In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United StatesCynthia B. Cohen (bio) and Mary A. Majumder (bio)Human pluripotent stem cell research, meaning research into cells that can multiply indefinitely and differentiate into almost all the cells of the body, has become a minefield in which science, ethics, and politics have collided over the last decade in the United States. President Barack Obama entered this highly (...) charged territory when he indicated during his campaign that once in office he would issue an executive order expanding federally funded human embryonic stem cell (hESC) research and introduce rigorous oversight of it (Obama 2008a & b). Candidate Obama stated that he would require that the hESC lines involved were derived with donor consent from early embryos that otherwise would be discarded following in vitro fertilization (IVF) treatment. However, in contrast with the policy of President George W. Bush, he would do so without regard to the date of their derivation. He added that he would call upon the director of the National Institutes of Health (NIH) to develop guidelines for federally funded hESC and other pluripotent stem cell research that would draw from the guidelines developed in 2005 by the National Academies of Science (NAS) for privately funded research (National Research Council 2005).A similar policy was written into the 2008 version of the Stem Cell Research Enhancement Act, which reiterates the policy enunciated in earlier versions of this bill, passed twice by the Congress but vetoed by President Bush each time (House of Representatives, 110th Congress 2008).1 Depending on how one reads the 2008 version of the act, it could also apply in certain respects to hESC research that is not federally funded. We proceed on the assumption that the act applies at least to federally funded stem cell research. Therefore, it appears that the president or the Congress, or both, will approve of an expanded policy of federal funding of hESC research, as well as other forms of human pluripotent stem cell research. [End Page 79]This policy would make the guidelines developed by a committee appointed by NAS, a prestigious private body of American scientists and related experts, the primary basis for the development of new federal guidelines for oversight of hESC research in the United States. This would have certain advantages in that those familiar with the relevant scientific issues are likely to address them accurately and stem cell investigators are apt to accept restrictions on their research written by fellow scientists and ethics and policy experts whom they perceive as strong supporters of stem cell research. However, it also would have certain disadvantages. Chief among these is that the NAS committee appointed to write guidelines for this research, in its concern to see stem cell science move forward after a period in which many scientists and others maintained that it had been unduly restricted, might have overlooked or deferred consideration of some pressing ethical and policy issues. We maintain that this is the case—although we also maintain that the NAS guidelines provide a responsible foundation for developing NIH guidelines for stem cell research. Consequently, we propose that an NIH task force charged by the director of NIH with writing new guidelines for hESC and other stem cell research should revise and expand the NAS guidelines in ways that we propose below, as well as others that it considers necessary, and make it obligatory for those seeking federal funding of such research to follow these new guidelines.We highlight certain areas in which an ethical case can be made for strengthening the existing NAS guidelines and certain areas in which more fundamental ethical reflection—and building on that, additional guideline/policy development—seems warranted. Among the sections of the NAS guidelines that need clarification and reworking, we include those regarding consent to embryo donation, which provide one of their central focuses, and the development of human-nonhuman chimeras, which they address relatively briefly. In addition, we maintain that new guidelines need to be written to address the nascent ethical and policy issues raised by the possibility that human gametes will be induced from pluripotent stem cells in the next few years and that... (shrink)

Persons with serious and disabling medical conditions have traveled abroad in search of stem cell treatments in recent years. However, weak or nonexistent oversight systems in some countries provide insufficient patient protections against unproven stem cell treatments, raising concerns about exposure to harm and exploitation. The present article, the first of two, describes and analyzes stem cell tourism in Russia and India and addresses several scientific/medical, ethical, and policy issues raised by the provision of unproven stem cell-based treatments within them. (...) The distinction between treatment based on proven clinical research and "innovative treatment" is addressed and the authors conclude that the innovations at issue constitute neither. Regulatory measures need to be developed or strengthened in accord with internationally accepted standards in such countries to protect those seeking stem cell treatments. (shrink)

Clinics and hospitals around the globe are offering stem cell treatments to persons with serious conditions for whom no effective therapies are available in their home countries. Many of these treatments, which are touted as cures for such conditions as Parkinson's and Alzheimer's Diseases, multiple sclerosis, and spinal cord injuries, have not gone through clinical trials that establish their safety and efficacy. Indeed, it is unclear whether some of them even utilize stem cells. State regulation of these therapies tends to (...) be weak or nonexistent in some of the countries in which they are offered. This puts those who believe they must travel abroad for stem cell treatments at risk of injury from procedures that .. (shrink)

