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A published study reported by Munné using uterine lavage to retrieve in vivo blastocysts for preimplantation genetic testing has been the subject of several technical and ethical critiques. None of these critiques has been based on a review of the study's IRB-approved informed consent. This commentary seeks to do that, examining the Munné (and related Nadal) consent forms for their conformity to existing requirements for a full and informed consent.

Advances in genomic science and reproductive medicine are hastening the day when parents will be able to select or design desired traits for their children. This possibility raises a series of challenging questions: will our ability to choose our children’s biological inheritance deform parenting? Will it diminish children’s freedom by making them creatures of their parents’ whims? Will it widen social divisions, creating a ‘genobility’? Will it recreate the horrors of early twentieth century eugenics? In this perspective article I reply that while these are all important questions, the answers do not necessarily rule out the judicious use of human genetic engineering.

Although we need the good witness of others to form our best selves, an argument can be made that we need to study the dark side of the equation as well. The understanding and analysis of bad leaders/misleaders is an important component of leadership studies. However, we argue that bad leaders should never be defined as leaders. Leadership aims at the good of its communities, while misleaders do not. Ethics, therefore, is not only essential to the practice of leadership but to the very meaning of the term.

Although the first human embryonic stem cells (hESCs) were produced in 1998, the direction of U.S. policy on stem cell research was set nearly 20 years earlier when the recommendations of a congressionally established Ethics Advisory Board were ignored by the Reagan administration. Thus began an unprecedented and unparalleled 30-year-long history of political intrusions in an area of scientific and biomedical research that has measurable impacts on the health of Americans. Driving these intrusions were religiously informed public policy positions that have usually escaped critical ethical analysis. Here I record my own encounters with this history of intrusions and the thinking behind them.My most abrupt encounter with the politics of stem cell research occurred on September 6, 2006, at a hearing of the Senate Subcommittee on Labor, Health and Human Services and Related Agencies, chaired by Senator Arlen Specter. Just a week before, scientists at Advanced Cell Technology (ACT), a small Massachusetts biotech company, had published a paper in the journal Nature in which they described a method for extracting stem cells from early human embryos while leaving the embryos intact and viable. As head of ACT’s Ethics Advisory Board, I had supported this research.

Human embryonic stem cell research offers great promise for the treatment of many serious disease conditions in a variety of medical areas, including wound healing. Before this promise can be realized, society and individual researchers, clinicians, and patients will have to answer four ethical questions: 1) Can we ever intentionally destroy a human embryo? 2) Can we benefit from others' destruction of embryos? 3) Can we create an embryo to destroy it? 4) Can we clone human embryos? After outlining the issues raised by each question, the author concludes by indicating his own affirmative answer to each of these questions.

As a “case” in business ethics, the conduct of the firearms industry is hardly dilemmatic. The responsible choices before firearm manufacturers have long been clear, if largely neglected. The great interest here for business ethicists lies in understanding how civil law and ethics can work together to bring a rogue industry under control. Business ethicists have a role to play in shaping the formation of legal standards in this area. In turn, emerging concepts of manufacturers’ liability can make a contribution to the teaching of business ethics.

Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.

The science of reproductive and therapeutic cloning has stirred heated ethical debates. Some of the fears and apprehensions are based on misconceptions of the science, but others are real and substantial. It may be ethically possible to undertake reproductive cloning once the direct physiological risks of cloning are reduced to the level of current assisted reproductive technologies, but this should be done only in a research context with careful monitoring and follow-up of children and families.

On the morning of December 2, 1994, after a preceding afternoon of discussion, the Advisory Committee to the Director of the National Institutes of Health (NIH) unanimously voted to approve the recommendations of the Report of the Human Embryo Research Panel. Panel members like myself who were present were elated. The vote marked the culmination of nearly a year of work. Approval of the report also represented a decisive step forward in bringing an end to a 15-year long moratorium on federally funded research on the preimplantation human embryo and techniques ofin vitrofertilization.

