must be done in their body" and the surgeon that operates on them without the patientHs consent commits an assault" which is why he is responsible for the damage. This is true e#cept in cases of emergency where the patient is unconscious and where operating is necessary before the surgeon can get consent> )@oi oet#ea" .//;*" which at least in the 8nited States was useful to establish the legal basis for informed consent. 3owever" the fact which shoo consciences more profoundly was the nowledge of the atrocities carried out by the 9a%i regime. Shown during the 9uremberg Trial held between &'th 9ovember ./74 and .st ,ctober in ./7J" where the main leaders of 9a%ism" who were still alive" were -udged and condemned )+ernPnde% and 1odr:gue%" .//J*. In the following trials" &< @erman doctors were -udged" .J of them were declared guilty and 0 condemned to death )@afo" .//;*. It is important to highlight the fact that during the 9uremberg Trial" the denunciations of eugenic practices conduted in @ermany were practically non$e#istent. 9eedless to say" the use of humans as guinea pigs in e#periments and the physical elimination and mass e#termination of people belonging to various groups" especially de Dews" was denounced and condemned. 3owever" the foundation of the eugenic laws applied in ./<< was not called into question. This was due to the fact that in many 9orth !merican states the eugenic laws were also applicable" some of which had even inspired the writing of the @erman laws )Eevles" .//4*. ,ne of the immediate consequences of the trial was the application in ./70 of the 9uremberg 6ode" written in ten points" aimed at protecting the dignity and freedom of the individual" against possible abuses or perversions of biomedical e#perimentation )6asado" &''7*. In the si#ties and seventies" denouncements of e#periments with human beings" where their rights as people had not been respected or were flagrantly violated" began to arise.

Some of them referred to the use of drugs which caused serious iatrogenic effects when a satisfying e#perimentation had not been carried out previously" as was the case of thalidomide" in ./J.. ,thers" the most serious and abundant" referred to e#periments where human sub-ects had been treated as simple guinea pigs. In ./0& the Tus egee case came to lightA an e#periment which had started in ./<& and carried on for almost forty years. This involved monitoring the course of syphilis in a sample of almost four hundred !fro$!merican people from !labama who had never been treated. The intention was to observe the natural evolution of the disease" in the long term" without any treatment. The people studied were not informed and the participant doctors merely stood watching" regularly" what naturally happened. The ob-ectives could not be clearer" since they were e#pressed in an article in ./<J" published in the !ournal of the "merican #edical "ssociation" which described it as =an unusual opportunity to study the syphilitic patient who was not treated from the beginning of the disease to the death of the person> )?olas" &''.*. In ?olasH opinion =the long duration of this study" the moment of its beginning" the nature of the disease and the racial condition of the people studied" besides the fact that even having the suitable treatment" the individuals who too part in the research were not informed" ma e it an e#emplary case in the history of bioethics> )?olas" &''.*. The Tus egee case was not the only case of abuse for medical purposes. ,thers" which also shoo the 9orth !merican public opinion" were the infection of the hepatitis virus in mentally handicapped children to study the natural course of the disease" with the aim of developing a vaccine against it" occurred from ./4J to ./0. in Willowbroo " an institution for retarded children in Staten Island )9ew Oor * or the inoculation of cancerous cells into old patients" carried out in ./J<" in the Dewish 3ospital in 5roo lyn )+errer and Flvare%" &''<*. Some of these cases were e#posed in an influential article by 3enry 5eecher" published in ./JJ" in the $ew England !ournal of #edicine " with the title of =Ethics and clinical research>. 5eecher denounced in his wor that && medical articles published during the year ./J7 )appro#imately .&Q of the articles analy%ed* had questionable procedures from an ethical point of view )@afo" .//;*. In other countries" abusive medical investigations were recorded" using vulnerable sub-ects in e#periments" which did not respect some of the basic human rights" such as in !ustralia where" between ./74 and ./0'" hundreds of babies and children from orphanages were used to prove the effectiveness of vaccines against herpes" whooping cough and flu )Mili en" .//0*. In the 8nited States" the nowledge of these e#periments provo ed" in ./JJ" the creation of an ethics committee depending on the 9I3 which" subsequently culminated in setting up the 9ational 6ommission for the 2rotection of 3uman Sub-ects and 5ehavioral 1esearch" in ./07. ! product of this wor was the publication of %he Belmont &eport: Ethical 'rinciples and (uidelines for the 'rotection of )uman Sub*ects of &esearch" where the principles of bioethics were stated for the first time" presented as three principles" respecting people" charity and -ustice" subsequently reformulated by 5eauchamp and 6hildress in the nown principles of autonomy" absence of malice" charity and -ustice )5eauchamp and 6hildress" .//7*. In this new formulation" the principle of beneficence divided into twoA absence of malice and