An important examination of the theological, spiritual, and ethical issues surrounding death. At the end of a life of faithfulness comes our dying. To approach it as faithfully as we have our living calls for some serious forethought. Because one of the simplest facts of life—that we all die—seems like the most complicated thing we do. Not only have advances in medical technology saved lives, but they also have prolonged death, and raise a number ethical, moral, social, and theological issues. (...) How far should we go to sustain life? Is it right to withdraw artificial feeding from the dying? Is it wrong to end the lives of those in pain? No matter who we are, dealing with these sorts of choices near the end of life is difficult to do on our own.Faithful Living, Faithful Dying: Anglican Reflections on End of Life Care brings together the wisdom of a task force created by the 72nd General Convention of the Episcopal Church to study what faithful living and faithful dying mean today. The task force’s reflections, published for the first time in this book, assist individuals, congregations, and the Church as a whole to disentangle the thicket of ethical, theological, pastoral, and policy concerns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 205-209 [Access article in PDF] Bioethics Inside the Beltway Banning Human Cloning-Then What? Cynthia B. Cohen The public wonder and concern that accompanied the birth of Dolly, the cloned sheep, four years ago died down soon after her arrival. Little has been heard about human reproductive cloning since then in the public square. This silence was pierced recently when two (...) groups each announced its intention to clone a child from a human being within the next few years.The Raelians, a religious organization, disclosed in October 2000 that they had found a grieving American couple willing to pay $500,000 to clone their deceased child and that they would proceed with cloning in a secret laboratory within the United States. A few months later, an international consortium led by Pavos Zavos, Ph.D., a University of Kentucky emeritus professor of biology, and Severino Antinori, M.D., an Italian infertility specialist, declared that it intended to clone the first human within two years at an undisclosed location outside the United States. These announcements led Representative James Greenwood (R-PA), chair of the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce, to convene a hearing on human cloning on 28 March 2001.Why did human reproductive cloning suddenly become of concern to the House of Representatives? What will the federal government do with regard to the development of human cloning at this point in time? And what should it do to address human cloning in the long-term? I will briefly highlight the major controversies that surfaced at the hearing and then consider the broader questions. Scientific Controversies The initial question of concern to the House subcommittee members was whether cloning science has now reached the point of application to humans. Scientists at the hearing offered widely diverging views about this. Zavos testified that only a small number of cloned animals has died after birth and declared that the key to avoiding impaired human clones is to engage in prenatal screening. Consequently, it is now safe to undertake human cloning, he maintained. He was supported in this view by Brigitte Boisselier, Ph.D., visiting assistant professor [End Page 205] of chemistry at Hamilton College and scientific director of the Raelians, who argued that human cloning would not give rise to the problems that have been encountered in nonhuman mammalian cloning.However, professor of veterinary medicine Mark Westhusin, Ph.D., of Texas A&M University, and Massachusetts Institute of Technology researcher Rudolf Jaenisch, Ph.D., maintained that the same sorts of problems that have appeared in nonhuman mammalian cloning would reappear in human cloning. Westhusin stated that mammals have incurred serious defects leading to spontaneous abortion and that mammalian newborns often display severe respiratory and circulatory problems. The most likely explanation for such abnormalities, Jaenisch hypothesized, is that in cloning, the genetic reprogramming that governs the way an organism develops must take place in a much shorter period of time than in coital or in vitro reproduction. This may result in faulty reprogramming leading to dysregulation of gene expression and consequent genetic defects in cloned animals. There is good reason to think that this also would occur in human cloning, Jaenisch maintained. Until reproductive cloning research has been carried out on several generations of primates and is better understood, he argued, human cloning should not be attempted. Even then, several generations of descendants of human clones would have to be observed before scientists could be sure that it would not have a destructive impact on humans. This process could take as long as a century. Ethical Controversy Bioethicists who testified focused on those aspects of the ethical controversy surrounding human cloning that are of particular interest to public policy makers. Thomas Murray, Ph.D., President of The Hastings Center and a member of NBAC, maintained that human cloning is still unsafe, as NBAC had predicted, and that, if carried out, would leave in its wake "damaged women, many dead fetuses, and children born with serious impairments." He expressed particular concern that couples suffering... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionCynthia B. CohenThe explosion of genetic information in recent years raises a fundamental question for us as individuals and as members of various communities: Have we an obligation to know as much as possible about our genes—or should we bypass genetic information, leaving it hidden? A terrible ambivalence grips us when it comes to our genes. We want to respond to the Socratic call to know ourselves by learning (...) what lies on the minute threads of the chromosomes spun into the nuclei of our cells. At the same time, we fear obtaining that information, for it seems functionally equivalent to the oracle at Delphi, revealing a distinct and dangerous knowledge we would rather not have.What is it about genetic knowledge that creates such ambivalence in us? Genetic knowledge is empowering. It offers us the freedom to shape the contours of our lives and those of our families. At the same time, genetic knowledge is disempowering. It bears a peculiar mark of inevitability, telling us that we have no control over our present or future in important respects. Better to hide from such overbearing information than to suffer the assaults on our freedom it seems to create.We can see this ambivalence about genetic knowledge appearing again and again as the field of genetics has grown. Initially, genetics emerged as a tool for understanding how traits and diseases are passed from generation to generation. We used genetic testing mostly to enhance our personal decision making about reproductive matters. It was at this time that our hesitancy about pursuing such testing first arose, for we feared being put into a position of asking such painful questions as, “Knowing what we do about our genes, should we have children?” As the scope of genetic information expanded, we learned to test for genes that could signal the development of such terrible conditions as Huntington’s disease. The possibility of gaining access to such disturbing information exacerbated our fear of genetic knowledge—to some, the certainty of knowing seemed worse than the uncertainty of not knowing. As genetic research has disclosed genes associated with conditions that might, but not necessarily will occur, the uncertainty of knowing, to some, seems worse than that of not knowing. Further, questions focused on individuals, although still pertinent, are being supplanted by broader questions about families and [End Page vii] social groups. When added to the personal agony that genetic information can engender, the specter of egregious discrimination seems to some to outweigh the value of knowing. As the net is cast further and further from the initial genetic inquiries, the call to halt or control certain kinds of genetic testing is growing increasingly loud.Ambivalence about whether to obtain genetic information hovers over the pages of this issue of the Kennedy Institute of Ethics Journal. The authors address both the promise and the threat of the information to be derived from genetic tests. Each examines a different facet of the problem of knowing that vexes the terrain of genetic technology and proposes blueprints for resolving it.Cynthia B. Cohen opens by examining whether genetic testing should be used to unearth information about conditions children might develop later in life. She challenges the current trend within the professional genetics community to keep such information hidden, claiming that the putative psychosocial burdens of receiving that information are outweighed by the psychosocial benefits. Moreover, Cohen maintains that having such information can enhance, rather than impair, the adult autonomy of children. She offers a framework for assessing whether to test in individual cases and maintains that it is the responsibility of parents to make the final decision for their children.A similar response to our ambivalence about obtaining genetic knowledge is given by Robert Wachbroit. In discussing the dilemma caused by pleiotropic genetic tests—those in which a single gene mutation is involved in several apparently unrelated diseases—he favors fully disclosing their dual nature to patients before testing. Wachbroit’s emphasis on openness extends beyond informed consent recommendations, for he maintains that patients have an obligation to know as much about their genetic proclivities as possible. He goes on to confute the common wisdom that genetic information is... (shrink)