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge to us to show that our account of mortality is more adequate than principlism. In particular we show that recognition of mortality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label "Dartmouth Descriptivism." Language: en

A short while ago, I participated in a class discussion of a case whose focus was on the auditor's report for a company about to launch an initial public stock offering.l The report showed that the company had taken many liberties with the discretions normally afforded by generally accepted accounting practices (GAAP). The company immediately booked franchises it sold as revenue, while cancelled sales (described as srepurchases" of franchises) were handled as depreciable capital expenditures. What seemed to be interest-bearing loans from corporate officers to the company were booked unambiguously as franchise sales to these officers. The resulting balance sheet made the company seem in far better financial health than it was. Accounting experts present for the case discussion pointed out that at the time they occurred these practices did not violate GAAP, although they i'pushed the envelope" of accepted conduct. During our case discussion, several persons present with experience in investment banking repeatedly sought to defend the company's practices. They pointed out that most firms make efforts to see that audits for IPOs cast the most favorable light on the firm's financial condition. Because so many companies do this, they added, one that didn't skew its audit in a favorable direction would disadvantage itself in the capital markets. As the discussion proceeded, I counted at least ten instances where one or another participant used some variant of the phrase i'Everyone does it." I mention this discussion not because I believe these practices were morally justified. Indeed, they were apparently regarded as so flagrant that they subsequently led to a tightening of FASB standards. Rather, I raise this case to show how prevalent the Everyone's doing it'§ claim is in moral arguments, especially in the field of business ethics. In his response to my paper, Richard DeGeorge repeatedly suggests that the ZEveryone's doing it" claim is either morally irrelevant or mis

Our film Dreams and Dilemmas: Parents and the Practice of Neonatal Care is on its way to meeting its goal of furthering the "Principles for Family Centered Neonatal Care" (Harrison H. Pediatrics 1993;92:643-50) through cinéma vérité depiction of parental involvement in decision-making. Reality-based filmmaking can provide valuable and successful educational material that advances care and understanding. However, there are real practical and ethical concerns such as privacy, consent, and uncertain or unknown future impact on participants. Successful reality-based filmmaking in a complex medical environment such as a neonatal intensive care unit requires careful attention to ways of ensuring full communication between all those involved and efforts to allay participants' anxiety about being portrayed unfavorably. The most important ingredient, however, is the skill and ability of the filmmaker to engender trust.

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major arguments for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.

H. G. Wells warned, in 1895, not to allow economic injustices to become to so acute that they ultimately transform human biology. Wells's warn- ing is all the more pertinent today as society contemplates the use of biotechnolo- gies to manipulate or "enhance" the human genome. I n his 1895 novel The Time Machine, H. G. Wells has the reader fol- low a Time Traveller to a remote future world where the human race has become divided into two separate species. The Eloi are a gentle, herbivorous people who inhabit the park-like surface of the planet. Dwell- ing beneath them, in a dark subterranean world, are the Morlocks, a grotesque, mole-like species, who appear to maintain the planet's me- chanical life support systems and who, as their price for this service, occa- sionally capture and devour an Eloi. Wells's two species are not the result of genetic engineering. They seem to have evolved naturally over time—it is not clear whether by Lamarck- ian or Darwinian mechanisms—from the extreme class divisions of nine- teenth century British society. But Wells's warning to his contemporaries is clear: Do not allow economic injustices to become to so acute that they ultimately transform human biology. It is a warning that remains appli- cable in the present era of genetic engineering. Ronald Lindsay (2005) tells us not to worry. Among other things, he argues that if the human species were to divide into Eloi and Morlocks, the circumstances of justice, as described by Hume and Rawls, might no longer apply. This could be true if the unenhanced are possessed of a "marked inferiority" of body and mind. In that case, the two species would be as human beings are to animals. Although duties of compassion or kindness might apply—we think it desirable to prevent animal suffering—

Objective: To determine the opinions of assisted reproductive technology (ART) clinic directors on access-to-services issues and to compare these opinions with policy at ART clinics. Design: Survey sent to ART clinic directors. Setting: Academic medical center, university-based ethics institute. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): Assisted reproductive technology directors' opinions about access to services are related to specific clinic policies. Access issues examined include patient attributes (marital status, age, sexual preference), patient behaviors (substance abuse, psychiatric history, child abuse), number of cycles, and types of procedures offered (surrogacy, cloning, ova cryopreservation, ART for HIV-positive individuals). Result(s): Provider opinion was more restrictive than clinic policy in 19 of 20 categories measured. The largest difference between opinion and policy was seen on the question of setting restrictions as to age of the male partner. About 20% of directors think that surrogacy for convenience should be allowed: about 10% of directors think cloning of human beings should be offered. Conclusion(s): The opinions of ART directors on access to services are more conservative than clinic policies. Contributing factors may include respect for patient autonomy; fear of litigation; policy that reflects a continuum of beliefs among providers; and economic pressure to offer a broad range of procedures.

