Human Evolution and Species Protection

Human Embryonic Stem Cell research in general, but the immortalizing properties of such research in particular raises another acute question. If we become substantially longer lived and healthier, and certainly if we transformed ourselves from mortals into immortals we would have changed our fundamental nature. One of the common defining characteristics of a human being is our mortality. Indeed in English we are mortals persons not immortals or Gods, demi-gods or devils. Is there then any moral...

Questioning the Whole Brain Formulation

The whole-brain formulation has been attacked at the conceptual level, and on the ground that the answers at each level collectively provide an incoherent account of concept, criterion and clinical tests for determining death. The President's Commission's concept or definition of death has been objected to by those who favor one centered on the essential features of a personal life, as well as by those who favor a circulatory concept and consider that only the irreversible cessation of...

Deep brain stimulation

Electrical stimulation of the brain is an important therapy for refractory neurological disorders such as drug resistant Parkinson's disease and severe tremor and has become an area of active clinical research in both neurology and psychiatry. Using a technique called deep brain stimulation (DBS), small electrical leads are placed into the brain using stereotactic localization. A special head frame is attached to the skull under local anesthesia, and electrodes are implanted using internal...

Investigational Applications

Research in deep brain stimulation is blurring the disciplinary boundaries between neurology and psychiatry. French investigators have discovered that DBS caused transient acute depression in a patient with Parkinson's disease whose motor function had improved markedly through DBS intervention (Bejjani et al.). Investigators are conducting clinical trials for the use of DBS for severe psychiatric illnesses such as obsessive compulsive disorder using techniques pioneered in the treatment of...

Educational Issues for Specific Endof Life Domains

Pain must be controlled before physicians can assist patients with the myriad of physical, psychological, and spiritual problems at end-of-life. Yet, physicians frequently fail to apply accepted standards of care for acute or chronic pain management. Moreover, it is clear that despite a multitude of clinical guidelines, position papers, workshops, lectures, grand rounds, journal articles, and book chapters written about pain management, clinical practice is still far from ideal....

Public Health Service Policy

PHS policy requires that each awardee institution provide a written assurance setting forth how that institution will comply with regulations. This assurance then forms the basis for the care and use of animals in research, education, and testing at that institution and is the basis for judging the adequacy of the institution's compliance with the policy. PHS policy calls for the establishment of a program for animal care and use, using the NRC guide as a basis for developing the program. Also...

Toward Reform

Agriculturists have recognized that the welfare of animals in confinement represents one of the three major challenges to agriculture in the next century, the other two being food safety and environmental concerns. When the British public became aware of factory farms in the 1960s as a result of Ruth Harrison's pioneering book Animal Machines, the outcry generated a royal commission, the Brambell Commission, that was highly critical of confinement agriculture as violating the animals' natures....

Institutional Ethics Committees

Ethics committees have played clinically relevant roles in U.S. healthcare contexts since the 1960s. At that time, some hospitals established committees to approve requests for abortion and sterilization and to allocate scarce dialysis machines. Universities and hospitals created human subjects committees to scrutinize research protocols and consent forms in the 1970s, these committees became federally mandated institutional review boards (IRBs). In the 1976 QQuinlan case, in which parents won...

Ethical Considerations

Deep brain stimulation raises special concerns because neuromodulation techniques deal with the direct stimulation of the brain. No other organ is so closely involved with concepts of mind or self, self-determination and consent. POTENTIAL ALTERATION OF THE SELF. Interventions involving brain structure or function may result in alterations in cognition, memory, or emotions that may have a bearing on personhood. The potential of DBS to alter brain function may lead some to argue categorically...

Rhetoric and the Holocaust

The term holocaust is derived from the Greek holokauston, meaning burnt whole, which was a derivation of the Greek translation of the Hebrew olah, a biblical term for a burnt sacrifice. Historically, the term was used to denote great destruction of human life, especially through conflagration. For that reason it was employed often by journalists in World War II to refer not only to the destruction perpetrated by the Nazis on Jews and others but also to Allied acts such as the bombing firestorms...

Epidemics of the Late Twentieth Century

In the West, epidemic infectious disease was regarded by the second half of the twentieth century as indicating an uncivilized state of mind, and was ascribed above all to nonwhite populations in parts of the world outside Europe and North America. This reflected structural inequalities in the world economy, as the great infections became increasingly concentrated in the poor countries of the Third World. By the middle of the twentieth century, however, rapidly increasing life expectancy was...

Nonprofit Status Of Health Insurance Pioneers

Because the pioneers in U.S. health insurance were nonprofit, charitable organizations, they were developed to provide a social function beyond creating a profit for shareholders or syndicate owners. However, the social objective was not always to benefit consumers. Blue Cross was first organized to provide for the financial survival of the American voluntary, nonprofit hospital system during the period of the Great Depression. Although organized medicine initially opposed the new insurance...

Research Ethics and National Security

The development of human research ethics, and of biomedical ethics itself, has been decisively influenced by experience with the involvement of human subjects in national security experiments. The signal event in this often dispiriting history was the exploitation of concentration camp prisoners in experiments under the cover of World War II, many sponsored by the Nazi German military apparatus. The culmination of the Nazi doctors' trial in 1947 was the creation of the Nuremberg Code, which set...

