Suffering is a central component of our lives. We suffer pain. We fall ill. We fail and are failed. Our loved ones die. It is a commonplace to think that suffering is, always and everywhere, bad. But might suffering also be good? If so, in what ways might suffering have positive, as well as negative, value? This important volume examines these questions and is the first comprehensive examination of suffering from a philosophical perspective. An outstanding roster of international contributors explore the nature of suffering, pain, and valence, as well as the value of suffering and the relationships between suffering, morality, and rationality. Philosophy of Suffering: Metaphysics, Value, and Normativity is essential reading for students and researchers in philosophy of mind, philosophy of psychology, cognitive and behavioral psychology as well as those in health and medicine researching conceptual issues regarding suffering and pain.

Biomedical Ethics Reviews * 1990 is the eighth volume in a series of texts designed to review and update the literature on issues of central importance in bioethics today. Two topics are discussed in the present volume: (1) Should the United States Adopt a National Health Insurance Plan? and (2) Are the NIH Guidelines Adequate for the Care and Protection of Laboratory Animals? Each topic constitutes a separate section in our text; introductory essays briefly summarize the contents of each section. Bioethics is, by its nature, interdisciplinary in character. Recog nizing this fact, the authors represented in the present volume have made every effort to minimize the use of technical jargon. At the same time, we believe the purpose of providing a review of the recent literature, as well as of advancing bioethical discussion, is admirably served by the pieces collected herein. We look forward to the next volume in our series, and very much hope the reader will also.

Biotechnologies already on the horizon will enable us to be smarter, have better memories, be stronger and quicker, have more stamina, live longer, be more resistant to diseases, and enjoy richer emotional lives. To some of us, these prospects are heartening; to others, they are dreadful. In Beyond Humanity a leading philosopher offers a powerful and controversial exploration of urgent ethical issues concerning human enhancement. These raise enduring questions about what it is to be human, about individuality, about our relationship to nature, and about what sort of society we should strive to have. Allen E. Buchanan urges that the debate about enhancement needs to be informed by a proper understanding of evolutionary biology, which has discredited the simplistic conceptions of human nature used by many opponents of enhancement. He argues that there are powerful reasons for us to embark on the enhancement enterprise, and no objections to enhancement that are sufficient to outweigh them.

Genetic screening technologies involving pre-implantation genetic diagnosis (PGD) raise particular issues about selective reproduction and the welfare of the child to be born. How does selection impact on the identity of the child who is born? Are children who are selected for a particular purpose harmed or treated as commodities? How far should the state interfere with parents' reproductive choices? Currently, concerns about the welfare of the child in selective reproduction have focused on the individual interests of the child to be born. This book re-evaluates the welfare of the child through the controversial topic of saviour sibling selection. Drawing on relational feminist and communitarian ethics, Michelle Taylor-Sands argues that the welfare of the child to be born is inextricably linked with the welfare of his/her family. The author proposes a relational model for selective reproduction based on a broad conception of the welfare of the child that includes both individual and collective family interests. By comparing regulation in the UK and Australia, the book maps out how law and policy might support a relational model for saviour sibling selection. With an interdisciplinary focus, Saviour Siblings: A Relational Approach to the Welfare of the Child in Selective Reproduction will be of particular interest to academics and students of bioethics and law as well as practitioners and policymakers concerned with the ethics of selective reproduction.

This book addresses well-known issues - the ethical, legal, and social implications of human genetics - but does so from an unusual perspective: the perspective of the scientific community itself. In distinction to what is common in the ELSI literature, the book also discusses bioethical method. A new kind of casuistry is developed on the basis of the empirical findings of cognitive semantics. It will be of interest to philosophers, bioethicists, geneticists, and policymakers.

Patient organizations and social health movements offer one of the most important and illuminating examples of civil society engagement and participation in scientific research and research politics. Influencing the research agenda, and initiating, funding and accelerating the development of diagnostic tools, effective therapies and appropriate health-care for their area of interest, they may champion alternative, sometimes controversial, programs or critique dominant medical paradigms. Some movements and organizations advocate for medical recognition of contested illnesses, as with fibromyalgia orADHD, while some attempt to "de-medicalize" others, such as obesity or autism. Bringing together an international selection of leading scholars and representatives from patients' organizations, this comprehensive collection explores the interaction between civil society groups and biomedical science, technology development, and research politics. It takes stock of the key findings of the research conducted in the field over the past two decades and addresses emerging problems and future challenges concerning the interrelations between health movements and patient organisations on the one hand, and biomedical research and research policies on the other hand. Combining empirical case studies with conceptual discussion, the book discusses how public participation can contribute to, as well as restrict, the democratization of scientific knowledge production. This volume is an important reference for academics and researchers with an interest in the sociology of health and illness, science and technology studies, the sociology of knowledge, medical ethics or healthcare management and research, as well as medical researchers and those involved with health-related civil society organizations.

