The High School Years

My interest in moral problems began in 1957, when I was a student in the mediocre public high school system in Dallas, Texas. I attended Woodrow Wilson, the only public high school in the United States that has had two Heisman Trophy winners: the school’s only claim to distinction. I was, through the early high school years, unexceptional as a learner, lacking in the curiosity essential to a quest for learning. Near the time I turned 17, my mental lethargy vanished after I read a book given to me by an assistant minister in a Methodist church. It had the most memorable effect on me of any book I have read.

The book was Cry, the Beloved Country, by Alan Paton, a novel set in South Africa shortly before the apartheid laws were passed. In a calm yet vivid style, Paton depicts the explicit, as well as the semi-hidden, racism then ripping South Africa apart. While reading the book, I made connection after connection to Dallas, which was a city in which schools and universities, restaurants, city buses, residential communities, and almost all religious houses of worship, were segregated. This state of affairs was sustained in Dallas by an underlying and visceral racism that I had never thought much about.

As Paton described the early South African bus boycotts, I saw the indignity that underlay the segregation of Dallas city buses. When he discussed the Afrikaner Nationalist Party platform of the so-called “separate development” of the races, I thought about Texas politicians and school officials who at the time were declaring that the “separate but equal” doctrine would forever remain in Texas schools, despite the then-recent debacle at Little Rock Central High School and despite a historic ruling by the United States Supreme Court that rendered segregated systems unconstitutional (Brown v. Board of Education of Topeka, 1954). Even the appalling conventions in South Africa of avoiding touching or coming close to a black person mirrored customs that were commonplace in Dallas.

When I finished Paton’s novel, I was a different person. I was angry at what surrounded me, and I judged myself harshly for culpable ignorance and lack of discernment. I was filled with questions to which I wanted answers. I was, finally, serious and passionate about investigating something on my own.

The first place I went for answers to my questions was the Methodist church in which I was raised. I went to discuss these questions with ministers whom I trusted in several churches, and they helped me to get in touch with several ministers in black churches in South Dallas. My primary question to each was “What justification is there for a division of the Methodist Church into black churches (The African Methodist Episcopal Church) and white churches?” These two Protestant denominations had once been one church—the Methodist Church—but then split in the mid-1840s, first in Philadelphia, over the indignity of having segregated galleries for black people for church services. My primitive understanding of Christian ethics suggested that an apology, reconciliation, and reintegration should be the agenda for the 1960s. Like the doctrine of separate but equal schools, a racially segregated Methodist Church made no sense to me.

Discussion with these ministers was a potent learning experience for me at the age of 17, however disappointing. Every minister with whom I spoke agreed that, yes, it makes no moral sense, now or ever, to have a segregated Methodist Church. However, not a single minister was prepared to go public with that view. Why not? Here I came to a near-identical conclusion to one that Paton advances in Cry, the Beloved Country. In his words, the explanation is “fear, fear, fear.” These Dallas ministers, white and black, were deeply afraid of the consequences of the integration of their churches. They believed that integration would tear apart their congregations, with members defecting to other churches or leaving the church altogether. These pastors seemed to me more captives of their parishioners’ beliefs than moral leaders. There was no resistance to segregation in churches in any of them. Nor was there any interest in participating in the activist side of the civil rights movement.

I had learned what I had set out to learn, but it was disquieting, and it stimulated in me a stream of thoughts about moral problems of racial segregation and discrimination. This was the start of my moral thinking. I had no teachers and few models other than early figures in the civil rights movement, but these issues would remain central in my life as a university student and academic, when I found colleagues who had the same questions and issues. I now push on to those years.

Southern Methodist University (SMU)

In 1958, I enrolled in SMU. When I arrived, I was surprised to learn that the university was, by policy, segregated. I knew that black ministers had graduated from SMU’s Perkins School of Theology. How, then, could a university that is integrated be segregated? I was puzzled enough to dig into the history. As it happens, the theology school was among the first schools in a university in the South to integrate. It started to enrol black students in 1951 by an act of the Board of Trustees, but the Trustees explicitly stated that the theology school was the only school that would be integrated. After the first two black students matriculated at Perkins, there arose swift opposition in Dallas to even this tiny bit of integration, especially when it was learned that the two students had been assigned white roommates. A related fuss over the theology school’s so-called liberalism was still ongoing when I landed on the campus as a freshman.

