INTRODUCTION

A chapter by authors whose expertise is politics and policy making is appropriately an underinformed and perhaps overly cynical contribution to a history of medical ethics, which we take to mean disciplined statements about what is proper in relationships between health professionals and patients and between persons responsible for public health and populations. Whatever the achievements of ethicists in other arenas (Jonsen 1998), their influence on the development of legislation and regulation in the United Kingdom and the United States has been at best mixed.

Ethical doctrines have sometimes influenced the development of public policy, such as regulations in the United States for the protection of human subjects of research (see Chapters 50, 51, and 57). Ethical doctrines have also influenced how policy is implemented. That is, ethicists have helped to implement policies made for other reasons than the persuasiveness of their reasoning. Moreover, ethicists have helped to shape public opinion and, perhaps, the views of some of the elected and appointed officials who make policy, sometimes through commissions appointed by public bodies. Unfortunately, we do not know how to isolate the influence of ethical doctrines from that of the vast amount of other information available to policy makers.