Medical therapy, research and technology enable us to make our bodies, or parts of them, available to others in an increasing number of ways. This is the case in organ, tissue, egg and sperm donation as well as in surrogate motherhood and clinical research. Bringing together leading scholars working on the ethical, social and cultural aspects of such bodily exchanges, this cutting-edge book develops new ways of understanding them. Bodily Exchanges, Bioethics and Border Crossing both probes the established giving and selling frameworks for conceptualising bodily exchanges in medicine, and seeks to develop and examine another, less familiar framework: that of sharing. A framework of sharing can capture practices that involve giving up and giving away part of one's body, such as organ and tissue donation, and practices that do not, such as surrogacy and research participation. Sharing also recognizes the multiple relationalities that these exchanges can involve and invites inquiry into the context in which they occur. In addition, the book explores the multiple forms of border crossing that bodily exchanges in medicine involve, from the physical boundaries of the body to relational borders - as can happen in surrogacy - to national borders and the range of ethical issues that these various border-crossings can give rise to. Engaging with anthropology, sociology, philosophy, and feminist and postcolonical perspectives, this is an original and timely contribution to contemporary bioethics in a time of increasing globalization. It will be of use to students and researchers from a range of humanities and social science backgrounds as well as medical and other healthcare professionals with an interest in bioethics.

Debate regarding organ sales is largely innocent of the history of thought on the matter. This volume seeks to remedy this shortcoming. Positions for or against a market in human organs are nested within moral intuitions, ontological or political theoretical premises, or understandings of special moral concerns, such as permissible uses of the body, which have a long history of analysis. The essays compass the views of Plato, Aristotle, Aquinas, Locke, Kant, Hegel, Mill and Christianity, as well as particular methodological approaches, such as the phenomenology of the body, natural law theory, legal theory and libertarian critique of legal theory. These discussions cluster a number of conceptually independent philosophical concerns: (1) What is the appropriate understanding of the relationship between persons and their bodies? (2) What does it mean to own' an organ? (3) Do governments have moral authority to regulate how persons use their own body parts? (4) What are the costs and benefits of a market in human organs? Such questions are related by an urgent public health challenge: the considerable disparity between the number of patients who could significantly benefit from organ transplantation and the number of human organs available for transplantation. This volume explores the theoretical, normative, and historical foundations for alternative policies for procurement and transplantation of human organs.

The Elements of Ethical Dilemmas: Applied Psychology Ethics in Australia is a comprehensive and applied guide to practising psychology in an ethical and professional manner. This book is designed to assist applicants for general registration as a psychologist successfully navigate one of the eight core competencies for general registration set by the Psychology Board of Australia; specifically ethical, legal, and professional matters. The exploration of ethical dilemmas is a core task for the 4+2 pathway to general registration, while related ethical applications require exploration in the 5+1 and higher education pathways to registration as well. This book will teach readers how to identify, explore, and choose the appropriate professional course of action when confronted by ethical dilemmas in practice. The chapters include personal reflections from expert contributors relating to each of the ethical dilemmas, expertly highlighting clients' and stakeholders' circumstances, ethical codes and guidelines, scholarship and research, as well as other key elements in the ethical decision-making process. Especially relevant to those applying to become a registered psychologist in Australia, this book offers invaluable guidance on responding to ethical dilemmas as required by the Psychology Board of Australia in various pathways to general registration.

With implications that go to the core of what it means to be human, the issues raised by genetic manipulation–especially cloning–have sparked a passionate debate among governmental, religious, and scientific quarters, as well as the media and the general public. Keeping to the actual science rather than speculation is of the utmost importance for an enlightened approach to this weighty discussion.

