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."

This volume tracks the development in the United States of the field of Bioethics, Ethics applied to the disciplines of medicine, nursing, and health care in general, including medical research and the complex economic and political problems surrounding the provision of medical and nursing care. It explains how the United States developed, case by case, the central rules and principles of ER ethics in the Health Care System. The discussion includes the controversies centering on birth, death, clinical research, experimental procedures (cloning, reproductive technology, organ transplants), and ends with a substantial suggestion on the provision of health care for all.

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.

Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics, first published in 2007, Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by which other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law.

Focusing on the period between the 1970s and the present, Life as Surplus is a pointed and important study of the relationship between politics, economics, science, and cultural values in the United States today. Melinda Cooper demonstrates that the history of biotechnology cannot be understood without taking into account the simultaneous rise of neoliberalism as a political force and an economic policy. From the development of recombinant DNA technology in the 1970s to the second Bush administration's policies on stem cell research, Cooper connects the utopian polemic of free-market capitalism with growing internal contradictions of the commercialized life sciences. The biotech revolution relocated economic production at the genetic, microbial, and cellular level. Taking as her point of departure the assumption that life has been drawn into the circuits of value creation, Cooper underscores the relations between scientific, economic, political, and social practices. In penetrating analyses of Reagan-era science policy, the militarization of the life sciences, HIV politics, pharmaceutical imperialism, tissue engineering, stem cell science, and the pro-life movement, the author examines the speculative impulses that have animated the growth of the bioeconomy. At the very core of the new post-industrial economy is the transformation of biological life into surplus value. Life as Surplus offers a clear assessment of both the transformative, therapeutic dimensions of the contemporary life sciences and the violence, obligation, and debt servitude crystallizing around the emerging bioeconomy.

Cyberthreats are among the most critical issues facing the world today. Cybersecurity Management draws on case studies to analyze cybercrime at the macro level, and evaluates the strategic and organizational issues connected to cybersecurity. Cross-disciplinary in its focus, orientation, and scope, this book looks at emerging communication technologies that are currently under development to tackle emerging threats to data privacy. Cybersecurity Management provides insights into the nature and extent of cyberthreats to organizations and consumers, and how such threats evolve with new technological advances and are affected by cultural, organizational, and macro-environmental factors. Cybersecurity Management articulates the effects of new and evolving information, communication technologies, and systems on cybersecurity and privacy issues. As the COVID-19 pandemic has revealed, we are all dependent on the Internet as a source for not only information but also person-to-person connection, thus our chances of encountering cyberthreats is higher than ever. Cybersecurity Management aims to increase the awareness of and preparedness to handle such threats among policy-makers, planners, and the public.

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.

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.

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]."

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.

* 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.

This book summarizes the efforts and results of the first international Ifgene conference on presuppositions in science and expectations in society with respect to genetic engineering which was held at the Goetheanum, Dornach, Switzerland, October 2-5, 1996. The Goetheanum provided a unique opportunity to gather people from diverse disciplines who have opposing attitudes on modern science and technology. It is due to this venue, among other things, that the participants were able to develop an open, power-free dialogue and could focus more on judgement-forming than a polarizing debate. This Ifgene conference could not have happened without the financial support from many private individuals and the following organisations listed in no particular order: Fetzer Foundation; Stichting Triodos; Evidenzgesellschaft; Mahle Stiftung GmbH; Gemeinnlitzige Treuhandstelle e. Y. Bochum; Initiative gegen 'Bioethik'; Verband fur anthroposophische Heilpadagogik - CHi Verband flir anthroposophische Heilpadagogik, Sozialtherapie und Sozialarbeit e. Y. - D; Stichting ter bevordering van de Heilpaeda- gogie; Iona Stichting; Antroposofische Vereniging in Nederland; Stichting Klaverblad; Swissair & Crossair; The Rudolf Steiner Association; The Welcome Association; Anthro- posophische Gesellschaft in Deutschland; Helixor Heilmittel GmbH & Co; Goethea- num Dornach; Verein flir anthroposophisches Heilwesen e. Y. - D; The Oakdale Trust; Unilever Nederland BV; NV Verenigde Bedrijven Nutricia; Migros-Genossenschafts- Bund; Ministerie van Landbouw, Natuur en Visserij; CIBA; Stichting Elise Mathilde Fonds; Anthroposophic Society Australia; Therexsys; COOP Schweiz and selected speakers (G. Stotzky - USA, H. A. de Boer - NL, J. Girard-Bascou - F, P. G.

