As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different regions of the world. It is often difficult, however, to obtain timely information about these matters. The Bioethics Yearbook series analyzes how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withholding and withdrawing treatment, euthanasia, the definition of death, and organ transplantation are being discussed in different religions and regions. Volume 5 discusses theological developments from 1992 to 1994 in Anglican, Baptist, Catholic, Hindu, Jehovah's Witness, Jewish, Latter-Day Saint, Lutheran, Methodist, Muslim, Pentecostal, and Presbyterian traditions.

Though the current political climate might lead one to suspect that religion and medicine make for uncomfortable bedfellows, the two institutions have a long history of alliance. From religious healers and religious hospitals to religiously informed bioethics and research studies on the impact of religious and spiritual beliefs on physical and mental well-being, religion and medicine have encountered one another from antiquity through the present day. In Religion and Medicine, Dr. Jeff Levin outlines this longstanding history and the multifaceted interconnections between these two institutions. The first book to cover the full breadth of this subject, it documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. Levin summarizes a wide range of material in the most comprehensive introduction to this emerging field of scholarship to date.

A comprehensive and thoughtful analysis of human reproduction issues in the U.S. with emphasis on the ethical and policy implications of cutting-edge reproductive technologies. Human cloning. Stem cell research. Abortion. All of these subjects are surrounded by controversy. But now readers can cut through the usual emotion, misinformation, and distortion-and get a fair and balanced picture of human reproduction issues in the United States. Few subjects are as divisive and partisan as the issues surrounding the propagation of the human species. This thorough examination covers the full scope of the debates and offers an up-to-the-minute survey of the controversial technologies that are at the heart of reproductive rights in the United States. The areas explored range from abortion and sterlization to fetal research and human cloning. The moral, societal and public policy implications of each subject are examined thoroughly, with emphasis on those areas where cutting-edge technology has raced ahead of public policy, thereby creating new concerns for ethicists and policy-makers. Legislative oversight or the freedom to pursue reproductive technologies at any cost, this debate is far fr

The genie is out of the bottle. A whole new world of genetics research is underway with its exciting potential for a better understanding of heredity and genetically inherited disease, with opportunities for prevention, management and cure. But the current explosion of human genetic information has the potential for abuse also, for damage to rights, privacy and fair treatment for individuals and vulnerable groups. This book brings us up to date with important contributions from the authoritative "Encyclopaedia of the Human Genome" on the urgent social, legal and ethical aspects of the Human Genome enterprise, accessibly written and introduced for the undergraduate, postgraduate and general reader.

Like many novel ideas, the idea for this volume and its predecessor arose over lunch in the cafeteria of the old Wellcome Institute. On an atternoon in Sept- ber 1988, Dorothy and Roy Porter, and I, sketched out a plan for a set of conf- ences in which scholars from a variety of disciplines would explore the emergence of modern medical ethics in the English-speaking world: from its pre-history in the quarrels that arose as gentlemanly codes of etiquette and honor broke down under the pressure of the eighteenth-century "sick trade," to the Enlightenment ethics of John Gregory and Thomas Percival, to the American appropriation process that culminated in the American Medical Association's 1847 Code of Ethics, and to the British turn to medical jurisprudence in the 1858 Medical Act. Roy Porter formally presented our idea as a plan for two back-to-back c- ferences to the Wellcome Trust, and I presented it to the editors of the PHI- LOSOPHY AND MEDICINE series, H. Tristram Engeihardt, Jr. and Stuart Spicker. The reception from both parties was enthusiastic and so, with the financial backing of the former and a commitment to publication from the latter, Roy Porter, ably assisted by Frieda Hauser and Steven Emberton, - ganized two conferences. The first was held at the Wellcome Institute in - cember 1989; the second was sponsored by the Wellcome, but was actually held in the National Hospital, in December 1990.

