This volume introduces a new subseries of Philosophy and Medicine, Classics of Medical Ethics. The purpose of this new subseries is to bring out scholars' editions of major works in the history of medical ethics and philosophy of medicine. This new subseries will target for publication texts that are long out of print and difficult to access. Each volume will contain an introduction to the writings on medical ethics and philosophy of medicine produced by the original author. Each volume will also contain a guide to the primary and major secondary Hterature, to facilitate teaching and scholarship in bioethics, philosophy of medicine, and history of medicine. Texts will be presented in their origi nal style and will provide pagination of the original, so that citations can be made either to the original text or to the page numbers in these vol umes. Finally, each volume will be well indexed, again to facilitate teaching and research. Bioethics and philosophy of medicine - the former more so than the latter - have an insufficiently developed understanding of themselves as having a history. As a consequence, these fields lack the maturity that critical dialogue of the past with the present provides for other fields and disciplines of the humanities. To the extent that this problem is due to the fact that major primary historical sources are not readily available, this subseries will contribute to the further development and maturation of bioethics and philosophy of medicine as fields of the humanities."

Despite reservoirs of moral discourse about duties in religious communities, professional caregiving traditions, and philosophical perspectives, the dominant moral language in contemporary biomedical ethics is that of rights'. Duties to Others begins to correct this imbalance in our ethical language through theoretical expositions of the ideas of duty and of the other', and by applied exemplifications of particular duties to identified others that arise in the context of health care. A pronounced multidisciplinary orientation informs this analysis of our moral call to respond to the needs of others. The essays in this volume offer a stimulating intellectual freshness through a continual engagement of theological, professional, and philosophical understandings of the duties that arise in our relationships with others in medicine, nursing, and social contexts. Duties to Others provides provocative challenges about the terrain of our moral world for both students and professionals in biomedical ethics, medicine, philosophy, and theology.

Questions concerning the notion of quality of life, its definition, and its ap plications for purposes of assessment and measurement in social and medical contexts, have been widely discussed in Scandinavia during the last ten years. To a great extent this discussion mirrors the international develop ment in the area. Several methods for the assessment and measurement of quality of life have been borrowed from the UK and the US and then further developed in northern Europe. But there has also been an internal develop ment. This holds in particular for the social arena, where Scandinavia has had a special tradition both in theory and practice. In this volume an attempt is made to illustrate some aspects of the philo sophical, and in general theoretical, discussion concerning quality of life in Scandinavia. In addition, some prominent scholars from other parts of Europe, i. e., France, the Netherlands, the UK and Italy, have been invited to contribute. The volume is divided into three sections. The first contains philosophical analyses of the general notion of quality of life and proposes a number of different explications. The second section considers various ap plications of the notion of quality of life in health care. The papers serve to disentangle some intellectual and ethical problems that stem from these ap plications. The third section is more practical and focuses on methods of measuring quality of life in medicine and health care."

debating (and possibly ratifying) the Convention at the national level 13]. The Convention identified basic principles necessary for the applica tion of medicine and the life sciences. It set out to protect the dignity and identity of all human beings: ''The interests and welfare of the human being shall prevail over the sole interest of society or science" (art. 2). It also requests that appropriate measures be taken to provide equitable access to healthcare of appropriate quality. The principle of respecting the free and informed consent of the person is clearly stressed. The issue of interventions on persons unable to provide an informed consent has been controversial for a long time; in the first draft, the exact formulation of the relevant article remained open. Now it states that interventions may be carried out on persons with impaired decision-making capacities, but only for their benefit, and only if minimal risks and minimal burdens are imposed. Consensus apparently exists over a broad range of issues. Privacy and free access to information are defined as rights, in article 10. Discrimination against a person on the basis of his or her genetic heritage is prohibited. Sex selection in medically assisted procreation is prohibited (except to avoid serious hereditary, sex-related diseases). Financial gain from using the human body and its parts is explicitly prohibited. The more controversial issues in bioethics are not addressed in this Convention, however. An exception is research on embryos in vitro."

A major focus of the philosophy of medicine and, in general, of the philosophy of science has been the interplay of facts and values. Nowhere is an evaluation of this interplay more important than in the ethics of diagnosis. Traditionally, diagnosis has been understood as an epistemological activity which is concerned with facts and excludes the intrusion of values. The essays in this volume challenge this assumption. Questions of knowledge in diagnosis are intimately related to the concerns with intervention that characterize the applied science of medicine. Broad social and individual goals, as well as diverse ethical frameworks, are shown to condition both the processes and results of diagnosis. This has significant implications for bioethics, implications that have not previously been developed. With this volume, the ethics of diagnosis' is established as an important branch of bioethics.

Religious beliefs and attitudes have long been recognized as playing an important role in sexual functioning, but the relationship between religion and sexual behavior has rarely been studied in a comprehensive way. The essays in this volume bring the views of sex counsellors, therapists. theologians, and bioethicists to bear on the relationship between religion and sexuality. A major theme emerging from these essays is that religion and counselling need to learn from one another. Religious traditions, at the popular or theological levels, are often marked by ignorance and misinformation about sexuality and can benefit by the insights of those who work closely with patients in medical and counselling settings. Counsellors, in turn, need to develop a sensitivity to past and present religious attitudes toward sexuality in order to assist their patients achieve sexual health.

Enhanced knowledge of the nature and causes of mental disorder have led increasingly to a need for the recruitment of cognitively vulnerable participants in biomedical research. These individuals often fall into the grey area between obvious decisional competence and obvious decisional incompetence and, as a result, may not be recognised as having the legal capacity to make such decisions themselves. At the core of the ethical debate surrounding the participation of cognitively vulnerable individuals in research is when, if at all, we should judge them decisionally and legally competent to consent to or refuse research participation on their own behalf and when they should be judged incompetent in this respect.

In this book, the author develops a novel justificatory framework for making judgments of decisional competence to consent to biomedical research with reference to five groups of cognitively vulnerable individuals - older children and adolescents, adults with intellectual disabilities, adults with depression, adults with schizophrenia and adults with dementia, including Alzheimer s disease. Using this framework, the author argues that we can make morally defensible judgments about the competence or incompetence of a potential participant to give contemporaneous consent to research by having regard to whether a judgment of competence would be more harmful to the generic rights of the potential participant than a judgment of incompetence. The argument is also used to justify an account of supported decision-making in research, and applied to evaluate the extent to which this approach is evident in existing ethical guidelines and legal provisions. The book will be of interest to bioethicists as well as psychiatrists and academic medical lawyers interested in normative questions raised by the concepts of competence and capacity."

The idea of preparing a new critical edition of Elisha Bartlett's Essay on the Philosophy of Medical Science was suggested to me several years ago by Dr. H. Tristram Engelhardt, Jr. Since that time it has been a pleasure to get to know the life and work of Elisha Bartlett. I am pleased to be completing this book in the bicentennial year of Bartlett's birth. Bartlett was born in 1804 in Smithfield, Rhode Island, less than twenty-five miles from Worcester, Massachusetts, my present home-a short journey even in Bartlett's day. I have been able to walk at some of the sites to which Bartlett continually returned during his life. Visiting Bartlett's grave in the Slatersville cemetery has been an inspiration for the preparation of this book. Proximity to several institutions with rich holdings in Bartlett's works and in nineteenth-century American history of medicine greatly facilitated my research. First, though, I want to acknowledge the College of the Holy Cross for supporting my sabbatical leave for the academic year 2003-2004. The American Antiquarian Society, in Worcester, Massachusetts, was generous in giving me access to its remarkable resources. I was able to find many of Bartlett's published works and other nineteenth-century medical literature there, and the entire library staff provided quick and able research assistance.

In 1978, the World Health Organization (WHO) designated the year 2000 as the "due date" for world health. The Alma Ata declaration set the turn of the century as the target for a level of health that would permit all people of the world to lead a socially and economically productive life. ' At that (magic but arbitrary) date most infectious diseases and many chronic conditions, including diabetes and cancer, were expected to have been eradicated or at least controlled. Such predictions were based on solid foundations. In the 1 20 h century, and particularly since the 1970's, Western science and technology based (or "modern") medicine has made quantum leaps in numerous areas as diverse as pharmacology, genetic and molecular biology, surgical techniques, infertility treatments, and pre- and neo-natal care. This impressive trajectory of progress, which continues unabatedly, gave every reason to assume that come the year 2000 humanity would finally be free from many of its ancient scourges. However, as we are all too well aware, the new millennium witnesses also ever more terrifying threats to our health as a result of the emergence of 2 AIDS in the early 80's, the resurgence of infectious diseases such as 3 tuberculosis and malaria, now drug resistant, the absence of significant breakthroughs in the treatment of cancer and cardiovascular diseases, and the continuing dramatic gap in health care between industrialized and developing countries, to mention but a few examples.

