The exact numbers are not known and likely never will be, but somewhere between one-third and two-thirds of all “naturally” fertilized human eggs never develop into anything most people would recognize as human. In fact, the majority of those never-known pre-embryos come and go before their brief existence is even known to the woman who hosts them—she is most likely to experience only a late menstrual period, or more likely, nothing at all. For whatever reasons, spontaneous “wastage” of early fertilized eggs is extremely (to many people, astonishingly) common. But this is human biology, and maybe natural selection, in action. It just happens. There is little or no element of “choice” involved, and thus little controversy attached to this biological phenomenon.

In the literature of bioethics there are milestones worth periodic rereading. Mary Midgley's “Must Good Causes Compete?” (CQ, Vol. 2, No. 2) is surely one such marker. Her piece is especially appropriate to revisit in light of this issue's Special Section, “On Animal Experimentation: Seeking Common Ground.”

One of the most pervasive and compelling issues in bioethics has to do with the host of prickly questions that arise when treatment decisions are made, not by individuals themselves, but by others on their behalf. These dilemmas come to the fore when, for example, patients have lost or are judged to suffer from diminished decisionmaking capacity, are unable to make treatment decisions themselves because they lack the necessary development to do so, or because they choose to give others the task of deciding for them.

The award-winning film “Titanic” released in 1997 once again brought to our attention the problems associated with the lifeboat ethic. Stunned audiences everywhere witnessed the chaos on board as, by design, one-third fewer lifeboats were available than for the passenger list. Violence erupted in the competition for a disputed spot; heroism and altruism also abounded. Additionally, viewers of the movie witnessed efforts to cheat and the power of money in having a secret lifeboat for the rich. (A first-class cabin on that cruise cost the equivalent of $75,000 per person in today's money.)

Joann Starr, a Roman Catholic nun, and Bruce Zawacki, a burn surgeon, met 22 years ago in the Los Angeles County, University of Southern California Burn Center in the roles of a patient and her physician struggling over issues of autonomy and informed consent. After recovery, she remained a nun and has become a patient advocate and doctoral candidate in bioethics. He remained a burn surgeon and has become a bioethics teacher and author. Although they live in distant locations, they maintain their friendship and frequently discuss their shared experience. Recently they met to reflect on the events, lessons, and meanings of their original encounter.

For a very long time, the scientific and animal welfare communities have faced each other across a seemingly unbridgeable divide. Each side tends to view the other in simplistic and distorted terms. Animal welfare advocates see scientists as, at worst, sadists who enjoy torturing animals, and at best, as self-interested careerists intent on building careers out of publishing more papers and getting more grants, irrespective of the cost to animals. Scientists committed to research see the animal movement as consisting of, at best, ignorant, simple-minded people awash in emotion and sensationalism, and at worst, violent and dangerous fanatics who claim to care for animals but are indifferent to human suffering.

When Maggie Hall died on March 3, 1999, CQ lost a valued friend and irreplaceable editorial consultant. Maggie, with her musician's gift for the sound of the written word, left her mark on every issue of the journal; and, with gratitude, this volume is dedicated to her memory. We asked Henrik Blum, Emeritus Professor in the School of Public Health, University of California, Berkeley, who worked with her over many years, to share some of his memories of Maggie.

In March 1997, 60 Minutes, a nationally syndicated news magazine program, featured a story in which it was claimed that The Cleveland Clinic Foundation (CCF) had in place a non-heart-beating donor (NHBD) protocol that involved killing patients for their organs. These charges were brought by a philosopher from a local university. A student who worked at LifeBanc, the northeastern Ohio organ procurement agency where the organ donation protocol originated, was given the protocol by LifeBanc with the understanding that it was to be used in class; the student and professor charged that the protocol involved killing patients for their organs. These claims were advanced without noting that the protocol was a draft that was being reviewed and revised and had not been implemented.

Living related organ transplantation is morally problematic for two reasons. First, it requires surgeons to perform nontherapeutic, even dangerous procedures on healthy donors—and in the case of children, without their consent. Second, the transplant donor and recipient are often intimately related to each other, as parent and child, or as siblings. These relationships challenge our conventional models of medical decisionmaking. Is there anything morally problematic about a parent allowing the interests of one child to be risked for the sake of another? What exactly are the interests of the prospective child donor whose sibling will die without an organ? Is the choice of a parent to take risks for the sake of her child truly free, or is the specter of coercion necessarily raised?

