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For most of human history, religion has been closely bound up with the understanding of health and disease. Religions have provided accounts of the origins of health and disease, as well as means for preserving health or restoring it. Although religious traditions around the world differ in the specifics of their understanding of disease, there are broad similarities in their basic views. Keywords: practical (applied) ethics; religion; bioethics

Religious traditions of medical ethics tend to differ from more secular approaches by stressing limitations on autonomous decision-making, by more positively valuing the experience of suffering, and by drawing on beliefs and values that go beyond empiric verification. I trace the impact of these differences for some of the world's great religious traditions with respect to four issues: (1) religious conscientious objection to medical treatments; (2) end-of life decision-making, including euthanasia, physician-assisted suicide, and the withholding or withdrawing of life-sustaining treatments; (3) definitions of moral personhood (defining life's beginning and end); and (4) human sexuality.

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.

From the first initiatives in preimplantation genetic diagnosis (PGD) and gene therapy through the advent of stem cell research to the development of mammalian cloning, the past two decades have witnessed remarkable advances in “reprogenetic” medicine: the union of assisted reproductive technologies (ARTs) with genetic control. This period has also been marked by intense debates within the bioethical literature and in national policy forums about the appropriate uses of these emerging human capabilities. We can now, in a limited way, select for genetic traits, and the power to modify the genome or introduce new gene sequences is not far off. How should these new powers be used?

For nearly a generation, Derek Parfit's arguments in his 1984 book Reasons and Persons have shaped debates about our moral responsibilities to future people. Struggling to accommodate Parfit's insights, philosophers and bioethicists have minimized or accentuated obligations to the future in ways that defy ordinary moral intuitions. In this issue, Robert Sparrow develops the troubling implications of the views of two leading theorists whose work favoring human genetic enhancement is influenced by Parfit. Sparrow believes they return us to the horrors of early twentieth-century eugenics. But the real problem may be a purely theoretical one: the unfortunate influence of Parfit. This is no place to review all of Parfit's complex and brilliantly developed arguments. I can, however, present his core insights. One is that in certain decisions that affect which person is born--what he calls "person-affecting decisions"--there may be no one harmed by the decision, even if its outcome is terrible. For example, imagine a woman who has contracted rubella and wants to become pregnant. Her doctor warns her to delay conception because the child runs the risk of birth defects, but the woman ignores the advice, and her child is born blind, deaf, and with severe heart disorders. Many of us think that the mother has acted irresponsibly. But Parfit points out that the impaired child cannot say that he has been harmed. Normally, one is harmed if one is made worse off than one would have been. But if the mother had taken the doctor's advice, a different child would have been born at a later date. One can perhaps argue that the impaired child would be better off if it had not been born rather than being born with severe impairments, but most people prefer being alive to being dead, no matter how bad their condition. Faced with these counterintuitive conclusions, Parfit moved to an "impersonal" account of moral judgment. On this account, the moral goal is to increase welfare in the world and reduce suffering. The mother acts irresponsibly if she refuses to defer conception, as her decision decreases the net sum of well-being in the world. Parfit's presence haunts Sparrow's discussion in two crucial ways. First, Parfit's argument for an impersonal account of obligations to the future helps support the consequentialist or utilitarian approaches adopted by the two theorists Sparrow examines, Julian Savulescu and John Harris. Sparrow correctly identifies a number of problems in their views. …

The author reviews a series of deep affinities between the Catholic social teaching embodied in Pope John Paul II's recent encyclical,Centesimus Annus, and traditional Jewish teachings about economic justice. At the same time, the author maintains that from a Jewish perspective there is a “disquieting” feature to this recent papal letter. It presents twentieth century history in ways that mute or conceal the role some earlier papal teaching played in the rise of corporatist states, with their authoritarian regimes and xenophobic nationalism.Centesimus annus thus obscures the complex contribution Catholic social teaching made to the events leading up to the Holocaust of European Jewry.

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

This paper contends that work in business ethics participates in two key aspects of the broad philosophical and aesthetic movement known as postmodernism. First, like postmodernists generally, business ethicists reject the “grand narratives” of historical and conceptual justification, especially the narratives embodied in Marxism and Milton Friedman’s vision of unfettered capitalism. Second, both in the methods and content of their work, business ethicists share postmodernism’s “de-centering” of perspective and discovery of “otherness,” “difference” and marginality as valid modes of approach to experience and moral decision.

This article examines how the mission of business ethics has fostered several methodological approaches, which were chiefly drawn from philosophical analysis and descriptive methodologies. It discusses the focus on individual managerial decision making and the tension between methods within business ethics education. It evaluates the work of leading business ethics scholars and suggests that this field is both limited and intellectually ambitious.

While the literature in business ethics abounds with philosophical analyses, perspectives from religious thinkers are curiously underrepresented. What religious analysis has occured has often been moralistic in tone, more fit to the pulpit than the classroom or the boardroom. In the three essays that follow, presented originally at a panel at the Annual Meeting of the American Academy of Religion in 1989, ethicists from the Protestant, Roman Catholic, and Jewish traditions analyze a case study familiar to many who teach and research in business ethics — the Consolidated Foods Case. Each author shows how a particular religious tradition might react to the case. The authors show how insights from their traditions would affect corporation's moral deliberations about policy. Specific policy recommendations are offered to CEO John Bryan.

