Scientific research involving human embryos was a major topic of public debate in Britain during the 1980s. Despite strong support from the scientific community, embryo research was initially condemned by many ordinary people as well as by special interest groups, and came close to being banned by Act of Parliament. Michael Mulkay describes the dynamics of the parliamentary struggle over the future of embryo research, focusing on such issues as: the clash between the anti-abortion and pro-research lobbies; the tactics of the Government; political ideology; the media's role; the importance of gender; religion; the impact of science fiction; the lure of medical advance; and the difficulty of maintaining ethical control. He explains how the advocates of embryo research eventually triumphed, and ends with an examination of the cultural tensions which linger after the debate.

This book provides a nontechnical account of the debate concerning human embryo research, concentrating on the British parliamentary debates of 1984-1990. It traces the debates' origins back to conflicts over abortion and moral reform in the 1960s, and examines reactions in the 1990s to sex selection and the use of eggs from human fetuses for research. Michael Mulkay shows how embryo research develops within a complex social environment, writing for anyone interested in the relationship between science-based assisted reproduction and society.

Offering a format that is significantly different than that offered by other books, Ethical Health Care beings by asking what is meant by health and how it is achieved. The book then proceeds to explore with care and context the nature of the relationship between patients and clinicians, health care providers and the societies in which they inhabit, and finally the relationship between the health care enterprise and the international community. By emphasizing the ethical issues that arise in the broad quest to foster human health, and appreciating that health is not primarily a function of medical interventions, Ethical Health Care introduces students to problems such as the international distribution of pharmaceuticals and the dangers of reemerging infections. To a far greater extent than is done traditionally, Ethical Health Care provides an interdisciplinary perspective to bioethics, relying heavily upon the teachings of economics, law, and public health.

We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the United States explores the claim that justification in ethics, whether concerning matters of theory or practice, involves achieving coherence or "reflective equilibrium" (as Rawls has called it) between our moral and nonmoral beliefs. Among the practical issues the volume addresses are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing practices. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy.

This book offers a comprehensive roadmap for determining when and how to regulate risky reproductive technologies on behalf of future children. First, it provides three benchmarks for determining whether a reproductive practice is harmful to the children it produces. This framework synthesizes and extends past efforts to make sense of our intuitive, but paradoxical, belief that reproductive choices can be both life-giving and harmful. Next, it recommends a process for reconciling the interests of future children with the reproductive liberty of prospective parents. The author rejects a blanket preference for either parental autonomy or child welfare and proposes instead a case-by-case inquiry that takes into account the nature and magnitude of the proposed restrictions on procreative liberty, the risk of harm to future children, and the context in which the issue arises. Finally, he applies this framework to four past and future medical treatments with above average risk, including cloning and genetic engineering. Drawing lessons from these case studies, Peters criticizes the current lack of regulatory oversight and recommends both more extensive pre-market testing and closer post-market monitoring of new reproductive technologies. His moderate, pragmatic approach will be widely appreciated.

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers.

In the late twentieth century the impressive achievements of modern medicine are obvious, yet medicine seems to have failed to satisfy public expectation. Government regulation is tightening, health funding is a divisive political issue and medical complaints departments are increasingly busy. In the United States medical litigation has already reached alarming levels. Is there something wrong with medical research and practice? This book examines what it is that doctors do, and what patients expect of them. It finds that expectation and reality often diverge. Humane Medicine forcefully argues that more science cannot heal this rift, nor can better education in ethics. It argues that to foster better communication, medical teachers must change their philosophy and methods, so that value-laden issues in clinical medicine are interwoven with the necessary science. Professor Little outlines some possible ways to achieve this.