A review of the literature on palliative care in the United Kingdom over the last fifteen years suggests that elements such as the development of the modern hospice, on the model developed by Cicely Saunders (at St. Christopher's Hospice, London), have led to major improvements in the lot of the terminally ill.

When I was 19 years old, I fell crazily in love with a hometown girl. This was very surprising for both of us, as we had been acquainted since childhood but had never really noticed each other until a certain amount of maturing of mind and body took place. A second surprise, maybe inevitable in retrospect, came along a few months after we began spending virtually every possible hour in each others' arms. She called me from the university she was attending a few hours away and told me she was fairly certain she was pregnant.

Since the 1940s the Draize test had been the standard test applied to any substance that might conceivably get into a human eye. The Draize test involved immobilizing fully conscious rabbits in stocks so that they could not scratch their eyes, and then applying the substance to one eyeball of each rabbit. The eyeballs were examined at intervals of, for example, 24, 48, and 72 hours, and graded for damage such as blindness or blistering. In 1980 Henry Spira launched a campaign against the Draize test. By taking out full-page ads asking Revlon why it was blinding rabbits for the sake of beauty, he persuaded that company to donate $750,000, over 3 years, to a search for alternatives to the Draize test. Other leading cosmetics corporations soon followed suit. By 1982 there were signs that progress was being made. In July of that year Revlon reported that it had established a panel to ensure that unnecessary Draize tests are not performed, and as a result it had cut back the number of rabbits it used annually in the Draize test from 2,210 in 1979 to 1,431 in 1981. Avon adopted a policy of always using local anaesthetics if there was any anticipated discomfort for the animals. Bristol-Myers said that it was using fewer animals than had been used in the classical Draize test. All three of the companies were continuing to contribute substantial sums to research programs designed to find alternatives to the Draize test.

Medical ethics is a footnote to the larger problem of directing our technology to good human ends. Written large, then, medical ethics must ask five basic questions:

1)Is it even possible to direct biomedical technology to good human ends, or is the medical enterprise almost entirely technology driven?

2)If it is possible to direct biomedical technology, on what basis or norms should this direction take place?

3)How should decisionmaking in this control over biomedical technology be structured?

4)Who should be involved in the process of making those decisions, and of those involved, whose values and opinions ought to carry more weight?

5)Based on the answers to these four questions, what ought to be our concern for the future of medicine?

Reverence for the autonomy of patients dominates healthcare ethics in the United States. Such reverence emblematizes personal freedom, a cherished American ideal.

Volumes have been written arguing the morality of abortion. A crucial premise in many of these arguments concerns the status of the fetus; specifically, that the fetus has or does not have a right to life. Opponents of abortion typically argue that fetuses are persons and hence have an inviolable right to life. Advocates of the right to abortion typically maintain that fetuses are not persons and hence have no right to life.

It is commonly taken for granted that abortion is necessarily impermissible if the fetus is a person with a right to life. In her influential essay “A Defense of Abortion,” Judith Jarvis Thomson offers what I will call the violinist example to show that merely having a right to life does not in and of itself give rise in the fetus to a right to use the mother's body. On Thomson's view, if the fetus has a right to use the mother's body that precludes terminating its life by means of an abortion, it is because the mother did something to give the fetus that right. Thus she concludes that the proposition that the fetus is a person does not imply that abortion is morally impermissible.

Few human uses of nonhuman animals (hereafter simply “animals”) have incited as much controversy as the use of animals in biomedical research. The political exchanges over this issue tend to produce much more heat than light, as representatives of both biomedicine and the animal protection community accuse opponents of being “Nazis,” “terrorists,” and the like. However, a healthy number of individuals within these two communities offer the possibility of a more illuminating discussion of the ethics of animal research.

The emergence of new obstetrical and neonatal technologies, as well as more aggressive clinical management, has significantly improved the survival of extremely low birth weight (ELBW) infants. This development has heightened concerns about the limits of viability. ELBW infants, weighing less than 1,000 grams and no larger than the palm of one's hand, are often described as “miracles” of late twentieth century technology. Improved survivability of ELBW infants has provided opportunities for long-term follow-up. Information on their physical and emotional development contributes to developing standards of practice regarding their care.

The coauthors of this dialogue, a surgeon and an internist, work together on an institutional patient selection committee for transplantation of solid organs. They have observed a spectrum of outcomes of organ transplantation, mostly favorable, at several institutions.