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Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin. [ABSTRACT FROM AUTHOR]

Comments on a study by R. M. Werner and colleagues, which examined issues relating to the use of deception by physicians to get an insurance company to pay for a medical procedure. Percentage of physicians in the U.S. who had supported misrepresentation of facts given to insurance companies; Ethical implications of the deceptive approach to health insurance; Arguments concerning the health care system in the U.S.

A letter from the editor is presented in which he discusses the founding of the "American Journal of Bioethics (AJOB)" while working as an assistant professor at the University of Pennsylvania. He presents a historical overview of the events leading up to the publication of the "AJOB," including his meetings with "AJOB's" publisher MIT Press, and why he believes the "AJOB" has been such a success.

The author reflects on the article "Research Exceptionalism," by J. Wilson and D. Hunter. In the article the author offers his opinions on several arguments and assumptions that are contained in Wilson and Hunter's article and on factors that he feels people should consider when assessing the case for the regulation of research.

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. [ABSTRACT FROM AUTHOR]

The article comments that the difference between conscientious objection and civil disobedience is important for medical professionals in the United States. There are conscience clauses at both federal and state levels. The clauses apply to abortion services but they will be expanded, as physician-assisted suicide legislation works its way through various legislatures.

The author discusses the implications of clinical ethics consultation practice with reference to study conducted on Ethics Consultation in United States Hospitals by E. Fox and others. It is informed that further assessment is required to find ethics consultation services (ECS) role in handling conflicts, such as whether some ECSs prioritize reducing legal liability over patient rights. An establishment and implementation of guidelines that can help optimize the ECS processes is suggested.

We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning. [ABSTRACT FROM AUTHOR]

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. [ABSTRACT FROM AUTHOR]

Health and Social Justice (Ruger 2009a) developed the 'health capability paradigm,' a conception of justice and health in domestic societies. This idea undergirds an alternative framework of social cooperation called 'shared health governance' (SHG). SHG puts forth a set of moral responsibilities, motivational aspirations, and institutional arrangements, and apportions roles for implementation in striving for health justice. This article develops further the SHG framework and explains its importance and implications for governing health domestically. [ABSTRACT FROM AUTHOR]

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for-as though health care is a commodity that needs no examination-or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with 'health care,' the terminology used in the current debate, but with the more modest and limited topic of medical care. Integral to this rationing proposal-which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society-is a definition of a 'decent minimum,' the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span. [ABSTRACT FROM AUTHOR]

When in 2006 the Centers for Disease Control and Prevention issued revised recommendations for HIV testing in health care settings, vocal opponents charged that use of an 'opt-out' approach to presenting HIV testing to patients; the implementation of nontargeted, widespread HIV screening; the elimination of a separate signed consent; and the decoupling of required HIV prevention counseling from HIV testing are unethical. Here we undertake the first systematic ethical examination of the arguments both for and against the recommendations. Our examination reveals that the ethical concerns raised by the critics predominately pertain not to ethically suspect elements of the recommendations themselves, but to suspicions that they will be implemented improperly. It has not been shown that the recommendations cannot be implemented properly. Here we show that in the United States the recommendations are morally justifiable and that safeguards or regulatory oversight may serve to ensure that the recommendations are properly implemented. [ABSTRACT FROM AUTHOR]

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians' experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5] [ABSTRACT FROM AUTHOR]

Bariatric surgery is effective on short- and medium-term weight loss, reduction of comorbidities, and overall mortality. A large and increasing portion of the population is eligible for bariatric surgery, which increases instant health care costs. A review of the literature identifies a series of ethical challenges: unjust distribution of bariatric surgery, autonomy and informed consent, classification of obesity and selecting assessment endpoints, prejudice among health professionals, intervention in people's life-world, and medicalization of appearance. Bariatric surgery is particularly interesting because it uses surgical methods to modify healthy organs, is not curative, but offers symptoms relief for a condition that it is considered to result from lack of self-control and is subject to significant prejudice. Taking the reviewed ethical issues into account is important when meeting persons eligible for bariatric surgery, as well as in the assessment of and decision making on surgery for obesity. [ABSTRACT FROM AUTHOR]

The article discusses the use of pain contracts or pain agreements, which are documents that are presented by a health care professional to a patient and describe the prescriber’s expectations of the patient and the conditions under which the physician will prescribe and/or discontinue opioids. In the article the authors offer opinions on the use of opioids to treat pain, on the use of pain contracts and on prescription drug abuse.

