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."

This authoritative new handbook offers a comprehensive and cutting-edge overview of the state of the medical humanities globally, showing how clinically oriented medical humanities, the critical study of medicine as a global historical and cultural phenomenon, and medicine as a force for cultural change can inform each other. Composed of eight parts, the Routledge Handbook of the Medical Humanities looks at the medical humanities as: a network and system therapeutic provocation forms of resistance a way of reconceptualising the medical curriculum concerned with performance and narrative mediated by artists as diagnosticians of culture through public engagement. This book describes how the medical humanities can be used in and out of clinical settings, acting as a point of resistance, redistributing medicine's capital amongst its stakeholders, embracing the complexity of medical instances, shaping medical education, promoting interdisciplinary understandings and recognising an identity for the medical humanities as a network effect. This book is an essential read for all students, scholars and practitioners with an interest in the medical humanities.

K. Danner Clouser is one of the most important figures in establishing and shaping the fields of medical ethics, bioethics, and the philosophy of education in the second half of the twentieth century. Clouser challenged many established approaches to moral theory and offered innovative strategies for integrating the humanities into professional education, especially that of physicians and nurses. The contributions published in Building Bioethics: Conversations with Clouser and Friends on Medical Ethics are unique both in their devotion to a critical review of his contributions, and in bringing together internationally known figures in bioethics, medical ethics, and philosophy of medicine to comment upon Clouser's work. These leaders of the field include Tom Beauchamp, Daniel Callahan, James Childress, Nancy Dubler, H. Tristram Engelhardt, Al Jonsen, Loretta Kopelman, Larry McCullough, John Moskop, and Robert Veatch. This book merits special attention from those interested in bioethics, philosophy of medicine, medical ethics, philosophy, medical education, religious studies, and nursing education.

"Globalizing Feminist Bioethics" is a collection of new essays on the topic of international bioethics that developed out of the Third World Congress of the International Association of Bioethics in 1996. Rosemarie Tong is the primary editor of this collection, in which she, Gwen Anderson, and Aida Santos look at such international issues as female genital cutting, fatal daughter syndrome, use of reproductive technologies, male responsibility, pediatrics, breast cancer, pregnancy, and drug testing.

The last several years have seen a sharpening of debate in the United States regarding the problem of steadily increasing medical expenditures, as well as inflation in health care costs, a scarcity of health care resources, and a lack of access for a growing number of people in the national health care system. Some observers suggest that we in fact face two crises: the crisis of scarce resources and the crisis of inadequate language in the discourse of ethics for framing a response. Laurie Zoloth offers a bold claim: to renew our chances of achieving social justice, she argues, we must turn to the Jewish tradition. That tradition envisions an ethics of conversational encounter that is deeply social and profoundly public, as well as offering resources for recovering a language of community that addresses the issues raised by the health care allocation debate. Constructing her argument around a careful analysis of selected classic and postmodern Jewish texts and a thoughtful examination of the Oregon health care reform plan, Zoloth encourages a radical rethinking of what has become familiar ground in debates on social justice. |In order to move current disputes over the allocation of health care resources to an equitable solution, this book advocates a return to the principles of Jewish teachings regarding community and the ethics of conversational encounter.

Historically and across societies people with disabilities have been stigmatized and excluded from social opportunities on a variety of culturally specific grounds. In this collection, the authors explore the impact that the philosophical framing of disability can have on public policy questions, in the clinic, in the courtroom, and elsewhere. They examine the implications of this understanding for legal and policy approaches to disability, strategies for allocating and accessing health care, the implementation of the Americans with Disabilities Act, health care rights, and other legal tools designed to address discrimination. This volume should be read by anyone seeking a balanced view of disability and an understanding of the connection between the framing of disability and policies that have a real-world impact on individuals.

The ultimate goals of human genome research are the treatment, cure and eventual prevention of genetic disorders but treatment and cure lag behind the ability to detect disease or increased suceptibility to disease. Most genetic services today deliver diagnosis and counseling, effective treatment is rare. As more genes are identified there is growing pressure to implement new testing programs or broaden existing programs and otherwise increase both the number of available genetic tests and the amount of genetic information. The main issues concerned among others are: voluntariness of services, freedom of choices, patient autonomy, informed consent, confidentiality of genetic information, privacy, testing of minors, social discrimination and stigmatization.

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.

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.

