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.

Ever since the rise of Adolf Hitler, mental health professionals have sought to use their knowledge of human psychology to understand - and intervene in - political developments. From Barry Goldwater to Donald Trump, psychiatrists have commented, sometimes brashly, on public figures' mental health. But is the practice ethical? While the American Psychiatric Association prohibits psychiatric comment on public figures under its 'Goldwater Rule', others disagree. Diagnosing from a Distance is the first in-depth exploration of this controversy. Making extensive use of archival sources and original interviews, John Martin-Joy reconstructs the historical debates between psychiatrists, journalists, and politicians in an era when libel law and professional standards have undergone dramatic change. Charting the Goldwater Rule's crucial role in the current furor over Trump's fitness for office, Martin-Joy assesses the Rule's impact and offers a more liberal alternative. This remarkable book will change the way we think about psychiatric ethics and public life.

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.

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.

This book originated in an international conference on "Values in medical Decision Making" held at the University of Aarhus, Denmark, in June 1988. This was the second conference of the European Society for Philosophy of Medicine and Health Care (ESPMH), which was founded in Maastricht, the Netherlands, in 1987. ESPMH aims at promoting philosophy of medicine and health care in a wide sense and at stimulating contacts between European scholars in this field.

"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.

Current therapies for most human genetic diseases are inadequate. In response to the need for effective treatments, modern molecular genetics is providing tools for an unprecedented new approach to the treatment of diseases; e.g. the direct manipulation of mutant genes or the input on new therapeutic genes. The treatment of human disease by gene transfer has now moved from the theoretical to the practical realm. With the initiation of clinical trials involving somatic gene therapy in different countries, a critical assessment of the different aspects involved with this new technique is necessary. This volume provides an overview on all these interdisciplinary aspects by some well known experts all over the world.

This is the first book of case studies on animal ethics. It deals with important social controversies involving the human use of animals and analyses the moral issues involved. An excellent introduction to ethical theory provides a framework to the 16 original case studies, which include the use of animals in research, testing, and education, as food, as companion animals, and in religious rites.

In 1995 the People's Republic of China passed a controversial Eugenics Law, which, after a torrent of international criticism, was euphemistically renamed the Maternal and Infant Health Law. Aimed at "the implementation of premarital medical checkups" to ensure that neither partner has any hereditary, venereal, reproductive, or mental disorders, the ordinance implies that those deemed "unsuitable for reproduction" should undergo sterilization or abortion or remain celibate in order to prevent "inferior births." Using this recent statute as a springboard, Frank Dik?tter explores the contexts and history of eugenics in both Communist China and Taiwan. Dik?tter shows how beginning in Late Imperial China, Western eugenics was imported and combined with existing fears of cultural, racial, or biological degeneration in Chinese society, leading to government regulation of sexual reproduction.

"Imperfect Conceptions" is a revealing look at the cultural history of medical explanations of birth defects that demonstrates how Chinese assumptions about the relationship of the individual to society form the very core of their attitudes toward procreation. Dik?tter explains the patrilineal model of descent, where a person is viewed as the culmination of his or her ancestors and is held responsible for the health of all future generations. By this logic, a pregnant woman's behavior and attitude directly influence the well-being of her baby, and a deformed or retarded child reflects a moral failing on the part of the parents. Dik?tter also shows how the holistic medicine practiced in China blurs any distinction between individual and environment so that people are held responsible for illness.

Drawing on cultural, social, economic, and political approaches, Dik?tter goes beyond a simple authoritarian model to provide a more complex view of eugenic policy, showing how a variety of voices including those of popular journalists, social reformers, medical writers, sex educators, university professors, and politicians all disseminate information that supports rather than questions the state's program.

"Imperfect Conceptions" reveals how Chinese cultural currents -- fear and fascination with the deviant and the urge to draw clear boundaries between the normal and the abnormal -- have combined with medical discourse to form a program of eugenics that is viewed with alarm by the rest of the world.

Giving Voice to Values as a Professional Physician provides students with the theoretical background and practical applications for acting on their values in situations of ethical conflict. It is the first medical ethics book that utilizes the Giving Voice to Values methodology to instruct students in medical ethics and professionalism. In doing so, it shifts the focus of ethics education from intellectually examining ethical theories and conflicts to emphasizing moral action. Each section of the book explains how moral decision-making and action can be implemented in the healthcare arena. Medical ethics cases are provided throughout in order to assist students in giving voice to their values and developing skills for professional action. The Giving Voice to Values methodology, and the cases in this book, do not focus on the big questions of academic ethics, but rather on the ethics of the everyday, even if the challenges presented are difficult. In other words, the ethical questions students will have to face, in this book and in medical education and practice, are about how to interact with others, whether they be patients or colleagues, who might have different ethical positions. The book provides a unique guide for professional identity formation and the teaching of ethics in medical schools.

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."

The Neuroethics of Memory is a thematically integrated analysis and discussion of neuroethical questions about memory capacity and content, as well as interventions to alter it. These include: how does memory function enable agency, and how does memory dysfunction disable it? To what extent is identity based on our capacity to accurately recall the past? Could a person who becomes aware during surgery be harmed if they have no memory of the experience? How do we weigh the benefits and risks of brain implants designed to enhance, weaken or erase memory? Can a person be responsible for an action if they do not recall it? Would a victim of an assault have an obligation to retain a memory of this act, or the right to erase it? This book uses a framework informed by neuroscience, psychology, and philosophy combined with actual and hypothetical cases to examine these and related questions.