Akira Akabayashi, M.D., Ph.D., is Professor in the Department of Biomedical Ethics at the School of Health Science and Nursing, University of Tokyo Graduate School of Medicine, Tokyo, Japan, and Chair of the Advisory Committee for Conflicts of Interest, Faculty of Medicine, University of Tokyo.

Although keeping up with developments in any field is a challenge, because of bioethics' interdisciplinary nature and growing international community, it is especially important to keep the larger landscape in view, beyond one's own specialty and nationality.

The Islamic Republic of Pakistan has a population of more than 145 million people, about 95% of whom are Muslims (approximately 20% Shi'i and the rest Sunni). Although it has a few large cities such as Karachi, almost 65% of the country is still rural, with a per capita income of $408 per year. The overall literacy rate is estimated to be 41.5% but is much lower for women in many of the provinces. Pakistan has a complex culture with many ethnic groups and socioeconomic strata, but overall the society is characterized by hierarchical systems in both private and public domains. The population is religious and family centered with the “family” understood as extending beyond the nuclear; it is not uncommon to have three generations residing under one roof or within close proximity to each other and pooling their resources.

This article examines bioethics in Tanzania, particularly in relation to the HIV/AIDS epidemic for the following reasons: First, not only is HIV/AIDS the most alarming health problem in most parts of Africa, but the complexity of issues involved in medical and research ethics (codes of conduct and standard guidelines, conflicting rights and responsibilities, and issues of distributive justice) clearly illustrates the various levels of problems that bioethics—more precisely, both professional medical ethics and research ethics—faces in a poor, developing country. The article defends uniformity in the general, international bioethical guidelines but calls for wider discussion in their applicability in different economic and social conditions by claiming that in the present debates the issues of distributive justice, culture, and individual professional judgment have been tangled together in a manner that tends to justify double standards in practice. To avoid this confusion there is a need to find a more coherent approach to bioethics that brings together the normative requirements set by international guidelines, national policy planning, social ethics, and professional medical ethics.I thank particularly Dr. Louis Mlingi, Tanzanian Occupational Health Service, and Dr. Pekka Nokso-Koivisto, Tanzanian Occupational Health Service and the Nordic Clinic, for their insightful views and for sharing their personal experiences in the issues of medical ethics in Tanzania in relation to their participation in our development ethics project funded by the Finnish Academy of Science 2000–2003. Some of the empirical examples are collected from our medical and healthcare ethics training in Lindi, Southern Tanzania with the Finnish funded Professional and Civic Ethics Project (CPEP), 2003. In addition I am grateful to professor Zul Premji, Muhimbili University College of Health Sciences, Dar es Salaam, for his advise on research ethics in Tanzania.

Readers of the Cambridge Quarterly of Healthcare Ethics need hardly be told that each year a huge amount of very valuable work in bioethics is carried out in the academic's study and the university seminar room and appears in the pages of specialist, restricted-readership journals. However, if it is to be as effective, relevant, and influential as it deserves to be, there arguably comes a point when this work needs to leave the confines of the academy and engage the wider public. This perhaps happens less often than it should.

Until recently, many of Japan's medical and bioethical communities had ignored the issue of conflicts of interest (CIs). This is no longer the case. Discussion on the economic and ethical problems defined by CIs is now apparent in academic, political, and even industrial spheres. In June 2004, this debate was sparked by a scandal involving AnGes MG, Inc., a bioventure company set up by a faculty member at Osaka University Graduate School of Medicine. AnGes MG developed a gene therapy using the Hepatic Growth Factor for obstructive blood vessel disease. Japanese newspapers reported that “several physicians involved with clinical trials for AnGes obtained unlisted shares of stock. One physician allegedly received 32 million yen (U.S. $320,000) after AnGes MG went public on the ‘Mothers’ stock exchange” (a market for high-growth and emerging stocks).

A pilot center for clinical ethics in France opened with the establishment of the “Centre d'éthique clinique” at Cochin Hospital in Paris, September 2002. Unlike the longer history in the United States of providing ethics consultation for ethical issues deriving from physician–patient interactions, this center marks a new development in bringing clinical ethics to Europe.

