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When we placed “finitude”, “limits of human existence” as a motto over a round of discussion on biomedicine and bioethics (which led to this collection of essays) we did not know how far this would lead us into methodological quandaries. However, we felt intuitively that an interdisciplinary approach including social and cultural sciences would have an advantage over a solely disciplinary (philosophical or theological) analysis. Bioethics, if it is to have adequate discriminatory power, should include sensitivity to the cultural contexts of biomedicine, and also to the cultural contexts of bioethics itself.

On August 9, 2001, President George Bush made his first formal media address to the American people. In this first speech, delivered from his home in Crawford, Texas, he announced his decision to allow federal funds to support research only on existing stem-cell lines, and concluded what was, in effect, a moral sermon as much as a policy statement with the words, “As we go forward, I hope we will always be guided by both intellect and heart, by our capabilities and our conscience”. This was an extraordinary moment. One commentator noted that the President chose to appear before the nation for the first time as a bioethicist! His decision came after months of public debate that had exposed the American people and its politicians to a large dose of bioethical language and argument. I intend to use this event to illustrate the nature of American bioethics. I shall suggest that its general contours follow the lines of moral argument that are deeply drawn in American history, and then comment on the role of the American bioethics community in the debates and the policy formulation. Finally, I will attempt to relate this American story to the broader theme announced in my title, the “History and Future of Bioethics”.

The revolutionary developments taking place in genetic research as regards pharmacology, plant and animal breeding, and human medicine, make a revision of long-established views on human nature a concern for anyone involved with this matter. The success in mapping and sequencing the human genome, thanks to methodological achievements no-one thought possible a few decades ago, seems to speak for itself. Ethical evaluations are either the task of helpless philosophers or theologians who are not easily persuaded of the positive results of the genetic revolution, or of professionals who aim for positive feedback from the public. Scientists and ethicists seem to come from different planets, to speak a different language, and to regard each other as having rather reductionist views on humans and humanity. This paper aims to reopen the discussion by stressing the need for ethical evaluation when social changes of this magnitude are possible or even contemplated.

“The energies and possibilities of medicine must be given direction.” And this, as H. Tristram Engelhardt stresses, in a situation where “unexpected possibilities are becoming real”, and in which it seems impossible to elaborate a common fundamental intellectual response to that challenge (1991: XVI).

If ethics is to say anything helpful concerning human practice it must develop a vision of what is good in human life. This is the job of ethics. But in attempting this we are to a certain extent afflicted by the epistemological limitations of our vision and knowledge of practice. An ethics that does not reflect on these constraints would not be eligible as a good guide.

Scientific and technical progress has led to changes, unimaginable up to a few years ago, in our way of being and in our confrontation with reality, including that of our own body; (changes which, perhaps, we still have difficulty in understanding completely). Genetic manipulation has permitted us to modify the human biological structure and, in part, psychological structure too. The sexual frontiers are becoming less defined; the phenomenon of trans-sexuality is just one example. Assisted reproduction has multiplied the parental f igur e and if, at one time, the Latin maxim “mater semper certa, pater incertus” had significance, paradoxically the opposite is now almost becoming true, with the donation of the oocyte and use of surrogate mothers.

From the very beginning of the bioethical debate, this new (sub-) discipline emphasized its independence from the big normative theories, like utilitarianism and Kantianism. Of course, there have been very influential bioethicists, like Engelhardt or Singer, who have explicated their normative ethical theories systematically and have shown which moral principle formed the basis for their moral judgements. But the mainstream in bioethics wanted to evade an explicit normative framework (Jonsen 1998: 325–351). The most popular approaches in bioethics tried to avoid the impression that their normative judgments are dependent on only one normative ethical theory. Instead, approaches became popular which could hope to deal with moral problems without needing a philosophical foundation for their normative basic assumptions. In that context we could mention a casuistic approach (Jonsen and Toulmin 1988), a common morality approach (Gert 1998 and 2004; Gert, Culver and Clouser 1997) or the very popular four principles approach of Beauchamp and Childress. These approaches hope to find the normative basis for moral evaluations in well established practices or in widely shared moral standards. Respect for autonomy, informed consent or the duty to avoid harm, seem to be moral principles that are morally acceptable by everybody, independent of other convictions concerning morality, religion, politics or metaphysics. The normative force of such principles seems to be easily defensible and no great effort to provide a foundation for those principles seems to be necessary. The meta-ethical presuppositions behind such an approach often form

Undeniably, the most influential book in modern bioethics so far has by Tom Beauchamp and James Childress (1979-2001). This may even prove true beyond Anglo-American discourse. Although to my knowledge only one translation of what has already become a classic has yet been made (a Spanish translation of the 4th edition appeared in 1999), the book has been the basis of much debate and research within European countries. Since its publication in 1979, this remarkable book has covered most of the problems and controversies in the field of normative bioethics, providing sensitive analysis, telling cases, and careful reflections thereon.

Over the last hundred years, biomedecine has undergone a genuine revolution. New powers have been vested in doctors. Medicine now not only offers treatment but also the creation, or even alteration, of humankind. From medically assisted conception producing embryos, to gene therapies which transform one’s genetic makeup, procedures have developed enormously.

The approach sketched in this paper develops a personalistic interpretation of Kant’s Categorical Imperative. The main difference from the purely Kantian perspective is the attempt to introduce a somewhat richer notion of the human person than the one used by Kant himself, one that is suggested by the phenomenological analysis of the experience of being a person. Such a notion highlights three highly relevant dimensions of the fundamental principle of morality, rather hidden in Kant’s wording of it. The first of these is the moral significance of the mutual of each other as persons (i.e. as a subject and an individual). The second is an account of the idea of as a disposition of the will rather than as a merely emotive response to an awareness of the moral law. Thirdly there is the value of the moral reasons for action, a feature that helps to overcome the rather “monological” appearance of Kant’s imperative. I will first of all try to formulate the fundamental principle of morality in a way that emphasizes the centrality of the idea of “respect for persons”, and outline an interpretation of it within the boundaries of a Kantian approach. Then, I will present an argument concerning the issue of euthanasia based on that principle, partially reinterpreting one of Kant’s arguments against suicide.