I am not sure how well I would have adjusted to SMU but for a piece of luck. I quickly made friends with a small group of freshmen who were as concerned as I was that the university and the city of Dallas were citadels of segregation. These new friends were academically serious and socially committed young people who gave me wonderful lessons in how important one’s fellow students, not just one’s professors, can be during one’s college education. What we debated and learned from each other, as we planned and conducted sit-ins at Dallas establishments, usually lunch counters, might be likened to a seminar in the justification of civil disobedience; but this was a real-life seminar with risks for all of us.

We could not have sit-ins without someone of color, so we found an African-American theology student named Earl Allen. Earl was my first real African-American friend. I learned much about life and social injustice from this man, who was several years my senior. Earl was an exemplary human being. Nonetheless, he would, shortly after our time together, be relentlessly smeared by the political establishment in his hometown of Houston for starting a campaign of voter registration.

After participating in several sit-ins in Dallas that were more failures than successes, my friends and I came to see that social protest in Dallas was frustratingly ineffective. The mayor, R. L. Thornton, was too smart to let Dallas become a Montgomery or a Little Rock.

Meanwhile, as a second semester junior at SMU, I was considering graduate school in philosophy, which I found the most challenging and interesting field to which I had been exposed. However, I was annoyed by philosophy’s conception of the field of ethics. Philosophers were heavily preoccupied with issues in meta-ethics, especially the meaning of the word “good.” Meta-ethics engaged me theoretically, but I was much more interested in the practical intersection of philosophical thinking with social problems. I took a course in political philosophy to see if that field was more promising, but the course was dreadful and even more distant from real-world problems than the field of ethics was. I discovered, largely on my own, the philosophical writings of John Stuart Mill, who met me where I wanted to be met by a philosopher, but philosophers all over the world seemed to me to have no interest in practical ethics. This distressed me, especially when I compared philosophy with the field of religious studies, which at the time not only exhibited considerable interest in practical ethics, but had produced active leaders in ethics and public policy such as Martin Luther King Jr. and Henry Sloane Coffin, the Chaplain at Yale. During the period 1961–63 I read as many of King’s publications, addresses, and sermons as I could find. They had a profound effect on me. King was for me a joy and a relief from the narrowness of meta-ethics.

I believed then, as I do today, that professional training in philosophy beautifully suits one for practical ethics, and that something is amiss in practical ethics remaining on the outermost sidelines of philosophy. Issues of racism, poverty, inequality, social justice, capital punishment, civil disobedience, abortion, research with human subjects, and just and unjust wars seemed to me a natural for philosophers to address; however, philosophy professors of my acquaintance seemed uninterested in this idea. One philosopher told me that publications such as those of Martin Luther King are “un-philosophical.” This comment was a wallop to me as a young student of philosophy.

I decided to forgo graduate school in philosophy because I found a program sponsored by the Yale Divinity School that seemed almost designed for me. It had a special track entitled “teaching and research in religion” that allowed open access to courses in several disciplines, including philosophy, in the Yale Graduate School. So, I went off to Yale, where I started to develop what I think of as a scholarly disposition and set of skills, philosophical and otherwise.

Yale University

Yale was a treasure trove of smart people, faculty and students alike. One cherished learning experience stands out in my memory. In my second year I discovered a program started and run by a law student named Harriet Bograd. Harriet placed Yale graduate students from different fields and departments in summer teaching programs in historically black universities to prepare entering students for their fall classes as freshmen. I signed up, and Harriet assigned me to Texas Southern University in Houston. Four of us from four different Yale departments went to Texas Southern that summer. We learned richly from this experience, including how underresourced, segregated high schools had failed the TSU students we were teaching.

I came to a critical decision at Yale. Despite my earlier reservations about philosophy, and despite an unruly, divisive, and ill-managed philosophy department at Yale, I knew that I had to be a philosopher. So I graduated from Yale and went to The Johns Hopkins University for a PhD in philosophy.

The Johns Hopkins University

Hopkins was my first choice and it was the right choice for me. I loved the small seminar environment, my fellow graduate students, and the navigable size of the university. Hopkins also permitted me to teach some courses at Morgan State University, which provided a different experience with students at another historically black university.

At Hopkins, I formed a close friendship with fellow student Alex Rosenberg, and we became jointly immersed in theories of causation. Eventually, we determined to write a book with the goal of providing a new theory of, and defense of, Scottish philosopher David Hume’s celebrated theory of causation. This book would be the most demanding and exhausting philosophical work that I would ever do—and a great learning experience in teamwork. Neither of us could have written this book alone, but together we turned out to be a good team to write what I regard as an original and compelling work in the history of philosophy, metaphysics, and the philosophy of science. After 10 years of labor, it was published in 1981.

