“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].

In a recent edition of the Medical Journal of Australia, Greg Dore and David Cooper called on persons in developed nations like Australia to bridge the divide between resource-rich countries to nations in the developing world, where therapies to ease or halt the ravages of the virus are nonexistent or in short supply.

As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court (Vacco v. Quill), came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying (PAD). Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship.We wish to express our most sincere appreciation to all the physicians who spoke so openly and generously about what can only be described as profound and life-altering experiences with dying patients. We also wish to thank the Section of Philosophy and Medical Ethics of the Vrije Universiteit Medical Center (Professor Evert van Leeuwen, Ph.D., Chair) for consenting to serve as the host institution for this study. This project was also made possible by a generous grant from the Research Foundation of the Professional Staff Congress of the City University of New York.

Brazilian bioethics became consolidated in the 1990s. It was during this time that teaching and research centers were instituted, associative groups were created, and the first papers of Brazilian authors were published. In Brazil, the first years of teaching and research in bioethics were marked by a strong influence of the United States, particularly in the theoretic and thematic fields. Among the main topics of discussion were subjects related to the end of life and to research involving human beings, and bioethics was then chiefly influenced by Tom Beauchamp and James Childress's theory of the four principles.

The following papers evolved as a continuing discussion begun by John Harris in his paper “Stem Cells, Sex, and Procreation” (CQ Vol 12, No 4). First, Julian Savulescu responds to the Harris paper, with Harris following with a response to Savulescu. Next, the two authors suggested a joint paper in which, despite their continuing differences, they would examine where they agree. This remarkable collection of papers, presented here, is a rare opportunity to follow the developing thoughts of two of today's most influential philosophers through what they describe as “a somewhat tortuous process of reason and argument.” They test their own positions as they challenge the views of the other, and they discover points at which their intellectual paths converge.

These CQ Sources were compiled by Bette Anton.

CQ Sources/Bibliography.

Addressing groups of industrial or academic experts goes with my job as editor in chief of Scientific American, and I enjoy it, but I confess that it inevitably feels peculiar. The audience consists of people who, almost by definition, have expertise or experience in the subjects of discussion. Why should anyone listen to me? I am a journalist—what do I know?This article is adapted from a luncheon address delivered by the author on April 29, 2003, to attendees of the BioTechnica America 2003 conference held in Santa Monica, California.

John Harris gives a comprehensive and generally valid defense of embryo research. Although nearly all his arguments are valid, one—the argument comparing natural reproduction to embryo research—is problematic in several important ways. I focus here on that argument.

I am in general a great admirer of the work of Savulescu and Harris (S&H), not because I think their conclusions are often right but because they state these conclusions and their arguments very clearly. In their joint paper “The Creation Lottery,” they do, nevertheless, tendentiously overstate their case both with regard to the conclusions that flow from identifying natural reproduction as a creation lottery (CL) and in seeing their exchange as an example of good method in bioethics. In the following short comment I want to point to some of the problematic areas in S&H's arguments.

In the fall of 2001, Baxter International, Inc., was faced with a crisis after more than 50 people died using Baxter dialyzers. In this interview, Harry M. Jansen Kraemer, Jr., Chairman and Chief Executive Officer of Baxter, and Sally Benjamin Young, Vice President, Communications, discuss how the company managed this emergency situation.

In November 2003, researchers at Cambridge University announced they had identified a gene associated with an elevated risk of breast and related ovarian cancers. The gene—christened EMSY in honor of a breast-cancer nurse who is the sister of the study's lead author—is particularly significant because it is linked to so-called sporadic cancers. Such cancers do not arise from hereditary mutations of the BRCA1 and BRCA2 genes, in which genes that ordinarily prevent breast and ovarian cancers are altered, often giving rise to multiple cases of cancer within a family as the mutation is passed along. The Cambridge researchers determined that the presence of extra copies of EMSY in an individual may instead switch off a healthy BRCA2 gene.