Genetic counselors translate the findings of scientific investigation into meaningful accounts that enable individuals and families to make decisions about their lives. This collection of original papers explores the history, values, and norms of that process, with some focus on the value of nondirectiveness in counseling practice. The contributors; examination of genetic counseling issues serves as a foundation from which to address other ethical, legal, and policy considerations in the expanding universe of clinical genetics.

Before Bioethics narrates the history of American medical ethics from its colonial origins to current bioethical controversies over abortion, AIDS, animal rights, and physician-assisted suicide. The first history of American medical ethics published in more than a half century, Before Bioethics tracks the evolution of American medical ethics from colonial midwives and physicians' oaths, to medical society codes and bioethical principles. Applying the concept of "morally disruptive technologies," it analyzes the impact of the stethoscope on conceptions of fetal life and the criminalization of abortion, and the impact of the ventilator on our conception of death and the treatment of the dying. The narrative offers tales of those whose lives were affected by the medical ethics of their era: unwed mothers executed by puritans because midwives found them with stillborn babies; the unlikely trio-an Irishman, a Sephardic Jew and in-the-closet gay public health reformer-who drafted the American Medical Association's code of ethics but received no credit for their achievement, and the founder of American gynecology celebrated during his own era but condemned today because he perfected his surgical procedures on un-anesthetized African American slave women. The book concludes by exploring the reasons underlying American society's empowerment of a hodgepodge of ex-theologians, humanist clinicians and researchers, lawyers and philosophers-the bioethicists-as authorities able to address research ethics scandals and the ethical problems generated by morally disruptive technologies.

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better.

This book focuses on justice and its demands in the way of providing people with medical care. Building on recent insights on the nature of moral perceptions and motivations from the neurosciences, it makes a case for the traditional medical ethic and examines its financial feasibility. The book starts out by giving an account of the concept of justice and tracing it back to the practices and tenets of Hippocrates and his followers, while taking into account findings from the neurosciences. Next, it considers whether the claim that it is just to limit medical care for everyone to some basic minimum is justifiable. The book then addresses finances and expenditures of the US health care system and shows that the growth of expenditures and the percentage of the gross national product spent on health care make for an unsustainable trajectory. In light of the question what should be changed, the book suggests that overdiagnosis and medicalizing normal behavior lead to harmful, costly and unnecessary interventions and are the result of unethical behavior on the part of the pharmaceutical industry and extensive ethical failures of the FDA. The book ends with suggestions about what can be done to put the U.S. health care system on the path to sustainability, better medical care, and compliance with the demands of justice.

This book examines the ethical obligations binding a doctor to her patient's confidences and asks "Should those ethical obligations be recognized in the courtroom?". Increasingly, English law has shown a responsiveness to the need to accord respect to patient confidentiality. In practice this has involved the prohibition of unauthorized disclosure of medical records in national newspapers and the provision of special protection for data stored on computer. In one area, however, the law has been unwilling to protect patient confidences - the courtroom. A patient cannot stop her doctor from testifying even though the doctor has promised not to divulge medical information under any circumstances. Jean V. McHale examines cases to see whether the denial in law of the doctor-patient privilege is consistent with the protection of other confidential relationships. She discusses the nature of medical information and confidentiality and she considers the practical issues and questions which are raised by confidentiality. This book challenges orthodox ideas of medical confidentiality and questions the overriding right of the law.

In the early 1970s, well before the field ofbioethics had established itself in medicine or anywhere else, the Hastings Center organized a small meeting of law school professors. The question we put to them was: what could or should be done to stimulate legal interest in the field? The answer we got was a wise one. We should do nothing to forcefeed the interest. It should simply be allowed to develop on its own, by the ordinary route of attracting a following because of its inherent importance. That is just what happened, and one of the first young legal scholars drawn to what remains (oddly enough) a relatively small field was George Annas. The idea of a column on law and ethics for the Hastings Center Report was not by 1976 a particularly bold one. It had been clear to us from the outset of the Center in 1969, and the establishment of the Report in 1971, that the rapidly emerging moral problems in medicine and biology would have enormous legal and policy implications. Even so, we were hardly prepared for the large and steady number of cases that were to come before the courts during the 1970s and that were to continue unabated in the 1980s. But our concern about a column on the subject was of a more pedestrian kind.

