What Does the Future Hold? Introduction

What does the future hold for bioethics? This young field of research and practice, which emerged in the 1960s, is now coming of age. Looking back, one cannot ignore its significant achievements. Bioethics helped establish the centrality of respect for the autonomy of patients and research participants. It has transformed the norms of medical care and the standards underlying bio-medical research involving human participants, thus contributing to the protection of vulnerable populations. Bioethics also led to the formulation of certain crucial guidelines that lay down fundamental principles in the area of ethics and heath, documents that have garnered wide consensus and have shaped Western societies. As it embarks on its 6th decade, bioethics may seem fully established. With its own academic journals, professional societies, university programs, graduate degrees, and even a variety of possible careers in industry and government, the future of bioethics may seem secure. Yet, the field is undoubtedly in its adolescent stage: it suffers from growing pains and its identity issues are far from resolved. Questions still abound: What is bioethics? Is it an academic discipline or an interdisciplinary field of study? Does it have agreed-upon theoretical or conceptual frameworks, research methodologies, or analytical tools? Or is it simply a set of questions posed by advances in the biomedical sciences and health technologies and answered in an unsystematic manner by a loosely-knit group of researchers who share similar interests? And what is a “bioethicist”? While some embrace the title, others passionately reject it, sticking to their more traditional disciplinary backgrounds. Despite these ambiguities, bioethics is moving forward and expanding its areas of specialisation. So what challenges will it face in the coming decade? Bioethics will have to do more of the same, but in a changing environment. It will have to pursue its traditional role of protecting individuals and promoting respect for autonomous decision-making, in the face of new threats to this autonomy. While the culture of paternalism within medical practice has largely changed, threats to individual autonomy now emerge from systemic pressures to increase the cost-effectiveness of the healthcare system. One expression of this new type of threat can be found in routinized opportunistic testing that does not meet the well-established norms of informed and voluntary consent. This challenge is addressed in Davis’ contribution to this issue and is certain to remain the focus of bioethical attention in coming years. Furthermore, the norms underlying research involving human participants have changed, and elaborate systems have been implemented world-wide to protect the interests of research participants (and communities). However, a new research environment is emerging based on large-scale bio-banks and health information databases, often involving open ended longitudinal studies, international collaborations and transfer of information across borders. In this new environment, individual autonomy may once again be threatened in the name of pursuing knowledge that could benefit society and future generations. However, new rationalizations emerge to justify limitations to individuals’ control over their information.ontrol over their information. This time, the principle of respect for autonomy is being countered by principles such as reciprocity, mutuality, and solidarity . In this new research environment, new principles (some focused on appropriate governance mechanisms) sometimes overshadow the old and well-established principles of research ethics (such as respect for persons, beneficence and justice). Striking the right balance between the old and the new is a major challenge facing bioethics in the decade to come. Bioethics will have to pursue a new path on which it recently embarked. After decades of focusing on the protection of individuals within the healthcare and the research systems, bioethics has finally turned its attention to the context of …