Canada is one of the few countries in the world—China is another—that has decriminalized abortion. In Canada, there are no legislative or judicial restrictions whatsoever on abortion: When, where, and under what circumstances abortions can be performed are all unregulated. In sharp contrast, abortion is generally illegal in South American and predominantly Catholic countries, as well as in African and Muslim countries. And the countries that do allow legal abortions, including most in Europe along with America, Australia, and Russia, typically permit it only up to a certain time or make it subject to circumstances such as risk to the woman. In what follows we will first explain how Canada came to decriminalize abortion and then go on to assess that position from an ethical point of view.

Important bioethcs changes are underway in the Netherlands that carry, for better or worse, far-reaching social consequences. The two major areas of change involve (1) economics and containing soaring health costs and (2) end-of-life care as reflected in several high-profile cases: in a decision handed down by the Dutch Supreme Court on reviewing the procedures for the termination of life, in the discussion surrounding The Groningen Protocol and the active ending of lives in neonatology, and in a report of a Royal Dutch Medical Society's Committee on the role of physicians in ending life in cases of requests to die outside the area of terminal diseases.

These CQ Sources were compiled by Bette Anton.

I would have preferred that the Special Section on Children as Organ Donors had focused on the donation of a specific organ because morally relevant differences are obscured when the subject is discussed in general terms. The donation of a lobe of liver and peripheral blood or bone marrow stem cells does not result in the permanent loss of vital tissue because these organs regenerate; however, a kidney does not regenerate and its donor loses a vital organ permanently. Liver tissue and peripheral blood or bone marrow stem cells are typically required to save a life, but, because most patients with end-stage renal disease can be kept alive on dialysis, the donation of a kidney is rarely life saving. Also, donor risk is organ specific; for example, it is more dangerous to donate a lobe of liver than it is to donate peripheral blood or bone marrow stem cells.

Given that, globally, health professionals' involvement in crises—especially complex crises where human action plays a contributing role—has risen to new proportions, emergency preparedness is an increasingly integral capacity of health systems. As the United States has come to see itself as vulnerable to violence, its leaders have begun to reorganize the country's health system around protection from terrorism and other health emergencies, upholding this as an essential element or “indispensable pillar” in their strategy for securing the homeland. Biodefense and emergency preparedness have thus come to capture the energies and expertise of nearly all health professionals and, increasingly, to define the specific ends that organize their work.The author thanks Lisa S. Parker and members of the Duke University–University of North Carolina at Chapel Hill Bioethics Forum for their helpful comments on earlier versions of this essay.

In “Ethics and the Underpinnings of Policy in Biodefense and Emergency Preparedness,” Lisa Eckenwiler advances discussion about emergency preparedness by exploring ethical commitments that shape healthcare and defense policy in an age of terrorism. Eckenwiler rightly discerns that policymakers' assumptions about controlling and containing hostile malefactors and (lack of) the need for public consent regarding security measures are part of an epistemic framework that orders the current response to terrorism. Again rightly, she suggests that (1) citizens ought to have a say in shaping and interpreting such fundamental assumptions, (2) a reductive medical model that focuses on mitigation and the management of casualties is insufficient for understanding and responding to the complex social, political, and economic factors that precipitate terrorist attacks, and (3) there is in emergency preparedness an ethically problematic disproportion between the demands society places on public health/medical professionals and the resources society provides for them to meet these demands. She is also probably correct in claiming that, properly understood, the ethical underpinnings of public health policy are teleological in nature (though her conception of the telos is suspect).

“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].

Developments in the last several years have sparked renewed interest in the ethics of research involving humans. Issues relating to the global extent of research and its guiding principles are of particular importance to researchers, health officials, and individual ethics committees who want a deeper and more encompassing inquiry regarding the foundation and evolution of human research. This department of CQ launches a long overdue effort to explore these wider issues. Readers are invited to submit papers to Charles MacKay, 5011 Worthington Drive, Bethesda, MD, 20816, USA. E-mail: [email protected].Funding was provided by a research fund of the faculty of medicine, University of Geneva. I thank Prof. T.W. Harding and Prof. C.-N. Robert for their support.

Disease and illness are terms that are often used interchangeably by physicians and the lay public. But not all usage permits this. For instance, diseases are referred to in terms of entities with etiologies; illnesses are not. We also speak of illness as being the effect or symptom of a disease, but not the converse. In what follows, disease and illness will be treated as distinct concepts.I thank Dr. Rosamond Rhodes, Director of Bioethics Education, Mount Sinai School of Medicine, for her extremely helpful questions and comments concerning this article.

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.