One of the barriers between ordinarily compassionate animal researchers and pro-animal ethicists is that the ethicists are usually seen as asking for far too much. They are perceived as demanding the complete abandonment of careers. In consequence, the ethicist is often ignored. Ethicists rarely give clear-cut rules to animal researchers as to how they can continue in animal research while at the same time adopting an increasingly moral approach. The purpose of this paper is to provide some rules to help the animals by aiding conscientious researchers who are not (yet) in a position to give up their careers entirely. These are ethical rules and not, therefore, in quite the same category as Russell and Burch's “three Rs” (replacement, refinement, and reduction) or the proposal that experimenters should seek proper training and retraining in animal care, and in the skills of euthanasia, anaesthesia, and analgesia. Nor are ethical rules quite the same as the requirement that all experimenters should acquaint themselves with the latest techniques for improving the animals' quality of life (such as the techniques of environmental enrichment, for example) or the need to keep themselves up to date in alternative research techniques that do not use animals. All these steps are of great importance and should be taken in addition to the ethical rules I propose.

The United Network for Organ Sharing (UNOS) recently changed the policy by which donor livers are allocated to liver failure patients in the United States. Formerly, all liver failure patients were characterized as status 1 and placed at the top of the transplant list. Under the new policy, only patients with liver failure due to acute illness (“ALF patients”) are eligible for status 1; patients with liver failure due to chronic liver disease (“CLF patients”) are characterized as status 2. Since donor organs are allocated first to status 1 patients and then to status 2 patients, the new policy moves all CLF patients down on the waiting list relative to all ALF patients. This means that some livers that would have gone to CLF patients under the old policy will now go to ALF patients. Accordingly, while the new policy will likely increase the number of ALF patients saved, it will also increase the number of deaths among CLF patients waiting for a transplant.

This article is a thoughtful and well written examination of some of the complex issues that have emerged as a result of recent improvements in the treatment of extremely low birth weight (ELBW) infants, including those who weigh 500 to 600 grams or who are believed to be 23 to 24 weeks gestation. The authors argue that the 23 to 24 week gestation period is filled with ambiguity and flexibility in practice relative to active resuscitation. However, such ambiguity and flexibility is likely to prevail whatever the boundary conditions of viability happen to be. Thus moral guidelines that inform the rescue of an infant believed to be 500 to 600 grams or 23 or 24 weeks gestation are likely to be relevant whatever the boundary conditions are.

Judith Thomson argues that a fetus may have a right to life yet lack the right to use its mother's body to stay alive. According to Kenneth Einar Himma, Thomson's argument applies only to cases where the parties meet two conditions. First, they must “have a history of physical independence” and, second, they must be “autonomous moral agents, capable of incurring obligations.” Himma devises a case involving conjoined twins to show why the mother–fetus case does not meet these conditions.

This article will explore a pregnant woman's experience of relationship with the fetus, using a clinical case study in which abortion would have been clinically indicated because of severe fetal abnormality. Emphasizing the pregnant woman's actual experience in this case study helps to highlight inadequacies in how the debate about abortion is usually conducted.

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the “gray area” gestation period of approximately 23–25 weeks may result in situations where various people involved in such cases may feel “held hostage” to technological imperatives. Legal decisions and standards have evolved that are discordant with the views of many clinicians most familiar with the treatment of such patients. Increasing concerns regarding such scenarios have fueled much academic and professional debate about the need for consensus about ethical limits to clinical interventions with high probability of nonbeneficial impact. While at least some clinicians and ethicists may be inching toward consensus regarding limits to such treatment, the voices of some bedside personnel, particularly neonatal intensive care unit (NICU) nurses, have been relatively muted in this debate. At least one previous survey of clinicians, which included nurses, indicated that many nurses experienced a high level of “moral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of futility.

It began in 1992, with two men walking out of a television studio. Colin Blakemore, Oxford Professor of Physiology, is a quiet-spoken, eloquent defender of the use of animals in medical research. Les Ward, Director of the Edinburgh-based Advocates for Animals, is a passionate opponent of animal use. Bringing them together in front of an invited audience with strong opinions on both sides would make the sparks fly and be good viewing. But Blakemore and Ward, retiring after yet another bout that neither side won, were dissatisfied. Both knew that media debates gave them a chance to highlight the flaws and evasions in the other side's arguments, and perhaps to recruit some new supporters to their own. But Ward realized that this was not enough to achieve the radical change he wanted: replacement of animals by other methods. And Blakemore disliked defending animal experiments against all comers. He too wanted to replace animals, albeit only when this could be done without forgoing the real benefits of research.

The behavior of people in the presence of scarce resources has long been a source of ethical concern and debate. Many of the responses, ranging from outright brutality and cheating on the one hand to altruism, nobility, and sacrifice on the other, were most recently demonstrated in the movie Titanic. It should come as no surprise, then, that rational efforts to allocate the very scarce life-saving resource of organs are sometimes circumvented by these natural human impulses and sheer human creativity. This is especially true when the organs in question are required for continued life and cannot be temporarily or permanently replaced by technology. Thus the focus of this paper will be on the competition for livers.

Nationwide, almost 11% of women abuse drugs during their pregnancy. In some communities, these numbers are as high as 25–30%. Drug abuse is not limited to the poor or to African Americans, but is seen among affluent and white Americans as well. It is widespread, irrespective of race or social class. Annually, nearly 375,000 infants are exposed to drugs in America. Because of the terrible suffering caused by these births, and the conflicts caregivers experience in the treatment of these infants, Trollope's quote is very apropos. Although caregivers have good motives in trying to rescue these babies and helping place them in a nurturing environment, despair about this objective is always close to the surface.

