This issue of the journal had already been planned when CQ lost its own “first voice,” David Thomasma. David died unexpectedly on April 25, 2002, after undergoing surgery. The Special Section herein titled “First Voices,” with collected reminiscences of some early bioethics pioneers, had been David's idea from beginning to end. As such, we had decided to deviate from our usual practice of a collaborative editorial and to have David offer a solo voice from the perspective of someone who intimately participated in molding the discipline. This issue of CQ, which we dedicate to him, was his last project.

Can it be already 30 years since the first days of modern, secular bioethics? As those of us in the field for almost all these years arrive near the end of our careers, we find that time has truly flown and the challenges have not diminished one bit. If anything, they are even greater than in the early years. Along the way it was tempting to think that the broad consensus reached on research ethics, on the four principles, on the need for consent in clinical ethics, and then on rights in reproduction and dying, would paint the picture rather well. Only fill-in would be needed by the apprentices coming afterward. Yet time and again new biological and medical discoveries continued to challenge that painting. A new canvas had to be hung. Among the major newer developments were the challenges of healthcare reform, genetics, antifoundationalism, the certification of ethics consultants, and now, the internationalization of bioethics, its relationship to the environment and world politics, and biotechnology.

I first met Van Potter nearly 40 years ago when I was 17 and entering the University of Wisconsin as a new freshman. During the summer of 1963, Van was a participant in a series of evening seminars designed to familiarize premed students to the community at the University of Wisconsin Medical School. I was immediately struck by Van's unique ability to cut straight to the core of virtually any issue having to do with biomedicine. As with many of his students, I quickly found myself in a father-son relationship of both our making. Van has been a source of inspiration and guidance to me ever since.

Van Rensselaer Potter was the first voice to utter the word “bioethics,” yet he is too little appreciated by the bioethics community. My expectations for my first visit with Professor Van Rensselaer Potter were primed by conversations with leaders and historians of the field of biomedical ethics, including Warren Reich, Al Jonsen, and David Thomasma. When mentioning my interest in environmental ethics and my concerns for the current state of biomedical ethics, I was told that I must meet Van. On my first visit to Madison, Wisconsin, Van met me at the McArdle Laboratories for Cancer Research at the University of Wisconsin, where he spent essentially his entire academic career as a basic oncological researcher. He was dressed informally and driving a rusting1984 Subaru station wagon with a license plate that read YES ZPG. We spent this first portion of our visit at the Institute where he is an Emeritus Professor and has contributed to understanding cancer metabolism as recognized by his election to the National Academy of Sciences. However, Van felt most at home in his shack located outside Madison. This country retreat included a rather primitive hut surrounded by acres of property owned by the family. I felt at the heart of Van's world when I sat in one of a pair of inexpensive plastic outdoor chairs in a particularly secluded part of the woods on the property, the place where Van himself communed with nature.

The first book on my shelf at the newly created Program on Human Values and Health Sciences at the University of Tennessee Center for the Health Sciences in Memphis was by Van Rensselaer Potter on Global Bioethics. He was a cancer specialist at the University of Wisconsin and had the vision that bioethics should be a global concern—global in terms of scope, disciplines involved, and relationship to the environment and cultural context. This view has shaped my own career as well as influencing many others.

The single most important intellectual event in my career in medical ethics occurred the day I realized that the Hippocratic ethic for medicine was not merely outdated and irrelevant but actually in conflict with all the dominant religious and secular moral traditions of our day. Whether one stood in any of the great modern religious traditions or in any of the camps of secular philosophy—the liberal tradition of political philosophy, Marxism, or more recent feminist or communitarian views—the Hippocratic ethic was wrong, both metaethically (epistemologically) and normatively.

How does a self-described “simple teacher of religion” at the College of the Holy Cross get involved in bioethics? Nothing in my training or experience had prepared me for involvement in medicine. Much like that of my moral theology professor and then mentor, Richard McCormick, my training was in moral theology and social ethics. I also had an abiding interest in the courts and constitutional law. That interest led to a doctoral dissertation at the University of Southern California's Program in Social Ethics on “The Supreme Court's Understanding of Religion in Conscientious Objector Cases.” Interestingly, doctoral work in the late 1960s on the ethical dimension of war was the starting point for other ethicists such as Leroy Walters and James Childress who subsequently became early voices in bioethics.

Albert Jonsen in The Birth of Bioethics notes that his career in bioethics began with a phone call to him from soon-to-be colleagues at the University of California at San Francisco Medical Center. Bioethics didn't begin with a bang but as an accident in the root sense—something that happened, not by necessity, but rather by chance. Indeed, the opening chapters of Jonsen's book chronicle a series of accidents that helped to create the field of bioethics. Principal among these was the fact that physicians and biomedical scientists who became puzzled about the moral dimensions of their work and began to think about these puzzles sought help in doing so from moral theologians and philosophers. These physicians and scientists, for the most part, were university people. They thought broadly, not just deeply, about their work, but they just as well could have defined themselves by their academic discipline and departments and not reached beyond these familiar and comfortable intellectual confines to the “culture” of the humanities disciplines and departments. The theologians and philosophers whom these physicians and scientists sought out were also university people who also happened to have generous views of the intellectual life in their disciplines—atypical of the time, especially in philosophy. If C. P. Snow had been altogether right and if ungenerous self-understanding of their work by physicians, scientists, philosophers, and theologians had prevailed, bioethics might not have happened at all.

