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."

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)."

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.

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.

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.

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.

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.

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.

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.

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.

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.

This book provides an overview of the US laws that affect clinical practice for healthcare professionals with no legal background. Divided into thirteen sections, each chapter starts with a summary of the chapter's content and relevant legal concepts in bullet points before discussing the topics in detail. An application section is provided in many chapters to clarify essential issues by reflecting on clinically relevant case law or clinical vignette(s). Filling a crucial gap in the literature, this comprehensive guide gives healthcare professionals an understanding or a starting point to legal aspects of healthcare.

Working Virtue is the first substantial collective study of virtue theory and contemporary moral problems. Leading figures in ethical theory and applied ethics discuss topics in bioethics, professional ethics, ethics of the family, law, interpersonal ethics, and the emotions.
Virtue ethics is centrally concerned with character traits or virtues and vices such as courage (cowardice), kindness (heartlessness), and generosity (stinginess). These character traits must be looked to in any attempt to understand which particular actions are right or wrong and how we ought to live our lives. As a theoretical approach, virtue ethics has made an impressive comeback in relatively recent history, both posing an alternative to, and, in some ways, complementing well-known theoretical stances such as utilitarianism and deontology. Yet there is still very little material available that presents virtue-ethical approaches to practical contemporary moral problems, such as what we owe distant strangers, our parents, or even non-human animals. This book fills the gap by dealing with these and other pressing moral problems in a clear and theoretically nuanced manner.
The contributors offer a variety of perspectives, including pluralistic, eudaimonistic, care-theoretical, Chinese, comparative, and stoic. This variety allows the reader to appreciate not only the wide range of topics for which a virtue-ethical approach may be fitting, but also the distinctive ways in which such an approach may be manifested.

Our ability to map and intervene in the structure of the human brain is proceeding at a very quick rate. Advances in psychiatry, neurology, and neurosurgery have given us fresh insights into the neurobiological basis of human thought and behavior. Technologies like MRI and PET scans can detect early signs of psychiatric disorders before they manifest symptoms. Electrical and magnetic stimulation of the brain can non-invasively relieve symptoms of obsessive-compulsive disorder, depression and other conditions resistant to treatment, while implanting neuro-electrodes can help patients with Parkinsons and other motor control-related diseases. New drugs can help regenerate neuronal connections otherwise disrupted by schizophrenia and similar diseases.
All these procedures and drugs alter the neural correlates of our mind and raise fascinating and important ethical questions about their benefits and harms. They are, in a sense, among the most profound bioethical questions we face, since these techniques can touch on the deepest aspects of the human mind: free will; personal identity; the self; and the soul. This is the first single-author book on what has come to be known as neuroethics. Walter Glannon uses a philosophical framework that is fully informed by cutting edge neuroscience as well as contemporary legal cases such as Terri Schiavo, to offer readers an introduction to this fascinating topic. He starts by describing the state of the art in neuroscientific research and treatment, and gives the reader an up-to-date picture of the brain. Glannon then looks at the ethical implications of various kinds of treatments, such as: whether or not brain imaging will end up changing our viewson free will and moral responsibility; whether patients should always be told that they are at future risk for neurological diseases; if erasing unconscious emotional memories implicated in depression can go too far; if forcing behavior-modifying drugs or surgery on violent offenders can ever be justified; the implications of drugs that enhance cognitive abilities; and how to define brain death and the criteria for the withdrawal of life-support. While not exhaustive, Glannons work addresses a wide range of fascinating issues and his pathbreaking work should appeal to philosophers, psychiatrists, neurologists, neurosurgeons, radiologists, psychologists, and bioethicists.

