Unlocking the debate behind the headlines, this book combines clear thinking with the very latest in science and medicine, enabling readers to decide for themselves exactly what the scientific future should hold.

In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns.Although the particular process the hospital uses to address such concernsmay vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many (...) have some and a few have sweeping clinical powers in hospitals. (shrink)

Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they play compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics (...) committees report that they play a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies. (shrink)

The Perfect Baby is the most popular introduction to ethical issues in genetics. This new edition has been updated to discuss and debate advances in high tech reproduction, genetic testing, gene therapy, human cloning, and stem cell research. It includes a new epilogue by cloning pioneer Ian Wilmut and Glenn McGee.

Modern scientific and medical advances bring new complexity and urgency to ethical issues in health care and biomedical research. This book applies the American philosophical theory of pragmatism to such bioethics. Critics of pragmatism argue that it lacks a universal moral foundation. Yet it is this very lack of a metaphysical dividing line between facts and values that makes pragmatism such a rigorous and appropriate method for solving problems in bioethics. For pragmatism, ethics is a way of satisfying the complex (...) demands of multiple individuals and groups in a contingent and changing world. Pragmatism also demands careful attention to the ways in which scientific advances change our values and ethics.The essays in this book present different approaches to pragmatism and different ways of applying pragmatism to scientific and medical matters. They use pragmatism to guide thinking about such timely topics as stem cell research, human cloning, genetic testing, human enhancement, and care for the poor and aging. This new edition contains three new chapters, on difficulties with applying pragmatism to law and bioethics, on helping people to die, and on embryonic stem cell research. (shrink)

When one examines the emerging debate about genetic patenting, it becomes clear that those who oppose so-called misunderstand genetics or apply inappropriate moral and jurisprudential theory. In this brief essay I examine some arguments against gene patents of the variety, and conclude that patents on methods for detecting the presence of a genetic correlation with disease-related (and other) phenotypes can be appropriate, and that with several precautions the U.S. Patent and Trademark Office should continue granting patent protection to investigators who (...) generate genetic disease diagnostic innovations. (shrink)

Clinical bioethics is big business. There are now hundreds of people who bioethics in community and university hospitals, nursing homes, rehabilitation and home care settings, and some who play the role of clinical ethics consultant to transplant teams, managed care companies, and genetic testing firms. Still, there is as much speculation about what clinically active bioethicists actually do as there was ten years ago. Various commentators have pondered the need for training standards, credentials, exams, and malpractice insurance for ethicists engaged (...) in clinical consultation. Much of the discussion seems to accept an implicit presumption that all clinical ethics consultation practices look pretty much alike. But is this accurate? What do clinical ethicists do, how and where do they do it, and what kind of clinical ethics is useful in the hospital and in other settings? (shrink)

Genetic counselors are on the front lines of the genetic revolution, presented with tests of varying predictive values and reliability, unfair testing distribution mechanisms, tests for conditions where no treatment exists, and companies that oversell the usefulness of their tests to physicians and nurses. Many scholars, both genetic testing task forces as well as the newly formed National Bioethics Advisory Commission, have all noted that genetic counseling programs and services are critical for adequate genetic testing. At the same time, in (...) our own work at the University of Pennsylvania we have encountered many requests for new materials for training genetic counselors in ethics and providing ethics resources for genetic counseling. One of us has noted elsewhere that it is crucial that resources from the Human Genome Project, the Centers for Disease Control, and other public agencies be devoted to providing better resources for genetic counselors facing difficult ethical issues. Although the American Board of Genetic Counseling requires that training programs include some formal coursework in ethics, many wonder whether enough is being done to prepare genetic counselors for an ever-tougher job, and in particular there has been much concern expressed about whether is an outmoded ideal that hampers this profession as it attempts to grow and identify the value of its practice. On the basis of many comments to us by genetic counselors and on the basis of our review of the current literature, we hypothesized that accredited genetic counseling training programs are poised at the turn of the century to begin planning a new approach toteaching the philosophy of genetic counseling, one that integrates philosophical, theoretical, and ethical training throughout thecurriculum in genetic counseling. (shrink)

is the newest section of CambridgeQuarterly. Twice each year these pages will feature a colloquium on a breaking issue in bioethics.

The role of the healer is expanding. Attempts by physicians to enhance human capacity are but one among many new medical projects. The twentieth century ushered in significant changes in therapeutic modalities, and the past two decades have seen the role of the physician reshaped by economic, political, and dramatic new social mores. People ask new and different things of their clinicians. Under managed care, the primary care clinician is expected to have much more skill than was traditionally expected of (...) a general internist, and new incentives force physicians to much more explicitly ration the care they provide to patients and to patient populations. But perhaps no change in the contemporary world of health portends more long-term effects than the introduction of enhancement technologies. (shrink)