I was the graduate student that Albert Jonsen so aptly describes. Bronx born and educated at the City College of New York, I emigrated to the Midwest to study at the Minnesota Center for the Philosophy of Science, where May Brodbeck, Herbert Feigl and other “logical positivists” were engaging in an ongoing dialogue with postpositivists like Paul Feyerabend and Karl Popper. In this environment, I studied philosophy of science, epistemology, and metaethics—the epistemology and logic of ethical concepts and language. I even wrote my thesis on the ur-text of the metaethical turn, G. E. Moore's Principia Ethica. Then, like other epistemologists and metaethicists, “a public disaster, the American military involvement in Southeast Asia,” as well as the burgeoning civil rights movement, drew me into the sphere of public debate.

Like Saint Paul, I was “born out of due time” insofar as the study of bioethics is concerned. (Incidentally, I prefer the term “healthcare ethics” to “bioethics” because the discipline in question addresses issues more far-reaching than medical issues, such as downsizing access to healthcare.) I spent 15 years in teaching and administration at the Aquinas Institute of Theology, then in Dubuque, Iowa, now on the campus of Saint Louis University. I was given a sabbatical study year in 1972–1973 to refresh my mind and spirit. Though my major study and research emphasis prior to the sabbatical study had been in the field of Church law and religious government, I determined to direct my attention to the study of moral theology and ethics, because at that time there was confusion in this area of discipline, especially insofar as the Catholic community was concerned. With this in mind, I chose the University of Chicago as the locale for my study and was awarded a postdoctoral fellowship.

The history in which bioethics developed is well reviewed in a recent book written by Al Jonsen. This superb little volume gives a concise—even if a necessarily rather subjective—account of the development of the field. A more objective history of the contemporary development of the field cannot be expected from those who helped craft it and awaits historians of the future. What I have been asked to do here is to supply my own personal impressions of the development of this field as I have experienced it. What I have been asked to do here is to supply my own personal impressions of the development of this field as I have experienced it.

These CQ Sources were compiled by Bette Anton.

Since the decade of the 1970s, and particularly since the first successful test-tube baby in 1978, the development and use of assisted reproductive technologies (ARTs) have grown exponentially. Would-be parents—including those in so-called traditional male-female marriages, unmarried adults, postmenopausal women, and same-sex partnerships—who just over 20 years ago had no recourse for their (in)fertility issues can now pursue their desires to have children with at least a partial, if not, total, genetic and/or biological relationship. Ovulation-stimulating medications, artificial insemination using the sperm of a husband or unrelated donor (AIH or AID, respectively), in vitro fertilization with embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICS), and gamete and zygote intrafallopian transfers (GIFT and ZIFT) are but a few of a host of treatment options ranging in complexity, invasiveness, and expense. And on the horizon are genetic techniques such as cloning—which was once considered “pure” science fiction but in 1997 became what some call an inevitability, with the development of mammalian cloning in the form of the now-famous (if not infamous) Dolly the sheep.

Old habits die slowly. Hence there is little surprise that attorneys fashioning the Model State Emergency Health Powers Act preserved much of their own standard operating procedure. This model statute was designed for the worst of times—for horrific scenarios in which terrorism, infectious disease, or natural calamity threaten to derail the machinery of civilization while snuffing out thousands or even millions of human lives. Such grave threats seem to justify grave measures aimed at restoring order and maximizing survival. So, the model statute bestows sweeping power on state governors and public health officials, allowing them to seize private property, obtain clinical services through impressment, and enact quarantine and isolation measures without the usual due process. Yet amid all these drastic measures, certain standards persist.

Camaraderie is what I remember most about my anatomy course in medical school. There were six of us to the cadaver; six strangers who, during the course of endless hours of dissection and study, formed unique bonds. As time went on, we developed closer friendships with others, but none of these included that special sense of having been together at the beginning. We named our cadaver Ernest so we could kid about telling our parents that we were working in dead earnest. I can still visualize the man's sharp, rough face, gray and emaciated. I see his ravaged black lungs. As I write this review, the trenchant odor of formaldehyde reaches out from 36 years in the past and makes my eyes water. Nowadays, I could no more list the skull's foramina than I could speak Sanskrit, but I haven't forgotten most of the lessons that Ernest taught me.

Among industrialized nations the United States is relatively unique in relying on a mix of public and private financing and delivery of healthcare: federal and federal-state programs, such as Medicare and Medicaid; employment-based health insurance (primarily HMOs); and state-subsidized insurance pools for high-risk individuals. In recent years, however, there have been efforts to apply the principles of private employment-based health insurance to the other forms of healthcare, and there is speculation that rising healthcare costs can only be addressed by further extending capitated payment plans. This suggests that U.S. healthcare may increasingly be organized according to market principles. For some, this represents a historic departure from an emphasis on public responsibility for healthcare and a sacrifice of the value principles embodied in health relationships between patient and provider. But defenders of HMOs and a larger role for markets argue that managed care allows for a more rational allocation of scarce healthcare resources by minimizing inefficient low-benefit–high-cost care. More individuals receive essential care if inessential care is eliminated. HMOs are also said to encourage non-HMOs to provide lower priced healthcare.

It's a chilly winter night outside, but very warm inside the hospice guest house. All of the people gathered here have wished one another “Happy New Year” and settled on cushions in the big meeting hall. Both fireplaces are lit, and the many little white cards with the names of each person who died last year are arranged on the mantels over the fireplaces and on a table in the center of the room. Paul, our teacher for the evening, says a few simple and wise words about impermanence and about being of service and then explains tonight's process: we, the volunteers in attendance, will pick up the cards, either by choosing a specific patient's name or at random, and take them one by one to the fires, dropping them in and saying something about each deceased person. The idea is to hear a litany of names being remembered and honored and sent onward as volunteers flow steadily to and from the fireplaces.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will igve you an opportunity to respond in the letters section. Your input is desired and anticipated.