Medical and ethical decision concerning treatment for handicapped newborns have always been difficult. Despite technological advances, parents and health-care professionals still search for criteria that will address treatment categories from an ethical standpoint. Richard A. McCormick, a leading Roman Catholic moral theologian, has proposed a patient-centered, quality-of-life approach to treatment decision that appears to meet the needs of decision-makers.Peter A. Clark applies McCormick's ethical approach to five categories of handicapped newborns as a practical demonstration of the treatment decision process. "Clark constructs, analyzes, and criticizes McCormick's developing methodology which McCormick himself never explicitly elaborated in his own writings." -Charles E. Curran, Southern Methodist University"Modern neonatology has worked wonders in the care of the newborn. Some of its successes have however resulted in the most difficult clinical and ethical dilemmas. Physicians, families and nurses will need and appreciate Fr. Peter Clark's judicious, sensitive and practical guidance through both the philosophical and the theological issues." - Edmund D. Pellegrino, Georgetown University Medical Center

No developed nation relies exclusively on the private sector to finance health care for citizens. This book begins by exploring the deficiencies in private health insurance that account for this. It then recounts the history and legal character of America's public health care entitlements - Medicare, Medicaid, and tax subsidies for employment-related health benefits. These programs are increasingly embattled, attacked by those advocating privatization (replacing public with private insurance), individualization (replacing group and community-based insurance with approaches based on individual choice within markets) and devolution (devolving authority over entitlements to state governments and to private entities).

The book critically analyzes this movement toward disentitlement. He also examines the primary models for structuring health care entitlements in other countries - general taxation-funded national health insurance and social insurance, and considers what we can learn from these models. The book concludes by describing what an American entitlement-based health care system could look like, and in particular how the legal characteristics of our entitlement programs could be structured to support the long-term sustainability of these vital programs.

of UB's medical school, that UB developed its School of Arts and Sciences, and thus, assumed its place among the other institutions of higher education. Had Fillmore lived throughout UB's first seventy years, he would probably have been elated by the success of his university, and he should have been satisfied and pleased that UB remained intrinsically bonded to its community while at the same time engrafting the values and standards important to higher education's mission in the region. UB and its medical school have undergone many challenging transitions since 1846. Included among them were: (1) the completion of an academic campus in the far northeast comer of the City of Buffalo while leaving its medical, dental and law schools firmly situated in the core of downtown Buffalo; (2) the eventual relocation, after the second world war, of the law school to the newer campus in Amherst, and the medical and dental school to the original academic campus: and (3) the merger with the State University of New York System in 1962. Despite these significant transitions, any one of which could have changed the intrinsic integrity of UB and disrupted the bonding between community and university, that did not happen. To this day, the ties between community and academe persist. Fillmore and White should celebrate their success and important contribution to Buffalo and Western New York.

This book is a philosophically sophisticated and scientifically well-informed discussion of the moral and social issues raised by genetically engineering animals, a powerful technology that has major implications for society. Unlike other books on this emotionally charged subject, the author attempts to inform, not inflame, the reader about the real problems society must address in order to manage this technology. Nontechnical and anecdotal in nature, written by a professor of philosophy, physiology and biophysics, this book will appeal to both specialists and general readers with an interest in genetic engineering.

Mental illness is the poor, and somehow "damaged," cousin to physical ailments in the eyes of too many in our society. Compare the difference in how people would respond to someone who had fallen and broken their leg on the street, to how most react to those mentally ill among us, on those same streets, who spend their winters on steam grates and forage for food in dumpsters. " Rationing Sanity "is a provocative analysis of the mental health care system in the United States, dealing with issues of justice and access to mental health care.

How should a decent society, affluent but facing many serious calls on its resources, best care for citizens afflicted with severe and persistent mental illnesses? James Lindemann Nelson brings together, for the first time, scholars of the ethics of mental health care and top managed care policy analysts to address this crucial problem. "Rationing Sanity" integrates those perspectives with the thoughtful practice-based experience of physicians well versed in the actual care of people with emotional and behavioral problems. Over a period of years, the contributors met face-to-face to engage each other on the ethics of managed mental health care -- the result is a unique, collaborative effort that provides a wealth of important new insights on not only how Americans can readjust their attitudes toward the mentally ill -- but also how we may find more just and humane treatment for those afflicted.

Beyond Brain Death offers a provocative challenge to one of the most widely accepted conclusions of contemporary bioethics: the position that brain death marks the death of the human person. Eleven chapters by physicians, philosophers, and theologians present the case against brain-based criteria for human death. Each author believes that this position calls into question the moral acceptability of the transplantation of unpaired vital organs from brain-dead patients who have continuing function of the circulatory system. One strength of the book is its international approach to the question: contributors are from the United States, the United Kingdom, Liechtenstein, and Japan. This book will appeal to a wide audience, including physicians and other health care professionals, philosophers, theologians, medical sociologists, and social workers.