The history of the vivisection debate is a case study in the use of vilification not unlike its rhetorical use by adversaries in the pro-life/pro-choice controversy. According to Vanderford, vilification in that debate serves a number of functions: to identify adversaries as “them and us”; to cast opponents in an exclusively negative light; to attribute diabolical motives to one's adversaries; and to magnify the opposition's power as an enemy capable of doing great evil. In the vivisection debate, both sides have attempted to delegitimize each other by one or more of these means. On the antivivisection side, Samuel Johnson in 1758 produced the fiercest attack up to that time on “the inferior Professors of medical knowledge” and “race of wretches whose lives are only varied by varieties of cruelty.” When the antivivisectionist movement peaked in England in the 1870s, the animal experimentalists began to organize in earnest to fend off the charge that vivisection was both cruel and useless. By the turn of the century an American neurologist, Charles Loomis Dana, identified a way to discredit the mainly female antiscience “cranks” in the antivivisection movement by inventing the disease “zoophil-psychosis” to describe one of the diseases affecting mainly women who, having no children or a useful occupation, joined animal protection societies and campaigned against vivisection. Zoophil-psychosis, it was claimed, was a form of mental illness, an incurable insanity that afflicted the hysterical opponents of vivisection.

Debates continue to surround the system in the United States for allocating transplantable cadaveric organs, due in large part to the scarcity of such organs in relation to the number of individuals waiting to undergo transplantation. Candidates awaiting transplantation gain access to cadaveric organs by being placed by individual transplant programs on the national list of the Organ Procurement and Transplantation Network (OPTN), overseen by the United Network for Organ Sharing (UNOS). In recent years, the UNOS board has visited (and revisited) the issue of multiple listing, that is, allowing one candidate to be registered on the waiting lists of two or more transplant programs, and has continued to permit multiple listing.

Although the abortion debate continues to simmer in many places, the general issue of a woman's right to an abortion, at least in the Western democracies, is largely settled. In its place, the question of late-term abortion begins to assume a prominence only recently attributed to abortion itself. The advent of sophisticated fetal screening techniques makes possible detection of potentially severe fetal anomalies that in many cases are detected only late in the pregnancy, resulting in the need for late-term abortion.

How aggressively should we pursue life-sustaining treatment of the demented patient? This question becomes increasingly important as our population ages and medical technology offers ever more life-prolongation. In Life's Dominion, Ronald Dworkin addresses the issue in the context of an Alzheimer patient who had previously declared the desire to avoid life-sustaining intervention. Dworkin argues for the primacy of what he calls precedent autonomy: “A competent person's right to autonomy requires that his past decisions about how he is to be treated if he becomes demented be respected even if they contradict the desires he has at a later point.” In 1995, the Hastings Center Report carried thoughtful rebuttals by Daniel Callahan and Rebecca Dresser. Much of Callahan's article is devoted to patients who never executed an advance directive, but he states unequivocally that such directives can be overridden, basing much of his argument on the writings of Sanford Kadish. Together, Dresser, Callahan, and Kadish define a clear position opposed to precedent autonomy.

Approximately 62,000 people in this country await organ transplants. Ten years ago the waiting list numbered 16,000. The line gets longer every day. Up to 30% of those waiting in line will die waiting. We face a chronic shortage of organs. While demand for organs steadily increases, the number of cadaveric organ donors remains relatively constant: approximately 4,000 in 1988, and approximately 5,500 in 1997. In response to this environment of scarcity, policymakers have considered initiatives in a number of domains.

Since the early 1970s, despite popular opposition, to control the rapid growth of population the Chinese government has been carrying out the strictest and most comprehensive family planning policy in the world. In addition to contraceptive methods and sterilization, artificial abortion—both surgical and nonsurgical—has been used as an important measure of birth control under the policy. Many women have been required, persuaded, and even forced by the authorities to abort fetuses no matter how much they want to give birth.

The publication in 1959 of Russell and Burch's The Principles of Humane Experimental Technique initiated a new era in the history of the debate between science and animal protection, the era of alternatives. Although Russell and Burch never used the word “alternatives” (speaking instead of the “three Rs”: replacement, reduction, and refinement), and although the animal protection movement was somewhat moribund at the time in both England and the United States, within a decade of the book's publication a number of signs indicating a resurgence of public interest in the issue began to appear. At the same time, increased knowledge and understanding of neurophysiology and ethology heightened scientific awareness of the significance of humane treatment in the laboratory and professionalized laboratory animal science.

In the late 1970s, while working in my laboratory at the American Health Foundation, I received a phone call from Henry Spira. Not one for small talk, he did not even bother introducing himself beyond his name. He immediately began questioning me about my studies using the protozoan Tetrahymena thermophila, which I hoped would serve as an alternative to the Draize ocular irritation test. While flattered that someone cared about my work, I was soon lost in confusion and skepticism about the true purpose of his call. Who was Henry Spira? Why did he want to visit my animal facility and why did he want to bring a physician colleague with him? Not only was I naive about the budding opposition to the Draize test, I was equally naive that it was Spira, an ardent animal protectionist, who was leading the fight. This seminal interaction began a friendship that spanned nearly twenty years; a friendship that indelibly changed my perception of nonhuman animals and how I relate to them.

These CQ Sources were compiled by Bette Anton.

In the fall of 1996 I taught a course at Fudan University in Shanghai dealing with medical ethics in America. As part of the course we spent some time on the heated American debate about abortion. The reaction of Chinese students was revealing.

The Institute of Medicine's report, “Approaching Death: Improving Care at the End of Life,” the American Medical Association's “Education for Physicians on End-of-Life Care” project, the Open Society Institute's “Project on Death in America,” and the “Last Acts” initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives (ADs). Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form.