Contributors.

John Rawls was remembered by his publishers with the following quotation: “The perspective of eternity is not a perspective from a certain place beyond the world, nor the point of view of a transcendent being; rather it is a certain form of thought and feeling that rational persons can adopt within the world.” In that spirit, CQ's annual nonthematic Open Forum issue offers a collection of provocative papers on a variety of topics chosen to stir rational debate and challenge the prejudices and intellectual mistakes that can so easily cloud ethical vision.

On March 8, 2005, the General Assembly adopted the United Nations Declaration on Human Cloning in which Member States are called upon to

a) protect adequately human life in the application of life sciences

b) prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human life

c) prohibit the application of genetic engineering techniques that may be contrary to human dignity

d) prevent the exploitation of women in the application of life sciences

e) adopt and implement national legislation to bring into effect paragraphs a to d

f) take into account the pressing global issues such as HIV/AIDS, tuberculosis, and malaria, which affect in particular the developing countries. Katrien Devolder acknowledges the stimulus and support of the European project “CLEMIT: Developing an operational ethical framework to analyse and monitor the ethics of creating and redesigning human beings,” sponsored by the European Commission, DG-Research as part of the Science and Society research programme—6th Framework, in the preparation of this paper. The authors are also grateful to Norman Ford and Carolyn Cameron for their helpful comments on an earlier draft and to Konrad Hochedlinger for advice.

On both sides of the debate on the use of embryos in stem cell research, and in reproductive technologies more generally, rhetoric and symbolic images have been evoked to influence public opinion. Human embryos themselves are described as either “very small human beings” or “small clusters of cells.” The intentions behind the use of these phrases are clear. One description suggests that embryos are already members of our community and share with us a right to life or at least respectful treatment, whereas the other focuses on the differences between embryos and adult human beings with normal capacities, that is, their lack of sentience and of personal identity. The research on stem cells has been nicknamed “Frankenstein science” or presented as “research that could stop Parkinson disease.” Again, one description reminds us of scary science-fiction scenarios where the scientist is guilty of “playing God,” whereas the other description highlights the worth and potential benefits of the research outcomes.The authors acknowledge the stimulus and support of the “European project on delimiting the research concept and the research activities (EU-RECA)” sponsored by the European Commission, DG-Research, as part of the Science and Society research programme–6th Framework in the preparation of this paper.

Sara Goering has suggested that familiar Rawlsian ideas can be pressed into service to distinguish morally permissible from impermissible forms of genetic engineering. My project is to develop and to assess this idea. Specifically, I argue that, when developed, Goering's Rawlsian resources fail to distinguish permissible from impermissible genetic engineering.This paper was written with assistance from the Social Sciences and Humanities Research Council of Canada. I am grateful to audience members at the 2005 meetings of the Pacific Division of the American Philosophical Association in San Francisco and at the 2005 meetings of the Canadian Philosophical Association at the University of Western Ontario for helpful discussion. Special thanks go to Anita Ho and Chris MacDonald.

On June 3, 2003, the European Council of health ministers rejected a proposal from the European Commission to allow drug manufacturers to advertise directly to particular groups of patients; the proposal had already been rejected by the European Parliament subsequent to a heated public debate in which consumer and patient groups almost unanimously argued that it was not the role of drug companies to provide information to patients. The pilot scheme suggested by the Commission would only have applied to patients with three chronic diseases, AIDS, diabetes, and asthma, and would, it was argued, not undermine an overall ban. Drug companies would have been required to abide by a special code of conduct and clear any information given to patients—on web sites or in specialized publications—with national authorities.

In the United States, people may donate organs and tissues to a family member, friend, or anyone whose specific need becomes known to them. For example, in late 2003 dozens of people came forward to donate a kidney to a professional basketball player known to them only through his sports performances. People may also donate a kidney to no one in particular through a process known as nondirected donation. In nondirected donation, people donate a kidney to the organ allocation system rather than to anyone known to them personally. There are limits, though, to generosity. People are usually not allowed to donate to groups of people, no matter the contours of the group, whether white, black, Catholic or Presbyterian, third-time liver recipient, and so on. As the agency that oversees national transplantation policy, the United Network for Organs Sharing (UNOS) does not allow this sort of restricted donation, though it appears that some regional Organ Procurement Organizations (OPOs) occasionally bend the rules when donors insist that their organs go to children or to first-time recipients. Those ad hoc arrangements are, however, the exception to the rule.

