New Harvest includes contributions from specialists in medical, philosophical, psychological, religious, and legal fields. These essays are not simply a collection, but were developed from a single conception of the four ethical concerns of trans plan tation described in the first chapter. The indi vid ual chapters are all parts of a structure unified by the search for ethical foundations basic to the four concerns. Transplantation is surrounded by a great deal of under standable emotional sensitivi ty. The authors trust that words like "procurement," "harvest," and possibly other expressions found in this book will not offend. We use the current lan but do so with objectivity and respect for those who guage, are personally involved in transplantation. We have made room for, and indeed have invited, different and sometimes conflicting points of view on the complicated ethical ques tions raised by transplant operations. We can not assume that there is one right answer to these questions, at least at our present level of scientific knowledge and ethical wisdom. We do not presume to have identified and analyzed all the ethical questions raised with equal thoroughness. There are four ways in which the scope of the book is limited. Identifying these limitations also helps designate what it is in its own right. First, some questions have been given more attention than others."

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.

The Vatican insists that human embryos must be treated as persons. This would block almost all "in vitro" fertilization and associated biomedical techniques. Moreover this demand is presented as a matter of natural justice, binding on Catholics and non-Catholics alike, and therefore to be incorporated into civil law. The author explores the basis on which the Vatican presumes to proclaim universally binding prescriptions, paying particular attention to those concerning the value of human life. Against this backgroud, the demand that the embryo be treated as a person is assessed. It is argued that the case in natural justice has not been made out, and that in persisting with its demand the Vatican is departing from the fundementals of the Catholic tradition.

This is the second edition of the comprehensive guide to diabetes for nurses and is updated to take account of changes in dietary advice, legislation and terminology. The text addresses diabetes as both a biochemical disease and a psychosocial problem. It provides research-based information with suggestions for problem solving and planning.

The book is divided into three sections. The first introduces diabetes and examines the altered physiology, the diagnosis, the treatments available and the complications of diabetes. The second section addresses the practice of patient education and the clinical management of diabetes. The third section puts diabetes in care into context. It examines the broader issues involved in diabetes care, including the psychological and ethical aspects of diabetes.

a [ Should abnormal fetuses be carried to term just to be used for infant transplant organs?
a [ Should physicians sell the drugs they prescribe?
a [ Should human death be deemed to occur when one permanently loses consciousness?
These questions-burning issues in today's already hot bioethical climate-are the focus of this seventh volume in Humber and Almeder's renowned Biomedical Ethics Reviews series.
Interdisciplinary in approach, Biomedical Ethics Reviews a [ 1989 offers insightful, penetrating chapters contributed by leading experts in forefront areas of ethics and medicine. Each topic is briefly summarized in an introductory chapter, followed by a more focused, in-depth analysis of the specific issue, as well as a review of the recent literature. And to ensure that these articles are as accessible and useful to as many readers as possible-whether professional or informed layperson-the authors have made every effort to minimize the use of technical jargon.
Biomedical Ethics Reviews a [ 1989 is not only a valuable reference, but also constitutes a real eye-opener for everyone concerned with bioethics today!

When physicians in training enter their clinical years and first begin to become involved in clinical decision making, they soon find that more than the technical data they had so carefully learned is involved. Prior to that time, of course, they were aware that more than technology was involved in practicing medicine, but here, for the first time, the reality is forcefully brought home. It may be on the medical ward, when a patient or a patient's relatives ask that no further treatment be given and that the patient be allowed to die; it may be in ob/gyn, when a 4- or 5-month pregnant lady with two other children and just deserted by her husband pleads for an abortion; it may be in the outpatient setting, where patients unable to afford enough to eat cannot afford to buy antibiotics for their sick child or provide him or her with the recom mended diet. Whatever the setting, students soon find themselv. es con fronted with problems in which an answer is not given by the technical possibilities alone; indeed, students may have to face situations in which, all things considered, the use of these technical possibilities seems ill-advised. But choices need to be made. Some of us may choose to hide behind a mastery of technology."