charity. In this manner" bioethics acquired a level of discipline with recognition of institutional importance. ,ther statements" which also made an important contribution to the recognition of the problematic of bioethics in relation to the treatment to give to patients and to the sub-ects of medical e#perimentation" were the subsequent declarations of the World Medical !ssociation" beginning with the one given in 3elsin i in ./JJ" later amended in To yo )./04*" Venice )./;<* and 3ong$Eong )./;/*. The 3elsin i Ieclaration is inspired on the values of the 8niversal Ieclaration of 3uman 1ights and defines the ethical conditions of e#perimentation with people. !mong these conditions an e#plicit recognition of informed consent is made )point .'* and the formation of committees to evaluate the research pro-ects" independent of the researcher and research sponsor is recommended )point &*. ". Biology We have commented that in physics the development of nuclear energy" above all" with military purposes" fostered reflection on the social consequences of research and the dangers of its applications. We have also seen how" in medicine" the e#cesses in e#perimentation with human beings" on the one hand" and the scientific and technical advances in therapies and operations on the other hand" contributed to provo e a profound change in medical ethics. We now focus on the changes ta ing place in the field of biology and its effect on bioethical thought. +rom the ./7'Hs" we begin to note a series of research wo s in the field of genetics which" in the end" provo e such deep changes that we can almost spea of the real revolution" that which corresponds to molecular biology and biotechnology. This period commenced ./77 with the discovery" by !very" Mac?eod and Mc6arty" that I9! constitutes the hereditary material" a fact corroborated a few years later" in ./4&" by 3ershey and 6hase )Stent and 6alendar" ./0;*. These discoveries stimulated the research into I9! structure" established by Watson and 6ric in ./4<" with the famous three$dimensional model of the double heli#" which perhaps constituted the most outstanding scientific discovery in the entire &' th century and perhaps with the greatest significance in the whole history of biology. Since then" research wor accelerated. ! few years later" the mechanisms of genetic e#pression )transcription and translation*" which led to the synthesis of proteins" are established" and the nature of the genetic code is deciphered )Enippers" ./04*. +rom the beginning of the seventies" these advances in research culminate in the development of genetic engineering and biotechnology" provo ing a very deep change in biology" which not only e#tends down to nowadays" but also pro-ects its developments towards a future that will undoubtedly provo e scientific and social changes of enormous consequences. This revolution in molecular biology" its applications in diverse fields" especially in the biomedical field and its economical and social consequences" have decisively contributed to broaden the field for thought in biomedical ethics to other grounds until it became the new discipline of bioethics which covers" besides the characteristic topics

and concerns in medicine" new challenges derived from the uses of molecular biology applied to human beings. !n event of enormous importance in this revolution was the discovery" made in ./J; by ?inn and Werner !rber" of the restriction en%ymes )SPnche% 1on" &''.*. These are a ind of en%yme of bacterial origin" which cut the I9! in specific places inside the molecule )endonucleases*" the Eco1I being the first to be identified" from the intestinal bacterium Escherichia coli. 8sing restriction en%ymes" it is possible to cut I9! fragments from different origins" even from very different species" and assemble them in a new hybrid molecule called recombinant I9!. This was precisely what" for the first time" 5oyer and 6ohen in ./0< were able to achieve )Watson" &''<*" thus inaugurating the era of genetic engineering. Manipulation of I9!" which is possible with genetic techniques engineering" has an important influence on the subsequent development of biology and biomedicine and also in its implications for bioethics. ,ne of the first was the awareness among molecular biologists about the safety problems in the e#periments" as a consequence of the potential or real dangers that research with recombinant I9! could entail. ,n the 9obel 2ri%e winner 2aul 5ergHs own initiative" a group of outstanding biologists" who proposed the holding of an international conference to discuss safety problems in the laboratories where genetic engineering e#periments were carried out" met in ./07. The conference was held in +ebruary ./04" in !silomar )6alifornia*" with the participation of .4' scientists )SPnche% 1on" &''.*. ! research moratorium was passed and some self$regulation criteria were drawn up" and these criteria were subsequently adopted by the 9orth !merican !dministration. !nother of the important implications of genetic engineering was the possibility of commercial e#ploitation of the research results" due to their potential industrial uses. Indeed" recombinant I9! technology made it possible for industry to obtain molecules of biological interest with pharmaceutical applications" such as human insulin" the growth hormone or the coagulation factors for the treatment of haemophilia" which led to the development of biotechnology" with uses in the field of biomedicine" cattle raising or agriculture. +ruit of this was" first" the appearance and subsequent and proliferation of a new type of biotechnology companies devoted to economic e#ploitation or research )MuRo%" &''.