Reproductive medicine, a sector of a health care system increasingly captured by the demands of the marketplace, is enmeshed in a drive to sell certain human bits and pieces, such as gametes, cells, fetal eggs, and fetal ovaries, for reproductive purposes. The ethical objection raised by Kant and Radin to the sale of human organs -that this is incompatible with human dignity and worth - also applies to these sales. Moreover, such sales nullify the reproductive paradigm, irretrievably replacing it with (...) a ma nufacturing paradigm. This represents a change in kind, not just of degree, in the way that we view our capacity to generate children and destroys our concept of reproduction as an essentially human activity. In the face of a struggle to retain those common ethical values at the foundation of reproductive medicine, this form of commodification of the human body should be viewed as ethically unacceptable. (shrink)

Expressions used in religious contexts have often seemed odd and paradoxical to philosophers. Statements have appeared in Christian discourse to the effect that God is not a person and yet is a person, that he is a servant and a king, that he is nothingness and being itself. These statements appear unintelligible either because their terms are self-contradictory or because they are mutually exclusive.

: The transplantation of adult human neural stem cells into prenatal non-humans offers an avenue for studying human neural cell development without direct use of human embryos. However, such experiments raise significant ethical concerns about mixing human and nonhuman materials in ways that could result in the development of human-nonhuman chimeras. This paper examines four arguments against such research, the moral taboo, species integrity, "unnaturalness," and human dignity arguments, and finds the last plausible. It argues that the transfer of human (...) brain or retinal stem cells to nonhuman embryos would not result in the development of human-nonhuman chimeras that denigrate human dignity, provided such stem cells are dissociated. The article provides guidelines that set ethical boundaries for conducting such research that are consonant with the requirements of human dignity. (shrink)

: Gill and Sade, in the preceding article in this issue of the Kennedy Institute of Ethics Journal, argue that living individuals should be free from legal constraints against selling their organs. The present commentary responds to several of their claims. It explains why an analogy between kidneys and blood fails; why, as a matter of public policy, we prohibit the sale of human solid organs, yet allow the sale of blood; and why their attack on Kant's putative argument against (...) the sale of human body parts is misplaced. Finally, it rejects the claim that the state is entitled to interfere with the actions of individuals only if such actions would harm others. We draw certain lines grounded in what Rawls has termed "public reason" beyond which we do not give effect to the autonomous self-regarding decisions of individuals. Public resistance to the sale of human body parts, no matter how voluntary or well informed, is grounded in the conviction that such a practice would diminish human dignity and our sense of solidarity. A system of organ donation, in contrast, conveys our respect for persons and honors our common humanity. (shrink)

Some evidence suggests that IVF and other reproductive technologies create serious illness and disorders in a small but significant proportion of children who are born of them. If these technologies were found to do so, it would be wrong to forge ahead with their use.

