This thought-provoking treatise argues that current human fertility rates are fueling a public health crisis that is at once local and global. Its analysis and data summarize the ecological costs of having children, presenting ethical dilemmas for prospective parents in an era of competition for scarce resources, huge disparities of wealth and poverty, and unsustainable practices putting irreparable stress on the planet. Questions of individual responsibility and integrity as well as personal moral and procreative issues are examined carefully against larger and more long-range concerns. The author's assertion that even modest efforts toward reducing global fertility rates would help curb carbon emissions, slow rising global temperatures, and forestall large-scale climate disaster is well reasoned and more than plausible. Among the topics covered: * The multiplier effect: food, water, energy, and climate. * The role of population in mitigating climate change. * The carbon legacy of procreation. * Obligations to our possible children. * Rights, what is right, and the right to do wrong. * The moral burden to have small families. Toward a Small Family Ethic sounds a clarion call for bioethics students and working bioethicists. This brief, thought-rich volume steers readers toward challenges that need to be met, and consequences that will need to be addressed if they are not.

Bioethics has long been accepted as an interdisciplinary field. The recent 'empirical turn' in bioethics is, however, creating challenges that move beyond those of simple interdisciplinary collaboration, as researchers grapple with the methodological, empirical and meta-ethical challenges of combining the normative and the empirical, as well as navigating the difficulties that can arise from attempts to transcend traditional disciplinary boundaries. Empirical Bioethics: Theoretical and Practical Perspectives brings together contributions from leading experts in the field which speak to these challenges, providing insight into how they can be understood and suggestions for how they might be overcome. Combining discussions of meta-ethical challenges, examples of different methodologies for integrating empirical and normative research, and reflection on the challenges of conducting and publishing such work, this book will both introduce the novice to the field and challenge the expert.

The social practice of forming, shaping, expressing, contesting, and maintaining personal identities makes human interaction, and therefore society, possible. Our identities give us our sense of how we are supposed to act and how we may or must treat others, so how we hold each other in our identities is of crucial moral importance. To hold someone in her identity is to treat her according to the stories one uses to make sense of who she is. Done well, holding allows individuals to flourish personally and in their interactions with others; done poorly, it diminishes their self-respect and restricts their participation in social life. If the identity is to represent accurately the person who bears it, the tissue of stories that constitute it must continue to change as the person grows and changes. Here, good holding is a matter of retaining the stories that still depict the person but letting go of the ones that no longer do. The book begins with a puzzling instance of personhood, where the work of holding someone in her identity is tragically one-sided. It then traces this work of holding and letting go over the human life span, paying special attention to its implications for bioethics. A pregnant woman starts to call her fetus into personhood. Children develop their moral agency as they learn to hold themselves and others in their identities. Ordinary adults hold and let go, sometimes well and sometimes badly. People bearing damaged or liminal identities leave others uncertain how to hold and what to let go. Identities are called into question at the end of life, and persist after the person has died. In all, the book offers a glimpse into a fascinating moral terrain that is ripe for philosophical exploration.

Remediation in medical education is the act of facilitating a correction for trainees who started out on the journey toward becoming excellent physicians but have moved off course. This book offers an evidence-based and practical approach to the identification and remediation of medical trainees who are unable to perform to standards. As assessment of clinical competence and professionalism has become more sophisticated and ubiquitous, medical educators increasingly face the challenge of implementing effective and respectful means to work with trainees who do not yet meet expectations of the profession and society. Remediation in Medical Education: A Mid-Course Correction describes practical stepwise approaches to remediate struggling learners in fundamental medical competencies; discusses methods used to define competencies and the science underlying the fundamental shift in the delivery and assessment of medical education; explores themes that provide context for remediation, including professional identity formation and moral reasoning, verbal and nonverbal learning disabilities, attention deficit disorders in high-functioning individuals, diversity, and educational and psychiatric topics; and reviews system issues involved in remediation, including policy and leadership challenges and faculty development.