This compact and innovative book tackles one of the central issues in drug policy: the lack of a coherent conceptual structure for thinking about drugs. Drugs generally fall into one of seven categories: prescription, over the counter, alternative medicine, common-use drugs like alcohol, tobacco and caffeine; religious-use, sports enhancement; and of course illegal street drugs like cocaine and marijuana. Our thinking and policies varies wildly from one to the other, with inconsistencies that derive more from cultural and social values than from medical or scientific facts. Penalties exist for steroid use, while herbal remedies or cold medication are legal. Native Americans may legally use peyote, but others may not. Penalties may vary for using different forms of the same drug, such as crack vs. powder cocaine. Herbal remedies are unregulated by the FDA; but medical marijuana is illegal in most states.
Battin and her contributors lay a foundation for a wiser drug policy by promoting consistency and coherency in the discussion of drug issues and by encouraging a unique dialogue across disciplines. The contributors are an interdisciplinary group of scholars mostly based at the University of Utah, and include a pharmacologist, a psychiatrist, a toxicologist, a trial court judge, a law professor, an attorney, a diatary specialist, a physician, a health expert on substance abuse, and Battin herself who is a philosopher. They consider questions like the historical development of current policy and the rationales for it; scientific views on how drugs actually cause harm; how to define the key notions of harm and addiction; and ways in which drug policy can be made more consistent. Theyconclude with an examination of the implications of a consistent policy for various disciplines and society generally.
The book is written accessibly with little need for expert knowledge, and will appeal to a diverse audience of philosophers, bioethicists, clinicians, policy makers, law enforcement, legal scholars and practitioners, social workers, and general readers, as well as to students in areas like pharmacy, medicine, law, nursing, sociology, social work, psychology, and bioethics.

Reshaping Life is an eminently authoritative and lucid description of modern molecular biology and genetics, and the ethical implications of genetic engineering. Now in its third edition, it is fully revised and updated, taking advantage of a decade of progress in genetics and biotechnology. It offers a concise working knowledge of DNA science and of those aspects of cell biology needed to understand such issues as animal cloning, genetically modified food, and gene therapy. It examines the debates on the sociological and ethical issues surrounding modern technology, laying out the issues for the reader, while urging a rational approach.

Reshaping Life is an eminently authoritative and lucid description of modern molecular biology and genetics, and the ethical implications of genetic engineering. Now in its third edition, it is fully revised and updated, taking advantage of a decade of progress in genetics and biotechnology. It offers a concise working knowledge of DNA science and of those aspects of cell biology needed to understand such issues as animal cloning, genetically modified food, and gene therapy. It examines the debates on the sociological and ethical issues surrounding modern technology, laying out the issues for the reader, while urging a rational approach.

Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated with issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on medicine, science and technology. The study appeals to a wide range of readers in ethics, bioethics and related disciplines.

This is a book for anyone who has ever paused to wonder whether cloning will ever be legal. Why it is that "savior siblings" and sex selection provoke such strong reactions? Will there ever be such a thing as an artificial womb?
Assisted reproductive technologies are unique in their capacity to challenge our assumptions and elicit passionate responses. Looking at the moral, philosophical, and legal issues surrounding cases of surrogacy, single or same-sex parenthood, retrieval of sperm from dead or dying patients, and the impregnation of post-menopausal women, this book questions whether these rapidly-developing technologies are refashioning the nature of the family.
The US and UK have played unique roles in the development and regulation of reproductive technologies, and has been at the forefront of controversy over "savior siblings," designer babies, reproductive cloning, and embryo research. This book provides a clear and simple account of the techniques involved in assisted reproduction and embryo research, and discusses the legal and ethical implications of some of these technologies, illustrated by compelling descriptions of real-life cases. The book also addresses the ways in which reproductive technologies are regulated, critically examining the role of the Human Fertilization and Embryology Authority and comparing the UK's approach with that of other countries. Finally, it contemplates the possibility that some of our most deeply-held assumptions about human nature may be called into question by further developments in stem cell research and fertility treatments.

The genie is out of the bottle. A whole new world of genetics research is underway with its exciting potential for a better understanding of heredity and genetically inherited disease, with opportunities for prevention, management and cure. But the current explosion of human genetic information has the potential for abuse also, for damage to rights, privacy and fair treatment for individuals and vulnerable groups. This book brings us up to date with important contributions from the authoritative "Encyclopaedia of the Human Genome" on the urgent social, legal and ethical aspects of the Human Genome enterprise, accessibly written and introduced for the undergraduate, postgraduate and general reader.

Reproductive science continues to revolutionise reproduction and propel us further into uncharted territories. The revolution signalled by the birth of Louise Brown after IVF in 1978, prompted governments across Europe and beyond into regulatory action. Forty years on, there are now dramatic and controversial developments in new reproductive technologies. Technologies such as uterus transplantation that may enable unisex gestation and babies gestated by dad; or artificial wombs that will completely divorce reproduction from the human body and allow babies to be gestated by machines, usher in a different set of legal, ethical and social questions to those that arose from IVF. This book revisits the regulation of assisted reproduction and advances the debate on from the now much-discussed issues that arose from IVF, offering a critical analysis of the regulatory challenges raised by new reproductive technologies on the horizon.