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United States: An UpdateMary A. Majumder (bio) and Cynthia B. Cohen (bio)On 9 March 2009, President Barack Obama (2009a) signed an executive order revoking the statement issued by President George W. Bush during a televised speech in August 2001, in which the latter had sharply restricted the scope of federally funded human embryonic stem cell (hESC) research (...) to cell lines derived (without federal funding) prior to 9:00 P.M. EDT on 9 August 2001. Action by President Obama to remove the cut-off date had been expected. It came as a surprise, however, that he gave authority to determine the scope of eligible research to the Director of the National Institutes of Health (NIH), referencing only general concerns of responsibility, scientific worth, and legality.1 This contrasted not only with the approach of former President Bush, but also with that of former President Clinton, who had expressed personal opposition to the creation of embryos for research and had a distinction between hESCs derived from embryos created for research and those derived from spare embryos enshrined in NIH policy.President Obama’s remarks upon signing the executive order give some insight into the thinking behind his approach. Implicit in them are the views that earlystage human embryos outside the womb do not have full moral status and that the destruction of human embryos in the effort to care for and ease the suffering of human beings who do have full moral status does not devalue human life. The President also stressed that the decision to pursue hESC research reflected not only his opinion, but also a broad social consensus. He concluded with strong ethical commitments on two fronts:We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.(Obama 2009b)The specific guarantee that President Obama gave against government support for the development of cloning techniques for human reproductive purposes made his silence on the use of cloning for research seem significant. Comments he had made in the course of the campaign (Obama 2008) suggested that he would affirm [End Page 195] the Clinton-era policy of limiting federal funding to hESCs derived from spare embryos. Did this silence mean that President Obama was opening the door to federal funding of research cloning when and if scientists might manage that feat?2009 NIH GuidelinesThe answer to this question and several others came on 17 April, when Raynard Kington, the acting director of NIH, released Draft NIH Guidelines for Human Stem Cell Research (NIH 2009), developed by an NIH Stem Cell Task Force, along with a request for public comment within 30 days of their publication in the Federal Register.2 The 2009 Draft Guidelines exclude from federal funding the derivation of hESCs, a restriction mandated by the reenactment of the Dickey-Wicker Amendment as part of the 2009 Omnibus Appropriations Act (Public Law 111-8, Division F, Title V, § 509). The 2009 Draft Guidelines also exclude the use of hESCs derived from embryos created for research purposes, and so represent a refusal to open the funding door as broadly as the NIH interpretation of the Dickey-Wicker Amendment might allow, at least for the time being.It appears that the drafters used as their starting point the 2000 NIH Guidelines for Research Using Human Pluripotent Stem Cells (NIH 2000) dating from the Clinton Administration, rather than more recent guidelines from the National Academy of Sciences (National Research Council 2005; 2007; 2008) and other private bodies. Both the format and content of the 2000 and 2009 NIH efforts are similar, making the departures in the latter stand out in high relief. We highlight departures related to informed consent to embryo donation, creation of human-nonhuman chimeras, and the role of an NIH task force, updating our original comment (Cohen and Majumder 2009).Informed Consent to Embryo DonationThe 2009 NIH Draft Guidelines require that certain statements... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cynthia B. Cohen THE TRIALS OF SOCRATES AND JOSEPH K. No two trials could have been more unlike than those of Socrates and Joseph K. As portrayed in Plato's Apology,' Socrates was the conscience of Athens, a thoughtful and courageous man whose life was devoted to the pursuit of wisdom. He challenged others to examine themselves and to transform themselves into lovers of truth and goodness. This (...) gadfly of Athens was put on trial by those whom he had stung and was dispatched with a final slap. He died the bravest, wisest, and most upright man of his time. By contrast, Joseph K., the protagonist of Kafka's novel, The Trial, was an ordinary bank clerk locked into a life of unreflective routine. His arrest one day by the agents of a Court he could not comprehend failed to change his rote approach. Like a fly stuck fast to flypaper, he was glued to the details of his immediate experience, and would not rise above these to find meaning in his dreary life, or even in his shameful death. Socrates was an original and constructive thinker who died rather than deny the purpose that he found in human life; Joseph K. was a leaden bureaucrat whose life was one long moment of guilty hesitation before a broader vision of things. Or is it that Socrates was an arrogant, peculiar, conniving failure who was engaged in an insidious attempt to undermine the moral and political values of Athens? And is it that Joseph K. was a successful young businessman who had established himself as a conscientious, decent, and eminently reasonable man struggling bravely for justice against an alien and capricious authority? Or perhaps these two trials should be seen as very similar. Each man was tried on charges of which he claimed to be innocent; each wanted to restore order and meaning to a disintegrating world; each led a life that became the cause of his death; and each was condemned for claiming that the unexamined life was not worth living. Or is it that Joseph K. was condemned for maintaining that it was the examined life that was not worth living...? 212 Cynthia B. Cohen213 Difficulties in the interpretation of works of literature are to be expected when their subjects are complex and subtle individuals set in an atmosphere in which basic questions of human significance are raised. Both the Apology and The Trial are such works. Socrates initially seems a model of clarity to the interpreter. He responds to his accusers in a form of direct discourse that can be taken at face value. He presents his arguments openly and cogently. There can be no doubt that his general position is coherent, consistent, and reasonable. Yet the interpreter 's initial satisfaction fades as Socrates' irony creates confusion about what Socrates professes to know. His lines of reasoning seem to intersect in paradox; his answers to questions about the meaning and purpose of human life curve around to miss each other. The interpreter emerges confused and perplexed. These transformations of perspective and significance are repeated in The Trial. Joseph K., too, is described in a straightforward manner that is clear and quite detailed. His reactions and arguments appear sensible and well-reasoned. Yet on closer examination, his simple statements turn out to have hidden meanings; his responses often contradict one another; his logical arguments appear pointless. His answers to questions about the meaning and purpose of human life are immediately challenged by a horde of competitors. To the interpreter, The Trial metamorphizes into a model of intentional obscurity. The problem of interpretation is compounded in the case of Socrates by the question of the accuracy of our information about him. The "Socratic problem" is well known. Each of the four major sources about his life and thought, Xenophon, Aristophanes, Plato, and Aristotle, presents a somewhat different person. There has been strong support for the view that the portrayal of Socrates in the earlier dialogues of Plato is essentially sound, even though this earlier Socrates seems at variance with the later one. The resolution of this problem is irrelevant to this endeavor. Our purpose is to consider the life and... (shrink)

