The Dutch experience has influenced the debate on euthanasia and death with dignity around the globe, especially with regard to whether physician-assisted suicide and euthanasia should be legitimized or legalized. A review of the literature reveals complex and often contradictory views about the Dutch experience. Some claim that the Netherlands offers a model for the world to follow; others believe that the Netherlands represents danger, rather than promise, and that the Dutch experience is the definitive answer regarding why we should not make active euthanasia and physician-assisted suicide part of our lives. Given these contradictory views, it has become clear that fieldwork is essential to developing a more informed opinion. Having investigated the Dutch experience for a number of years, and after thoroughly reading the vast literature published in English, I went to the Netherlands for one month in the summer of 1999 to get a feel for the local situation. I felt that this would provide the basis on which I could better interpret the findings of the available literature. I visited the major centers of medical ethics, as well as some research hospitals, and spoke with leading figures in the euthanasia policy and practice. The time spent was extremely beneficial and enriching. I followed in the footsteps of Carlos Gomez, who 1 published a book following one month of extensive research in the Netherlands.

K. Danner Clouser is one of the most important figures in establishing and shaping the fields of medical ethics, bioethics, and the philosophy of education in the second half of the twentieth century. Clouser challenged many established approaches to moral theory and offered innovative strategies for integrating the humanities into professional education, especially that of physicians and nurses. The contributions published in Building Bioethics: Conversations with Clouser and Friends on Medical Ethics are unique both in their devotion to a critical review of his contributions, and in bringing together internationally known figures in bioethics, medical ethics, and philosophy of medicine to comment upon Clouser's work. These leaders of the field include Tom Beauchamp, Daniel Callahan, James Childress, Nancy Dubler, H. Tristram Engelhardt, Al Jonsen, Loretta Kopelman, Larry McCullough, John Moskop, and Robert Veatch. This book merits special attention from those interested in bioethics, philosophy of medicine, medical ethics, philosophy, medical education, religious studies, and nursing education.

This book contributes to an overall understanding of the nature and the impact of sexual boundary violations. By exploring an extreme human experience, childhood sexual abuse, the present study allows an insight into a hidden, silenced, and destructive aspect of human relations. It is the first of its kind to make comprehensible both the general path from violation to sickness, and the particular logic of assault embodiment. Due to its theoretical and methodological framework, the present study provides evidence that the embodiment of sexual violation experience is informed by situated logic and rationality. These, however, do not correspond to scientific logic and rationality. The universe of socio-culturally constituted meaning and that of scientifically constructed knowledge are shown to be incompatible. Subjectively informed violation embodiment is likely to be misinterpreted and consequently maltreated within the objectively grounded framework of current biomedical praxis. Consequently, victims of silenced sexual violence are revictimized by medicine.

The editors have incurred many debts in preparing this book, and both etiquette and ethics would be contravened if they were not discharged here. Above all, we wish to thank the contributors for so cheerfully complying with our suggestions for preparing their papers for publication and efficiently meeting our schedules. It is thanks to their cooperation that this volume has appeared speedily and painlessly; their revisions have helped to give it internal coherence. This volume has emerged from papers delivered at a conference on the History of Medical Ethics, held at the Wellcome Institute for the History of Medicine, London, 1 December, 1989. We are most grateful to the Wellcome Trust for having underwritten the costs of the conference, and to Frieda Houser and Stephen Emberton whose organizational skills contributed so much to making it a smoothly-run and enjoyable day. In addition to the papers delivered at the conference, we are delighted to have secured further contributions from David Harley and Johanna Geyer-Kordesch. Our thanks to them for their eager help. From start to finish, we have received splendid encouragement from all those connected with the Philosophy and Medicine series, especially Professor Stuart Spicker, and Martin Scrivener at Kluwer Academic Publishers. Their enthusiasm has lightened our load, and expedited the editorial process.