Andrew Thompson, Norman J. Temple We humans are an extraordinary species. One of our finest achievements is the development of morality, of a sense of right and wrong. We articulate and then impose this sensitivity upon ourselves in the form of ethical guidelines, rules, regulations, and laws. We have, regrettably, also developed marvelously clever ways of justifying our behavior whenever it runs afoul of these prescriptions. We have, for example, developed the concept of objectivity to guide scientific pursuits and subsequently established rights which undermine the possibility of ever coming close to attaining the goal of being objective -- rights which entitle participating scientists to gain personal, tangible profits from scientific discoveries. Formerly, we envisaged gods who kept us in place, who reminded us that we were not all-powerful or especially wise. Now we tend to worship our achievements, especially our technological ones, and ourselves. Mary Midgley' aptly names this phenomenon, "humanolatry." We have lost our respect for nature in our enthusiasm for changing it to that which suits our shortsighted ends. We must, as she says, "unlearn" this way of thinking.

This readable and balanced book is an original discussion of contemporary issues in bioethics. Max Charlesworth argues that as there can be no public consensus on a set of core values--liberal societies accept a variety of religious, nonreligious, political and moral stances, there should be a plurality of ethical stances as well. On this basis he discusses issues such as the ending of human life, new reproductive technologies and the ethical distribution of limited healthcare resources, particularly hospital care.

This new edition of a highly regarded standard text continues to focus on an ethic of care, while significantly enhancing and strengthening its theoretical basis. Extensively revised and updated in both content and approach, the third edition: o addresses many of the current pressing issues in nursing o emphasises the importance of relationships in health care o examines the process of decision making o uses an four-questions model for ethical decision making o offers material to stimulate discussion o considers the international dimensions of nursing ethics o includes the newly published NMC Code of Professional Conduct 2002 For nurses who practise primary nursing and who are therefore in a special relationship with their patients, this book is particularly appropriate. However, any nurse, whether qualified or in training, will find it easy to read, constructive and thought-provoking.Places ethics within the caring context of nursing

New developments in reproductive technology have made headlines since the birth of the world's first in vitro fertilization baby in 1978. But is embryo experimentation ethically acceptable? What is the moral status of the early human embryo? And how should a democratic society deal with so controversial an issue, where conflicting views are based on differing religious and philosophical positions? These controversial questions are the subject of this book, which, as a current compendium of ideas and arguments on the subject, makes an original contribution of major importance to this debate. Peter Singer is the author of many books, including Practical Ethics (CUP, 1979), Marx (Hill & Wang, 1980), and Should the Baby Live? (co-authored with Helga Kuhse, Oxford U.P., 1986).

The possibility that human beings may soon be cloned has generated enormous anxiety and fueled a vigorous debate about the ethics of contemporary science. Unfortunately, much of this debate about cloning has treated cloning as singular and revolutionary. The essays in Cloning and the Future of Human Embryo Research place debates about cloning in the context of reproductive technology and human embryo research. Although novel, cloning is really just the next step in a series of reproductive interventions that began with in vitro fertilization in 1978. Cloning, embryo research, and reproductive technology must therefore be discussed together in order to be understood. The authors of this volume bring these topics together by examining the status of preimplantation embryos, debates about cloning and embryo research, and the formulation of public policy. The book is distinctive in framing cloning as inextricably tied to embryo research and in offering both secular and religious perspectives on cloning and embryo research.

This thoughtful and compassionate account addresses some of the difficult ethical and medical issues raised in the provision of health care for the dependent elderly patient. Care of the dependent elderly is subject to conflicting priorities arising from the demands of patients, their relatives, the fair allocation of medical and financial resources, and the medical ethos to prolong life. A distinguished team of contributors, selected from the fields of medicine, philosophy, ethics, and law, discuss and critically evaluate these issues. This volume will provide a focus for further debate and interest in this important subject.

