The making of British bioethics WILSON BIOETHICS 9780719096198 PRINT.indd 1 17/07/2014 11:48 WILSON BIOETHICS 9780719096198 PRINT.indd 2 17/07/2014 11:48 The making of British bioethics Duncan Wilson Manchester University Press Copyright © Duncan Wilson 2014 The right of Duncan Wilson to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. Published by Manchester University Press Altrincham Street, Manchester M1 7JA, UK and Room 400, 175 Fifth Avenue, New York, NY 10010, USA www.manchesteruniversitypress.co.uk Distributed in the United States exclusively by Palgrave Macmillan, 175 Fifth Avenue, New York, NY 10010, USA Distributed in Canada exclusively by UBC Press, University of British Columbia, 2029 West Mall, Vancouver, BC, Canada V6T 1Z2 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data applied for ISBN 978 0 7190 9619 8 hardback ISBN 978 1 8477 9887 9 open access First published 2014 This electronic version has been made freely available under a Creative Commons (CC-BY-NC-ND) licence, thanks to the support of The Wellcome Trust. A copy of the licence can be viewed at https://creativecommons.org/licenses/by-nc-nd/2.0/uk/. The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Typeset in 10/12 Sabon by Servis Filmsetting Ltd, Stockport, Cheshire Printed in Great Britain by TJ International Ltd, Padstow To Nisha and my parents, and in memory of John Pickstone WILSON BIOETHICS 9780719096198 PRINT.indd 5 17/07/2014 11:48 WILSON BIOETHICS 9780719096198 PRINT.indd 6 17/07/2014 11:48 Contents Acknowledgements viii List of abbreviations x Introduction 1 1 Ethics ‘by and for professions’: the origins and endurance of club regulation 24 2 Ian Ramsey, theology and ‘trans-disciplinary’ medical ethics 64 3 ‘Who’s for bioethics?’ Ian Kennedy, oversight and accountability in the 1980s 105 4 ‘Where to draw the line?’ Mary Warnock, embryos and moral expertise 140 5 ‘A service to the community as a whole’: the emergence of bioethics in British universities 187 6 Consolidating the ‘ethics industry’: a national ethics committee and bioethics during the 1990s 220 Conclusion 255 Bibliography 270 Index 298 WILSON BIOETHICS 9780719096198 PRINT.indd 7 17/07/2014 11:48 Acknowledgements My interest in British bioethics started during my PhD research, when I noticed that philosophers, lawyers and other ‘outsiders’ had begun to enter debates that had traditionally been the preserve of doctors and scientists from the mid 1970s onwards. I soon realised that the growth of this outside input, or ‘bioethics’, was well documented for the United States, but that there was much less written for Britain, where it emerged slightly later and for different reasons. I decided then to make the history of British bioethics my next research topic. The progression from that initial idea to this book owes a lot to the help of many people. I first want to thank the Wellcome Trust for funding my research (grant number 081493). I am also grateful to the many archivists who provided access to materials. I want to thank staff at the National Archives, London; the Wellcome Library for the History of Medicine, London; the John Rylands Library at the University of Manchester; the British Film Institute, London; the Durham Cathedral archives; and the Historical Collections at the University of Virginia. I owe particular thanks to those people who allowed me to look through private papers and uncatalogued archives. I want to thank Catherine Spanswick, from the University of Manchester’s Institute for Science, Ethics and Innovation (ISEI), for letting me access papers from the Centre for Social Ethics and Policy; David Archard, from the University of Belfast, who let me look at papers from the Society for Applied Philosophy when he was working at the University of Lancaster; and Jonathan Montgomery, from University College London, who let me look through correspondence relating to the Nuffield Council on Bioethics. I am extremely grateful to all the interviewees listed in the bib- liography. My research would not have been possible had they not spared the time to meet me and patiently answer my questions. I am WILSON BIOETHICS 9780719096198 PRINT.indd 8 17/07/2014 11:48 Acknowledgements ix also grateful to the many people whom I did not formally interview, but who provided me with crucial materials and leads. I owe par- ticular thanks to Robin Downie, for his hospitality in Glasgow and many useful readings. I also owe thanks to David Archard, Margaret Brazier, Raymond Plant, Rebecca Bennett, Richard Ashcroft, Adam Hedgecoe, David Weatherhall, Nathan Emmerich, Noortje