Can medical ethics be legislated? Can a complex bioethical question be definitively answered through legislation? In July 1987 the New York State legislature experimented with legislating medical ethics by amending the state's public health law to regulate Do Not Resuscitate' orders. The consequent law was complex and remains controversial. This volume reviews both the background bioethical debates and the elements of the public policy making process that are essential to understanding New York's experience with the DNR law. It features debates between leading exponents and critics of the law; case studies that examine the impact of New York's DNR law on clinicians, hospitals and patients; and a review of all empirical studies of the law by their lead authors. Appended to the volume is the New York State DNR law and a comprehensive set of background documents. The co-editors, Robert Baker and Martin A. Strosberg, are both professors at Union College, Schenectady, New York. They have collaborated on many projects including, Rationing America's Medical Care: The Oregon Plan and Beyond (Brookings, 1992).

Bioethicists, moral philosophers and social policy analysts have long debated about how we should decide who shall be saved with scarce, lifesaving resources when not all can be saved. It is often claimed that it is fairer to save younger persons and that age is an ethically relevant consideration in such tragic decisions. Medical benefit should be maximized and final selection should aim to minimize the contaminating influence of chance. These claims are challenged by Duff R. Waring in Medical Benefit and the Human Lottery, one of the few books that attempts a sustained defence of random patient selection.

This book combines ethics and political philosophy in its novel and strict egalitarian approach to patient selection for transplantable organs. Waring addresses the question of whether we should choose between lives on the basis of fair chances or best outcomes. He argues that final selection criteria should be based on fair chances that equalize opportunity as opposed to best outcomes. His defence of "hardy" egalitarianism aims to show that random selection by lottery can affirm both a common humanity and the equal value of lives. The notion of patient selection by lottery has not fared well in bioethics and has been regarded by some as a moral affront. Waring argues that a human selection lottery may be neither as crude nor as ethically anomalous as some have supposed. Indeed, it can reflect a familiar conception of equality as a political and moral ideal. This conception abstracts from many undeniable differences between patients and claims that scarce resources should be allocated on the principled assumption that each of their lives is equally worth saving. The book isalso notable for its critiques of some recent utilitarian notions of medical benefit which can have an age-biased impact on elderly patients. Waring then argues against the leading, contemporary age-based approaches to patient selection. He explores the way random selection by lottery can affirm his egalitarian ethos in cases where eligible transplant candidates have each passed a threshold level of prospective medical benefit that has been set by democratic deliberation. Taming chance with a human lottery is defended as the most lucid means of ensuring equal opportunity. In so doing, Waring argues that we give the principle of equal concern and respect a radical expression: above a noncomparative threshold of medical benefit, each candidate can have an equal claim to life.

+ Clearly exposes the most frequent calumnies made against science + Shows how dogmatic religion, the financial interests of certain industries, and opportunistic politicians sometime work in cohort to undermine the public’s trust in science + Acknowledges that science’s most mistaken critics are often skilled communicators, and that effectively defending science requires an equally skilled defense + Shows that while the “Science Wars“ of the 1990s have abated, their effects on some of the methodologies in higher education and the larger population continue + Examines three case studies to clearly illustrate how reliable scientific knowledge is secured: • Eratosthenes’ discovery of the circumference of the earth • Louis Pasteur’s development of anthrax and rabies vaccines • The rapid emergence of scientific consensus regarding continental drift

In general, the history of virtue theory is well-documented (Sherman, 1997; O'Neill, 1996). Its relationship to medicine is also recorded in our work and in that of others (Pellegrino and Thomasma, 1993b; 1996; Drane, 1994; Ellos, 1990). General publications stress the importance of training the young in virtuous practices. Still, the popularity of education in virtue is widely viewed as part of a conservative backlash to modern liberal society. Given the authorship of some of these works by professional conservatives like William Bennett (1993; 1995), this concern is authentic. One might correspondingly fear that greater adoption of virtue theory in medicine will be accompanied by a corresponding backward-looking social agenda. Worse yet, does reaffirmation of virtue theory lacquer over the many challenges of the postmodern world view as if these were not serious concerns? After all, recreating the past is the "retro" temptation of our times. Searching for greater certitude than we can now obtain preoccupies most thinkers today. One wishes for the old clarity and certitudes (Engelhardt, 1991). On the other hand, the same thinkers who yearn for the past, like Engelhardt sometimes seems to do, might stress the unyielding gulf between past and present that creates the postmodern reaction to all systems of Enlightenment thought (1996).

A study of the historical genesis and present-day persistence of antisexualism in American healthcare and social/legal policy.

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.

