To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

The ethical tension in childhood vaccination policies is often framed as one of balancing the value of choice with the duty to protect. Because infectious diseases spread from person to person, unvaccinated children are usually described as putting others around them at risk, violating a perceived right to be protected from harm. Editors of Lancet Infectious Diseases recently argued against mandatory vaccination, reminding us that the resort to mandatory vaccination as a means of achieving high vaccination rates is still very much a topic of Western vaccine debates. The nation of Japan offers an interesting case study in childhood vaccination policy, as it has an entirely voluntary (opt-in) system that achieves high vaccination rates. In this paper, we offer an overview of Japanese childhood vaccine policy, suggest some ways to contextualize and understand how a voluntary system achieves high vaccination rates, and speculate on what the future of Japanese vaccination policymaking and government–public relations may hold.

There are 12 different Mental Health Acts (MHAs) in Canada, all of which provide for the involuntary confinement of the mentally disordered to protect both them from themselves and others from them. The Acts differ in many ways, but three issues stand out above all: (1) involuntary admission criteria, (2) the right to refuse treatment, and (3) who has the authority to authorize treatment. I first describe how the MHAs differ on these issues. I then take up the methodological question of how to select or construct a MHA from the many, all of which have something to be said for them. Finally, I apply this test to the three main issues in dispute and identify which solutions would be in an ideal MHA. My aim in this last is not to settle the issues but to engage with them and so deepen our understanding of what is at stake.

Recent bioethics discussion and research in Iceland has been greatly affected by the fact that one of the world’s largest genetics research companies is based there and has been in the forefront of creating a population database resource for its research projects. Consequently, a large part of this article is centered around the bioethical discussion engendered by these projects, but other recent bioethical developments related to issues at the beginning and the end of life will also be discussed.

Several bioethical topics received a great deal of news coverage here in Scotland in 2009. Three important issues with transatlantic connections are the swine flu outbreak, which was handled very differently in Scotland, England, and America; the U.S. debate over healthcare reform, which drew the British National Health Service (NHS) into the controversy; and the release to Libya of the Lockerbie bomber, which at first glance might not seem particularly bioethical, but which actually hinged on the very public discussion of the prisoner’s medical records. On a national level, there have been attempts in both Scotland and England to change the law on assisted suicide, where success looks more likely than ever. This paper discusses each of these issues and hopefully will raise awareness of how these issues were dealt with in the United Kingdom and its component countries.

Dutch medical ethics policy is renowned for being highly liberal, due largely to the Dutch law on euthanasia. The Netherlands is one of the very few countries in which euthanasia performed by physicians and physician-assisted suicide (PAS) has been legalized. Acts of euthanasia and PAS go unpunished, provided certain conditions are fulfilled.

Charles de Gaulle once famously complained about the difficulty of governing a nation with 250 different kinds of cheese (now estimates range from 400 to 1,000). His comment is a true description of France’s diversity and its population. We are like a loud, unruly family always arguing among ourselves. However, as much as we disagree, there is one thing on which we French stand united—we love our healthcare system and do not want it changed, even as economic realities make it increasingly difficult to maintain.

The current practice of late termination of pregnancy in Germany has been criticized by the German Medical Association as well as several sociopolitical groups. The controversy has especially concerned the time limit for the termination of pregnancies and the counseling process prior to that intervention. The criticism, in part, originates from the reform of the German Abortion Law in 1995, and demands for change led to legislative initiatives in 2008.

The Mental Capacity Act 2005 came into force in England and Wales in 2007. Its primary purpose is to provide “a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.” Examples of such people are those with dementia, learning disabilities, mental health problems, and so on. The Act also gives those who currently have capacity a legal framework within which they can make arrangements for a time when they may come to lack it. Toward this end, it allows for them to make advance decisions (in effect, refusals of consent to certain forms of treatment) or to appoint proxy decision makers with lasting powers of attorney.