*. In this same direction" applications for several types of biological patents started to appear" and even for genes" which led to important changes in patent rights" first in the 8nited States and later in Europe. =In ./;0" the !merican 2atent ,ffice gave the right to patent transgenic pets" i. e." created by means of genetic engineering. 8sing this agreement of .&th !pril ./;;" the patent of a transgenic mouse produced at 3arvard 8niversity was accepted )SPnche% 1on" &''.*. The debates about the convenience or not of accepting this and other similar patents of material from human beings contributed to the enrichment and maturing of bioethics. The importance of the development of molecular genetics for bioethical reflection reached its pea with the 3uman @enome 2ro-ect" i. e." the ob-ective of sequencing the complete I9! in human cells" which contains two entire complements of chromosomes with <".'' million nucleotides each )Soutullo" &''J*. This underta ing"

initiated in the /'s and completed at the beginning of this century due to the combined competence and effort )not e#empt of tensions* of an international public consortium and the private company" 6elera @enomics" entailed an enormous encouragement for the development of bioethics. In the first place" for the huge economic" scientific and social consequences that the pro-ect could have in the medium and long termB in the second place" because one part of its economic budget )<Q at the beginning" subsequently e#tended to 4Q* was for studying its ethical" legal and social repercussions )Iavies" &''.*B in the third place" because it triggered a plethora of debates" symposia and publications where these repercussions were analy%ed and discussed deeply from different points of view. This all led to an important boast for bioethics" whose concerns began to appear more and more regularly in the media. The ethical and legal concern about the consequences of research into the human genome ended in the passing of a 8niversal Ieclaration on the 3uman @enome" .. th 9ovember .//0" at the 89ES6, @eneral 6onference" also approved later by the 8.9.,. @eneral !ssembly /th Iecember ./;; )1omeo 6asabona" .//4*. This declaration includes some of the concerns" by way of recommendations" which have been part of the bioethical debates of the last few years regarding the consequences of research in molecular biology with human biological material. ,ne of the topics which is quoted" although not developed in the declaration" but which has been very important in the biological discussions" is the topic of gene therapy" especially the possibility of its use in the human germinal line. Somatic gene therapy" which involves inserting a gene in a patientHs cells to restore normal function in the organism" is at the e#perimental stage and" although limited success has been achieved" for the moment it has not produced the results e#pected in the future. Its ethical implications are quite limited. ,n the contrary" germinal gene therapy" which has never been put into practice in human beings so far" presents ethical problems of great importance )Soutullo" &''J*" which is why its prohibition has been called for by several fields or at least a moratorium" until all the implications can be evaluated in depth. !mong these" there would be the possible eugenic consequences if this form of human genetic engineering were to be applied not with a therapeutic purpose but for purposes of genetic improvement )5uchanan et al" &'''*. The discussion about the ethical and social implications of germinal gene therapy and genetic engineering for improvement illustrate the maturity that bioethics has been achieving in recent years in relation to the consequences of the development of molecular biology. 5esides genetics" other two areas of biology have had important repercussions in bioethics due to the moral implications which are derived from them. These are reproduction biology" particularly assisted reproduction" and embryology" above all" regarding cloning. !ssisted reproduction has made a considerable impact on the world of bioethics since ?ouise 5rown was born in England on &4 th Duly ./0;" the first person born from an in vitro fertili%ation )@robstein" ./;J*. Such an important achievement" 2. Edwards and 2. SteptoeHs doing" supposed a true landmar " which soon started to have a wide medical

use" since it enormously increased the possibilities of treatments against infertility. 2articularly its moral repercussions due to possible problems of affiliation as the oocytes and spermato%oids donated by third persons or pregnancy by a surrogate mother. 9o less ethical importance is the possibility of embryo manipulation" which opened the way for in vitro fertili%ation" the oocytes fertili%ed being outside the female reproductive system. Iebates on these issues have been developed over the years" being e#pressed in many countries in laws which reflected" to a greater or lesser e#tent" the ma-ority state of opinion e#isting in every country in relation to the questions provo ed by assisted reproduction. The other field quoted" embryology" although conceptually different from reproductive biology" needs this as a prior condition. Indeed" it is only possible to research into embryonic development if the embryos are accessible for study. That is why the development of embryonic research in humans )and in mammals in general* was boosted since in vitro fertili%ation could be used as a regular form of assisted reproduction. This boost e#perienced by embryology made nowledge of the first stages of embryonic development advance enormously and made it possible to implement several techniques for handling embryos. The different modalities of cloning were among these" such as the division of embryos and nuclear transfer. !lthough cloning techniques were not used directly in humans" with the e#ception of the division of embryos made in .