The study of society's approach to civil commitment of the mentally ill is made particularly interesting by the strength of the values it finds in conflict. On one plane, “good” or “moral” people are supposed to provide care for those unable to care for themselves. The capacity to consider the needs of others helps define our “humanness.” In this context, this value manifests itself in the attempt to provide mental health care for those unable, because of their illness, to provide it for themselves.

On another plane, however, the oppression that drove many to immigrate to America and that resulted in our own revolution has left us with an abiding fear of governmental limitations on individual autonomy. Cries of totalitarianism and “big brotherism” often accompany governmental attempts to restrict that autonomy. In this context, this value manifests itself in the attempt to permit individuals to choose whether to receive mental health care.

The task of determining who should or should not have access to a life-prolonging procedure would not be easy even if cost were no consideration. In an era in which rhe health industry has largely converted to the cost cutting religion, or at least the religion of budget limitation, a conversion for which health economics is partly responsible-the task becomes doubly difficult.

At one level, the Massachusetts Task Force on Organ Transplantation has dealt with this task simply by recommending that the final decision be postponed, and that a limited program of organ transplantation he introduced in an “Initial Social Assessment” phase.

RU 486 is a synthetic drug with antisteroid hormone properties, synthesized by the Roussel-Uclaf Company, Paris, France, which owns a world-wide patent for all uses.

I have summarized the story of RU 486's discovery, testing and use in the Journal of the American Medical Association, in Science? and in a book entitled The Abortion Pill, also published in French as Génération Pilule.

Based on antiprogesterone action, RU 486 was first approved in France for voluntary pregnancy interruption (VIP), within the framework of the abortion law, as a medical method to replace the instrumental technique in use when the law was passed in 1975. Registration of RU 486 was obtained in September 1988.

When individual patients' medical decisions contribute to population-level trends, physicians may struggle with how to promote justice while maintaining respect for patient autonomy. This article argues that this tension might be resolved by using the informed consent conversation as an opportunity to position patients as societal stewards.

In addition to disability insurance purchased privately by individuals or employers, three other major types of disability insurance are available: Workers’ Compensation, Social Security Disability Insurance (SSDI), and Supplemental Security Insurance (SSI). The first two, Workers’ Compensation and SSDI, are available to individuals with work connections. The third, SSI, does not require a work connection.

Workers’ Compensation laws were initially passed to provide economic protection for workers and their families when a worker suffered an accident on the job resulting in an injury. The first laws passed were subject to court challenges based on their constitutionality. Ultimately courts approved the constitutionality of the Workers’ Compensation laws rationalizing that the laws created a compromise whereby an employee gave up her right to sue for a tort recovery in exchange for the employer's agreement to pay benefits without regard to the cause of the accident.

My aim in this paper is simply to show that, in bioethics no less than in other areas of health care, policy in democracies is shaped not only by principles and values, but also — and to some extent independently — by the shape and history of particular political institutions and past policies. “Path dependency,” or what one scholar has called the “accidental logics” of already-existing institutions, condition and guide national policy choices. These institutional and historical pressures can even create substantial policy divergences between quite likeminded nations. I shall illustrate the point using some comparative data about national policies regarding research on human embryonic stem cells. The fact that gaps can develop between values and policies is readily visible to anyone who compares national stemcell research policies to the expressed attitudes of the citizens of various democratic countries regarding human embryonic stem-cell research. The role of path dependency and the accidental logics of institutional structure in creating those gaps can be illustrated by tracking down the details of the development of human embryonic stem cell policies in a few different countries.

Like all her work, Jody Madeira’s “Conceiving of Products and the Products of Conception: Reflections on Commodification, Consumption, ART, and Abortion,” is a rich, nuanced discussion that mixes various conceptual vocabularies (Marxist, semiotics, legal) into a complex dish. If her work is like the best of French cooking, my comment, I fear, will be more like fast food. In the short space I have, I want to pick off a few items of common interest and discussion and reconfigure them.

The currently evolving debate over ethical and legal approaches to DNA data banks reflects, in part, shifting societal perceptions of dividing lines between humanity and commodity, definitions of genetic inheritance between individuals and families, and the rights of the individual versus the rights of the community. Tensions arise whether the data bank has been created for medical or for forensic purposes. The authors, through their work as community activists described more fully below, have come to realize that the key to resolving these tensions and developing ethically acceptable DNA data bank practices is meaningful community engagement. Not unlike medical DNA data banks, personally identifiable DNA samples are routinely retained by states long after a convict's or arrestee's DNA profile has been derived from it and entered into the state database. The question arises, then, as to what, if any, non-forensic uses can these samples – ethically – be put.

Over the last century, and especially since the publication of the Belmont Report in 1978, respect for persons, as exemplified by respect for autonomous decision-making, has become a central tenet in the practice of medicine. The authority of cognitively competent adults to make their own healthcare decisions is enshrined in both law and practice in most advanced industrialized nations. The right to consent to or to refuse medical interventions is virtually absolute, but is contingent on the provision of materially relevant information about the benefits and burdens or risks of the proposed treatment as well as the freedom from coercion by others, especially healthcare personnel. This power also extends to the kinds, amounts and details of the proposed intervention, including the option to decline to hear anything, if one so chooses, assuming that this is a rational choice. This respect transfers to other competent individuals who are authorized as surrogates to decide for those who have temporarily or permanently lost the capacity to make their own healthcare decisions.