This book examines all aspects of narrative medicine and its value in ensuring that, in an age of evidence-based medicine defined by clinical trials, numbers, and probabilities, clinical science is firmly embedded in the medical humanities in order to foster the understanding of clinical cases and the delivery of excellent patient care. The medical humanities address what happens to us when we are affected by a disease and narrative medicine is an interdisciplinary approach that emphasizes the importance of patient narratives in bridging various divides, including those between health care professionals and patients. The book covers the genesis of the medical humanities and of narrative medicine and explores all aspects of their role in improving healthcare. It describes how narrative medicine is therapeutic for the patient, enhances the patient-doctor relationship, and allows the identification, via patients' stories, of the feelings and experiences that are characteristic for each disease. Furthermore, it explains how to use narrative medicine as a real scientific tool. Narrative Medicine will be of value for all caregivers: physicians, nurses, healthcare managers, psychotherapists, counselors, and social workers. "Maria Giulia Marini takes a unique and innovative approach to narrative medicine. She sees it as offering a bridge - indeed a variety of different bridges - between clinical care and 'humanitas'. With a sensitive use of mythology, literature and metaphor on the one hand, and scientific studies on the other, she shows how the guiding concept of narrative might bring together the fragmented parts of the medical enterprise". John Launer, Honorary Consultant, Tavistock Clinic, London UK

This volume presents a number of controversial cases of enforced medical treatment from around the globe, providing for the first time a common, biopolitcal framework for all of them. Bringing together all these real cases guarantees that a new, more complete understanding of the topic will be within grasp for readers unacquainted with the aspects involved in these cases. On the one hand, readers interested mainly in the legal and medical dimensions of cases like those considered will benefit from the explanation of the biopolitical framework within which each case develops. On the other hand, those focusing on only one of the situations presented here will find the parallels between the cases an interesting expansion of the complexity of the problem. Despite the book's ambitious goal, for those willing to use it as supplemental material or interested in only one of the cases, the chapters can function as self-standing pieces to be read separately. This volume will be a valuable tool for both academics and professionals. Bioethicists in both the analytic and continental traditions, will find the book interesting for not only the specific concepts and issues considered, but also for its constructive bridging of the two schools of thought. In addition to philosophers, the structure of this work will also appeal to lawyers, doctors, human rights activists, and anyone concerned in the most disparate way with real-life cases of enforced medical treatment.

This readable overview offers a public health framework for integrating medical and alternative care to improve health outcomes in patients with chronic illnesses. It details the promise, potential, and challenges of holistic services as patients seek diverse treatment options and health care systems address the demand for more affordable, accessible, and effective care. The book's integrative model describes the process in theory and practice, from cost and reimbursement issues and turf wars between providers to expanding on traditional concepts of illness and wellness. Learning objectives, case studies, discussion questions, and other helpful features make this a vital student text. The book's concentrated coverage: Introduces concepts of integrative health services. Applies integrative health concepts to public health areas, e.g., prevention. Contrasts integrative models of health with the traditional biomedical model. Outlines the scope of integrative health practice. Reviews implications for the public health workforce. Integrative Health Services benefits public health students, pre-med students, and those with an interest in health policy and health trends. Additionally, public health educators, practitioners, and scholars who may not be familiar with integrative health services and conflicts related to their increased use in health care will find it a helpful tool to quickly bring them up to date

Anti-natalism is the provocative view that it is either always or almost always all-things-considered wrong to procreate. Philanthropic anti-natalist arguments say that procreation is always impermissible because of the harm done to individuals who are brought into existence. Misanthropic arguments, on the other hand, hold that procreation is usually impermissible given the harm that individuals will do once brought into existence. The main purpose of this short monograph is to demonstrate that David Benatar's misanthropic argument for anti-natalism ought to be endorsed by any version of African Communitarianism. Not only that, but there are also resources in the African philosophical tradition that offer unique support for the argument. Given the emphasis that indigenous African worldviews place on the importance of procreation and the immediate family unit this result is highly surprising. This book marks the first attempt to bring anti-natalism into conversation with contemporary African ethics.

Neuroscientists are mining nucleic acids, blood, saliva, and brain images in hopes of uncovering biomarkers that could help estimate risk of brain disorders like psychosis and dementia; though the science of bioprediction is young, its prospects are unearthing controversy about how bioprediction should enter hospitals, courtrooms, or state houses. While medicine, law, and policy have established protocols for how presence of disorders should change what we owe each other or who we blame, they have no stock answers for the probabilities that bioprediction offers. The Neuroethics of Biomarkers observes, however, that for many disorders, what we really care about is not their presence per se, but certain risks that they carry. The current reliance of moral and legal structures on a categorical concept of disorder (sick verses well), therefore, obscures difficult questions about what types and magnitudes of probabilities matter. Baum argues that progress in the neuroethics of biomarkers requires the rejection of the binary concept of disorder in favor of a probabilistic one based on biological variation with risk of harm, which Baum names a "Probability Dysfunction. " This risk-reorientation clarifies practical ethical issues surrounding the definition of mental disorder in the DSM-5 and the nosology of conditions defined by risk of psychosis and dementia. Baum also challenges the principle that the acceptability of bioprediction should depend primarily on whether it is medically useful by arguing that biomarkers can also be morally useful through enabling moral agency, better assessment of legal responsibility, and fairer distributive justice. The Neuroethics of Biomarkers should be of interest to those within neuroethics, medical ethics, and the philosophy of psychiatry.

