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Re-moralising medicine: The bioethical thought collective and the regulation of the body in British medical research

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Abstract

The way in which the scientific and medical use of the human body is problematised and governed in the United Kingdom was radically reconfigured over the last 30 years, changing from a logic of rule articulated around ‘supply’ and ‘solidarity’ to one construed around ‘ethics’. Drawing on the work of Ludwik Fleck and others, this article argues that one of the reasons for this reconfiguration was the existence and influence of a network of philosophers, doctors and lawyers who sought, from the 1960s onwards, to re-moralise medicine: the bioethical thought collective. The article first describes the collective’s membership and organisation, focusing in particular on the form of the interdisciplinary expert committee. It also describes some of the knowledge and practices that make up the community’s thought style, such as its moral concern about modern medicine and the notions of respect for persons and informed consent. The article then shows how these organisational forms, knowledge and practices that characterise the collective have shaped the government of human tissue research over the last 15 years. By highlighting the important role played by expert networks and knowledge, the article makes an original contribution to the sociology of the ethical government of biomedical science.

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Notes

  1. This development is not exclusive to the United Kingdom. It has been taking place in most countries in the Western world and, more recently, beyond (Jasanoff, 2005; Petryna, 2009; Reubi, 2010).

  2. In the United Kingdom, there were calls for the adoption of ethical codes regulating human experimentation from the 1960s onwards. The first such codes to be adopted include: the Medical Research Council's 1963 Responsibility in Investigations on Human Subjects; the Association of the British Pharmaceutical Industry's 1977 Guidelines for Preclinical and Clinical Testing of New Medicinal Products Part 2 – Investigations in man; and the Royal College of Physicians’ Guidelines on the Practice of Ethics Committees in Medical Research. The Nuremberg Code remained largely unknown in the United Kingdom until the 1960s and was never deemed to be relevant for British researchers; the same is true about the World Medical Association’s 1964 Helsinki Declaration. There was no ethical code that specifically addressed the use of human tissue in research until the late 1990s (Cooter, 2000; Hazelgrove, 2002; Weindling, 2006).

  3. Of course, questions of supply and the technique of the gift are still present today. But they have become notions of secondary importance and have been subsumed under the new way of thinking about the medical use of the human body articulated around ethics and respect (Tutton, 2004; Busby, 2006).

  4. The notion of informed consent had had an already long history before it was picked up, further elaborated and promoted by British bioethicists and medical lawyers from the 1970s onwards. Interestingly, one of the first articulations of the notion of informed consent was done in Germany in the late nineteenth and early twentieth centuries (Vollmann and Winau, 1996). It was this German version of the notion of informed consent, which had been codified by the Ministry of Interior of the German Reich in its 1931 Guidelines for New Therapy and Human Experimentation, that was later used and further developed by the American, British, and French officials who drafted the Nuremberg Code after World War Two (Weindling, 2006).

  5. An important foreign influence on the making of the British bioethical thought collective was the rapid emergence and institutionalisation of bioethics in the United States from the 1970s onwards (Jonsen, 1998; Stevens, 2000). To start with, American funding agencies quickly began to demand from British scientists whom they financed that they respect the ethical principles and procedures that were being developed in the United States (Hedgecoe, 2009). Furthermore, several members of the British bioethics thought collective such as Ian Kennedy, Onora O’Neill, and Julia Neuberger spent time in North American universities learning about and working on bioethics.

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Acknowledgements

I thank Roger Cooter, Thomas Osborne, Nikolas Rose and two anonymous reviewers for their comments which helped me substantially improve this article. I also thank Alex Mold for inviting me to present an earlier version of this article at a panel on the history of British bioethics the 2011 Anglo-American Conference on Health in History, University of London, alongside Duncan Wilson and herself. This article was made possible by the generous financial support of a University of London Leon Studentship in Social Sciences, a London School of Economics Research Studentship and a Brocher Foundation Visiting Fellowship.

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    David Reubi

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Reubi, D. Re-moralising medicine: The bioethical thought collective and the regulation of the body in British medical research. Soc Theory Health 11, 215–235 (2013). https://doi.org/10.1057/sth.2012.15

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