Clinical Use of Advance Directives

Rarely do advance directives clearly dictate the care that should be given to a patient who lacks decision-making capacity. Generally, some interpretation of the document is required, a responsibility left to the named surrogate decision maker, other family members, and the healthcare team. When a patient who has an advance directive lacks decision-making capacity and is seriously ill, the healthcare providers should discuss the situation with the named surrogate and other appropriate loved...

Health Insurance Social Justice and Rights

The concept of justice is the second major ethical theme associated with health insurance. Concerns about justice and health insurance derive from the question whether it is fair for some, but not all, citizens to have insured access to healthcare. Originally, health insurance was viewed as required by social justice not for everyone, but only for those made vulnerable by the conditions of wage labor. Compulsory insurance schemes were designed to help capitalism by making the working class more...

The Artificial Heart Goes Private

In 1976, Willem Kolff (a physician and the inventor of kidney dialysis and one of the first artificial hearts) and some of his Utah colleagues formed a private company, Kolff Medical Associates, to attract venture capital to support their research. In order to interest private investors, they had to create a marketing program for their mechanical heart. The decision to proceed with a private company constituted a first step into the emerging and often ethically controversial world of...

Historical Background

In its broadest sense, the term adoption may be used to describe the taking in, nurturing, and rearing of biologically unrelated children in need of protection and care. The terms adoption and fostering are used interchangeably in some countries, but in the United States adoption, in contrast to temporary foster arrangements, is a legal and permanent transaction. Shaped by the laws and cultures of each society, adoption was seldom concerned primarily with rescuing abandoned children but rather...

Competence and Mental Healthcare

The presence of a mental disorder does not automatically negate the presumption of a person's competence. Although some severely mental ill persons are indeed incapacitated in many areas of their functioning, most mentally ill persons have only some discrete areas of decision-making incapacity, often confined to episodes of their illness. A paranoid delusional patient who denies that he is mentally ill, for example, may be unable to rationally decide whether or not to consent to antipsychotic...

Intercountry Adoption

The shortage of desirable adoptable babies in the United States has led many who wish to adopt to seek children in other countries. The first international adoptions generally involved Amerasian children, that is, those fathered by GIs in Japan during and after World War II, in Korea during and after the Korean War, and in Vietnam during the U.S. involvement there. These adoptions were first sponsored by church groups and then by licensed adoption agencies (Lifton, 1994). Since the middle of...

Cardiac assist devices

Congress budgeted 581,000 to establish an artificial heart program at the National Institutes of Health (NIH). This was the first large-scale effort by any nation to support systematic research into the development of an artificial heart. The effort to build a reliable, totally implantable artificial heart has yielded marginal results. But even though an effective device does not exist, the artificial heart has, since the 1960s, been at the center of a heated ethical, economic,...

Norplant

Norplant is a sustained-release contraceptive system that acts continuously for five years. It consists of six silicone rubber capsules, each the length and diameter of a matchstick, which are surgically implanted under the skin of the upper arm. The synthetic progestin Levonorgestrel, a hormone found in many oral contraceptives, is slowly released into the bloodstream, resulting in a constant hormone level. The contraceptive effect of Norplant is due primarily to inhibition of ovulation,...

Healthcare Issues

Fear and social stigma may be barriers to seeking HIV testing or care. In the United States, special procedures, protections, and programs have been developed to encourage testing and to provide care. TRANSMISSION AND PREVENTION. HIV is transmitted by direct contact with bodily fluids that contain the virus. The major modes of transmission are sexual contact and injection drug use (through sharing needles and drug paraphernalia). HIV can also be transmitted from mother to infant during...

The Holocaust in Bioethical Discourse

In bioethical contexts the Holocaust often is invoked as a form of moral approbation. The development of the Nuremberg Code in the wake of the Holocaust was the clear precursor to the emergence of modern protection measures for human subjects and therefore often is referenced legitimately (Caplan). However, the Holocaust-Nazi analogy also is invoked regularly to condemn a wide range of practices (e.g., abortion, physician-assisted suicide), healthcare strategies (e.g., managed care, age...

New Points of Emphasis

The third edition includes a wide array of new titles ranging from Bioterrorism, Holocaust, and Immigration, Ethical and Health Issues of, to Artificial Nutrition and Hydration, Cancer, Ethical Issues Related to Diagnosis and Treatment, Dementia, Dialysis, Kidney, DNR Do Not Resuscitate, and sets of articles under Cloning and Pediatrics. Topic areas such as Reproduction and Fertility, Organ and Tissue Transplantation, Death and Dying, Ethical Theory, Law and Bioethics, Mental Health, Genetics,...

Early Protestant Views of Abortion

Martin Luther's and John Calvin's theological and moral reforms were shaped by their reconceptions of both the meaning of Christian life and Christian ritual practice. Neither could be said to have proposed shifts in the foundational notions of human nature embedded in late medieval Christianity. Traditional notions of human nature, including gender and human species reproduction, were not in dispute and did not shift at the time of the Reformation. What is notable among Protestant reformers is...

