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Introduction Background Definitions Embryo Conception/Fertilization Human Description Why Conduct Human Embryo Research? Limits of Animal Models Assisted Reproduction Implantation Research Normal/Abnormal Development Genetic Diagnosis Cell Differentiation Laws and Regulations Other Countries Areas of Agreement U.S. State Law Early Federal Initiatives Human Embryo Research Panel Subsequent Developments Ethical Issues Range of Views Genetic Individuality and Moral Status Biological Problems Personhood Views Symbolic Concerns Public Policy Public Reasoning Policy Analysis Policy Conclusions Special Questions Time Limits Intent to Transfer Philosophical Complexities Donor Rights and Donor Sources Commercialization “Spare” versus “Research Embryos” Moral Issues Scientific Issues Keywords: human subjects research; ethics

In this chapter, I review some of the background thinking concerning matters of moral status that I had developed in previous years and that I would now bring to the work of the Human Embryo Research Panel. Two ideas were at the forefront of my thinking. First, that biology usually offers not decisive "events" but only continuous processes of development. Second, in making status determinations we do not so much "identify" a point on a developmental continuum where moral respect should be accorded as "choose" that point. These choices are "balancing decisions" in which the community of moral agents weighs its interests in protecting an entity against the burdens of doing so. After illustrating these two contentions, I consider some of the reasons why thinkers on the "right" and "left" of our bioethics debates have resisted or missed this basic insight.

Advanced Cell Technology's Ethics Advisory Board has been called window dressing for a corporate marketing plan. But the scientists and managers have paid attention, and the lawyers have gone along.

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.

Last year, President Obama launched the Brain Research through Advancing Innovative Neurotechnologies Initiative with the goal of developing new technologies for studying the brain's functioning, right down to the cellular level. The President subsequently asked the Presidential Commission for the Study of Bioethical Issues to develop “a core set of ethical standards” to guide neuroscience research and its applications. This May, the PCSBI issued “Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society,” the first of a two-volume response to this request. Although “Gray Matters” mentions some of the ethical issues that together define the emerging field of neuroethics, the report as a whole may disappoint those seeking answers. It focuses almost entirely on the metaquestion of how ethics might be integrated into neuroscience research, offering four recommendations. Even as a preliminary proposal, however, the recommendations in “Gray Matters” do not go far enough.

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.

Sparrow's (2010) argument is ingenious in two respects. First, it overturns the accepted idea that sex selection will result in female “gendercide”: the widespread choice by parents to have boys in...

1 January 2027. Immanuel Kant and Soren Kierkegaard unexpectedly find themselves sharing a corner in the Delta Medallion Club at Denver Airport Snow has delayed their flights for several hours.

In the past two decades, neuroscientific investigations such as postmortem and neuroimaging studies have revealed a variety of regional brain disturbances in major mental illnesses. These emerging findings are difficult to appreciate fully without a sufficient grasp of the neuroanatomy of the regions identified in these studies. The authors have developed, for psychiatrists-in-training, a braincutting exercise designed to highlight the neuroanatomical features of specific regions; namely, regions with behavioral affiliations relevant to contemporary hypotheses about the brain bases of major mental disorders. The focus of the braincutting is markedly different from the traditional braincuttings that have been available to trainees in neurology, neurosurgery, and neuropathology. This article describes the authors' approach to braincutting and the behavioral neuroanatomy seminar of which it is a part.

Until recently, genetics counselors and medical geneticists considered themselves lucky if they could provide parents with predictive information about a small number ofsevere genetic disorders. Testing and counseling were indicated primarily for conditions of thithis s sort. Out of respect for the autonomy of parental reproductive decision making, the prevailing ethic of genetic counseling stressed nondirectiveness and value neutrality As summarized by Arthur Caplan, the hallmarks of this stance includea willingness to provide testing and counseling to all who voluntarily seek it, the presentation of information concerning findings in a manner that is balanced and comprehensible to patients or clients, the fair and balanced presentation of all options for action if a problem is discovered, a willingness to answer all questions asked by those seeking services, and an obligation to protect privacy and confidentiality at all times regardless of societal needs or benefits.

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

Le Conseil du President des Etats-Unis pour la bioethique a un parcours clairement conservateur, qui refletait l’opposition de son president aux valeurs du progres scientifique et medical. Il a reflechi aux questions de bioethique d’une autre facon que les commissions precedentes pour debattre des fins autant que des moyens. Le cpbe est helas devenu un forum pour les refractaires a toute idee de medecine reproductive et genetique moderne. Les rapports qu’il a produits cachent des references religieuses nettement conservatrices, qui traitent les questions ethiques de maniere unilaterale. Le changement de directeur n’a pas entraine un changement de ligne notoire, malgre la plus grande ouverture du nouveau. Il convient de tirer des lecons de la disparition du cpbe : promouvoir une diversite equilibree, se centrer sur des avis reglementaires lies a des questions specifiques, limiter les reflexions a la « raison publique » (J. Rawls).

