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This article examines two typical bioethics frameworks: the "Four Principles" by Beauchamp and Childress, and the "Four Boxes" by Jonsen, Siegler, and Winslade. I show how they are inadequate to address the ethical issues raised by pediatrics, in part because they do not pay adequate attention to families. I then consider an alternate framework proposed by Buchanan and Brock that focuses on four questions that must be addressed for the patient who lacks decisional capacity. This model also does not give adequate respect for the family, particularly the intimate family. I then describe my own framework, which provides answers to Buchanan and Brock's four questions in a way that is consistent with the intimate family and its need for protection from state intervention. [ABSTRACT FROM AUTHOR]

Virtually every infant in the United States undergoes a heel stick within the first week of life to test for a variety of metabolic, endocrine, and hematological conditions as part of state-run universal newborn screening (NBS) programs. The history of this mandatory public health program is examined, as well as whether the policy was morally justifiable. Three changes in NBS practice necessitate a re-evaluation of the mandatory nature of NBS. First is the adoption of NBS for hemoglobinopathies in the 1980s that led to the identification of many sickle cell carriers and carriers of other hemoglobin variants. In all other contexts, carrier testing requires consent, and there is no moral rationale why NBS ought to be exceptional. Second is the application of tandem mass spectrometry (MS/MS) to NBS in the 1990s that led to the identification of many metabolic conditions and variants, some of which were not treatable and others of which had unknown clinical relevance. To the extent that the conditions do not need emergent diagnosis and treatment, there is less justification for mandatory screening. Third, there is great interest in using residual blood spots for research, and the cornerstone of research ethics is the voluntary consent of the participant (or his or her proxy). These three changes support revising mandatory NBS with a tiered consent process to best balance respect for parental autonomy and the promotion of children's health. [ABSTRACT FROM AUTHOR]

In March 1966, the CIBA Foundation sponsored an international interdisciplinary conference on transplantation. Attendees included surgeons, physicians from many medical disciplines, legal professionals, a minister, and a science reporter. Although the main topic of discussion was the living donor, none was present. This article gives voice to the living donor through two qualitative interviews with men who donated at different centers in the United States in the early 1960s and subsequently developed end-stage renal disease (ESRD). These narratives contribute to five topics discussed at the CIBA meeting that are still relevant today: (1) pressure to donate; (2) special donor categories; (3) donor health; (4) socioeconomic consequences of donation; and (5) lack of regret.