An anencephalic infant, who came to be known as Baby K, was born at Fairfax Hospial in Falls Church, Virginia, on October 13, 1992. From, the moment of birth and repeatedly thereafter, the baby's mother insisted that aggressive measures be pursued, including cardiopulmonary resuscitation and ventilator support, to keep the baby alive as long as possible. The physicians complied. However, following the baby's second admission for respiratory failure, the hospital sought declaratory relief from the court permitting it to forgo emergency life support on the grounds that “a requirement to provide respiratory assistance would exceed the prevailing standard of medical care,” and that “because any treatment of their condition is futile, the prevailing standard of medical care for infants with anencephaly is to provide warmth, nutrition, and hydration.” The United States Court of Appeals for the Fourth Circuit ruled in favor of the baby's mother, citing the federal Emergency Medical Treatment and Active Labor Act (popularly known as the “anti-dumping” act), which contained no “standard of care” exception to the requirement to provide “treatment necessary to prevent the material deterioration of the individual's condition.” An appeal to the United States Supreme Court was rejected. The baby died some two and one-half years later of cardiac arrest during her sixth visit to the emergency department of Fairfax Hospital for respiratory failure.

A scientist at Edinburgh University announced in 1994 that he had removed ovaries from, mouse fetuses and transplanted them, to adult mice. The ovaries released eggs, and conceptions occurred. Although this was not the first such attempt with mice, the study attracted attention because the researcher suggested, that fetal to adult ovarian transplants were a theoretical possibility for humans. If aborted, fetuses were used, as egg sources in assisted conception, a new entity would arise: the never-born genetic mother. Using eggs from aborted fetuses for conception would lead to quixotic and novel family ties. Its use would echo surrogate gestational motherhood, in which a child has both a genetic mother who contributed her egg and a gestational mother who contributed her uterus for gestation and childbirth. With fetal egg use, however, the child's genetic mother would be a never-born fetus without sentience or known, physiology.

Starting bioethics in Russia we were motivated with the idea of the democratization of our society on a basic micro-social level. The country was swift enough to take several important steps in this direction on the macro-social level, i.e., to adopt a new constitution with guarantees of human rights and rights of ownership of private property, to elect the parliament and the president. But these modernizations in the Russian political facade did not sufficiently change the internal structure of the society–the net of everyday relationships in the home, at work, at school, in hospitals and other places. One of the most brilliant philosophers of the Russian “silver age,” L.S. Frank, wrote in the beginning of the century that a tyrannical state (at his time the czarist state) grows out of tyrannical interpersonal relationships. Political revolution not grounded in a social evolution on the basic level of satisfying “simple” human economic, physical, and psychological needs could reproduce only the same totalitarian pattern under a new ideological label. Events resulting from the Bolshevik revolution in 1917 proved the wisdom of his statement. Russia could suffer the same fate today.

Treatment of sick children of Jehovah's Witness and Christian Scientist families at times presents significant dilemmas to American medicine and ethics, for modern healthcare professionals rely heavily on active treatment, and withholding of some treatments is a central religious tenet for Witnesses and Scientists. In important instances, physicians, nurses, ethicists, and courts may wish to set aside traditional religious beliefs and values when medical values support treatment to which adherents of these sects at times object.

“Ethical dilemmas…are rarely simple and stark but are, instead, multifaceted, complex, and gut wrenching for parents and care givers alike.” This is never more the case than when one must treat vulnerable babies who are not, nor ever can be competent to offer us some guidance about that treatment. The ethical problems are heightened when the parents, or the single mother, are incompetent to make decisions themselves, for example, because of drug addiction. In such cases, when the baby is premature and suffering the effects of the drugs the mother has taken, and the mother herself is either no longer available for consultation or so damaged by her own addiction that she is not a reliable decisionmaker, the usual trend In the United States is to initiate treatment and continue until it is virtually certain that the infant will die.

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding the concept of advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a focus group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure.

“Any bad settlement,” the wise patent litigator Elmer S. Albritton once observed, “is better than a good lawsuit.” Given the notorious strain of court proceedings and the recognition that settlement does not always prove attainable, a popular movement has recently arisen in favor of “alternative dispute resolution” (or ADR). Indeed it has seemed to many who have participated as committee members, witnesses, or respondents in scientific misconduct cases that there ought to be some method of resolving such matters that is less vexing than traditional adjudication.

