It is easy to enumerate the list of unique achievements of the bioethics program of UNESCO. The adoption of three normative instruments, the establishment of the IBC (with independent scientific experts as members) and the Intergovernmental Bioethics Committee (with governmental representatives as members), the creation of national bioethics committees in several countries, the promulgation of the core bioethics curriculum in universities around the world, and the setting up of the Global Ethics Observatory with data on bioethics experts, ethics entities, ethics teaching programs, and ethically relevant legislation in various Member States are all major achievements that help to promote and sustain bioethics across the world.

Without the activities of UNESCO these achievements would not exist today. However, these results and activities are the manifestations of a deeper concern that is closely related to the mission of UNESCO: the intellectual and moral solidarity of humanity that is the only guarantee that progress in science will contribute to human flourishing, peace and security. Against this foundational background that will be elaborated in the next paragraph, UNESCO’s early involvement in bioethics can be explained. By 1970, the organization had started to organize symposia and conferences on bioethics, mainly related to the development of genetics, life sciences and reproductive technologies and in cooperation with UNESCO’s Scientific Coordinating Committee for the Human Genome Project (UNESCO 1993). It is also remarkable that the Council for International Organizations of Medical Sciences (CIOMS) established in 1949 jointly by WHO and UNESCO with the purpose of promoting international activities in the biomedical sciences convened in 1967 a conference in Paris (most probably in UNESCO’s Headquarters), on biomedical science and the dilemma of human experimentation. This conference would be the first of a long series of annual Round Tables on the ethical aspects of modern medicine, organized with the assistance of UNESCO and WHO (Bankowski and Dunne 1982). In 1976 CIOMS appointed a standing Advisory Committee on Bioethics. This Committee started an intensive international dialogue among researchers, ethics experts and policy-makers from around the world in order to develop guidelines for international medical research.

As parent organization and co-organizer UNESCO must have become aware of the increasing ethical issues associated with the rapid development of medicine and life sciences, even before the term “bioethics” was coined. While CIOMS membership consists of academic and scientific organizations, UNESCO is an inter-governmental organization; it brings together governments that have an interest in the promotion of science. In 1970, the word ‘bioethics’ was introduced for the first time by Van Rensselaer Potter who gave a broad definition of the concept (Ten Have 2012). The same era witnessed revolutionary changes and innovations in medical diagnosis and treatment but also in science and technology. Additionally, scandals, misuses and injustices came to light and alarmed the public and policy-makers, leading to the establishment of the first bioethics centers, ethics committees, review boards and efforts to codify patient rights and to regulate the medical and biomedical research community (Rothman 1991). Although bioethics emerged first in the United States , it quickly developed in other parts of the world. However, the birth and early growth of bioethics left conceptual and methodological markers on the new discipline. The story is familiar. Potter complained that the new term ‘bioethics’ was readily accepted and widely used but only as a new fancy name for ‘medical ethics,’ not as a different approach to ethical issues. The acceptance of the term falsely suggested that there was something new, as he himself intended by coining the term, but in fact it only continued the traditional approach albeit under a different guise (Potter 1988). The approach to bioethics that became dominant, especially under the influence of the Kennedy Institute at Georgetown University (established in 1971, with ‘bioethics’ in its original name) has two flaws according to Potter. First, it is concerned with the perspective of the individual patient. Its main concern is how individual lives could be enhanced, maintained, and prolonged through the application of medical technologies. Second, it is exclusively interested in the short-term consequences of medical and technological interventions. It is not concerned with what Potter regarded as the basic and most urgent ethical problems of humankind that are threatening the human survival, problems such as poverty, pollution, and violence. These flaws assure that contemporary bioethics is not generating really new perspectives and new syntheses that are focused on safeguarding the future of the human species. In order to reiterate that a new approach is essential, Potter again introduced in the late 1980s a new term: global bioethics (Potter 1988). What we currently have is biomedical ethics or medical bioethics. What we need is an unquestionably innovative and multi-disciplinary approach that combines medical and individual perspectives with social and ecological concerns so that it has global scope, not only in the sense that it has worldwide significance but also is encompassing and broad (Ten Have and Gordijn 2013).