In clear, lively prose, The Science and Ethics of Engineering the Human Germ Line: Mendel’s Maze provides an authoritative treatment of the principles of science and bioethics that bear upon such technologies as germ-line insertion and cloning. It offers a realistic assessment of possible applications, limitations, and new developments likely to arise in these areas.

Written by a top physician-investigator, this book progresses from the basics of building a living organism from inanimate parts through to recombinant DNA technology, assisted reproductive technologies, and gene transfer and germ-line engineering. Ethical considerations are woven into this material throughout, while a special section covers the intellectual role played by various social biases.

As genetic and reproductive technologies spread from the laboratory to the clinic–and society takes further notice–students and practitioners of biology and medicine, as well as the interested general reader, will find The Science and Ethics of Engineering the Human Germ Line: Mendel’s Maze to be an essential and accessible guide to these important subjects.

"I would really recommend this as an excellent class text and desk reference. I would describe this as a very comprehensive, up to date text on ethics that includes most mental health professionals. This was very thorough and well written....the inclusion of case examples throughout the chapters really brought home the points that the author was trying to make. The author was very skilled at going into depth while covering the ethical dimensions and did not merely provide superficial discussion." -- Kathleen M. Salyers, The University of Toledo -- Kathleen M. Salyers, Ethical Reasoning for Mental Health Professionals addresses a fundamental need of ethics training in psychology and counseling: the development of reasoning skills to resolve the complex professional ethical issues that arise. Author Gary G. Ford provides readers with a background in ethical reasoning and introduces them to an easy-to-follow eight step model of ethical decision making. Key Features: Covers philosophical models of ethical reasoning: Readers are provided with the needed background for understanding sources of ethical duties and the metaethical justification underlying the ethical code of their profession. Addresses APA and ACA ethics codes: A greater understanding between the professions of psychology and counseling is illustrated by covering current versions of ethical codes for both fields (APA, 2002 & ACA, 2005). Recommendations are given for those who wish to pursue certification, degree, or licensure in the other field. Exemplifies ethical dilemmas and ethical responses: Treats the issue of ethical dilemmas, in which two or more ethical duties actually conflict. Other texts present issues one at a time, supplemented by case examples involving 'right' and 'wrong' answers, leaving professionals ill-equipped to apply ethical principles to novel circumstances, particularly where multiple ethical duties conflict. Reflects the complexity of real-life situations: Numerous thought-provoking case examples help students apply ethical principles to novel professional circumstances. In-depth coverage of ethical concerns in assessment, therapy, industrial/organizational, teaching, research, and forensic activities is provided, as well as in emerging areas such as e-therapy and Internet research. Addresses multicultural concerns: The ubiquitous nature of cultural influences in our lives and professional activities is demonstrated. Readers are guided to identify cultural biases in their own life and the ethical principles and practices of the mental health professions. Intended Audience: This text is perfect for students studying ethical issues in psychology and counseling, as well as a great resource for clinical/counseling psychologists, psychotherapists, and practitioners. This text is perfect for students studying ethical issues in psychology and counseling, as well as a great resource for clinical/counseling psychologists, psychotherapists, and practitioners.

We live at a time when the human lifespan has increased like never before. As average lifespans stretch to new lengths, what impact should this have on our values? Should our values change over the course of our ever-increasing lifespans? Nancy S. Jecker coins the term, the life stage relativity of values, to capture the idea that at different stages of our lives, different ethical concerns shift to the foreground. During early life, infants and small children hold dear the value of being cared for and nurtured by someone they trust-and their vulnerability and dependency make these the right values for them. By early adulthood and continuing into midlife, the capacity for greater physical and emotional independence gives people reason to place more emphasis on autonomy and the ability to freely choose and carry out their plan of life. During old age, heightened risk for chronic disease and disability gives us a reason to shift our focus again, emphasizing safeguarding our central capabilities and keeping our dignity and self-respect intact. Despite different values becoming central at different stages of life, we often assume the standpoint of someone in midlife, who is in the midst of planning a future adulthood that stretches out before them. Jecker coins the term, midlife bias, to refer to the privileging of midlife. Midlife bias occurs when we assume that autonomy should be our central aim at all life stages and give it priority in a wide range of ethical decisions. The privileging of midlife raises fundamental problems of fairness. It also suggests the possibility of large gaps in the ethical principles and theories at hand. Ending Midlife Bias: New Values for Old Age addresses these concerns in a step-wise fashion, focusing on later life. Jecker first introduces a philosophical framework that extends moral theorizing to older adults, addressing midlife bias, the life stage relativity of values, human capabilities and dignity, time's passage, the narrative self, and justice between old and young. She then turns to policy and practice and explores ethical issues in bioethics, long term care, personal robotic assistants, care of the dying and newly dead, ageism in medical research, the allocation of healthcare, mandatory retirement, and the future of population aging.

