Contributors

In Greek mythology, Icarus and his father Daedalus attempted to escape from Crete on artificial wings built of wax and feathers. Against his father's warning, Icarus flew so close to the sun that the wax melted and he fell to his death in the Aegean Sea. There is no question that the advances of biotechnology are creating a new landscape; but the question is whether that landscape more closely resembles a promised land, or as in Auden's poem, a sea in which the legs of Icarus are disappearing.

In 1970, Jacque Monod, a Nobel Laureate and a founding father of molecular biology, wrote a short celebrated book entitled Chance and Necessity.

It is a commonplace in the scientific and corporate discourse advocating biotechnology that the public is largely uneducated or scientifically illiterate when it comes to understanding the research methods and goals of biotechnology. Public dissent from biotechnology is, in this understanding, based exclusively in irrational fears. The way to dispel these public fears is for scientists in the research community and among corporate culture to engage in education of the public. At one level, it is argued that public educational forums will provide the information the public needs to make an informed choice about the scientific, ethical, and social implications of biotechnology or will provide guidance on such practical questions as whether to consume genetically modified food. However, the educational agenda is not quite that innocent of normative intent: rather, the assumption is that information the public is provided about biotechnology will persuade them of its benefits, its minimal risks, and its ultimate prospects for reshaping our world for the good of all. Objections to biotechnology will then largely dissipate, perhaps voiced occasionally by extremists who will represent the inevitable Luddite resistance to all things technological.

Sex is not the answer to everything, though young men think it is, but it may be the answer to the intractable debate over the ethics of human embryonic stem cell research. In this paper, I advance one ethical principle that, as yet, has not received the attention its platitudinous character would seem to merit. If found acceptable, this principle would permit the beneficial use of any embryonic or fetal tissue that would, by default, be lost or destroyed. More important, I make two appeals to consistency, or to parity of reasoning, that I believe show that no one who either has used or intends to use sexual reproduction as their means of procreation, nor indeed anyone who has unprotected heterosexual intercourse, nor anyone who finds in vitro fertilization (IVF) acceptable, nor anyone who believes that abortion is ever permissible can consistently object on principle to human embryo research nor to the use of embryonic stem cells for research or therapy.

The possibility of creating human embryonic stem cell lines from the inner cell mass of blastocysts has led to considerable debate about how these scientific developments should be regulated. Part of this debate has focused on the ethical analysis and part on how this analysis should influence policymaking.

In two articles about the controversy surrounding stem cell research, Søren Holm claims that no argument has so far been advanced in the debate to justify the necessity of destructive research on human embryos for the therapeutic potential of stem cell research to be achieved, and that it is up to the scientists themselves to produce “convincing arguments” for their case. This seemingly defeatist statement on behalf of bioethics originates from the viewpoint that neither a reiteration of old arguments about the moral status of the human embryo nor the generation of new arguments of the same kind are likely to have any positive bearing on the controversy; on the other hand, the impact of science on the current debate is unquestionable, due to three “partially independent” developments:

Recently, the U.S. House of Representatives voted, for the second time in two years, to ban all human-cloning research, whether the research involves reproduction or creating cells that might be used to understand and treat disease. As I explain in this article, the proposed legislation has important implications not only for human cloning research but also for research in general.

This paper explores the implications of human reproductive cloning for our notions of parenthood. Cloning comes in numerous varieties, depending on (among other things) the kind of cell to be cloned, the age of the source at the time the clone is created, the intended social relationship, if any, between source and clone, and whether the clone is to be one of one, or one of many, genetically identical individuals alive at a time. The moral and legal character of an act of cloning may, moreover, differ in light of these distinctions. Surprisingly, however, reproductive cloning in all its variety seems to undermine the view of parenthood that is most popular among proponents of reproductive technology in the bioethics literature. This view, geneticism, has much to recommend it. I will show, however, that as commonly understood, geneticism is incompatible with the reproductive view of cloning. I then canvass alternative accounts of parenthood—namely, conventionalism, gestationalism, and intentionalism—but none succeeds in explaining reproductive cloning. I thus return to a reconstructed version of geneticism. I argue that the problem for geneticism rests not with the notion of genetic parenthood as such but with a particular, flawed, understanding of it, which I call informational geneticism. Informational geneticism should be rejected in favor of a “physicalistic” version of geneticism, which treats genes as particular objects, not abstract types, and takes seriously the essentially embodied character of reproduction. For these reasons, physicalistic geneticism survives the challenge represented by reproductive cloning. Additionally, physicalistic geneticism accommodates attractive aspects of competing views of parenthood, meeting some powerful objections in the process.

“What is a poet? An unhappy person who conceals profound anguish in his heart but whose lips are so formed that as sighs and cries pass over them they sound like beautiful music.” These opening lines from Kierkegaard's Either/Or signify a tragic state of affairs because the poet brings joy to others and yet experiences no joy himself. In a similar vein, consider the child prodigy—Bobby Fischer, Shirley Temple, Mozart. Although there is no question that these children were gifted, there is some debate about how happy their childhoods were. There are benefits to just “being a kid,” and it is not clear that these individuals had that opportunity.