The Concept of Cancer An Overview

Although the biological, epidemiological, and genetic origins and indicators of cancer are vitally important they are the frontiers on which the disease is being battled cancer is more than the sum of its physical parts. It is also a socially imagined disease that is collectively thought about, embellished, and reacted to in ways that mesh with a people's established social and cultural norms. In some African countries, for example, perceptions of cancer as a stealthy, insidious disease mesh...

Historical Development

Although Catholic claims about abortion are not narrowly religious, certain biblical and early Christian characterizations of life in the womb no doubt have contributed to an ethos in which abortion is viewed negatively. The Hebrew Scriptures (Old Testament) did not treat the killing of a fetus as the killing of an infant (Exod. 21 22), although the Greek Septuagint translation of the Hebrew (early third century b.c.e.) adds a distinction between the formed and the unformed fetus, and presents...

Integrating Genetic and Environmental Information in Clinical Research

The risks posed by exposure to chemical and environmental agents are related to the level of exposure, the intrinsic potency of the agent, and the susceptibility of the person exposed. In general, the highest exposures are in patients receiving potent drugs or radiation as medical treatments and in workers manufacturing or cleaning up chemicals in various operations. Therefore, it is logical and efficient to investigate potential risks to human health in patients and in workers with known...

Theories And Conclusions Drawn From The Data

Emphasis upon traditional disciplinary approaches that are quantitative and maintain the distance between observer and experimental subject supposedly removes the bias of the researcher. Ironically, to the extent that these objective approaches are synonymous with a particular approach to scientific phenomena, they may introduce bias. As a corrective to such bias to a science that is too narrow, Sandra Harding proposes the notion of strong objectivity which recognizes the cultural, social, and...

Unintended Research Bias

Given the high costs of sophisticated equipment, maintenance of laboratory animals and facilities, and salaries for qualified technicians and researchers, little behavioral or biomedical research is undertaken without governmental or foundation support. The choice of problems for study in medical research is substantially determined by a national agenda that defines what is worthy of study, that is, worth funding. As Marxist (Zimmerman et al.), African-American (Campbell, Denes, and Morrison),...

Religious Traditions B Roman Catholic Perspectives

The following is a revision and update of the first edition entry Abortion Roman Catholic Perspectives by John R. Connery. The Roman Catholic tradition has always treated abortion as a serious sin. Yet Catholic teaching on abortion has not always centered on the right to life of the individual fetus, nor has it always viewed all abortion as homicide. For several centuries, early abortion in particular was characterized more as a sexual sin than as killing, and was condemned as an interference...

Integration of Alternative and Complementary Medicine into Palliative Care

Patients and their families may be subject to strong pressures to utilize ethnomedical practices and procedures believed to be efficacious. Recent immigrants may utilize products obtained abroad or from Mexico and Central America. Practices vary widely, including acupuncture for pain, cupping or coining, dietary prohibitions based on hot-cold belief systems, Chinese herbal products, Ayurvedic patent medicines, and full-blown rituals including chanting and the sacrifice of animals. A skilled...

Limits

If beneficent duties are more than supererogatory, or optional, a persistent issue is how to discern their proper scope. Where do obligations to benefit others end Are we morally required to give away all our surplus income and, beyond that, to chasten ourselves to more modest patterns of consumption Are physicians obligated never to say no to patients so long as any thread of hope for improvement exists Would beneficence require acceptance of higher taxes to fund universal health coverage, or...

Ethical And Legal Issues

Alternative medicine covers a dizzyingly heterogeneous group of medical theories and practices. Alternatives range from the different forms of faith healing, Christian Science, and folk medicine to allegedly scientific systems like homeopathy, chiropractic, and visualization therapy. Also included under the term are acupuncture herbalism iridology the traditional medicines of India, China, Japan, the Philippines, and indigenous peoples holistic medicine naturopathy (treatment using agents or...

Cancer and Endof Life Care

In the past oncologists typically greeted with foreboding and mistrust the prospect of relinquishing treatment in favor of palliative, end-of-life support such as hospice care. That open opposition has been replaced in most cases with careful circumspection. Many oncologists recognize a threshold beyond which continued treatment does more harm than good even though they may struggle to unite that recognition with the Hippocratic imperative to heal. This threshold, however, may not always...

Cancer Care and the Future

Future developments in cancer care will be affected by advances in the clinical control and prevention of the disease. Ongoing genetic and molecular research promises not just more effective treatments for cancer but also less invasive procedures for patients, greater patient autonomy, and improved quality of life. Potential problems may include a compounding of concerns about informed consent for cancer clinical trials and genetic susceptibility testing, as well as more macro issues such as...

The Limits of Medicine

Interestingly, one sector of medicine that is strongly wed to a naturalist ideology is biomedicine. Human health is usually understood by biomedicine not merely as the absence of diagnosable disease, but as functioning within a range that is typical for human beings of one's age and gender (Boorse). For functionalists in biomedicine, the statistically normal is morally normative that is, it represents the state of health that is supposed to be the goal of research and the priority of practice....

Extending Life Expectancy

The prospect for increasing life expectancy further is a subject of intense scientific debate. Projections of life expectancy can have a significant influence on anticipated changes in social programs, such as Social Security and Medicare, that are influenced by the future size and health status of the older population. Some scientists have argued that life expectancy at birth for humans cannot practically exceed about eighty-five years (Olshansky et al., 1990). This conclusion is based on the...