Genetic Democracy involves an in-depth analysis of the ethical, social and philosophical issues related to modern genetic research and gene technology. The aim of the book is to introduce systematic research on the social and ethical impacts of the use and development of genetically modified organisms (GMOs) as well as the acquisition, use and storage of human genetic information (HGI). The book contributes to enhancing public discussion and reaching fair and democratic decision-making practices in GMO and HGI use and development both on local and global level.

There are currently few European texts which address the issues involved in a theoretical and systematical manner. Genetic Democracy has been written from the viewpoint of social and political philosophy rather than that of traditional bioethics. There is a clear need for a throughout and authoritative philosophical and ethical analysis of the issues involved in genetic research and gene technology. The book will appeal to philosophers, social scientists, genetics professionals, policy makers, academics, industrial organisations and human rights organisations as well as university students and legal scholars. The book will have a broad appeal across Europe, Asia and America since many states are currently considering policy responses to many of the practices discussed in the books (e.g., human biobanks)."

This is the first book in healthcare ethics addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. The book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific legal arrangements in The Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed: libertarian, personalist, deontological and utilitarian theories of body ownership.

1 Historical Introduction INTRODUCTION This chapter is mainly about the history of medicine and its ethics. As usually c- ceived, history is retrograde: It is what happened yesterday, and, much as we may try, it is what happened yesterday seen with a set of today's eyes. Trying to understand yesterday's culture may help us put on a pair of corrective glasses, but it fails in - tirely correcting our vision. Contemporary cultural anthropology may likewise help us understand the way today's events and cultural habits shape what we call history tomorrow. Past events and the kaleidoscopic pattern of today's cultures may help guide us into a future that in at least some respects is ours to forge. Learning about ethics yesterday and thinking about ethics as it expresses itself in various cultures today can help us shape the ethics of tomorrow: This is true whether we are speaking of that part of social ethics called "medical" or of any other part of social ethics. The social aspects of medical practice-how the institution called medicine fits into and works within the greater society called culture-shape the way its ethics ultimately must play itself out.

In virtually all the developed countries of the Western world, people are living longer and reproducing less. At the same time, costs for the care of the elderly and infirm continue to rise dramatically. Given these facts, it should come as no surprise that we are experi- encing an ever-increasing concern with questions relating to the proper care and treatment of the aged. What responsibilities do soci- eties have to their aging citizens? What duties, if any, do grown chil- dren owe their parents? What markers should we use to determine one's status as "elderly"? Does treatment of pain in aged patients present special medical and/or moral problems? How can the com- peting claims of autonomy and optimal medical care be reconciled for elderly persons who require assisted living? When, if ever, should severely demented patients be included in nontherapeutic clinical tri- als? These questions, and others of similar interest to those con- cerned with the proper treatment of the aged, are discussed in depth in the articles included in this text. The essays in this volume of Biomedical Ethics Reviews fall loosely into two broad categories. The first four articles-those con- tributed by Sheila M. Neysmith, Allyson Robichaud, Jennifer Jackson, and Susan McCarthy-raise general questions concerning the propri- ety of Western society'S current mechanisms for dealing with and treat- ing elderly citizens. The remaining four articles-those by Simon Woods and Max Elstein, Marshall B.

Any list of the most influential figures of the second half of the twentieth century would arguably have to begin with the name of Pope John Paul II. From 1978, when he was inaugurated, to the present, over a quarter of a century later, the Pope has been a dominant force in the world, both within the Catholic and Christian Church, and in the larger international community. Among the areas in which the Pope has been of signal importance to contemporary discussion, argument, and policy has been the field of bioethics. This collection brings together for the first time in an accessible and readable form a summary and assessment of John Paul II's contribution to bioethical issues and theories. It includes discussion of the Pope's views on the dignity of the person and the sanctity of human life, and the application of these views to various difficulties in medical ethics such as abortion and embryo research, the right to health care and the problem of suffering. Throughout, attention is paid to the way in which the Pope stands as a recognizably authentic voice for the Catholic faith in the medical arena.

