Bioethics Literature Grows As Academic Interest Expands

Sidebar: Ethics Journals The rise in bioethics centers, courses, and degree programs within the last decade has spawned an expansion in the literature devoted to the subject. According to scientists and ethicists, this is exemplified by an upswing in the number of periodicals and, particularly, individual articles in peer-reviewed publications. This new literature genre covers such areas as scientific fraud and integrity; patients' rights; informed consent; genetic screening; and the dissemination of scientific, technological, and medical information. Some observers, however, contend that the surge in material represents simply more discussion about age-old issues. 'THE RIGHT OUTLET': The purpose of Science and Engineering Ethics is to encourage practicioners to write ethics articles, notes Western Hemisphere editor Stephanie Bird. A search conducted on the Science Citation Index, published by the Philadelphia-based Institute for Scientific Information, found that the number of journal articles with the root word 'ethic' in their titles almost doubled between 1987 and 1996. "Ten years ago, there were about three to four major, vital journals in the field of bioethics," says Arthur Derse, associate director for medical and legal affairs at the Center for the Study of Bioethics at the Medical College of Wisconsin in Milwaukee. "Now the number is closer to 15. The amount of literature out there now is outstripping the ability of any bioethicist to be a comprehensive reader in the field." (The list on page 3 includes some of the journals that have started in the last seven years.) HARD TO KEEP UP: The amount of literature now available is making it difficult for any bioethicist to be a comprehensive reader, notes Arthur Derse. Derse manages the Bioethics Online Service (http://www.mcw.edu/bioethics/), an information source on the World Wide Web. The site offers abstracts of journal articles and news accounts, as well as links to other bioethics Web sites. The accumulation of an extensive information base on bioethics is apparent in cyberspace, notes Derse. About two years ago, he says, there were only two bioethics Web sites-his center's and that of the University of Pennsylvania Center for Bioethics (http://www.med.upenn.edu/~bioethic/). Currently, the Medical College of Wisconsin's Web site has links to 20 bioethics programs, centers, societies, and other related organizations. The reasons for the surge in interest in scientific and bioethics are as varied as the issues the articles cover. Robert J. Levine, a professor of medicine at Yale University School of Medicine, maintains that two factors contribute the most to the volume. "One of them is that we have formed centers of bioethics around the country, and each one of them has decided to publish something-usually a periodical or a newsletter," says Levine, editor of IRB: A Review of Human Subject Research, a journal published by the Briarcliff, N.Y.-based Hastings Center since 1979. "A second phenomenon is that until relatively recently we haven't had many programs producing people who want to make a living in ethics, but in the 1980s we saw the beginnings of these centers for bioethics. These are all now graduating people who then want to pursue careers doing things in ethics, which includes publication of papers in the field." There are more than 100 bioethics programs and centers in the United States (K.Y. Kreeger, The Scientist, Sept. 5, 1994, page 1). Still others say the growing attraction is related to the many recent inquiries into scientific fraud. "I think the reason for the dramatic interest in bioethics is the frequency of whistleblowing in science lately," says Gerald Koocher, an associate professor of psychiatry at Harvard Medical School and editor of Ethics and Behavior. NEW TOOLS: New technology, especially in the field of genetics, has spurred an upswing in attention to bioethics, says Martha Montague Smith. "There's also an increase in space being provided for ethical issues at various conferences, which then result in publications," notes Martha Montague Smith, director of the program in library and information science at Indiana University, South Bend. While a surge in written material is evident, some observers maintain that what's covered is simply a new take on timeless topics. Although Barbara J. Culliton, editor-in-chief of Nature Medicine, doubts that the incidence of ethics articles in Nature, Nature Genetics, and Nature Medicine has increased in the last five to 10 years, she adds that "there is a lot more written about ethics [in general]. I personally don't detect a lot written about ethics that is new or fresh, but that doesn't mean it's