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

Biomedical Ethics Reviews is an annual publication designed to review and update the literature on issues of central importance in bioethics today. Ordinarily, more than one topic is discussed in each volume of Biomedical Ethics Reviews. This year, however, we have decided to devote the entire volume of Biomedical Ethics Reviews: 1988 to disussion of one topic, namely, AIDS. The ra tionale for this decision should be clear: AIDS is arguably the most serious public health threat facing our nation today, and the char acter of the disease is such that it creates special problems for ethicists, philosophers, theologians, educators, jurists, health care professionals, and politicians. Indeed, the questions that AIDS gives rise to are so numerous and complex that no one text could hope to treat them exhaustively. Still, if it is impossible, in anyone text, to deal with all of the perplexing difficulties that AIDS generates, it nevertheless remains true that each addition to the AIDS literature contributes to our collective knowledge, and in so doing, brings us one step closer to resolving at least some of the problems associated with the disease. We believe that the articles included in the present volume of Biomedical Ethics Reviews serve this purpose admirably, and we hope the reader will agree. James M. Humber Robert F. Almeder vii Contributors Ronald Carson * Medical Humanities Institute, University of Texas Medical Branch, Galveston, Texas David J.

principles. A second solution to this problem is to develop a scale for weighing the significance of the conflicting principles in a given case and for concluding which action should be adopted because it is supported by the weightier considerations in that case. Such a solution seems more realistic than the lexical ordering approach, but the development of such a scale is a problematic task. Still other, more complex solutions are possible. Which is the best solution to this problem of conflicting principles of bioethics? We need a moral theory to answer that question. This is the first reason for concluding that the principles of bioethics are not the true foundations of justified judgment in bioethics. What is the problem of the unclear scope and implications of the principles of bioethics and how can an appeal to moral theory help deal with that problem? The scope of a bioethical principle is the range of cases in which it applies. The implications of a bioethical principle are the conclusions to be derived from that principle in those cases in which it applies. It is clear from a review of the discussions in bioethics that there are major unclarities about the scope and implications of each of the principles. Consider, for example, the principle of autonomy.

Civil Dialogue on Abortion provides a cutting-edge discussion between two philosophy scholars on each side of the abortion debate. Bertha Alvarez Manninen argues for her pro-choice view, but also urges respect for the life of the fetus, while Jack Mulder argues for his pro-life view, but recognizes that for the pro-life movement to be consistent, it must urge society to care more for the vulnerable. Coming together to discuss their views, but also to seek common ground, the two authors show how their differing positions nevertheless rest upon some common convictions. The book helps to provide a way forward for a divide that has only seemed to widen the aisle of public discourse in recent years. This engaging book will prove essential reading for students across multiple disciplines, including applied ethics, medical ethics, and bioethics, but will also be of interest to students of religious studies and women's studies.

The idea for an anthology on personhood grew out of two things, viz., the work I did with Martin Benjamin during the Summer of 1982 at Michigan State University on the question, What is a person?, and the amount of time, effort, and expense required for serious research on the topic itself. The former experience taught me the importance of, among other things, attempting to get clear about what we are to mean by 'person, ' while the latter experience suggested a possible course of action whereby getting clear might be made more manage able simply by having relatively convenient access to some of the most insightful and stimulating writings on the topic. The problems of personhood addressed in this book are central to issues in ethics ranging from the treatment or termination of infants with birth defects to the question whether there can be rational suicide. But before questions on such issues as the morality of abortion, genetic engineering, infanticide, and so on, can be settled, the prob lems of personhood must be clarified and analyzed. Hence What Is a Person? has as its primary theme the examination of various proposed conditions of personhood."