This book describes, in fascinating detail, a variety of experiments sponsored by the U.S. government in which people were exposed to radiation without their knowledge. After reviewing hundreds of thousands of documents from the Atomic Energy Commission and other agencies, the Advisory Committee appointed by President Clinton in January 1994 found that nearly 4,000 human radiation experiments--most involving very low doses of radioactive tracers--were sponsored by the federal government between 1944-1974. This book documents these findings to provide a fascinating if not disturbing reminder of both the shocking standards for human experimentation and the shrouded practice of government secrecy in recent history. Carried out at the height of the Cold War, experiments included feeding radioactive cereal to teenagers at a school for the mentally retarded, irradiating the testicles of prison inmates, injecting plutonium into hospital patients, and intentional releases of radiation into the environment. The book places these experiments within their historical context, and a review of the relevant government policies and ethics standards at the time is included. The analysis is then applied to contemporary research on human subjects. The book concludes with a discussion of the Committee's key findings and a set of recommendations for changes in in institutional review boards, the interpretation of ethics rules and policies, the conduct of research involving military personnel, the oversight and accountability for ethical violations, compensation for research injuries, and balancing national securities interests with the rights of the public. This compelling volume will prove to be a landmark in the development of standards for human experimentation. Ethicists, public health professionals and those interested in the history of medicine and Cold War history will be intrigued by the findings in this volume.

Should parents aim to make their children as normal as possible to increase their chances to "fit in"? Are neurological and mental health conditions a part of children's identity and if so, should parents aim to remove or treat these? Should they aim to instill self-control in their children? Should prospective parents take steps to insure that, of all the children they could have, they choose the ones with the best likely start in life? This volume explores all of these questions and more. Against the background of recent findings and expected advances in neuroscience and genetics, the extent and limits of parental responsibility are increasingly unclear. Awareness of the effects of parental choices on children's wellbeing, as well as evolving norms about the moral status of children, have further increased expectations from (prospective) parents to take up and act on their changing responsibilities. The contributors discuss conceptual issues such as the meaning and sources of moral responsibility, normality, treatment, and identity. They also explore more practical issues such as how responsibility for children is practiced in Yoruba culture in Nigeria or how parents and health professionals in Belgium perceive the dilemmas generated by prenatal diagnosis.

This book presents a critical analysis of the debate at the religious, legal and political level sparked off by the introduction of new biomedical technologies (cloning, genetics, organ transplants, IVF, etc.) in Muslim countries. It compares the positions of classic Muslim law and contemporary religious authorities; laws in Muslim countries; the attitudes and concrete behaviour of populations, families and individuals, as well as the regulations of medical associations, bioethics committees, and others. The result is a mosaic of positions which are often different (including from the point of view of ethics) but all in pursuit of legitimisation according to the Koran and the Sharia. The work has an interdisciplinary approach, drawing on law, sociology, anthropology, politics and the history of science. For this reason, it will be of interest to scholars and operators in a wide variety of disciplines and fields.

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.

Internationally recognized scientists, clinicians, and technologists review and explain the fundamental molecular and cellular biology that has been applied to the emerging field of transplant immunology and xenotransplantation, and what impact these advances might optimally have on medicine and science. The authoritative experts writing here-many of whom made the basic discoveries underlying the recent advances-examine the biological and immunological hurdles to xenotransplantation, illuminating how the immune system interacts with the xenograft and laying a practical foundation for the use of genetic engineering and animal transplants in the treatment of human disease.

"Mercy killing," "assisting a suicide," "planning your own death," and "euthanasia" are once again high-profile issues. Recent popular referendums have sought to legalize doctor-assisted suicide, while best-selling books have been published about how to kill yourself. In short, Americans are searching for more control over their own mortality.
Hemlock's Cup is the first history of the active euthanasia movement in America, as represented by its most visible proponent, the Hemlock Society. Donald W. Cox traces the growth of the society from its beginnings as a three-person cause to its current world-wide fame. The work of Derek Humphrey, the society's founder, is reviewed and the publicity surrounding Dr. Jack Kevorkian and his controversial "suicide machine" is discussed.
Cox also addresses the Washington and California initiatives to legalize doctor-assisted suicide and the ethical questions they pose. He reflects on the impact of the Quinlan and Cruzan cases to establish the "right to die" for all Americans and he explores the reasons for the delays in enacting living-will laws in various states. In addition, Cox examines the significant connections among AIDS, abortion, and assisted suicide.