The first suggestions and exchange of ideas for this Workshop began about two years ago when, at the invitation of Professor E Bennett, Director of Health and Safety of the Commission of the European Communities and Professor W W Holland of the Panel of Social Medicine and Epidemiology of the EEC, I asked the Panel to sponsor a project for the study of Ethical Issues in Preventive Medicine. The Panel gave its approval and support and asked Dr L Karhausen, Dr R Blaney, and me to undertake the planning. Since then we have had several meetings in Brussels and have added Professor Heleen Terborgh-Dupuis and Mrs Susie Stewart to our small planning team. The Planning Committee invited many experts to collaborate with us on the project and, as can be seen from the list of participants, they represent many scientific disciplines and many countries. About a year ago we also asked for the help and sponsorship of the NATO Science Council which was generously given. The culmination of our efforts was the Workshop held in Athens in January 1985, the proceedings of which are contained in the present book. The members of the Planning Committee and the participants at the Workshop would like to express thanks to Mr H Durand, Secretary General for NATO Scientific Affairs and Dr M di Lullo, Programme Director of N A TO Scientific Affairs and to Professor Bennett and Professor Holland for all the moral and financial support they have given to this project.

Section I examines historical philosophical understandings of expertise in order to situate the current institution of bioethics. Section II focuses on philosophical analyses of the concept of expertise, asking, among other things, how it should be understood, how it can be acquired, and what such expertise warrants. Finally, section III addresses topics in bioethics and how ethics expertise should or should not be brought to bear in these areas, including expertise in the court room, in the hospital room, in the media, and in making policy. 2. A GUIDED HISTORICAL TOUR As Scott LaBarge points out, Plato's dialogues can be viewed as an extended treatment of the concept of moral expertise, so it is fitting to begin the volume with an examination of "Socrates and Moral Expertise." Given Socrates' protestations (the Oracle at Delphi notwithstanding) that he knows nothing, LaBarge observes that it would be interesting to determine both what a Socratic theory of moral expertise might be and whether Socrates qualified as such an expert. Plato's model of moral expertise is what LaBarge calls "demonstrable expertise," which is concerned mainly with the ability to attain a goal and to explain how one did it. The problem with this account is that when one tries to solve the various problems in the model - for example, allowing that moral expertise is not an all-or-nothing skill - then one is immediately faced with the "credentials problem." As LaBarge puts it, ." . .

Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each of the topics is addressed in such a way that it includes an examination of the locus of responsibility for ethical decision making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems.

This volume explores Confucian views regarding the human body, health, virtue, suffering, suicide, euthanasia, human drugs, ' human experimentation, and justice in health care distribution. These views are rooted in Confucian metaphysical, cosmological, and moral convictions, which stand in contrast to modern Western liberal perspectives in a number of important ways. In the contemporary world, a wide variety of different moral traditions flourish; there is real moral diversity. Given this circumstance, difficult and even painful ethical conflicts often occur between the East and the West with regard to the issues of life, birth, reproduction, and death. The essays in this volume analyze the ways in which Confucian bioethics can clarify important moral concepts, provide arguments, and offer ethical guidance. The volume should be of interest to both general readers coming afresh to the study of bioethics, ethics, and Confucianism, as well as for philosophers, ethicists, and other scholars already familiar with the subject.

This open access book offers a framework for understanding how the Holocaust has shaped and continues to shape medical ethics, health policy, and questions related to human rights around the world. The field of bioethics continues to face questions of social and medical controversy that have their roots in the lessons of the Holocaust, such as debates over beginning-of-life and medical genetics, end-of-life matters such as medical aid in dying, the development of ethical codes and regulations to guide human subject research, and human rights abuses in vulnerable populations. As the only example of medically sanctioned genocide in history, and one that used medicine and science to fundamentally undermine human dignity and the moral foundation of society, the Holocaust provides an invaluable framework for exploring current issues in bioethics and society today. This book, therefore, is of great value to all current and future ethicists, medical practitioners and policymakers - as well as laypeople.