This textbook presents epidemiology in a practical manner, contextualized with discussions of theory and ethics, so that students and professionals from all academic backgrounds may develop a deep appreciation for how to conduct and interpret epidemiological research. Readers will develop skills to: -Search for and appraise literature critically, -Develop important research questions, -Design and implement studies to address those questions, -Perform and interpret fundamental statistical estimations and tests, -Consider the ethical implications of all stages of research, -Report findings in publications, and -Advocate for change in the public health setting. Epidemiology is and will remain a discipline in motion, and this textbook aims at reflecting this dynamism and keeping pace with its momentum. This textbook is not only a classroom tool with high utility but also an essential reference and guide for those engaging in research involving human subjects.

This book looks at health policy through the lens of public versus private: population health versus the somatic, social, or emotional experiences of a patient. Rather than presenting policy/ethics as overly technical, this book takes a novel approach of framing public and private health in terms of political philosophy, ethics, and popular examples. Each chapter ties back to the general ethics or political literature as applicable, which are not customarily parts of the current public health curriculum. The author's work on the Orgcomplexity blog has touched on this subject by systemically exploring public policy issues, and the tone of this book mimics the blog with an extension of the arguments.

In this edited volume, scientists from different disciplines discuss modern biotechnological processes and a knowledge-based bioeconomy. The authors base their arguments on ecological, economic, legal, social and ethical aspects. Moreover, they explore the opportunities, risks, and challenges of bioeconomic concepts and biotechnologies in many subject areas. The chapters consider land use, nature and environment, nutrition, technology and governance, energy, economy, law and regulation, as well as ethics. A special focus should be on new technologies and how they can be used, without compromising the ambitious goal of creating a more sustainable, but also fair world. To do justice to this broad array of topics, the editors frame all topics in overarching introductions and close the volume with final conclusions. Thereby this volume offers data and critical thoughts for any member of a Bioeconomy - be it from academia, the industry or public regulation.

For over thirty years Susan Wolf has been writing about moral and nonmoral values and the relation between them. This volume collects Wolf's most important essays on the topics of morality, love, and meaning, ranging from her classic essay "Moral Saints" to her most recent "The Importance of Love." Wolf's essays warn us against the common tendency to classify values in terms of a dichotomy that contrasts the personal, self-interested, or egoistic with the impersonal, altruistic or moral. On Wolf's view, this tendency ignores or distorts the significance of such values as love, beauty, and truth, and neglects the importance of meaningfulness as a dimension of the good life. These essays show us how a self-conscious recognition of the variety of values leads to new understandings of the point, the content, and the limits of morality and to new ways of thinking about happiness and well-being.

Many deep concerns in the life sciences and medicine have to do with the enactment, ordering and displacement of a broad range of values. This volume articulates a pragmatist stance for the study of the making of values in society, exploring various sites within life sciences and medicine and asking how values are at play. This means taking seriously the work scientists, regulators, analysts, professionals and publics regularly do, in order to define what counts as proper conduct in science and health care, what is economically valuable, and what is known and worth knowing. A number of analytical and methodological means to investigate these concerns are presented. The editors introduce a way to indicate an empirically oriented research program into the enacting, ordering and displacing of values. They argue that a research programme of this kind, makes it possible to move orthogonally to the question of what values are, and thus ask how they are constituted. This rectifies some central problems that arise with approaches that depend on stabilized understandings of value. At the heart of it, such a research programme encourages the examination of how and with what means certain things come to count as valuable and desirable, how registers of value are ordered as well as displaced. It further encourages a sense that these matters could be, and sometimes simultaneously are, otherwise.

