Ever since I learned a year ago about the honor you intended to bestow upon me, I have asked myself: What is it in my life's work that led you to confer upon me your Second Presidents' Award? You could have chosen many other, perhaps more deserving, recipients. But tonight I do not wish to compare myself to others. It would be most ungracious to charge you with being mistaken, or too self-effacing to charge myself with being unworthy of your Award.

Ultimately, I concluded that you honor me less for the work I have published and more for the impact I have had on so many of you as your teacher and colleague during the last thirty years. I have lived my life with people—family, friends, students. I have cherished, and still cherish, the contacts with my students, a remarkable number of whom soon became collaborators, colleagues, friends or took off on their own, enriching in significant ways what we had first learned together.

Even many women who view reproductive capabilities not as a detriment but as an important source of joy in their lives recognize that women's reproductive capabilities have long been used to oppress them. The ability to reproduce has been an important factor in women's loss of control over their own lives, contributing to their being controlled by chance, by government, and by other people—husbands, boyfriends, parents. In the past, to the extent that reproduction has not been left to chance, the woman herself has often not been the decision-maker. Husbands have often coerced women into producing and raising offspring when they did not want to, and societal attitudes have had the same effect of encouraging marriage, then motherhood. Historically, state governments have participated in coercing childbirth as well, some by prohibiting or restricting birth control and all states by prohibiting abortion.

Even many women who view reproductive capabilities not as a detriment but as an important source of joy in their lives recognize that women's reproductive capabilities have long been used to oppress them. The ability to reproduce has been an important factor in women's loss of control over their own lives, contributing to their being controlled by chance, by government, and by other people—husbands, boyfriends, parents. In the past, to the extent that reproduction has not been left to chance, the woman herself has often not been the decision-maker. Husbands have often coerced women into producing and raising offspring when they did not want to, and societal attitudes have had the same effect of encouraging marriage, then motherhood. Historically, state governments have participated in coercing childbirth as well, some by prohibiting or restricting birth control and all states by prohibiting abortion.

On August 22, 1986, as part of its response to the AIDS epidemic, the Public Health Service (PHS) invited U.S. industrial firms to collaborate with the government in the development of an AIDS vaccine. The framework for the collaboration was outlined in a PHS document entitled, “AIDS Vaccine Development: Private Sector/Government Collaborative Efforts.” This document identified the resources the government is prepared to make available to industry, including patents, facilities, data, and assistance with clinical trials. The overall aim of the PHS proposal was to establish a formal framework for coordinating existing government and private efforts and to foster industry participation in the search for an AIDS vaccine.

An example of private sector/government collaboration is provided in the human trial of an AIDS vaccine approved by the FDA in August 1987. The vaccine, named “VaxSyn HIV-1,“ is the product of a joint effort between a company called MicroGeneSys and investigators at the National Institute of Allergy and Infectious Disease (NIAID).

This well known position of the AMA Judicial Council implies that the distinction between intentionally causing death and letting a patient die is conceptually clear and ethically significant. Most opponents of active voluntary euthanasia accept the validity of this distinction; proponents inevitably do not. The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research is a notable exception.

Although in its 1986 Report on medical malpractice, the General Accounting Office found “No Agreement on the Problem or Solution,” it is readily apparent to any participant in or informed observer of health care delivery in the United States today that problems do exist regarding both the occurrence of medically-induced patient injuries and the management and resolution of medical liability claims. Public policymakers, on both the federal and state levels, have devoted a great amount of attention and energy in the past several years to attempts to devise solutions to these troubling patient injury and provider liability difficulties, difficulties that arguably impact negatively on the quality of medical care, its accessibility, its costs, the physician/patient relationship, and the progress of medical innovation. Private organizations have also undertaken initiatives in this area.

In Britain the movement towards “Community Care” gathers apace. Segregation techniques in their traditional forms are steadily losing ground to newer community based alternatives. Both America and Britain have seen a massive reduction in the register of patients resident in mental hospitals; specifically in America from a peak of 560,000, and in Britain 165,000 in 1955, to some 273,000 and 70,000 respectively. And how has this been achieved? Through the rhetoric of “community care,” whose influence over policy in hospital admissions and discharges has been particularly remarkable, according to Peter Sedgwick, in that it does not in reality exist. America has been swift to adopt this new panacea “community care” where the emptying of asylums has turned out to have unforeseen problems. Creedmoor asylum for the borough of Queens in New York released 3,000 patients within a few months. Britain has been rather slow to follow—perhaps a little less ruthless—but the reduction of beds continues.

The Infertility (Medical Procedures) Act passed by the Parliament of Victoria, Australia in 1984 was the first legislation anywhere in the world to deal specifically with the regulation of in vitro fertilization and embryo experimentation. As with any pioneering legislation, it has had its problems. Prominent among them was the question of precisely when an embryo comes into existence. This question, which may seem mere semantics, gave rise to a heated controversy with real practical consequences for researchers and infertile couples. The issue was only resolved by the Victorian parliament passing an amendment which specified, more precisely than any legislature had done before, the moment at which egg and sperm become an embryo. This enactment could be seen as a legal declaration of when a life begins—although it remains an open question what legal or ethical significance such a starting point possesses.