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

The claim that “Everyone's doing it” is frequently offered as a reason for engaging in behavior that is widespread but less-than-ideal. This is particularly true in business, where competitors’ conduct often forces hard choices on managers. When is the claim “Everyone's doing it” a morally valid reason for following others’ lead? This discussion proposes and develops five prima facie conditions to identify when the existence of prevalent but otherwise undesirable behavior provides a moral justification for our engaging in such behavior ourselves. The balance of the discussion focuses on testing these conditions by applying them to a series of representative cases in business ethics.

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.

Our human embryonic stem cell debates are not simply about good or bad ethical arguments. The fetus and the embryo have instead become symbols for a larger set of value conflicts occasioned by social and cultural changes. Beneath our stem cell debates lie conflicts between those who would privilege scientific progress and individual choice and others who favour the sanctity of family life and traditional family roles. Also at work, on both the national and international levels, is the use of the embryo by newly emergent social groups to express resentment against cultural elites. The organisational needs of religious groups have also played a role, with the issue of protection of the embryo and fetus serving as a useful means of rallying organisational allegiance in the Roman Catholic and evangelical communities. Because the epiphenomenal moral positions on the status and use of the embryo are driven by the powerful social, cultural or economic forces beneath them, they will most likely change only with shifts in the underlying forces that sustain them.

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.

Human embryonic stem-cell (hESC) research faces opposition from those who object to the destruction of human embryos. Over the past few years, a series of new approaches have been proposed for deriving hESC lines without injuring a living embryo. Each of these presents scientific challenges and raises ethical and political questions. Do any of these methods have the potential to provide a source of hESCs that will be acceptable to those who oppose the current approaches?

The [covery][1] of the 30 June issue shows a board game called “Life Cycles.” Also shown are two dice. For those not familiar with dice, there are “proper” and “not proper” die. A proper die must have the sum of the numbers on opposite sides equal to seven. It is clear that the die on

There is much that I like in this essay. I share the conclusion that on this issue (as many others) the President's Council on Bioethics (PCB) has not really delivered the “fair and accurate” accou...

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—

This chapter explores converging and diverging issues between genetic and neuroimaging science research and clinical applications. It shows how genetics is intensely communal and familial, while the study of the central nervous system is more focused on the individual. Nonetheless, we learn how the ‘therapeutic gap’ gene hype, and the risk of scientific over-promising from both can lead to advances that may make situations worse before they make them better.

traveled to China to meet with those associated with the UNFPA program there. The delegation was assembled by Frances Kissling, of Catholics for a Free Choice, which also provided support and funding for the necessary travel and adminis- trative services. In China, our contacts included UNFPA administrators, Chinese government officials, and ordinary villagers touched by UNFPA efforts. In the middle of its week-long stay, the delegation left Beijing in three separate groups to travel to remote provincial regions (Hubei, Gansu, and Ningxia). Our goal was to respond to the Bush administration's defunding decision by deepening our understanding of the current Chinese population program and UNFPA's re- lationship to it. In the course of this enquiry, I encountered challenging ques- tions that drew on my own training in ethics in novel ways. HISTORICAL BACKGROUND UNFPA is the world's largest organization providing family planning and re- productive health services. It was established in 1969 as the United Nations Fund for Population Activities. In 1987, the Economic and Social Council decided to rename it the United Nations Population Fund, but to retain the original abbre- viation-acronym. UNFPA works to improve access to and the quality of family planning services in more than 140 of the poorest countries in the world. It is also very active in providing services aimed at preventing the spread of HIV/ AIDS. It does not provide abortion services, but works to prevent abortion through family planning and to help countries provide services for women suffering from the complications of unsafe abortion.

Publisher Summary This chapter addresses several ethical questions that need to be considered when using human embryos for medicinal purposes. One of the questions that needs to be addressed is on the necessity of using the human embryo. Current induced pluripotent stem (iPS) cell lines exhibit high rates of tumorigenicity in mice, possibly a result of the use of retroviral vectors to carry pluripotency-inducing transcription factors, including the cancer-related factor c-Myc. Active research is under way on replacement of c-Myc and the direct upregulation of the relevant genes. Some believe that, in moral terms, human life begins at conception when a new, self-developing genome comes into being. For those holding this view, the early embryo is not morally different from a child or an adult human being. It could not be used in research that is not to its benefit, and it could not be used without its consent. Some believe that the embryo is not yet fully a human being in a moral sense. They do not deny that the early embryo is alive and has the biological potential to become a person. Religious views on the question of whether one may ever benefit from others' wrongdoing are diverse. The Roman Catholic moral tradition, despite its staunch opposition to complicity with wrongdoing, presents different answers, including some that permit one to derive benefit in particular cases. This suggests that some researchers, clinicians, or patients who morally oppose the destruction of human embryos on religious or other grounds might ethically use human embryonic stem (hES) cell lines derived from embryos otherwise slated for destruction.