Publisher Summary This chapter focuses on some of the leading concerns with human cloning. Some of the fears and apprehensions are based on misconceptions of the science, but others are real and substantial. Future research on animals and human embryos would reveal whether cloning is ever likely to be safe enough to be used in human reproduction. No efforts at reproductive cloning can ethically be undertaken until there is reasonable confidence within the research community that this standard can be met. If and when this occurs, the initial efforts at cloning should take place in research contexts and be subject to careful monitoring and followup. Therapeutic cloning raises several different but related ethical issues. These include the appropriateness of creating embryos with the intention of destroying them, of hastening the day when reproductive cloning might become feasible, and of fostering a market in human oocytes for research purposes. Although none of these issues justifies prohibiting therapeutic cloning research, scientists engaged in this research should be sensitive to the ethically controversial nature of their work. They can help to reduce public apprehension by making special efforts to ensure that all aspects of their work conform to the highest standards of research on human subjects.

OBJECTIVE: Our goal was to investigate policy on patient access to services at assisted reproductive technology clinics in the United States. STUDY DESIGN: Surveys asked about a variety of ethically and socially challenging cases and were mailed to directors of all Society for Assisted Reproductive Technology-associated assisted reproductive technology clinics. RESULTS: Written policies on access to services are present at 40% of assisted reproductive technology clinics. Universal agreement was not found on any issue; 79% of clinics treat single women, 27% treat patients with a history of schizophrenia, 10% treat patients who use alcohol excessively, 7% treat human immunodeficiency virus-positive women, and 2% would treat patients previously convicted of child abuse. A breakdown of the responses indicated that some clinics are more permissive in terms of access to services than others, whereas some are more restrictive. CONCLUSIONS: The data demonstrate considerable variability in policy among clinics on most access-to-services questions. The results highlight the importance of ongoing discussion of the ethical and legal issues related to access and the need to develop consistent methods to deal with complex cases.

(2001). Access to Healthcare: Going Beyond Fair Equality of Opportunity. The American Journal of Bioethics: Vol. 1, No. 2, pp. 22-23.

Joint ventures by physician entrepreneurs may introduce an intolerable conflict of interest into the heart of patient care, eroding patient trust and professional esteem. In 1986 a national chain opened a new radiological facility in Philadelphia near the office of Dr. Robert Hochberg, a private radiologist. Within several months, Hochberg noticed a decline in his business. Two and a half years later, less than half as many patients were using his office. Some of this was attributable to the superior technology at the competing facility, which boasted a state-of-the-art magnetic resonance imaging (MRI) machine. But Hochberg also blames the decline on what he believes are the chain's unfair business practices. When the new center opened, Hochberg notes, it recruited local doctors as limited partners, many of whom previously referred patients to him. According to Hochberg, "A few of the guys just turned off the spot."(1) A year earlier, Dr. William Birnbaum, a radiologist in Irvine, California, was approached by a colleague demanding a share of his profit. Birnbaum says he was told that if he didn't comply with the request, this colleague and the other physicians would stop referring patients to Birnbaum. "He said he wanted a piece of the action," Birnbaum later commented. "He said since it was their patients, they deserved some of the income.(2) Implicit in this request was the threat that the others might open a competing facility, which they eventually did. These stories suggest that medicine is no longer immune to the hardball tactics and hostile takeovers reported in the business pages of the newspapers. Behind these anecdotes, however, lies a development with potentially major impact on the quality of health care in this country and the future of the medical profession: the enormous growth in the number of medical facilities owned in "limited partnerships" by physicians who refer their own patients to them. Radiological offices, with their expensive CAT-scan and MRI technologies, are probably at the forefront of this development, but physician-ownership also plays a major role in the growth of many new outpatient, nonhospital medical facilities. These include women's health centers, alcohol and drug abuse treatment facilities, home health care services, freestanding urgent/primary care offices, same-day surgery centers, cardiopulmonary testing services, sports medicine clinics, parenteral nutrition services, and diagnostic medical laboratories.(3) In some cases, new hospital-based facilities have been opened in collaboration with groups of physician-investors or existing facilities have been "privatized" to stimulate physician referral to them.(4) Although accurate figures are hard to come by, congressional analysts have estimated that tens of thousands of doctors already invest in limited partnerships,(5) and one independent health care analyst believes that physicians hold shares or are partners in medical facilities that generate tens of billions of dollars a year in medical services.(6) A 1988 survey by the American Medical Association indicated that 7 percent of physicians polled had an ownership interest in a health care facility to which they refer patients,(7) while a 1989 report by the Inspector General of the Department of Health and Human Services (HHS) indicates that physicians own or invest in at least 25 percent of the independent clinical labs to which they refer patients, 27 percent of independent physiological labs, including radiology and MRI centers, and 8 percent of durable medical equipment businesses.(8) Legal Controversies Much of this activity involves what is called "joint-venturing" physicians and their financial backers. Typically, a group of investors guided by a consulting firm will recruit physician-investors in a proposed facility. As "limited partnerships" these arrangements do not have to include other nonphysician investors and may exclude doctors who use or own competing facilities. …

