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George Campbell Gosling

This chapter seeks to answer whether the incorporation of payment into the working-class patient contract amounted to an abandonment of philanthropy. The appointment of hospital almoners to conduct what was effectively a means-test served as a double-safeguard. First, it allowed the hospital to grant reductions and exemptions to those unable to pay, ensuring this did not become a barrier to access. Second, along with the setting of income limits, the assessment of the almoner was a mechanism for weeding out those of the middle and upper classes who were not considered appropriate cases for medical charity. Prior to the First World War, Bristol's voluntary hospitals were typical in operating two well-established systems for admission: subscriber's tickets and 'receiving day'. More fundamentally, admission was not conditional on either almoner-assessed payment or contributory scheme membership.

in Payment and philanthropy in British healthcare, 1918–48
George Campbell Gosling

This chapter surveys some key themes in the historiography of healthcare in early twentieth-century Britain and presents a few enlightening international comparisons. A more nuanced understanding of the place of payment in British hospitals before and after 1948 adds to a growing appreciation that it was the high-point in a longer period of kaleidoscopic change. The history of the voluntary hospital system is itself, inevitably, bound up with funding. The question of whether a hospital could remain a charity whilst taking payments from patients, the recipients of that charity, is hard to separate from a wider historiographical debate in the social histories of medicine in Britain, Europe and North America, on whether the hospital had by now lost its social function. The pre-National Health Service (NHS) citizen patient was not so much a citizen-consumer or a welfare citizen as a citizen-contributor.

in Payment and philanthropy in British healthcare, 1918–48
The emergence of bioethics in British universities
Duncan Wilson

Many of the academics who taught on new interdisciplinary ethics courses were increasingly located in dedicated bioethics centres from the late 1980s onwards. During the 1960s and 1970s, as Edward Shotter notes, 'there was no teaching in ethics in British medical education' and leading doctors believed that ethical questions were best 'discussed by consultants, with consultants and in camera'. The non-doctors who taught medical students were initially based in law, philosophy and social science departments. The pressure on philosophy departments was compounded when the government replaced the University Grants Committee (UGC) with a new Universities Funding Council (UFC) in 1988. The degree's structure and focus, with input from many staff and departments across the university, reflected the British attitude that no one profession should dominate medical ethics or bioethics.

in The making of British bioethics
Open Access (free)
Duncan Wilson

Mary Warnock's support for assisted dying is significant in a number of respects. It shows, first, how an individual's ethical views are not fixed and can change according to what the observer called 'the lessons of life'. Secondly, and more importantly, it shows just how much authority bioethicists are thought to wield over public affairs. The fact that a philosopher fronted an episode of the BBC's flagship science series again shows how bioethicists emerged as a 'new epistemic power' in Britain from the 1980s onwards. Although the notion of moral expertise remains contested and many bioethicists refuse to acknowledge it, they are often portrayed as what the Guardian called 'ethics experts'. The legal philosopher Gerald Dworkin, working at Queen Mary University in London, highlighted the major differences in his paper on the 'delicate balance' between ethics, law and medicine in Britain and the United States.

in The making of British bioethics
A national ethics committee and bioethics during the 1990s
Duncan Wilson

During the 1980s, many of the individuals who were pivotal to the making of British bioethics sought to establish what the British Medical Journal identified as a 'national bioethics committee'. Ian Kennedy was the strongest advocate of bioethics in Britain during the late 1970s and early 1980s, so it is no surprise to find that he was also the first individual to endorse a national bioethics committee. Sir David Weatherhall's lobbying led members of the Nuffield Foundation to undertake informal soundings on the need for a national bioethics committee. After Foundation trustees approved the steering group's terms of reference, the Nuffield Council on Bioethics was officially established in May 1991. The Nuffield Council's limited impact on policymaking ensured that bioethicists continued to have greater authority as members of ad hoc public inquiries.

in The making of British bioethics
The origins and endurance of club regulation
Duncan Wilson

