Table 1. a Short Description of Subfields As an Indicator. Table 2. A

Home , Medical ethics, Professional ethics

Appendix tables Table 1. A short description of subfields as an indicator.

Subfield Description General General bioethics covers topics relevant to the history, development, bioethics methods and overview of the bioethics or its subfields. Clinical ethics Clinical or medical ethics covers general issues of bioethics, including health care systems, provider payment systems, health equity and justice, death and disability. Research ethics Research ethics covers everything relevant with research, including researchers’ integrity, methods and biobanks. Biotech ethics Biotech ethics covers advanced technologies in medicine and health, including nanotechnology, genetics and artificial intelligence. Public health Public health ethics covers topics relevant with public health, including public ethics participation, advertising, community health, smoke control, organ distribution and organ transplantation. Neuroethics Neuroethics covers topics relevant with mental health and psychiatry, including neurocognitive mechanisms of morality and ethics. Professional Professional ethics covers professional ethics, moral distress and education. ethics Religious Religious bioethics covers topics relevant with faith and religion. bioethics Law and Law and bioethics covers every topic relevant with regulations, laws and legal bioethics systems. Environmental Environmental ethics covers ethical issues relevant to local and global ethics environments, climate change and ecosystems.

Table 2. A short description of selected topics

Topic Description End of life issues Issues such as withdrawing/withholding treatment, brain death, advance directives, terminal care, etc. Patient decision Issues such as patient autonomy, informed consent, and issues relevant making to patient making decision in clinical and research settings. Reproduction issues Issues such as abortion, eugenics, surrogacy, cesarean, and IVF, etc. Enhancement Issues relevant to physical and cognitive enhancement, moral enhance, etc. Ethics education Issues concerning moral/ethics education to healthcare professionals and students

Table 3. Top institutions that published highly cited articles

Institute 1975-1984 1985-1994 1995-2004 2005-2014 Total Harvard University 6 14 7 8 35 Georgetown University 7 4 7 1 19 University of Oxford 0 2 3 12 17 National Institutes of Health 1 3 5 5 14 University of Michigan 4 2 6 1 13 Johns Hopkins University 2 4 2 4 12 University of Toronto 0 3 6 2 11 Boston University 6 2 2 1 11 Yale University 5 3 2 1 11 University of Washington 5 1 1 3 10 University of Chicago 5 4 0 1 10 University of Pennsylvania 1 3 2 4 10 Duke University 5 3 2 0 10 University of Minnesota 2 4 2 2 10 University of British Columbia 2 3 2 2 9 Stanford University 2 1 0 6 9

Table.4 Variation of the subfield that top cited articles belong to in four decades

Subfield 1975-1984 1985-1994 1995-2004 2005-2014 Total Clinical Ethics 119 108 70 60 357 Research Ethics 13 16 36 31 96 Public Health Ethics 17 15 17 23 72 Law and Bioethics 22 23 19 8 72 Professional Ethics 10 9 13 23 55 Biotech Ethics 4 7 14 13 38 General Bioethics 5 8 15 9 37 Neuroethics 6 1 0 24 31 Environmental Ethics 2 10 15 7 34 Religious Bioethics 2 3 1 2 8

Table 5. Variation of highly cited articles on specific topics

Topic 1975- 1985- 1995- 2005- Total 1984 1994 2004 2014 End of life issues 14 15 10 13 52 Patient decision making 16 14 9 10 49 Reproduction issues 7 9 3 5 24 Enhancement 0 0 3 15 18 Ethics education 3 3 1 8 15 AIDS 0 11 3 0 14 Moral distress 0 0 3 10 13 Organ transplantation 0 9 3 1 13 Dealing with (incidental) research findings 0 0 0 8 8 Obesity 0 0 0 7 7 Developing countries 0 0 2 3 5

Figure 1 Citation counts of 800 articles from 1975-2014

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0 1974 1979 1984 1989 1994 1999 2004 2009 2014

Figure 2. The distribution of different institutions contributing to bioethics across four decades 200

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160 Hospital 140 Government agency 120 Research institute 100 Non-profit organization 80 Company 60 Other 40 University 20

0 1975-1984 1985-1994 1995-2004 2005-2014

Figure 3. A closer look at the distribution of non-university author affiliations

25 Hospital 20 Government agency

15 Research institute Non-profit organization 10 Company 5 Other 0 1975-1984 1985-1994 1995-2004 2005-2014