The author suggests three ''axions'' of intergenerational responsibility; basic quides to the thinking about obligations to the future. They are: present generation is bound by ties of justice to real future persons; (2) the lives of future persons ought ideally to be ''better'' than those of the present and certainly no worse; and (3) sacrifices on behalf of the future must be distributed equitably in the present, with special regard for those presently least advantaged. He warns against taking long-term risks that might jeopardize many times the number of generations that would profit from such ventures; he discusses a plutonium economy as an example.

It has long been recognized that Soren Kierkegaard's Fear and Trembling is a cryptogram. Encoded within a series of reflections and commentaries on Genesis 22 is a deeper message directed at a reader or readers presumably capable of deciphering the hidden meaning. That this is true is suggested by the book's epigraph: ‘What Tarquinius Superbus said in the garden by means of the poppies, the son understood but the messenger did not.’

KIE: The economic recession, the mounting costs of medical technology, and the weakening of public support for welfare state ideals have led to philosophical qualification of the right of equal access to health care by writers like Norman Daniels and Lawrence Stern. Green rejects their arguments and reiterates the claim that a Rawlsian theory of justice provides an appropriate way of thinking about the right to health care, which should be treated on a par with basic civil liberties.

Can a commitment to social justice and to altruism in medicine coexist? Can medicine remain a locus of human generosity and compassion as health care provision becomes more and more a social responsibility? Over the past decade a number of writers, myself among them, have sought to assert that there is a fundamental human right to health care. In different ways we have argued that access to health care cannot be allowed to depend upon one’s financial resources or on the free generosity of some health care providers. Each person, we have said, has a legitimate moral claim to a fair share of the health resources a society provides ([11, 12, 24, 33]). But even as we have argued this way, it has been incumbent upon us to consider the costs of the right we would affirm. On the economic side, this matter has received attention as thinkers have explored the problem of how quality of care can be conjoined with equality of its distribution ([4, 9]). But far less attention has been given to the possible moral costs of this right. In what follows I want to examine one of these possible costs by asking whether some of the altruistic moral attitudes and practices traditionally associated with medical care can survive in an environment of social or legally established rights and claims.

We performed a family study of 39 individuals with proven manic-depressive disorder. Among the affected first-degree relatives of these probands, an overall parity of the male-female ratio was found. In addition, there were four instances of father-son transmission of affective illness involving probands of the sample. These results suggest that any gene locus that exists on the X chromosome is not of itself a sufficient or necessary condition for the transmission of manic-depressive illness. Hence, any implication that X linkage is the primary mode of transmission in manic-depressive illness is premature.

Must we be morally concerned with the welfare and the health of future generations? Are we required to leave our distant descendants the conditions for a healthy life? And how do our answers to questions like these affect our health care responsibilities to our contemporaries? While a focus on our obligations to the future is a hallmark of much recent ethical discussion — the issues of population growth, energy and environmental protection come immediately to mind — the question of our health-related responsibilities to the future has rarely been explored. Most ethical discussion of health care and justice, for example, has focused on the equitable distribution of present health care resources, especially the right of less–advantaged individuals to medical services.