Physician aid in dying is a broader topic than euthanasia in that the latter usually refers to active euthanasia, while physician assistance also encompasses the issue of assisted suicide. Volumes could be and have been written on physician-assisted death. But my purpose here is to address a specific aspect of the topic: the policy implications with regard to proposed legislation on physician-aided death.Although the title's reference to physician assistance suggests a focus on the role of the professional, what people often (...) take to be most important and at the heart of the topic is the issue of the patient's rights, usually seen as being manifested in four different ways. First is the right to a dignified death, as free from pain and suffering as possible. In crossing national boundaries and preceding the organization of the professions and the creation of societies, this right is viewed as one that ought to be recognized. (shrink)

Biomedical and behavioral research is a complex, multidisciplinary, and highly varied enterprise with but a single goal: to produce and disseminate knowledge about the causes, effects, prevention, diagnosis, and treatment of human illnesses and impairments. Success requires public trust in the process. When that trust has been shaken (or worse), the response has been to establish offices to exercise oversight of the various actors and to require them to adhere to regulations that specify, with various levels of detail, what they (...) may or may not do.The two regulatory frameworks examined in this report by Barbara Bierer and Mark Barnes began separately, provoked by different scandals and abuses of public trust. (shrink)

At every moment, somewhere in the world, a group of men and women are sitting around a table deliberating about an ethical issue posed by medicine and research, whether as a research ethics committee; a hospital or clinical ethics committee; a stem‐cell review committee; a gene transfer research committee; a biobank ethics committee; an ethics advisory committee for a medical or nursing association or nongovernmental organization; a state, provincial, national, or intergovernmental bioethics committee; or an ad hoc panel examining a (...) particular development or case. However, the last national committee in the United States, the Presidential Commission for the Study of Bioethical Issues, held its final meeting at the end of August 2016 and closed its doors. Should we regret its departure? I believe that the United States would benefit from having another national bioethics advisory body, but I do not think that the commission should simply have continued under a new president in the same form. Instead, looking at the experience of that commission and its six predecessors—who they were, how they worked, the functions they served, and the problems they experienced—we can derive some useful ideas for anyone planning to build the next commission. (shrink)

Mea culpa. In 1981 the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, of which I was the Executive Director, recommended to the President and Congress that all federal departments and agencies that conduct or support human subjects research adopt “as a common core” the HHS regulations, “while permitting additions needed by any department or agency that are not inconsistent with these core provisions.” The commission believed—rightly, I still think—that having uniformity would ease (...) administration, reduce regulatory burdens, simplify oversight, and make research more efficient. Yet our naïve expectation the task could be accomplished in 180 days meant that we failed to anticipate that if it took much longer—namely, the 10 years that passed before the Common Rule was issued—federal officials would thereafter be reluctant to change the regulations and that when they tried to do so twenty years later, with the issuance of the ANPRM in 2011, they would propose comprehensive revisions. I argue that was the wrong conclusion to draw from the difficulties in issuing the first Common Rule, and that the process of producing the new “final rule” on January 19, 2017—during which many of the proposed changes were either dumped or promulgated without being adequately vetted—reinforces the conclusion that a more incremental process, with ongoing involvement of the public through an advisory body like the President's Commission, would be a much better way to proceed. (shrink)

In the article “A Conceptual Model for the Translation of Bioethics Research and Scholarship,” Debra Mathews and her colleagues want to apply to bioethics various translational concepts developed for biomedical research. According to experts in translational science, this would mean evaluating not only the extent to which research produces the “changes in thinking, practice, and policy” that interest Mathews et al. but also the appropriateness of bioethics training and the level of competency of people working in the field. Their proposal (...) thus raises two sets of questions. The first, which the authors recognize must be the starting point for their argument, is, what precisely is the field in question? The second is whether the tools of translational science provide the right means of measuring the achievements of bioethics. (shrink)

Does the practice of questioning the decision-making capacity of patients who disagree with recommended medical interventions amount to paternalism on the part of physicians who would not have raised questions about competence had these patients accepted the recommendation? Brudney and Siegler provide a nuanced argument why the practice can be both pragmatically and ethically justifiable, particularly if physicians follow a “decision tree” that they recommend for cases where disagreements occur. Nonetheless, the history of this subject shows that bioethicists have long (...) been worried that the “outcome approach” (challenging patient’s capacity because of substantive disagreements with their choices) undermines respect for autonomy, and the more refined version from Brudney and Siegler still creates some further concerns about the resulting inadequacies in communication and comprehension in the physician-patient relationship. (shrink)

Five decades ago, Henry Knowles Beecher, a renowned professor of research anesthesiology, sought to solve a problem created by modern medicine. The solution proposed by Beecher and his colleagues on the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proved very influential.1 Indeed, other contemporaneous medical developments magnified its significance yet also made the solution it offered somewhat problematic. As we mark this fiftieth anniversary, at a time when concerns about the conceptual model (...) on which its recommendations rested are being voiced by critics from medicine as well as philosophy, it is worthwhile to view the committee's report in relation to the problem that prompted its existence as well as the one to which it was quickly applied. (shrink)