Mortality rates for middle-aged whites in the U.S. are rising due to drugs, alcohol, and depression. Unique to our country, these “deaths of despair” disproportionately occur among the under-educated, who are at particular risk for dying young. At one time, less-educated persons aspired to work in the same factory as their parents, at union wages, with benefits. Those jobs, and the sense of community and prosperity and security they allowed, are evaporating. Many former workers suffer from chronic pain, which underlies America's ongoing opioid overdose epidemic. The pain is not only physical. It is psychic, spiritual, and economic.

Although RU 486 has been the subject of extensive research and media coverage, in the United States the actual clinical use of the drug remains largely a theoretical possibility. California is the site of the only American clinical research on the use of RU 486 for termination of early pregnancy, and the California state legislature has adopted a strongly-worded resolution in favor of the testing and use of RU 486 in the state. However, the degree of physician awareness, the nature of physician opinion and the potential use patterns of this drug remain speculative.

To gain a better picture of what the physicians most likely to utilize RU 486 think about the drug, licensed California obstetricians and gynecologists were surveyed regarding their opinions about RU 486. The physicians were queried about their general awareness of the history of RU 486, their level of confidence in the existing data regarding the drug and their possible plans to administer the drug clinically if it were to become available.

Concern for one's moral integrity is often a part of discussions about moral conflicts in health care. The presumption is that moral integrity is good, even though the full meaning of the concept and its relative worth are not completely understood.

The word “integrity” comes from the Latin integritas, which referred to a state of completeness or wholeness and a quality of purity. The subject of integritas included all of life. More recent understandings of integrity are limited in scope to specific areas of life, though the early meaning of an unimpaired condition has survived. But the scope of integrity is commonly limited to a firm adherence to a code of moral standards.

U.S. immigration law has excluded noncitizens likely to become a “public charge” since 1882. When the Trump administration proposed a new Rule expanding the interpretation of that exclusion in 2018, over 55,000 people wrote public comments. These comments, overwhelmingly opposed to the change, are the subject of Rachel Fabi and Lauren Zahn’s insightful article in this issue of The Journal of Law, Medicine, and Ethics. The themes they identify resonate with the history of the public charge exclusion, which has always reflected a tension between two aims of American governance — to provide for those in need of assistance, and to shape the nation’s citizenry according to ideals of self-sufficiency.

Informed consent, as the courts define it, is the patient's right to know, before agreeing to a procedure, what the procedure entails — the hazards, the possible complications, and expected results of the treatment. The patient must understand any reasonable alternatives to the proposed procedure, including, in most cases, the results that can be predicted from nontreatment. The choice among alternative risks involves value judgments falling outside the scope of medical decision-making, including the patient's views on social, economic, and other personal factors of which health professionals cannot possibly be aware.

The negotiations necessary to obtain the patient's informed consent are the responsibility of the person who will perform the procedure. If a physician is in charge, the physician may delegate the discussion to another but retains the legal responsibility to make sure the patient understands.

When a medical malpractice injury occurs in a hospital, the hospital is often sued under the theory that it is vicariously liable for the actions of its employees, through the doctrine of respondeat superior. Depending on the facts of the case and the laws of the state, however, the hospital may also be directly liable to the patient. Establishing the direct liability of the hospital where the facts will not support a vicarious claim may ensure for the plaintiff an adequate “deep pocket” in cases where the physician is inadequately insured. In addition, direct liability carries a longer statute of limitations.

Imposing liability on hospitals, whether vicarious or direct, encourages hospitals to oversee physicians’ competence.

Surrogate motherhood, as it is practiced today, differs only in insemination technique from this biblical effort. A married couple, unable to conceive because of female infertility, or, perhaps, a single male who desires a child would, as did Sarah, seek out a woman willing to act as a surrogate mother It is likely that the couple would make the initial contact through a classified advertisement and negotiate a contract with a fertile woman through their attorneys. The contract, in its most basic terms, would provide that the surrogate be artificially inseminated with the husband's semen, carry the child to term, and relinquish her parental rights upon birth of the child. Although there have been cases where a woman becomes a surrogate mother without payment, the surrogate mother typically receives a fee for her services as a carrier.

Proponents of surrogacy arrangements assert that a married couple's right to procreative autonomy includes the right to contract with consenting collaborators for the purposes of bearing a child. The right to genetic continuity and to rear offspring are all part of the right of reproductive choice for the contracting father and his partner.

Critics of surrogacy arrangements similarly cite reproductive autonomy as the basis for their claim that women cannot be compelled by contract to use their bodies in particular wayeither to forgo the right to abortion or to be fetal containers. The right to autonomy over her own body and to rear the offspring she has borne are all part of the mother's reproductive freedom.

Both proponents and critics of surrogacy arrangements, therefore, claim that their positions maximize freedom and liberty. Each position, of course, focuses on the autonomy of the party the commentator favors; the analysis is invariably outcome-determinative, without enunciating a neutral civil liberties framework. Neither proponents nor critics define clearly what the right to procreate entails, or what resolution is warranted when there is a conflict.

Since its inception in 2010, the Network for Public Health Law (Network) has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation (RWJF) has invited the Network and other partners to consider new ideas and strategies toward building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations.