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.

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.

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.

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.

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.

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.

In Reproduction, Technology, and Rights, philosophers and ethicists debate the central moral issues and problems raised by today's revolution in reproductive technology. Leading issues discussed include the ethics of paternal obligations to children, the place of in vitro fertilization in the allocation of health care resources, and the ethical implications of such new technologies as blastomere separation and cloning. Also considered are how parents and society should respond to knowledge gained from prenatal testing and whether or not the right to abort should relieve men of the duty to support unwanted children. Reproduction, Technology, and Rights illuminates the moral and ethical choices that our society faces because of advances in reproductive technology and helps to make those decisions better informed.

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.

Biotechnologies already on the horizon will enable us to be smarter, have better memories, be stronger and quicker, have more stamina, live longer, be more resistant to diseases, and enjoy richer emotional lives. To some of us, these prospects are heartening; to others, they are dreadful. In Beyond Humanity a leading philosopher offers a powerful and controversial exploration of urgent ethical issues concerning human enhancement. These raise enduring questions about what it is to be human, about individuality, about our relationship to nature, and about what sort of society we should strive to have. Allen E. Buchanan urges that the debate about enhancement needs to be informed by a proper understanding of evolutionary biology, which has discredited the simplistic conceptions of human nature used by many opponents of enhancement. He argues that there are powerful reasons for us to embark on the enhancement enterprise, and no objections to enhancement that are sufficient to outweigh them.

Demonstrating that animal cruelty behaviours are another form of antisocial behaviour, alongside human aggression and violence, and almost without exception are carried out by the same individuals this book offers clear recommendations for future research on animal cruelty and future action aimed at prevention.

Medical or hio- ethics has in recent years been a growth industry. Journals, Centers and Associations devoted to the subject proliferate. Medical schools seem increasingly to be filling rare positions in the humanities and social sciences with ethicists. Hardly a day passes without some media scrutiny of one or another ethical dilemma resulting from our new-found ability to transform the natural conditions of life. Although bioethics is a self-consciously interdisciplinary field, it has not attracted the collaboration of many social scientists. In fact, social scientists who specialize in the study of medicine have in many cases watched its development with a certain ambivalence. No one disputes the significance and often the painfulness of the issues and choices being addressed. But there is something about the way these issues are usually handled which seems somehow inappropri ate if not wrong-headed to one trained in a discipline like sociology or history. In their analyses of complex situations, ethicists often appear grandly oblivious to the social and cultural context in which these occur, and indeed to empirical referents of any sort. Nor do they seem very conscious of the cultural specificity of many of the values and procedures they utilize when making ethical judg ments. The unease felt by many in the social sciences was given articulate expression in a paper by Renee Fox and Judith Swazey which appeared in 1984."

If you die through mistakes in moral reasoning, then you are as dead as if you die through mistakes made in medicine. Organ transplantation saves lives yet thousands die every year on waiting lists through lack of organs. We are exhorted to donate; but is our individual reluctance the essence of the problem, or is it caused by deeper issues in the way public policy is discussed and formulated? Janet Radcliffe Richards casts a sharp critical eye on the moral arguments, forcing us to confront the logic and implications of our own position. A book for everyone who is up for intellectual challenge and is serious about moral reasoning in any context.

Recent advances in techniques and understanding in the fields of genetics, embryology and reproductive biology have opened up new ways to treat a wide range of medical problems. They range from new options for infertility treatment and pre-implantation genetic diagnosis to stem-cell-based therapies for debilitating diseases. Since all these approaches involve the manipulation of human gametes, embryos or embryonic cells, and could also permit more contentious uses, they have stimulated a controversial debate as to what aims are desirable and to what extent experiments on human embryos are morally permissible, if permissible at all. The situation is further complicated by the fact that scientific projects are increasingly realized through international co-operation and that patients are increasingly ready to seek morally contentious medical treatment wherever it is available and thus to bypass national legislation. In view of this situation the Europaische Akademie assembled a temporary interdisciplinary project group in which scientists from universities and non-university research organizations in Europe working on the relevant subjects were brought together and charged with establishing a knowledge base and providing suggestions for long-term solutions that would be acceptable for society. Presented here are the results of this project, ranging from a discussion of the theoretical and practical possibilities in human-embryo experimentation and its alternatives in research on adult stem cells, a comparison of the situations and prospects of regulation of embryo research in Europe, a survey of European public attitudes, and a philosophical analysis of the arguments and argumentative strategies used in the debate."