The ultimate goals of human genome research are the treatment, cure and eventual prevention of genetic disorders but treatment and cure lag behind the ability to detect disease or increased suceptibility to disease. Most genetic services today deliver diagnosis and counseling, effective treatment is rare. As more genes are identified there is growing pressure to implement new testing programs or broaden existing programs and otherwise increase both the number of available genetic tests and the amount of genetic information. The main issues concerned among others are: voluntariness of services, freedom of choices, patient autonomy, informed consent, confidentiality of genetic information, privacy, testing of minors, social discrimination and stigmatization.

When Did I Begin? investigates the theoretical, moral, and biological issues surrounding the debate over the beginning of human life. With the continuing controversy over the use of in vitro fertilization techniques and experimentation with human embryos, these issues have been forced into the arena of public debate. Following a detailed analysis of the history of the question, Reverend Ford argues that a human individual could not begin before definitive individuation occurs with the appearance of the primitive streak about two weeks after fertilization. This, he argues, is when it becomes finally known whether one or more human individuals are to form from a single egg. Thus, he questions the idea that the fertilized egg itself could be regarded as the beginning of the development of the human individual. The author also differs sharply, however, from those who would delay the beginning of the human person until the brain is formed, or until birth or the onset of conscious states.

Advances in genetic technology in general and medical genetics in particular will enable us to intervene in the process of human biological development which extends from zygotes and embryos to people. This will allow us to control to a great extent the identities and the length and quality of the lives of people who already exist, as well as those we bring into existence in the near and distant future. "Genes and Future People" explores two general philosophical questions, one metaphysical, the other moral: (1) How do genes, and different forms of genetic intervention (gene therapy, genetic enhancement, presymptomatic genetic testing of adults, genetic testing of preimplantation embryos), affect the identities of the people who already exist and those we bring into existence? and (2) How do these interventions benefit or harm the people we cause to exist in the near future and those who will exist in the distant future by satisfying or defeating their interest in having reasonably long and disease-free lives?"Genes and Future People" begins by explaining the connection between genes and disease, placing genetic within a framework of evolutionary biology. It then discusses such topics as how genes and genetic intervention influence personal identity, what genetic testing of individuals and the knowledge resulting from it entails about responsibility to others who may be at risk, as well as how gene therapy and genetic enhancement can affect the identities of people and benefit or harm them. Furthermore, it discusses various moral aspects of cloning human beings and body parts. Finally, it explores the metaphysical and moral implications of genetic manipulation of the mechanisms of aging to extend the human life span.The aim "Genes and Future People" is to move philosophers, bioethicists, and readers in general to reflect on the extent to which genes determine whether we are healthy or diseased, our identities as persons, the quality of our lives, and our moral obligations to future generations of people.

The majority of patients in need of organ transplants do not survive long enough for a suitable human organ to become available. Xenotransplantation, the transplant of animal organs into humans, has attracted substantial media attention. If, as appears likely, it proves possible to "humanize" animal organs and evade the problems of rejection, in the coming few years there will be a tremendous increase in this procedure, mostly using organs from animals specifically for their harvestable organs. This book will lay out the potential and promise of the technique, the history of organ transplantation, the technical problems and breakthroughs in overcoming immune rejection, and typing and humanizing donor organs for transplantation. The ethical question of growing animals specifically for organ harvest, and the substantial public health concern from the certainty that animal viruses will pass into humans with the donated organs, will be fully discussed. The authors are among the leaders in the field of Xenotransplantation.

claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient's unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court's decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the * patient; Requests based on full information; * The patient is in a situation of intolerable and hopeless suffering (either * physical or mental); No further acceptable alternatives to euthanasia. All alternatives * acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be * 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.

"Globalizing Feminist Bioethics" is a collection of new essays on the topic of international bioethics that developed out of the Third World Congress of the International Association of Bioethics in 1996. Rosemarie Tong is the primary editor of this collection, in which she, Gwen Anderson, and Aida Santos look at such international issues as female genital cutting, fatal daughter syndrome, use of reproductive technologies, male responsibility, pediatrics, breast cancer, pregnancy, and drug testing.