This textbook provides a brief history of human experimentation and reviews various theories of ethics from which the principles and rules that govern this research are derived. All relevant international documents and national regulations, policies and memoranda are referred to extensively to assist in addressing issues that regularly arise during the course of research involving human subjects. It includes case examples and exercises and is of interest to students and experienced researchers.

In the past decade the body of literature in the area of biomedical ethics has expanded at an astounding rate. Indeed, on every major topic, the literature in this area has mUltiplied, and continues to do so, so rapidly that one can easily fall behind important advances in our thinking about and understanding of the problems of contemporary bioethics. Awareness of this need to keep apace of developments in the area prompted a recent reviewer of our earlier collection Biomedical Ethics and the Law (Plenum, 2nd edition, 1979) to suggest that somebody ought to offer the service of providing a biennial review or update of the literature on the various central topics in bioethics. Thomas Lanigan, of The Humana Press, agreed with this last sug gestion and so asked us to edit a series of texts consisting of previously unpublished essays on selected topics, a series that would seek to re view and update recent literature on the central topics, while also striv ing to advance distinctive solutions to the problems on the topics under discussion. Accordingly, this first collection of previously unpublished essays focuses on the selected topics, and the authors commissioned were charged with addressing the basic problems assigned while also bringing the reader either directly or indirectly up to date on the rele vant literature."

Biomedical Ethics Reviews * 1987 is the fifth volume in a series of texts designed to review and update the literature on issues of central importance in bioethics today. Three topics are discussed in the present volume: (1) Prescribing Drugs for the Aged and Dying; (2) Animals as a Source of Human Transplant Organs, and (3) The Nurse's Role: Rights and Responsibilities. Each topic constitutes a separate sec tion in our text; introductory essays briefly summarize the contents of each section. Bioethics is, by its nature, interdisciplinary in character. Recognizing this fact, the authors represented in the present volume have made every effort to minimize the use of techni cal jargon. At the same time, we believe the purpose of pro viding a review of the recent literature, as well as of advancing bioethical discussion, is admirably served by the pieces col lected herein. We look forward to the next volume in our series, and very much hope the reader will also.

Biomedical Ethics Reviews: 1985 is the third volume in a series of texts designed to review and update the literature on issues of central impor tance in bioethics today. Four topics are discussed in the present volume: ( 1) Should citizens of the United States be permitted to buy, sell, and broker human organs? (2) Should sex preselection be legally proscribed? (3) What decision-making procedure should medical per sonnel employ in those cases where there is a high degree of uncer tainty? (4) What do we mean when we use the terms "health" and "disease"? Each topic constitutes a separate section in our text; intro ductory essays briefly summarize the contents of each section. Bioethics is, by its nature, interdisciplinary in character. Recognizing this fact, the authors represented in the present volume have made every effort to minimize the use of technical jargon. At the same time, we believe the purpose of providing a review of the recent literature, as well as of advancing bioethical discussion, is admirably served by the pieces collected herein. We look forward to the next volume in our series, and very much hope the reader will also."

The National Science Foundation, The National Institute of Occupational Safety and Health, and the Center for Technology and Humanities at Georgia State University sponsored a two-day national conference on Moral Issues and Public Policy Issues in the Use of the Method of Quantitative Risk Assessment ( QRA) on September 26 and 27, 1985, in Atlanta, Georgia. The purpose of the conference was to promote discussion among practicing risk assessors, senior government health officials extensively involved in the practice of QRA, and moral philosophers familiar with the method. The conference was motivated by the disturbing fact that distinguished scientists ostensibly employing the same method of quantitative risk assessment to the same substances conclude to widely varying and mutually exclusive assessments of safety, depending on which of the various assumptions they employ when using the method. In short, the conference was motivated by widespread concern over the fact that QRA often yields results that are quite controversial and frequently contested by some who, in professedly using the same method, manage to arrive at significantly different estimates of risk.