Jacobs and Bella Starling, for providing valuable material and information on developments in sociology, bioethics, philosophy, law and the biomedical sciences. I am also indebted to everyone who gave feedback on seminar papers at the University of Leeds, the London School for Hygiene and Tropical Medicine, University College London, Imperial College London, the University of Liverpool, the University of Manchester, the Postgraduate Conference on Bioethics and the Institute for Historical Research’s 2011 conference on Anglo-American History. I am espe- cially grateful to colleagues at the University of Manchester’s Centre for the History of Science, Technology and Medicine (CHSTM), who gave me valuable advice on ideas, drafts and potential titles. These include, in no particular order, Michael Worboys, Neil Pemberton, Emma Jones, Michael Bresalier, Carsten Timmermann, Ed Ramsden, Rob Kirk, Elizabeth Toon and Jenny Goodare. I owe particular thanks to my former colleague Sam Alberti, now director of the Hunterian Museum at the Royal College of Surgeons in London, and to John Pickstone, most recently emeritus professor at CHSTM, who both gave feedback on several draft chapters. We were all deeply saddened when John died following a short illness in February 2014. He was CHSTM’s founding director and remained a huge presence in the department, and the field more gener- ally, until his death. Aside from an incomparable body of work, John’s legacy is evident in the number of historians he mentored and encour- aged – myself included. I valued his help with this book as much as I did when I started my PhD under his supervision, and will miss his guidance and friendship. John’s advice was peerless, as always, and improved the book a great deal. It goes without saying that any mistakes that may appear in the following chapters are mine alone. I also want to thank friends and family who have put up with me throughout this whole process. My parents, John and Helen Wilson, continue to provide invaluable support and still don’t tell me to ‘get a real job’. Nisha, meanwhile, is the best proofreader, friend and wife anyone could wish for. WILSON BIOETHICS 9780719096198 PRINT.indd 9 17/07/2014 11:48 Abbreviations AAMR Association for the Advancement of Medicine by Research BAAS British Association for the Advancement of Science BMA British Medical Association BSSRS British Society for Social Responsibility in Science CCH Churches’ Council of Healing CCHMS Central Committee for Hospital Medical Services CEC Central Ethical Committee CHAI Commission for Healthcare Audit and Inspection CHI Commission for Health Improvement CMO Chief Medical Officer CSEP Centre for Social Ethics and Policy DES Department of Education and Science DHSS Department for Health and Social Security EMG Edinburgh Medical Group ESBAC Emerging Science and Bioethics Advisory Committee FMG Frontier Medical Group GMAG Genetic Manipulation Advisory Group GMC General Medical Council HFEA Human Fertilisation and Embryology Authority HGC Human Genetics Commission HRA Health Research Agency HTA Human Tissue Authority IME Institute of Medical Ethics IRM Institute of Religion and Medicine LMG London Medical Group MMG Manchester Medical Group MRC Medical Research Council NCP National Committee for Philosophy WILSON BIOETHICS 9780719096198 PRINT.indd 10 17/07/2014 11:48 Abbreviations xi PHS Public Health Service RAE Research Assessment Exercise REC Research Ethics Committee RCP Royal College of Physicians SCM Student Christian Mission SPUC Society for the Protection of Unborn Children SSME Society for the Study of Medical Ethics UCL University College London UCLA University of California, Los Angeles UFC Universities Funding Council UGC University Grants Commission WILSON BIOETHICS 9780719096198 PRINT.indd 11 17/07/2014 11:48 WILSON BIOETHICS 9780719096198 PRINT.indd 12 17/07/2014 11:48 Introduction What is bioethics? Recent decades have witnessed profound shifts in the politics of medicine and the biological sciences, in which members of several professions now consider issues that were traditionally the preserve of doctors and scientists. In government committees and organisa- tions such as the General Medical Council, professional conduct is determined by a diverse group of participants that includes phi- losophers, lawyers, theologians, social scientists, doctors, scientists, healthcare managers and representatives from patient or pressure groups. Teaching ethics, once a matter of professional etiquette, takes place on dedicated courses and in specialised departments that emphasise