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.

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.

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.

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.

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 shows how pressing issues in bioethics - e.g. the ownership of biological material and human cognitive enhancement - successfully can be discussed with in a virtue ethics framework. This is not intended as a complete or exegetic account of virtue ethics. Rather, the aim here is to discuss how some key ideas in Aristotle's Nicomachean Ethics, when interpreted pragmatically, can be a productive way to approach some hot issues in bioethics. In spite of being a very promising theoretical perspective virtue ethics has so far been underdeveloped both in bioethics and neuroethics and most discussions have been conducted in consequentialist and/or deontological terms. "

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.

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.

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."

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.

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

Many debates about the moral status of things-for example, debates about the natural rights of human fetuses or nonhuman animals-eventually migrate towards a discussion of the capacities of the things in question-for example, their capacities to feel pain, think, or love. Yet the move towards capacities is often controversial: if a human's capacities are the basis of its moral status, how could a human having lesser capacities than you and I have the same "serious" moral status as you and I? This book answers this question by arguing that if something is human, it has a set of typical human capacities; that if something has a set of typical human capacities, it has serious moral status; and thus all human beings have the same sort of serious moral status as you and I. Beginning from what our common intuitions tell us about situations involving "temporary incapacitation"-where a human organism has, then loses, then regains a certain capacity-this book argues for substantive conclusions regarding human fetuses and embryos, humans in a permanent vegetative state, humans suffering from brain diseases, and humans born with genetic disorders. Since these conclusions must have some impact on our ongoing moral and political debates about the proper treatment of such humans, this book will be useful to professionals and students in philosophy, bioethics, law, medicine, and public policy.

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."

Narratives and Jewish Bioethics searches for answers to the critical question of what roles ancient narratives play in creating modern norms by Jewish bioethicists utilizing the Jewish textual tradition.

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, suicide, 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 existing law further questioned. In the case of abortion, for example, the laws have changed radically, and the widely pub licized recent conviction of Dr. Edelin in Boston has done little to foster a moral consensus or even render the exact status of the law beyond reasonable question."

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.

This book challenges the unchallenged methods in medicine, such as "evidence-based medicine," which claim to be, but often are not, scientific. It completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine. No specific or absolute recommendations are given regarding medical treatment, moral approaches, or legal advice. Given rather is discussion about each issue involved and the strongest arguments indicated. Each argument is subject to further critical analysis. This is the same position as with any philosophical, medical or scientific view. The argument that decision-making in medicine is inadequate unless grounded on a philosophy of medicine is not meant to include all of philosophy and every philosopher. On the contrary, it includes only sound, practical and humanistic philosophy and philosophers who are creative and critical thinkers and who have concerned themselves with the topics relevant to medicine. These would be those philosophers who engage in practical philosophy, such as the pragmatists, humanists, naturalists, and ordinary-language philosophers. A new definition of our own philosophy of life emerges and it is necessary to have one. Good lifestyle no longer means just abstaining from cigarettes, alcohol and getting exercise. It also means living a holistic life, which includes all of one's thinking, personality and actions. This book also includes new ways of thinking. In this regard the "Metaphorical Method" is explained, used, and exemplified in depth, for example in the chapters on care, egoism and altruism, letting die, etc.

* How important is national health insurance? * What should a national health insurance plan entail? * What about the welfare of laboratory animals? These important issues form the core of this eighth volume in Humana's acclaimed Biomedical Ethics Reviews series. Interdisciplinary in approach, Biomedical Ethics Reviews * 1990 presents keen insights into these and related problems in chapters by leading experts in ethics and medicine. Each topic is briefly summarized in an introductory chapter, followed by a focused, thought-provoking analysis of specific issues within the topic. The use of technical jargon has been minimized in order to render the articles readily accessible and useful to interested laypersons. Biomedical Ethics Reviews * 1990 constitutes an extremely valuable-as well as timely-resource for everyone concerned with national health insurance or laboratory animal welfare today-topics that have had an undisputed, and sometimes tumultuous, impact not only on healthcare professionals, but also on the public agenda.

The Bishop Bekkers Foundation, devoted to the welfare of those with mental handicap and to the amelioration and prevention of this and related disabilities, is to be warmly congratulated for sponsoring and organizing the 1986 Inter national Workshop from which the present book is derived. With commendable foresight, the Foundation recognized that genetic aspects of mental handicap were a timely focus for the Workshop and that dramatic biomedical developments and prospects in this sphere have highly significant psychosocial and ethical ramifications. The papers of the 23 contributors in each of these areas, together with an introductory essay and discussion summaries, comprise this volume. Much of the subject matter is inevitably concerned with such sensitive issues as sanctity and quality of life and the - sometimes contrasting and even in conflict - rights and needs of the actually and potentially handicapped, their relatives and society in general. Such considerations, not surprisingly, engender different approaches and viewpoints. The papers in this book reflect this, with the editing attempting to achieve, as far as possible, a coherent and consistent format and not an identical outlook. The perceptions and views expressed in each paper are there fore those of the author concerned and not necessarily those of the editors or of the Bishop Bekkers Foundation."

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries 5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ( 8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics ll]."

Recent rapid advances in the biosciences have led to considerable debate about the social, ethical, and legal implications of research and its applications. The mapping of the human genome, advances in cloning techniques, the harvesting of embryonic stem cells for research, increasing use of genetic testing in healthcare, and the development of large-scale genetic databases have not only generated high expectations about new diagnostics and treatments but also considerable widespread fear about their consequences. This book offers a critical appraisal of bioethics and its implications as it pertains to the fields of health and medicine and public health, with a particular emphasis on recent technological innovations as they provide a noteworthy exemplar of the power of bioethics in shaping policies, practices and notions of societal benefits. Whereas other books have tended to examine ethical dilemmas and challenges of applying ethical principles, often in relation to a limited array of issues, this book investigates the socio-political implications of bioethics discourse and practices in relation to a range of controversial (or potentially controversial) developments. Providing a benchmark for future debate and scholarly work, this volume will be of interest to policymakers, clinicians, scholars, and others who are looking for new ways of making sense and evaluating recent developments in the field of bioethics.

Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each of the topics is addressed in such a way that it includes an examination of the locus of responsibility for ethical decision making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems.

Tris' request for a leave that interrupted his clinical c1erkships, so that he could undertake his graduate studies in Austin. The field, not just Tris, owes Jim Knight a hearty "thank you" for his decision to approve Tris' request, which was unusual, to say the least, in the conservative world ofmedical education at the time. Whenhereturned toTulane to complete his medical degree, Tris undertook withRichardZanerthe translationofAlfred Schutz'sandThomas Luckmann's 6 The Structures of the Life-World. Tris did this work while on his clinical rotations, including obstetrics and gynecology. In between delivering babies, most of whom were delivered by medical students at New Orleans' Charity Hospital, he worked on this translation. Tris once told me that, as a medical student, he had delivered scores ofbabies alone. Ican see him sitting with a patient in the labor area or maybe in the hall, attending to her, monitoring her progress in labor and the fetus' status, and translating from German, which is his first language, as well as thatofhis children. As this translation indicates, Tris believes in texts and scholarship about texts in a way that is decidedly not post-modem. This is also plain to anyone who has read his work. Forexample, the two editions of The Foundations of Bioethies, whateverelse one might thinkofthem, are monuments ofscholar- ship in the historiesofphilosophy, medicine, theology, and ideas generally, not to mention excellent primers on Texana. These books are packed with re- ferences and footnotes.

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