Scientists seeking hard evidence of prayer's curative powers misunderstand the nature of prayer in the Western theistic traditions. Yet theistically consonant ways in which religious belief may influence health do not figure as they should in current professional practice.

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United StatesCynthia B. Cohen (bio) and Mary A. Majumder (bio)Human pluripotent stem cell research, meaning research into cells that can multiply indefinitely and differentiate into almost all the cells of the body, has become a minefield in which science, ethics, and politics have collided over the last decade in the United States. President Barack Obama entered this highly (...) charged territory when he indicated during his campaign that once in office he would issue an executive order expanding federally funded human embryonic stem cell (hESC) research and introduce rigorous oversight of it (Obama 2008a & b). Candidate Obama stated that he would require that the hESC lines involved were derived with donor consent from early embryos that otherwise would be discarded following in vitro fertilization (IVF) treatment. However, in contrast with the policy of President George W. Bush, he would do so without regard to the date of their derivation. He added that he would call upon the director of the National Institutes of Health (NIH) to develop guidelines for federally funded hESC and other pluripotent stem cell research that would draw from the guidelines developed in 2005 by the National Academies of Science (NAS) for privately funded research (National Research Council 2005).A similar policy was written into the 2008 version of the Stem Cell Research Enhancement Act, which reiterates the policy enunciated in earlier versions of this bill, passed twice by the Congress but vetoed by President Bush each time (House of Representatives, 110th Congress 2008).1 Depending on how one reads the 2008 version of the act, it could also apply in certain respects to hESC research that is not federally funded. We proceed on the assumption that the act applies at least to federally funded stem cell research. Therefore, it appears that the president or the Congress, or both, will approve of an expanded policy of federal funding of hESC research, as well as other forms of human pluripotent stem cell research. [End Page 79]This policy would make the guidelines developed by a committee appointed by NAS, a prestigious private body of American scientists and related experts, the primary basis for the development of new federal guidelines for oversight of hESC research in the United States. This would have certain advantages in that those familiar with the relevant scientific issues are likely to address them accurately and stem cell investigators are apt to accept restrictions on their research written by fellow scientists and ethics and policy experts whom they perceive as strong supporters of stem cell research. However, it also would have certain disadvantages. Chief among these is that the NAS committee appointed to write guidelines for this research, in its concern to see stem cell science move forward after a period in which many scientists and others maintained that it had been unduly restricted, might have overlooked or deferred consideration of some pressing ethical and policy issues. We maintain that this is the case—although we also maintain that the NAS guidelines provide a responsible foundation for developing NIH guidelines for stem cell research. Consequently, we propose that an NIH task force charged by the director of NIH with writing new guidelines for hESC and other stem cell research should revise and expand the NAS guidelines in ways that we propose below, as well as others that it considers necessary, and make it obligatory for those seeking federal funding of such research to follow these new guidelines.We highlight certain areas in which an ethical case can be made for strengthening the existing NAS guidelines and certain areas in which more fundamental ethical reflection—and building on that, additional guideline/policy development—seems warranted. Among the sections of the NAS guidelines that need clarification and reworking, we include those regarding consent to embryo donation, which provide one of their central focuses, and the development of human-nonhuman chimeras, which they address relatively briefly. In addition, we maintain that new guidelines need to be written to address the nascent ethical and policy issues raised by the possibility that human gametes will be induced from pluripotent stem cells in the next few years and that... (shrink)

This chapter argues that although there are certain limits on how religious bodies and their members should attempt to insert their beliefs into public policy matters, religiously based arguments should, as a matter of principle, be allowed to enter into public debate. This is the case even when many participants in these debates do not accept the premises on which the arguments of religious believers are constructed. The first part of the chapter considers the stances that various religious bodies and (...) commentators have taken publicly regarding embryonic stem cell research and the ways in which they have justified their views in the course of public discussion. It then examines why critics of religious bodies object to the introduction of religious views into public policy debates and offer several responses to these critics, using the responses of religious bodies and thinkers to embryonic stem cell research as examples. Finally, the chapter sets out an alternative view that offers a system for allowing religious bodies to present their views in the public sphere, provided that they follow certain practices that allow fair and open debate. (shrink)