Patricia Rosier died at her home in Fort Myers, Florida, in January of 1986, having sought the help of her prominent physician husband, Peter, to end her cancer-ravaged life with some measure of dignity. By November 1987, Peter had been indicted for first degree murder and faced death in Florida's electric chair. How could it happen? How does a loving husband and father get charged with first degree murder? This compelling true story shows just how easy it is in America's legal system. "Euthanasia" remains a crime in Florida and in most other states, yet the majority of such "criminals" are never prosecuted. But Dr. Rosier was singled out because he "confessed", both in a television interview and in writing, to believing in euthanasia and to assisting his wife's suicide. In Murder of Mercy every heart-pounding moment of Dr. Rosier's legal ordeal is vividly captured by famed trial attorney Stanley M. Rosenblatt, who, together with his wife and law partner, Susan, represented the accused. Describing an intriguing array of legal twists and turns, this riveting book is more than just gripping courtroom drama. Find out why Patricia's father and brothers sought immunity before they would testify. Feel the rush, the exhilaration, of planning defense strategy: How could anyone explain away Dr. Rosier's confessions? Could the Fort Myers judge be persuaded to change the location of the trial? Should Peter Rosier testify in his own defense? The powerful arguments of the State and the defense are laced with ridicule, sarcasm, and scorn: each side accusing the other of treacherous character assassination. Rosenblatt's penetrating assessment of judges, the use of expert witnesses, the exclusion ofrelevant evidence, attorney-client privilege, and the granting of immunity serve as the foundation for a searing critique of America's criminal justice system and the society it is designed to protect.

Written by experts, this first encyclopedia about U.S. biomedical policy since the 1970s covers a broad array of key issues and developments in human genetics, reproduction, neonatal intensive care, organ transplantation, intervention in the brain, and medical interventions at the end of life. This easily accessible reference describes court cases, legislation, public policies, technologies, issues, key government agencies, and private organizations dealing with the complex economic, cultural, social, and political context for biomedical decisionmaking today. A chronology, directory of major organizations, carefully selected sources for further reading, and index further enrich this interdisciplinary guide designed for students; teachers; policymakers; public administrators in college, university, and institutional libraries; and general readers in public libraries. This easily accessible reference describes court cases, legislation, public policies, technologies, issues, key government agencies, and private organizations dealing with the complex economic, cultural, social, and political context for biomedical decisionmaking today. A chronology, directory of major organizations, carefully selected sources for further reading, extensive cross references and index further enrich this interdisciplinary guide designed for students; teachers; policymakers; public administrators in college, university, and institutional libraries; and general readers in public libraries.

The central idea for this book is that we lack consensus on principles for allocating resources and in the absence of such a consensus we must rely on a fair decision-making process for setting limits on health care. The authors characterize key elements of this process in a variety of health care contexts where such decisions are made- decisions about insurance coverage for new technologies, pharmacy benefit management, the design of physician incentives, contracting for mental health care by public agencies, etc.- and they connect the problem in the U.S. with the same problem in other countries. They provide a cogent analysis of the current situation, lucidly review the usual candidate solutions, and describe their own approach, which represents a clear advance in thinking. Their intended audience is international since the problem of limits cuts across types of health care systems whether or not they have universal coverage.

Despite many technological challenges faced by the xenotransplantation field, many major advances have been made in the last two decades. The field seeks to overcome the limitations and difficulties in organ procurement, which also apply to human cells and tissues, and facilitate the development of new therapies based on cell and engineered-tissue. Xenogeneic cells are simpler than solid organs and seem to pose less hurdles to attain long-term graft survival. In, Xenotransplantation: Methods and Protocols expert researchers study characterizations of xenogeneic interactions at the cellular and molecular levels and describe the use of relevant small-animal and pig-to-primate models. Related ethical and legal considerations are also covered. Written in the highly successful Methods in Molecular Biology (TM) series format, the chapters include the kind of detailed description and implementation advice that is crucial for getting optimal results in the laboratory. Thorough and intuitive, Xenotransplantation: Methods and Protocols aids scientists in continuing to study xenotransplantation and its multiple aspects.

The recent interest in biomedical ethics has resulted in the publication of a great many textbooks in the field. As good as many of these texts are, their attempts to encompass the ethical issues in all areas of health care have left them wanting in comprehensive treatments of specific areas that are of immediate concern to clinicians, and over-comprehensive in areas that are peripheral. While the numerous anthologies of articles have the merit of not presenting students with a single biased approach, they usually have the disadvantage of pre senting articles that are narrowly focused criticisms of other narrowly focused articles. On the other hand, texts by single authors tend to be overly theoretical in their approach. The philosopher teaching ethics in a medical school or in a hospital set ting must tread a difficult intellectual path. There are no "desert island" issues in clinical ethics, and few of the actual cases can be simply stripped down to clear con flicts between two philosophical theories. The horns of vii viii Preface the dilemmas that he encounters are more likely to re semble a stag's horns than a bull's. A philosopher work ing in these settings must quickly change his accus tomed approach to philosophical issues if he is to be effective. Very often he will be presented with an issue that he would prefer to mull over for a year or two, but which will require some sort of immediate direction or resolution because action must be taken.