Positive conceptions of healthy aging are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When the body or mind begins to fail, a legitimate need for intervention and care will arise. This second volume on Aging discusses this theme.

The term bioethics' was coined in 1971, just as interest in the medical humanities claimed a prominent place in medical education. Out of this interest, a substantial area of research and scholarship took shape: the philosophy of medicine. This field has been directed to the epistemological, ontological, and value-theoretical issues occasioned by medicine and the biomedical sciences. Bioethics is nested in this field and can only be fully understood in terms of the foundational issues it addresses. This collection of essays in honor of Stuart F. Spicker, one of the individuals who gave shape to the philosophy of medicine, lays out the broad scope of concerns from the philosophy of embodiment, to issues of the role of ethics consultants, to concepts of disease, equity and the meaning of history.

This book is a part of the ongoing enterprise to understand the nature of human health and illness. This enterprise has expanded dramatically during the last decades. A great number of articles, as weIl as a fair number of monographs, on this topic have been published by renowned international publishers. In this discussion most participants share the idea that health is a partially normative concept, Le. that health is not a phe nomenon which can be wholly characterised in biological (or otherwise descriptive) terms. To ascribe health to a person is eo ipso, according to this line of thought, to as cribe a positively evaluated property to this person. Moreover, most debators share the idea that health is a holistic property, belonging to the person as a whole, whereas dis eases, injuries and defects are entities (or properties of entities) which can be very lim ited and and normally affect only a part of the individual. My own monograph belongs to this tradition. A feature of my position, which is not universally acknowledged in riyal theories, however, is my emphasis on the notion of ability as a fundament in the theory of health. In my formal characterisation of health I view it as astate of a person which is such that the person has the ability to fulfi1 his or her vital goals."

This book addresses well-known issues - the ethical, legal, and social implications of human genetics - but does so from an unusual perspective: the perspective of the scientific community itself. In distinction to what is common in the ELSI literature, the book also discusses bioethical method. A new kind of casuistry is developed on the basis of the empirical findings of cognitive semantics. It will be of interest to philosophers, bioethicists, geneticists, and policymakers.

Charles Bonnet began his career as a naturalist, from an early age establishing a reputation as a careful observer. It is for those youthful observations, as well as for some suggestive speculations proposed relative to this field, that he is best remembered in English-speaking countries: regarding the taxonomic de mands of natural history he refurbished the idea of a chain of beings; regarding the question of generation he marshaled evidence in support of preforma tion theory; and regarding the analysis of the physiology of the nervous system he advanced a theory that individual nerve fibers receive and retain specific sensations. Following his loss of eyesight in his mid-twenties Bonnet entered a more reflective period, turning to philosophy and pondering the nature of human understanding - considerations he had formerly disdained, but that now seemed a natural outgrowth of his reflections on nature. This essay focuses on the philosophical and psychological works of the later period, the period in which he wrote all his major books. By giving these writings a broader exposure it has been one of my hopes that Bonnet's audience would also be broadened, releasing him, so to speak, from the charge of historians of science so that he might fmd his way, in general books on the "Enlightenment," from scattered footnotes into the texts themselves."

Over a period of a year, the symposium on clinical judgment has taken shape as a volume devoted to the analysis of how knowledge claims are framed in medicine and how choices of treatment are made. We hope it will afford the reader, whether layman, physician or philosopher, a useful perspective on the process of knowing what occurs in medicine; and that the results of the dis cussions at the Fifth Symposium on Philosophy and Medicine will lead to a better understanding of how philosophy and medicine can usefully challenge each other. As the interchange between physicians, philosophers, nurses and psychologists recorded in the major papers, the commentaries and the round table discussion shows, these issues are truly interdisciplinary. In particular, they have shown that members of the health care professions have much to learn about themselves from philosophers as well as much of interest to engage philosophers. By making the structure of medical reasoning more apparent to its users, philosophers can show health care practitioners how better to master clinical judgment and how better to focus it towards the goods and values medicine wishes to pursue. Becoming clearer about the process of knowing can in short teach us how to know better and how to learn more efficiently. The result can be more than (though it surely would be enough ) a powerful intellectual insight into a major cultural endeavor, medicine."