//J by 3all and Stillman from unviable embryos remaining from in vitro fertili%ation )Soutullo" .//;*" the controversies about the moral implications of reproducing clonal human beings have been frequent )Donas" .//0* and have become one of the central themes of bioethical discussion since the birth of Iolly the sheep )Wilmut et al" &'''*. To conclude this section on biology" we must point out that its influence on bioethics has not been confined e#clusively to the problems directly related to human biology. The problematic of genetically modified cultivation )transgenic plants* )IPRe%" &''&* and the use of animals in research or as a possible source of organs for #enotransplantations )1omeo 6asabona" &''&*" above all the first of them" have generated strong controversies" which have sometimes e#tended the regular circles of discussion of bioethics and have acquired a much wider social score. !lthough its repercussion about the development of bioethics has been a bit late" especially referring to the problematic of transgenic plants" its scope has acquired a quite notable range. We must also point that some of the problems provo ed by genetically modified cultivations are related to some of the environmental concerns e#pressed by 2otter in his germinal documents on bioethics. #. $ther fields of bioethical influence !lthough the areas of science analy%ed here have a narrower relationship with the birth and development of bioethics as a discipline" they are not the only ones that" at different moments" have drawn attention to its influence. The problems derived from demographic growth at a worldwide level and the policies of birth control in third world countries have also formed part of the universe of the concerns of bioethics )Eieffer"

./;<*" which is why they not only affect the economic and social development of the countries but also the peopleHs rights" particularly womenHs reproductive rights. The questions related to women rights to control their own body and the capacity to decide essential questions about reproduction have spread to different scenes. We have -ust referred to those related to demographic growth. We have also focused on assisted reproduction problems" which have provo ed so many discussions of bioethical nature. These topics have been part of the demands of the feminist movement" a movement which has had a profund influence on the evolution of mentalities in many facets of social life" especially in the Western developed countries. Their repercussions have affected many fields of theoretical" political and social reflections" apart from bioethics. 3aving been constituted as a movement with its own demands" with a capacity to organi%e and with demonstrations to defend them" it has given feminism a very wide social dimension. !mong their demands" one which has had a great repercussion in the discussions of a moral order" and which has left an important mar in the bioethics" has been its defence of the right to abortion" as the clearest and conclusive e#pression of the capacity of women to control their own bodies. The question of abortion has been central in bioethical discussions" since it affects the moral assessment of embryos and" as a consequence" the respect and protection derived from this assessment and" of course" the conflicts of values which inevitably arises )!my" &''4*. Iemographic growth is also lin ed to environmental problems" another of the fields where ethical reflection has developed" although autonomously from the rest of the bioethicsB to show this difference" ecoethics or environmental ethics are usually mentioned )3ottois" &''4*. We have already commented that environmental problems formed part of 2otterHs original theoretical discourse. 3owever" as we have -ust pointed out" these problems have been somewhat separated from the subsequent display of bioethics. It has been another importance social movement" the environmentalist movement" which has been responsible both for the theoretical development and practice" including its organi%ed dimension" of environmental problems. 5ut" despite this dissociation" the environmental problems come" as we will e#pound later" the same critical current before the development of techno$sciences where bioethics has also inspired" even before it appeared li e one. %. The social conte&t of the birth of bioethics The social conte#t which led bioethics to emerge as part of the human rights philosophy" reflected in the 8niversal Ieclaration of 3uman 1ights" was approved by the 8.9.,. @eneral !ssembly in ./7;. !lthough the initial inspiration of the declaration has nothing to do with the ethical problems caused by science and technology" above all of a political nature )3ottois" &''4*" several authors have pointed out that the human rights philosophy" as the rights of the person or individual" has been a very important source of inspiration in the development of bioethics )?olas" &''.B 3ottois" &''4*" which has been clearly revealed in some important declarations which mar ed its history" such as the ones of the World Medical !ssociation" of the World 3ealth ,rganisation or the 5elmont 1eport itself.