'Clinical epidemiology' is now widely promoted and taught as a 'basic science' of Evidence-Based Medicine, of clinical EBM to be specific. This book, however, is mostly about that which Miettinen takes to be the necessary substitute for this now-so-fashionable subject - namely, Theory of Clinical Medicine together with its subordinate Theory of Clinical Research. The leit motif in all of this is Miettinen's perception of the need, and opportunity, to bring major improvements into clinical medicine in this Information Age, now that theoretical progress has made feasible the development of practice-guiding Expert Systems for it. Parts of this text constitute essential reading for whoever is expected, or otherwise inclined, to study - or teach - 'clinical epidemiology,' and the same is true of those who set policy for the education of future clinicians; but practically all of it is essential reading for future - and current - academics in the various disciplines of clinical medicine. After all, the text is the result of a concentrated effort, over a half-century no less, to really understand both clinical and community medicine and the research to advance the knowledge-base of these. Research epidemiologists, too, will find this text interesting and instructive.

The privacy concerns discussed in the 1990s in relation to the New Genetics failed to anticipate the relevant issues for individuals, families, geneticists and society. Consumers, for example, can now buy their personal genetic information and share it online. The challenges facing genetic privacy have evolved as new biotechnologies have developed, and personal privacy is increasingly challenged by the irrepressible flow of electronic data between the personal and public spheres and by surveillance for terrorism and security risks. This book considers the right to know and the right not to know about your own and others' genomes. It discusses new privacy concerns and developments in ethical thinking, with the greater emphasis on solidarity and equity. The multidisciplinary approach covers current topics such as biobanks and forensic databases, DIY testing, group rights and accountability, the food we eat and the role of the press and the new digital media.

This book offers a new theory of property and distributive justice derived from Talmudic law, illustrated by a case study involving the sale of organs for transplant. Although organ donation did not exist in late antiquity, this book posits a new way, drawn from the Talmud, to conceive of this modern means of giving to others. Our common understanding of organ transfers as either a gift or sale is trapped in a dichotomy that is conceptually and philosophically limiting. Drawing on Maussian gift theory, this book suggests a different legal and cultural meaning for this property transfer. It introduces the concept of the 'divine lien', an obligation to others in need built into the definition of all property ownership. Rather than a gift or sale, organ transfer is shown to exemplify an owner's voluntary recognition and fulfilment of this latent property obligation.

Living and Dying Well takes an informed, interdisciplinary approach to the problems, data, theory, and procedures that a just society must consider when establishing policies regarding human life and death. Leading psychologist Lewis Petrinovich expands on the controversial arguments developed in his earlier work, Human Evolution, Reproduction, and Morality, and considers such contemporary issues as: the morality of human genetic screening and of the Human Genome Project; organ transplants; the allowance of suicide and euthanasia; and physicians assisting in the dying process.

Medical ethics and the medical profession are inseparable, yet the formal teaching of medical ethics is a relatively new phenomenon. Furthermore, since the introduction of managed health care, with the physician becoming a 'health provider' and the patient a 'client', the whole concept of medical ethics has undergone a sea change. The contractual relationship between the provider and the client engenders caution and precaution, resulting in defensive medicine. This book both presents a succinct history of medical ethics and discusses a wide range of important ethical dilemmas in the provision of modern health care. A synopsis is provided of ethics through the ages and the role of ethics in the evolution of medicine. Principles and sources of medical ethics, as well as different religious and secular perspectives, are explained. Ethical concerns in relation to a variety of specific issues are then examined. These issues include, for example, human experimentation, stem cell research, assisted reproductive technologies, termination of pregnancy, rationing of health care, euthanasia, and quality of life issues. The author's many years of practicing medicine in different cultures and countries and his passion for religious works, philosophy, literature, poetry, history, and anthropology have informed and enriched the contents of this stimulating book.

It is difficult to think of an example of an advancement in the biological sciences that has had an impact on society similar to that of the new genetics. Recent developments in biotechnology have occasioned much discussion among academics, professionals, and lay people alike. In particular, many questions and concerns have arisen over the acquisi tion, access, and control of genetic information. There are several reasons why the new genetics has commanded such widespread attention, and why it is now the subject of con siderable debate. Special reference is given in this volume to the implications of genetic information for five different subject areas: eugenics, the insurance industry, the commer cialisation of genetic testing, strategies for raising public awareness, and the value of theo retical ethical and sociological frameworks in the debate. This diverse collection of papers attempts to address and critically discuss issues surrounding the control of, and access to, genetic information from ethical, medical, legal, and theoretical points of view. The first and shortest section of the book attempts to address concerns over the eugenic potential of new biotechnologies. It also provides a historical context for the de bate, for controversy over the subject of eugenics predates the current debate over genetic information by a considerable length of time. Indeed, by the time the first patent was is sued for Chakrabarty's strain of oil eating bacteria in the early 1970s, the term eugenics had already acquired strong pejorative connotations.