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D. , joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J.

Nanobiotechnology is the convergence of existing and new biotechnology with the 1 ability to manipulate matter at or near the molecular level. This ability to manipulate matter on a scale of 100 nanometers (nm) or less is what constitutes the nanotechnology revolution occurring today, the potentially vast economic and social implications of which are yet to be fully understood (Royal Society, 2004). The most immediate way to understand the implications of nanobiotechnology for ethics is to consider the real life concerns of communities that are mobilizing within civil society. The conflicts and ethical debates surrounding nanotechnology will, almost by definition, emerge on the fault lines between different civil society actors, researchers and financial interests associated with nanobiotechnology, as well as (potentially) government regulators. These fault lines are all reflected within the concerns (as expressed d- cursively) of the communities mobilizing. This chapter will explore converging d- courses regarding converging technologies. Converging Technologies (CT) are already a familiar theme in the next gene- tion of biotechnology, nanotechnology, pharmacogenomics and proteomics research 2 and development. Nanobiotechnology means that previously separate disciplines (IT, physics, chemistry, and biology) are merging and converging to create new applications and even new life forms through converged technological platforms. Schummer (2004), and Glimell and Fogelberg (2003, p. 43), note the predominance of interdisciplinarity as a core theme of nano-discourse.

1. GENERAL The term "diagnostics" refers to the general theory of diagnosis, not to the study of specific diagnoses but to their general framework. It borrows from different sciences and from different philosophies. Traditionally, the general framework of diagnostics was not distinguished from the framework of medicine. It was not taught in special courses in any systematic way; it was not accorded special attention: students absorbed it intuitively. There is almost no comprehensive study of diagnostics. The instruction in diagnosis provided in medical schools is exclusively specific. Clinical instruction includes (in addition to vital background information, such as anatomy and physiology) specific instruction in nosology, the theory and classification of diseases, and this includes information on diagnoses and prognoses of diverse diseases. What is the cause of the neglect of diagnostics, and of its integrated teaching? The main cause may be the prevalence of the view of diagnostics as part-and parcel of nosology. In this book nosology is taken as a given, autonomous field of study, which invites almost no comments; we shall freely borrow from it a few important general theses and a few examples. We attempt to integrate here three studies: ll of the way nosology is used in the diagnostic process; of the diagnostic process as a branch of applied ethics; ~ of the diagnostic process as a branch of social science and social technology.

The question of whether there might be a duty to die was first raised by Margaret Battin in 1987 in her ground-breaking essay, "Age Distribution and the Just Distribution of Health Care: Is There a Duty to-Die?" In 1997 the issue was reprised when two new articles appeared on the topic written by John Hardwig and the other by former Colorado Governor Richard D. Lamm. Given the renewed interest in the topic, as well as its undeniable importance, Biomedical Ethics Re views sought to initiate an in-depth discussion of the issue by soliciting articles and issuing a general call for papers on the topic "Is There a Duty to Die?" The twelve articles in this volume represent the ultimate fruits of those initiatives. The first seven essays in this text are sympathetic to the claim that there is a duty to die. They argue either: (a) that some form of a duty to die exists, or (b) that arguments that might be offered against the existence of such a duty cannot be sustained. By way of contrast, the last five articles in the text are critical of duty-to-die claims: The authors of the first three of these five articles attempt to cast doubt on the existence of a duty to die, and the writers of the last two essays argue that if such a duty did exist, severe problems would arise when ever we attempted to implement it."