! second aspect which has mar ed a precedent in the birth of bioethics" as mencioned earlier" has been the increasing critical conscience against the science and technology advances" what we could call the critic of the idea of progress. This has appeared and has e#tended due to the problems generated by the very e#pansion of science and technology. In view of the optimistic" naNve idea that science and its applications would almost automatically solve all the present and future problems of man ind" a current of scepticism and pessimism began to arise" when it was noted that technological development led to important problems" as in the case of environmental problems" for which we cannot discern clear solutions from science itself. !s 3ottois has pointed out" =the power associated with the new technologies seems to be loaded with new dangers for individual rights. The manipulative virulence of techno$science seems to have ris s for the equality and dignity of the human being>. !nd although" he addsA =a fairer appreciation consists" undoubtedly" of recognising the ambivalence of the techno$ scientific development and eeping away both from progressive messianism and apocalyptic and technophobic obscurantism> )3ottois" &''4*" we have to recognise that in the years prior to the birth of bioethics" the ideologies critical with the scientific and technological development of the capitalist countries e#tended and e#erted a not inconsiderable influence in the reflections about how to face the problems arising from the application of scientific advances to human beings. ! third aspect which has also been present in the advent of bioethics has been a certain perception of the failure of the traditional ethical problems to give a response to the concerns generated by scientific advance )!rcher" .//J*. The philosophical ethics which was developing in the J's in the &' th century" above all in some countries such as the 8S!" was far removed from the normative ethics and was dealt" above all" with the other ind of problems with limited or %ero interest for the moral reflection which techno$sciences provo ed. In the words of I. 6allahanA =Moral philosophy in that analytic model was almost entirely centred on the fight between utilitarianism and deontology" and even this debate remained submerged below the interest" even greater" in the metaethics" bogged down in the uses and the statute of concepts and moral language> )6allahan" .///*. Some philosophers reacted against this situation" among whom were 3. Donas" S. Toulmin and others and were oriented towards the bioethical reflection. ToulminHs sentence" =bioethics saved the philosophical ethics> )+errer and Flvare%" &''<* is well nown. +inally" we note the issue of the social conte#t where the birth of bioethics has been possible. This" which in essence is based on the reflection and debate about the problems of medicine" science and technology" developed freely and unconstrained by dogmatic or authoritarian attitudes" can only e#ist in open and plural societies" where the different moral conceptions can be e#posed and coe#ist )3ottois" &''4*. The possibility of solving ethical dilemmas or loo ing for acceptable consensus is only possible when the discussion about central topics of bioethics" about =the sense and the value of life and death> )3ottois" &''4* can be debated in an environment of freedom and respect" even the thorniest topics" those on which" a priori we now that the agreement is practically impossible. In countries where the ethical plurality of the society is repressed and substituted by an imposed official moral" it is not possible for bioethics to be developed. That is the reason why bioethics was born" grew and