The standard argument in favor of the practice of voluntary physician-assisted death, by means of assisted suicide or active euthanasia, rests on liberal, individualistic grounds. It appeals to two moral considerations: (1) personal self-determination—the right to choose the circumstances and timing of death with medical assistance; and (2) individual well-being—relief of intolerable suffering in the face of terminal or incurable, severely debilitating illness. One of the strongest challenges to this argument has been advanced by Daniel Callahan. Callahan has vigorously attacked the practice of physician-assisted death and the goal of legalization as deep affronts to values of community: “By assuming that the relief of suffering is a goal important enough to legitimate killing as a way of achieving it, we corrupt the idea of such relief as a social goal and duty. We cease helping to bear one another's suffering, but eliminate altogether the person who suffers. We thereby jeopardize both the future of self-determination and the kind of community that furthers its members' capacity to bear one another's suffering. Why bear what can be eliminated altogether?” In another passage Callahan remarks, “For there is a deep sense in which suicide and euthanasia are likely to represent, at least in part, a failure of the community, whether that of the intimate community of family and friends, or the larger civic community, to respond to the needs of another.”

In January 1995 we (Social Service Department) received a referral for an in-patient Mrs. B. Mrs. B was a 56-year-old, African-American female who had been admitted to our facility with a diagnosis of R/O cerebral vascular accident. When first seen, Mrs. B evidenced clear cognitive impairments, including slurred speech, decreased concentration and memory, and tangentiality. The history she was able to provide was sketchy, but did Include the following: Mrs. B was a recent widow, her husband having died in a nursing home from. AIDS 2 weeks prior to admission. She had been diagnosed HIV+ in 1992, when she began hemodialysis for chronic renal failure. She believed she had contracted the virus heterosexually from her husband. She denied any history of substance abuse. Mrs. B had seven adult children, none of whom were aware of her HIV diagnosis. Prior to admission, she was living alone. Prior to 1992 Mrs. B had worked as an office cleaner, and later qualified for Social Security and Medicare benefits. She had once previously been seen in our community mental health clinic for depression, and was treated at a nearby satellite dialysis facility for end-stage renal disease.

This case is another in a series intended to highlight the new questions emerging from advances in mapping the human genome and the application of genetic findings to clinical practice. The National Human Genome Research Institute, a component of the National Institutes of Health, by law is directed to designate a portion of its annual budget to furthering understanding of the ethical, legal, and social questions emerging from research on the human genome. As part of the effort, the Institute supports research by scientists and scholars around the nation with the aim of clarifying and resolving the tough ethical and research choices facing this endeavor. But recently it has launched an intramural program, which is expected to take a catalytic role in grappling with the array of issues the researchers face in carrying out investigations in human genetics.

“Power is the ability to take one's place in whatever discourse is essential to action” With these words, Carolyn Heilbran urges women to rewrite their lives. Their angry and frustrated voices, heard in the privacy of letters and quiet conversations, tell their true stories, while their public biographies are sentimental and passive. Women, she says, need to learn how to declare their right to public power. With this advice In mind, I recently joined a conversation with colleagues from the University of Nebraska Medical Center (UNMC) about issues in global bioethics.

Too often, the limits of our language are the limits of our thinking. “If thought corrupts language, language can also corrupt thought,” warned George Orwell. How we label something too often controls how we think about it. We get particular concepts in our head and they are hard to change. They govern how we think and how we act. “Disease” and “death” used to be considered as “God's will,” and it took hundreds of years and no small number of martyrs to get that corrected. It was very hard to develop modern medicine when so many subjects were thought of as outside of human control. Similarly, the number of children a woman had was thought to be “God's will,” and that has made the development of contraception controversial to this day. Human control over any part of human destiny is usually opposed vigorously. Humankind has the tendency to confuse the familiar with the necessary.

The rock climber and the law share in a common etymological allusion when each reaches a steep, high, and hard place. The climber “appeals” to the mountain by inching down on a rope and the law's “rappel” is similarly a route to more comfortable footing. Each step in this common process is germane to the eventual resolution, for it is to be found in the rappel process itself and in the meaning of each appeal.