Partiality and Justice in Nursing Care examines the conflicting normative claims of partiality and impartiality in nursing care, looking in depth at how to reconcile reasonable concerns for one particular patient with equally important concerns for the maximisation of health-related welfare for all with relevant nursing-care needs, in a resource-limited setting. Drawing on moral philosophy, this book explores how discussions of partiality and impartiality in moral philosophy can have relevance to the professional context of clinical nursing care as well as in nursing ethics in general. It develops a framework for normative nursing ethics that incorporates a notion of permissible partiality, and specifies which concerns an ethics of nursing care should entail when balancing partialist and impartialist concerns. At the same time, Nordhaug argues that this partiality must also be constrained by both principled and context-sensitive assessments of patients' needs, as well as of the role-relative deontological restriction of minimising harm, something that could be mitigated by institutional and organisational arrangements. This thought-provoking volume is an important contribution to nursing ethics and philosophy.

Food products with genetically modified (GM) ingredients are common, yet many consumers are unaware of this. When polled, consumers say that they want to know whether their food contains GM ingredients, just as many want to know whether their food is natural or organic. Informing consumers is a major motivation for labeling. Consumers who want GM-free products will pay a premium to support voluntary labeling. Labeling need not be mandatory. When polled, consumers say that they want to know whether their food contains GM ingredients, just as many want to know whether their food is natural or organic. Informing consumers is a major motivation for labeling. Why do consumers want to know about GM ingredients? GM foods are tested to ensure safety and have been on the market for more than a decade. Still, many consumers, including some with food allergies, want to be cautious. Also, GM crops may affect neighboring plants through pollen drift. Despite tests for environmental impact, some consumers may worry that GM crops will adversely effect the environment. The study of risk and its management raises questions not settled by the life sciences alone. This book surveys various labeling policies and the cases for them. It is the first comprehensive, interdisciplinary treatment of the debate about labeling genetically modified food. The contributors include philosophers, bioethicists, food and agricultural scientists, attorneys/legal scholars, and economists.

What will be the greatest moral challenge facing our society throughout this century? Are we ready to face it? Editors Charles W. Colson and Nigel M. de S. Cameron, along with a panel of expert contributors, make the case in this book that the greatest watershed debates of the twenty-first century concerning ethics and public policy will surround the issue of biotechnology. In twelve essays they address several of the legal and ethical challenges before us: embryo research, stem cell research, cloning, genetic engineering, gene therapy, pharmacogenomics, cybernetics, nanotechnology and, of course, abortion. Contributors include William L. Saunders, J. D., Family Research Council Christopher Hook, M.D., The Mayo Clinic Henk Jochemsen, Ph.D., Free University of Amsterdam David A. Prentice, Ph.D., Indiana State University Nathan A. Adams IV, Ph.D., J.D., Christian Legal Society David Stevens, M.D., Christian Medical Association Paige Comstock Cunningham, J. D., Americans United for Life C. Ben Mitchell, Ph.D., Trinity Evangelical Divinity School Richard Doerflinger, M.A., Secretariat for Pro-life, National Conference of Catholic Bishops Wesley J. Smith, J.D., International Task Force on Euthanasia and Assistend Suicide Leaders in their fields, these contributors point out the crucial role Christians can and should play in the public square. The well-informed and forward-looking perspectives they present will help us prepare for the challenges ahead.

Strategies or decisions aimed at affecting, in a manner considered to be positive, the genetic heritage of a child in the context of human reproduction are increasingly being accepted in contemporary society. As a result, unnerving similarities between earlier selection ideology so central to the discredited eugenic regimes of the 20th century and those now on offer suggest that a new era of eugenics has dawned. The time is ripe, therefore, for considering and evaluating from an ethical perspective both current and future selection practices. This inter-disciplinary volume blends research from embryology, genetics, philosophy, sociology, psychology, and history. In so doing, it constructs a thorough picture of the procedures emerging from today's reproductive developments, including a rigorous ethical argumentation concerning the possible advantages and risks related to the new eugenics.

