People have always had to make decisions about how best to live as physical creatures. About 2400 years ago, members of the Hippocratic tradition, in contrast to other itinerant healers, swore not to aid patients in obtaining their own death or abortion. In the Middle Ages, people realized that amputating a limb with gangrene improved the chances of the patient’s survival. Was there an obligation to undergo the gruesome procedure of sawing off a limb with crude tools, infections, and no anesthesia? They were advised by the Church of their day that such an extraordinary measure was a matter of individual conscience.

Bioethics now, as specifically an academic, professional, and public discussion, was triggered in the 1970s by the Tuskegee Syphilis Study. The US National Health Service wanted to understand syphilis in hope of curing it, or even better, preventing it. They sought a county in the US that already had a high rate of the disease. A doctor in Macon County Alabama volunteered that he had many such patients and the backing of a prestigious institute to do a long-term study of how the disease naturally progressed. Implementing the study, a whole series of decisions were made that did not take the welfare of the subjects as the first priority. The study was never secret from the medical establishment, but when the public heard of the lies and withholding of valid treatment that had compounded over forty years, there was horror.

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