This book traces the growth of managed care as a mechanism for curbing excessive growth in health costs, and the controversies that have risen around for-profit health care. Also examined are decentralization in US health care, and the absence of comprehensive health care planning, access rules, and minimum health care benefit standards. Finally, the author proposes a framework for improving access to quality, affordable health care in a competitive market environment.

This series is directed to health care professionals who are leading the tra- formation of health care by using information and knowledge. Launched in 1988 as Computers in Health Care, the series offers a broad range of titles: some addressed to specific professions such as nursing, medicine, and health administration; others to special areas of practice such as trauma and radi- ogy. Still other books in the series focus on interdisciplinary issues, such as the computer-based patient record, electronic health records, and networked health care systems. Renamed Health Informatics in 1998 to reflect the rapid evolution in the discipline now known as health informatics, the series will continue to add titles that contribute to the evolution of the field. In the series, eminent - perts, serving as editors or authors, offer their accounts of innovations in health informatics. Increasingly, these accounts go beyond hardware and so- ware to address the role of information in influencing the transformation of healthcare delivery systems around the world. The series also increasingly focuses on "peopleware" and the organizational, behavioral, and societal changes that accompany the diffusion of information technology in health services environments.

Is the involuntary commitment of the mentally ill morally proper? How can we determine proper psychiatric care in a managed health care system? And can a mental health professional violate patient's confidentiality when they believe a patient is a threat to someone? In six non-ideological essays, leading bioethicists, including one with practical experience in medical administration, search for clear moral and legal guidelines for dealing with the complex issues presented when treating mentally ill patients. Objective and readily understandable, Mental Illness and Public Health Care illuminates for the educated reader some of the key ethical issues facing mental health care professionals and provides convincing practical conclusions with real moral import.

Western societies generally recognize both a legal and a moral right to privacy. However, at the present time there is no settled opin ion in the United States regarding how these rights should relate to medical information. On the one hand, virtually everyone agrees that one' s medical records should not be open to just any interested person' s inspection. On the other hand, most also agree that some sacrifices in medical privacy are necessary for scientific advancement, public health protection, and other social goals. However, what limits should be set upon those sacrifices, and how those limits should be determined, have long been issues of debate. In recent years this debate has intensified. There are a variety ofreasons for this; to mention only three: (1) Over the years the US health care delivery system has become increasingly complex, and with this complexity there has come a need for more and more people to have access to patients' medical records. With each transference of information, breaches in confidentiality become more likely. (2) Medical costs have risen at an alarming rate. This makes health insurance a virtual necessity for adequate medical care, and people worry that they will be denied employment and/or medical cov erage if certain sorts of medical information are not kept strictly confi dential. (3) Finally, many medical records are now kept in computer files, and the impossibility of guaranteeing confidentiality for files of this sort is a constant worry."

A comprehensive review of recent scientific evidence examining the contributions of animal experimentation to human healthcare. The book also explores toxicity prediction, animal use during life and health sciences education, impacts on student attitudes toward animals, and the extent to which animals suffer in laboratories.

Social Work and Animals represents a pioneering contribution to the literature of social work ethics and moral philosophy. It advances cogent and detailed arguments for the inclusion of animals within social work's moral framework, arguments that have profound theoretical and practical implications for the discipline and its practitioners.

In this book, Dr. Richard Allen Williams has assembled the very best scholars on healthcare disparities to raise the public consciousness of this issue. Arranged into discrete categories, this volume contains comprehensive coverage, both historical and current, of the healthcare disparity crisis currently plaguing our country in hopes of leading us all to a brighter future.