This volume developed from and around a series of six lectures sponsored by Rice University and the University of Texas Medical Branch at Galveston in the Fall of 1976. Though these lectures on the concepts of mental health, mental illness and personal responsibility, and the social treatment of the mentally ill were given to general audiences in Houston and Galveston, they were revised and expanded to produce six extensive formal essays by Dan Brock, Jules Coleman, Joseph Margolis, Michael Moore, Jerome Neu, and Rolf Sartorius. The five remaining contributions by Daniel Creson, Corinna Delkeskamp, Edmund Erde, James Speer, and Stephen Wear were in various ways engendered by the debates occasioned by the original six lectures. In fact, the majority of the last five contributions emerged from informal dis. cussions occasioned by the original lecture series. The result is an interlocking set of essays that address the law and public policy insofar as they bear on the treatment of the mentally ill, special atten. tion being given to the defmition of mental illness, generally and in the law, to the issues of the bearing of mental incompetence in cases of criminal and civil liability, and to the issue of involuntary commitment for the purpose of treatment or for institutional care. There is as well a critical defense of Thomas Szasz's radical proposal that mental illnesses are best understood as problems in living, not as diseases."

Medical or health-oriented screening programs are amongst the most debated aspects of health care and public health practices in health care and public health ethics, as well as health policy discussions. In spite of this, most treatments of screening in the research literature restrict themselves to isolated scientific aspects, sometimes complemented by economic analyses or loose speculations regarding policy aspects. At the same time, recent advances in medical genetics and technology, as well as a rapidly growing societal focus on public health concerns, inspires an increase in suggested or recently started screening programs.

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.It explores the considerations that arise when heath care interacts with other societal institutions on a large scale, as is the case with screening: What values may be promoted or compromised by screening programs? What conflicts of values do typically arise - both internally and in relation to the goals of health care, on the one hand, and the goals of public health and the general society, on the other? What aspects of screening are relevant for determining whether it should be undertaken or not and how it should be organised in order to remain defensible? What implications does the ethics of screening have for health care ethics as a whole?

These questions are addressedby applying philosophical methods of conceptual analysis, as well as models and theories from moral and political philosophy, medical ethics, and public health ethics, to alarge number of ongoing and proposed screening programs whichmakes this book the first comprehensive work on the ethics of screening. Analyses and suggestions are made that are of potential interest to health care staff, medical researchers, policy makers and the general public."

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically.

George Annas, America's leading proponent of patient rights, spells them out for you in this revised, up-to-date edition of his groundbreaking classic. Thorough, comprehensive, and easy to follow-using a question-and-answer format in much of the text-The Rights of Patients explores all aspects of becoming an informed patient: * hospital organization * hospital rules * emergency treatment * admission and discharge * the patient rights movement * informed consent * surgery * obstetrical care * human experimentation and research * privacy and confidentiality * care of the dying * death, autopsy, and organ donation * medical malpractice.

This volume, which has developed from the Fourteenth Trans Disciplinary Symposium on Philosophy and Medicine, September 5-8, 1982, at Tel Aviv University, Israel, contains the contributions of a group of distinguished scholars who together examine the ethical issues raised by the advance of biomedical science and technology. We are, of course, still at the beginning of a revolution in our understanding of human biology; scientific medicine and clinical research are scarcely one hundred years old. Both the sciences and the technology of medicine until ten or fifteen years ago had the feeling of the 19th century about them; we sense that they belonged to an older time; that era is ending. The next twenty-five to fifty years of investigative work belong to neurobiology, genetics, and reproductive biology. The technologies of information processing and imaging will make diagnosis and treatment almost incomprehensible by my generation of physicians. Our science and technology will become so powerful that we shall require all of the art and wisdom we can muster to be sure that they remain dedicated, as Francis Bacon hoped four centuries ago, "to the uses of life." It is well that, as philosophers and physicians, we grapple with the issues now when they are relatively simple, and while the pace of change is relatively slow. We require a strategy for the future; that strategy must be worked out by scientists, philosophers, physicians, lawyers, theologians, and, I should like to add, artists and poets."

Medical research involving human subjects has contributed to considerable advancements in our knowledge, and to medical benefits. At the same time the development of new technologies as well as further globalisation of medical research raises questions that require the attention of researchers from a range of disciplines. This book gathers the contributions of researchers from nine different countries, who analyse recent developments in medical research from ethical, historical, legal and socio-cultural perspectives. In addition to reflections on innovations in science such as genetic databases and the concept of "targeted therapy" the book also includes analyses regarding the ethico-legal regulation of new technologies such as human tissue banking or the handling of genetic information potentially relevant for participants in medical research. Country and culture-specific aspects that are relevant to human medical research from a global perspective also play a part. The value of multi- and interdisciplinary analysis that includes the perspectives of scholars from normative and empirical disciplines is a shared premise of each contribution.