prospered in democratic and plural societies. It is also for the same reason that bioethics" which at the beginning was lin ed to certain 6hristian religious options" has tended to evolve towards a secular bioethics" where the reflections are inspired on rational arguments" which can be debated and shared at least in theory" by any interlocutor apart from the moral or religious options of its beginning. !lthough in reality such an agreement is practically unviable in many cases" it is only a precondition for the e#istence of bioethics that the different moral options can coe#ist and face each other without pre-udices. '. (onclusions a. The precedents of bioethics date bac to antiquity" in the codified medical deontology in the 3ippocratic ,ath. b. In modern times" it has become medical ethics" when patients began to be considered as autonomous people" with a capacity to ta e decisions over their own lives while the figure of informed consent appeared. The human rights philosophy" the abuses of medical e#periments in treatments and surgical techniques are the driving forces behind this change. c. The broadening of the scope of medical ethics and its evolution into modern day bioethics occurred in relation to the consequences of techno$scientific development in the field of biology. !lthough the application of nuclear fission technology with military purposes acted as a salutary lesson for the awareness of the scientific community of the social consequences of techno$science applications" it was the development of molecular biology and embryology and their applications to the human beings" which created the appropriate conditions for the start of bioethics as a branch of ethics" with sufficient strength to become a discipline in its own right. d. The revolution of molecular biology" with multiple potential applications in several areas" especially in the biomedical field" has made bioethical reflection progress enormously. The dilemmas associated with the enormous development of the techniques of genetic diagnosis and the possibilities of therapeutic interventions andMor eugenic derived from them have fostered the appearance of bioethics" with a certain frequency" from the speciali%ed circles and has been focused on by the media. The 3uman @enome 2ro-ect and the advances in the cloning techniques have been the latest events of great importance in the maturing and developing of bioethics. e. The e#tension of a critical current in the light of the scientific and technological advances and the negative consequences of some of their applications" on the one hand" and the fact that the traditional ethics reference points turned out to be insufficient to ma e an in$depth analysis of the problems arising from the development of techno$ science" especially from biotechnology" on the other hand" have provided the right environment for the development of bioethical reflection" above all in countries where the conditions of freedom have allowed ethical and ideological plurality present in society to come to the surface in the form of discussions and debates where the bioethics has been ta ing shape.

Bibliogra)hy
!my" D." &''4" =!borto>. $ova enciclopedia de bio+tica" edited by @. 3ottois and D. Missa. Santiago de 6ompostelaA 8niversidade de Santiago de 6ompostela" pp. <0$7<. !rcher" ?." .//J" =+undamentos e princ:pios>. Bio+tica" edited by ?. !rcher" D. 5iscaia and Walter ,sswald. ?isboaA Editorial Verbo. 5eauchamp" T. ?." and 6hildress" D. +." .//7" 'rinciples of Biomedical Ethics. 9ew Oor A ,#ford 8niversity 2ress. 5uchanan" !." 5roc " I." Ianiel" 9. and Wi ler" I." &'''" rom ,hance to ,hoice: (enetics and !ustice. 6ambridge )8E*A 6ambridge 8niversity 2ress. 6allahan" I." .///" =The 3astings 6enter and the Early Oears of 5ioethics>. Kennedy -nstitute of Ethics !ournal / ).*" 4<$0.. 6asado" MS" &''7" .as leyes de la bio+tica. 5arcelonaA Editorial @edisa. 6ornwell" D." &''<" )itler/s Scientists. ?ondonA 2enguin 5oo s. Iavies" E." &''." ,rac0ing the (enome. 9ew Oor A The +ree 2ress. Echeverr:a" D." &''<" .a revoluci1n tecnocient2fica. MadridA +ondo de 6ultura EconTmica de EspaRa. +ernPnde%" !. and 1odr:gue%" D. ?." .