Modern physicians are taught that they should not involve themselves in their patients’ religious concerns. Many worry that doing so would be intrusive, manipulative, difficult, and embarrassing. Patients, however, often want their physicians to explore questions of religion and faith with them. If these questions are broached in a sensitive and flexible way, they can be a natural and appropriate part of the physician‐patient relationship.

into treatment decisions is viewed as pernicious by some who claim that these presuppose the Nazi position that those who are ‘devoid of value’ must be exterminated. ‘Quality of life’ judgments are said to deny the equal value of human beings and to assume that some lives are not ‘worthy to be lived’. It is argued that the analogy misconstrues the senses of ‘value’ and ‘quality’ employed by Naziism and a ‘quality of life’ position. This leads the analogizers incorrectly to (...) claim that both views assimilate the value of human beings to the value of their condition. A ‘quality of life’ position is grounded in recognition of the logical priority of the value of human beings as self-reflective evaluators and agents, which is a matter of kind, not degree. The ‘quality of life’ is explicated in terms of the standards of well-being of individuals, which are derived from their basic human needs and their individual priorities and goals. The use of ‘quality of life’ judgments is morally required to ensure that considerations of justice and individual autonomy govern treatment decisions. The purported analogy misconstrues the views of both the Nazi position and a ‘quality of life’ position and so is seriously misdirected. CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.1 (2004) 97-114 [Access article in PDF] Stem Cell Research in the U.S. after the President's Speech of August 2001 Cynthia B. Cohen On 9 August 2001, in a nationally televised speech, President Bush addressed the contentious question of whether to provide federal funds for human embryonic stem cell research (White House 2001).1 This research involves taking the primordial cells found in (...) embryos and transforming them into certain specialized cells, such as those of the heart, nerves, and muscles, with the ultimate goal of transferring these cells into patients to repair damaged cells and tissues. In his remarks, the President authorized funding for research only on stem cells already harvested from remaining embryos at in vitro fertilization (IVF) centers as of 9 August 2001, the date of the speech. In a "Fact Sheet" about embryonic stem cell research, he added the ethical requirements that (1) the donors of embryos gave informed consent to the derivation of stem cells from their embryos, (2) the embryos were created solely for reproductive purposes, and (3) no financial inducements were given to the embryo donors. The President also prohibited federally funded research on embryonic stem cells derived from embryos after 9 August 2001, as well as the creation of embryos for research purposes and the cloning of human embryos for both reproductive and research purposes. He did not seek to ban the pursuit of embryonic stem cell research with private funds. "This allows us to explore the promise and potential of stem-cell research without crossing a fundamental moral line by providing taxpayer funding that would sanction or encourage further destruction of embryos," the President stated (White House 2001).The President's speech stirred intense controversy. Many applauded the new policy because it allowed some embryonic stem cell research to proceed, thereby raising hope that treatments might be developed for those suffering from such conditions as Parkinson's disease, Alzheimer's disease, and diabetes. Others supported it on grounds that it would discourage the future destruction of embryos in stem cell research. They maintained that although it was wrong to have derived stem cells from embryos, this wrong was no longer remediable and it therefore was justifiable to allow research using such embryos to proceed. Some, however, objected to the new policy because they held that it unduly limited the [End Page 97] number of embryonic stem cells available for federally funded research. Still others opposed it on grounds that it made the federal government complicit in what they took to be the wrongful destruction of human embryos that had taken place prior to 9 August 2001. The President established the President's Council on Bioethics by executive order in November 2001 and charged it, among other tasks, with monitoring stem cell research and recommending guidelines and regulations for biomedical innovations.Questions about the moral status of human embryos have so captured public attention since the President issued his remarks that other significant ethical and policy issues raised about stem cell research inside the Beltway have remained in the shadows. A number of individuals and organizations—legislators, scientists, patient groups, the President's Council on Bioethics, ethicists, religious task forces, and social commentators—have attempted to bring these other issues to legislative and public attention. They also have revisited the more publicly prominent question of what sorts of protections we owe to human embryos. In response, Congress has attempted to address several of these newly emerging issues at hearings and in legislation. I review these efforts, consider developing issues and arguments, and conclude by exploring possible future directions for federal and private sector stem cell policy. The Availability of Embryonic Stem Cell Lines to Federally Funded Researchers President Bush, in developing his stem cell research policy, accepted a distinction between the "derivation" and the "use" of embryos enunciated by the General Counsel of the Department of Health and Human Services toward the end of the Clinton administration. This distinction was adopted to avoid contravening the Dickey-Wicker Amendment (added... (shrink)

The discussion by Greely et al. (2007) of the Stanford advisory committee's deliberations regarding whether to pursue research involving the transfer of human brain stem cells to fetal mice not onl...

