The Nobel Laureate Illya Prigogine compares the recent breakthroughs in human biology to the major changes that occurred when the Neolithic period succeeded the Paleolithic, 12,000 years ago. Although there is disagreement about the meaning of these changes, most opposing views recognize that a “major transformation” took place. Some interpret the recent breakthroughs in neuroscience as the first step toward “our posthuman future” whereas others see the consequences of these achievements as the end of humankind. Genomics and neuroscience are the main fields that, at this point, give rise to such a debate, some authors stating that neuroscience raises even greater anthropological and ethical challenges than does genomics. This article focuses on neuroscience. Its main object is to critically assess these diverging opinions on the impact of neuroscience and to determine whether both sides are not telling us something important about ourselves and how neuroscience could enlighten healthcare ethics.I acknowledge the help of Dr. Nancy Burbidge and Dr. Béatrice Godard in the preparation of this manuscript.

These CQ Sources were compiled by Bette Anton.

On September 30–October 2, 2005, a group of individuals drawn from civil society organizations, governments, international agencies, and academic institutions came together in Montréal, Québec, Canada, for an international workshop entitled “Human Rights and Access to Essential Medicines: The Way Forward.” At the conclusion of the workshop, we drafted the “Montréal Statement on the Human Right to Essential Medicines.” This “Statement” is reprinted at the end of this comment, which offers some background on the problem addressed at the workshop.Many thanks to Patricia Illingworth, Mira Johri, Doris Schroeder, and Michael Selgelid for their helpful critical comments.

The question of the influence of commercialism in medicine is often put in terms of how the money factor influences the actions and the judgments of the individual physician—just as in the culture at large there is and has always been the question of sacrificing personal moral values for financial gain. But it is necessary now, perhaps especially for physicians and others who are presumably operating in the “market-free zone,” to put the question in an even more intimate way. The question becomes to what extent does the pressure of financial gain influence perception itself in the clinical setting. To what extent do the pressures of commercialism block or interfere with perceptions of fact and truth in establishing diagnosis, in projecting methods and strategies of treatment, and in assessing the medical, psychological, and moral needs of the individual patient? To this extent, it is not so much a question of physicians making intentional, self-serving decisions. It is a question of physicians unconsciously making such decisions based on perceptions and processes of judgment subconsciously or semiconsciously governed by the monetary considerations that have permeated nearly every corner and pocket of the contemporary culture.

These last words are titled “Conclusion,” but they should be “Inception.” Professor Jacob Needleman encourages a vigorous conversation about commercialism in medicine. An honest conversation, he maintains, will spur understanding, indignation, and reformation. We do sincerely hope that such a conversation begins and is carried on to meaningful change. However, as the essays in this collection show, that conversation must take place in many different places and about many different things. All of our authors acknowledge that the problem of commercialism is extremely complex. It cannot be understood as a simple fact or a single feature of modern healthcare. Thus, the conversation that discusses it must be varied and diverse.

CQ sources/bibliography.

“Health and Human Rights,” edited by Doris Schroeder, welcomes contributions on all areas outlined below. Submitted papers are peer-reviewed (short discussion papers will be reviewed by at least one, full papers by at least two reviewers). To submit a paper or to discuss suitable topics, please e-mail Doris Schroeder at [email protected].

Commerce can be defined as an exchange of goods and services using money as the medium for the exchange. People engage in commerce to make money. It has the potential to remain morally neutral. But when the emphasis on making money becomes the goal or value that directs the process, rather than the value of the endeavor itself, things can become distorted. Making money as a primary goal is understood and recognized for the venture capitalist, but it is less attractive when identified as the goal of medical care. Society, or at least medical practitioners, hold their profession to duties beyond the pursuit of personal gain. Medical duties toward beneficence, justice, and respect for autonomy are deemed far too important to be distracted by the desire for financial reward. Any conduct that seems to place the physician's self-interest above that of the patient's reduces the respect and moral authority claimed by the profession.