In this book, developed by a group of collaborating scholars in bioethics from different European countries, an overview is given of the most salient themes in present-day bioethics. The themes are discussed in order to enable the reader to have an in-depth overview of the state of the art in bioethics. Introductory chapters will guide the reader through the relevant dimensions of a particular area, while subsequent case discussions will help the reader to apply the ethical theories to specific clinical problems and health policy queries. The book focuses on perspectives typical for the European context. This highlights not only particular bioethical themes such as social justice, choices in health care, and health policy (e.g., in post-communist countries), it also emphasizes specific approaches in ethical theory, in relation to Continental philosophies such as phenomenology and hermeneutics.
Because of its articulation of what is typical for the European health care setting as well as for bioethical debate, this book is unique in comparison to existing textbooks in bioethics.
The book is an introductory textbook acquainting the reader with the major issues in present-day health care as well as the various theoretical and practical approaches to clarify these issues.

Efforts to evaluate the clinical encounter in terms of autonomous agents governed by rationally justified moral principles continue to be criticised. These essays, written by physicians, ethicists, theologians and philosophers, examine various models of the clinical encounter emerging out of these criticisms and explore the prospects they offer for theological and religious discourse. Individual essays focus on the reformulation of covenant models; revisions of principles approaches; and topics such as power, authority, narrative, rhetoric, dialogue, and alterity. The essays display a range of conclusions about whether theology articulates generally accessible religious insights or is a tradition-specific discipline. Hence the volume reflects current debates in theology while analysing current models of the clinical encounter. Students, professionals, and scholars who find themselves at the intersection of theology and medicine will welcome these voices in an ongoing conversation.

Papers presented at a symposium on philosophy and medicine at the Institute for the Medical Humanities at the University of Texas Medical Branch in 1974 were published in the inaugural volume of this series. To help celebrate more than 20 years of extraordinary success with the series, another symposium was convened in Galveston in 1995. The convenors asked the participants these questions: In what ways and to what ends have academic humanists and medical scientists and practitioners become serious conversation partners in recent years? How have their dialogues been shaped by prevailing social views, political philosophies, academic habits, professional mores, and public pressures? What have been the key concepts and questions of these dialogues? Have the dialogues made any appreciable intellectual or social difference? Have they improved the care of the sick? Authors respond from a variety of theoretical perspectives in the humanities. They also articulate conceptions of philosophy of medicine and bioethics from various practice experiences, and bring critical attention to aspects of the contemporary health policy.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

This is an original contribution to the much debated area of the value that we should place on human life. With the euthanasia issue highlighted in the public arena this book argues for a non-absolutist highest value on life ethic and how that fits with society's current emphasis on individual autonomy. By the use of everyday examples the impact of placing a high value on life is explored. It will be useful for students of ethics, nursing and medicine and those engaged in the public debate on euthanasia.

in the culture of medicine, and they saw their mission as a generation of profit for stockholders, not necessarily medical care for clients. Cost-effective medicine was the goal in the context of a profit-making enterprise. Although preventive health care programs were promised, very few were realized and they were not nearly comprehensive. The definition of unnecessary testing slowly expanded to mean virtually any high-cost test requiring the service of a medical specialist, and low priced generalist physicians with limited diagnostic and therapeutic skills were made available to patients with the instruction they should limit their access to high-cost specialists. Managed care organizations tended to re ward primary care physicians who avoided specialty referrals, and severed contracts with those who persisted in sending their patients to outside consultants. Most notoriously, managed care organizations maintained veto authority over the provision of complex and expensive care, and that veto was often wielded in defiance of a physician's recommendation by managed care employees without medical training or experience. Managed care did indeed slow the rate in increase of medical costs, but not without limitations on the care provided to patients and the professional integrity of physicians. Managed care organizations were so successful that they could provide extremely high salaries to their executives even in the context of limiting cost and care. It is these developments that the papers of this symposium addressed. The most fundamental ethical issue is posed in the first paper by Dr."

