Barron H. Lerner, MD, PhD; Arthur L. Caplan, PhD
Disclosures: Dr. Caplan reports other from Janssen Pharmaceuticals outside the submitted work. Dr. Lerner has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2642.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Barron H. Lerner, MD, PhD, Divisions of Medical Ethics and General Internal Medicine, New York University, Langone School of Medicine, 227 East 30th Street, 7th Floor, New York, NY 10016; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Lerner: Divisions of Medical Ethics and General Internal Medicine, New York University, Langone School of Medicine, 227 East 30th Street, 7th Floor, New York, NY 10016.
Dr. Caplan: Division of Medical Ethics, New York University, Langone School of Medicine, 227 East 30th Street, 7th Floor, New York, NY 10016.
Author Contributions: Conception and design: B.H. Lerner, A.L. Caplan.
Analysis and interpretation of the data: B.H. Lerner, A.L. Caplan.
Drafting of the article: B.H. Lerner, A.L. Caplan.
Critical revision of the article for important intellectual content: B.H. Lerner, A.L. Caplan.
Final approval of the article: B.H. Lerner, A.L. Caplan.
Collection and assembly of data: B.H. Lerner.
Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the “bad old days” of physicians behaving immorally. Bioethical discourse—both in the classroom and in practice—should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.
Lerner BH, Caplan AL. Judging the Past: How History Should Inform Bioethics. Ann Intern Med. ;164:553–557. doi: 10.7326/M15-2642
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Published: Ann Intern Med. 2016;164(8):553-557.
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