The Direction of Medical Ethics The direction bioethics, and specifically medical ethics, will take in the next few years will be crucial. It is an emerging specialty that has attempted a great deal, that has many differing agendas, and that has its own identity crisis. Is it a subspecialty of clinical medicine? Is it a medical reform movement? Is it a consumer pro tection movement? Is it a branch of professional ethics? Is it a ra tionale for legal decisions and agency regulations? Is it something physicians and ethical theorists do constructively together? Or is it a morally concentrated attack on high technology, with the prac titioners of scientific medicine and the medical ethicists in an adversarial role? Is it a conservative endeavor, exhibiting a Frankenstein syn drome in Medical Genetics ("this time, they have gone too far"), or a Clockwork Orange syndrome in Psychotherapy ("we have met hods to make you talk-walk-cry-kill")? Or does it suffer the afflic tion of overdependency on the informal fallacy of the Slippery Slope ("one step down this hill and we will never be able to stop") that remains an informal fallacy no matter how frequently it's used? Is it a restricted endeavor of analytic philosophy: what is the meaning of "disease," how is "justice" used in the allocation of medical resources, what constitutes "informed" or "consent?" Is it applied ethics, leading in clinical practice to some recommenda tion for therapeutic or preventive action? This incomplete list of questions indicates just how complex,"

This book presents the findings of a study into the social shaping of reproductive genetics in Germany and Israel, two exceptionally interesting social settings, which share a traumatic history. Based on a variety of empirical materials (including in-depth interviews with genetic counsellors and survey data on their practices and opinions, as well as analysis of legal, religious, professional and media texts), the study reveals dramatic differences between the way that the German and Israeli societies address the question of a life (un)worthy of living: while in Germany, social, cultural, religious and legal conditions restrict the selection of embryos based on prenatal diagnosis, in Israel they strongly encourage it.

This book contributes to an overall understanding of the nature and the impact of sexual boundary violations. By exploring an extreme human experience, childhood sexual abuse, the present study allows an insight into a hidden, silenced, and destructive aspect of human relations. It is the first of its kind to make comprehensible both the general path from violation to sickness, and the particular logic of assault embodiment. Due to its theoretical and methodological framework, the present study provides evidence that the embodiment of sexual violation experience is informed by situated logic and rationality. These, however, do not correspond to scientific logic and rationality. The universe of socio-culturally constituted meaning and that of scientifically constructed knowledge are shown to be incompatible. Subjectively informed violation embodiment is likely to be misinterpreted and consequently maltreated within the objectively grounded framework of current biomedical praxis. Consequently, victims of silenced sexual violence are revictimized by medicine.

The Patient Self-Determination Act of 1990 required medical facilities to provide patients with written notification of their right to refuse or consent to medical treatment. Using this Act as an important vehicle for improving the health care decisionmaking process, Lawrence P. Ulrich explains the social, legal, and ethical background to the Act by focusing on well-known cases such as those of Karen Quinlan and Nancy Cruzan, and he explores ways in which physicians and other caregivers can help patients face the complex issues in contemporary health care practices. According to Ulrich, health care facilities often address the letter of the law in a merely perfunctory way, even though the Act integrates all the major ethical issues in health care today. Ulrich argues that well-designed conversations between clinicians and patients or their surrogates will not only assist in preserving patient dignity - which is at the heart of the Act - but will also help institutions to manage the liability issues that the Act may have introduced. He particularly emphasizes developing effective advance directives. Ulrich examines related issues, such as the negative effect of managed care on patient self-determination, and concludes with a seldom-discussed issue: the importance of being a responsible patient. Showing how the Patient Self-Determination Act can be a linchpin of more meaningful and effective communication between patient and caregiver, this book provides concrete guidance to health care professionals, medical ethicists, and patient-rights advocates.