The peculiarities and characteristics of mainstream bioethics have become under particular scrutiny during the 1990s. It was recognized that the growing appeal of this new discipline among public and scientific circles of opinion leaders could be attributed to the empowering combination of two traditional notions from the history of moral philosophy: ‘application’ and ‘principle’. In Beauchamp and Childress’ well-known textbook, biomedical ethics is defined as applied ethics, “the application of general ethical theories, principles and rules to problems of therapeutic practice, health care delivery, and medical and biological research” (Beauchamp and Childress 1983: ix–x). Instead of the theoretical abstractions of traditional moral philosophy, applied ethics can contribute to the analysis of dilemmas, the resolution of complex cases and the clarification of practical problems arising in the healthcare setting. The practical usefulness of applied ethics not only manifests itself in biomedicine, but it has a wider scope; the same approach is important for other areas such as business ethics and environmental ethics. Applied ethics therefore can extend to almost any area of life where ethical issues arise. ‘Application’ here has a double connotation: it indicates that ethics is available for what we usually do, it applies to our daily problems; but it also is helpful, practical, in the sense that ethics is something to do; it works to resolve our problems.

The second characteristic of the dominant conception of bioethics is the focus on principles. If ethics is conceived as applied ethics, then subsequent reflection is needed on what is being applied. The emerging consensus that principles should provide the answer to this quest is coherent with the moralities of obligation that have dominated modern ethical discourse, especially since Kant . Behavior in accord with moral obligations is considered morally right. Morality is understood as a system of precepts or rules people are obliged to follow. Particularly in the early days of bioethics, when medical power was strongly criticized, and the rights of patients were vehemently emphasized as requiring respect, the moralities of obligation presented themselves as a common set of normative principles and rules that we are obliged to follow in practice. As Gracia (1999) has pointed out, the Belmont Report in 1978 was influential because it was the first official account to identify three basic ethical principles: autonomy, beneficence and justice. A basic principle was defined as a general judgment serving as a justification for particular prescriptions and evaluations of human actions. From these principles, ethical guidelines can be derived that could be applied to the biomedical area. About the same time, Beauchamp and Childress, in the first edition of their book, introduced the four-principles approach, adding “nonmaleficence” to the above three principles. In their view, principles are normative generalizations that guide actions.

Although Beauchamp and Childress have considerably elaborated and adapted their theoretical framework in later editions, their work has contributed to the conception of bioethics that has long dominated the practical context, in ethics committees, clinical case-discussions, ethics courses, and compendia and syllabi. This conception is sometimes called ‘principlism’ The focus is on the use of moral principles to address ethical issues and to resolve conflicts at the bedside (DuBose et al. 1994). Long-time editor of the Journal of Medical Ethics, Raanan Gillon, for example, argues that principlism is a universal tool; it provides a method to resolve all moral issues in all areas of daily life, whatever the personal philosophies, politics, religions, cultural traditions and moral theories of the persons involved (Gillon 1994). Although principlism was dominant approach in bioethics, it was not the only one and it was also criticized from the start. Since the 1990s this criticism has grown (Ten Have 2011). One critique is that it pays insufficient attention to the practical setting since it uses the mould of the four moral principles to address actual cases and issues, without taking into account the concretely lived experiences of patients and health professionals. The other critique points out that bioethics has developed within a particular Western cultural and social context while at the same time critical reflection upon the social and cultural value system within and through which it operates is rare. In response to these criticisms new approaches to bioethics became more influential during the 1990s, for instance phenomenological ethics, hermeneutic ethics, narrative ethics, and care ethics. It was also recognized that ‘application’ was often regarded in a restricted sense since bioethical debate was usually focused on a highly selective and limited number of topics and issues that were associated with individual choice and technological opportunities; these bioethical issues were relevant for Western countries but not for the majority of people living in the developing world. Finally, it became clear that the focus of principlism on duties and rights was associated with the dominance of the moral principle of individual autonomy while in other cultures more emphasis is placed on responsibility and community.