Effects of Extended Life Expectancy on General Population

Observing historical trends in mortality, and anticipating future improvements, raises the question of how the overall health of the population is influenced by these trends. From a historical perspective, there is little doubt that the thirty-year increase in life expectancy in the twentieth century was a result of trading one set of diseases and causes of death for another. The epidemiologic transition allowed much larger proportions of each birth cohort to survive to older ages, something...

The Ultimate Explanation Evolutionary Considerations

Nothing in biology makes sense except in the light of evolution. This statement by the well-known geneticist Theodosius Dobzhansky has been verified by the study of aging. The operation of natural selection means that some genetic variants of any population will be more successful (i.e., leave more copies of their genes in the next generation) than will other variants, and the first variant will be favored. Most known populations are structured by age that is, the population is composed of...

Pharmaceutical Interventions into the Aging Process

The genetic manipulations used in the laboratory are not likely to be well received as therapeutic tools. Once the longevity extension mechanisms described above were identified, many scientists independently tried to develop pharmaceutical interventions by feeding various drugs suspected of regulating those two processes to their laboratory animals. Five of those experiments have shown signs of success. Although those independent experiments used different intervention strategies and...

Is a Complete Understanding of Aging Needed Before Intervening in the Process

There are other mechanisms that the laboratory data suggest also may be involved in regulating the aging rate. Perhaps the most persuasive is the cell senescence telomere theory. Except for stem cells, body cells either divide very rarely (i.e., nerve cells, muscle cells) or divide either continuously (i.e., blood cells, skin cells) or when stimulated (i.e., liver cells). Those cells that divide seem to have an upper limit on the number of divisions they can undergo. There is some evidence that...

Fairness in Anti Aging Medicine

Critics might reply that appeals to the public welfare change the terms of the debate once again. At the level of social policy, the dangers of the off-label use of medical interventions for anti-aging purposes dim in comparison to the injustices that might be facilitated if anti-aging interventions are treated as elective enhancements. Public attitudes toward the enhancement technologies already available suggest that the demand for truly effective anti-aging interventions will be so...

Laboratory Interventions into the Aging Process

An obvious limitation of the laboratory record is that there are few human data One cannot experiment on humans for both ethical and practical reasons. There are four species of multicellular animals that account for most of the recent research into longevity extension. Two of those model systems, the mouse and the rat, are mammals commonly used in biomedical research. The other two are invertebrates beloved of geneticists the fruit fly and the worm. Also, some laboratories focus on the use of...

Organization of the Encyclopedia

Some entries are comprised of several subentries. For example, Aging and the Aged I. Theories of Aging and Life Extension II. Life Expectancy and Life Span V. Anti-Aging Interventions Ethical and Social Issues The reader wishing to study ethical aspects of aging and anti-aging research would do well to read all five of these interlocking articles. Cross-references are provided for each article. However, for a complete perspective on the thematic...

Penultimate Explanations Mechanisms of Aging

How good are those reasons The categorization of the reasons leads to the different mechanisms that are known to be involved in the aging process. There are several methods by which one can organize the different theories of aging. None of these systems is fully satisfactory, but the origins of the change and its level of action both appear to be reasonable and logical pegs from which to hang these descriptions. Here a dual classification scheme is employed in which one considers whether the...

Life Expectancy And Life Span

In the United States in 1900, the average life expectancy (also referred to as longevity) of a newborn baby was 47.7 years 46.4 for males and 49.0 for females. By 1990 the average life expectancy increased to 75.4 years 78.8 for females and 72.0 for males. Why did life expectancy increase so rapidly in the twentieth century, and what are the prospects for increasing it further Perhaps more important, has the overall health of the population improved or worsened during this transition, and what...

Healthcare of Older People

The nature of illness in older people greatly influences the ethical issues in their healthcare. Older people have a higher burden of illness than younger people. On average, they are likely to have several chronic medical conditions, be on multiple medications, and have frequent encounters with the healthcare system, including more hospitalizations. Because older people are closer to the end of their life expectancy, they have a greater chance of being involved in situations where difficult...

Theoretical Considerations

Early attempts to understand the nature of elder abuse were influenced by the child-abuse model. Victims were viewed as very dependent older women mistreated by well-meaning but overburdened adult daughters. Later findings suggested that spouse abuse might be a more useful framework for study, since the individuals involved were legally independent adults. To some health researchers, however, using the family violence paradigm, with its emphasis on harm, intentionality, and responsibility, was...

Ethical And Societal Perspectives

People who are physically or mentally disabled have many disadvantages. They may have an impairment, such as paralysis, blindness, or a psychiatric disorder, that reduces their ability to do things that nondisabled people do and may interfere with their fulfillment of socially valued roles. Also, disabled people often are subjected to various degrees of exclusion from the social and economic life of their communities. Political movements by disabled people to remove barriers and overcome...

Should Scientists Attempt to Control Aging

The fundamental philosophical and cultural challenge of anti-aging research is the blow that it could deal to aging's historical role as a constant in human affairs. If it is not necessary to assume the universality of aging in the ordering of society, new choices present themselves. From the point of view of the public good, is aging, as it is now known, a human experience to be encouraged or discouraged Both biomedicine and American culture reinforce the inclination to interpret the...