Medical healing implies knowledge of the assumptions that underlie our understanding of "health," and, concomitantly, how we define well being and its opposites, illness and disease. Today, health, health care (business, wellness, recreation), and medicine (especially research-driven scientific medicine) have become separate entities with different institutions, budgets, marketing philosophies and "corporate cultures." Furthermore, healing is individual and subjective, yet at the same time also culturally determined. The present volume brings together papers on these topics in an unique interdisciplinary approach. The book provides an ethical framework for healthcare from a political perspective. It discusses definitions of the terminology of healing and health and their ethical and medical implications including their historical contexts. A separate section expands the theme of the cultural constructedness of healing by the concepts of traditional Chinese medicine and homeopathy. Modern medicine has a strong focus on acute care, which urgently needs to place greater emphasis on preventive medicine including the crucial importance of social factors on health and on the emergence of "public health." The point of view of Business Concepts, their potential and limitations are by no means neglected and the legal ramifications of genetic research and innovative medical strategies with regard to some of our most foundational notions are discussed.

In this remarkable book, Gary Wright focuses thirty years experience as a family physician, and his Ph.D. in philosophy, to address the nature of good medical reasoning. Wright folds cognitive science into a pragmatist framework developed by John Dewey; this alternative view of mind and medical judgment leads to a model of reasoning that offers realistic guidance for medical decisions, one that each of us would want our own physicians to adopt.

The idea for an anthology on personhood grew out of two things, viz., the work I did with Martin Benjamin during the Summer of 1982 at Michigan State University on the question, What is a person?, and the amount of time, effort, and expense required for serious research on the topic itself. The former experience taught me the importance of, among other things, attempting to get clear about what we are to mean by 'person, ' while the latter experience suggested a possible course of action whereby getting clear might be made more manage able simply by having relatively convenient access to some of the most insightful and stimulating writings on the topic. The problems of personhood addressed in this book are central to issues in ethics ranging from the treatment or termination of infants with birth defects to the question whether there can be rational suicide. But before questions on such issues as the morality of abortion, genetic engineering, infanticide, and so on, can be settled, the prob lems of personhood must be clarified and analyzed. Hence What Is a Person? has as its primary theme the examination of various proposed conditions of personhood."

Internationally recognized scientists, clinicians, and technologists review and explain the fundamental molecular and cellular biology that has been applied to the emerging field of transplant immunology and xenotransplantation, and what impact these advances might optimally have on medicine and science. The authoritative experts writing here-many of whom made the basic discoveries underlying the recent advances-examine the biological and immunological hurdles to xenotransplantation, illuminating how the immune system interacts with the xenograft and laying a practical foundation for the use of genetic engineering and animal transplants in the treatment of human disease.

Prominent bioethicists whose work is rooted in philosophy, religion, medicine, nursing, literature, history, and policy analysis join together to discuss their methods and professional insights, as well as to better define the field and its future development. Writing from the perspective of their own specialties, the authors: review just how their personal disciplines have contributed to bioethics, debate the current and future bioethical issues they face, and identify the most significant strengths and weaknesses in the current practice of bioethics. Seeking a sound foundation for the discipline, they also consider what basic knowledge and skills are necessary to be competent in bioethics, what methods and theoretical approaches are most promising for its future development, and what issues or perspectives have been neglected.

In the second half of the 20th century, the body has become a central theme of intellectual debate. How should we perceive the human body? Is it best understood biologically, experientially, culturally? How do social institutions exercise power over the body and determine norms of health and behavior? The answers arrived at by phenomenologists, social theorists, and feminists have radically challenged our cenventional notions of the body dating back to 17th century Cartesian thought. This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine. Its authors suggest that many of the problems often found in modern medicine -- dehumanized treatment, overspecialization, neglect of the mind's healing resources -- are directly traceable to medicine's outmoded concepts of the body. New and exciting alternatives are proposed by some of the foremost physicians and philosophers working in the medical humanities today.