Public health law courses typically focus a good deal of attention on two related topics: the duty of government agencies to control the spread of communicable diseases and their use of the police power to do so. While governments sometimes take forceful actions in responding to disease outbreaks, they can also act to prevent their occurrence. Indeed, one of the great triumphs of public health in the 20th century was the development of vaccines and their widespread use, which seemed on (...) course to relegate many formerly crippling or deadly diseases to the history books. Particular success occurred with vaccinations against childhood diseases such as polio, smallpox, and measles, outbreaks of which once routinely closed schoolrooms, playgrounds, and community swimming pools. By the last quarter of the century, completion of an elaborate schedule of immunizations was not merely the standard in pediatric practice but an official requirement for school enrollment. As a result, the range of communicable diseases that had once terrified parents had become threats to be feared only in memory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Egg Takes Flight: The Once and Future Life of the National Bioethics Advisory Commission*Alexander Morgan Capron (bio)Attempting to describe the National Bioethics Advisory Commission (NBAC) is comparable to the surreal feat performed by the artist in a famous painting by René Magritte. The artist (Magritte himself) sits with his back to the viewer, a palette in his left hand. The brush in his right hand is raised (...) to a canvas, blank except for a bird in flight that he is in the process of painting. The artist is looking to his left at a tabletop, bare except for a single, plain egg.Having held its second formal meeting in mid-January, NBAC is certainly still embryonic, its future mysterious within its shell. Yet answers to four major questions that will determine not just what kind of bird the Commission turns out to be but the heights to which it will fly should be evident by April or May 1997. First, will the White House take the sort of interest in NBAC that is needed if it is to succeed? Second, will the Commission’s term be extended beyond October 1997—and will the decision come early enough to allow it to start soon on projects that will take more than a single year to complete? Third, will the Commission take a broad view of the issues it addresses, reexamining widely accepted assumptions and going back to basic premises, or will it respond primarily in bureaucratic terms, guided by its charter’s focus on improving the policies and practices of federal departments and agencies? Fourth, will the Commission move beyond its initially mandated topics—the rights and welfare of human research subjects and the management and use of genetic information—and become what its name promises, the nation’s advisory body on the full range of bioethical issues that arise in the organization and management of health services and research?The Origins of the Egg: NBAC’s PredecessorsThe creation of a national bioethics commission has been demanded for years, at the least since its most recent predecessor, the Biomedical Ethics [End Page 63] Advisory Committee (BEAC) finally expired in 1990. BEAC’s statutory authority lapsed after the hapless committee had spent several years itself like an in vitro embryo in a vat of liquid nitrogen. BEAC’s opponents in Congress froze its appropriation and forbad it to meet until the Biomedical Ethics Board of six senators and six representatives to which it was supposed to report resolved the chaos resulting from the Board members’ ideological differences and personal distrust; this never occurred, and the Board proved unable even to choose its chairman. 1 BEAC, which met only twice, had laid preliminary plans to study the issues raised by the new genetics, but the politics of abortion—which had greatly complicated and slowed the Board’s naming of the BEAC members—was strong enough to interfere even with the topic of genetics, on which the difference among committee members actually gave no sign of dividing on pro-life/pro-choice grounds.The disappearance of BEAC left the nation without a mechanism for “public bioethics,” and several efforts were undertaken in the early 1990s to generate a new commission that could carry on in the tradition of the two previous, successful bioethics commissions. (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research operated under a Congressional mandate in the Department of Health, Education, and Welfare from 1974 to 1978, and the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, which had been authorized by Congress in 1978, actually operated as an independent body with government-wide purview from January 1980 to March 1983.) The Institute of Medicine established a committee to assess the mechanisms available not only to the federal government but also to states, professional bodies, and the public for deliberating about and resolving ethical issues stemming from developments in biomedicine (Bulger, Bobby, and Fineberg 1995). In September 1992, Senators Mark O. Hatfield (R-OR), Edward M. Kennedy (D-MA), and Dennis DeConcini (D-AZ) requested that the Office of Technology Assessment (OTA) evaluate the... (shrink)

The Philosophers' Library features the most important philosophy manuscripts and books as stepping stones to take your through the history of philosophy. By cataloguing the history of philosophy via its key works, this book reflects the physical results of human thinking and endeavour; brilliant thought manifested in titles that literally changed the course of knowledge, sometimes by increments, and sometimes with revolutionary impact. This is a unique book of books, all as beautiful as they are important, whether they be ancient, (...) modern or those in-between"--Publisher's description. (shrink)

The religions of the world preserve the knowledge and protect the secrets of ancient powerful mantras. At the heart of world religion, and among the most powerful mantras in the history of religion, is the Navkar mantra, or Trimantra. In the book “Trimantra”, Gnani Purush (embodiment of Self knowledge) Dada Bhagwan explains the Trimantra, its mantra meaning, and the extraordinary benefits of its recitation. Whether wishing to live with no worry while facing problems in everyday life, wondering how to get (...) inner peace, or on a spiritual quest seeking spiritual enlightenment (self realization), utilizing Trimantra provides that – and more. Among the many spiritual books available today, Dadashri’s spiritual guidance about the value of Trimantra, and how to best access its spiritual power, is invaluable. (shrink)

Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

"Aptavani 2" is the second in a series of spiritual books titled "Aptavani". In this series, Gnani Purush (embodiment of Self knowledge) Dada Bhagwan addresses age-old unanswered questions of spiritual seekers. Dadashri offers in-depth answers to questions such as: "What is religion?", "What are the benefits of the different types of religion?", "How do I understand spirituality vs. religion?", "What is spirituality?", "What are the different types of yoga, and how are they relevant to spirituality and practice?", "How can I (...) experience a spiritual awakening, and attain spiritual enlightenment?", "How can I lead a spiritual life?"Dadashri also provides spiritual clarification on the topics of: "What is the meaning of ignorance?", "Who am I?", "How can I experience my own pure Soul?", and "What is moksha, or liberation?"Ultimately, Dadashri describes that knowledge of Self is the primary goal of all seeking, and the beginning of true spirituality. Having attained Self knowledge, spiritual development begins, after which one may attain ultimate liberation, or moksha. (shrink)

"Aptavani 4" is the fourth in a series of spiritual books titled "Aptavani". In this series, Gnani Purush (embodiment of Self knowledge) Dada Bhagwan addresses age-old unanswered questions of spiritual seekers. Dadashri offers in-depth answers to questions such as: "What is the definition of self awareness, and what are the signs of lack of awareness?", "What is spirituality?", "What are the benefits of spirituality and practice?", "How can I experience a spiritual awakening, and what are the signs of spiritual awakening?", (...) "How may I attain spiritual enlightenment and lead a spiritual life?"Dadashri also provides spiritual explanations regarding: "What is the meaning of ignorance?", "Who am I?", and "How can I experience the spiritual power of my pure Soul?"For those seeking to learn how to become more spiritual, Dadashri explains that the knowledge of Self is the beginning of true spirituality. Upon attaining Self knowledge, one's spiritual development begins, which eventually leads to ultimate liberation, or moksha. (shrink)

"Aptavani 8" is the eighth in a series of spiritual books titled "Aptavani". In this series, Gnani Purush (embodiment of Self knowledge) Dada Bhagwan addresses age-old unanswered questions of spiritual seekers. Dadashri offers in-depth answers to questions such as: "What does karma mean, and what is the law of karma?", "How was the world created, and what is the journey of souls?", and "Who am I, and who is the 'Doer' (ego definition)?"Dadashri also provides profound explanations on: "What is spirituality?", (...) "How can I experience the spiritual power of my pure Soul?", "What are the signs of spiritual awakening?", "How may I attain spiritual enlightenment and lead a spiritual life?"For those wanting to learn how to become more spiritual, Dadashri describes how to attain the Self - explaining that the knowledge of Self is spiritual awakening, and the beginning of true spirituality. (shrink)

Drugs, and the states they induce, play central and interwoven roles in the Dune saga. Spice melange, the most valuable object in the known universe, is a cinnamon‐scented, life‐prolonging, mind‐altering drug found only on the planet of Arrakis. Psychedelics, drugs in the hallucinogen class, share many properties with Arrakeen drugs. It's also intriguing that Imperial denizens refer to the universe's most valuable substance as “spice” and “melange.” Computers, thinking machines, and conscious robots threatened humanity's sovereignty and humanity's unique moral status, (...) particularly from a religious perspective. After years of forced migrations from planet to planet, the Fremen finally settled on Arrakis, becoming its indigenous population. Experiential knowledge will be an important teacher to someone without any prior technical or technological training in sustaining a presence in spiritual realms. Techniques and technologies change the people and societies that use them. (shrink)

The earth, the abode of the only form of intelligent life in the universe of which we are aware, is a minor member of a system of nine planets, 40 or so moons and about 100 billion asteroids orbiting around the Sun, an average-size member of the 100-billion-star community making up our galaxy, the Milky Way. It is the third planet to the Sun, which it orbits, following an almost circular elliptical path maintaining an average distance of 1.5×108 km, with (...) the longest and the shortest radii now being 1.53×108 km and 1.47×10 km respectively (Fig. 1). This orbit is subject to changes in its “eccentricity” (i.e., in how much it deviates from a circle) with periods of 105 and 4×10 years5 years (Fig. 2A). In addition, the elliptical orbit itself slowly rotates as shown in Fig. 2B, in what we call the precession. (shrink)

The universe, of which our domicile the planet Earth forms but a minuscule part, has an architecture that changes and has been changing in time. In other words, it has a history of evolution. Lack of experimental evidence denies us the knowledge of what the universe was like “at the time of its origin,” as discussed by Hubert Reeves in the preceding chapter. Neither do we know much about its geometry, simply because our observatories are concentrated, for all practical purposes, (...) vanishingly close to a single point in an immensity whose size can only be measured by the billions of years required by light to go from one extremity to another! (shrink)