This book exposes some of the hardest decisions to be made in a profession in which peoples bodies and souls are laid bare. 'Doctors on the Edge' is the account of doctors who are faced by wrenching moral dilemmas, uninvited and unexpected dilemmas that are thrust upon them. Law, medicine, and morality -- sometimes complementary and sometimes conflicting -- intrude on in the daily practice of medicine. In gripping stories that often including life-and-death decisions, doctors maneuver the ambiguities, subjectivity, and essential principles of medical ethics. Each chapter is a true account of physicians who lied, betrayed confidences, or broke the law to bring about what they believed was best for their patients.

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.

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.

"Over the last two decades, medical researchers have become more comfortable wit the idea that serious attention must be given to ethical issues when the tests of new technologies are being designed. They have come to see that experimental trials must meet certain standards, not only of scientific rigour, but also of moral acceptability." (Introduction)

Presented by an international group of experts, the eight essays included in this volume evaluate the new technologies in fetal care and also wrestle with the new problems, often moral ones, that have accompanied techonological advancement. The opening chapters review state-of-the-art ultrasound imaging and molecular genetics and focus on the new patient--the fetus. From here, the efficacy of fetal therapy, the problem of assessing long-term viability, the ethical issues involved in both clinical practice and medical research, and the legal rights of the new patients and their parents are examined. The final chapter "Are Fetuses Becoming Children?" brings a fresh philosophical perspective to the question of a fetus's status and rights.

Biomedical Ethics Reviews * 1987 is the fifth volume in a series of texts designed to review and update the literature on issues of central importance in bioethics today. Three topics are discussed in the present volume: (1) Prescribing Drugs for the Aged and Dying; (2) Animals as a Source of Human Transplant Organs, and (3) The Nurse's Role: Rights and Responsibilities. Each topic constitutes a separate sec tion in our text; introductory essays briefly summarize the contents of each section. Bioethics is, by its nature, interdisciplinary in character. Recognizing this fact, the authors represented in the present volume have made every effort to minimize the use of techni cal jargon. At the same time, we believe the purpose of pro viding a review of the recent literature, as well as of advancing bioethical discussion, is admirably served by the pieces col lected herein. We look forward to the next volume in our series, and very much hope the reader will also.

Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths - e.g. 'vaccines cause autism' - have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs in areas of inquiry in which expertise is required (like vaccine immunology). Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is 'unnatural' and because they view vaccine-preventable diseases as a 'natural' part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments - 'for the greater good' - that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause.

The National Science Foundation, The National Institute of Occupational Safety and Health, and the Center for Technology and Humanities at Georgia State University sponsored a two-day national conference on Moral Issues and Public Policy Issues in the Use of the Method of Quantitative Risk Assessment ( QRA) on September 26 and 27, 1985, in Atlanta, Georgia. The purpose of the conference was to promote discussion among practicing risk assessors, senior government health officials extensively involved in the practice of QRA, and moral philosophers familiar with the method. The conference was motivated by the disturbing fact that distinguished scientists ostensibly employing the same method of quantitative risk assessment to the same substances conclude to widely varying and mutually exclusive assessments of safety, depending on which of the various assumptions they employ when using the method. In short, the conference was motivated by widespread concern over the fact that QRA often yields results that are quite controversial and frequently contested by some who, in professedly using the same method, manage to arrive at significantly different estimates of risk.

Biomedical Ethics Reviews: 1985 is the third volume in a series of texts designed to review and update the literature on issues of central impor tance in bioethics today. Four topics are discussed in the present volume: ( 1) Should citizens of the United States be permitted to buy, sell, and broker human organs? (2) Should sex preselection be legally proscribed? (3) What decision-making procedure should medical per sonnel employ in those cases where there is a high degree of uncer tainty? (4) What do we mean when we use the terms "health" and "disease"? Each topic constitutes a separate section in our text; intro ductory essays briefly summarize the contents of each section. Bioethics is, by its nature, interdisciplinary in character. Recognizing 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."