Margaret Brazier has argued that, in the literature on reproductive technology, women's “right” to reproduce is privileged, pushed, and subordinated to patriarchal values in such a way that it amounts to women's old “duty” to reproduce, dressed up in modern guise. I agree that there are patriarchal assumptions made in discussions of whether women have a right to select which embryos to implant or which fetuses to carry to term. Forcing ourselves to see women as active, rational decisionmakers tends to counteract any lingering patriarchal assumptions. But rational decisionmaking requires information. Voting wisely requires information about the candidates. Taking women's reproductive rights seriously means taking seriously women's need for relevant information to make rational decisions, including decisions about which embryos to implant or alter. I argue that preimplantation genetic profiles and prenatal test information should be made available to prospective parents, especially prospective mothers, unless doing so threatens to harm the resulting child or the larger society in specifiable and important ways.

In an effort to create a mechanism for addressing a critical need of providing medicines for economically developing countries, the Chiron Corporation and the Global Alliance for TB Drug Development have entered into an innovative public-private partnership. In the following interview, Craig Wheeler discusses the origins and nature of this agreement that could set a pattern for how corporations and nonprofit organizations can work together in drug development.

According to Native American myths, there once roamed an Eye Juggler—a humanoid deity who could detach his eyes and juggle them. His talents were of no special appeal to members of the various tribes, given that it is quite possible to hunt buffalo, prepare meals, or play stickball without tossing around your eyes. However, there was a white man who grew interested in the Eye Juggler. Sensing great utility in detachable eyes—for spying, or looking two ways at once—the white man formulated a deal. He would trade away his wealth in return for the Eye Juggler's gift. To this proposition the Juggler agreed, but also issued a warning. If the eyes stay detached for very long, they rot and cannot be used.

These CQ sources were compiled by Judith Schaeffer Young.

I think that utilitarianism is a good moral theory, and definitely better than its rivals, deontology and teleology. For practical purposes in multicultural contexts, at least, I think that no one should overlook a theory that is able to take into account a variety of ethical views and accommodate the ever-changing facts of the material world. But utilitarianism has a bad reputation in bioethics. It is often seen as the inhumane theory that allows the sacrifice of minorities, the killing of the innocent, and simplistic calculations on the value of life. Hardly anyone cares to remember that most formulations of the theory do not allow these actions. The economic doctrine sometimes labeled as utilitarianism could be guilty as charged, but ethics and economy are not interchangeable words. Also as a theory that can actually propose answers to no-win situations, utilitarianism has been an easy target for criticism.

In situations with limited medical resources, be they personnel, equipment, or time (and it always boils down to a lack of time), clinicians use “triage” to determine which patients receive treatment. What type of treatment a patient receives depends on the triage “lottery” rules in place. Although these rules for sorting patients and distributing resources are standardized for most situations, they must be somewhat altered after overwhelming, nonstandard (i.e., biological, chemical, and radiological) disasters.

I recently read through the most recent 24 issues of Environmental Health Perspectives—the National Institutes of Health journal of, among other issues, scientific research into how environmental contaminants impact animal and human health. It is a catalog of horrors from a public health perspective. Fish and frogs with their sex scrambled; deformed frogs with altered hormone levels in their blood; a nearly threefold increase in birth defects among Minnesota farm children exposed to pesticides; 2,4-D exposure reducing hormone levels in men; insignificant levels of four environmental chemicals adding up to a significant dose; a third study reconfirming a 50% sperm decline in U.S. men, 1934–1996; phthalates elevated in the blood of Puerto Rican girls developing breasts before they are 8; some 6,000 chemicals declared candidates for study as hormone disrupters (selected by computer from a universe of 58,000 chemicals for “most” of which we have “no biologic data”); children living near incinerators having delayed sexual development; hypospadias linked to organochlorine levels in the blood of mink, otter, and polar bears; and “No living organism may be considered DDT-free.” Nothing definitive, but it all suggests that things are tending in a direction that is perfectly awful.

Only within the past decade or so have medical ethicists, healthcare policy analysts, and politicians devoted significant time and energy to the myriad issues and problems facing the elderly. Careful consideration has revealed multiple concerns over the treatment of the elderly by families, healthcare providers, government agencies, and facility administrators and staff. One particularly troublesome area of concern involves nursing home placement and care. Dramatic stories sometimes rise to the level of national attention and scrutiny. We hear and read accounts of elder abuse by nursing home staff, indifference by nursing home administrators, disagreements over whether to initiate or withdraw a particular life-sustaining treatment, pain management protocols, physician-assisted suicide, and the issuing and honoring of DNR orders. But then these stories, as well as the ethical and policy debates they engender, are soon forgotten by the general public. Stories often not heard at all involve the everyday, mundane problems and dilemmas faced by nursing home residents. These problems include roommate selection, waiting lists, privacy surrounding grooming and sexual relations, scheduling of meals and sleeping, confidentiality of medical conditions, freedom to walk around the facility or take trips outside the facility, and use of mechanical and chemical restraints. In one sense, these issues are more problematic and more intractable than those represented in dramatic but fleeting news accounts. What is gradually becoming obvious to many is that the problems faced by the elderly in long-term care—whether these problems are remarkable or mundane, rare or frequent—deserve sustained, careful attention.

In this second edition of Death to Dust: What Happens to Dead Bodies?, emergency physician/bioethicist Kenneth Iserson has revised and expanded the original 1994 edition. The second edition improves on its predecessor in several ways. First, it updates information on several important topics, such as rates of organ donation and the number of patients awaiting organ transplantation. Second, it includes new information in a number of topic areas, such as embalming, mummification, and cryonics. Third, the design of the book, including the page layout, graphs, and illustrations, is much clearer and more attractive. The goals and organization of the second edition, however, remain unchanged from the first.

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.