Public Health Policy and Ethics brings together philosophers and practitioners to address the foundations and principles upon which public health policy may be advanced. What is the basis that justifies public health in the first place? Why should individuals be disadvantaged for the sake of the group? How do policy concerns and clinical practice work together and work against each other? Can the boundaries of public health be extended to include social ills that are amenable to group-dynamic solutions? These are some of the crucial questions that form the core of this volume of original essays sure to cause practitioners to engage in a critical re-evaluation of the role of ethics in public health policy.

This volume is unique because of its philosophical approach. It develops a theoretical basis for public health and then examines cutting-edge issues of practice that include social and political issues of public health. In this way the book extends the usual purview of public health. Public Health Policy and Ethics is of interest to those working in public health policy, ethics and social philosophy. It may be used as a textbook for courses on public health policy and ethics, medical ethics, social philosophy and applied or public philosophy.

Human Lives: Critical Essays on Consequentialist Bioethics is a collection of original papers by philosophers from Britain, the USA and Australia. The aim of the book is to redress the imbalance in moral philosophy created by the dominance of consequentialism, the view that the criterion of morality is the maximization of good effects over bad, without regard for basic right or wrong. This approach has become the orthodoxy over the last few decades, particularly in the field of bioethics, where moral theory is applied to matters of life and death. The essays in Human Lives critically examine the assumptions and arguments of consequentialism, reviving in the process important concepts such as rights, justice, innocence, natural integrity, flourishing, the virtues, and the fundamental value of human life.

Do people of differing ethnicities, cultures, and races view medicine and bioethics differently? And, if they do, should they? Are doctors and researchers taking environmental perspectives into account when dealing with patients? If so, is it done effectively and properly? In "African American Bioethics", Lawrence J. Prograis Jr. and Edmund D. Pellegrino bring together medical practitioners, researchers, and theorists to assess one fundamental question: Is there a distinctive African American bioethics? The book's contributors resoundingly answer yes - yet their responses vary. They discuss the continuing African American experience with bioethics in the context of religion and tradition, work, health, and U.S. society at large - finding enough commonality to craft a deep and compelling case for locating a black bioethical framework within the broader practice, yet recognizing profound nuances within that framework. As a more recent addition to the study of bioethics, cultural considerations have been playing catch-up for nearly two decades. "African American Bioethics" does much to advance the field by exploring how medicine and ethics accommodate differing cultural and racial norms, suggesting profound implications for growing minority groups in the United States.

Once dialysis treatment, in 1960, permitted life prolongation for some but not all patients in kidney failure, an ethical genie' was released. The introduction of peritoneal dialysis and kidney transplantation compounded the physician's dilemma by underscoring those left untreated. Who should be selected for uremia therapy? Should exclusion from treatment be properly delegated to administrators or physicians, or better left to a committee? Are some candidates more worthy than others? As examples: Do Presidents and Kings warrant priority in cadaver organ allocation over ordinary citizens? Are rich people more deserving than the poor? Is it ethical to choose a younger over an older patient? Can children and/or mentally incompetent persons serve as living organ donors? Is it proper to market organs under controlled circumstances? Eli A. Friedman, an experienced nephrology training program director, and Medical Advisor to the American Association of Kidney Patients, has collected 24 difficult cases that focus on these and other vexing though common stressful issues faced by those who manage kidney patients. Using a novel approach to each case, the opinions of lawyers, nephrologists, patients, and a transplant surgeon are proffered sequentially. Friedman asks and then answers searching questions arising from the debate. The quality of information presented is positively flavored by the fact that three of the respondents (one an attorney) are kidney transplant recipients. Members of the kidney team, those immersed in seeking truth in medical ethics, and all participating in exploring the legality or ethical basis of organ replacement will find this book pertinent to their effort.

Michael Ryan (d. 1840) remains one of the most mysterious figures in the history of medical ethics, despite the fact that he was the only British physician during the middle years of the 19th century to write about ethics in a systematic way. Michael Ryan s Writings on Medical Ethics offers both an annotated reprint of his key ethical writings, and an extensive introductory essay that fills in many previously unknown details of Ryan s life, analyzes the significance of his ethical works, and places him within the historical trajectory of the field of medical ethics."