//J" El *uicio de $uremberg, cincuenta a3os despu+s. MadridA !rco ?ibros. +errer" D. D." and Flvare%" D. 6." &''<" 'ara fundamentar la bio+tica. %eor2as y paradigmas te1ricos en la bio+tica contempor4nea. 5ilbaoA 8niversidad 2ontificia de 6omillas$Editorial IesclCe Ie 5rouwer. @afo" D." .//;" =3istoria de una nueva disciplinaA la 5ioCtica>. 5erecho biom+dico y bio+tica" edited by 6. MS 1omeo 6asabona. @ranadaA Editorial 6omares. pp. ;0$.... @ayon" D." .//0" =EugenicsA an historical and philosophical schema>. .udus 6italis ;" ;.$.''. @oi oet#ea" MS D." .//;" -ntroducci1n a la Bio+tica. 5ilbaoA 8niversidad de Ieusto. @robstein" 6." ./;J. 5e la casualidad a la intenci1n. 7na apreciaci1n de la fertili8aci1n humana externa . MadridA Editorial !lhambra. 3ottois" @." &''4" =5ioCtica>. $ova enciclopedia de bio+tica" edited by @. 3ottois and D. Missa. Santiago de 6ompostelaA 8niversidade de Santiago de 6ompostela" pp. .7<$.4'. IPRe% 2are-a" E. )coord.*" &''&" 'lantas transg+nicas: de la ,iencia al 5erecho. @ranadaA Editorial 6omares. Donas" 3." .//0" %+cnica medicina y +tica. 5arcelonaA Ediciones 2aidTs IbCrica. Eevles" I. D." .//4" -n the $ame of Eugenics. (enetics and the 7ses of )uman )eredity . 6ambridge )Massachusetts*A 3arvard 8niversity 2ress. Eieffer" @. 3." ./;<" Bio+tica. MadridA Editorial !lhambra. Enippers" 1." ./04" (en+tica #olecular. 5arcelonaA Ediciones ,mega. ?olas" +." &''." Bio+tica. El di4logo moral en las ciencias de la vida. Santiago de 6hileA Editorial MediterrPneo. Mart:n Mateo" 1." ./;0" Bio+tica y 5erecho. 5arcelonaA Editorial !riel. Milli en" 1." .//0" =5ebCs de orfanatos australianos fueron utili%ados como cobayas>. El 'a2s" .. Dune. MuRo%" E." &''." Biotecnolog2a y sociedad. Encuentros y desencuentros. MadridA 6ambridge 8niversity 2ress. 2otter" V. 1." ./0'" =5ioethics" the Science of Survival>. 'erspectives in Biology and #edicine .7" .&0$.4<. 2otter" V. 1." ./0." Bioethics, Bridge to the uture. Englewood 6liffs )9. O.*A 2rentice 3all. 1omeo 6asabona" 6. MS" .//4" =El 2royecto de IeclaraciTn de la 89ES6, sobre protecciTn del @enoma 3umanoA observaciones a una iniciativa necesaria>. &evista de 5erecho y (enoma )umano <" .J.$.07. 1omeo 6asabona" 6. MS" .///" =?as prPcticas eugenCsicasA nuevas perspectivas>. .a eugenesia hoy" edited by 6. MS 1omeo 6asabona. 5ilbaoA 6Ptedra de Ierecho y @enoma 3umano$Editorial 6omares" pp. <$&0. 1omeo 6asabona" 6. MS )coord.*" &''&" .os xenotrasplantes. "spectos cient2ficos, +ticos y *ur2dicos . @ranadaA Editorial 6omares. SPnche% 1on" D. M." &''." El *ard2n de $ewton. .a ciencia a trav+s de su historia. 5arcelonaA Editorial 6r:tica.

Smith" D. I." .//<" =Ieterminismo biolTgico y concepto de la responsabilidad social. ?a lecciTn de 6arrie 5ac >. 'royecto (enoma )umano: 9tica" edited by +undaciTn 55V. 5ilbaoA +undaciTn 55V" pp. .J/$.0/. Soutullo" I." .//0" .a Eugenesia. 5esde (alton hasta hoy. MadridA Talasa Ediciones. Soutullo" I." .//;" 5e 5arwin al "5$. Ensayos sobre las implicaciones sociales de la biolog2a . MadridA Talasa Ediciones. Soutullo" I." &''J" .as c+lulas madre, el genoma y las intervenciones gen+ticas. Ensayos sobre las implicaciones sociales de la biolog2a. MadridA Talasa Ediciones. Stent" @. and 6alendar" 1." ./0;" #olecular (enetics. "n -ntroductory $arrative. San +ranciscoA W. 3. +reeman and 6ompany. Stric berger" M." .//'" Evolution. 5ostonA 5artlett 2ublishers. Vidal" M." .//7" Bio+tica. Estudios de bio+tica racional. MadridA Editorial Tecnos. Villala:n" D. I." &''." =El origen de la 5ioCtica y su desarrollo>. #anual de Bio+tica" edited by @. MS TomPs @arrido. 5arcelonaA Editorial !riel" pp. </$40. Watson" D." &''<" "5$. El secreto de la vida. MadridA Taurus. Wilmut" I." 6ampbell" E. and Tudge" 6." &'''" .a segunda creaci1n. 5e 5olly a la clonaci1n humana. 5arcelonaA Ediciones 5. Woodward" V." ./;&" =6ociente intelectual )IU* y racismo cient:fico>. .a Biolog2a como arma social" edited by The !nn !rbor Science for the 2eople Editorial 6ollective. MadridA Editorial !lhambra" pp. J;$.'7.