Over the past year, aggressive billing practices have been exposed at a number of hospitals in the United States. Despite the fact that a widower had paid $16,000 of his late wife's bill of $18,740, some 20 years after the incurrence of the bill a teaching hospital held a lien on his home for $40,000 in interest. Many years earlier the hospital had seized his bank account, and now the 77-year-old man was destitute. Only tremendous publicity caused the hospital to back down. That same week, another nonprofit teaching hospital reportedly drove a 25-year-old uninsured woman from New York City while dunning her for a $19,000 bill for a two-day stay for an appendectomy. In California, a patient was forced into bankruptcy in 2000 by a for-profit hospital from a day-and-a-half stay in the hospital that did not include any surgery but totaled $48,000 in hospital bills. These have become common stories as hospitals aggressively market, bill, collect, and foreclose, just like any other corporation. The uninsured are facing the brunt of the hospital industry's billing practices.

Schneiderman, Teetzel, and Gilmer offer an amusing but misleading response to my article on medical futility (CQ Vol 11, No 2). Although I did make note of the falloff in citations to medical futility in Medline and Bioethicsline after 1995, my analysis focused on the precipitous rise in professional publications on the concept in the period from 1988 to 1995—a trend confirmed by the authors' own search results. I certainly did not argue, either explicitly or implicitly, that the discussion of medical futility was over. I made limited use of this citation survey—to raise a question about what sparked so much professional debate after 1988. This seems to me an entirely appropriate methodology.

The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers, by Katharine Greider. New York: Public Affairs; 2003. 189 pp.

The Big Fix is, as Greider describes, “the utter folly of allowing a profit-driven industry to name its price, while quietly making over our public-health agenda in its own image”—the theme of the book. Written in an easy-to-understand, conversational manner targeted to the American consumer, The Big Fix is a comprehensive description of the commonly held views of critics of the pharmaceutical industry, although most of the points made are not novel. In eight chapters, each given a catchy descriptive title, Greider does a good job of detailing the issues and citing well-known experts and critics of the industry, such as Marcia Angel and Thomas Bodenheimer, even though she does not always provide the exact sources of these citations for those academic types who may want to know more.

I have argued that because human sexual reproduction inevitably involves the creation and destruction of embryos, it is a problematic activity for those who believe that the embryo is “one of us.” Or, if it is not a problematic activity, then neither is the creation and destruction of embryos for a purpose of comparable moral seriousness—the development of lifesaving therapy, for example. I assume that, whereas it is possible for the very first act of unprotected intercourse to result in a live human baby, and hence not in a given case cause any embryo loss, this is a rare event and that, statistically, for every live birth from three to five embryos must be created only to die. For dramatic effect, I assume that five is a reasonable figure, giving each embryo a 20% chance of survival; however, nothing in the argument depends on any specific figures being correct.Søren Holm has been an important source of ideas for this paper. Julian Savulescu has also been very generous in commenting in detail on this paper, and I have taken account of the critique that I have received.

Busy physicians and scientists tend to be willfully naive about politics. Physics, chemistry, and biology are clean—that is, subject to relatively consistent and identifiable laws or at least trends and, certainly in the case of medicine, beneficial when properly applied. Politics, on the other hand, tend to be unpredictable, murky, and dirty—that is, too often all about self-serving power and, ultimately, money.

D. Micah Hester thinks the residency match system helps sustain the divide between the haves and the have-nots in healthcare. He believes that the match system channels talent away from the have-nots in a more or less systematic way, damaging moral values in physicians as it goes. As a way of making inroads against these effects, he has asked whether assigning medical school graduates to residencies at random would distribute talent and educational opportunity more broadly and promote desirable moral values. I pointed out what I think are serious limitations of this proposal, and Hester has extended me the courtesy of a reply. Yet with that reply, I find that he has made it even more difficult to defend a lottery approach to residency assignment.

In Community as Healing, Micah Hester aspires to offer a bold alternative to the theoretical approach that has dominated bioethics since the 1970s. He begins by claiming that the concepts of individual patient autonomy portrayed in the well-known works of Tom Beauchamp and James Childress in Principles of Biomedical Ethics and H. Tristram Engelhardt in The Foundations of Bioethics are inadequate. As he states:

Opponents of destructive embryo research, such as embryo rightists, as well as proponents accept that natural reproduction is permissible. There is an alternative to natural reproduction—to remain childless. John Harris began this series of articles by asking, what does a commitment to the permissibility of natural reproduction entail? Harris has argued that a commitment to the permissibility of natural reproduction entails a commitment to the permissibility of destructive embryo research. Julian Savulescu has denied this. However, there are significant areas in which our views have converged.