In the aftermath of allegations of the misuse of human eggs in the United States, questions are being raised about whether profitable reproductive services should continue to function in a free market under the aegis of physicians or should be regulated. Other countries in which reproductive technologies are employed to a significant degree have developed regulations governing their use, many as a result of recommendations made by inter‐disciplinary commissions that solicited public input. Policy makers in the United States have been (...) reluctant to regulate reproductive technologies, however, because their use is politically controversial, they want to whittle down government, some do not consider infertility an illness, and some believe regulation would interfere with the right to reproduce. Yet the unfettered use of reproductive technologies can create such harms as lack of informed consent, providing procedures not medically indicated for financial gain, practice by unqualified personnel, injury to patients and donors, failure to screen donated gametes, and inadequate medical record keeping. Americans place special value on the welfare of children and those who bring them into the world. Such values can outweigh individual procreative liberty when new reproductive technologies are at issue. Although the optimal course would be to establish a regulatory body to govern reproductive technologies, this is not politically feasible now. The newly established National Bioethics Advisory Commission provides a forum in which issues surrounding reproductive technologies should be addressed at this time in the United States. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Human Cloning by Embryo Splitting:After the HullabalooCynthia B. Cohen (bio)In October 1993, a paper entitled, "Experimental Cloning of Human Polyploid Embryos Using an Artificial Zona Pellucida," was presented at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Although it was awarded a prize, its authors, who are affiliated with George Washington University, decided against calling a press conference (...) to announce their findings. Word of their experiment soon leaked out, however, and the New York Times blazoned on its front page that human embryo cloning had been achieved. The story was accompanied by a diagram of cloning by nuclear transplantation.Newspapers and television networks around the world picked up the story and embellished it. The idea of unlimited, xeroxed copies of human beings gripped the public imagination. Wild scenarios of hundreds of Hitlers plotting to take over the world and of clones giving birth to their own twins enlivened media reports. Only gradually did it become clear that the term "polyploid" in the title of the paper referred to abnormal embryos that could never develop into living human beings and that "cloning" referred to embryo splitting or twinning, not to nuclear transplantation or the transfer of a donor nucleus into an enucleated egg. Once this sank into public consciousness, the "hullabaloo," as Dr. Howard W Jones, Jr., called it, died down.It left in its wake unanswered questions about the ethics of splitting embryos. During the height of the publicity given to the George Washington experiment, newspaper and TV stories had not delved in any depth into the ethical issues it raised. Ethicists, given limited time to discuss the ethical questions at stake, had been quoted in quick, simplistic responses. Some had offered little analysis of the rights and wrongs of embryo splitting, but, revealing tremendous creative talent, had spun out [End Page 187] imaginary and frightening applications of the procedure. This was a story essentially about ethics in which ethics was never really discussed.The National Advisory Board on Ethics in Reproduction* (NABER), an independent, multidisciplinary group that addresses ethical issues in modern reproductive science, technology, and care, became concerned about the sparsity of reflective ethical debate about embryo splitting. NABER's chair, Albert Jonsen, observed that "reporters phoning ethicists for comment and ethicists appearing on talk shows do not a debate make. Debate requires face to face (or at least essay to essay) argument among persons sharing the same information. This has yet to take place." Consequently, NABER decided to convene a workshop on human cloning by embryo splitting at the National Academy of Sciences in February 1994. The board invited participants who would provide a broad range of opinion about the ethical and public policy issues entailed by human embryo splitting. Embryologists, ethicists, reproductive biologists, public policy experts, staff from the National Institutes of Health (NIH), legal scholars, journalists, and infertility specialists were among those who participated. The feature articles in this issue of the Kennedy Institute of Ethics Journal derive from that workshop. Their authors were given free rein to take whatever stance they deemed ethically supportable.The first article is designed to provide some understanding of the science of human cloning as a basis for exploring the ethical issues raised by this set of techniques. Jacques Cohen, a leading reproductive embryologist, and Giles Tomkin, a science writer, both of Cornell University Medical School, explain, in a way that is clear to laypersons and biologists alike, the meaning, nature, and function of cloning. They discuss recent: advances in this area and offer an assessment of feasible uses of human cloning procedures, hoping to dispel what they view as mistaken fears about its future applications. Dr. Howard W Jones, Jr., a pioneer infertility specialist, briefly comments on Cohen and Tomkin's paper, pointing out that embryo splitting may not improve pregnancy results if genetic heterogeneity is required for successful embryo transfer and implantation.In the next article, three major ethical arguments against human cloning by embryo splitting are analyzed and rejected by Ruth Macklin, an expert in reproductive ethics from Albert Einstein College of Medicine. She finds the first argument, that the worth of individuals... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Private Bioethics Forums:Counterpoint to Government BodiesCynthia B. Cohen (bio) and Elizabeth Leibold McCloskey (bio)Ethical issues associated with reproductive technologies quickly gain public attention. The front pages of newspapers have featured stories about grandmothers giving birth to their own grandchildren, couples "renting" wombs from surrogates, and researchers prepared to transplant fetal ovaries into women unable to produce viable eggs. With each new and bolder foray into reproductive realms, the (...) question of whether to set limits on the use of such technologies surfaces. An ancillary debate inevitably ensues about the proper forum for discussing and deciding such limits. The recent announcement of human embryo splitting or cloning research is no exception to this pattern. Articles in both the popular press and academic circles in the wake of the reported research contain lamentations about the absence of a national ethics body that could address the ethical issues raised by the cloning experiment. This research also breathed new life into congressional calls to create a government bioethics commission.1At times, it appears that the substantive questions raised by a procedure like cloning are subsumed under the debate about whether this ethics group or that should be convened to study the matter. But the forum in which options are discussed is as crucial to the development of sound ethical thought and public policy as are the conclusions themselves. Thus, we address the question of whether a private, as opposed to a public, bioethics body provides a distinctively useful forum for reaching an understanding of issues such as cloning that have significant ethical and public policy implications.A 1993 Office of Technology Assessment report, in which the authors suggest that a new federal bioethics commission might be useful, has helped to frame recent discussions about the value of government-sponsored bioethics bodies (Office of Technology Assessment 1993). To most people, the question of whether a national forum for bioethics is needed is synonymous with the question of whether a new federal body should be convened. Yet the existence of the National Advisory Board on Ethics in Reproduction (NABER) suggests that the scope of the question should be broadened. [End Page 283]NABER was born in 1992, in part as a response to an Institute of Medicine report on infertility. That document endorsed the formation of a nongovernment body to develop guidelines for assisted reproductive measures and fetal research in the event that a government body was not forthcoming (Institute of Medicine 1989). NABER, which was founded by the American College of Obstetricians and Gynecologists and the American Fertility Society, now functions wholly independently of those groups and is supported by private foundations including the Ford, Greenwall, and Josiah Macy, Jr., Foundations and the Walter and Elise Haas Fund. NABER has issued a report on ethical issues related to the use of fetal tissue (Cohen and Jonsen 1993), is about to publish a report and background papers on oocyte donation, and presents a report on human cloning in this issue of the Kennedy Institute of Ethics Journal. In addition, it has developed a protocol for NABER review of research proposals from federal agencies subject to federal guidelines on the use of human subjects in research.Thus, in function and form, NABER was envisioned as a substitute for a government body, and it now functions in a manner similar to several types of government bioethics groups. Like the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission) and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (President's Commission), NABER functions primarily through the publication of reports intended for a broad audience of practitioners, patients, policymakers, and the general public. Just as the Ethics Advisory Board of the late 1970s examined ethical issues related to specific protocols or types of research as they arose, NABER's purposes include scrutinizing the ethics of various research efforts in the reproductive area.NABER also parallels past government bodies in form. Like these groups, NABER is a multidisciplinary board that meets regularly and is supplemented by consultants and staff who provide research and writing for the board. Its members are nationally recognized in... (shrink)