The article discusses whether deidentification is sufficient to protect health privacy in research. Topics include an in-depth discussion on the effects on privacy from the creation, use, and disclosure of deidentified health information in research without the consent or knowledge of the individual.

Provides information on the report "Taking Care: Ethical Caregiving in Our Aging Society," which was issued by the President's Council on Bioethics in the U.S. in September 2005. Ethical issues construed in caregiving for society; Ostensible objective of the report; Association between death and old age.

Comments on the article "Lying to Insurance Companies: The Desire to Deceive Among Physicians and the Public," which focused on physicians' relationship to truth in the service of beneficent patient care. Example of procedures practiced by physicians to misrepresent insurance companies prior to the emergence of managed care in the U.S.; Conflict associated with truth-telling between physicians and insurance companies; Implications of the managed care system for several physicians in the U.S.

I argue that there has been inadequate attention to and questioning of the dominance and normativity of whiteness in the cultural construction of bioethics in the United States. Therefore we risk reproducing white privilege and white supremacy in its theory, method, and practices. To make my argument, I define whiteness and trace its broader social and legal history in the United States. I then begin to mark whiteness in U.S. bioethics, recasting Renee Fox's sociological marking of its American-ness as an important initial marking of its whiteness/WASP ethos. Furthermore, I consider the attempts of social scientists to highlight sociocultural diversity as a corrective in U.S. bioethics. I argue that because they fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces. Accordingly, the dominant white center of mainstream U.S. bioethics must be problematized and displaced for diversity research to make a difference. In conclusion, I give several examples of how we might advance the recommended endeavor of exploring our own ethnicity, class, and other social positioning and norms operating in U.S. bioethics, briefly highlighting "white talk" as one challenge. [ABSTRACT FROM AUTHOR]

Relates the creation of a program for addressing the fertility care needs of people with HIV by the Center for Women's Reproductive Care at Columbia University in 1997. Background and introduction; Application of the principles of medical ethics; Outcome of the program.

The author discusses professionalism of physicians in the context of role morality when providing health care. He argues that moral significance of professionalism should be considered as function of role morality in solving the dual agency problem and its dangers in fostering professional actions. Also discussed are the professional responsibility and liability model, equality in the distribution of health care resources and structural injustice in access to health care.

The article discusses the article "Clarifying Conflict of Interest," by Howard Brody. In the article the authors offer their opinions on several facts and assertions that are contained in Brody's article, on recommendations on conflicts of interest that were released by the U.S. Institute of Medicine and on how conflict of issue policies related to the field of medicine should be evaluated.

The article discusses the article "Doctor, Would you Prescribe a Pill to Help Me . . ?” A National Survey of Physicians on Using Medicine for Human Enhancement," by T. D. Hotze, K. Shah, E. E. Anderson and M. K. Wynia. In the article the authors offer their opinions on several assertions and facts found in Hotze's article, on ambivalence which has been voiced by physicians about the use of enhancement drugs and on the need for a new policy on the use of enhancement drugs which exists in the U.S.

The article summarizes the moral basis for universal and uniform protection of human subjects in medical research. The article explains why the current federal regulatory scheme is inadequate. It proposed that states act to protect their citizens, following the example of an enacted law in Maryland and the absence of a federal law embodying universal protection.

Comments on a study by R. M. Werner and colleagues, which investigated the public's and physician's willingness to support deception of insurance companies in order to obtain necessary health care services in the U.S. Background on the context of deception throughout the history of medicine; Concept of informed consent that emerged during the twentieth century; Influence of the fiduciary obligation of physician to its decision to lie.

The author reflects on the state of bioethics in the year 2000 and presents predictions for the field in the year 2025. Topics include the use of bioethics policy by U.S. President George W. Bush to restrict embryonic stem cell research, international cooperation on bioethics issues, and the role of bioethics in research into potential therapeutic applications of human genomics data.

In this article the authors discuss social considerations in research. They argue that an inquiry into the benefits from the analysis of social contexts within research programs should not be used to place limits on scientific research. Topics include an overview of U.S. patent law and how the U.S. biotechnology industry has fostered diverse innovation by allowing all possible inventions to be considered patentable subject matter regardless of social considerations and social contexts.