Human existence is marked by pain, limitation, disability, disease, suffering, and death. These facts of life and of death give ample grounds for characterizing much of the human condition as unfortunate. A core philosophical question is whether the circumstances are in addition unfair or unjust in the sense of justifying claims on the resources, time, and abilities of others. The temptation to use the languages of rights and of justice is und- standable. Faced with pain, disability, and death, it seems natural to complain that "someone should do something," "this is unfair," or "it just isn't fight that people should suffer this way." Yet it is one thing to complain about the unfairness of another's actions, and another thing to complain about the unfairness of biological or physical processes. If no one is to blame for one's illness, disability, or death, in what sense are one's unfortunate circumstances unfair or unjust? How can claims against others for aid and support arise if no one has caused the unfortunate state of affairs? To justify the languages of fights to health care or justice in health care requires showing why particular unfortunate circumstances are also unfair, in the sense of demanding the labors of others. It requires understanding as well the limits of property claims. After all, claims regarding justice in health care or about fights to health care limit the property fights of those whose resources will be used to provide care.

Murdering Animals confronts the speciesism underlying the disparate social censures of homicide and "theriocide" (the killing of animals by humans), and as such, is a plea to take animal rights seriously. Its substantive topics include the criminal prosecution and execution of justiciable animals in early modern Europe; images of hunters put on trial by their prey in the upside-down world of the Dutch Golden Age; the artist William Hogarth's patriotic depictions of animals in 18th Century London; and the playwright J.M. Synge's representation of parricide in fin de siecle Ireland. Combining insights from intellectual history, the history of the fine and performing arts, and what is known about today's invisibilised sites of animal killing, Murdering Animals inevitably asks: should theriocide be considered murder? With its strong multi- and interdisciplinary approach, this work of collaboration will appeal to scholars of social and species justice in animal studies, criminology, sociology and law.

As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different parts of the world. It is often difficult, however, to get accurate information about these matters. The Bioethics Yearbook Series provides interested parties with analyses of how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withdrawing treatment, active euthanasia, the definition of death, and organ transplantation are being discussed in these different traditions and different parts of the world. The first volume, and every second succeeding volume, will discuss developments in the Anglican, Baptist, Buddhist, Catholic, Eastern Orthodox, Hindu, Jewish, LDS, Lutheran, Methodist, Muslim, and Presbyterian Traditions. The second volume, and every second volume succeeding it, will discuss official governmental and medical society policies on these topics throughout the world.

In the past few years, an increasing number of colleges and universities have added courses in biomedical ethics to their curricula. To some extent, these additions serve to satisfy student demands for "relevance. " But it is also true that such changes reflect a deepening desire on the part of the academic community to deal effectively with a host of problems which must be solved if we are to have a health-care delivery system which is efficient, humane, and just. To a large degree, these problems are the unique result of both rapidly changing moral values and dramatic advances in biomedical technology. The past decade has witnessed sudden and conspicuous controversy over the morality and legality of new practices relating to abortion, therapy for the mentally ill, experimentation using human subjects, forms of genetic interven tion, and euthanasia. Malpractice suits abound, and astronomical fees for malpractice insurance threaten the very possibility of medical and health-care practice. Without the backing of a clear moral consensus, the law is frequently forced into resolving these conflicts only to see the moral issues involved still hotly debated and the validity of the existing law further questioned. Take abortion, for example. Rather than settling the legal issue, the Supreme Court's original abortion decision in Roe v. Wade (1973), seems only to have spurred further legal debate. And of course, whether or not abortion is a mo rally ac ceptable procedure is still the subject of heated dispute."

The subject of medical ethics is always current and offers an inviting theme, particularly for anyone who has spent his life in medical practice. But the subject of ethics is impossible to deal with unless one first asks its purposes. Therefore, this book is divided into two parts, the first comprehends theoretical considerations and the second, pragmatic and empirical data on, and discussions of, current problems. Part One will be of greater interest to moral philosophers, philosophers and historians of science, and social scientists. Part Two should have greater appeal to physicians, medical students and medical planners. Nevertheless, it is hoped that the latter will look into Part One for the justification of the conclusions the author could reach on the material presented in Part Two. Likewise, it will become obvious why it is believed the solutions of many, if not most, ethical dilemmas are not always discernible at a given moment in time. Also, those who are more concerned with the theoretical material of Part One might find its application to current real-life problems interesting. It should not be too much to hope that the entire book will appeal to many general readers. The bio-ethical problems presented are of frequent and growing personal concern, and are discussed almost daily in the news media.