The fate of seriously ill newborns has captured the atten tion of the public, of national and state legislators, and of powerful interest groups. For the most part, the debate has been cast in the narrowest possible terms: "discrimination against the handicapped"; "physician authority"; "family autonomy." We believe that something much more profound is happening: the debate over the care of sick and dying babies appears to be both a manifestation of great changes in our feelings about infants, children, and families, and a reflection of deep and abiding attitudes toward the newborn, the handi capped, and perhaps other humans who are "less than" nor mal, rational adults. How could we cast some light on those feelings and attitudes that seemed to determine silently the course of the public debate? We chose to enlist the humanities-the dis players and critics of our cultural forms. Rather than closing down the public discussion, we wanted to open it up, to illuminate it with the light of history, religion, philosophy, literature, jurisprudence, and humanistically oriented sociol ogy. This book is a first effort to place the hotly contested Baby Doe debate into a broader cultural context."

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.

The place of drugs in American society is a problem more apt to evoke diatribe than dialog. With the support of the Na tional Science Foundation's program on Ethics and Values in Science and Technology, and the National Endowment for the Humanities' program on Science, Technology, and Human Values, * The Hastings Center was able to sponsor such dialog as part of a major research into the ethics of drug use that spanned two years. We assembled a Research Group from leaders in the scientific, medical, legal, and policy com munities, leavened with experts in applied ethics, and brought them together several times a year to discuss the moral, legal and social issues posed by nontherapeutic drug use. At times we also called on other experts when we needed certain issues clarified. We did not try to reach a consensus, yet several broad areas of agreement emerged: That our society's response to nontherapeutic drug use has been irrational and inconsistent; that our attempts at control have been clumsy and ill-informed; that many complex moral values are entwined in the debate and cannot be reduced to a simple conflict between individual liberty and state paternalism. Of course each paper should be read as the statement of that particular author or authors. The views expressed in this book do not necessarily represent the views of The Hastings Center, the National Science Foundation, or the National En dowment for the Humanities."

This is the second volume of Biomedical Ethics Reviews, a series of texts designed to review and update the literature on issues of central importance in bioethics today. Five topics are dis cussed in the present volume. Section I, Public Policy andRe search with Human Subjects, reviews the history of the moral issues involved in the history of research with human subjects, and confronts most of the major legal and moral problems involving research on human subjects. Questions addressed in this section range from those concerning informed and proxy consent to those dealing with the adequacy of monitoring hu man research via institutional review boards (IRBs). Section II deals with a second broad topic in bioethics, The Right to Health Care in a Democratic Society. Here the concern not merely that of determining whether there is a right to is health care, but also, if there is such a right, how it ought best be understood and implemented. To answer questions such as these, we learn that one must distinguish legal from moral rights, assess the merits of various theories of rights, clarify the relationship between rights and duties, and attempt to deter mine a just method for the distribution of health care. Advances in medical technology often pose new legal and moral problems for legislators and health care practitioners."

In the quarter century since the landmark Karen Ann Quinlan case, an ethical, legal, and societal consensus supporting patients' rights to refuse life-sustaining treatment has become a cornerstone of bioethics. Patients now legally can write advance directives to govern their treatment decisions at a time of future incapacity, yet in clinical practice their wishes often are ignored.

Examining the tension between incompetent patients' prior wishes and their current best interests as well as other challenges to advance directives, Robert S. Olick offers a comprehensive argument for favoring advance instructions during the dying process. He clarifies widespread confusion about the moral and legal weight of advance directives, and he prescribes changes in law, policy, and practice that would not only ensure that directives count in the care of the dying but also would define narrow instances when directives should not be followed. Olick also presents and develops an original theory of prospective autonomy that recasts and strengthens patient and family control.

While focusing largely on philosophical issues the book devotes substantial attention to legal and policy questions and includes case studies throughout. An important resource for medical ethicists, lawyers, physicians, nurses, health care professionals, and patients' rights advocates, it champions the practical, ethical, and humane duty of taking advance directives seriously where it matters most-at the bedside of dying patients.