Health Risks and Benefits of GM Food

Critics of GM food present three kinds of arguments to suggest that it may not be good to eat (Thompson, p. 76). First, GM foods may produce allergic reactions because known or unknown allergens could be introduced into products people believe are safe. The food industry should and does take this problem seriously the liability issues alone are sobering. For example, because many people are allergic to peanuts, it would be risky to introduce into other crops genes that code for a protein unique...

Is There a Natural Life Cycle

In reply, the critics of anti-aging medicine ask us to imagine our reactions to a hypothetical biomedical intervention that would interrupt the development of a child and extend childhood by delaying puberty (Hayflick). What is worrisome about that is not simply the psychological harm such a developmental distortion might produce. Nor is it just a matter of violating the child's rights to self-determination those rights are not yet in full flower and it is their parents' role to protect, and to...

The Effects of Individual Reproductive Choices on Society

In addition to advantageous or deleterious effects on individual women and couples, concerns exist about the effects of prenatal testing on society. THE DISABILITY CRITIQUE. The most forceful critique of prenatal testing is that made by disability theorists (Parens and Asch). Their most straightforward claim is that prenatal testing represents search and destroy missions against those who would be born with disability and is, simply, a eugenic program. A more subtle disability critique states...

Male Genital Alteration in Judaism

While circumcision is the sign of belonging to the covenant, it does not confer Jewishness. Uncircumcised males can still be considered Jewish Judaism does not practice female circumcision, but females are not thereby excluded from the covenant. In order for the religious obligation of circumcision to be fulfilled, the surgery must be set in the proper context, which includes the blessings, the correct procedure, the appropriate mindset, and the religiously mandated day of performance. The...

Medical and Ethical Issues

The basic ethical question regarding circumcision is whether it is justified to perform a surgical procedure on a healthy, unconsenting child to prevent the possibility of future disease. The primary ethical task is to balance the pain and potential complications with the potential benefits. In addition, there is a strong tradition of respecting parental wishes when their decisions are not clearly contrary to the welfare of the child. Although the full details of the risks and benefits are...

Christian Orientations toward Death

Because the dominant religious influence in this history of the Western world has been that of Christianity, it is appropriate to outline the main Christian patterns of orientation toward death. There is no doubt of the predominance of a duality of levels in the Christian paradigm of the human condition, the levels of the spiritual and the material, the eternal and the temporal. On the one hand, there is the material-temporal world, of which one religious symbol is the dust to which humankind...

Harmful Effects of Female Circumcision or Female Genital Mutilation

The medical consequences of female genital mutilation are quite grave (El Dareer Koso-Thomas). In Africa an estimated ninety million females are affected (Hosken). Three levels of health problems are associated with the practice. Immediate problems include pain, shock, hemorrhage, acute urinary retention, urinary infection, septicemia, blood poisoning, fever, tetanus, and death. Occasionally, force is applied to position candidates for the operation, and as a result, fractures of the clavicle,...

Stephen G Post

SEE ALSO Abuse, Interpersonal Elder Abuse Advance Directives and Advance Care Planning Aging and the Aged Artificial Nutrition and Hydration Autonomy Beneficence Care Christianity, Bioethics in Compassionate Love Competence Confidentiality Genetic Testing and Screening Grief and Bereavement Human Dignity Informed Consent Judaism, Bioethics in Life, Quality of Life, Sanctity of Long-Term Care Medicaid Medicare Moral Status Neuroethics Palliative Care and Suffering Research, Unethical Right to...

Christianity

As with other religious traditions, Christian responses to cloning have been mixed. As early as the mid-1960s, Christian ethicists split sharply over whether cloning was playing God. Supporting new biotechnologies, Joseph Fletcher famously claimed let's play God (p. 126). Paul Ramsey's equally famous and oft-quoted response cautioned against advancing reproductive technologies Men ought not to play God before they learn to be men, and after they have learned to be men they will not play God (p....

Attitudes toward Other Drugs

The image of alcohol did not wax and wane in isolation from the public's perception of drugs such as morphine, heroin, and cocaine, although the peaks of their favorable and unfavorable public images did not coincide precisely with those of alcohol. The use of cocaine rose rapidly after its introduction into the United States in the mid-1880s. Not until the Harrison Act of 1914 did the federal government prohibit the sale of cocaine without a prescription. A similar restriction on alcohol,...

In a public health context

Psychoactive drugs are substances that alter the mental state of humans after ingestion. There are a wide variety of those substances, both naturally occurring and synthesized, including tobacco, alcoholic beverages, coffee, tea, chocolate, and some spices, as well as substances that are legally available only through medical channels, such as benzodiazepides, cannabinols, opiates, and cocaine. Such substances often have other use values along with their psychoactive properties. Users may like...

Contemporary Philosophy

The problem of death has not often been seen by contemporary philosophers as a choice between devising consolations for our finitude and demonstrations of our eternalness. For many, perhaps most philosophers early in the twenty-first century, the death of God is more than a century past, the grieving finished more than half a century ago. The problem of death, understood as the struggle to make life meaningful in an increasingly secular age plagued by the temptations of nihilism, continues. The...

