The Connection and the Difference.
Bioethics is an area of Philosophy concerned with ethical issues arising from biomedical scientific technologies. It is a field of applied, or practical ethics. Although it is a relatively new field, it has developed swiftly over the last few decades, as new medical technologies and legal cases have thrown up ethical issues which benefit from, and are worthy of, philosophical analysis.
However, as I have already indicated, bioethics is not just a project for practical philosophers. It is by its very nature multidisciplinary, and this is one of the most important and exciting features of the field. Bioethicists learn from doctors and other scientists working in clinical and research areas of biomedicine, and the work of ethicists also sometimes also influences the legal status of activities considered in the study of bioethics in turn. The heterogeneous nature of the contributions to Bioethics enriches it as a disclipline and thereby improves its relevance and value. It is improved by being clinically, legally, and philosophically informed.
Bioethics and Medical Ethics are closely related, it is possible to describe the latter as a field within, or branch of, the former. However, the distinction between Bioethics and Medical Ethics should be clarified. Bioethics is broader, and is still mainly the domain of philosophers as I have described. However, in its development it has influenced Medical Ethics. Bioethics is generally more to do with theoretical ethical issues and concepts surrounding all biomedical technologies, such as cloning, stem cell therapy, xenotransplantation and the use of animals in research. Medical Ethics is more specific and focuses on the medical treatment of humans in particular. However, this is not to say that only doctors can do Medical Ethics. Not so, other health and social care professionals, philosophers, lawyers, and policy makers are all involved, to the benefit of the field as a whole but also particularly to doctors and patients alike.
Medical Ethics began with the Hippocratic Oath, and so has a longer history than Bioethics, which itself only really began after the Second World War, with the Nuremberg Code, and Declaration of Helsinki. Medical Ethics, as the name suggests, was historically the preserve of Doctors alone. Judges in medical law cases¹ have in the past been very deferential to doctor’s clinical judgment of good practice (although this is changing). The law associated Medical Ethics with professional guidelines and codes of practice, such as those produced by organisations like the BMA and GMC, and suggested that Medical Ethics was defined by the medical profession (in a self-regulating manner). The relationship between law and morality in this area is very rich and important and I will write more about this separately. But Medical Ethics today is not only about professional conduct.
The ‘new’ Medical Ethics is the result of the influence of Bioethics. At its core there are still issues arising from clinical practice and the development of new technologies in areas such as reproduction, end of life care and everything in between. But these issues inevitably raise deeper, more philosophical considerations such as the value of life, moral status of embryos and the significance of personhood². Hence the relevance of theoretical bioethics³ (including metabioethics as a part of metaethics, which concerns the methodology of bioethics), and the application of ethical theories such as consequentialism, deontology and virtue ethics to real, practical dilemmas as opposed to hypothetical or imaginary thought experiments. Research Ethics has always been separate, as indicated by the independent function of Clinical Ethics Committees (CEC’s) and Research Ethics Committees (REC’s), but it is obviously related to good clinical practice as practising doctors have a duty to keep up to date with new developments and treatments within their specialty, plus all treatments are developed through research. But Research Ethics is broadly concerned with ensuring that research (medical or otherwise) on human or non human animals is done in an ethical manner. Both Clinical and Research Ethics concentrate on the importance of consent, so there are areas where the two overlap. As Spike suggests, ‘each of the three fields of bioethics needs to have philosophers, doctors and lawyers in it…[and furthermore] none of these fields could exist alone‘³.
The study of Medical Ethics involves the analysis of concepts such as the doctor-patient relationship, competence, autonomy, beneficence, compassion, personhood, quality and sanctity of life, best interests and just resource allocation. Ideas like these are, I think, unique to Medical Ethics. At least, they are not considered by Bioethics or any other field in quite the same way. The work of Medical Ethics builds on that of Bioethics and enables good medical practice. It is not an activity purely for doctors, or philosophers, or others; but instead can gain from the insights of many different perspectives. Medicine allows for the practical application of the valuable contribution of these other disciplines.
¹ Such as Lord Keith and Lord Lowry in the Bland case (Airedale NHS Trust v Bland Appellant  2 WLR 316).
²Holland, S 2003 Bioethics: a philosophical introduction p.2 Cambridge: Polity.
³Spike, J 2006 ‘Bioethics Now’ in Philosophy Now, Issue 55 May/June 2006: p. 8 London: Anja Publications Ltd.