In the following essays discussing clinical ethics consultation, three sorts of reflective writing are presented. The first is a description of a clinical ethics consultation, more generously detailed than most that have been published, yet obviously limited as a documentation of the experiences at its source. It is followed by three examples of a second kind in the probing commentaries by highly regarded figures in biomedical and clinical ethics - Francois Baylis, Tom Tomlinson, and Barry Hoffmaster. Finally, these are followed by a third variety of reflection in the form of responses to those three commentaries, by Bilton and Stuart G. Finder, and my Afterword - a further reflection on some of the issues and questions intrinsic to clinical ethics consultation and to these various essays. The consultation itself was conducted by Bliton; but Finder not only assisted at one point (he is the colleague' mentioned in Bliton's manuscript) but frequently participated in the discussions that are invariably part of our clinical ethics consultative practice in our Center for Clinical and Research Ethics at Vanderbilt University Medical Center. It was thus natural for Finder to participate in the response. Each of these essays is fascinating and important on its own; together, however, they constitute a truly unusual and, we believe, very significant contribution that will hopefully figure prominently in subsequent discussions, and in shaping and deepening an endeavor - clinical ethics - still in much-needed search of its own discipline, method rationale and place in the domain of clinical practice more generally. This group of essays is also quite unique, addressing as it does the coherence of a form of practice - and, it must be emphasized, several forms of writing about as well as theoretical proposals for understanding that practice - whose current and future character remains very much in contention. That a situation such as the one discussed here often provokes strong and passionate responses will be no surprise &endash; whether because of its relative novelty, its risky nature, the high stakes involved, or something else. It is in any event a striking feature of ethics consultations that the people directly or even indirectly involved tend at times to feel rather passionately about what is said (and not said), what is done (and not done), and what is then reported (or, it may be, left out). Even so, such energetic feelings, much less the candor of my colleague's response to such passion, are rarely if ever apparent from published reports. For this reason alone, a considerable debt of gratitude is surely owed to our commentators &endash; reflective and deliberative, yet passionate and forceful as each of them are."

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed.

"A Cross-Cultural Dialogue on Health Care Ethics" provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness.

Leading physicians and scientists from around the world critically examine the pharmacological and molecular basis of the therapeutic properties of marihuana and its active ingredient, THC. They detail the broad array of marihuana's effects on brain function, the immune system, male and female reproductive functions, and cardiac and pulmonary functions, as well as evaluate its clinical applications in psychiatry, glaucoma, pain management, cancer chemotherapy, and AIDS treatment. Their studies indicate that marihuana persistently impairs the brain and reproductive function, and that marihuana smoke is more toxic and damaging to the lung than tobacco smoke. Marihuana and Medicine's reports of the latest findings on the pharmacological and molecular mechanisms of marihuana and of its clinical manifestations will be essential reading for physicians, psychiatrists, pharmacologists, health-care professionals, policy makers, public health officials, and attorneys.

This collection of essays represents the work produced in the course of a three-year project funded by the Commission of the European Communities under the Biomed I programme, on the ethics of genetic screening, entitled 'Genetic screening: ethical and philosophical perspectives, with special reference to multifactorial diseases'. The short title of the project was Euroscreen, thereafter known as Euroscreen I, in the light of the fact that a second project on genetic screening was subsequently funded. The project was multinational and multidisciplinary, and had as its objectives to examine the nature and extent of genetic screening programmes in different European countries; to analyse the social policy response to these developments in different countries; and to explore the applicability of normative ethical frameworks to the issues. The project was led by a core group who had oversight of the project and members of which have acted as editors for this volume. Darren Shickle edited the first section; Henk ten Have the second; Ruth Chadwick and Urban Wiesing the third and final part. The volume opens with an overview of genetic screening and the principles available for addressing developments in the field, with special reference to the Wilson and Jungner principles on screening. The first of the three major sections thereafter includes papers on the state of the art in different countries, together with some analysis of social context and policy.

That concern about human genetics is at the top of many lists of issues requiring intense discussion from scientific, political, social, and ethical points of view is today no surprise. It was in the spirit of attempting to establish the basis for intelligent discussion of the issues involved that a group of us gathered at a meeting of the International Society for the History, Philosophy, and Social Studies of Biology in the Summer of 1995 at Brandeis University and began an exploration of these questions in earlier versions of the papers presented here. Our aim was to cross disciplines and jump national boundaries, to be catholic in the methods and approaches taken, and to bring before readers interested in the emerging issues of human genetics well-reasoned, informative, and provocative papers. The initial conference and elements of the editorial work which have followed were generously supported by the Stifterverband fUr die Deutsche Wissenschaft. We thank Professor Peter Weingart of Bielefeld University for his assistance in gaining this support. As Editors, we thank the anonymous readers who commented upon and critiqued many of the papers and in tum made each paper a more valuable contribution. We also thank the authors for their understanding and patience. Michael Fortnn Everett Mendelsohn Cambridge, MA September 1998 vii INTRODUCTION In 1986, the annual symposium at the venerable Cold Spring Harbor laboratories was devoted to the "Molecular Biology of Homo sapiens.