During the writing of this book, I met David Norton, a Hume scholar in the philosophy department at McGill University in Montreal. We shared a deep disquiet about the dreadful editing in the standard edited works of Hume. After sober reflection on what would be an enormous commitment of time, we decided to undertake a full-fledged critical edition of Hume’s corpus of philosophical works. We submitted a grant to the National Endowment for the Humanities for funding to support this expensive research, and somehow it was funded. Today, 40 years after planning this edition, I am still at work on the final volume of the four that I agreed to edit.

These two projects on Hume’s philosophy were the beginnings of what would come to be my abiding commitment to collaborative work. For that story, I push on to Georgetown, where I was hired in January 1970 and where I began teaching in September 1970. During the 1970s, my future fell into place, piece by piece, with bioethics as the centerpiece.

My Early Years at Georgetown

During the 1970s, I met a number of truly extraordinary people who gave me a mammoth boost to my career, helped me grow as an academic, protected me from being fired by the senior members of my department, and introduced me to fields far beyond philosophy. The fastest learning curve of my life occurred in the 6 years between 1973 and 1979, taking me into new fields that I had never visited before.

Once hired by the philosophy department, I requested to teach a course titled “Freedom and Dissent.” This course allowed me to teach a philosophically serious course for undergraduates in practical ethics, which had no name or status in philosophy at the time, no textbook, and basically no teachers in philosophy. I started with Mill’s On Liberty and then went to specific practical and policy issues about the limits of liberty, including civil disobedience, political protests, affirmative action, and paternalism. Protests against the Vietnam War on college campuses were widespread at the time: 1970 was the year of the Kent State shootings, followed 11 days later by the Jackson State College killings, which eventuated, on June 13, 1970, in President Richard Nixon’s appointment of a “President’s Commission on Campus Unrest.” This commission, headed by Governor William Scranton of Pennsylvania, issued its superb report on the day I arrived at Georgetown in September 1970. The report immediately found its way into my syllabus.

Moral problems surrounding student protests and reactions to them were then abundant, and it was not difficult to interest students in the philosophical issues surrounding these events. My goal as a teacher was to stimulate students to focus on the underlying philosophical problems rather than the public clamor often seen on television.

An Anthology Entitled Ethics and Public Policy

In 1971, I collected some ideas gained from teaching this course and took them to the planning stages of an edited book in practical ethics entitled Ethics and Public Policy. The book appeared 2 years later, and was my first publishing venture in practical ethics. However, before my book appeared, a volume would arrive on my desk in late 1971, edited by James Rachels, a young professor at New York University. It bore the simple title Moral Problems. Rachels beat me to the goal of the first philosophy textbook of practical ethics. His book was beautifully conceived and written. He would become a friend and one of the people I have most admired and learned from during my career. Rachels and I clearly saw eye to eye about how philosophy needed to expand its conception of ethics. I was grateful to Jim and to Richard Wasserstrom, then at the University of California at Los Angeles, for giving me inspiration to continue with a career in practical ethics conceived philosophically.

The Kennedy Institute of Ethics and André Hellegers

Close to the time that Ethics and Public Policy was published, I met André Hellegers, a physician at the Georgetown Medical School who had recently founded the Kennedy Institute of Ethics. He would launch me into bioethics and would have a massive influence on my career, literally redirecting it.

André and I both worked in our offices on Saturdays, so we took to having lunch at a local campus restaurant (the Tombs, where he always reserved his favorite booth). In one of our first lunches, André said, “I tell you, Tom, physicians have no idea about what is on the horizon of ethical issues in medicine.” André was a salesman, as good as I have seen in the academy. He was selling me on the importance of bioethics and its future. But he was no mere salesperson. He educated me about moral problems in medicine that I had never encountered. He did so with genuine passion and conviction, and he quickly pulled me into his world and captured my imagination. André had the interesting view that he didn’t have the answers to these profoundly important moral problems, being a mere physician, but he thought people well trained in ethics should be able to figure out the answers. Little did he know that a trained moral philosopher can do more to confuse and puzzle than to solve moral problems, but he firmly believed in the importance of doctoral-level training in ethics as the proper background for the new field of bioethics.

I soon realized that André was recruiting me. In his world, I was a perfect choice for his institute because I had graduate degrees in both theology and philosophy. André personally esteemed these two disciplines because they are pivotal in Jesuit universities, and he wanted to build an institute of ethics on the foundations supplied by these two fields. Soon he made me a formal offer of an office overlooking the Potomac River, an office assistant, and research assistants, but no additional salary, which I naively didn’t request. I accepted his offer without hesitation.