Religious Perspectives

Even for those who are not actively religious, nascent human life evokes awe and a sense of being in the presence of primal powers of creation. In the procreation of all species, from plants to domestic pets, religious consciousness often senses the divine at play in the natural. In human procreation in particular, human beings not only observe but also participate in that power, and by conceiving and giving birth humans play a small but profoundly personal role in creation. There is little...

Search and Reunion

One of the effects of the civil-rights movement of the 1960s was the emergence of an adoption-reform movement led by adult adoptees. Its rallying cry was that the civil rights of the adopted had been violated when their original birth records were sealed, denying them access to information available to nonadopted people. Adoption support groups have been established across the United States to provide emotional support, lobby for open records, and facilitate the search for birth parents. Some...

Control and Responsibility

But in what sense are we human beings able to choose their emotional responses How, if at all, can the will intervene in emotional behavior Aristotle is once again helpful here. Both action and emotion, he holds, are subject to choice in the following sense. We choose to develop a state of character that stabilizes certain dispositions toward action and emotion. Accordingly, how one feels (and acts) may be less a matter of choice at the moment than the indirect...

Is Addiction a Real Disease

In addition to genetics, addiction as a disease is supported by the common signs and symptoms among the homeless and physician drug addicts. The target for drugs of abuse is the brain and changes in the neuroanatomy of the brain occur in all addicts and underlie the disease of addiction. Recent research in neuroscience has identified a specific area of the brain described as the reward center. This area of the brain makes essential survival behaviors such as eating, drinking and sex...

From Creation to Procreation

As an arena of divine presence, nascent life must be held in respect, for if it is God's work, its development must not be thwarted nor its condition questioned. According to the prophet Isaiah, God declares Woe to you who strive with your Maker, Does the clay say to the one who fashions it, What are you making or Your work has no handles Woe to anyone who says to a father, What are you begetting Or to a woman, With what are you in labor (Isa. 45 9-10) Because procreation is the work of God, it...

Complicated Grief

While models of complicated grief vary (Rando Worden), complicated grief reactions generally involve intensifications and exaggerations of the earlier described responses to grief that effectively impair the individual's ability to function. Complicated grief can also be evident in masked reactions that is, the grief is masked by another problem such as substance abuse. One factor that can complicate grief is disenfranchise-ment. The term disenfranchised grief refers to a grief that results...

Ethical Aspects

Since some followers of Islam in Africa, the Far East, and the Middle East endorse circumcision, it has been widely identified as an Islamic rite. However, female genital mutilation is not practiced in Saudi Arabia, Algeria, Iran, Iraq, Libya, Morocco, or Tunisia. Many Islamic and Christian religious leaders have categorically denied that female circumcision or female genital mutilation is an injunction in the Qur'an or a commandment in the Bible. Since the foundations of the practice lie...

The Social Force of Diagnosis

Concepts of disease have been used to impose political judgments. For example, in the United States prior to the Civil War it was proposed that the flight of a slave to the North and the absence of a wholesome inclination to do effective plantation work were diseases for which explanatory accounts and treatments could be provided (Cartwright). Masturbation was once viewed as a serious disease for which castration, excision of the clitoris, and other invasive therapies were employed. Individuals...

Orientations to the Body

The history of medical anthropology is to a large extent a history of scrutinizing and challenging Western assumptions about sickness, beginning with the distinction between biomedicine and traditional medicine. (Most medical anthropologists prefer the term biomedicine to the alternative terminology scientific, modern, and Western medicine. For an explanation see Leslie.) At first glance the distinction appears to be a commonsense way to classify different kinds of medical systems in practice...

Help and Grief

Persons experiencing acute grief can help themselves in a number of ways. Because grief is a form of stress, lifestyle management including adequate sleep and diet, as well as other techniques for stress reduction, can be helpful. Bibliotherapy or the use of self-help books can often validate or normalize grief reactions, suggest ways of adaptation, and offer hope. Self-help and support groups can offer similar assistance as well as social support from others who have experienced loss. Others...

The Distinction between Conventional Breeding and Genetic Engineering

For thousands of years human beings have altered the genomes of all major crops radically and constantly to change growth and ripening characteristics, speed maturity, eliminate grain shattering, improve taste and reduce toxins, increase size, and even get rid of seeds, as in grapes and bananas. Pictures comparing the wild and cultivated types of any crop invite incredulity because the differences are so sweeping. Crops that are very different from each other, such as Brussels sprouts, cabbage,...

Difficulties with the WHO Definitions

There are two main deficiencies in the definitions given above that should be remedied. First, they contain no account of what is normal or abnormal for human beings either in structure and function (as in the definition of impairment) or in the manner and range of performing an activity (as in the definition of disability). Second, only the definition of a handicap makes reference to disadvantage, yet intuitively, disadvantage, or at least inconvenience, is part of the concept of disability....

Cognitive Abilities and Intelligence

Though there are more data about the inheritance of intelligence than about any other complex behavioral characteristic of humans, the word intelligence is viewed even by the proponents of IQ testing as misleading because it has too many different meanings. IQ researchers seem to prefer to use the expression general cognitive ability, represented by the letter g (Jensen Plomin, DeFries, et al., 2001). The notion of substantial genetic influences on individual variation in g or intelligence...

