Bioethics Forum Essay
The Hastings Center at 50: Looking Back and Ahead
This year, The Hastings Center will celebrate its 50th anniversary. The Center was first located on the second floor of my house in Hastings-on-Hudson, N.Y., with some overflow paperwork stored at the home of my neighborhood friend and cofounder, Willard Gaylin.
Neither of us had ever run an organization or raised money. I am a philosopher and Will is a psychiatrist. The word bioethics had yet to be coined. But Will was 43 and I was 39, ready to stir up our lives. Each of us had stumbled on the ethical problems that the medical dilemmas generated by fast-moving medical technologies such as dialysis and ventilators. And we each liked to write.
The Center grew and flourished, and the field of bioethics took flight and is now an international phenomenon. You will hear more about celebratory events and other Hastings Center activities in the coming months, but I want to talk about some features of my own life over the past 50 years. An inescapable feature of those years is that I have become older, now 88, falling apart bit by bit, getting a large dose of the medical and hospital technologies available to help me. I have a combination of advanced COPD and a mild but unpleasant form of Parkinson’s disease. My memory and hearing are declining, and what geriatricians call frailty is evident. Some days I get along fine, other days I feel sorry for myself. Good or bad days are unpredictable. Despite widespread talk about the stigma of aging, I don’t notice it in my life. I am well treated and helped.
On the whole, my life has been happy and successful. I had supportive and loving parents in Washington, D.C., where I grew up. I had the advantage of an education at Yale and Harvard.
But my PhD in philosophy at Harvard did not go as I expected. That was the era of hardcore analytic philosophy, strong on detailed conceptual analysis, but not on the kinds of questions that brought me to the field, the kind I associated with Socrates: what is a good life and what does it mean to live it? When I complained of that dearth, one of my professors said, “We don’t do that kind of thing now.”
I soon realized I did not want a standard academic career. I had a chance to become a magazine editor in New York while finishing my doctorate, and I seized it. After a few years there, I spent a year at the Population Council in New York examining the ethical problems of family planning programs. I then got a grant from the Ford Foundation to write a book on abortion, the first written by an American philosopher.
While writing in the New York Academy of Medicine’s library, I often browsed the medical magazine racks and started noticing articles on new ethical problems in medicine. They gave me the idea of starting an interdisciplinary research organization to take up such issues. I envisioned an organization that embraced the disciplines of many scientific and humanistic fields and aimed for an audience that included the public as well as practitioners in medical and health specialties. The Hastings Center has achieved those goals.
Almost everyone who makes it to old age notes how fast the years have passed—and how much faster our present days seem to fly by. I retired from the Center 20 years ago. I had always written a good bit while managing the Center, but since retiring I have been writing all the time. Most recently, as my health has failed, I have turned to more reading and writing pertinent to that decline, notably death and old age, topics I first took up at least 40 year ago. In “Aging: Drawing a Map for the Future,” which appeared in the Hastings Center Report’s recent special report on aging, I wrote about what I envisioned to be an alternative goal for medicine with two fundamental aims: to make health care affordable for patients and economically sustainable for governments and to greatly reduce open-ended aspirations to extend life or to end all physical and psychological suffering.
When I look back, I am struck by the persistence of most of the topics The Hastings Center worked on in its early years: end-of-life care, human subjects research, genetic developments, costs and equitable health care, and reproductive issues. One exception is global population growth, an early topic that faded, in great part because of declining birth rates in developed countries. The concept of brain death and how to determine death by neurological criteria was The Hastings Center’s first major project, but old questions remain and new ones have emerged, as discussed in a special report recently published by the Hastings Center Report on the topic.
Although over the years there is hardly any bioethics I have not written about, aging has been the most dominant. How much and what kind of resources should go to the health of the elderly? My 1987 book on that topic, Setting Limits: Medical Goals in An Aging Society, was the most read, selling 36,000, most reviewed, and was a finalist for a Pulitzer Prize. It was also the most attacked. It was not a flat-out argument for age rationing, but instead an effort to show that rising costs were inexorably pushing that way. What we have now are stand-ins for the fictional “death panels” that Sarah Palin imagined: Medicare copayments and deductibles, too often heavy enough to bankrupt the elderly. Little noted in the U.S. is that the European countries praised for their universal health care employ the same rationing tactic: copays and deductibles to discourage use and lower government costs.
Inevitably, as befits my age, I give some thought these days to my own legacy. My children have reached middle age, my marriage is now 65 memorable years long, and The Hastings Center has reached 50. My writing, prolific and steady, going back to 1961, has produced many books and articles. I am one of those lucky people who finds my greatest satisfaction sitting at my computer most of the day, wrestling with ideas and the prose to articulate them. One of our children was once asked what his parents did on vacation. “They type,” he responded. Only in the past year have I even considered giving up writing. The noxious mix of energy loss and memory loss, as well as worries about repetition, sap my drive. But here I am writing this article.
I have wondered over the years whether my professional legacy will be my writing or The Hastings Center. But I have come to think that the shelf life of my writing will be much shorter than the life of the Center. “Old soldiers,” General Douglas MacArthur once said, “never die, they just fade away.” The same can be said of authors who write on timely issues of public interest, and so it has been with bioethics.
I am confident that The Hastings Center will endure because it keeps moving forward, trying to catch new issues in the bud, wrestling with the constant metamorphosis of old ethical dilemmas, and a steady influx of younger generations with new ideas and interests. My fellow presidents —Will Gaylin, Strachan Donnelley, Thomas Murray, and now Millie Solomon—have served the Center well. On to the next 50 years.
Daniel Callahan, cofounder and President Emeritus of The Hastings Center, is the author or editor of 47 books and nearly 800 articles.
Photo: Hastings Center staff in 1981.
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