The National Institute on Aging (NIA) has historically been concerned with the protection of human subjects. In July 1977, the NIA sponsored a meeting to update and supplement guide lines for protecting those participating in Federal research pro jects. Although the basic guidelines had been in effect since 1966, it had been neglected to include the elderly as a vulnerable population. In November 1981, the NIA organized a conference on the ethical and legal issues related to informed consent in senile dementia cases. The present volume offers the latest and best thinking on Alzheimer's Dementia to have emerged from the dialog that was first embarked upon at the NIA meeting. Indeed, the issues and concerns it treats now seem even more relevant than they appeared historically because of the vastly greater awareness in the community of the entire spectrum of problems Alzheimer's disease confronts us all with. Our interest and concern is both humanitarian and self serving. Clearly older people must be protected from in appropriate research and careful attention must be paid to the circumstances under which research is conducted on those older persons who have given anything less than full consent. It is equally necessary, however, for the research enterprise to be protected so that today's elderly and those of the future can benefit from the fruits of research."

Some conferences produce proceedings, others an inspiration to labor, which finally leads to a published work. Such has been the case with regard to this volume. In 1984, the Center for Ethics, Medicine, and Public Issues held a conference with the title 'When are Competent Patients Incompetent?' with the support of the Texas Committee for the Humanities, a state-based program of the National Endowment for the Humanities. Assistance was provided by both Baylor College of Medicine and the Institute of Religion. This conference evoked a con siderable interest in examining further the moral status of competency determinations in the clinical setting. This interest is realized in this volume, which now affords us an opportunity to thank all those individ uals who made the conference possible, only some of whom are acknowledged in this Preface. In particular, we wish to express our gratitude to Baruch A. Brody, Rebecca Dresser, the Honorable Jerome Jones, H. Steven Moffic, Margery W. Shaw, Eleanor Tinsley, and Albert Van HeIden. The volume took its shape through the labors of Earl Shelp and Mary Ann Gardell Cutter, who inspired the further evolution of the papers presented at the conference and attracted contributions from individuals who had not attended. Earl Shelp and Mary Ann Gardell Cutter have produced a volume following extensive reflection and dialogue; they were ably assisted in the final preparation of the manu script by Thomas J. Bole III and George Khushf, to whom special thanks are due."

In When Medicine Went Mad, one of the nation's leading bioethicists-and an extraordinary panel of experts and concentration camp survivors-examine problems first raised by Nazi medical experimentation that remain difficult and relevant even today. The importance of these issues to contemporary bioethical disputes-particularly in the thorny areas of medical genetics, human experimentation, and euthanasia-are explored in detail and with sensitivity.

The roles of both the consumer and the health advocate professional have become increasingly significant in to day's climate of "rationed" health care. It seems clear that the timely exchange of ideas among seasoned health care advocates is necessary if we are to deal with the complex problems of a technologically advanced so ciety seeking to ration its heath care in a truly humane way. Toward such a timely exchange, the first Confer ence on Advocacy in Health Care was organized by the Health Advocacy Program of Sarah Lawrence College and recently held. Advocacy in Health Care: The Power of a Silent Constituency is the proceedings of the conference and will, we believe, greatly extend our efforts to share both the problems and solutions that effective patient advocacy entails. Never before has the issue of advocating for special population groups by combining the resources of consumers and professionals been the exclusive focus of one volume. This book discusses the power of such an alignment and describes specific organizational techniques that have been effective in bringing about changes in the delivery system. The final section of the book, "Questions, Com ments and Answers," presents a selection of topics of special interest that surfaced during the open disc- vii viii Preface sion at the last conference session. The comments were forthright in their criticism of public policy, and the vigor of the argument underscored the vitality of the co alition between professionals and consumers."

