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.

In recent times, the phrase 'personalised medicine' has become the symbol of medical progress and a label for better health care in the future. However, a controversial debate has developed around whether these promises of better, more personal and more cost-efficient medicine are realistic. This book brings together leading researchers from across Europe and North America, from both normative and empirical disciplines, who take a more critical view of the often encountered hype associated with personalised medicine. Partially drawing on a four year collaborative research project funded by the German Ministry for Education and Research, the book presents a multidisciplinary debate on the current state of research on the ethical, legal and social implications of personalised medicine. At a time when future health care is a topic of much discussion, this book provides valuable policy recommendations for the way forward. This study will be of interest to researchers from various disciplines including philosophy, bioethics, law and social sciences.

How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices? Should we stop treating smokers who refuse to give up smoking, for example, or put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic ? Or can we nudge people towards healthy options without compromising their freedom to choose? Such questions are at the heart of public health ethics. In this second edition of his well respected textbook, Stephen Holland shows that to understand and debate these issues requires philosophy: moral philosophies, including utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology, health promotion, and screening. The new edition has been fully revised and updated to reflect recent developments in the field. There is a new chapter on the ethics of 'harm reduction', looking at policies which aim to reduce the harmful effects of unhealthy behaviour, such as using illicit drugs, as opposed to trying to get people to abstain. Additional material has been added on the recent interest in 'nudging' people towards more healthy choices in a new theoretical section on libertarian paternalism, as well as more on debates on the ethics of other current public health policies, such as using financial incentives to get people to take more responsibility for their own health. Public Health Ethics provides a lively, accessible and philosophically informed introduction to such issues. As well as being an ideal textbook for students taking courses in public health ethics, Holland s systematic discussion of the ethics of public health will engage and inform the more advanced reader too.

In the past decade the body of literature in the area of biomedical ethics has expanded at an astounding rate. Indeed, on every major topic, the literature in this area has mUltiplied, and continues to do so, so rapidly that one can easily fall behind important advances in our thinking about and understanding of the problems of contemporary bioethics. Awareness of this need to keep apace of developments in the area prompted a recent reviewer of our earlier collection Biomedical Ethics and the Law (Plenum, 2nd edition, 1979) to suggest that somebody ought to offer the service of providing a biennial review or update of the literature on the various central topics in bioethics. Thomas Lanigan, of The Humana Press, agreed with this last sug gestion and so asked us to edit a series of texts consisting of previously unpublished essays on selected topics, a series that would seek to re view and update recent literature on the central topics, while also striv ing to advance distinctive solutions to the problems on the topics under discussion. Accordingly, this first collection of previously unpublished essays focuses on the selected topics, and the authors commissioned were charged with addressing the basic problems assigned while also bringing the reader either directly or indirectly up to date on the rele vant literature."

Ethics for Psychotherapists and Counselors utilizes positive discussions accompanied by a variety of thought-provoking exercises, case scenarios, and writing assignments to introduce readers to all the major ethical issues in psychotherapy. First book designed to engage students and psychotherapists in the process of developing a professional identity that integrates their personal values with the ethics and traditions of their discipline Authors take a positive and proactive approach that encourages readers to go beyond following the rules and to strive for ethical excellence Utilizes a variety of thought-provoking exercises, case scenarios, and writing assignments Authors present examples from their own backgrounds to help clarify the issues discussed Text emphasizes awareness of one's own ethical, personal, and cultural backgrounds and how these apply to one's clinical practice

This volume is a collection of essays concerned with the morality of hu man treatment of nonhuman animals. The contributors take very different approaches to their topics and come to widely divergent conclusions. The goal of the volume as a whole is to shed a brighter light upon an aspect of human life-our relations with the other animals-that has recently seen a great increase in interest and in the generation of heat. The discussions and debates contained herein are addressed by the contributors to each other, to the general public, and to the academic world, especially the biological, philosophical, and political parts of that world. The essays are organized into eight sections by topics, each sec tion beginning with a brief introduction linking the papers and the sec tions to one another. There is also a general introduction and an Epilog that suggests alternate possible ways of organizing the material. The first two sections are concerned with the place of animals in the human world: Section I with the ways humans view animals in literature, philosophy, and other parts of human culture, and Section II with the place of animals in human legal and moral community. The next three sections concern comparisons between human and nonhuman animals: Section III on the rights and wrongs of killing, Section IV on the humanity of animals and the animality of humans, and Section V on questions of the conflict of human and animal interests."