Contemporary bioethics has evolved over the past 40 years predominantly as a “Western” construct drawing fundamental inspiration for its conceptual and methodological frameworks from secular, Anglo-American philosophical traditions. American bioethicists can be credited with playing a defining role in the globalization of this new discipline to the developing countries of the world, but in this process, in the words of LaFleur, “Bioethics has become international without becoming internationalized.” Among the criticisms leveled against the dominant American model of bioethics is that in its focus on universalism it ignores local cultural and religious influences that are vital to the comprehension of the moral life in many societies. Medical sociologist Renée C. Fox and historian Judith P. Swazey have termed this as a form of “cultural myopia.”

As of June 2009, Israel’s population was 7,424,400 people, 5,604,900 of which were Jewish, 1,502,400 were Arabs, and approximately 317,200 had no religion or are non-Arab Christians. Established in 1948, Israel is a highly urban and industrialized country. Its gross domestic product (GDP) per capita (based on exchange rate) is US$23,257, positioning it among the European developed countries. Life expectancy is 79 years for males and 82 years for females, with infant mortality rate of 4 cases per 1,000 live births. Of Israel’s GDP, 7.7% is spent on health.

The international media recently reported the case of Eluana Englaro, a 38-year-old woman in a permanent vegetative state (PVS) who died in February 2009 following withdrawal of her feeding tube. At the time of her death, she had been unconscious for 17 years. For many years, her father had been seeking permission to allow her to die. His request was rejected by the courts several times on different grounds, until the Italian Supreme Court finally granted it. The case caused considerable political turmoil. The government, the president, the Constitutional Court, and the European Court of Human Rights got involved. This paper gives an account of the history of the case, enriched by personal communications with the people directly involved and a memoir by the father of Eluana.

End-of-life (EoL) decisions concerning euthanasia, stopping life-support machines, or handling advance directives are very complex and highly disputed in industrialized, democratic countries. A main controversy is how to balance the patient’s autonomy and right to self-determination with the doctor’s duty to save life and the value of life as such. These EoL dilemmas are closely linked to legal, medical, religious, and bioethical discourses. In this paper, we examine and deconstruct these linkages in Germany and Israel, moving beyond one-dimensional constructions of ethical statements as “social facts” to their conflicting and multifaceted embedding within professional, religious, and cultural perspectives.

Croatia is a transitional society in that it is a country emerging from a socialist command economy toward a market-based economy with ensuing structural changes of a social and political nature—some extending into the healthcare system. A legacy from our past is that, until now, Croatian healthcare institutions have had no real experience with clinical ethics support services. When clinical cases arise presenting complex ethical dilemmas in treatment options, the challenges presented to the medical team are substantial. The case described below recently occurred on a ward in a university hospital in Croatia. An unexpected request from the patient’s parents created a number of issues that needed to be addressed by the medical team, which was made more difficult by the lack of clinical ethics support services. Such cases press the question currently being debated as to what type of ethics support services would be suitable for Croatia and why.

These CQ Sources were compiled by Bette Anton.

To submit a case that has been reviewed by an ethics committee or to submit papers on related topics in clinical ethics, readers are invited to contact Ruchika Mishra, editor of “Ethics Committees at Work,” at: [email protected].

Thirty years later we seem no closer to a consensus on the ethics of sterilizing profoundly mentally compromised young girls than was Judge Blumenfeld.

There is nothing more humbling to one’s inner moral compass than to realize that you do not initially know what is right or wrong! I found myself in just such a situation after reading the above case. Much has been written, both in the professional literature and the popular media, about the “Ashley Treatment” since Gunther and Diekema published their article in 2006. It is unclear if others in the United States or around the world have, to any significant degree, adopted growth attenuation therapy and/or surgical intervention for children with severe neurological compromise, but the case quoted above suggests that hospital ethics committees may also be struggling with these decisions. An informal survey of pediatric endocrinologists, mentioned in a recent article on the topic, claims that many physicians are facing this dilemma as well.

Should a 9-year-old, severely mentally disabled child undergo extensive operations to limit her growth, prevent development of sexual characteristics, and alter appearance, all in the interests of protecting her from other alleged harms and allowing her to be cared for by her family? I think we should resist engaging with this question, and I think the ethics committee was wrong to accept the burden of making the decision regardless of the outcome they arrived at.