André was a person with presence. I learned quickly from him not only about how to develop what truly was a new field of learning and scholarship, but about leadership, mentoring, and vision in a university. André was intense, focused, and visibly excited about his ideas for a new field. He was the right person at the right time for me, and it was my great luck to have been introduced to him by our mutual friend LeRoy Walters.

André would soon introduce me to Judy Areen, a young professor in the law school who would later become its dean. He packaged the three of us to speak to university audiences on the problem of abortion. This was in the immediate aftermath of the 1973 Roe v Wade decision, which André could see was destined for massive public discussion. Introducing me to Judy would have been gift enough, but the biggest gift was how much I learned from the two of them about the legal and medical aspects of the abortion issue. And so my relationship with André would continue, until his untimely death at the young age of 52 in 1979, a huge personal and professional loss for me.

I shift now to three other pivotal experiences that occurred in the last half of my first 10 years at Georgetown (1975–80), notably my writing of books and related projects that were published under three titles: Principles of Biomedical Ethics, The Belmont Report, and A History and Theory of Informed Consent. All were multidisciplinary works, and each of these partnerships would alter the course of my career.

Principles of Biomedical Ethics and Jim Childress

In the early summer of 1975, the Kennedy Institute offered a 1 week course for health professionals in which James Childress and I gave six lectures on ethical theory and bioethics. After the last lecture, we were approached by psychiatrist Seymour Perlin, who proposed that we expand our lectures into a book. He noted that nothing like what we had presented was found in the medical ethics literature. He offered to contact the medical editor at Oxford University Press. Soon the editor, Jeffrey House, asked us if he could come to DC to talk about this book. After a lengthy discussion over dinner, he asked if we were willing to write a proposal and, after editorial approval, start work on the book immediately. Not a line of the book was written, but Jeff seemed to want the book tomorrow.

The writing of Principles of Biomedical Ethics, and subsequent work on seven extensively revised editions over the course of 40 years (the eighth and presumably last edition still ongoing) has been a constant learning experience for me in disciplines I had never expected to know about, primarily medicine and biomedical and behavioral research. Principles is the most influential book I ever published and also the most heavily revised in subsequent editions, because of the rapid growth in bioethics literature.

Jim and I had been graduate students together at Yale, but as we drafted the book, I learned much more about this quiet, thoughtful man. His well-balanced judgments have been crucial to the success of Principles. In vital respects, Jim and I taught each other about bioethics in our early years in the field.

The Belmont Report and the National Commission for the Protection of Human Subjects

While I was working with Jim on Principles, I was hired as the staff philosopher for the National Commission for the Protection of Human Subjects at the National Institutes of Health (NIH), which had been created by the United States Congress. I was hired by the Staff Director, Michael Yesley, after he consulted with the commissioners. On my second day on the job, Yesley came to my office carrying a 1,208 page book under his arm. He said, “There is only one required reading in this job, and it’s this,” as he handed the book to me. The book was Experimentation with Human Beings (published in 1972), edited by Jay Katz, with associate editors Alexander Capron and Ellen Swift Glass. This book would be my constant companion and guide in my new position.

At first, I was mildly surprised that no philosophers were found in its pages, and that nothing whatever existed in the book about philosophical principles. But as I consumed the material, I appreciated that Katz had not overlooked philosophy; rather, philosophy had overlooked the ethics of research. No philosopher had made even a single contribution to this literature. In the end, this book would teach me about what bioethics in the area of human-subject research could become and why it had to be multidisciplinary. It was unquestionably the first book to teach me how to think about bioethics as essentially a multidisciplinary field.

Having given me the book, Yesley said: “Using this book as background, I want you to write for us a monograph we are required by a public law to write. We call it ‘the Belmont Paper,’ and I am assigning you to write the moral principles part of this work, which will be the bulk of it.” I asked, “What’s the content of these principles?” He responded, “I think that’s for you to figure out.” So, I found myself with the job of giving shape and substance to something called the “Belmont Paper,” though at that point I had never heard of Belmont or the paper. It struck me as an odd title. Moreover, this document had never been mentioned during my interview for the job or at any other time, until Yesley gave me the assignment.

My immediate sense was that I was the new kid on the block and had been given an assignment that no one else wanted. I had thought, when I decided to join the staff of the commission, that I would be working on the ethics of psychosurgery and research involving children, which were heated and perplexing controversies at the time. I was slightly chagrined to learn that I was to write something on which no one else was working and that had its origins in a retreat that I had not attended. Moreover, the mandate to do the work had its roots in a federal law that I had not seen until Yesley showed it to me.