Calum MacKellar is Director of Research of the Scottish Council on Human Bioethics, Edinburgh, and Visiting Professor of Bioethics at St Mary's University College, London, UK.

Christopher Bechtel holds a degree in philosophy and is a Research Fellow with the Scottish Council on Human Bioethics, Edinburgh, UK.

What role does ethics play in the practice of psychoanalysis and psychotherapy? For most of its history, psychoanalysis has viewed ethics as a "side issue" in clinical work-occasionally relevant, but not central to therapeutic action. In Psychoanalysis as an Ethical Process, Robert Drozek highlights the foundational importance of ethical experience in the therapeutic relationship, as well as the role that ethical commitments have played in inspiring what has been called the "relational turn" in psychoanalysis. Using vivid clinical examples from the treatment of patients with severe personality disorders, Drozek sketches out an ethically grounded vision of analytic process, wherein analyst and patient are engaged in the co-construction of an intersubjective space that is progressively more consistent with their intrinsic worth as human beings. Psychoanalysis can thus be seen as a unique vehicle for therapeutic and ethical change, leading to a dramatic expansion of agency, altruism, and self-esteem for both participants. By bringing our analytic theories into closer contact with our ethical experiences as human beings, we can connect more fully with the fundamental humanity that unites us with our patients, and that serves as the basis for deep and lasting therapeutic change. This book will be of interest to psychotherapists and psychoanalysts, as well as scholars in ethical theory and philosophy.

Culture, Health, and Social Change is the first of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "aging" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of aging is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

Can the ethical mission of health care survive among organizations competing for survival in the marketplace? On this question hinges not only the future of health care in the US, but that of the health care systems of all advanced countries. This book presents both an analytic framework and a menu of pragmatic answers. The team of authors, physician-ethicists from Harvard Medical School and the National Institutes of Health, worked with a consortium of health care organizations to explore some of the most challenging dilemmas in health care today: How can health plans determine medical necessity in a way that ensures quality care, controls costs, and builds trust with patients and physicians? What are the strategies for caring for vulnerable populations that meet their special neds without dramatically increasing costs? To answer these and other similar questions the authors blend ethical analysis with real-world example. The outcome is a rich analysis of the ethical challenges facing health care organizations, combined with tangible examples of exemplary methods to address these challenges. This book will help health care leaders, regulators, and policy makers incorporate exemplary practices, and the underlying themes they embody, into the very heart and soul of health care organizations.

This title was first published in 2002: This volume discusses the subject of biomedical ethics. Various views, historical and contemporary, are discussed, with the editors using the contrasting concepts in the shift from paternalism to autonomy in 20th-century medicine as a heuristic tool for the critical study of ethics in medicine.As far as the evidence in this volume goes, paternalistic medical practices and patient autonomy had an uneasy relationship by the beginning of the 20th century. A hundred years later, full autonomy in decisions on medical treatment is still subject to numerous caveats. The text pays close attention to the interplay between various players, noting how factors such as social contexts, governmental organizations and the biotechnological industry influence and shape responses to the principle of bioethics.

Is the legal protection that is given to the expression of Abrahamic religious belief adequate or appropriate in the context of English medical law? This is the central question that is explored in this book, which develops a framework to support judges in the resolution of contentious cases that involve dissension between religious belief and medical law, developed from Alan Gewirth's Principle of Generic Consistency (PGC). This framework is applied to a number of medical law case studies: the principle of double effect, ritual male circumcision, female genital mutilation, Jehovah's Witnesses (adults and children) who refuse blood transfusions, and conscientious objection of healthcare professionals to abortion. The book also examines the legal and religious contexts in which these contentious cases are arbitrated. It demonstrates how human rights law and the proposed framework can provide a gauge to measure competing rights and apply legitimate limits to the expression of religious belief, where appropriate. The book concludes with a stance of principled pragmatism, which finds that some aspects of current legal protections in English medical law require amendment.