In April 1982, an infant boy was born in Bloomington, Indiana, with Down syndrome and a defective, but surgically correctable, esophagus. His parents refused to consent to surgery or intravenous feeding. The hospital unsuccessfully sought a court order to force treatment, and appeals to higher courts also failed. The child, identified as Baby Doe by the news media, subsequently died. The events in Bloomington became the catalyst for action by the Reagan administration, the courts, and Congress that culminated in a federal policy that makes failure to treat newborns with disabilities a form of child neglect. This book centers on the public policy aspects of withholding treatment from critically ill newborns who are disabled. Specifically, it deals with why the policy was enacted and what impact it has had on health care workers, families, and infants. Some of the contributors to this book spearheaded the early debate on withholding treatment. Anthony Shaw's New York Times Magazine article in 1972 was the first to address these issues in the popular press. The following year, he published a related article in the New England Journal of Medicine. Also appearing in this same issue of NEJM, was the pathbreaking study, coauthored by A. G. M. Campbell, on withholding treatment in the special care nursery at Yale-New Haven Hospital. Each of these articles promoted much public and professional discussion.

This book is the first major work that addresses a core question in biomedical research: the question of acceptable risk. The acceptable level of risks is regulated by the requirement of proportionality in biomedical research law, which state that the risk and burden to the participant must be in proportion to potential benefits to the participant, society or science. This investigation addresses research on healthy volunteers, children, vulnerable subjects, and includes placebo controlled clinical trials. It represents a major contribution towards clarifying the most central, but also the most controversial and complex issue in biomedical research law and bioethics. The EU Clinical Trial Directive, the Council of Europe's Oviedo Convention (and its Additional Protocol), and national regulation in member states are covered. It is a relevant work for lawyers and ethicists, and the practical approach makes a valuable tool for researchers and members of research ethics committees supervising biomedical research.

Today's news is full of stories about suicide machines, critical life-and-death decisions, who owns a person's life, death with dignity, prolonging painful life, and euthanasia as a justifiable release for terminally ill patients. And this year, California voters will be faced with a real life-and-death decision: the Euthanasia Initiative. Other states are expected to follow suit soon.
Can euthanasia be accepted as a reasonable choice? Or must a patient's pain and suffering be prolonged in order to preserve life, without regard to the quality of that life? Are there viable alternatives? Can a patient in fact live out his or her days in relative comfort, with love and support from family, friends, and health care workers?
A mind-opening new book from Humana Press, Euthanasia Is Not the Answer shows how terminally ill patients, especially those with cancer or AIDS, can live in comfort and dignity until death. The proper use of modern pain medications can ease the pain that drives them to despair and the request for euthanasia. And dedicated hospice care can allow them a meaningful life to the end.
Written with intelligence, deep understanding based on the author's pioneering experience in hospice care--and, above all, sensitivity and respect--Euthanasia Is Not the Answer explores these alternatives, using case reports and powerful medical and socioeconomic analysis that soundly argue Dr. Cundiff's case.
This important book adds new dimensions to our society's concern for the pain and suffering of the dying, clarifying the key issues associated with euthanasia and hospice, putting them into a new perspective, and showing that an approach based on easing pain and providing kind, caring support--rather than heroic high-tech medicine--is what is really needed for the terminally ill.
Death with dignity can be a reality...without drastic measures

Two ofthe most important notions concerning the rights of people with mental illness are among the most neglected: the first is that human rights and duties are complementary and that both must be considered in constructing a framework for mental health care. The second is that we must strive for equity and not only for equality in developing mental health programs. The first ofthese notions is complex. It refers to the duties ofpeople with mental illness and to the duties ofthose who surround them. Mental illness does not liberate the person who has it from civic obligations. The most basic ofthese is to give support to others and to refuse to harm them Their carers, society and the patient's self-respect all gain through their recognition, even though the fulfilment of these obligations might be difficult or impossible in certain periods ofillness. The duty of those surrounding the patients is to recognise and respect their existence and to make the necessary arrangements to respond to their needs, protect their rights and compensate for their temporary or permanent inability to fulfil their civic duties. A society's social capital is the public good that results from the mutual supportofmembers ofa society: iffor one reason or another, some or all members ofa society fail to offer such support the social capital will diminish and the society will cease to be civic.