not a growth industry." One of the newest journals in the burgeoning bioethics field- Science and Engineering Ethics -is dedicated to providing a place for life science researchers and investigators from other fields to submit their articles, essays, and reviews. "The journal started because we looked at what was out there in terms of places to publish for practitioners of science and engineering who were concerned about ethical issues in what they came across in their research," says neuroscientist Stephanie J. Bird, special assistant to the provost at the Massachusetts Institute of Technology and the Western Hemisphere editor of Science and Engineering Ethics. "They didn't have any place to publish. Although we publish articles by a wide range of professionals-including ethicists, lawyers, and sociologists-we especially want to focus on that audience of practitioners." Photo: Davis Studio PROVIDING A CONTEXT: The Journal of Clinical Ethics aims to present physician-patient interactions using actual case histories, says Norman Quist. Another relatively new journal, the Journal of Clinical Ethics, is aimed at an audience similar to that of Science and Engineering Ethics. "There's a large chasm between theory and practice in clinical medicine," asserts the periodical's publisher, Norman Quist. Because physician-patient interactions have become more complex, he says, articles written in the context of actual cases provide a forum to discuss issues like informed consent and withholding and withdrawing treatment, which have now become a regular focus of medicine. More than 70 percent of recent articles have been authored or coauthored by physicians, adds Quist. In addition to the emergence of periodicals devoted solely to ethics, some mainstream scientific and medical journals are devoting more space to bioethical topics. "The New England Journal of Medicine was probably the first," notes Levine. "It began to show an interest in the 1970s. Some of the others are relative latecomers, like JAMA [Journal of the American Medical Association], Lancet, British Medical Journal, and Annals of Internal Medicine. Now, somebody picks up an issue of one of these journals and sees something on ethics, and says: 'I'm going to send my next article there.'" HIGH DEMAND: Arthur Caplan observes that "reader just want more" articles on bioethics issues. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania Medical Center, agrees that more scientists and physicians, as well as ethicists, are contributing ethics articles to scientific and medical journals in general. "Their readers just want more of it," he observes. There are many converging elements to explain the current focus on scientific ethics and integrity, notes MIT's Bird. "Certainly the public attention on the issues-both at the National Academy of Sciences and the National Institutes of Health, with the establishment of the Ryan Commission, for example-[is a] contributing factor." The congressionally mandated Commission on Research Integrity-chaired by Kenneth Ryan from Harvard Medical School-was formed in 1993 in response to research misconduct and retaliation against whistleblowers. ALPHA AND OMEGA: "Since Day 1, we have seen a concern with the beginnings and endings of life," says Yale’s Robert J. Levine. But more important, according to Bird, is the growing number of professional societies that have now ratified codes of ethics-although she notes that many, such as the American Chemical Society and several engineering societies, have had them for decades. "I think to a large degree that really reflects the fact that people in the field have awakened to the idea that there's a lot more to doing science than simply knowing scientific concepts and the current lab techniques." But, she adds, "we're really not communicating this to students and trainees and to each other." To that end, notes Bird, one of the goals of Science and Engineering Ethics is to communicate views on ethical issues that scientists deal with every day, like authorship disputes, denial of access to biological specimens, and patent rights. Robert Hauptman, professor of learning resources at St. Cloud State University and editor of the Journal of Information Ethics, cites two global reasons for the surge in the number of articles on the ethics of scientific research. "In general, the public has become more sensitized to ethical issues in the last 20 years, and it's now much easier and quicker to disseminate information about occurrences with ethical repercussions." A sampling of relatively new journals related to science, medical, and engineering ethics that have started in the past seven years: Cambridge Quarterly Journal of Healthcare Ethics Cambridge Univeristy