Doctors and scientists successfully argued that they should be left to determine their own conduct during the nineteenth and much of the twentieth centuries, in a form of self-governance that Michael Moran terms 'club regulation'. They portrayed medical and scientific ethics as internal concerns in this period, produced 'by and for' colleagues and mainly concerned with limiting intra-professional conflicts. The emergence of club regulation in medicine and other professions resulted from social and economic changes during the nineteenth century. The reluctance to issue binding ethical guidelines was mirrored by the British Medical Association (BMA), which represented the interests of doctors after its formation in 1836. The BMA's belief that collaboration with theologians was 'necessary and desirable' might appear surprising, as club regulation was particularly strong in the late 1940s.

in The making of British bioethics
Duncan Wilson

During the 1960s and 1970s Anglican theologians increasingly endorsed 'trans-disciplinary' discussion of new procedures such as in vitro fertilisation (IVF) in societies and journals dedicated to medical ethics. Figures such as Ian Ramsey, an Oxford theologian and later Bishop of Durham, endorsed greater engagement with social and moral issues to maintain the Church's relevance in the face of increasing secularisation. He viewed theologians as the 'common link' who facilitated debates between 'experts in different disciplines and from different occupations'. This was especially the case for discussions of medical and biological research, which Ramsey considered to be the major source of 'frontier problems' in the 1960s and 1970s. Joseph Fletcher, professor of Christian ethics at the Episcopal Theological School in Cambridge, Massachusetts, was one of first American theologians to look at scientific and medical ethics.

in The making of British bioethics
Open Access (free)
Duncan Wilson

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book explores how and why bioethics became so influential in Britain, including the archives of government departments, public inquiries, universities and professional organisations, as well as private papers, published materials, press reports, television programmes and interviews. It looks at why doctors and scientists came to regulate themselves throughout the nineteenth and for much of the twentieth century. The book examines why outsiders increasingly joined debates on medical procedures such as in vitro fertilisation (IVF) during the late 1960s and 1970s, and shows how this was led by Anglican theologians. It also examines the growth of bioethics in British universities during the 1980s and 1990s. The book also explores how some senior doctors and bioethicists led calls for a politically funded national bioethics committee during the 1980s.

in The making of British bioethics
Author: Duncan Wilson

The international growth and influence of bioethics has led some to identify it as a decisive shift in the location and exercise of 'biopower'. This book provides an in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It discusses how club regulation stemmed not only from the professionalising tactics of doctors and scientists, but was compounded by the 'hands-off' approach of politicians and professionals in fields such as law, philosophy and theology. The book outlines how theologians such as Ian Ramsey argued that 'transdisciplinary groups' were needed to meet the challenges posed by secular and increasingly pluralistic societies. It also examines their links with influential figures in the early history of American bioethics. The book centres on the work of the academic lawyer Ian Kennedy, who was the most high-profile advocate of the approach he explicitly termed 'bioethics'. It shows how Mary Warnock echoed governmental calls for external oversight. Many clinicians and researchers supported her calls for a 'monitoring body' to scrutinise in vitro fertilisation and embryo research. The growth of bioethics in British universities occurred in the 1980s and 1990s with the emergence of dedicated centres for bioethics. The book details how some senior doctors and bioethicists led calls for a politically-funded national bioethics committee during the 1980s. It details how recent debates on assisted dying highlight the authority and influence of British bioethicists.

Mary Warnock, embryos and moral expertise
Duncan Wilson

The political enthusiasm for external oversight was made clear in 1982 when officials at the Department for Health and Social Security (DHSS) broke from the longstanding reliance on scientific and medical expertise. It prioritised 'an outside chairman' for their public inquiry into in vitro fertilisation (IVF) and embryo experiments. Mary Warnock's appointment as chair of the IVF inquiry provided her with the chance to engage with practical affairs and led other philosophers to view bioethics as the most profitable branch of what Peter Singer called 'applied ethics'. While the Warnock committee, the press, scientists and politicians all agreed on the need for external oversight, there was less consensus when it came to deciding specific policies for embryo research. While the Warnock committee was disagreeing over embryo research, Robert Edwards used the prospect of moral disagreement to revive his opposition to outside involvement with science and medicine.

in The making of British bioethics