The Yearbook series alternates between a biennial volume tracing recent theological discussions on topics in bioethics and a biennial volume tracing recent regional discussions in bioethics. Volume 4 provides a comprehensive single-volume summary of recent international and regional developments on specific topics in bioethics. To give uniformity to the discussions all authors were asked to report on the following topics: new reproductive technologies, abortion, maternal-fetal conflicts, case of severely disabled newborns, consent of treatment and experimentation, confidentiality, equitable access to health care, ethical concerns raised by cost-containment measures, decisions to withhold or withdraw life-sustaining treatment, active euthanasia, the definition of death, organ donation and transplantation, and a final broad category of other issues. The internationally respected contributors report on the following 16 areas: the United States, Canada, Latin America, the United Kingdom and Ireland, France, the Netherlands, Germany/Austria/Switzerland, Spain/Portugal/Italy, Scandinavia, Southeast Asia, China, Japan, Australia/New Zealand. The commentators draw on three sets of resources: Statutes, legislative proposals, and regulatory changes that directly influence or have implications for, areas of bioethical concern; Case law and court judgments that shape, either decisively or suggestively, recent legal interpretations of particular issues of areas in bioethics; Formal statements of governmentally appointed commissions, advisory bodies, and representative professional groups, as well as less formal statements and recommendations of other organisations. In addition to providing timely summaries of recent developments, the volume offers rich and useful bibliographical references to a wide array of documents, many of which would be difficult for readers to learn about, given the lack of centralized international collection of such documents. The Yearbook will be widely consulted by all bioethicists, public policy analysts, lawyers and theologians.

As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different regions of the world. It is often difficult, however, to obtain accurate information about these matters. The Bioethics Yearbook series provides interested parties with analyses of how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withholding and withdrawing treatment, active euthanasia, the definition of death, and organ transplantation are being discussed in different religious traditions and regions. Volume Three discusses theological developments from 1990--1992 in Anglican, Baptist, Buddhist, Catholic, Continental Protestant, Eastern Orthodox, Hindu, Jewish, Latter-Day Saint, Lutheran, Methodist, Muslim, and Presbyterian traditions. Volume Four will continue coverage of official governmental and medical society policies on these topics throughout the world.

Ethics in Psychiatry: (1) presents a comprehensive review of ethical issues arising in psychiatric care and research; (2) relates ethical issues to changes and challenges of society; (3) examines the application of general ethics to specific psychiatric problems and relates these to moral implications of psychiatry practice; (4) deals with recently arising ethical problems; (5) contains contributions of leading European ethicists, philosophers, lawyers, historians and psychiatrists; (6) provides a basis for the exploration of culture-bound influences on morals, manners and customs in the light of ethical principles of global validity.

Suppose an accountant discovers evidence of shady practices while ex amining the books of a client. What should he or she do? Accountants have a professional obligation to respect the confidentiality of their cli ents' accounts. But, as an ordinary citizen, our accountant may feel that the authorities ought to be informed. Suppose a physician discov ers that a patient, a bus driver, has a weak heart. If the patient contin ues bus driving even after being informed of the heart condition, should the physician inform the driver's company? Respect for patient confidentiality would say, no. But what if the driver should suffer a heart attack while on duty, causing an accident in which people are killed or seriously injured? Would the doctor bear some responsibility for these consequences? Special obligations, such as those of confidentiality, apply to any one in business or the professions. These obligations articulate, at least in part, what it is for someone to be, say, an accountant or a physician. Since these obligations are special, they raise a real possibility of con flict with the moral principles we usually accept outside of these spe cial relationships in business and the professions. These conflicts may become more accentuated for a professional who is also a corporate employee-a corporate attorney, an engineer working for a construction company, a nurse working as an employee of a hospital."

1.1 Goals 1.1.1 I have two main goals in this book. The first is to give an account of the moral significance of merely possible persons - persons who, relative to a particular 1 circumstance, or possible future or world, could but in fact never do exist. I call that account Variabilism. My second goal is to use Variabilism to begin to address the problem of abortion. 1.1.2 We ought to do the best we can for people. And we consider this obligation to extend to people who are, relative to a world, existing or future. But does it extend to merely possible people as well? And, if it does, then does it extend to making things better for them by way of bringing them into existence? If we say that surely it doesn't, does that then mean that our obligation to do the best we can for people does not, after all, extend to the merely possible - that the merely p- sible do not matter morally? But if the merely possible do not matter morally, then doesn't that mean that it would be permissible for us to bring them into miserable existences - and even obligatory to do just that - in the case where bringing the merely possible into miserable existences creates additional wellbeing for existing 1 References to merely possible persons and, later on, to persons who do exist - existing persons