Any given Sunday morning, a bioethicist somewhere in America suits up for a TV appearance on the hot issue of the day or stands by a hospital bed to consult on a wrenching dilemma.

Should doctors prolong the life of a baby born without a brain? Should they be allowed to help the terminally ill kill themselves by prescribing a lethal drug dose? Should there be limits on embryonic stem cell research?

But who are these people opining on what we should do?

"Anyone who wants to," says Arthur Derse, chairman of Veterans' Health Administration's National Ethics Committee.

He's president of the American Society for Bioethics and Humanities, which draws most of its 1,600 members from medical schools and academics in ethics and philosophy. Lawyers, theologians, clergy members, sociologists and others staff scores of bioethics centers and work in the pharmaceutical industry as well.

There are no standards or certification procedures, says Derse, an emergency medicine physician. And rarely are bioethicists questioned about the basis for their views or who pays for their work.

It's hard for the average person to sort out the political activists with an agenda or ethicists with a vested interest, such as those employed, directly or indirectly, by drug companies seeking an ethical halo for their products.

"Like business and journalism, these are unregulated professions in an uncredentialed field," says Daniel Callahan, who in 1969 co-founded the oldest such center, The Hastings Center in Garrison, N.Y. (Related link: Five vioces in the bioethics field)

"The good side of this is that it's not excessively rigid, so you can have a great variety of people raising important questions. Raising questions is what bioethicists do best," Callahan says.

The field emerged to address questions raised by major medical and technical advances that arose since the 1960s, including kidney dialysis, the widespread use of ventilators and cardiopulmonary resuscitation. Demand for organ transplants soared after the first heart transplant in 1967, prompting discussion over who is "dead" enough to donate a vital organ and who should have access to transplants.

Social changes such as Medicare, established in 1965, reordered how Americans use medicine and where, raising questions about the just distribution of limited resources. Research ethics also came under scrutiny, with questions raised about informed consent for drug development and new surgical techniques.

Originally, bioethics was cultivated by Catholic medical schools and theologians. But, says Ronald Numbers, historian of science and medicine at the University of Wisconsin-Madison, "those voices were marginalized as the field came to rely more on principles that appear to transcend specific religions."

This may have begun with the seminal textbook Principles of Biomedical Ethics, first published in 1979 by Tom Beauchamp and James Childress of the Kennedy Institute for Ethics at Georgetown University. It details four major principles: autonomy, non-maleficence (the obligation not to do harm), beneficence (the obligation to do good) and justice (what is fair, equitable and appropriate). God is mentioned on just six of 431 pages in the 2001 edition.

Beauchamp says he is concerned that conservative religious groups today are "unwilling to concede what the courts have made clear, that bioethics is fundamentally a secular enterprise. ... It's as clear as anything in ethics can be that you have the right, especially when you are threatened by a disastrous fate, to determine what happens to you."

There's little common ground between Beauchamp and conservative religious bioethicists such as C. Ben Mitchell, a senior fellow at the Evangelical Christian-based Center for Bioethics and Human Dignity, near Chicago, and editor of a journal, Ethics & Medicine.

"Why should you listen to any of us?" Mitchell asks. He uses terms such as "covenant" — used in the Bible to talk about the relationship of promises and obligations between God and man — to talk about Judeo-Christian values in medicine.

"Why do people think they alone are the judges of quality of life?" he asks. "We all have a stake in a person's life. ... There is something important about caring for and being cared for."

But sociologist Alan Wolfe says the hodgepodge state of the "ethics industry" is precisely because Americans are so diverse. And Americans place such a high premium on individuality that there's no agreed overarching authority, even God.

"Since we agree on nothing, the answers become very eclectic. It's every person their own ethicist."

For now, with Catholic bioethicist Edmund Pellegrino of Georgetown University heading the President's Council on Bioethics starting next month, beneficence seems likely to gain a bigger place in bioethics debates, Beauchamp says.

And the council debated earlier this month whether to put the entire field of bioethics under the ethical microscope. A decision rests with Pellegrino, who says he will discuss where he wants the group to head at its next meeting, which is planned by the end of the year.