Yesley proceeded to explain that no one had yet worked seriously on the sections of the report on principles because no one knew how to analyze them in the context of the commission’s work. This moment of honesty was not heartening, but I was not discouraged either, because Childress and I were at that time well into the writing of our book on basic principles in biomedical ethics, which we had construed largely in term of clinical ethics and public policy. It intrigued me that the two of us had worked relatively little on research ethics, which was the sole focus of the National Commission. I began to see in my early conversations with Yesley that these two projects, Principles and Belmont, had many points of intersecting interest and could be mutually beneficial. Yesley’s assignment was, in the end, the best project he could possibly have given me.

As it happened, one Commissioner (1 of 11) was my colleague Patricia King at Georgetown’s law school. I called Pat and asked, “Can you tell me what this Belmont thing is?” Pat explained the situation and, over the course of several lunches, brought me up to speed about the history leading up to the National Commission as well as about the relevant law and public policy, NIH as a federal agency, and critical differences between law and ethics. She was a brilliant teacher with a natural gift for bioethics and remarkable insights about public policy. These lunches were the first of innumerable times I learned from Patricia about ethics and public policy, as I still do today.

The monograph I drafted for the National Commission was ultimately published as The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Publication OS 78-0012, Washington, DC: Department of Health, Education, and Welfare; 1978, and named after a Smithsonian conference facility where the monograph was first conceived. The Belmont Report remains today the ethical core of the federal regulatory system of protections of human subjects, and the reach of its ethical principles is felt worldwide; however, while drafting it, I was certain that it would remain forever unseen on some remote government library shelf. I got a pleasant surprise.

A History and Theory of Informed Consent and Ruth Faden

The third work central to my life of learning in the late 1970s is the most memorable because, among other things, I co-wrote it with the person who has been the paramount influence on me, both personally and academically: my wife, Ruth Faden of The Johns Hopkins University, where she founded and for 20 years was director of the Berman Institute of Bioethics. André Hellegers, who had been on the Hopkins faculty before coming to Georgetown, had arranged in 1977 for Ruth to have a joint appointment at the Kennedy Institute. Ruth and I quickly discovered that we shared a deep interest in issues of informed consent. We wrote a successful grant application to the National Library of Medicine to write a book on the topic. Little was known at the time about the history of informed consent, and there was no theory of it. The grant would be funded in 1979 and resulted not only in a wonderful book-writing experience, but eventually in a wonderful marriage and family, built around our children, Karine and Zack. I often say, “Thank you, André, and thank you National Library of Medicine!” The book was published in 1986 as A History and Theory of Informed Consent, New York: Oxford University Press.

While working on this book, I learned to appreciate Ruth as the extraordinary talent that she is. The work-meetings in our dining room, where we invited colleagues in medicine and law to help us, would do more even than the National Commission did to embed me in attacking a problem by seamlessly integrating diverse disciplinary perspectives, one of Ruth’s special gifts. Our book emerged from head-butting debates about theory and history that brought medicine, public health, psychology, law, and philosophy into play. It was published in 1986 and remains in print today.

Final Reflections

In this account of my origins in bioethics, I have emphasized two key features of my beginnings: (1) an early commitment to practical ethics generally and (2) an appreciation that, for me, the best scholarship in practical ethics comes from multidisciplinary literature and collaboration. In the late 1950s and 1960s, my confrontation with racial injustice and discrimination gradually developed into an intellectual passion for academic practical ethics, especially ethics and social policy. This passion became permanently fixed and has been the foundation of my attraction to controversial social issues on which I have worked, such as informed consent, affirmative action, end-of-life issues, and the moral standing of animals.

The various scholarly projects that I undertook in the 1970s (including my work in the philosophy of David Hume) occupied me for the rest of my career down to the present day. I came to bioethics from a professional discipline that promotes and prioritizes individual achievement in scholarly research. Co-authored and multidisciplinary work in philosophy was uncommon and somewhat discounted in the 1960s and 1970s.

Over the years, I have been deeply influenced by colleagues trained in public health, psychology, law, medicine, religious studies, veterinary science, business, pharmaceutical research, and philosophy. By working with people from an array of disciplines, a life of learning never ceases. I have not regretted my commitment to collaborative and multidisciplinary work, but I have regretted that philosophy has not made a sharper turn in that direction. Still, I see signs today that philosophy is increasingly headed that way and that some of its fields will flourish because of it.