Debates about embryo and human embryonic stem (ES) cell research reveal deeply divided judgments about the status of early forms of human life and are often occasions for polemics rather than respectful dialogue. It is a merit of these two books that they engage their subjects thoughtfully and earnestly, even though they take very different approaches. Green describes his work as a "philosophical memoir" (p. xv) of his experiences as a member of the 1994 NIH Human Embryo Research Panel. His reflections on that tenure, as well as chapters about human cloning and ES cells, provide a highly engaging critique of what he deems an inappropriate politicization of such debates, especially by conservative religious groups (thus the "vortex" of his title). The Holland-Lebacqz-Zoloth edited volume, with its twenty chapters from nineteen contributors, provides a broader overview, with four sections devoted, respectively, to the state of current ES cell research, ethical issues, religious perspectives, and policy concerns. These books are especially interesting for the issues of policy ethics that they engage. First is the central, apparently unresolvable issue of the moral status of the human embryo, which raises questions about which perspectives should govern appropriate pluralistic policy. Second, how are we to assess claims about possible scientific breakthroughs, and how should we weigh them against other less quantifiable values and perspectives? Finally, what are the implications of so-called "public reason" and "deliberative democracy" for embryo and ES cell debates? More generally, how should we craft genuinely respectful public policy on controversial matters that involve collective funding? Too often, emphases on individual liberty and social utility tend to dismiss other concerns as merely "symbolic," parochial, or epistemologically privileged. Yet all forms of public discourse, including appeals to individual rights and preference satisfaction, are deeply symbolic in their own right as particular (and often quite minimalistic) depictions of human flourishing. These questions may be less intriguing to many observers than musings about tomorrow's scientific miracles. Yet issues of policy ethics are of fundamental importance because the framework for public dialogue and policy choice we establish now may well set the tone and substance of public debates about reproductive and regenerative medicine for the foreseeable future. Consider how an appropriate pluralism might address the core question in dispute--the moral status of embryonic human life. Green and several contributors to the stem cell volume (Elliot Dorff, Laurie Zoloth, Margaret Farley, Erik Parens, Gilbert Meilaender, and Ted Peters) explore this issue in detail. In comparing and contrasting their perspectives, two questions arise. What interpretive paradigms best frame their differing views and, more pointedly, what, if anything, does "respect" for human embryos entail? For a significant minority, including traditional Roman Catholics and others, respect for embryos follows from seeing them as early and quite vulnerable forms of human life and therefore as human subjects worthy of protection. It is not entirely clear what that perspective suggests for the fate of "spare" embryos, but one can surmise either of two recommendations: that such embryos should be "adopted" by other infertile couples or, in ways analogous to the ethics of end of life care, that such subjects be "allowed to die" (that is, that "life-suspending" treatment be discontinued) but not killed for non-therapeutic reasons. For others who see embryos as very early forms of human pre-personal or even pre-individuated life, the language of respect is more difficult to interpret. It clearly cannot mean that embryos are deemed human subjects. Instead, it may suggest parallels with the paradigm of tissue donation, wherein donor consent is a central requirement. …

Human embryonic stem (hES) cells are unique in their demonstrated potential to differentiate into all cell lineages. Reports by T. Wakayama et al. (“Differentiation of embryonic stem cell lines generated from adult somatic cells by nuclear transfer,” 27 Apr., p. [740][1]) and N. Lumelsky et al. (“Differentiation of embryonic stem cells to insulin-secreting structures similar to pancreatic islets, “ScienceExpress, [26 Apr., 10.1126][2]) testify to the enormous promise of ES cell research. The editorial “Disappearing stem cells, disappearing science,” by Irving L. Weissman and David Baltimore (27 Apr., p. [601][3]) emphasizes the implications of this research for human health. Weissman and Baltimore point out that hES cells are currently the most promising source of cells for tissue regeneration research. They also note that this area has enormous potential for shedding light on some of the greatest mysteries of early human development. During this same week, the U.S. Department of Health and Human Services suddenly asked the National Institutes of Health (NIH) to cancel a planned first meeting of a committee that was to review applications from scientists seeking federal funds for hES cell research. This announcement heightens concerns that the Bush administration may eventually block implementation of the NIH's guidelines supporting this research. We hope that these fears are groundless and that the Bush administration will use this additional time to move toward support of the guidelines. Whatever the outcome, however, these delays have a real cost in terms of human suffering. According to data from the Centers for Disease Control's National Center for Health Statistics, approximately 3,000 Americans die every day from diseases that in the future may be treatable with ES-derived cells and tissues. We believe that these urgent health needs provide strong moral grounds for pursuing ES cell research. In addition, at least three ethical considerations recommend federal funding for this research. First, withdrawal of support will slow this research, but not stop it from going forward. Private organizations and overseas researchers will fill the void. In some cases, they will do so without the kinds of comprehensive ethical oversight provided by U.S. human subjects regulations. Second, prohibiting such funding will not prevent the destruction of embryos. Each year, thousands of spare embryos created in infertility procedures are routinely destroyed at the request of their progenitors. A very small number of these embryos could be used to produce immortal stem cell lines that could be grown and used for research without ever using more embryos. The relevant ethical question is whether these spare embryos will simply be thrown away or used for human benefit. Third, and finally, we note that the United States is a religiously and ethically pluralistic nation. Many of those who oppose ES cell research base their position on religious views not shared by other citizens. As much as possible, the government should try to avoid taking sides in these debates and confine itself to policies that promote public health and welfare. ES cell research within the framework of the NIH guidelines is such a policy. [1]: /lookup/doi/10.1126/science.1059399 [2]: http://www.sciencemag.org/cgi/content/short/1058866v1 [3]: /lookup/doi/10.1126/science.292.5517.601