This book offers the first ever book-length treatment of the topic of transitioning from adolescence to adulthood with autism and the attendant ethical, legal and social issues for the individual as well as caregivers and professionals. It features experts in a variety of areas (law, bioethics, philosophy, pediatrics, neurology, medicine, psychology, special education, social work, employment, civic participation, social media) who provide commentary on these areas and the relevant ethical/legal/social challenges young autistic adults face in these different areas. This is an indispensable read for educators, therapists, and other professionals who work in transition with young autistic adults.

The Ethics of Sport explores moral issues that arise in sports, especially competitive athletics, in a manner that is accessible not only to sports fans or participants but also to those critical of sports or simply interested in an introduction to the kind of moral issues raised by the practice of athletics. The issues considered range from the more abstract, such as the importance that should be assigned to winning in sports, to specific controversies such as arguments over the use of performance enhancing drugs, the nature of gender equity, and the evaluation of violence in competition. The book explores different sides of these issues and suggests reasonable resolutions to the kinds of ethical questions prevalent in the practice of sports.

This book summarizes the efforts and results of the first international Ifgene conference on presuppositions in science and expectations in society with respect to genetic engineering which was held at the Goetheanum, Dornach, Switzerland, October 2-5, 1996. The Goetheanum provided a unique opportunity to gather people from diverse disciplines who have opposing attitudes on modern science and technology. It is due to this venue, among other things, that the participants were able to develop an open, power-free dialogue and could focus more on judgement-forming than a polarizing debate. This Ifgene conference could not have happened without the financial support from many private individuals and the following organisations listed in no particular order: Fetzer Foundation; Stichting Triodos; Evidenzgesellschaft; Mahle Stiftung GmbH; Gemeinnlitzige Treuhandstelle e. Y. Bochum; Initiative gegen 'Bioethik'; Verband fur anthroposophische Heilpadagogik - CHi Verband flir anthroposophische Heilpadagogik, Sozialtherapie und Sozialarbeit e. Y. - D; Stichting ter bevordering van de Heilpaeda- gogie; Iona Stichting; Antroposofische Vereniging in Nederland; Stichting Klaverblad; Swissair & Crossair; The Rudolf Steiner Association; The Welcome Association; Anthro- posophische Gesellschaft in Deutschland; Helixor Heilmittel GmbH & Co; Goethea- num Dornach; Verein flir anthroposophisches Heilwesen e. Y. - D; The Oakdale Trust; Unilever Nederland BV; NV Verenigde Bedrijven Nutricia; Migros-Genossenschafts- Bund; Ministerie van Landbouw, Natuur en Visserij; CIBA; Stichting Elise Mathilde Fonds; Anthroposophic Society Australia; Therexsys; COOP Schweiz and selected speakers (G. Stotzky - USA, H. A. de Boer - NL, J. Girard-Bascou - F, P. G.

This book is a discussion of the most timely and contentious issues in the two branches of neuroethics: the neuroscience of ethics; and the ethics of neuroscience. Drawing upon recent work in psychiatry, neurology, and neurosurgery, it develops a phenomenologically inspired theory of neuroscience to explain the brain-mind relation. The idea that the mind is shaped not just by the brain but also by the body and how the human subject interacts with the environment has significant implications for free will, moral responsibility, and moral justification of actions. It also provides a better understanding of how different interventions in the brain can benefit or harm us. In addition, the book discusses brain imaging techniques to diagnose altered states of consciousness, deep-brain stimulation to treat neuropsychiatric disorders, and restorative neurosurgery for neurodegenerative diseases. It examines the medical and ethical trade-offs of these interventions in the brain when they produce both positive and negative physical and psychological effects, and how these trade-offs shape decisions by physicians and patients about whether to provide and undergo them.