The ideal of universal human rights is arguably the most potent moral concept marking the modern world. Its accelerated fruition in the last half of the twentieth century has created a powerful political force, laying the groundwork for future generations to extend and apply. Whereas anything resembling international legal status for human rights had to wait for the post-Nazi era, the bold proclamations of the Universal Declaration of Human Rights (UDHR, 1948) loosened a revolutionary force with endless potential for application to the full range of human endeavors. The roots of this movement can be traced to each and every era in which the vulnerable and powerless sought justification to oppose arbitrary domination. Its roots are, therefore, deep and wide.

This issue of the Cambridge Quarterly is dedicated to the memory of Jonathan Mann. He was an inspired leader in the global struggle against AIDS and a creative intelligence envisioning the integration of the goals of medicine, public health, and human rights. In a memorable keynote address to the Third World Congress of Bioethics held in San Francisco in 1996, he challenged this community to bring its expertise to contribute to a broader, more social, and more global conception of healthcare than is common to our thinking. Jonathan's tragic death in the crash of Swissair Flight 111 in September 1998 took from us a beacon of insight and an active collaborator in this exciting prospect. His vision of justice and of the essential integration of the sciences of humanity has inspired this collection of essays.

We offer it to his memory in gratitude and admiration.

Jonathan Mann was a pioneer in establishing communication between the world of public health and that of human rights activism. At the very start, he strongly believed that although each of these two fields was in the midst of separate paradigm shifts, these shifts are essential, perhaps causal, to the combined health and human rights movement.

Bioethics and human rights were conceived in the aftermath of the Holocaust, when moral outrage reenergized the outmoded concepts of “medical ethics” and “natural rights,” renaming them “bioethics,” and “human rights” to give them new purpose. Originally, the principles of bioethics were a means for protecting human rights, but through a historical accident, bioethical principles came to be considered as fundamental. In this paper I reflect on the parallel development and accidental divorce of bioethics and human rights to urge their reconciliation.

Globalization is often discussed as if it were a recent phenomenon relating primarily to the development of world financial markets and improvements in information and travel technologies. But globalization is an ancient process, beginning with mercantile and cultural exchanges and facilitated by advances in transportation. In the twentieth century, the results of globalization can be seen in the rise of global capitalism and in the construction of a global economy. Most recently, the process of globalization has moved beyond the world of finance, however, into areas still traditionally thought of as national concerns, such as culture and healthcare. It is no surprise, therefore, that increasingly the challenges the United States is confronting in healthcare, biotechnology, and the environment are simultaneously faced by the international community as a whole. In the wake of the HIV pandemic, growing environmental consciousness, and a series of sensational advances in biotechnology, there is a dawning realization that problems such as improving public health, regulating advances in biotechnology, and achieving sustainable environmental development transcend national borders. In other words, bioethics concerns are global in nature.

Human rights law is a powerful, but often neglected, tool in advancing the rights and freedoms of persons with mental disabilities. International law may seem marginal or unimportant in developed countries with democratic and constitutional systems of their own. Yet, even democracies often resist reform of mental health law and policy, and domestic courts do not always compel changes necessary for the rights and welfare of persons with mental disabilities. Additionally, human rights are obviously important for countries without democratic and constitutional systems because they may provide the only genuine safeguard against abuse of persons with mental disabilities ostensibly based on political, social, or cultural justifications.

A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors' human “experiments” and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians' human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists' role in repressing dissent, Latin American and Turkish military doctors' complicity in torture, and even the South African medical profession's systematic involvement in apartheid may seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse compel an inquiry into medicine's vulnerability to becoming an adjunct to illicit state purposes.

The current concern with reforming and regulating managed care under the general rubric of “patients' rights” has eclipsed the more fundamental need to legislate the human rights of those without adequate access to any healthcare. To characterize the regulatory activity as a “rights” movement inflates its moral dimension. The concept of “rights” carries a serious and powerful moral force that is currently inappropriately applied to the parochial concerns of a segment of the population privileged to have health insurance coverage. By contrast, the language of “rights” refers to a high level of universality for the most rudimentary of human concerns. If there was a universal right to become a patient equal to other patients, a concept of patients' rights would have legitimacy. As it is, however, the central determinant of this “right” is how much the insurance policy costs and what is covered. To so diminish the meaning of “right” within the miasma of managed care is to lose sight of the real possibilities of applying a positive “right” to healthcare and, in the long run, is to diminish the ethics of healthcare.

Our global knowledge of different cultures and the diversity of values increases almost daily. New challenges arise for ethics. This is especially true in the field of bioethics because the technological progress of medicine throughout the world is causing dramatic interactions with traditionally held values. Science and technology are rapidly advancing beyond discussions and corresponding political struggles over human rights, leaving those debates behind. This rapid development of science is at odds with the principle of sustained development that calls for measured and thoughtful planning, such that no new idea should rupture the delicate fabric of communities, environment, and cultural evolution.