Bioethics: The Basics is an introduction to the foundational principles, theories and issues in the study of medical and biological ethics. Readers are introduced to bioethics from the ground up before being invited to consider some of the most controversial but important questions facing us today. Topics addressed include: the range of moral theories underpinning bioethics arguments for the rights and wrongs of abortion, euthanasia and animal research health care ethics including the nature of the practitioner-patient relationship public policy ethics and the implications of global and public health '3 parents', enhancement, incidental findings and nudge approaches in health care. This thoroughly revised second edition provides a concise, readable and authoritative introduction for anyone interested in the study of bioethics.

Medicine is a complex social institution which includes biomedical research, clinical practice, and the administration and organization of health care delivery. As such, it is amenable to analysis from a number of disciplines and directions. The present volume is composed of revised papers on the theme of "Responsibility in Health Care" presented at the Eleventh Trans Disciplinary Symposium on Philosophy and Medicine, which was held in Springfield, illinois on March 16-18, 1981. The collective focus of these essays is the clinical practice of medicine and the themes and issues related to questions of responsibility in that setting. Responsibility has three related dimensions which make it a suitable theme for an inquiry into clinical medicine: (a) an external dimension in legal and political analysis in which the State imposes penalties on individuals and groups and in which officials and governments are held accountable for policies; (b) an internal dimension in moral and ethical analysis in which individuals take into account the consequences of their actions and the criteria which bear upon their choices; and (c) a comprehensive dimension in social and cultural analysis in which values are ordered in the structure of a civilization ( 8], p. 5). The title "Responsibility in Health Care" thus signifies a broad inquiry not only into the ethics of individual character and actions, but the moral foundations of the cultural, legal, political, and social context of health care generally."

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

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

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

"Will the future confront us with human GMOs? Greely provocatively declares yes, and, while clearly explaining the science, spells out the ethical, political, and practical ramifications."-Paul Berg, Nobel Laureate and recipient of the National Medal of Science Within twenty, maybe forty, years most people in developed countries will stop having sex for the purpose of reproduction. Instead, prospective parents will be told as much as they wish to know about the genetic makeup of dozens of embryos, and they will pick one or two for implantation, gestation, and birth. And it will be safe, lawful, and free. In this work of prophetic scholarship, Henry T. Greely explains the revolutionary biological technologies that make this future a seeming inevitability and sets out the deep ethical and legal challenges humanity faces as a result. "Readers looking for a more in-depth analysis of human genome modifications and reproductive technologies and their legal and ethical implications should strongly consider picking up Greely's The End of Sex and the Future of Human Reproduction... [It has] the potential to empower readers to make informed decisions about the implementation of advancements in genetics technologies." -Dov Greenbaum, Science "[Greely] provides an extraordinarily sophisticated analysis of the practical, political, legal, and ethical implications of the new world of human reproduction. His book is a model of highly informed, rigorous, thought-provoking speculation about an immensely important topic." -Glenn C. Altschuler, Psychology Today

More than a million patient safety incidents occur every year and medical error is the third leading cause of death in the United States. Illuminating the experiences of those affected by medical error -- patients, their loved ones, and physicians and other medical professionals -- Talking with Patients and Families about Medical Error delves deeply into the challenges of communicating honestly and openly about mistakes in medical practice. Based on guidelines from the Institute for Professional and Ethical Practice and the authors' own experiences, the practice-based approaches outlined here offer concrete guidance on initiating discussions dealing professionally and compassionately with patients' reactions who should be included in the conversation what information should be documented in the medical record how to respond to questions about financial compensation Aimed at promoting resolution and healing, this book stresses the importance of clear, empathetic communication that will improve clinical and organizational responses to medical missteps and mismanagement. It emphasizes five features of the physician-patient relationship deserving of special attention: transparency, respect, accountability, continuity, and kindness (TRACK). Narrative examples of common situations demonstrate how conversations about medical error can lead to healing. Robert D. Truog, M.D., is a professor of medical ethics, anaesthesiology, and pediatrics at Harvard Medical School and a senior associate in Critical Care Medicine at Children's Hospital Boston. David M. Browning, M.S.W., B.C.D., F.T., is a co-founder and senior scholar at the Institute for Professionalism and Ethical Practice at Children's Hospital Boston and a lecturer at Harvard Medical School. Judith A. Johnson, J.D., is an attorney, a clinical ethicist at Children's Hospital Boston, and a lecturer at Harvard Medical School. Thomas H. Gallagher, M.D., is a general internist and an