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

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

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

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

claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient's unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court's decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the * patient; Requests based on full information; * The patient is in a situation of intolerable and hopeless suffering (either * physical or mental); No further acceptable alternatives to euthanasia. All alternatives * acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be * 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.

In Human Cloning a panel of distinguished philosophers, medical ethicists, religious thinkers, and social critics tackle the thorny problems raised by the now real possibility of human cloning. In their wide ranging reviews, the distinguished contributors critically examine the major arguments for and against human cloning, probe the implications of such a procedure for society, and critically evaluate the "Report and Recommendations of the National Bioethics Advisory Commission." The debate includes both religious and secular arguments, as well as an outline of the history of the cloning debate and a discussion of human cloning's impact on our sense of self and our beliefs about the meaning of life.

This is the first book in healthcare ethics addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. The book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific legal arrangements in The Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed: libertarian, personalist, deontological and utilitarian theories of body ownership.

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics."

This volume introduces a new subseries of Philosophy and Medicine, Classics of Medical Ethics. The purpose of this new subseries is to bring out scholars' editions of major works in the history of medical ethics and philosophy of medicine. This new subseries will target for publication texts that are long out of print and difficult to access. Each volume will contain an introduction to the writings on medical ethics and philosophy of medicine produced by the original author. Each volume will also contain a guide to the primary and major secondary Hterature, to facilitate teaching and scholarship in bioethics, philosophy of medicine, and history of medicine. Texts will be presented in their origi nal style and will provide pagination of the original, so that citations can be made either to the original text or to the page numbers in these vol umes. Finally, each volume will be well indexed, again to facilitate teaching and research. Bioethics and philosophy of medicine - the former more so than the latter - have an insufficiently developed understanding of themselves as having a history. As a consequence, these fields lack the maturity that critical dialogue of the past with the present provides for other fields and disciplines of the humanities. To the extent that this problem is due to the fact that major primary historical sources are not readily available, this subseries will contribute to the further development and maturation of bioethics and philosophy of medicine as fields of the humanities."

debating (and possibly ratifying) the Convention at the national level 13]. The Convention identified basic principles necessary for the applica tion of medicine and the life sciences. It set out to protect the dignity and identity of all human beings: ''The interests and welfare of the human being shall prevail over the sole interest of society or science" (art. 2). It also requests that appropriate measures be taken to provide equitable access to healthcare of appropriate quality. The principle of respecting the free and informed consent of the person is clearly stressed. The issue of interventions on persons unable to provide an informed consent has been controversial for a long time; in the first draft, the exact formulation of the relevant article remained open. Now it states that interventions may be carried out on persons with impaired decision-making capacities, but only for their benefit, and only if minimal risks and minimal burdens are imposed. Consensus apparently exists over a broad range of issues. Privacy and free access to information are defined as rights, in article 10. Discrimination against a person on the basis of his or her genetic heritage is prohibited. Sex selection in medically assisted procreation is prohibited (except to avoid serious hereditary, sex-related diseases). Financial gain from using the human body and its parts is explicitly prohibited. The more controversial issues in bioethics are not addressed in this Convention, however. An exception is research on embryos in vitro."

How is the concept of patient care adapting in response to rapid changes in healthcare delivery and advances in medical technology? How are questions of ethical responsibility and social diversity shaping the definitions of healthcare?In this topical study, scholars in anthropology, nursing theory, law and ethics explore questions involving the changing relationship between patient care and medical ethics. Contributors address issues that challenge the boundaries of patient care, such as: - HIV-related care and research- the impact of new reproductive technologies- preventative healthcare- technological breakthroughs that are changing personal-caring relationships.Chapters range from a consideration of the practicalities of nursing and family healthcare to a debate about 'universal human needs' and patients' rights.This book is a provocative exploration of the ways in which healthcare models are socially constructed. It will be of interest to policy-makers, medical practitioners and administrators, as well as students of sociology, anthropology and social policy.

In contemporary ethical discussion widespread concern about the potential risks of genetic engineering is raising new and fundamental questions about our responsibilities towards unborn generations. Newly acquired knowledge in genetic engineering techniques has brought about not only potential benefits but also immense risks for the well-being of both present and future generations. This book raises a number of ethical issues concerning the impact of genetic engineering on generations yet to be born. The four topical areas that constitute the focus of the volume, namely (1) from laboratory to germ-line therapy, (2) the concept of human nature: theological and secular perspectives, (3) genetic intervention and the common heritage view, and (4) social responsibilities of geneticists towards future generations, raise intriguing ethical and legal questions, as well as important policy issues. As much as any set of issues, they reflect the hopes and fears, prejudices and uncertainties that people associate with germ-line intervention and the future of human kind.

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

This 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.