Contributors.

In Jane Austen's Mansfield Park (1814), Fanny, an 18-year-old orphan who lives with her aunt Lady Bertram, received an attractive offer of marriage, which she vehemently rejected and is not prepared to reconsider.

Imagine you are walking down a city street. It is windy and raining. Amidst the bustle you see a young woman. She sits under a railway bridge, hardly protected from the rain and holds a woolen hat containing a small number of coins. You can see that she trembles from the cold. Or imagine seeing an old woman walking in the street at dusk, clutching her bag with one hand and a walking stick with the other. A group of male youths walk behind her without overtaking, drunk and in the mood for mischief. It doesn't need an academic to say what vulnerability is. We can all see it, much more often than we care to.

Prematurely born children who have underdeveloped lungs may suffer a potentially fatal condition called respiratory distress syndrome. A U.S. company developed a drug, called Surfaxin, to treat such poorly functioning lungs. A placebo-controlled study was planned in four Latin American countries (Mexico, Ecuador, Bolivia, and Peru). At the time, in 2001, four treatments were already on the market, although not available to the research populations used in the study. This case is usually discussed as part of the standard of care debate or offered as an example of exploitation. However, what concerns us in this case is rather the choice given to the parents of a prematurely born child under these circumstances: “You can give consent for your child's participation in this study. Half of the babies enrolled will receive sham air and are as likely to die as if they had not enrolled. The other half will receive an active treatment and are more likely to survive.” The parents can vastly increase their baby's chances of survival by participating in the study. Can the consent be voluntary? Do the parents have any meaningful choice?

Vulnerable populations have been defined as those who face a significant probability of incurring an identifiable harm while substantially lacking ability and/or means to protect themselves. Vulnerabilities within population groups can be differentiated by factors that determine the different probabilities of incurring identifiable harms (risks) people face and the means available to them to protect themselves (their protective capacity). Among these factors is gender.

Researchers from the Universities of Oxford, Nairobi, and Manitoba are collaborating on a project to develop an HIV vaccine based on the immunological protection mechanisms found in commercial sex workers from the Majengo slum in Nairobi. This group consists of educationally and economically disadvantaged women who resort to commercial sex work for a living. A clinic was established in the slum to study sexually transmitted diseases, which now includes HIV/AIDS. The clinic serves as a research facility for the collaborating researchers who have been using the women's blood, cervical, vaginal, and saliva samples for the ongoing studies. The clinic runs two HIV-integrated activities: HIV research and HIV care and treatment. For HIV negative participants, samples are collected and used for research and care after they give informed consent.

In recent years, healthcare ethics, international law, and political philosophy have been moving closer together. The previously missing links are considerations of justice and their recognition through legal instruments. The most obvious example to date is the topic of benefit sharing.

These CQ Sources were compiled by Bette Anton.

"Dissecting Bioethics," edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated. The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 ([email protected]) regarding books they would like to see reviewed or books they are interested in reviewing.

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call “medical tourists.” Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling “all inclusive” kidney transplant packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals.

Continuing professional development (CPD) and life-long learning are now widely accepted goals of healthcare professions. Although this is perhaps more apparent in the medical profession, most other healthcare professions are in widespread agreement that in order to fulfill their professional requirements, healthcare professionals need to adopt a practice of life-long learning. Continuing professional development is seen as important for a number of reasons. One reason is that the continuing advances in biomedical science and technology mean that new drugs, devices, and procedures are constantly being introduced into healthcare practice, requiring ongoing acquisition of new content knowledge. A second reason for CPD is in response to the recognition that healthcare professionals do not emerge from their initial training with the skills they need for practice already fully mastered. Learning of skills, such as communication with patients, families, and other professionals, is an on-going process.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.