The History of Circumcision

The walls of Egyptian tombs depict male circumcision, so the practice is known to be at least 5,000 years old. The Jewish and Muslim traditions of circumcision have their origin in the Old Testament. Jews accept the practice as a sign of the covenant between God and Abraham. In Genesis 17 12, God instructs Abraham He that is eight days old shall be circumcised among you, every male throughout your generations. As a Jew, Jesus was circumcised, and the early Christian church debated the need for...

Feminist Bioethics

In Canada and the United States, the bioethics movement and second wave feminism both began in the late 1960s, but the two discourses had little to say to one another for the better part of two decades. It was not until 1989 that the U.S. journal of feminist philosophy, Hypatia, published two special issues devoted to feminism and medical ethics. The few essays by feminists published up to that time in the premier U.S. journal in bioethics, the Hastings Center Report, dealt solely with ethical...

Addiction as a Modern Governing Image

The concept of addiction as an affliction of habituated drug users first arose in its modern form for alcohol as heavy drinking lost its banalized status in the United States and some other countries under the influence of the temperance movement of the nineteenth century (Levine Valverde). Habitual drunkenness had been viewed since the Middle Ages as a subclass of gluttony now abstinence from alcohol was singled out as a separate virtue and an important sign of the key virtue in a democracy of...

Gender identity

The term gender has a long history, with Greek roots signifying birth, race, and family and Latin roots signifying birth, race, and kind. The psychologist John Money was among the first to use the term to refer to a person's felt identity as male or female, as distinguished from that person's biological sex traits (Money). The term also is used to refer to a person's nature or identity as male or female and to social aspects of sex such as the cultural roles of men and women. Various biological...

Gender Identity Disorders

Some people assert a gender identity that is at odds with their anatomy and genetic traits. The American Psychiatric Association (APA) treats some of those people as suffering from gender identity disorder (GID). GID sometimes is called gender dysphoria, and it occurs in children, adolescents, and adults. According to the APA, people with this disorder are characterized by a strong and persistent cross-gender indentification (American Psychiatric Association, 2000, p. 581). This preoccupation...

Addiction and dependence

While addiction has been called a victimless crime, nothing could be further from the truth. Research consistently demonstrates that acts of violence against self and others, accidents, decreased productivity, health problems, and a number of other social ills have links to alcohol and drug abuse and addiction. Every day we read about, hear about, or know someone who is a victim of a crime caused by those who use or seek drugs. For some, it is tempting to ignore the ravages of addiction by...

Risk Factors and Characteristics

Although early studies were useful in documenting the existence of the problem and promoting state elder abuse policies, they were generally based on data collected from agency files, used small, unrepresentative samples, and lumped together the various types of abuse. Karl Pillemer (1986) sought to overcome some of these methodological weaknesses by interviewing victims directly, adding a nonabused comparison group, and limiting the investigation to physical abuse. His results showed that the...

Is Alcoholism a Disease

Beliefs about the cause or causes of alcoholism and the nature of drinking problems exert an important influence on public perceptions, institutional responses, and treatment and prevention, and shape the framework that guides ethical inquiry and response. The disease concept of alcoholism, first articulated by Elvin M. Jellinek in the 1940s, was actively promoted by a loose coalition of reformers, service providers, and recovering alcoholics. Since then, it has become the official view of the...

Additional Ethical Issues

Unfortunately, many of the issues that affect younger individuals with regard to access to healthcare and research do not disappear when people get older. While this is not a great concern in countries with a national health service or national health insurance, it remains a major issue in the United States. Many people, including a surprising number of older people, assume that Medicare, the federal health insurance program for older people, covers most healthcare needs. While Medicare pays a...

Male Genital Alteration in Islam

In Islam male circumcision is performed for reasons of ritual cleanliness or purity the term used is fitra, which implies both physical hygiene and inner purity. Cleanliness is required for prayer to be efficacious the uncircumcised male faces the possibility that some trace of urine will remain under the foreskin and his prayers will be nullified. Circumcision is not mentioned in the Qur'an, but is part of the second source of Islamic law hadith (the sayings and doings of the Prophet)....

Islam

The idea of eugenics is not well developed in the Islamic world. Both Islamic law and tradition generally condemn abortion, which is permitted only if the mother's life is endangered, so there is no genetic counseling that would lead to abortion. Both religious law and tradition do include references to a man's choosing an appropriate wife, but these concerns have been interpreted as moral and social, rather than eugenic. Islamic religious-moral law, the Shari'a, deals with questions concerning...

Managing Incompetence

Because functional or decision-making capacities occur on a continuum and because a person's capacities can be expected to fluctuate over time, in most cases a clinician need not be resigned to accept a patient as permanently incapacitated. The clinician frequently has opportunities to enhance the person's functional or decision-making capacity. Hearing aids, eyeglasses, psychotropic medication, counseling and psychotherapy, and specific behavioral training in the area of incapacity are...

