This is an interesting case in that posthumous reproduction involves complex legal and moral problems. But I do not think it is a hard case, because there is no indication that the patient wished to parent a child with his woman friend, posthumously or otherwise.

Don't you just know it. It's a relatively peaceful day and you are getting some quality work done when the phone rings. The caller requests help in the form of an ethics consult. When you first hear about it you think someone is pulling your leg, but no, this is the real world. A case like this exemplifies many of the twists and turns of fact, and belief, that accompany many clinical ethics consultations. Several of the facts of the case generate an immediate emotional response that tempts the mind to run with them down enticing and confusing paths of thought. The “child,” age 19, is a minor in some states, but not in many. This introduces the whole notion of decisionmaking by parents or designated surrogates. Additional information suggests the comatose victim's mother is the prime motivator behind the request. The various motivations for the mother are revealed, primarily her desire to have a grandchild. The patient's own feelings are portrayed as ambivalent and the potential recipient, after the patient's sisters had been excluded because of consanguinity, is a 16-year-old girl who didn't even show up at the care conference. You are also told that the technical feasibility of the medical procedure under consideration is questionable and, of course, your legal department can't give you a straight answer—just hazard a guess.

In this case, the patient's mother repeatedly asked (1) about the health of any prospective child and (2) whether she would be assured some custodial role. She also questioned the role of the prospective recipient. The committee facilitated obtaining the necessary information, sharing this information with the surrogate, and assisted the surrogate and two of her daughters to share both their feelings and additional information they possessed.

The journal Nature Genetics recently reported a statement made by Dr. Brigitte Boisselier declaring the rights of parents to clone themselves. Dr. Boisselier is the scientific director of Clonaid—a Bahamas based company that plans to offer human cloning for $200,000. Does this offer have the same scientific credibility as Captain Kirk requesting “Beam me up, Scotty!”? How do we begin to respond to this offer and Dr. Boisselier's claim for its ethical justification?

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, “What might we do of practical use in preparation for the Supreme Court's ruling?” Based on the old principle of “think globally, act locally,” the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question.

The major dilemma for bioethics is choosing an appropriate method of ethical analysis, one that when applied to individual cases can illuminate if not resolve vexing ethical issues for providers and their patients. Two of these books offer direction in this regard. The framework Carson Strong adopts and makes a compelling case for in Ethics in Reproductive and Perinatal Medicine: A New Framework is one of modified casuistry. Casuistry, imported to bioethics by Jonsen and Toulmin, is a practical, case-based method of ethical decisionmaking. It relies on comparison between moral factors in a case under consideration and in paradigm cases with justifications for different outcomes. The preferred course of action is the one warranted by the paradigm case that most resembles the case under consideration. Strong's framework is a modified form of casuistry because it takes into account social and political views and allows for, upon occasion, a prioritization of values across cases.

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 Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will igve you an opportunity to respond in the letters section. Your input is desired and anticipated.