This collection of essays represents the work produced in the course of a three-year project funded by the Commission of the European Communities under the Biomed I programme, on the ethics of genetic screening, entitled 'Genetic screening: ethical and philosophical perspectives, with special reference to multifactorial diseases'. The short title of the project was Euroscreen, thereafter known as Euroscreen I, in the light of the fact that a second project on genetic screening was subsequently funded. The project was multinational and multidisciplinary, and had as its objectives to examine the nature and extent of genetic screening programmes in different European countries; to analyse the social policy response to these developments in different countries; and to explore the applicability of normative ethical frameworks to the issues. The project was led by a core group who had oversight of the project and members of which have acted as editors for this volume. Darren Shickle edited the first section; Henk ten Have the second; Ruth Chadwick and Urban Wiesing the third and final part. The volume opens with an overview of genetic screening and the principles available for addressing developments in the field, with special reference to the Wilson and Jungner principles on screening. The first of the three major sections thereafter includes papers on the state of the art in different countries, together with some analysis of social context and policy.

PERSONHOOD AND HEALTH CARE This book arose as a result of a pre-conference devoted to the topic held June 28, 1999 in Paris, France. The pre-conference preceded the Annual Congress of the International Academy ofLaw and Mental Health. Other chapters were solicited after the conference in order to more completely explore the relation of personhood to health care. The pre conference was held in honor of Yves Pelicier who led so many of our French colleagues in medicine, philosophy, and ethics as Christian Herve notes in his Tribute. As health care is aimed at healing persons, it is important to realize how difficult it is to construct a theory of personhood for health care, and thus, a theory of how healing in health care comes about or ought to occur. The book is divided into four parts, Concepts of the Person, Theories of Personhood in Relation to Health Care and Bioethics, Person and Identity, and Personhood and Hs Relations. Each section explores a critical arena in constructing the relation of personhood to health care. Although no exploration ofthis nature can be exhaustive, every effort was made to present both conflicting and complementary views of personhood from within similar and different philosophical and religious traditions. PART ONE: CONCEPTS OF THE PERSON Tracing the origins of the concept of person from antiquity through present day, Jean Delemeau provides an historical sketch of the development of a wide range of meanings."

Medicine Across Cultures: The History and Practice of Medicine in Non-Western Cultures consists of 19 essays dealing with the medical knowledge and beliefs of cultures outside of the United States and Europe. In addition to articles surveying Islamic, Chinese, Native American, Aboriginal Australian, Indian, Egyptian, and Tibetan medicine, the book includes essays on comparing Chinese and western medicine and religion and medicine. The essays address the connections between medicine and culture and relate the medical practices to the cultures which produced them. Each essay is well illustrated and contains an extensive bibliography. Because the geographic range is global, the book fills a gap in both the history of medicine and in cultural studies. It should find a place on the bookshelves of advanced undergraduate students, graduate students, and scholars, as well as in libraries serving those groups.

Section I examines historical philosophical understandings of expertise in order to situate the current institution of bioethics. Section II focuses on philosophical analyses of the concept of expertise, asking, among other things, how it should be understood, how it can be acquired, and what such expertise warrants. Finally, section III addresses topics in bioethics and how ethics expertise should or should not be brought to bear in these areas, including expertise in the court room, in the hospital room, in the media, and in making policy. 2. A GUIDED HISTORICAL TOUR As Scott LaBarge points out, Plato's dialogues can be viewed as an extended treatment of the concept of moral expertise, so it is fitting to begin the volume with an examination of "Socrates and Moral Expertise." Given Socrates' protestations (the Oracle at Delphi notwithstanding) that he knows nothing, LaBarge observes that it would be interesting to determine both what a Socratic theory of moral expertise might be and whether Socrates qualified as such an expert. Plato's model of moral expertise is what LaBarge calls "demonstrable expertise," which is concerned mainly with the ability to attain a goal and to explain how one did it. The problem with this account is that when one tries to solve the various problems in the model - for example, allowing that moral expertise is not an all-or-nothing skill - then one is immediately faced with the "credentials problem." As LaBarge puts it, ." . .