Findings about Morbidity and Mortality

In the 1980s some African clinician-activists from countries that practice those rites documented and brought to the world's attention the accompanying morbidity and mortality. Those pioneering medical studies include the ones conducted in the Sudan by Asma El Dareer (1982), in Sierra Leone by Olayinka Koso-Thomas (1987), and in Somalia by Raquiya Haji Dualeh Abdalla (1982). The death, infection, and disabilities associated with the rites are well established, challenging local beliefs that the...

Choice And Definition Of Problems To Be Studied

Many diseases that occur in both sexes have been studied in males only and or used a male-as-norm approach. Cardiovascular diseases serve as a case in point. Research protocols for large scale studies (MRFIT Grobbee et al. Steering Committee of the Physicians' Health Study Group) of cardiovascular diseases failed to assess gender differences. Women were excluded from clinical trials of drugs, they said, because of the desire to protect women or fetuses (and fear of litigation) from possible...

The Monetary Value of Life

CBA, in contrast to CEA, demands the assignment of monetary value to the benefits of a program or procedure. The health benefit whose monetarization has received the most explicit attention in the literature of CBA is life itself. Economic evaluation of life itself, as superficial and distorting as it may sound, is in one sense now an ordinary phenomenon. Now that a great number of effective but often costly means of preserving life are available, we inevitably and repeatedly pass up potential...

Normative Ethical Theories

The concept of normative ethics was invented early in the twentieth century to stand in contrast to the concept of metaethics. In ethical theories prior to the twentieth century, it is impossible to discern any sharp distinction between what have come to be called metaethics and normative ethics. In the first half of the twentieth century, however, this distinction began to structure ethics as an intellectual discipline and it continues to be influential at the end of the twentieth century even...

Casuistic Writings

Through the fourteenth and fifteenth centuries, many books of cases of conscience were published. The Summa Angelica (1480) and the Summa Sylvestrina (1516) were the most famous. However, these works were staid, unimaginative, and formalistic many authors simply plagiarized from more celebrated authors. But casuistry properly speaking came into its own in the mid-sixteenth century. In 1556 a Spanish canonist, Martin Azpilcueta, published A Handbook for Confessors and Penitents, which...

Dementia

The syndrome of dementia is an irreversible decline in cognitive abilities that causes significant dysfunction. Like most syndromes, dementia can be caused by a number of diseases. In the nineteenth century, for example, a main cause of dementia was syphilis. As a result of dramatic increases in average human life expectancy, dementia is caused primarily by a number of neurological diseases associated with old age. Dementia is distinguished from pseudo-dementia because the latter is reversible...

Confidentiality and the Control of Genetic Information

Medical genetics is more concerned with the family than almost any other medical subspecialty. As part of the evaluation of a clinically significant genetic disorder, the genetic counselor is required to collect detailed family data and record it in the form of a pedigree. This enables the counselor and the medical geneticist to determine whether there is a pattern of occurrence in the family consistent with control by a single gene of major effect (often referred to as a Mendelian gene). The...

The Argument from Cruelty

The language of this argument is sometimes taken from the Eighth Amendment of the U.S. Constitution (Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted) or from human-rights declarations that outlaw cruel, inhuman or degrading treatment or punishment. Thus, a brochure titled When the State Kills, issued by the British Section of Amnesty International (1990), contains the following passage under the heading Cruel, Inhuman and Degrading...

Law And Bioethics

Abortion Contemporary Ethical and Legal Aspects Abuse, Interpersonal Advance Directives and Advance Care Planning Animal Research Law and Policy Children Rights of Children Conflict of Interest Death, Definition and Determination of Legal Issues in Pronouncing Death Death Penalty Disability Legal Issues DNA Identification Environmental Policy and Law Epidemics Expert Testimony Fertility Control Legal and Regulatory Issues Genetic Discrimination Health Insurance Human Rights Impaired...

Mahayana Buddhist Thought and Practice

Even a brief survey of Mahayana Buddhism, which arose less than 500 years after the historical Buddha's lifetime, strongly suggests that Buddhist bioethics cannot be approached in singular terms. Mahayana refashions Theravada perspectives through the concept of sunyata (emptiness), while adding a new soteriological possibility based on faith birth in a Buddhist paradise as the goal of religious praxis. Thus, Mahayana Buddhism incorporates the ideal of enlightenment achieved through individual...

Bibliography

Islam and Biological Futures Ethics, Gender, and Technology. London Mansell. Augustine. 1955. Enchiridion. In Confessions and Enchiridion, tr. and ed. Albert C. Outler. Library of Christian Classics, vol. 7. Chap. 23 84-85. Philadelphia Westminster Press. Breck, John. 2000. The Sacred Gift of Life Orthodox Christianity and Bioethics. Crestwood, NY St. Vladimir's Seminary Press. Bush, Lester E. 1985. Ethical Issues in Reproductive Medicine A Mormon Perspective, Dialogue A...

Theories Of Aging And Life Extension

Theory without fact is fantasy, but fact without theory is chaos. C. O. Whitman (1894) An old adage says that nothing is certain except death and taxes. That is true, but it does not say anything about four score being the absolute measure of a person's years. That is good because knowledge about the biology of aging is changing, and with it people's expectations of what they can do about it. This new knowledge and the likely uses people will make of it will challenge perceptions of what...