This essay argues that while we have examined clinical ethics quite extensively in the literature, too little attention has been paid to the complex question of how clinical ethics is learned. Competing approaches to ethics pedagogy have relied on outmoded understandings of the way moral learning takes place in ethics. It is argued that the better approach, framed in the work of Aristotle, is the idea of phronesis, which depends on a long-term mentorship in clinical medicine for either medical students (...) or clinical ethics students. Such an approach is articulated and defended. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.1 (2000) 103-108 [Access article in PDF] Letters "Small Sacrifices" in Stem Cell Research Madam: I agree with Professors McGee and Caplan (in their article "The Ethics and Politics of Small Sacrifices in Stem Cell Research," KIEJ, June 1999) that the question of the nature and status of the source of stem cells must be addressed. However, in their eagerness to convince us (...) of the smallness of the sacrifices, I think the authors use some unfortunate rhetorical devices and move much too quickly over some necessary distinctions.The rhetorical display is unfortunate if the article is intended to be a fair and rational development of an argument--e.g., those who hold a position in opposition to the authors do not argue they "inveigh." The section on the political area of the controversy seems particularly dismissive of other's positions.However, I will focus on just two areas where I think a more nuanced consideration would make the question of the moral legitimacy of the "small sacrifices" of embryos less obvious than the authors' rhetoric would suggest.First, they claim that opponents of such research assume some sort of "super status" for an embryo. The rights generally conceded to born human beings may not be as "weak" as they characterize. But even considering only the "negative right against unwarranted violence," I think the authors misdescribe the situation. Contrary to their assertion, I do not know when "adults and even children are... forced to give life... in the defense or at least interest of the community's highest ideals and most pressing interests" (p. 153). Could they be speaking of capital punishment, justified in the name of protecting the community? But then why mention children?It is true that not everyone can be guaranteed every means to preserving and enhancing life. But this limitation on positive rights is not a "forced giving." Adults may be compelled to risk life--e.g. in a draft for the sake of a war. But, again, the more or less justifiable imposition of a risk is not the same as selecting out one particular individual or class to be directly killed. Neither adults nor born children are compelled to be killed for the sake of organ "donation," even if a greater number might be saved. If one grants equivalent status to the embryo (as the authors seem to do here for the sake of argument), opponents do not have to claim a "super status" for embryos, just the ordinary human right not to be killed even for "compassionate" motives.A second area where I think the authors move too quickly is in their impoverished definition of the essential humanity of the early embryo as exhaustively represented by the physical structure of its DNA. The authors seem to recognize [End Page 103] that, ordinarily, there is more to personhood than sheer physical structure. For example, they mention memories and habits (p. 154). They could also speak of relationships, attitudes, and the like. Since an early embryo has no such components of personality as we experience it, the authors hold that its identity could only be contained in its DNA. Since this DNA is preserved, even spread far and wide, by the use of stem cells, it almost seems as if we are doing the early embryo a favor by breaking it up.However, just because the embryo does not have any conscious memories or other attributes of character or personality, that does not mean its identity is constituted only by its physical structure described statically. The early embryo is not just a bundle of discrete structures, and its DNA is not just an inert lump made up of certain smaller lumps. Both the embryo and its DNA are active. Thus the identity of even an early embryo includes both its current processes and the innate potential for further activity and development. Although lacking a conscious will, the early embryo is already in a sense an agent, already doing things--growing, changing, and heading toward something that... (shrink)

: Pluripotent human stem cell research may offer new treatments for hundreds of diseases, but opponents of this research argue that such therapy comes attached to a Faustian bargain: cures at the cost of the destruction of many frozen embryos. The National Bioethics Advisory Commission (NBAC), government officials, and many scholars of bioethics, including, in these pages, John Robertson, have not offered an adequate response to ethical objections to stem cell research. Instead of examining the ethical issues involved in sacrificing (...) human embryos for the goal of curing fatal and disabling diseases, they seek to either dismiss the moral concerns of those with objections or to find an "accommodation" with those opposed to stem cell research. An ethical argument can be made that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dread and lethal diseases. Until this argument is made, the case for stem cell research will rest on political foundations rather than on the ethical foundations that the funding of stem cell research requires. (shrink)

Most parents want to improve the lot of their children. Providing a safe environment, a healthful diet, a good education, exposure to diverse experiences are some of the more conventional means of enhancing the health and opportunities of children. Increasingly, parents or would‐be parents are being offered genetic means for enhancing their children's lives. To whichever means parents turn, the road to enhancement is paved with some deadly and not‐so‐deadly sins that all parents and social stewards ought to learn to (...) avoid. They are calculativeness, overbearingness, shortsightedness, hasty judgment, and pessimism. (shrink)

The prelims comprise: Abortion and Physician‐Assisted Suicide The Philosophical Division of the Debate Philosophy, Politics, and the Control of Science Are Values and Objectivity Incompatible? Conclusion References.

The American Journal of Bioethics, Volume 11, Issue 6, Page 1-2, June 2011.

Although he devotes little explicit analysis to ethics, Whitehead’s understanding of the human moral life immerses both human moral agency and environmental ethics in the natural world, judging good actions in the context of complex and interdependent histories of value present in societies of what he calls actual occasions. In this sense, Whiteheadian environmental ethics draws on the most interesting features of Michel Foucault’s genealogies of values that suffuse institutions. Nevertheless, a Whiteheadian notion of environmental ethics exceeds Foucault’s work in (...) that Whitehead acknowledges the possibility of responsible human values and actions with regard to the environment. (shrink)