Amongst the scholars, secrets and soporifics of Victorian Oxford, the truth can be a bitter pill to swallow...Jesus College, Oxford, 1881. An undergraduate is found dead at his lodgings and the medical examination reveals some shocking findings. When the young man's guardian blames the college for his death and threatens a scandal, Basil Rice, a Jesus college fellow with a secret to hide, is forced to act and finds himself drawn into Sidney Parker's sad life. The mystery soon attracts the attention of Rhiannon 'Non' Vaughan, a young Welsh polymath and one of the young women newly admitted to university lectures. But when neither the college principal nor the powerful ladies behind Oxford's new female halls will allow her to become involved, Non's fierce intelligence and determination to prove herself drive her on. Both misfits at the university, Non and Basil form an unlikely partnership, and it soon falls to them to investigate the mysterious circumstances of Parker's death. But between the corporate malfeasance and the medical quacks, they soon find the dreaming spires of Oxford are not quite what they seem... An intriguing first installment of The Oxford Mysteries series by master crime writer, Alis Hawkins. Perfect for fans of Laura Shepherd-Robinson, Sarah Waters and Kaite Welsh. Praise for A Bitter Remedy 'Fearlessly tackles taboo attitudes of the era, taking aim at misogyny, homophobia, and sexual politics. An excellent addition to the historical mystery canon. Marvellous!' Vaseem Khan, author of Midnight at Malabar House 'A Bitter Remedy is a perfect tonic for our times.' S. G. MacLean 'Absolutely brilliant! Thoughtful, complex and engrossing' Chris Lloyd, author of The Unwanted Dead 'A superb atmospheric mystery to the last page' Rachel Lynch, author of Dark Game

Posthumous reproduction refers to the procedure that enables a child to be conceived using the gametes of a dead person. Advances in reproductive technology mean it is now possible to assist in creating a life after you die, and in recent years the number of women who have attempted to get pregnant using posthumous reproduction has increased. However, the law in many jurisdictions has not put regulations in place to deal with the ethical and legal consequences that arise as a result of posthumous reproduction. This is the first book to exclusively focus on posthumous reproduction. The book comprehensively explores the legal and ethical issues surrounding posthumous reproduction in a number of jurisdictions including the US, Israel, the UK and France. The book looks at a number of issues including: ascertaining the wishes of the dead and protecting the reproductive rights of men who have deposited frozen sperm in clinics prior to their deaths; cases involving people who want to acquire fresh sperm from deceased or incompetent men and determining who should have the right to accept the sperm; identifying the parents of the posthumously conceived child; and discussing the need to promote the best interests of the child. The book critically examines the current laws that are in place and proposes additional regulations and policies in order to effectively regulate posthumous reproduction.

This volume is the result of a conference sponsored by the Medical Alumni Association of the University of California, Davis and held in Sacramento, California, in January, 2000, The purpose of this conference was to examine the impact ofvarious health care structures on the ability of health care professionals to practice in an ethically acceptable manner. One of the ground assumptions made is that ethical practice in medicine and its related fields is difficult in a setting that pays only lip service to ethical principles. The limits of ethical possibility are created by the system within which health care professionals must practice. When, for example, ethical practice necessitates-as it generally does-that health care professionals spend sufficient time to come to know and understand their patients' goals and values but the system mandates that only a short time be spent with each patient, ethical practice is made virtually impossible. One of our chief frustrations in teaching health care ethics at medical colleges is that we essentially teach students to do something they are most likely to find impossible to do: that is, get to know and appreciate their patients' goals and values. There are other ways in which systems alter ethical possibilities. In a system in which patients have a different physician outside the hospital than they will inside, ethical problems have a different shape than if the treating physician is the same person.

Western societies generally recognize both a legal and a moral right to privacy. However, at the present time there is no settled opin ion in the United States regarding how these rights should relate to medical information. On the one hand, virtually everyone agrees that one' s medical records should not be open to just any interested person' s inspection. On the other hand, most also agree that some sacrifices in medical privacy are necessary for scientific advancement, public health protection, and other social goals. However, what limits should be set upon those sacrifices, and how those limits should be determined, have long been issues of debate. In recent years this debate has intensified. There are a variety ofreasons for this; to mention only three: (1) Over the years the US health care delivery system has become increasingly complex, and with this complexity there has come a need for more and more people to have access to patients' medical records. With each transference of information, breaches in confidentiality become more likely. (2) Medical costs have risen at an alarming rate. This makes health insurance a virtual necessity for adequate medical care, and people worry that they will be denied employment and/or medical cov erage if certain sorts of medical information are not kept strictly confi dential. (3) Finally, many medical records are now kept in computer files, and the impossibility of guaranteeing confidentiality for files of this sort is a constant worry."