Press 40 W. 20th St., New York, N.Y. 10011-4211 Tel: (212) 924-3900 Fax: (212) 691-3239 E-mail: journals_marketing@cup.org http://www.cup.org First issue published in 1992 Ethics and Behavior Lawrence Erlbaum Associates Inc. 10 Industrial Ave., Mahwah, N.J. 07430 Tel: (201) 236-9500 Fax: (201) 236-0072 http://www.erlbaum.com First issue published in 1990 Healthcare Ethics Committee Forum Kluwer Academic Publishers 101 Philip Dr., Norwell, Mass. 02061 Tel: (617) 871-6600 Fax: (617) 871-6528 E-mail: kluwer@wkap.com http://www.wkap.nl First issue published in 1989 Journal of Clinical Ethics University Publishing Group 12 S. Market St., Suite 300 Frederick, Md. 21701 Tel: (301) 694-8561 Fax: (301) 739-6842 First issue published in 1990 Journal of Information Ethics McFarland & Co. Inc., Publishers Box 611, Jefferson, N.C. 28640 Tel: (910) 246-4460 Fax: (910) 246-5018 E-mail: mcfarland@skybest.com http://www.mcfarlandpub.com First issue published in 1992 Kennedy Institute Ethics Journal Johns Hopkins University Press P.O. Box 19966, Baltimore, Md. 21211 Tel: (410) 516-6987 Fax: (410) 516-6968 E-mail: jlorder@jhunix.hcf.jhu.edu http://muse.jhu.edu First published in 1991 Science and Engineering Ethics Opragen Publications P.O. Box, Guildford, Surrey GU1 2YF, United Kingdom Phone/Fax: 44-1483-560074 E-mail: opragen@cableol.co.uk http://www.cableol.co.uk/opragen/ First issue published in 1995 Significant older bioethics journals: Bioethics Journal of the International Association of Bioethics Blackwell Publishing Ltd. 198 Cowley Rd., Oxford OX4 1JF OXON, U.K. http://www.blackwellpublishers.co.uk First issue published in 1987 Journal of Medical Ethics BMJ Publishing Department BMA House Tavistock Square, London WC1H 9JR, U.K. http://bmjpg.com/data/jme.htm First issue published in 1975 High-profile scientific scandals have generated a lot of literature and news reports in the general media, remarks Bette-Jane Crigger, editor of the Hastings Center Report and managing editor of IRB: A Review of Human Subjects Research. "In general, I think there's been a growing trend to look at these issues. I think that the whole bioethics movement, focused largely on medical care, has brought the notion of ethics broadly to the public." It doesn't hurt, she adds, to have representatives from the ethics community appearing on popular television shows like Nightline and 60 Minutes. "Many people are commenting about high-profile fraud cases," says Caplan, "but [these commentaries] are more of a letter-to-the-editor type article. It's too new to be part of the ethics research-journal literature." However, he does think that research integrity will be a more prominent topic in future journal issues. New technology in the field of genetics and publicity on such issues as genetic testing and counseling have also spurred the upswing in attention, say Smith and others. "People are seeing that issues like these that would have been discussed only in professional circles a short time ago are now having an impact on individuals and their communities," she asserts. "There's more of a movement to have public discourse on scientific and medical issues." Some observers note that over the past 10 years, there have been certain shifts in the subject matter being tackled in the ethics literature. For example, according to Caplan, there is a movement toward more articles on the management of scientific ethics, such as the performance of institutional review boards. He also predicts that there will be more articles by graduate students and postdocs, since established bioethics centers are conducting more empirical research and surveys on such subjects as informed consent and conflict of interest. Editors like Culliton and Levine don't see a drastic change in emphasis of ethics articles. "It's not as if there's more to write about than there ever was," notes Levine. "I think that a great emphasis is being placed on 'novel' ethical questions that are not novel in the least," declares Culliton. "Certainly that applies to such issues as genetic screening. I can't think of anything about genetic screening that presents ethical problems that [aren't also] presented by lots of other issues in experimental or new medicine." Culliton says that covering ethics is important for her journal, but she is "not persuaded that we ought to be increasing our coverage beyond what we're already doing. I think that a lot of the discussion is appropriately in the ethics journals." "Since Day 1, we have seen a concern with the beginnings and endings of life," states Levine. "Basically, we're still worried about the same sorts of issues."

Bioethics Literature Grows As Academic Interest Expands

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