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.

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.

Science, Technology, and the Art of Medicine contains papers by eminent scholars who discuss issues and concepts regarding the character of medicine. Special attention is given to the extent to which medicine is a science, art, and technology. Investigations are carried out with a particular focus on the nature of medical knowledge. Concepts of medical research, medical causality, intuition, and medical decision-making are examined in the light of medicine's revolutionary advances in the twentieth century. Past perspectives and present perplexities are also examined, bringing together a volume in the philosophy of medicine that treats a broad range of issues in medical epistemology and practise in a careful, critical fashion.

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.

We have come to know that our ability to survive and grow as a nation to a very large degree depends upon our scientific progress. Moreover, it is not enough simply to keep 1 abreast of the rest of the world in scientific matters. We must maintain our leadership. President Harry Truman spoke those words in 1950, in the aftermath of World War II and in the midst of the Cold War. Indeed, the scientific and engineering leadership of the United States and its allies in the twentieth century played key roles in the successful outcomes of both World War II and the Cold War, sparing the world the twin horrors of fascism and totalitarian communism, and fueling the economic prosperity that followed. Today, as the United States and its allies once again find themselves at war, President Truman's words ring as true as they did a half-century ago. The goal set out in the Truman Administration of maintaining leadership in science has remained the policy of the U. S. Government to this day: Dr. John Marburger, the Director of the Office of Science and Technology (OSTP) in the Executive Office of the President, made remarks to that effect during his 2 confirmation hearings in October 2001. The United States needs metrics for measuring its success in meeting this goal of maintaining leadership in science and technology. That is one of the reasons that the National Science Foundation (NSF) and many other agencies of the U. S.

This volume is dedicated to the philosophy of medicine advanced by Edmund D. Pellegrino, a renowned physician educator and philosopher. Pellegrino's thinking about the philosophy of medicine centers on the importance of illness in the life of the patient, and the professional relationship established by promising to alleviate suffering. From this relationship norms are established that contribute to the staying power of medicine as a moral enterprise. Chapters are included from established thinkers and newcomers to the field, all of whom have been influenced by Pellegrino. Some chapters expand upon his thinking for primary care, managed care, and other delivery systems. Other chapters explain in more detail certain key concepts in Pellegrino's thought, like beneficence, doing no harm, and clinical phronesis or prudential decision making. Still others explore areas of difficulty like the reliance on role modeling and virtue ethics, the problem of pluralism and a loss of professional normative ethics, and the search for the foundations of the philosophy of medicine. Constructing a viable philosophy of medicine for the next century is an essential task for grounding the morality of medicine during enormous social and economic change. Pellegrino's thinking and the ideas of those he has influenced will contribute immensely to this challenge.

TERMINAL SEDATION DURING THE 1990s During the 1990s a discussion took place in scholarly journals concerning a measure within palliative care that had earlier attracted little attention, to wit, the sedation of dying patients. There seem to have been two main reasons why the practice came under debate. On the one hand, some people felt that, when palliative medicine had advanced and methods to control symptoms had improved, it was no longer justified to sedate the patients in a manner that had often been done in the past. The system of 1 terminal sedation had turned into 'euthanasia in disguise' or 'slow euthanasia'. On the other hand, there were people sympathetic to the recently established Dutch system of euthanasia, people who agreed that terminal sedation was euthanasia in disguise, but who felt that, if it is not objectionable to sedate dying patients at their request, then why should it not be permitted for doctors to kill dying patients at 2 request? From these two motives a discussion about terminal sedation gained momentum. The intention behind this anthology is to continue and deepen this discussion. The anthology starts off with a chapter where an influential article from the 1990s has been reprinted.

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.

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.

Baruch A. Brody has been one of the most important voices in bioethics over the last several decades, asking new and challenging questions about a range of problems, examining recalcitrant issues in novel ways, always with the goal of offering practical solutions to complex problems. This volume presents a sustained philosophical analysis of Brody s contributions to biomedical ethics. The essays in this volume compass epistemological, methodological, and topical contributions to bioethics, including both application and criticism of Brody s normative moral theory pluralistic casuistry Jewish medical ethics, human embryo transfer, medical futility, life and death decisions in pediatrics, euthanasia and end-of-life decision-making, the obligations of clinical researchers toward study participants, and professional integrity.

Done well, philosophical work can clarify complex issues, facilitate creative problem solving, and lead to real-world solutions to difficult situations. Each contributor carefully and critically explores Brody s writings in biomedical ethics and the philosophy of medicine, illustrating his appreciation that thorough and critical scientific research and philosophical analysis are central to reining in the untutored human desire to ameliorate pain and suffering so that medical treatments and health care policy do more good than harm. "

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.

The strength of this collection of essays is its careful consideration, from a variety of perspectives within the Catholic tradition, of the practice of embryo adoption. It approaches the question in an open and reasonable way by allowing proponents of diverse positions within the tradition. This method both sheds a great deal of light on the particular question and at the same time introduces the reader to the relevant general principles that guide Catholic moral thought.