Debate regarding organ sales is largely innocent of the history of thought on the matter. This volume seeks to remedy this shortcoming. Positions for or against a market in human organs are nested within moral intuitions, ontological or political theoretical premises, or understandings of special moral concerns, such as permissible uses of the body, which have a long history of analysis. The essays compass the views of Plato, Aristotle, Aquinas, Locke, Kant, Hegel, Mill and Christianity, as well as particular methodological approaches, such as the phenomenology of the body, natural law theory, legal theory and libertarian critique of legal theory. These discussions cluster a number of conceptually independent philosophical concerns: (1) What is the appropriate understanding of the relationship between persons and their bodies? (2) What does it mean to own' an organ? (3) Do governments have moral authority to regulate how persons use their own body parts? (4) What are the costs and benefits of a market in human organs? Such questions are related by an urgent public health challenge: the considerable disparity between the number of patients who could significantly benefit from organ transplantation and the number of human organs available for transplantation. This volume explores the theoretical, normative, and historical foundations for alternative policies for procurement and transplantation of human organs.

The potential of modern medicine in a pluralistic world leads to the potential for moral conflict. The most prevalent bioethical theories often either overestimate or underestimate the amount of shared moral belief that can be used to address those conflicts. This work presents a means for taking seriously the pluralism in the modern world while recognizing the likelihood of moral "acquaintance" between persons with differing views. It criticizes moral theories that overstate the extent of the problem of pluralism as well as those that imply too much agreement between reasonable moral persons, yet it locates a means for the resolution of many moral conflicts in moral acquaintanceship. Drawing from the work of H. Tristram Engelhardt, Jr., casuists and principle-based theorists, and Erich Loewy and Kevin W. Wildes's initial development of the concept of moral acquaintanceship, Moral Acquaintances and Moral Decisions is philosophically indepth work with direct applications for decisionmaking in real medical settings. A work in moral theory as well as a source of real world guidance, clinically oriented bioethics professionals as well as students of bioethical theory should find the theory of moral acquaintanceship provided here important to their work.

Religion is a dominant force in the lives of many Americans. It animates, challenges, directs and shapes, as well, the legal, political, and scientific agendas of the new Age of Biotechnology. In a very real way, religion, biomedical technology and law are - epistemologically - different. Yet, they are equal vectors of force in defining reality and approaching an understanding of it. Indeed, all three share a synergetic relationship, for they seek to understand and improve the human condition.

This book strikes a rich balance between thorough analysis (in the body), anchored in sound references to religion, law and medical scientific analysis, and a strong scholarly direction in the end notes. It presents new insights into the decision-making processes of the new Age of Biotechnology and shows how religion, law and medical science interact in shaping, directing and informing the political processes.

This volume will be of interest to both scholars and practitioners in the fields of religion and theology, philosophy, ethics, (family) law, science, medicine, political science and public policy, and gender studies. It will serve as a reference source and can be used in graduate and undergraduate courses in law, medicine and religion.

Within contemporary society, globalization has emerged as a key concern at the centre of ethical, legal and policy debates relating to health care. Conflicts between public interests and individual rights, the challenge of regulating health professionals and access to health services, and the effects of a global market all feature prominently in these discussions. As a result of globalization, these issues can no longer be understood solely within the political boundaries that define traditional notions of individuals and communities. Rather, solutions demand a global conception of rights and obligations, which in turn requires new approaches to health policy formulation and a reevaluation of existing ethical and legal frameworks. In essence, the impact of globalization on human health is testing the robustness of modern regulatory systems, legal doctrines and ethical paradigms. PUBLIC HEALTH: DEVELOPING GLOBAL CONCERNS The interconnectedness of the global economy presents new challenges in public health. While globalization has facilitated improvements in health care, it has also created new hazards and avenues for the exploitation of vulnerable persons. It is becoming increasingly apparent that both national and international responses are required. Indeed, as the chapters in this section convey, public health is rightly a global concern. Globalization has led to a sharing of both risks and responsibilities in public health. Belinda Bennett reminds us of the ease with which infectious diseases can spread within the global community, given the speed of modern travel and trade.