It is a reality today that people die waiting in line for transplant organs. Something needs to be done to remedy this dire situation and alleviate the suffering. Broadly speaking, barring scientific progress that might make artificial organs and stem cell therapy viable alternatives, three options are available to us: increase voluntary donation, compel access to organs via government policy, or open up for a commercial market in organs.This article could not have been written without the help of Dr. Martin Petersson and Professor Sven Ove Hansson.

Mr. Paul Mills suffered from cancer of the esophagus (the passage between the mouth and the stomach). Three major surgeries were unsuccessful in correcting the problem, and other treatment methods likewise failed. His condition deteriorated to the point where there was no longer any hope of recovery. Dr. Morrison, who was Mr. Mills's intensive care physician at the Queen Elizabeth II Health Sciences Centre in Halifax, and Mr. Mills's family (Mr. Mills was incompetent by this time) agreed that active life support should be discontinued. Dr. Morrison then removed Mr. Mills's ventilator. To everyone's surprise, and dismay, Mr. Mills did not die. He continued to breathe spontaneously and started to show signs of distress. Dr. Morrison increased the dosage of morphine, to no effect. She increased it again to the point where death could reasonably be expected to occur; signs of distress continued. Dr. Morrison at this point administered a dose of potassium chloride and Mr. Mills died.I am grateful to Don Brown for very helpful comments and conversation.

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected].

“Health and Human Rights,” edited by Doris Schroeder, welcomes contributions on all health topics related to human rights and relevant generic contributions from the human rights debate. To submit a paper or to discuss suitable topics, please e-mail Doris Schroeder at [email protected].Thoughts raised here have been floated at seminars and workshops at Cardiff University, the Open University at Milton Keynes, University College London, Anglia Polytechnic University, the University of Brighton, and University of Wales, Newport. I am grateful both for these chances to float them and for the rich and helpful comments received on each occasion—too many to credit individually, but very much appreciated.

In a previously published multicenter, prospective, randomized, controlled trial of more than 500 intensive care unit patients involved in conflicts over treatment decisions, ethics consultations were found to be helpful in resolving the conflicts and reducing nonbeneficial treatments. The intervention received favorable reviews by 80% of patient surrogates and more than 90% of physicians and nurses. Nevertheless, several participants in the ethics consultation process expressed dissatisfactions with the intervention. In this paper, we report our efforts to determine the factors associated with these negative responses in hopes that we might provide insights of future use to ethics consultants.We gratefully acknowledge the contributions of Jeffrey Blustein, Kathleen B. Briggs, Ronald Cranford, Glen I. Komatsu, and Ernle W.D. Young to the original randomized controlled trial phase of this research. Grant support came from the Agency for Healthcare Research and Quality, 1 R01 HS10251.

As pressures increase to contain growing healthcare expenditures, there is currently a prominent rise in the shift of healthcare costs to patients in the form of deductibles, co-pays, and co-insurance. Rising co-payments are part of a larger picture of increasing overall out-of-pocket healthcare expenditures. From 1990 to 2000, per capita out-of-pocket payments for healthcare reached $707 in the United States, and doubled in several European countries with universal health insurance, reaching $396 in Denmark, $290 in Germany, and $466 in Italy in 2000.The authors thank Dan Brock, Nir Eyal, Alex Rajczi, and Dave Wendler for their invaluable criticism of the manuscript. This study was funded by the National Institutes of Health. The National Institutes of Health was not involved in the design of this study. SAH was partially supported by a grant from the University Hospitals of Geneva. This work was conducted while Dr. Hurst was a fellow in the Department of Clinical Bioethics at the National Institutes of Health. The views expressed here are the authors' own and do not reflect the position of the National Institutes of Health, the Public Health Service, the Department of Health and Human Services, or the University Hospitals of Geneva.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.