Interest in theories of virtue and the place of virtues in the moral life con- tinues to grow. Nicolai Hartmann [7], George F. Thomas [20], G. E. M. Anscombe [1], and G. H. von Wright [21], for example, called to our atten- tion decades ago that virtue had become a neglected topic in modem ethics. The challenge implicit in these sorts of reminders to rediscover the contribu- tion that the notion of virtue can make to moral reasoning, moral character, and moral judgment has not gone unattended. Arthur Dyck [3] , P. T. Geach [5], Josef Pieper (16], David Hamed [6], and, most notably, Stanley Hauerwas [8-11], in the theological community, have analyzed or utilized in their work virtue-based theories of morality. Philosophical probings have come from Lawrance Becker [2], Philippa Foot [4], Edmund Pincoffs [17], James Wallace [22], and most notably, Alasdair MacIntyre [12-14]. Draw- ing upon and revising mainly ancient and medieval sources, these and other commentators have ignited what appears to be the beginning of a sustained examination of virtue.

This volume inaugurates a series concerning philosophy and medicine. There are few, if any, areas of social concern so pervasive as medicine and yet as underexamined by philosophy. But the claim to precedence of the Proceedings of the First Trans-Disciplinary Symposium on Philos ophy and Medicine must be qualified. Claims to be "first" are notorious in the history of scientific as well as humanistic investigation and the claim that the First Trans-Disciplinary Symposium on Philosophy and Medicine has no precedent is not meant to be put in bald form. The editors clearly do not maintain that philosophers and physicians have not heretofore discussed matters of mutual concern, nor that individual philosophers and physicians have never taken up problems and concepts in medicine which are themselves at the boundary or interface of these two disciplines - concepts like "matter," "disease," "psyche. " Surely there have been books published on the logic and philosophy of medi 1 cine. But the formalization of issues and concepts in medicine has not received, at least in this century, sustained interest by professional phi losophers. Groups of philosophers have not engaged medicine in order to explicate its philosophical presuppositions and to sort out the various concepts which appear in medicine. The scope of such an effort takes the philosopher beyond problems and issues which today are subsumed under the rubric "medical ethics."

This book attempts to answer the question how health care can be incorporated into a comprehensive theory of justice, while realising an acceptable balance between efficiency, justice and care. It seems to be that we can have any two but not all three. Essentially, the central question addressed by this book is the following: how best to square the proverbial welfare circle.

Theologians and theologically educated participants in discussions of bioethics have been placed on the defensive during recent years. The dominance of religious perspectives and theological voices that marked the emergence and establishment of "bioethics" in the late 1960s and 1970s has eroded steadily as philosophers, lawyers, and others have relativized their role and influ ence, at best, or dismissed it entirely, at worst. The secularization of bioethics, which has occurred for a variety of reasons, has prompted some prominent writers to reflect on what has been lost. Daniel Callahan, for example writes, " . . . whatever the ultimate truth status of religious perspectives, they have provided a way of looking at the world and understanding one's own life that has a fecundity and uniqueness not matched by philosophy, law, or political theory. Those of us who have lost our reli gious faith may be glad that we have discovered what we take to be the reality of things, but we can still recognize that we have also lost something of great value as well: the faith, vision, insights, and experience of whole peoples and traditions who, no less than we unbelievers, struggled to make sense of things. That those goods are part of a garment we no longer want to wear does not make their loss anything other than still a loss; and it is not a neglible one" ([2], p. 2).