This volume maps the areas of ethical concern in the debate regarding the governance of genetic information, and suggests alternative ethical frameworks and models of regulation in order to inform its restructuring. Genetic governance is at the heart of medical and scientific developments, and is connected to global exploitation, issues of commodification, commercialisation and ownership, the concepts of property and intellectual property and concerns about individual and communal identity. Thus the decisions that are made in the next few years about appropriate models of genetic governance will have knock-on effects for other areas of governance. In short the final answer to 'Who Decides?' in the context of genetic governance will fundamentally shape the ethical constructs of individuals and their networks and relationships in the public sphere.

Advanced biomedical techniques such as genetic engineering are now used extensively in animal related research and development. As the pace of development has quickened, there has been growing public anxiety about the ethical issues involved. Animal Biotechnology and Ethics draws together in one book some of the leading themes and issues which have emerged in the recent debates surrounding biotechnology as applied to animals. With contributions from authors of many different viewpoints, the subject is given a thorough and balanced treatment. Among those to whom the book will be of particular interest are practitioners of animal biotechnology, and those whose interest lies in assessing its credentials, such as philosophers and social or political scientists. It also has a great deal to interest policy-makers and pressure groups, as well as more general readers. The strong chapters on the legal and regulatory framework will make it useful to those involved in advising on company policy, patenting or litigation.

Ethical Problems and Genetics Practice provides a rich, case-based account of the ethical issues arising in the genetics clinic and laboratory. By analysing a wide range of evocative and often arresting cases from practice, Michael Parker provides a compelling insight into the complex moral world of the contemporary genetics professional and the challenges they face in the care of patients and their families. This book is essential reading for anyone interested in the ethical issues arising in everyday genetics practice. Ethical Problems and Genetics Practice is also a sustained engagement with the relationships between bioethics and social science. In proposing and exemplifying a new approach to bioethics, it makes a significant contribution to debates on methods and interdisciplinarity and will therefore also appeal to all those concerned with theoretical and methodological approaches to bioethics and social science.

That concern about human genetics is at the top of many lists of issues requiring intense discussion from scientific, political, social, and ethical points of view is today no surprise. It was in the spirit of attempting to establish the basis for intelligent discussion of the issues involved that a group of us gathered at a meeting of the International Society for the History, Philosophy, and Social Studies of Biology in the Summer of 1995 at Brandeis University and began an exploration of these questions in earlier versions of the papers presented here. Our aim was to cross disciplines and jump national boundaries, to be catholic in the methods and approaches taken, and to bring before readers interested in the emerging issues of human genetics well-reasoned, informative, and provocative papers. The initial conference and elements of the editorial work which have followed were generously supported by the Stifterverband fUr die Deutsche Wissenschaft. We thank Professor Peter Weingart of Bielefeld University for his assistance in gaining this support. As Editors, we thank the anonymous readers who commented upon and critiqued many of the papers and in tum made each paper a more valuable contribution. We also thank the authors for their understanding and patience. Michael Fortnn Everett Mendelsohn Cambridge, MA September 1998 vii INTRODUCTION In 1986, the annual symposium at the venerable Cold Spring Harbor laboratories was devoted to the "Molecular Biology of Homo sapiens.

In ALLOCATING HEALTH CARE RESOURCES, leading authorities and researchers expose the basic philosophical, ethical, and economic issues underlying the current health care debate. The contributors wrestle with such complicated issues as whether it is ethical to ration health care, the morality of the worldwide bias against children in allocating health care resources, whether sin taxes can be defended morally, and how to achieve a just health care system. The book also includes an insightful analysis of the Clinton health care reform plan.
ALLOCATING HEALTH CARE RESOURCES will be of interest to philosophers, health policy experts, medical ethicists, health professionals, and concerned citizens. It serves to clarify and illuminate the logic and rhetoric of health care reform, and so to help us all achieve a fair and equitable distribution of these precious resources.