Medicine in the United States is big business. We spend 50 percent more on health care per capita than other developed countries, but a multitude of measures indicate that we are not getting health-care value for our money. In Too Big to Succeed, author Dr. Russell J. Andrews details why health care in America has become more expensive but less effective and outlines a new paradigm for health-care delivery.

Too Big to Succeed describes how American medicine is on an unsustainable course: costs are increasing while benefits are deteriorating in comparison with other developed nations. Beginning with the Hippocratic Oath and the the premedical student, Andrews traces the myriad ways in which the profit motive has infiltrated American medicine--including medical school training, current models of health-care delivery, medical professional societies, medical research, and medical drug and device development.

Presenting an insider's look into the current crisis in health care, Andrews demonstrates that until both the physician and the patient return to the relationship that underlies medicine, physicians will not experience the joy of healing those who seek their help and patients will not appreciate that a good physician is a permanent part of their lives.

With the success of organ transplantation and the declining number of heart beating cadaver doctors, the number of patients awaiting a transplant continues to rise. This means that alternative sources of donors have been sought, including donors after cardiac death. Such donors sustain rapid damage to their organs due to ischaemia, and as a consequence, some organs do not work initially and some none at all. The proportion of such transplants has increased dramatically in recent years--25% of kidney transplants in the UK were from such donors in 2006, highlighting how much progress has been made.
Written by international experts, this book lays out the moral, legal, and ethical restraints to using such donors for organ transplant together with the techniques that have been adpoted to improve their outcome. The different approaches and results of renal transplant according to country are covered together with the procedures and outcomes adopted to use other organs, notably the liver and lungs.

+ 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

The present volume is the result of a conference devoted to the topic of Rationing in Medicine, which was organized by the Europäische Akademie zur Erforschung von Folgen wissenschaftlich-technischer Entwicklungen Bad Neuenahr-Ahrweiler GmbH. One of the purposes of this volume is to contribute to a clarification of the concept of rationing and its possible implementations and thereby to help the participants in the debate to avoid further unnecessary confusion. Authors from the disciplines of medicine, philosophy, economics and law as well as practitioners of health care itself and from the field of health-care financing have contributed to this volume.

Anthologies on abortion and general medical ethics texts often seem to recycle the same old, but good, arguments. Can anything new be said about this sensitive and contentious topic? Contributors to this volume were invited to say something original, as well as something old, but essential about the factual, valuational, religious and metaphysical issues relevant to abortion, all of which are woven together so intricately into our diverse and seemingly irreconcilable world-views.

Essays in this volume consider the conceptual links between views on abortion and foetal development, abortion procedures, religion, laws and public funding (or no funding) policies. Authors also defend well-defined and differentiated positions on abortion that can broadly be described as the Roman Catholic, the Conservative, the Moderate and the Liberal positions.

New Essays on Abortion and Bioethics will provide readers with useful models of critical and rational thinking for addressing the topic of abortion. The essays will help to illuminate a subject about which there is often too much heat and too little light.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

Positive conceptions of healthy aging are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When the body or mind begins to fail, a legitimate need for intervention and care will arise. This second volume on Aging discusses this theme.

Ethics of Psychiatry addresses the key ethical and legal issues in mental health care, with selections by Paul S. Applebaum, Christopher Boorse, Kerry Brace, Peter R. Breggin, Paula J. Caplan, Glen O. Gabbard, Donald H.J. Hermann. Lawrie Rezneck, Thomas Szasz, Jerome Wakefield, Bruce J. Winick, and Robert M. Veatch, among others. This sourcebook offers the latest research in psychiatry, psychology, advocacy, mental health law, social services, and medical ethics relevant to the rational autonomy of psychiatric patients.

This book focuses on ethical issues faced by a variety of healthcare practitioners across the Anglophone African continent. This important resource contains in-depth discussions of the most salient current ethical issues by experts in various healthcare fields. Each profession is described from both an African and a South African perspective, and thus contributes to dialogue and critical thinking around African ethics and decision-making. In this way the book provides readers with an understanding of the ethical issues at hand in various professions, including the practical implications of the ethical issues and how to address those effectively. This is a beneficial resource for all those involved in the various healthcare professions addressed in this book, including undergraduate students, lecturers, researchers and practitioners across the continent. Simply put, with the dynamic changes and challenges in healthcare across the globe and in Africa, this is an indispensable resource for healthcare practitioners.

The question of whether there might be a duty to die was first raised by Margaret Battin in 1987 in her ground-breaking essay, "Age Distribution and the Just Distribution of Health Care: Is There a Duty to-Die?" In 1997 the issue was reprised when two new articles appeared on the topic written by John Hardwig and the other by former Colorado Governor Richard D. Lamm. Given the renewed interest in the topic, as well as its undeniable importance, Biomedical Ethics Re views sought to initiate an in-depth discussion of the issue by soliciting articles and issuing a general call for papers on the topic "Is There a Duty to Die?" The twelve articles in this volume represent the ultimate fruits of those initiatives. The first seven essays in this text are sympathetic to the claim that there is a duty to die. They argue either: (a) that some form of a duty to die exists, or (b) that arguments that might be offered against the existence of such a duty cannot be sustained. By way of contrast, the last five articles in the text are critical of duty-to-die claims: The authors of the first three of these five articles attempt to cast doubt on the existence of a duty to die, and the writers of the last two essays argue that if such a duty did exist, severe problems would arise when ever we attempted to implement it."

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.

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.

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.

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.