These CQ Sources were compiled by Bette Anton.

Genetic engineering is a social invention as much as a biological one. Ordinary citizens interested in the well-being of life on the planet should therefore be involved in the ethical debates concerning the future of nonhuman animals. The creations of genetic engineers ought to be evaluated on a case-by-case basis by what the American philosopher R. G. Frey calls “a jury of concerned individuals.” Frey is an advocate for putting animals in perspective, which means that animals matter, but not as much as humans. He therefore supports the prevailing moral orthodoxy, which currently in the West means that animals can be eaten, dissected, hunted, and exhibited, provided that these things are done humanely and that the benefits to humans outweigh the harms to the animals. The “concerned individual,” he suggests, would have no objection to humans killing animals as long as the animals do not suffer. In the present paper, my aim is to raise some of the ethical, welfare, and social issues from an animal-protectionist perspective which ordinary citizens would need to consider if they were ever asked to vote on the benefits or otherwise of the impact of genetic engineering on animal welfare.

In pseudo-patient study (PPS), fieldworkers cloak their identities and intentions and pose as “patients.” This enables them to observe the practice of healthcare from within a naturalistic, nonreactive research setting. Rosenhan and his assistants conducted the most famous PPS, where they faked symptoms of schizophrenia so that they could gain admittance to a mental-health facility and observe the treatment that genuine patients were receiving. More subtle pseudo-patients might arrange “appointments” over the phone, after reporting varying levels of health insurance. Others might provide dummy lab specimens or test a physician's response to technical questions. A few genuine patients have transformed their legitimate stays in the hospital into fieldwork, transforming themselves into disguised participant-observers.

The methodological device of “deception,” or, as sometimes euphemistically labeled, “less than full disclosure,” does not enjoy much support among institutional review boards (IRBs) and a large portion of scholars in bioethics. The reasons for this have been documented sufficiently, beginning with the now-paradigmatic attack on the well-known study by Milgram and the unsavory study of Laud Humphries on male homosexual activities in public restrooms. But are the current attitudes interfering with some worthwhile approaches to data gathering that seem to have no other methodology of equal effectiveness?

Public health and human rights are complementary—and, at times, conflicting—approaches to protecting and promoting human well-being and dignity. Public health addresses the needs of populations and seeks, through intervention and education, to prevent the spread of disease. Enshrined in international law, human rights describe the obligations of governments to safeguard their citizenry from harm and to create conditions where each individual can achieve his or her full potential. Human rights norms lie at the core of public health theory and practice, and their enforcement can help to ensure an equitable distribution of health resources.

Late in the afternoon of July 11, 1995, the Bosnian Serb army, under the command of General Ratko Mladic, seized the northeastern Bosnia town of Srebrenica. Declared a “safe area” by the United Nations two years earlier, the predominately Muslim community had swollen from a prewar population of 9,000 to over 40,000, many of whom had been “cleansed” from elsewhere in Bosnia. As Mladic's troops swarmed over the town, the women, children, elderly, and many of the men took refuge two kilometers away in the United Nations's Srebrenica headquarters, staffed by a Dutch battalion, in the village of Potocari. Meanwhile, the remaining Srebrenica men and boys—some 10,000 to 15,000—fled through the woods on foot, trying to reach Muslim-controlled territory, nearly 40 miles away.

As part of a research project, sponsored by the French Ministry of Health, comparing the role and function of French hospital ethics committees as compared to those in the United States, I was intrigued by differences that emerged. Particularly, why should it be that professional ethicists, such prominent figures in America, have no counterpart in France?

Historians of medicine and science, often using tools from sociology and anthropology, are particularly interested in that space where the world and some method of analysis meet. The space where generalizable rule and contingent variability face one another is a vacuum that attracts and creates conclusions about the world, heavily infused with social meanings and practices. Studying how these conclusions are made over time identifies the broader cultural projects that may be furthered by them and/or that make them possible.

A history of injustices to diverse groups of human subjects in medical research has resulted in concerted efforts by U.S. policymakers in the second half of the twentieth century to provide greater protection for future subjects. However, in the context of patient populations demanding better therapies, potential medical advances, and greater attention to issues of social justice, Kahn, Mastroianni, and Sugarman set out to reconceptualize the principle of justice in human subjects research to address these urgent concerns. In Beyond Consent, Kahn and colleagues advance a framework of justice in terms of access to participation in research, instead of protection. Their worthy cause, developed out of collaboration on the White House Advisory Committee on Human Radiation Experiments, aims to demonstrate how previously unaddressed notions of justice now require greater consideration in research. Specifically, they emphasize how fairness requires a greater distribution of risks and benefits, and that “equals should be treated equally.” The volume does not report new research findings but rather draws on multidisciplinary approaches, including law, medicine, philosophy, history, and health policy, to argue that justice must go beyond informed consent. The editors posit that this challenge to protectionism is necessary given the heightened urgency for patients to benefit from investigational therapies although they incur increased risks.

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.