Document Type

Article

Publication Date

1994

Abstract

Commemorating the thirtieth anniversary of the field of bioethics, this article analyzes the future of bioethics by identifying its role in intellectual history and classifying stages of its development.

Part I considers the formative role of Quinlan, where the New Jersey Supreme Court held that the withdrawal of medical treatment is legally permissible under some circumstances. Quinlan and its progeny established a legal framework for life-sustaining treatment decisionmaking, affirming the use of substituted judgment or best interests standards.

In Part II the article documents the framework shift brought by Cruzan, a high-profile case challenging a family’s authority to make medical decisions for an incompetent family member absent specific legal recognition. Reviewed by the Missouri Supreme Court and United States Supreme Court, Cruzan is significant for its turn away from Quinlan and for the legislation that it spawned regarding proxy representation.

Part III highlights three signs of change post-Cruzan. First, it notes a bioethics paradigm shift away from “principlism” and toward a communitarian paradigm. Second, political action has expanded the forum for bioethics. Third, health care allocation issues will expand bioethics beyond the context of individual medical treatment decisions, bringing the challenge to move beyond the bedside without losing the patient-centered moral aspect of treatment decisions.

The article concludes with a directive for future legal scholarship in bioethics. Critique of legislation and case law contributes to the development of law in bioethics, but bioethics must analyze the entire legal environment, including the administrative regulations that most directly affect provider behavior.

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