In 2003, the United Kingdom's Human Fertilisation and Embryology Authority (HFEA) published a report entitled Sex Selection: Options for Regulation. The report outlined the findings of a 2-year review of available sex selection techniques and recommended that the United Kingdom ought not to permit any regulated technique to be used other than for medical reasons (i.e., other than for the avoidance of serious sex-linked genetic conditions). In so doing, it reflected the widespread opinion—repeatedly expressed in the public consultations that formed the cornerstone of the HFEA's review—that there is something ethically unacceptable, or at least ethically suspect, about sex selection for nonmedical, or “social,” reasons.I thank Dr. Doris Schroeder for her incisive and extremely useful comments on an earlier draft of this paper.

These CQ Sources were compiled by Bette Anton.

A Field Guide to Good Decisions: Values in Action, by Mark D. Bennett and Joan McIver Gibson. New York: Praeger, 2006. 216 pp. $39.95.

Decisions are something we all face. Decisions change our lives. As parents, as community members, as professionals, we find ourselves daily in complex situations that require good decisionmaking. Most decisions impact not only the decision maker, but also a network of others whose lives they affect. For healthcare providers and clinical bioethicists, decisions lie at the heart of daily practice and are particularly challenging as they touch the lives of individuals who are often vulnerable and in need of guidance and clarity.Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 ([email protected]) regarding books they would like to see reviewed or books they are interested in reviewing.

A substantial portion of the developed world's population is increasingly dependent on machines to make their way in the everyday world. For certain privileged groups, computers, cell phones, PDAs, Blackberries, and IPODs, all permitting the faster processing of information, are commonplace. In these populations, even exercise can be automated as persons try to achieve good physical fitness by riding stationary bikes, running on treadmills, and working out on cross-trainers that send information about performance and heart rate.This essay is drawn from collaborative research conducted under the auspices of the “Altering Nature: How Religious Traditions Assess the New Biotechnologies” project at Rice University from 2002 to 2004 through the financial support of The Ford Foundation (Grant #1010-1601). The paper is submitted with the permission and acknowledgement of the project coordinators and The Ford Foundation. The authors also acknowledge the research and editorial assistance of Dr. Siobhan Baggot and Ms. Sarah Gehrke.

“Dissecting Bioethics,” a column 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].Many thanks have to go to several people: first to my patient proofreader, my mum (who else!), my even more patient sounding board Tanvi Shah, and finally, for the comments and criticisms, to Tuija Takala and Matti Häyry.

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.

“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 my paper “Parental Love and the Ethics of Sex Selection,” published in the previous issue of the Cambridge Quarterly of Healthcare Ethics, I set out to determine whether a plausible argument could be constructed in support of a common intuition about the ethics of sex selection. The intuition in question is that sex selection for nonmedical reasons is incompatible with a proper parental love: that is, with the sort of love that a parent ought to have for her child or, equivalently, with the sort of love that someone accurately describable as a good parent will have for her child. I concluded that there is a prima facie compelling argument that fits the bill, though I did little more than introduce and set that argument out. In the current paper, my aim will be to subject it to closer scrutiny, by considering a number of possible objections to it. I will start by asking why the argument should be thought to apply only to sex selection for nonmedical reasons and not to cases in which selection is employed in order to prevent the birth of children with serious sex-linked genetic conditions.Thanks are due to Doris Schroeder for enlightening discussions of the issues raised in this paper. I also extend my thanks to Rachel Cooper, Sean Crawford, Neil Manson, and Alison Stone for comments and objections made during and after a paper that I gave on this topic at Lancaster University.

This CQ department is dedicated to bringing noted bioethicists together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact “The Great Debates” department editor, D. Micah Hester ([email protected]), UAMS/Humanities, 4301 W. Markham St., #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

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].

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.

There is no greater paradox in bioethics than its tendency to constantly rediscover, in every conceivable venue, that the only way to honor and preserve the dignity and freedom of huddled, exploited masses is to trim away their decisional authority and appoint panels of well-educated, rational thinkers (such as bioethicists) to lay down the reasonable options for them. Bioethics cannot claim to be the first field to impugn the rationality of the oppressed as a means of upholding their dignity. But it certainly has claims on bringing this process toward its ultimate perfection.