Transcranial magnetic stimulation (TMS) is a technique introduced in 19851 that uses the principle of inductance to get electrical energy across the scalp and skull in order to produce changes in neural activity in the brain. It involves placing a small coil of wire on the calp and passing a very brief and powerful current through it. This produces a magnetic field that passes unimpeded through the tissues of the head. The magnetic field, in turn, induces a much weaker electrical current in the

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 authors examine the question of whether severely depressed patients can validly consent to ECT, indeed whether anyone should be asked to consent to a treatment that some have held is disabling and beyond the range of rational choice. They suggest some clarification in the use of the terms "competent" and "rational." The authors present examples of cases where ECT may appropriately be used with and without a patient's consent. They conclude that except in cases in which patients may die without ECT, physicians will not err morally by respecting patients' informed decisions about treatment.

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.

L'A. se propose de montrer que, malgre les apparences, la religion africaine traditionnelle a une base rationnelle et montre une conformite essentielle a la "structure profonde" de la raison religieuse et de la morale universelle dont parle E. Kant.

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.’

How is ethical theory used in contemporary teaching in business ethics? To answer this question, we undertook a survey of twenty-five of the leading business ethics texts. Our purpose was to examine the ways in which normative moral theory is introduced and applied to cases and issues. We focused especially on the authors' views of the conflicts and tensions posed by basic theoretical debates. How can these theories be made useful if fundamental tensions are acknowledged? Our analysis resulted in a typology, presented here, of the ways in which normative theory, and the difficulties within it, are handled in business ethics texts. We conclude that there is a serious lack of clarity about how to apply the theories to cases and a persistent unwillingness to grapple with tensions between theories of ethical reasoning. These deficiencies hamper teaching and ethical decision-making.

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.

THE life and thought of Reinhold Niebuhr are characterized by a running debate with rationalism. As a Christian, Niebuhr saw it as his task to defend the Biblical view of man against corruption by an opposing view found in the rationalist tradition of Hellenic philosophy. As a modern Christian, Niebuhr felt even more compelled to resist the incursion of rationalism into Christianity represented in theology by liberal Protestantism and in ethics by the Social Gospel movement. Niebuhr's polemic against rationalism makes it easy to rank him among those Christian thinkers who have refused to give reason a place in the religious or moral life. Yet, as a cursory reading of Niebuhr's work reveals, he was deeply indebted to the rationalist tradition. In an early work like Moral Man and Immoral Society, for example, Niebuhr draws heavily on the Kantian moral tradition, even as he criticizes Kant.' In his later work, The Nature and Destiny of Man, Niebuhr more than once affirms the essential role of reason in theological reflection.2 In view of this, it is valid to suggest that Niebuhr used reason as an important tool in his eventual attack on rationalism. In the remarks that follow, we seek to provide some limited evidence to support this suggestion. It should be noted, however, that we shall not attempt to trace the development of Niebuhr's own attack on rationalism. As important as it may be, a survey of Niebuhr's intellectual development is not our concern here. Rather, we seek to offer a limited and independent rational vali

"The individual who knows and says nothing more about me than that I am an atheist, knows and says nothing about me." This remark by Ludwig Feuerbach applies with equal force to his twentieth-century intellectual descendant, Ernst Bloch. Like Feuerback, Bloch is primarily concerned, not with the negation of religious belief, but with the attainment of a positive position by means of the criticism of religion. Yet, unlike Feuerbach, Bloch stands imbedded in the twentieth-century Marxist tradition, from which most vestiges of religion have been erased. His analysis of religion, therefore, first involves a constructive and creative reappropriation of the kernel of religious experience itself. This is especially true because Bloch is convinced that his radical Marxist philosophy of Hope, as elaborated in his monumental work Das Prinzip Hoffnung,l has reopened the door to a variety of human cultural expressions and creations. The past, which had been a repository of so many sealed and finished entities to former philosophies, becomes for Bloch an undiscovered continent filled with the dormant

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.