"The cases are presented in a concise and interesting manner... highlights the emerging consciousness of the importance of the contractual arrangement between physician and patient... " --Journal of the American Medical Association "The cases presented are interesting ones, and the commentaries are uniformly lucid.... Highly recommended... " --Religious Studies Review "Cohen contributes a well-selected collection of cases and commentaries which are presented in a crisp style... it is likely to have a real impact." --Ethics Twenty-six reports based on actual (...) cases with expert commentary that illuminate the ethical, medical, legal, and psychological contours of dilemmas surrounding termination of treatment decisions. Cases involve patients, families, physicians, nurses, lawyers, and health care administrators. A companion volume to the Hastings Center's Guidelines. See Guidelines for ad quotes when advertising both books. (shrink)

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways (...) of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia. (shrink)

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways (...) of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia. (shrink)

: National bioethics commissions have struggled to develop ethically warranted methods for conducting their deliberations. The National Bioethics Advisory Commission in its report on stem cell research adopted an approach to public deliberation indebted to Rawls in that it sought common ground consistent with shared values and beliefs at the foundation of a well-ordered democracy. In contrast, although the research cloning and stem cell research reports of the President's Council on Bioethics reveal that it broached two different methods of public (...) deliberation—balancing goods and following an overarching moral principle—it adopted neither. Thereupon its prime mover, Leon Kass, influenced particularly by the approach of Leo Strauss, sought to develop a method of public deliberation guided by tradition and practical wisdom. When this failed, the Council fell back on a method that took account of shared fundamental values of a free democracy—a method remarkably akin to that employed by the National Bioethics Advisory Commission. Respect for diverse reasonable conceptions of the good in a democratic polity requires national bioethics commissions to seek and incorporate that which is valuable in opposing positions. (shrink)

To address certain seemingly irresolvable conflicts between patients and clinicians regarding treatment plans that are rooted in patients' religious or spiritual beliefs, Kuczewski (2007), in a ref...

: Genetics professionals have been reluctant to test children for adult-onset conditions because they believe this would create psychosocial harm to children not counterbalanced by significant benefits. An additional concern they express is that such testing would violate the autonomy of these children as adults. Yet weighing the harms and benefits of such testing results in a draw, with no substantial harms proven. Moreover, such testing can enhance, rather than violate the adult autonomy of these children. In deciding whether to (...) proceed with predictive testing of children, parents, mature children, and health care professionals should consider a complex of factors relevant to the particular child. The importance of these factors will vary depending on the condition at issue, the age and stage of development of the child, family dynamics, and the concerns, values, and objectives of the parents and mature child. The final decision whether to test a child for an adult-onset condition should rest with the parents and the mature child. (shrink)