Medical Law and Moral Rights discusses live issues arising in modern medical practice. Do patients undergoing intolerable irremediable suffering have a moral right to physician-assisted suicide? Ought they to have a comparable legal right? Do the moral duties of a mother to care for and not abuse her child also apply to her fetus? Ought fetuses to be given legal rights requiring pregnant women to submit to medical treatment without their consent? Ought single women, homosexual couples or persons carrying serious genetic defects to have a legal right to procreate? Ought a physician to perform an abortion requested for some frivolous reason? Ought physicians to be permitted to refuse to provide medically futile treatment demanded by their patients? An examination of relevant court cases shows how United States law answers these questions. The author then advocates improvements in the law to make it respect our moral rights more fully. To justify his conclusions, he proposes original conceptions of the human rights to life, procreational autonomy, privacy, equitable treatment and personal security. Thus, these essays test the usefulness of the theory of rights explained and defended in An Approach to Rights and elsewhere.

A theory of Clinical Bioethics based on the integration of the moral logic of health care practice ("internal morality") and the larger social concerns and processes ("external morality")

Clinical Bioethics. A Search for the Foundations compares major theoretical models in the foundation of clinical bioethics and explains medicine as a normative practice. The goals of medicine are discussed with particular reference to the subjectivisation of health and the rationalisation of health care institutions. This volume provides a consistent reconstruction of bioethical judgment both at the level of epistemological statute and institutional context, i.e. clinical ethics committees and clinical ethics consultation.

This volume explores the different dimensions of how the contingency of life, and especially human life, is relevant for ethical discussions and the normative frameworks in bioethics. It explores the relevance of the notion contingency, needs and desires for moral argumentation and bioethics. The volume discusses those notions in a philosophical perspective. Additionally, the volume is a contribution to a deeper reflection on basic philosophical assumptions of bioethics.

Among the vast literature on contemporary reproductive technologies, Prosthetic Bodies stands out in its effective combination of insights, methods, and theories from the history of medicine, constructivist science and technology studies, and feminist theory. The double focus on IVF and related techniques, and fetal treatment and surgery, enables the identification of debatable tendencies within today's reproductive medicine: the translation of ever more medical problems basically unrelated to women's own reproductive health - and, in the case of fetal diagnosis and treatment, sometimes formerly even unrelated to reproduction as such - into medical indications for invasive, often highly experimental interventions in women's bodies. The analyses show how, through the operations and workings of reproductive technologies themselves, as well as a variety of discursive mechanisms within scientific language, today's recasting of men's fertility problems and children's congenital anomalies as women's reproductive problems comes to appear inevitable. The book challenges the ability of traditional forms of medical ethics and law to adequately identify this incremental process. The careful analyses and arguments in Prosthetic Bodies will be relevant to students of science and technology, gender studies, philosophy, medical ethics, and law, and others interested in the cultural, ethical, and political ramifications of contemporary reproductive technologies.

"Carefully reasoned, clearly articulated, and pulls no punches...Boldly tackles the most contentious issues in bioethics and public policy....Worst Case Bioethics is certain to provoke strong responses across disciplines and ideologies on issues of great importance."- Mark Rothstein, Journal of Legal Medicine
"Annas persuasively argues in Worst Case Bioethics that basing policy on extreme nightmare possibilities leads to a distortion of fundamental ethical principles and legal protections." - Arthur L. Caplan, The Lancet
"Worst Case Bioethics offers a valuable consideration of how public health policy is sometimes shaped by fear in a counterproductive manner. The book is well-written, well-reasoned, and persuasive." - Thomas May, Science

Besides offering a critical analysis of the WHO definition and a review of both ancient and contemporary conceptions of health, the cooperative effort of physicians and philosophers presented in this book works through the challenges which any definition of health faces, if it is to be both truly personalist, and at the same time operational.
The overall purpose of this book is to capture the essentials of human health and to propose the outlines for a personalist understanding of this concept, i.e., a conception that does justice to the personal nature of human beings by introducing dimensions that are essential to personal life and well-being, such as the realms of rationality, affectivity and freedom, the realms of meaning, values, morality, and spirituality, the realms of social and interpersonal relations.

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.

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.

This book explores and elaborates three theories of public reason, drawn from Rawlsian political liberalism, natural law theory, and Confucianism. Drawing together academics from these separate approaches, the volume explores how the three theories critique each other, as well as how each one brings its theoretical arsenal to bear on the urgent contemporary debate of medical assistance in dying. The volume is structured in two parts: an exploration of the three traditions, followed by an in-depth overview of the conceptual and historical background. In Part I, the three comprehensive opening chapters are supplemented by six dynamic chapters in dialogue with each other, each author responding to the other two traditions, and subsequently reflecting on the possible deficiencies of their own theories. The chapters in Part II cover a broad range of subjects, from an overview of the history of bioethics to the nature of autonomy and its status as a moral and political value. In its entirety, the volume provides a vibrant and exemplary collaborative resource to scholars interested in the role of public reason and its relevance in bioethical debate.

An assessment of some ethical implications of increasing life spans. Taking as a starting point the idea that to increase longevity is a form of medical enhancement, it examines the value of living longer; the means for extending life spans; the consequences of greater longevity for the fair distribution of resources and healthcare in particular.

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."